Maternal factors regulating preterm infants' responses to pain and stress while in maternal kangaroo care

The relationship between maternal factors and the response of preterm infants to pain and stress experienced during heel puncture while in maternal kangaroo care was investigated. This descriptive study included 42 mothers and their preterm infants cared for in a neonatal unit. Data were collected in the baseline, procedure, and recovery phases. We measured the neonates' facial actions, sleep and wake states, crying, salivary cortisol levels, and heart rate, in addition to the mothers' behavior, salivary cortisol levels, and mental condition. The influence of the maternal explanatory variables on the neonatal response variables were verified through bivariate analysis, ANOVA, and multiple regression. The mothers' behavior and depression and/or anxiety did not affect the neonates' responses to pain and stress, though the mothers' levels of salivary cortisol before the procedure explained the variance in the neonates' levels of salivary cortisol after the procedure (p=0.036). Additionally, the mothers' baseline levels of salivary cortisol along with the neonates' age explained the variance in the neonates' heart rate (p=0.001). The ability of mothers to regulate their own stress contributed to the infants' responses to pain and stress.

Pressão arterial, respostas metabólicas e autonômicas à insulina e infusão de intralipid® em pacientes chagásicos

FUNDAMENTO: Infusão de intralipid e heparina resulta em aumento da pressão arterial e também em anormalidades autonômicas em indivíduos normais e hipertensos. OBJETIVO: Avaliar a sensibilidade a insulina e o impacto da infusão de intralipid e de heparina (ILH) sobre a resposta hemodinâmica, metabólica e autonômica em pacientes com a forma indeterminada da doença de Chagas. MÉTODOS: Doze pacientes com a forma indeterminada da doença de Chagas e 12 voluntários saudáveis foram avaliados. RESULTADOS: A pressão arterial basal e a frequência cardíaca foram semelhantes nos dois grupos. Os níveis plasmáticos de noradrenalina encontravam-se ligeiramente aumentados no grupo de pacientes chagásicos. Após o Teste de Tolerância a Insulina (TTI), houve um declínio significativo na glicose dos dois grupos. A Infusão de ILH resultou em aumento da pressão arterial em ambos os grupos, mas não houve nenhuma mudança significativa na noradrenalina plasmática. O componente de Baixa Frequência (BF) mostrou-se semelhante e aumentou de forma semelhante em ambos os grupos. O componente de Alta Frequência (AF) apresentou-se menor no grupo chagásico. CONCLUSÃO: Pacientes com forma indeterminada da doença de Chagas apresentaram aumento da atividade simpática no momento basal e uma resposta inadequada à insulina. Eles também tiveram um menor componente de alta frequência e sensibilidade barorreflexa prejudicada no momento basal e durante a infusão de intralipid e heparina.

Débito cardíaco e fração de ejeção fetal por meio do spatio-temporal image correlation (STIC): comparação entre fetos masculinos e femininos

OBJETIVO: Comparar do débito cardíaco (DC) e a fração de ejeção (FE) do coração de fetos masculinos e femininos obtidos por meio da ultrassonografia tridimensional, utilizando o spatio-temporal image correlation (STIC). MÉTODOS: Realizou-se um estudo de corte transversal com 216 fetos normais, entre 20 a 34 semanas de gestação, sendo 108 masculinos e 108 femininos. Os volumes ventriculares no final da sístole e diástole foram obtidos por meio do STIC, sendo as avaliações volumétricas realizadas pelo virtual organ computer-aided analysis (VOCAL) com rotação de 30º. Para o cálculo do DC utilizou-se a fórmula: DC= volume sistólico/frequência cardíaca fetal, enquanto que para a FE utilizou-se a fórmula: FE= volume sistólico/volume diastólico final. O DC (combinado, feminino e masculino) e a FE (masculina e feminina) foram comparadas utilizando-se o teste t não pareado e ANCOVA. Foram criados gráficos de dispersão com os percentis 5, 50 e 95. RESULTADOS: A média do DC combinado, DC direito, DC esquerdo, FE direita e FE esquerda, para feminino e masculino, foram 240,07 mL/min; 122,67 mL/min; 123,40 mL/min; 72,84%; 67,22%; 270,56 mL/min; 139,22 mL/min; 131,34 mL/min; 70,73% e 64,76%, respectivamente; sem diferença estatística (P> 0,05). CONCLUSÕES: O DC e a FE fetal obtidos por meio da ultrassonografia tridimensional (STIC) não apresentaram diferença significativa em relação ao gênero.

