27 mai 2019

Triathlon and Adversity Score


We have touched this subject several times.  Nations want athletes to perform well and they put money into it.  Now a day’s performance in a test as well as in a race have to do with environmental factors which produce or not a competitive culture.  This is something well study to the point of creating an “adversity score” when taking a test as the SAT.  From the point of view of Human Rights, it is a big step, but let see how the involved parties play out; sometimes the pendulum swings to the other side and catastrophe appears also.  This is something we live in Mexico with the new government and happened after the Mexican Revolution. The rate exchange for the Mexican peso was one peso for two dollars before the Mexican Revolution (1910). The production decreased to almost nothing except for oil and raw materials after the Mexican Revolution; we still depend on these two. The worst part is that Mexicans live in the same conditions more than a 100 years later.  I grew up in one of the poorest states in Mexico and did my medical residency in New York, when these factors were not taken into account!  It took more than 30 years to challenge the “white privilege.”  The point is not to lower standards but to know that other factors are playing a role and we should improve conditions to make the floor even, or at least to know that somebody is competing with a handicap and have a competitive level.  We have paratriathlon for the physical conditions, but the social ones are handicaps of the same degree. I started with an average percentile my medical residency and finished residency at the 87th percentile (standardized test).
The Environmental Context Dashboard includes information about students' high schools, including the rate of teens who receive free or reduced lunch, and their home life and neighborhoods, such as average family income, educational attainment, housing stability and crime.

The dashboard "shines a light on students who have demonstrated remarkable resourcefulness to overcome challenges and achieve more with less," said David Coleman, chief executive of the College Board, which administers the SAT. "It enables colleges to witness the strength of students in a huge swath of America who would otherwise be overlooked."
The scores won't be revealed to SAT test-takers, but schools will see the numbers when reviewing college applications.
Fifty colleges and universities, including Yale, Florida State University and Trinity University, took part in a pilot program last year to test what some observers are calling an "adversity score."


We were asked in an interview why the central Americans and south Americans have not successful triathletes and apparently everything is in place for athletes; meaning Federations, tournaments, high performance centers, etc.  Obviously, the interviewers did not have knowledge that performance depends on the family and environment as it is vision in the “adversity score.”  Garry Kasparov, the one that lasted 20 years as a Chess World Champion, says that intuition is the big player in performance, and intuition is learned by experience in the environment.  Perhaps, fear of snakes is innate, but the rest we have to learn experiencing.

We have the subject of "adversity score" as a lecture in our team:

To even the floor, we started forming a subculture 20 years ago to overcome the problems mentioned above.  We want to develop and teach a better intuition to be competitive at the highest standards.


13 mai 2019

Triathlon and Nonadherence


“We educate triathletes; we do not train triathletes.”  This concept is very difficult to understand, but let see what happens in Medicine to explain our approach to triathletes.  The following is from Medscape:
James F. Sweeney
May 07, 2019
The True Cost of Nonadherence
Hippocrates warned about nonadherence. "Keep watch also on the fault of patients which makes them lie about taking of things prescribed," he is alleged to have said.
Much has changed in the 2500 years since Hippocrates laid the foundation of modern medicine, but his caution about nonadherence still holds true.
A review in the Annals of Internal Medicine[1] estimated that medication nonadherence causes 125,000 deaths in this country, placing it between stroke and Alzheimer disease as the sixth most common cause of mortality. It's also responsible for 10% of hospitalizations and costs the healthcare system as much as $289 billion a year. About one quarter of new prescriptions are never filled, and patients do not take their medication about half the time.
With the greater emphasis on value-based care and population health, more attention than ever is being paid to the problem of nonadherence, but there is no single proven way to correct it. And it's clear that current efforts are falling short.

Well, Medicine started to see why we have a high failure rate when treating patients.  The reason is simple:

Treating a nonadherent patient is frustrating for a physician and can feel pointless. In addition, nonadherent patients can hurt a practice's bottom line, as medicine shifts to outcome-based reimbursement.

We do not have the problem of reimbursement when coaching but we should.  Many countries and Federations have a huge budget without results.  Reimbursement based on outcome should be the way to go to be effective and professional in what we do.  This is something touched a bit in a previous post.
28 févr. 2019

The bottom line is that coaches have not idea of what makes an athlete succeed just as doctor have limited knowledge of why patients do not follow instructions.  If the coach is correct and there is a plan to follow we should look at the problem of nonadherence.  We have been looking at it for a long long time and have tried hard to overcome it but my guess is that we are 50/50 regarding achieving adherence.  This is without touching the point of how many points (subjects) of adherence we want to achieve.  Adherence to paying attention is our main adherence; adherence of nutrition and recovery are easier to achieve.

We try using electronics:
 How effective tech has been is the subject of debate and conflicting studies. What's clear, however, is that tech will continue to be a part of comprehensive adherence programs.
Jason Rose, MHSA, CEO of AdhereHealth, said the most effective technology will rely on data, but add a personal touch. For example, AdhereHealth (formerly PharmMD) scrapes data from pharmacies, physicians, insurers, healthcare systems, and elsewhere to identify instances in which patients are not filling prescriptions, not taking medication, or otherwise not adhering to treatment plans.

We have known Dorian Connix since he finished 10th in the Junior World Championship held in New Zealand.  Our competitor was 9th then.  Connix continue learning because he had multiple point of adherence to his life plan.  Nonadherence is the main cause of failure; even if the plan is not so good, it works if there are many adherence points from the part of the athlete.  “It is better a bad plan than no plan.”