The problem with ultra-endurance athletes

A nutrição é uma importante ferramenta dentro da prática desportiva. Dentre as modalidades esportivas, a nutrição exerce uma grande influência nos chamados "esportes de desafio", que são as provas de ultra-resistência ou de longa duração. O custo energético de uma prova de ultra-resistência pode variar de 5.000 a 18.000kcal por dia. É amplamente aceito que o consumo de carboidratos antes e durante exercícios prolongados irá retardar o aparecimento da fadiga, poupando o glicogênio hepático e muscular e fornecendo glicose diretamente para os músculos em atividade. Recomenda-se que a dieta de atletas de ultra-resistência possua 70% ou mais, ou de 7 a 10 gramas por quilo de peso corporal de carboidratos. Porém, apesar da melhora apresentada com a nutrição bem planejada, alguns pesquisadores procuram desenvolver novas intervenções nutricionais, visando a melhora do rendimento, que continuam a ser estudadas, como a suplementação com lipídios, através do consumo de triglicerídeos de cadeia média (TCM) ou de dietas ricas em lipídios nos dias que antecedem a competição. Sendo assim, esta revisão possui como objetivo elucidar como os carboidratos e os lipídios podem influenciar o desempenho nos exercícios de ultra-resistência.

BackgroundWhen seeking advice on allergy prevention in early childhood (Early Childhood Allergy Prevention, ECAP), parents often turn to health and social care providers, such as paediatricians, midwives, and family centres. However, these actors fulfil various, often care-related, roles, and cannot be considered ‘health information providers’ by default. In addition, although the scientific evidence for ECAP is often known by health professionals, it is not actively communicated. In this study protocol, we describe the planned procedure for the development and implementation of a process to communicate ECAP information to parents, with a focus on reaching out to those from migrant communities. Thereby, we also aim to contribute to the understanding of how to design more robust approaches to deliver health information.MethodsWe have chosen the Implementation Research Logic Model as our framework for a multi-stage process. Firstly, we will map regional and local health and social care providers to find potential providers of ECAP information. We will then approach actors from each mapping category for qualitative interviews to assess facilitators and barriers to implementation. Next, we will define actions to ease the implementation process, develop exemplary ECAP information materials for parents, and deliver these to pre-selected health and social care individuals and organizations. Each step will be adapted to meet the needs and preferences of culturally and linguistically diverse populations. Finally, the process will be evaluated for key implementation outcomes (e.g., acceptability, feasibility, effectiveness) by interviewing information providers and surveying information recipients.DiscussionFrom a Public Health perspective, studies seem warranted that investigate how evidence from health research may be effectively communicated to the public, rather than merely focusing on, e.g., intervention development. Also, it has often been highlighted that the dissemination of health information needs to better target those who face the greatest difficulties when seeking advice, i.e. individuals/parents who recently migrated. ECAP is a good use case, as scientific evidence is constantly evolving, and the communication of information is hampered by low awareness of high quality sources.

<p>The study examined the quality of health care services and provider’s determinants of health care seeking behavior among women in Khana local government area of Rivers State. The study adopted a descriptive cross-sectional survey design. Three research questions and two hypotheses guided the study. The sample size for the study was 1,200 women selected using multi-stage sampling procedures. A validated self-structured instrument, titled, “Determinants of Health Care Seeking Behavior Questionnaire”, with a reliability index value of 0.64 was used for data collection. Means and Standard Deviations were used to answer the research questions whole Analysis of Variance was used to test the hypotheses at the 0.05 level of significance. The results of the study showed that the respondents had good health care-seeking behaviors in terms of action on perceived signs and symptoms of disease (= 2.67 + 0.89), test-seeking behavior (= 2.93 + 0.94), choice of health care service’s factors (= 3.36 + 0.76), treatment-seeking behaviors (= 2.86 + 0.95), and treatment-adherent behavior (= 2.87+ 0.85). The results also showed that quality of health care service (= 2.90 + 0.97) were significant determinants, while health care provider’s factors (= 2.43 + 1.05) were not determinants of health care seeking-behavior of the respondents. The study recommended among others that health care services should be health care consumers-centered to sustain and improve on the health care-seeking behavior and proper re-orientation of health care providers should be carried out at every level of health care in order to create friendly relationship between health care providers and consumers or patients.</p><p> </p><p><strong> Article visualizations:</strong></p><p><img src="/-counters-/edu_01/0917/a.php" alt="Hit counter" /></p>