Exercício aeróbico ou com pesos melhora o desempenho nas atividades da vida diária de mulheres idosas

Este estudo aleatorizado não controlado teve como objetivo determinar o efeito de um protocolo de exercício com pesos ou aeróbico no desempenho das atividades da vida diária em mulheres idosas. Para tanto, a amostra foi constituída por 41 mulheres idosas aparentemente saudáveis na faixa etária de 60 a 85 anos de idade (x: 65,1 ± 7,9 anos) divididas aleatoriamente em grupo exercício com pesos (n: 22) ou aeróbico (n: 19). O grupo exercício com pesos consistiu na execução de três séries de oito a 12 repetições a 60% de uma repetição máxima no exercício leg press 45º. O grupo exercício aeróbico consistiu em pedalar em cicloergômetro durante 40 minutos a 60% da frequência cardíaca de reserva. Os dois protocolos foram realizados três vezes por semana durante cinco semanas. As atividades da vida diária selecionadas foram velocidade para se levantar de uma posição sentada (VLPS), velocidade para se levantar de uma posição deitada (VLPD), velocidade para subir escada (VSE) e velocidade para calçar e amarrar o tênis (VCAT). O grupo exercício aeróbico melhorou significativamente o desempenho em VCAT (19,1%), enquanto o exercício com pesos incrementou significativamente o desempenho em VSE (4,3%) e VLPS (8,9%). Os resultados deste estudo permitem concluir que tanto o exercício com pesos como o aeróbico induziram efeito positivo nas atividades da vida diária, sugerindo que ambas as modalidades de exercício devem ser associadas a um programa adequado de exercícios para a melhora da capacidade funcional de pessoas idosas.

Impact of artifact correction methods on R-R interbeat signals to quantifying heart rate variability (HRV) according to linear and nonlinear methods.

In the analysis of heart rate variability (HRV) are used temporal series that contains the distances between successive heartbeats in order to assess autonomic regulation of the cardiovascular system. These series are obtained from the electrocardiogram (ECG) signal analysis, which can be affected by different types of artifacts leading to incorrect interpretations in the analysis of the HRV signals. Classic approach to deal with these artifacts implies the use of correction methods, some of them based on interpolation, substitution or statistical techniques. However, there are few studies that shows the accuracy and performance of these correction methods on real HRV signals. This study aims to determine the performance of some linear and non-linear correction methods on HRV signals with induced artefacts by quantification of its linear and nonlinear HRV parameters. As part of the methodology, ECG signals of rats measured using the technique of telemetry were used to generate real heart rate variability signals without any error. In these series were simulated missing points (beats) in different quantities in order to emulate a real experimental situation as accurately as possible. In order to compare recovering efficiency, deletion (DEL), linear interpolation (LI), cubic spline interpolation (CI), moving average window (MAW) and nonlinear predictive interpolation (NPI) were used as correction methods for the series with induced artifacts. The accuracy of each correction method was known through the results obtained after the measurement of the mean value of the series (AVNN), standard deviation (SDNN), root mean square error of the differences between successive heartbeats (RMSSD), Lomb\'s periodogram (LSP), Detrended Fluctuation Analysis (DFA), multiscale entropy (MSE) and symbolic dynamics (SD) on each HRV signal with and without artifacts. The results show that, at low levels of missing points the performance of all correction techniques are very similar with very close values for each HRV parameter. However, at higher levels of losses only the NPI method allows to obtain HRV parameters with low error values and low quantity of significant differences in comparison to the values calculated for the same signals without the presence of missing points.

Efeito agudo do exercício aeróbio vigoroso sobre as funções executivas em adolescentes

Executive functions are determinant cognitive processes for student success, since they execute and control complex cognitive activities such as reasoning, planning and solving problems. The development of the executive functions performances begin early at childhood going through the adolescence until adulthood, concomitant with the neuroanatomical, functional and blood perfusion changes over the brain. In this scenario, exercise has been considered an important environmental factor for neurodevelopment, as well as for the promotion of cognitive and brain health. However, there are no large scientific studies investigating the effects of a single vigorous aerobic exercise session on executive functions in adolescents. Objective: To verify the acute effect of vigorous aerobic exercise on executive functions in adolescents. Methods: A randomized controlled trial (RCT) with crossover design was used. 20 pubescent from both sexes/gender with age between 10 and 16 years were submitted to two sessions of 30min each: 1) The aerobic exercise session intensity was between 65 and 75% of heart rate reserve, in which 5min for warm-up, 20min at the target intensity and 5min of cool down; and 2) control session watching cartoons. The computerized Stroop test – Testinpacs and trail making test were used to evaluate the inhibitory control and cognitive flexibility assessment respectively, before and after both experimental and control sessions. The reaction time (RT) and number of errors (n) of Stroop test were recorded. The total time (TT) and the number of errors (n) of the trail making test were also recorded. Results: The control session’s RT did not present significant differences in the Stroop test. On the other hand, the exercise session’s RT decreased significantly (p<0.01) after the session. The number of errors made at the Stroop test had no significant differences in control and exercise sessions. The ΔTT of trail making test of exercise session was significantly (p<0.001) lower than the control session’s. Errors made in trail making test did not show significant differences between control and exercise sessions. Additionally, there was significant and positive association among the Stroop test ΔRT of exercise session with xiii chronological age (r= 0.635, p=0.001; r 2 = 0.404, p=0.003) and sexual maturation (rs= 0.580, p=0.007; r 2 = 0.408, p=0.002). Differently, there was no association among the control session ΔRT and chronological age (r= – 0.144, p=0.273; r 2 = 0.021, p=0.545) or sexual maturation (rs= –0.155, p=0.513; r 2 = 0.015, p=0.610). Conclusion: Vigorous aerobic exercise seems to improve acutely executive functions in adolescents. The effect of exercise on inhibitory control performance was associated to pubertal stage and chronological age. In other words, the benefits of exercise were more evident in early adolescence (↑ ΔRT) and its magnitude decreases along the growing up process.

Estimulação transcraniana por corrente contínua (ETCC) sobre o córtex motor na modulação autonômica em pessoas com lesão medular com diferentes graus e níveis de lesão

Introduction: Transcranial Direct Current Stimulation (tDCS) has been used in studies for the treatment of chronic pain, but their effects on the autonomic nervous system (ANS) are non-existent. Therefore, the need for studies is of fundamental importance, as these individuals have autonomic imbalance and the intensity of this is dependent on the degree and level of injury. Objective: We investigated the effect of tDCS on the ANS in people with spinal cord injury (SCI) with different degrees and levels of injury. Methods: Randomized, placebo-controlled, double-blind, applied anodal tDCS or sham on the primary motor cortex (M1), bilaterally. The subjects (lower incomplete injury, n = 7; lower complete injury, n = 9; and high complete thoracic injury, n = 3) visited the laboratory three times and received active or sham tDCS for 13min. The heart rate variability (HRV) was measured before, during and after stimulation and analyzed the variables LF, HF and LF / HF. Results: The tDCS modulated the ANS in different ways among the groups. In individuals with SCI high complete thoracic the tDCS did not change the HRV. However, for individuals with SCI low incomplete, tDCS changed the HRV in order to increase sympathetic (LF, p = 0.046) and reduced parasympathetic (HF, p = 0.046). For individuals SCI low complete to tDCS changed the HRV reduction sympathetic (LF, p = 0.017) and increased parasympathetic (HF, p = 0.017). Conclusions: The present study suggests that anodal tDCS applied on the motor cortex bilaterally could modulate the ANS balance in people with spinal cord injury and that this effect is dependent on the degree and level of injury.