BackgroundNigeria has one of the highest child mortality rates in the world, with an estimated 750,000 deaths annually among children under age five. The majority of these deaths are due to pneumonia, malaria, or diarrhea. Many parents do not seek sick-child care from trained, biomedical providers, contributing to this high rate of mortality.MethodsThis qualitative study explores factors enabling or preventing parents from seeking care for sick under-five children in Nigeria’s Kogi and Ebonyi states, including gender-related roles and social norms. Interviews were conducted with parents of sick under-five children and service providers, and focus group discussions were held with community leaders to assess how care-seeking behavior was influenced by four modes from the Colvin et al. conceptual framework for household decision-making and pathways to care. These include (1) caregivers’ recognition and response to illness, (2) seeking advice and negotiating access within the family, (3) making use of community-based treatment options, and (4) accessing biomedical services.ResultsParents were found to have a general understanding of illness symptoms but did not always attribute illness to biomedical causes. Intra-household decision-making processes were shaped by gender dynamics between men and women, and were found to have great effects on decisions to seek care. Use of traditional medicine and self-treatment were found to be common first steps in treatment before turning to the biomedical care system. Once the decision to seek biomedical care was taken, the route of seeking care varied between seeking care at chemists and then continuing to health facilities or starting with a health facility and then accessing prescriptions from a chemist.ConclusionWe conclude that care-seeking decisions do not follow a linear process; that intra-household decision-making processes particularly among parents should not be underestimated in addressing sick-child care seeking; and that, given the role of mothers as primary caregivers, their knowledge in illness recognition and agency in care-seeking decision-making, and seeking biomedical care, is deserving of future study.

BackgroundThis study explored the factors associated with timeliness of care in the healthcare seeking pathway among patients with lung cancer in Bangladesh.MethodsA structured questionnaire was used for data collection from 418 patients with lung cancer through face-to-face interviews in three tertiary care hospitals. Log-rank tests were performed to test differences in the length of intervals between points in healthcare by socioeconomic characteristics and care seeking behaviours of the patients. Cox Proportional Hazard (PH) regression analysis was performed to identify the predictors of the intervals after adjustment for variations in other variables.ResultsA higher education level was associated significantly (p < 0.05) with a shorter interval between first contact with a healthcare provider (HCP) and diagnosis (median 81 days) and initiation of treatment (median 101 days). Higher monthly household income was associated significantly with a shorter time from first contact and diagnosis (median 91 days), onset of symptom and diagnosis (median 99 days), onset of symptom and treatment (median 122 days), and first contact with any HCP to treatment (median 111 days). Consulting with additional HCPs prior to diagnosis was associated significantly with longer intervals from first contact with any HCP and diagnosis (median 127 days), onset of symptom and diagnosis (median 154 days), onset of symptom and treatment (median 205 days), and first contact with any HCP to treatment (median 174 days). Consulting with informal HCPs was associated significantly with a longer time interval from symptom to treatment (median 171 days). Having more than one triggering symptom was associated significantly with a shorter interval between onset of symptoms and first contact with any HCP.ConclusionThe predictors for timeliness of lung cancer care used in this study affected different intervals in the care seeking pathway. Higher education and income predicted shorter intervals whereas consulting informal healthcare providers and multiple providers were associated with longer intervals.

Despite the high prevalence of pelvic organ prolapse, many women suffer in silence, lacking the language and opportunity to describe their condition. There are limited descriptions of women's experiences with pelvic organ prolapse in the literature. This qualitative study addressed the knowledge and experience of women with pelvic organ prolapse. Semistructured interviews were conducted with 13 women who had been previously diagnosed with pelvic organ prolapse. Transcripts of the interviews were reviewed and coded using a process of content analysis compared against the framework of authoritative knowledge, developed by Brigitte Jordan. By applying the concept of authoritative knowledge, we identified 3 themes of how women construct understanding about pelvic organ prolapse and how they demonstrate deference to the authoritative knowledge of medical providers. First, we found through women's narratives that authoritative knowledge was held by the health care provider and is considered consequential and legitimate by all participants. Second, women reported that the health care provider's authoritative knowledge was valued over personal, experiential knowledge. Finally, women described how they work with their health care providers to create a system of authoritative knowledge as they seek treatment for or discuss their condition. Throughout the narratives, women's experiences are not legitimized by the women or the medical community, perpetuating the "hidden" nature of these conditions. This analysis provides qualitative evidence of Jordan's authoritative knowledge: women and health care providers contribute to dimensions of authoritative knowledge surrounding pelvic organ prolapse. Despite what women experience, the health care provider's definition and understanding of pelvic organ prolapse is seen as legitimate and consequential. Because of their construction of their condition, and the power dynamic at play, women are silenced, and their expertise about their bodies is delegitimized, limiting their active participation in seeking care for this condition.