Influência de mudanças de fase no ciclo claro-escuro sobre o controle autonômico cardíaco de ratos

Introduction: The circadian system has neural projections for the Autonomic Nervous System (ANS), directly interfering with sympathetic-vagal modulation of the cardiovascular system. Disturbances in the circadian system, such as phase changes in light-dark cycle (LD), has been related to the risk of development of cardiovascular diseases due to increased sympathetic tone and reduction o Heart Rate Variability (HRV - RR intervals). Purpose: Investigate the interaction between Circadian Timing System and cardiac autonomic control in rats. Materials and methods: We used 18 Wistar rats (♀, age = 139.9 ± 32.1 days, weight = 219.5 ± 16.2 g), divided into three distinct groups: Control (CG), phase delay of 6h (GDe) and phase advance of 6h (GAd). Three animals were excluded during data collection (CG/GDe/GAd - n=5). Telemeters were surgically implanted in each animal for continuous acquisition of electrocardiographic (ECG) signals (duration of 21 days in the CG and 28 days in GDe/ GAd). A LD cycle was established 12h: 12h, beginning of light at18:00h and dark at 06:00h. The animals remained in the same CG LD cycle throughout the experimental period, while, on the 14th day of registration, the GDe and GAd underwent a delay and an advance in 6h, respectively. Throughout the experimental period, the locomotor activity (LA), the mean heart rate (mHR) and variables related to iRR [mean RR (mRR), SDNN, RMSSD, LF, HF and LF/ HF ratio ] were recorded. All data were analyzed in blocks of 3 and 7 days, for the presence of circadian rhythm, values of Cosinor - mesor, amplitude and acrophase (paired t test), phase relationship, differences between light and dark (t test independent), averages every 30 minutes along each time series (two-way ANOVA with post hoc Bonferroni). The data block B1,M1 and M2 in CG served as benchmarks for comparisons between series of analysis of the GAT/GAV. Results: We observed circadian rhythmicity in the variables LA, mRR and mFC(p<0.01). mRR and mFC showed phase relationship with the LA in all three groups, being less stable in GAd. In the CG, no significant differences between blocks were found in any of the analyzes(p>0.05). Among the 7 day blocks, there was a significant reduction in mRR(p=0.04) and mFC(p=0.03) in GDe and significant reduction in HF mean(p=0.02) in GAd; and between 3 day blocks, a significant increase of LF/HF(p= 0.04) in the GDe; besides mRR(p=0.03), SDNN(p=0.04), RMSSD (p=0.04), LF (p=0.01) and HF(p=0.02) significant increase in the GAd. It was found that the differences between the means of the mRR, LA and mFC in light and dark phases were not significant after phase changes in some of the blocks/moments (GDe and GAd). No significant results were found when comparing rhythmic variables means every 30 minutes over the blocks, except for a significant decrease in mRR at the middle of the dark phase (B2) and the start of light phase (B3) - (p<0.01). Conclusion: phase advances and delays (6h) altered cardiac autonomic control in the experimental groups by temporarily HRV decrease. Phase advances apparently had greater negative interference in this process, in relation to the phase delays.

Monitorização da carga de treino em Futsal: estudo piloto com jogadores amadores juniores e seniores

Este foi um estudo piloto que pretendeu monitorizar a carga de treino em Futsal, com jogadores amadores juniores e seniores. A amostra do presente estudo foi composta por 8 jogadores de Futsal do sexo masculino, 4 juniores com idade média de 16.5±0.5 anos (estatura de 1.67±0.04 m e 59.2±2.21 Kg de massa corporal) e 4 seniores com idade média de 27.2±2.7 anos (estatura de 1.71±0.05 m e 69.7±7.5 Kg de massa corporal). Os jogadores competiam nos campeonatos distritais amadores de Futsal, na sua categoria, organizados pela Associação de Futebol de Leiria. Para a realização deste estudo recorreu-se a 4 unidades do ZephyrTM BioHarnessTM System (Zephyr Technology, Auckland, New Zealand). Trata-se de um sistema de monitorização wireless de dados fisiológicos e que tem a capacidade de medir a frequência cardíaca (FC), frequência respiratória (FR) e acelerometria (ACC). Os resultados obtidos mostram que o sistema utilizado registou as variáveis que se pretendiam estudar, sem limitações para o atleta, isto é, sem cabos ou artefactos, que limitassem os movimentos durante a unidade de treino. Verificou-se também que, no somatório de 8 unidades de treino, a frequência cardíaca média no grupo de juniores foi mais elevada do que a dos jogadores seniores (p = 0.029). A monitorização permitiu avaliar a intensidade das unidade de treino, permitindo identificar as respostas fisiológicas por jogador e por treino. Utilizando esta tecnologia é possível fazer um acompanhamento monitorizado de cada atleta por forma a analisar a sua adaptação e evolução fisiológica e fazer uma prescrição/planificação da sessão de treino mais adaptada a cada atleta.

Association between physical activity and cardiorespiratory factors in adolescents: a cross-sectional exploratory study

Background: Currently, under half of the adolescents reach recommended daily levels of physical activity (PA). It is known that higher levels of PA lead to higher levels of cardiorespiratory fitness (CRF) and therefore, a health-related CRF criterion value could contribute to identify the target population for primary cardiovascular disease prevention. Therefore, the aim of this study was to explore the relation between PA levels and CRF factors in healthy adolescents. Methods: A cross-sectional exploratory study with healthy adolescents aged 12-18 years old was conducted. Socio-demographic and body composition data were collected using a questionnaire. PA level was scored with the Physical Activity Index (PAI) and CRF assessment included lung function (LF) measured with spirometry and exercise tolerance measured with Incremental Shuttle Walking Test (ISWT). According to PAI scores the sample was divided in two groups: 1 (sedentary, low and moderately active); 2 (vigorously active (VA)). Descriptive statistics were applied to characterise the sample. Independent sample t-tests assessed differences between groups and simple logistic regressions identified the predictors of being VA. Results: The study included 115 adolescents (14.63±1.70 years old; 56.52% female). Adolescents presented a normal body mass index=21.19±3.14 Kg.m-2) and LF (forced expiratory volume in the first second (FEV1)=105.58±12.73% of the predicted). Significant differences were found between groups in height (G1–163.44±8.01; G2–167±8.65; p=0.024), LF (FEV1/ forced vital capacity (FVC); G1–97.58±10.66; G2–94.04±8.04; p=0.049), ISWT distance (G1– 1089.81±214.04; G2–1173.60±191.86; p=0.038); heart rate (HR) at rest (G1– 84.61±13.68; G2–79.23±13.81; p=0.038), HR at the end of the best ISWT (G1– 124.71±37.57; G2–133.54±33.61; p=0.041) and percentage of the maximal HR achieved during ISWT (G1–63.09±19.03; G2–67.53±17.08; p=0.043). Simple logistic regressions showed that height (OR–1.054; 95%CI 1.006-1.104), ISWT distance (OR–1.002; 95%CI 1.000-1.004) and HR at rest (OR–0.971; 95%CI 0.945-0.999) were predictors of being VA. Conclusions: Results suggest that more physically active adolescents have a better CRF profile. The findings suggest that PA is important to adolescents’ health status and it should be encouraged since childhood. Clinical practice will benefit from the use of PAI, ISWT and HR findings, allowing physiotherapists to use it for prescribing exercise.

Efeitos do exercício moderado prévio com oclusão vascular sobre a cinética da oferta e utilização do oxigênio em um exercício subsequente de alta intensidade

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Educação Física, Programa de Pós-Graduação Stricto-Sensu em Educação Física, 2015.