BackgroundThe number of youths seeking care for gender dysphoria has increased globally over the last ten years. In December 2022, the Swedish National Board of Health and Welfare published an updated knowledge support for the care of minors (children and adolescents) with gender dysphoria. This knowledge support recommends stricter criteria for prescribing puberty blockers and cross-gender hormones to minors, and differs both from previous healthcare practices and from international guidelines.AimThis study aimed to explore healthcare professionals’ perceptions of the updated knowledge support and its impact on healthcare practices and the care seekers (minors with gender dysphoria).MethodsThis qualitative interview study included 11 participants who worked clinically with gender-affirming care of minors (both evaluation and providing medical interventions). The participants came from different regions, different evaluation teams, and different professions. Reflexive thematic analysis was used.ResultsWhile the new knowledge support was partly intended to solve geographical differences, different evaluation teams had implemented the new guidelines differently. New criteria around childhood debut, neuropsychiatric conditions, and hormonal treatment seemed to have partly changed the conditions for the evaluation. The greatest change had been regarding access to puberty blockers and hormonal treatment. Some participants argued for a larger shift towards psychosocial support, while others highlighted the tension between care seekers’ needs and the shrinking opportunities to help based on the new guidelines. Some participants perceived that people lacking in expert knowledge had affected the content of the knowledge support.ConclusionsDiffering opinions of the knowledge support were expressed by healthcare providers working with gender-affirming care for minors. Some were pleased with the new guidelines and believed the new knowledge support to be clearer than the old one. Others were more critical, stating that the knowledge support had not taken clinical experience into consideration, was too open to interpretation, and was too restrictive.

Background: Premenstrual dysphoric disorder (PMDD) is a severe mood disorder that affects ∼5% of menstruating individuals. Although symptoms are limited to the luteal phase of the menstrual cycle, PMDD causes significant distress and impairment across a range of activities. PMDD is under-recognized by health care providers, can be difficult to diagnose, and lies at the intersection of gynecology and psychiatry. Thus, many patients are misdiagnosed, or encounter challenges in seeking care. The aim of this study was to examine patients' experiences with different health care specialties when seeking care for PMDD symptoms. Methods: We examined data from the 2018 Global Survey of Premenstrual Disorders conducted by the International Association for Premenstrual Disorders (IAPMD). Patients rated their health care providers (general practitioners, psychiatrists, gynecologists, psychotherapists) in three key areas related to treatment of premenstrual mood complaints: interpersonal factors, awareness and knowledge of PMDD, and whether the patient was asked to track symptoms daily. Intraclass correlations examined between- and within-person variance. Multilevel regression models predicted ratings on each provider competency item, with ratings nested within individuals to examine the within-patient effect of provider type on outcomes. Results: The sample included 2,512 patients who reported seeking care for PMDD symptoms. Regarding interpersonal factors, psychotherapists were generally rated the highest. On awareness and knowledge of PMDD, gynecologists and psychiatrists were generally rated the highest. Gynecologists were more likely than other providers to ask patients to track symptoms daily. Conclusions: These findings suggest that different providers have different strengths in assessing and treating PMDD. Further, graduate and medical training programs may benefit from increased curricular development regarding evidence-based evaluation and treatment of PMDD.

The World Health Organization in 2002 recommended a focused antenatal care model of four visits for women in low-income countries. Despite the high percentage of mothers (95%) who see a skilled attendant and the adaptation of the recommended antenatal model, only 46% of Malawian mothers meet the recommendation. The purpose of this study was to identify the cultural beliefs that influence women's antenatal care or pregnancy-related health care decisions. Twenty pregnant mothers and eight health workers from two urban tertiary care hospitals in Malawi were recruited to participate in a qualitative study assessing barriers to antenatal care. Data were collected between September and December 2014 through face-face, audio-recorded interviews, and a demographic survey. Identified maternal cultural beliefs included: seeking advice from village elders, spousal fidelity, and disclosing pregnancy. Health workers mentioned that providers often held the same cultural beliefs and, therefore, turned women away if they tried to go against cultural norms. Cultural beliefs play an integral role in the decision-making process of antenatal care. Specifically, the belief and practice of when to disclose pregnancy prohibits women from seeking antenatal care in the first trimester.

This study examined the pattern of care-seeking behavior for childhood pneumonia and factors influencing it, in Madhya Pradesh (MP), Uttar Pradesh (UP) and Tamil Nadu (TN). Using a mixed-methods design, consenting mothers of children less than 5 years with probable pneumonia participated in a household survey to assess their care-seeking behavior. A purposively selected sub-sample participated in semi-structured interviews (SSIs) to understand their perceptions on care sought, decision making abilities and cultural influences that governed these behaviors. Health care providers (HCPs) participated in SSIs and focus group discussions. A total of 2194 children were identified with probable pneumonia during the survey. 40 mothers and 41 HCPs participated in semi-structured interviews and focus group discussions. In MP, utilization of private allopathic care was high at 74%, about 8% went to unqualified care providers. In UP, 71% went to unqualified care providers and 5% did not seek care at all. In TN, 75% went to private allopathic doctors, and utilization of government care was higher (19%) compared to MP and UP. Qualitative findings revealed that cultural beliefs coupled with poor decision making abilities, poor understanding of illness and inappropriate care-seeking practices resulted in delays in care seeking, particularly in MP and UP. Inadequacies in government health infrastructure also contributed to their poor utilization. Promoting health literacy in communities and strengthening the reach of government health facilities will help in optimizing appropriate health care utilization for childhood pneumonia.

ObjectivesThis overview of reviews aimed to identify (1) aspects of the patient experience when seeking care for musculoskeletal disorders from healthcare providers and the healthcare system, and (2) which mechanisms are used to measure aspects of the patient experience.Data sourcesFour databases were searched from inception to December 20th, 2019.Review methodsSystematic or scoping reviews examining patient experience in seeking care for musculoskeletal from healthcare providers and the healthcare system were included. Independent authors screened and selected studies, extracted data, and assessed the methodological quality of the reviews. Patient experience concepts were compiled into five themes from a perspective of a) relational and b) functional aspects. A list of mechanisms used to capture the patient experience was also collected.ResultsThirty reviews were included (18 systematic and 12 scoping reviews). Relational aspects were reported in 29 reviews and functional aspects in 25 reviews. For relational aspects, the most prevalent themes were “information needs” (education and explanation on diseases, symptoms, and self-management strategies) and “understanding patient expectations” (respect and empathy). For functional aspects, the most prevalent themes were patient’s “physical and environmental needs,” (cleanliness, safety, and accessibility of clinics), and “trusted expertise,” (healthcare providers’ competence and clinical skills to provide holistic care). Interviews were the most frequent mechanism identified to collect patient experience.ConclusionsMeasuring patient experience provides direct insights about the patient’s perspectives and may help to promote better patient-centered health services and increase the quality of care. Areas of improvement identified were interpersonal skills of healthcare providers and logistics of health delivery, which may lead to a more desirable patient-perceived experience and thus better overall healthcare outcomes.Trial registrationSystematic review registration: PROSPERO (CRD42019136500).

ABSTRACTThe current study explored factors associated with lesbian disclosure to health care providers (HCPs) and engagement in preventative health behaviors by replicating and extending a Canadian path analysis study with a sample of U.S. lesbians. Both patient (education, feminism, global outness, and internalized homophobia) and HCP-related (lesbian-friendly HCPs and patient comfort) factors were either directly or indirectly associated with disclosure and engagement in preventative health behaviors, including avoidance of health-compromising behaviors (e.g., smoking) and health care seeking. Importantly, findings suggest that HCPs—particularly those who are inclusive of lesbian patients—may play a role in assuaging their patients' experiences of minority stress. Overall, the findings were similar to those originally reported in the Canadian study, with the exception of internalized homophobia playing a more visible role in the current study.

BackgroundAccurate data on care-seeking for child illness are needed to improve public health programs and reduce child mortality. The accuracy of maternal report of care-seeking for child illness as collected through household surveys has not been validated.MethodsA 2016 survey compared reported care-seeking against a gold-standard of health care provider documented care-seeking events among a random sample of mothers of children <5 years in Southern Province, Zambia. Enrolled children were assigned cards with unique barcodes. Seventy-five health care providers were given smartphones with a barcode reader and instructed to scan the cards of participating children seeking care at the source, generating an electronic record of the care-seeking event. Additionally, providers gave all caregivers accessing care for a child <5 years provider-specific tokens used to verify the point of care during the household survey. Reported care-seeking events were ascertained in each household using a questionnaire modeled off the Zambia Demographic and Health Survey (DHS) / Multiple Indicator Cluster Survey (MICS). The accuracy of maternal report of care-seeking behavior was estimated by comparing care-seeking events reported by mothers against provider-documented events.ResultsData were collected on 384 children with fever, diarrhea, and/or symptoms of ARI in the preceding 2 weeks. Most children sought care from government facilities or community-based agents (CBAs). We found high sensitivity (Rural: 0.91, 95% confidence interval CI 0.84-0.95; Urban: 0.98, 95% CI 0.92-0.99) and reasonable specificity (Rural: 0.71, 95% CI 0.57-0.82; Urban: 0.76, 95% CI 0.62-0.85) of maternal report of care-seeking for child illness by type of provider. Maternal report of any care-seeking and seeking care from a skilled provider had slightly higher sensitivity and specificity. Seeking care from a traditional practitioner was associated with lower odds of accurately reporting the event, while seeking care from a government provider was associated with greater odds of accurate report. The measure resulted in a slight overestimation of true care-seeking behavior in the study population.ConclusionsMaternal report is a valid measure of care-seeking for child illness in settings with high utilization of public sector providers. The study findings were limited by the low diversity in care-seeking practices for child illness and the exclusion of shops.

BackgroundWorldwide about 4 million newborns die each year; of which around 600,000 newborns die from series bacterial infections. To reduce newborn death, community based newborn care is being implemented in Ethiopia though its utilization by clients is low. Studies conducted to address perception of the community towards newborn illnesses are limited. Therefore, this study was aimed in exploring community member’s perception, experiences and health seeking behavior towards newborn illnesses.MethodsA descriptive qualitative study was conducted from March 11– April 7, 2019 in Debre Libanos District, Ethiopia. Study participants were recruited purposively from six kebeles and women delivered within two months prior to data collection were the primary study participants. Five in-depth interviews, seven key informant interviews and three focused group discussions were conducted. Data were audio-recorded, transcribed verbatim, translated, and analyzed using inductive thematic analysis in Atlas ti.7.1 software package.ResultThis study found that community members locally diagnose newborn illnesses as sunburn, evil eye, kichitat, megagna, berd, enlarged/dropping of uvula, and common cold from misconceived cause when unspecific types of symptoms are recognized on newborns. For those locally diagnosed newborn illnesses, they primarily prefer traditional medications to manage the illnesses rather than seeking care from health facilities. This study also found that clients seek health care for these newborn illnesses late. They seek care either from traditional or from health facilities when newborns become unable to breast feed, weak and feeling too hot.ConclusionLocal newborn illness diagnosis negatively affected health seeking behavior of the community members in that they made them to rely on traditional medications or delay in seeking care from health facilities. This might leads to negative consequences like disability and mortality. Therefore, health care providers and policy makers should design social and behavioral change communication (SBCC) to change community member’s health seeking behavior towards newborn illnesses.

Although timely surgery is essential for improving general health and psychosocial outcomes, delays in cleft surgery remain common in low- and middle-income countries, including Rwanda, where little is known about the underlying causes. This study aimed to explore the factors influencing delays in cleft surgery in Rwanda using the four-delay framework. A phenomenological qualitative study was conducted between April and July 2024. We conducted 29 in-depth interviews with 15 caregivers of children with orofacial clefts and 14 healthcare providers involved in cleft care. Transcripts were analysed thematically using an inductive-deductive hybrid approach in MAXQDA (V.24), guided by the four-delay framework while allowing themes to emerge from the data. This qualitative study was conducted across six Operation Smile-supported hospitals in Rwanda. Operation Smile is a non-governmental organisation providing cleft care in several low- and middle-income countries, including Rwanda. Among these facilities, one is a tertiary-level hospital located in Kigali city, while the others are secondary-level hospitals distributed across all provinces of the country. Participants were purposively selected and comprised caregivers of children who underwent cleft surgery at Operation Smile-supported hospitals between 2023 and 2024, as well as healthcare providers with a minimum of 6 months' experience delivering cleft care at these facilities. Six major themes and 15 subthemes emerged. Limited caregiver awareness, cultural beliefs and inconsistent knowledge of clefts among healthcare providers influenced delays in seeking care. Reaching care was impeded by long distances, poor road infrastructure and inadequate transportation options. Receiving care was delayed by patient-related factors such as poor nutritional status of children and systemic issues, including shortages of specialised cleft care workforce (such as plastic surgeons, oral and maxillofacial surgeons, anaesthesiologists, etc) and surgical infrastructure. Remaining in care was affected by the absence of multidisciplinary follow-up services. Despite these barriers, caregivers appreciated the support services provided by Operation Smile, including nutrition, transportation and coverage of surgery costs. Cleft surgery delays in Rwanda are driven by multifactorial barriers across all stages of care. Strengthening early identification, public awareness, health provider training and post-operative support systems is essential to reducing delays and improving outcomes. Findings support the need for integrated cleft care within national surgical plans and broader health system strengthening efforts, and encourage the social and psychological support to affected children and caregivers.