Oxímetro de pulso com comunicação via Bluetooth

Dissertação (mestrado)—Universidade de Brasília, Faculdade Gama, Programa de Pós-Graduação em Engenharia Biomédica, 2015.

Patterns of sedentary behavior : insights from observational and experimental studies on body composition and energy expenditure

It is recognized that sedentary behavior (SB) has deleterious effects on numerous health outcomes and it appears that physiological mechanisms underlying these harms are distinct from the ones explaining moderate-to-vigorous physical activity (MVPA) benefits. Sedentary behavior represents a large portion of human’s life and is increasing with technological development. A new current of opinion supports the idea that the manner SB is accumulated plays an important role. This dissertation presents six research studies conducted under the scope of SB. In the methodological area, the first study highlighted the magnitude of potential errors in estimating SB and its patterns from common alternative methods (accelerometer and heart rate monitor) compared to ActivPAL. This study presented the accelerometer as a valid method at a group level. Two studies (2 and 5) were performed in older adults (the most sedentary group in the population) to test the associations for SB patterns with abdominal obesity using accelerometry. The findings showed positive graded associations for prolonged sedentary bouts with abdominal obesity and showed that those who interrupted SB more frequently were less likely to present abdominal obesity. Therefore, public health recommendations regarding breaking up SB more often are expected to be relevant. The associations between sedentary patterns and abdominal obesity were independent of MVPA in older adults. However, the low MVPA in this group makes it unclear whether this independent relationship still exists if highly active persons are analysed. Study 3 inovates by examining the association of SB with body fatness in highly trained athletes and found SB to predict total fat mass and trunk fat mass, independently of age and weekly training time. Study 4 also brings novelty to this research field by quantifying the metabolic and energetic cost of the transition from sitting to standing and then sitting back down (a break), informing about the modest energetic costs (0.32 kcal·min−1). Finally, from a successful multicomponent pilot intervention to reduce and break up SB (study 6), an important behavioral resistance to make more sit/stand transitions despite successfully reducing sitting time (~ 1.85 hours·day-1) was found, which may be relevant to inform future behavioral modification programs. The present work provides observational and experimental evidence on the relation for SB patterns with body composition outcomes and energy regulation that may be relevant for public health interventions.

Identificação e caracterização fisiológica do soldado nas operações em áreas edificadas

No âmbito do Trabalho de Investigação Aplicada foi elaborada uma caracterização fisiológica do soldado nas operações em áreas edificadas, tendo como objetivo geral contribuir para o quadro teórico e prático na área da motricidade humana, relativamente às aptidões fisiológicas, designadamente: a Frequência Cardíaca, o Consumo de Oxigénio máximo (VO2max) e o Lactato Sanguíneo. Neste estudo foi executada uma pista de combate em áreas edificadas, com o nível de dificuldade crescente, inicialmente sem e com carga (colete balístico) de seguida com o inimigo armado com airsoft e para finalizar, a esquadra de assalto com armas de airsoft. A pista desenrolou-se na Aldeia de Camões em Mafra. Para medição dos parâmetros em estudo, utilizou os monitores cardíacos Garmin Forerunner 310XT, que fornecem os valores das Frequências Cardíacas e o Lactete Plus, que nos dão os valores dos níveis de Lactato Sanguíneo. Verificou-se que não existe uma doutrina de referência que evidencie o treino físico orientado para o combate em áreas edificadas nos dias de hoje. Da análise dos resultados obtidos verificámos que a intensidade do esforço, durante a execução das pistas de combate, foi predominantemente realizada no regime anaeróbio. Com os resultados alcançados durante a realização da pista de combate, identificámos algumas das tarefas mais críticas na sua execução. Apurámos através dos níveis de lactato que a função do comandante de esquadra é de uma intensidade de esforço físico superior a exigida na restante esquadra de assalto.

Efeitos da aplicação do EDIC na função cardiorrespiratória em 3 grupos específicos de crianças

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia