CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / The presence of alterations of blood pression in children and adolescents has shown that arterial hypertension may have its initial history in this life stage. It is believed that the harmful effects of hypertension, when they exist, could be minimized if their presence was detected precociously, if the evaluation of blood pressure was done periodically and if it were a mandatory part of the consultations to children and adolescents. Epidemiologic studies about blood pressure in childhood also reveal that the persistence of high values in this stage of life reinforces the idea that hypertension in adulthood is a direct result of hypertension in childhood. One aimed to follow children and adolescents with family history of arterial hypertension for a long time, analyzing the evolution of percentage/classification of blood pressure in children and adolescents. The longitudinal/prospective study was developed in a poor community of Fortaleza-CearÃ. The blood pressure was evaluated in five meetings: first semester of 2004; first semester of 2005; second semester of 2005; first semester of 2006 and second semester of 2006. The data collection was conducted at home in pre-determined periods. By the data obtained, it was possible to confirm that children and adolescents can have high blood pressure, even without an specific cause and no sinthomatology. The group presented was composed by 141 participants, in the majority females (71). The ages varied from 6 to 21 years old in the period of accompaniment. The highest values of blood pressure were found in the male patients. A bigger percentage of the children and adolescents were relatives of second degree of arterial hypertension bearers (48.9%), and these showed the biggest average values of SBP and DBP. Out of 92 children, 30 remained with no alterations of the percentages of blood pressure in all evaluations; 42 presented alterations starting from the 3rd evaluation; eight showed alterations of the percentage only on the last evaluation conducted; 11 showed alterations of the percentages of blood pressure in all the evaluations and 20 presented alterations of the percentages in some evaluation, but in the last one showed normal percentage of blood pressure. Out of 49 adolescents, 32 remained with no alterations of the percentages of blood pressure in all evaluations; eight presented alterations starting from the 3rd evaluation; two individuals showed alterations of the percentages only on the last evaluation; six presented alterations of the percentages of blood pressure in all the evaluations and three presented alterations of percentages in some evaluation, but in the last one presented normal blood pressure percentage. It was not possible to identify statistic significance concerning the risk factors presented during the accompaniment, apparently being the family factor the biggest contribution to the high values of blood pressure. It is confirmed the necessity of a regular monitoring of children and adolescentsâ blood pressure and, even without significant statistic correlation, the precocious identification of risk factors such as overweight, obesity, sedentarism, positive history to hypertension, smoking and drinking in the prevention of future cardiovascular events. / A presenÃa das alteraÃÃes da pressÃo arterial em crianÃas e adolescentes tem evidenciado que a hipertensÃo arterial pode ter sua histÃria inicial nesta etapa de vida. Acredita-se que os efeitos deletÃrios da hipertensÃo, no caso de sua existÃncia, poderiam ser minimizados se a sua presenÃa fosse detectada precocemente, bastando para isso que a avaliaÃÃo da pressÃo arterial fosse feita periodicamente e constasse como parte obrigatÃria das consultas a crianÃas e adolescentes. Estudos epidemiolÃgicos sobre pressÃo arterial na infÃncia tambÃm revelam que a persistÃncia de valores elevados nesta fase da vida reforÃa a hipÃtese de que a hipertensÃo em adultos à resultado direto de hipertensÃo na infÃncia. Teve-se como propÃsito acompanhar por tempo prolongado crianÃas e adolescentes com histÃria familiar de hipertensÃo arterial, Analisando a evoluÃÃo dos percentis/classificaÃÃo de pressÃo arterial de crianÃas e adolescentes. O estudo longitudinal/prospectivo foi desenvolvido em uma comunidade da periferia de Fortaleza- CearÃ. A pressÃo arterial foi avaliada em cinco encontros: primeiro semestre de 2004; primeiro semestre de 2005; segundo semestre de 2005; primeiro semestre de 2006 e no segundo semestre de 2006. A coleta de dados foi realizada no domicÃlio em perÃodos prÃ-determinados. Pelos dados obtidos, foi possÃvel confirmar que crianÃas e adolescentes podem ter pressÃes arteriais elevadas, mesmo sem uma aparente causa especÃfica e sem sintomatologia. O grupo apresentado foi composto por 141 participantes, na sua maior parte do sexo feminino (71). As idades variaram de 6 a 21 anos no decorrer do perÃodo de acompanhamento. Os valores mais elevados de pressÃo arterial mostraram-se naqueles do sexo masculino. Um percentual maior das crianÃas e adolescentes tinha parentesco de 2 grau com o portador de hipertensÃo arterial (48,9%), sendo estes os que mostraram maiores valores mÃdios de PAS e de PAD. Das 92 crianÃas, 30 crianÃas permaneceram sem alteraÃÃes dos percentis de pressÃo arterial em todas as avaliaÃÃes; 42 apresentaram alteraÃÃes a partir da 3 avaliaÃÃo; oito mostraram alteraÃÃo dos percentis somente na Ãltima avaliaÃÃo realizada; 11 apresentaram alteraÃÃes dos percentis de pressÃo arterial em todas as avaliaÃÃes e 20 apresentaram alteraÃÃo dos percentis em alguma avaliaÃÃo, mas na Ãltima mostraram percentis normais de pressÃo arterial. Dos 49 adolescentes, 32 permaneceram sem alteraÃÃes dos percentis de pressÃo arterial em todas as avaliaÃÃes; oito apresentaram alteraÃÃes a partir da 3 avaliaÃÃo; dois indivÃduos mostraram alteraÃÃo dos percentis somente na Ãltima avaliaÃÃo; seis apresentaram alteraÃÃes dos percentis de pressÃo arterial em todas as avaliaÃÃes e trÃs apresentaram alteraÃÃo dos percentis em alguma avaliaÃÃo, mas na Ãltima mostraram percentis normais de pressÃo arterial. NÃo foi possÃvel identificar significÃncia estatÃstica em relaÃÃo aos fatores de risco apresentados ao longo do acompanhamento, parecendo ser o fator familiar o maior contribuinte para os valores elevados das pressÃes arteriais. Confirma-se a necessidade de monitoraÃÃo da pressÃo arterial rotineira de crianÃas e adolescentes e, mesmo sem correlaÃÃo estatÃstica significativa, a identificaÃÃo precoce de indicadores de risco como sobrepeso, obesidade, sedentarismo, histÃria positiva para hipertensÃo, uso de fumo e bebida alcoÃlica na prevenÃÃo de eventos cardiovasculares futuros.

INTRODUÇÃO: O exercício em imersão durante a gravidez é pouco estudado na literatura. Os poucos trabalhos sobre o tema têm metodologia variada e utilizam dados não atuais sobre o comportamento pressórico em imersão. Outrossim, os estudos não contemplam a resposta pressórica nos vários momentos que implicam mudanças na homeostase, tais como no instante de entrada na piscina e da interrupção do exercício, condição que sabidamente induz modificações fisiológicas importantes, as quais, uma vez mapeadas, fornecem subsídios clínicos importantes para o manejo da atividade física em imersão na gravidez. OBJETIVOS: O presente estudo teve como objetivos avaliar e comparar a pressão arterial (PA), a frequência cardíaca (FC) e a percepção subjetiva de esforço (PSE) de gestantes normotensas, em momentos específicos: antes e após exercício aeróbico em solo e imersão. MÉTODO: Foi realizado ensaio clínico randomizado com 29 gestantes normotensas, acompanhadas no pré-natal de baixo risco da Clínica Obstétrica do Hospital das Clínicas da FMUSP, no período entre novembro de 2007 a março de 2009. As pacientes foram submetidas a sessões de 15 minutos de caminhada, em esteira tradicional em solo e esteira em imersão, obedecendo à randomização das sessões entre as participantes. Dados sobre PA, FC e PSE foram coletados em momentos determinados: pré-exercício, repouso ortostático em esteira, durante a sessão, imediatamente na interrupção do exercício e no período pós-exercício, seguindo o mesmo protocolo em ambos os ambientes. RESULTADOS: Verificou-se redução estatisticamente significativa em imersão da Pressão Arterial Sistólica (PAS) a partir da entrada na piscina até 1° minuto, após interrupção do exercício (p<0,001) e no 3º minuto pósexercício, ainda em imersão (p=0,001). A Pressão Arterial Diastólica (PAD) também sofreu redução significativa em imersão, a partir da interrupção do exercício até o 3º minuto pós-exercício, ainda em imersão (p<0,001). O comportamento da FC se mostrou atenuado, em imersão, nos primeiros cinco minutos de exercício (p=0,019) e, também, nos dez minutos finais de caminhada e no 1º minuto de repouso pós-exercício (p<0,001). A PSE demonstrou sofrer influência da imersão com diferença significativa entre solo e imersão em todos os momentos (p=0,003). CONCLUSÕES: Gestantes normotensas apresentam resposta de elevação em imersão de PA, FC e PSE, porém em patamar inferior do verificado em solo, sendo uma opção importante para controle de pressão arterial durante exercício. / INTRODUCTION: Literature data regarding immersion exercise during pregnancy are scarce, with the few studies available using different methods and non-updated data on blood pressure behavior during immersion. Moreover, the studies do not investigate the blood pressure response at the various time points that implicate changes in cardiovascular homeostasis, such as when entering the pool and at exercise interruption, a condition known to induce important physiological modifications. Once identified, these changes provide important clinical evidence for the management of immersion exercise during pregnancy. OBJECTIVES: To evaluate and compare blood pressure (BP), heart rate (HR) and rate of perceived exertion (RPE) in normotensive pregnant women before and after aerobic exercise performed on land and during immersion. METHODS: A randomized clinical trial was conducted on 29 normotensive pregnant women receiving low-risk prenatal care at the Obstetrics Clinic of the University Hospital, FMUSP, between November 2007 and March 2009. The patients underwent 15-min sessions of walking on a traditional treadmill on land and in water according to the randomization of the sessions to the participants. BP, HR and RPE were collected before exercise, during orthostatic rest on the treadmill, during the session, immediately after exercise interruption, and post-exercise. The same protocol was used for the two environments. RESULTS: Patients submitted to immersion exercise presented a significant reduction in systolic blood pressure between entering the pool and the first minute after exercise interruption (p<0.001) and in the third minute post-exercise still during immersion (p=0.001). Diastolic blood pressure was also significantly reduced during immersion from the interruption of exercise to the third minute post-exercise still during immersion (p<0.001). HR was attenuated during the first 5 minutes of immersion exercise (p=0.019) and also during the final 10 minutes of walking and the first minute of post-exercise rest (p<0.001). The RPE was influenced by immersion, with a significant difference between land and immersion exercise at all time points (p=0.003). CONCLUSIONS: Normotensive pregnant women present elevated BP, HR and RPE during immersion exercise but at a level lower than that observed on land. Water immersion might be an important option for the control of cardiovascular overload during exercise.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2014-10-14T17:57:34Z No. of bitstreams: 2 Tese - Flávia Miquetichuc Nogueira Nascente - 2013.pdf: 2117132 bytes, checksum: 25ca3d263813d9ead167a558043dac40 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-10-16T18:45:27Z (GMT) No. of bitstreams: 2 Tese - Flávia Miquetichuc Nogueira Nascente - 2013.pdf: 2117132 bytes, checksum: 25ca3d263813d9ead167a558043dac40 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-16T18:45:27Z (GMT). No. of bitstreams: 2 Tese - Flávia Miquetichuc Nogueira Nascente - 2013.pdf: 2117132 bytes, checksum: 25ca3d263813d9ead167a558043dac40 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-07-29 / Introduction: Adolescence is a stage of transition from childhood to adulthood, marked by changes and exposure to different situations and health risks. Sedentary lifestyle is a risk factor for various diseases and knowing its prevalence and associated factors may help in combating and preventing diseases and promoting physical activity. Objective: To determine the prevalence of sedentary lifestyle and physical activity levels and associated factors in adolescents aged 14 to 18 enrolled in public and private school system of Goiania-Goias. Methodology: Cross-sectional study with a representative sample of adolescents. Physical activity was measured by the International Physical Activity Questionnaire _IPAQ_ (insufficiently active, sufficiently active and very active). Sedentary lifestyle was defined according to the World Health Organization as a moderate and/or vigorous physical activity expenditure less than 300 minutes a week. The independent variables: gender, age, skin color, smoking, alcohol consumption in the previous 30 days, socioeconomic status, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, heart rate, pulse pressure and caloric expenditure. To determine the factors associated with sedentary lifestyle the chi-square and Poisson regression test were applied, whereas for comparison of means the Student t test, ANOVA and Kruskal Wallis test were used, considering a significance level of p<0.05. Results: The sample consisted of 862 with mean age of 15.4􀁲1.1. Prevalence of the female gender (52.8%), with the majority in the age group of 14 and 15 (52.2%). For the skin color 51.2% related being “white”. In relation to the socioeconomic classification 52.5% from de students belonged to the Class C. Most of the adolescents was from public schools (69.1%). Smoking was present in 1.6% and alcohol consumption in 72.2% of the sample. Altered Blood pressure (17.4%), altered waist circumference (14.0%) and overweight (20.9%). Prevalence of sedentary lifestyle was 66.8% (95% CI: 63.5-69.9). The male adolescents were more physically active than the females ones (78.0% vs. 54.3%, p<0.001). According to the questionnaire used: 35.7% (n=308) were insufficiently active, 36.7% (n=316) sufficiently active and 27.6% (n=238) very active. The male gender presented lower levels of diastolic blood pressure (66.9 mmHg, p=0.025) and heart rate (72.7 mmHg, p=0.038) when associated with higher levels of physical activity. In females there were no significant associations among physical activity level and the independent variables (p>0.05). Conclusion: The majority of the adolescents were classified as sedentary. The male gender was more active than the female one. In the students from the male gender the physical activity levels were inversely associated with the diastolic blood pressure and the heart rate. / Introdução: A adolescência é uma fase de transição da infância para a vida adulta, exposta a diversas situações e riscos para a saúde. O sedentarismo é um fator de risco para vários tipos de doenças e conhecer sua prevalência e fatores associados podem ajudar no combate e prevenção de doenças e na promoção da atividade física. Objetivo: Determinar a prevalência de sedentarismo e os níveis de atividade física e fatores associados em adolescentes de 14 a 18 anos, de escolas públicas e privadas de Goiânia-Goiás. Metodologia: Estudo transversal com amostra representativa de adolescentes. A atividade física foi medida pelo Questionário Internacional de Atividade Física _IPAQ_ (insuficientemente ativo, suficientemente ativo e muito ativo). O sedentarismo foi definido pela Organização Mundial de Saúde como uma prática de atividade física moderada e/ou vigorosa menor que 300 minutos por semana. Variáveis independentes: sexo, idade, cor da pele, tabagismo, consumo de bebida alcoólica nos últimos 30 dias, nível socioeconômico, índice de massa corporal, circunferência da cintura, pressão arterial, frequência cardíaca, pressão de pulso e gasto calórico. Para determinar os fatores associados ao sedentarismo foram aplicados o teste de qui-quadrado e regressão de Poisson, enquanto que para comparação de médias foram utilizados o teste t de Student, ANOVA e Kruskal Wallis, considerando-se nível de significância p<0,05. Resultados: A amostra composta por 862 adolescentes com média de idade de 15,4􀁲1,1 anos. Predominância do sexo feminino (52,8%), com maioria na faixa etária de 14 e 15 anos (52,2%). Para a cor da pele 51,2% relataram ser “brancos”. Em relação à classificação socioeconômica 52,5% dos alunos pertenciam à classe C. A maioria era de escolas públicas (69,1%). Tabagismo presente em 1,6% e consumo de álcool em 72,2%. Pressão arterial alterada (17,4%), circunferência da cintura alterada (14,0%) e excesso de peso (20,9%). Prevalência de sedentarismo de 66,8% (IC95%: 63,5-69,9). Os adolescentes do sexo masculino foram fisicamente mais ativos do que as do feminino (78,0% vs. 54,3%; p<0,001). Segundo o questionário utilizado: 35,7%(n=308) eram insuficientemente ativos, 36,7%(n=316) suficientemente ativos e 27,6%(n=236) muito ativos. O sexo masculino apresentou menores níveis de pressão arterial diastólica (66,9mmHg; p=0,025) e frequência cardíaca (72,7mmHg; p=0,038) quando associado a maiores níveis de atividade física. No sexo feminino não foram observadas associações significativas entre nível de atividade física e as variáveis independentes (p>0,05). Conclusão: A maioria dos adolescentes foi classificada como sedentária. O sexo masculino foi mais ativo que o feminino. No sexo masculino os níveis de atividade física associaram-se inversamente à pressão arterial diastólica e à frequência cardíaca.

Monitoring of cerebral oxygenation, cerebrovascular reactivity and circulatory function in preterm infants Brain injury in the preterm infant is associated with death and lifelong disability. Cerebral hypoxia and fluctuations in cerebral blood flow in the first two days of life have been implicated in the pathophysiology of haemorrhagic and ischaemic brain injury. Monitoring of haemodynamic changes during the early transitional circulation from in-utero to ex-utero life are currently based on standard measurements of systemic oxygenation and mean arterial blood pressure, with no reliable assessment of end-organ perfusion. In this thesis, measurements using near-infrared spectroscopy (NIRS) and functional echocardiography were made to assess cerebral perfusion and systemic blood flow in a cohort of preterm infants undergoing intensive care. This thesis is divided into four sections: i) The feasibility of continuous monitoring of cerebral oxygenation and cerebrovascular reactivity is demonstrated in a series of case reviews, and the association between cerebral oxygenation and cerebrovascular reactivity with outcome of brain injury and mortality is described. ii) Combining measurements of systemic blood flow with end organ perfusion was applied to define MABPOPT in preterm infants based on an index of cerebrovascular reactivity. Deviations below MABPOPT were associated with intraventricular haemorrhage and mortality. iii) The complexity of brain and systemic signals was studied by using multi-scale entropy analysis. Most studies using cerebral NIRS or systemic measurements of blood flow use linear analysis; however, a complex biological system, such as the human brain, includes many regulatory mechanisms that interact in a complex manner, resulting in effects that cannot be understood wholly through the analysis of its individual constituents. Lower complexity of brain signals was observed in infants who developed intraventricular hemorrhage or died. iv) Changes in systemic and cerebral oxygenation in a cohort of preterm infants in the first 48 hours of life was assessed using functional echocardiography. The patterns of changes in cardiac output and cerebral oxygenation in infants who did and did not have intraventricular haemorrhage are discussed. Furthermore, the relationship between the presence of a haemodynamically significant ductus arteriosus and brain injury is assessed.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Science in Medicine, 2016 / Although it is well known that an increase in sodium intake (Na+) increases BP and is involved in the development of salt-sensitive hypertension (SS-HTN), the mechanism responsible for this increase in BP is uncertain. Further while low dietary potassium (K+) is also associated with the development of SS-HTN it is uncertain to what extent dietary potassium (K+) affects Na+-induced increases in BP. The purpose of this study was to determine whether Na+-induced increases in BP and target organ changes are altered by reductions in K+ intake. Four-month-old male Sprague-Dawley (SO) rats were randomly assigned to three dietary intervention groups for six weeks: a normal Na+ (0.3%), normal K+ (1.6%) group (CON, n=12), a high Na+ (6%), normal K+ (1.6%) group (NK+-HNa+, n=12) and a high Na+ (6%), low K+ (0.01%) group (LK+-HNa+, n=12). Tail-cuff BP, body weight, food and water intake were measured weekly. At termination, urine parameters, right kidney weight as well as left ventricular dimensions and function were measured. Vascular reactivity of the mesenteric and renal arteries was also assessed using a wire-myograph. During the diet intervention, water intake was significantly higher in the NK+-HNa+ and LK+-HNa+ groups compared to the CON group (P<0.0001). Although food intake was significantly lower in the NK+-HNa+ and LK+-HNa+ groups compared to the CON group during the first week (P=0.03 and P=0.05 respectively), no significant differences in body weight were observed between the groups (P>0.05). The urinary Na+/K+ ratio was higher in the LK+ HNa+ compared to the CON and NK+ -HNa+ groups (P<0.001). Following the 6 week dietary intervention, the systolic BP was significantly higher in the NK+-HNa+ and the LK+-HNa+ groups compared to the CON group (P=0.05 and P=0.04 respectively). The diastolic BP was significantly higher in the NK+-HNa+ and LK+-HNa+ groups compared to the CON group (P=O.05 and P=O.02, respectively). The increase in BP was not different between the NK+-HNa+ and LK+-HNa+ groups (P>O.05). In the mesenteric arteries, there was a significant increase in vascular responsiveness to phenylephrine in the NK+-HNa+ group compared to the CON group (P=O.02). However the vascular responsiveness to phenylephrine in the mesenteric arteries was similar between the NK+-HNa+ and LK+-HNa+ groups (P=O.82). No significant differences in vascular reactivity were observed in the renal arteries between the three groups. No significant differences were observed in the left ventricular dimensions and function between the different diet groups (P>O.05). In conclusion, 6 weeks of high Na+ intake increases BP, induces greater phenylephrine-induced contractions in mesenteric arteries but does not affect heart dimensions and function. The greater phenylephrine-induced contractions with a high Na+ intake may be responsible for the increase in BP. However a reduction in dietary K+ intake does not have any effect on the high Na+-induced changes in BP or mesenteric artery reactivity. / AC2016

Background: Hypertension is defined as an elevated systolic blood pressure (SBP ≥ 140 mmHg), or an elevated diastolic blood pressure (DBP ≥ 90 mmHg). The prevalence of hypertension is high in obese population. The potential effects of inadequate calcium intake on hypertension are receiving growing attention. The aim of the study was to examine the association between calcium intake and hypertension among obese adults. Methods: A total of 14,856 obese adults aged 20 years or older were obtained from the 1999-2010 National Health and Nutrition Examination Survey. Analysis of variance was used to examine if there was a relationship between calcium intake and blood pressure, SBP or DBP. Multiple logistic regressions were used to examine the association between calcium intake and hypertension after adjusting for potential confounders (energy intake, age, race, education level, alcohol use, smoking, and diabetes). Results: Prevalence of hypertension decreased with an increasing quartile of calcium intake (p < 0.0001). Multiple logistic regression showed that lowest quartile of calcium intake was associated with an increased risk of elevated SBP and elevated DBP (Odds Ratio (OR) =1.332, 95% Confidence Interval (CI): 1.084-1.636; OR=1.700, 95% CI: 1.234-2.342, respectively). Compared with adults in the highest quartile of calcium intake, those in lowest quartile had 1.4 times increased risk of hypertension (OR=1.400, 95% CI: 1.157-1.694). Conclusion: Our study provides support of research perspective that inadequate calcium intake may increase the risk of hypertension, high SBP, or high BDP among obese adults. Further studies are needed to understand physiological mechanism. Increasing the calcium intake in obese adults can be considered as a strategy to prevent hypertension.

The African American population has persistently suffered a greater disease burden from uncontrolled high blood pressure than any other ethnic/racial group. There have been many attempts to reduce the health disparity but with little changes in adverse outcomes over the years. As African Americans are very religious and incorporate spirituality into their everyday lives, this research followed a faith-based approach and was conducted in the church setting. The study was guided by the Illness Representation Model (IRM) and the Theory of Culture Care Diversity and Universality (TCCDU). One hundred male and female participants were recruited from five African American churches in Southeast Florida. Each participant met the inclusion criteria of being 35-80 years old, diagnosed with high blood pressure, members/attendees of a Judeo Christian church, and able to read and write English. A researcher-developed, five-day faith based health devotional which included high blood pressure education infused with Bible messages was used as the intervention. A quasi-experimental design of pre and posttesting was employed to evaluate high blood pressure knowledge and illness representation. High blood pressure knowledge was tested using the High Blood Pressure Prevention IQ Quiz (HBPP-IQ) and illness representation tested with the Revised Illness Perception Questionnaire (IPQ-R). The results demonstrated statistically significant improvements in four out of the five hypotheses tested, with a caveat for the timeline representation (presented as two separate outcomes). The findings indicated: High blood pressure knowledge (HBPP-IQ): p < .000; Illness Representation (IPQ-R); timeline acute/chronic: p = .003; timeline cyclical: p = .20; consequences: p = .024; personal control: p = .0005; treatment control: p = .002. These results support the use of the faith-based teaching method in educating African Americans about high blood pressure as an effort that might improve illness representation in this population. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

Numerous agencies have accumulated evidence since 1964 which implicates habitual cigarette smoking as a causal or facilitating factor in the development of many circulatory and respiratory diseases. This study sought to identify those psychological variables which possibly contribute to the maintenance of cigarette smoking and therefore, had two main purposes. First, this study investigated the individual and simultaneous physiological changes, i.e., Electroencephalography, Electromyography, Heart Rate, Blood Pressure and Skin Temperature that occurred during and immediately after the smoking of one cigarette. Second, the study investigated the hypothesis that smoking frequency would decrease when individuals were trained via biofeedback procedures to increase 8-12 Hz occipital EEG activity as a substitute for smoking. Three male, very heavy smokers (35 or more cigarettes per day ) and three male moderate smokers (15-24 cigarettes per day) physiologies were monitored while smoking, non-smoking and while they were provided with 8-12 Hz occipital EEG biofeedback training using a multiple baseline design. Results of the study indicate that of the six smokers physiologically monitored, four or more of the smokers demonstrated the following physiological changes while actually smoking one cigarette: the percent of time producing 4-8 cycles per second bra .in waves increased (S2 ,S3 ,S5); heart rate (beats per minute) increased (Sl,S2,S3,S4,S5,S6); and the percent of time producing 8-12 cycles per second (Hz) brain waves decreased (Sl,S2,S3,S4,S5,S6). Immediately after the smoking of one cigarette, four or more of the smokers demonstrated an increase in their rates (Sl,S2,S3,S4,S5, S6) and subjects 1,4,5 and 6 demonstrated an over-the-entire-session decrease in their skin temperatures. There did not appear to be any specific consistent brain wave changes across the subjects. However, the following subject-specific brain wave changes were evident: Subject 1 data indicates an increase in Alpha brain waves (8-12 Hz), a decrease in Theta brain waves (4-8 Hz), and a decrease in Beta brain waves (12-20 Hz). Subject 2 data indicates a decrease in Alpha brain waves, an increase in Theta brain waves, and a decrease in Beta waves. Subject 3 data indicates an Alpha wave decrease, Theta wave increase, and Beta wave increase. Subject 4 data indicates an Alpha wave decrease, Theta wave increase, and no observable change in Beta activity. Subject 5 data indicates an Alpha increase, a Theta decrease, and no observable change in Beta activity. Subject 6 data indicates an Alpha decrease, a non-observable change in Theta production and an increase in Beta activity. During the training period, when the smokers were given music feedback whenever they produced 8-12 Hz, four of the six smokers learned to increase the percent of time producing 8-12 Hz, (Sl,S2,S5, S6). Two of these four smokers were able to continue producing high levels of 8-12 Hz activity without the use of biofeedback equipment (Sl,S2). These smokers had quit smoking completely at the end of a six-month follow-up period. These two smokers were contacted by phone at the eight-month follow-up period and reported they were still absent from any cigarette smoking. The four smokers who could not increase their 8-12 Hz activity without the use of 8-12 Hz auditory feedback (Phase D) decreased their frequency of cigarette smoking at the six-month follow-up period as follows: Subject 3, from 38 to 15 cigarettes smoked per day; Subject 4, from 50 to 44 cigarettes smoker per day; Subject 5, from 18 to 8 cigarettes smoked per day; and Subject 6, from 17 to 10 cigarettes smoked per day. Possible reasons why Subjects 1 and 2 quit smoking are discussed and directions for future research are presented.

This thesis presents an investigation of statistical analytical methods applied to the analysis of the shape of the arterial pressure waveform. The arterial pulse is analysed by a selection of both supervised and unsupervised methods of learning. Supervised learning methods are generally better known as regression. Unsupervised learning methods seek patterns in data without the specification of a target variable. The theoretical relationship between arterial pressure and wave shape is first investigated by study of a transmission line model of the arterial tree. A meta-database of pulse waveforms obtained by the SphygmoCor"??" device is then analysed by the unsupervised learning technique of Self Organising Maps (SOM). The map patterns indicate that the observed arterial pressures affect the wave shape in a similar way as predicted by the theoretical model. A database of continuous arterial pressure obtained by catheter line during sleep is used to derive supervised models that enable estimation of arterial pressures, based on the measured wave shapes. Independent component analysis (ICA) is also used in a supervised learning methodology to show the theoretical plausibility of separating the pressure signals from unwanted noise components. The accuracy and repeatability of the SphygmoCor?? device is measured and discussed. Alternative regression models are introduced that improve on the existing models in the estimation of central cardiovascular parameters from peripheral arterial wave shapes. Results of this investigation show that from the information in the wave shape, it is possible, in theory, to estimate the continuous underlying pressures within the artery to a degree of accuracy acceptable to the Association for the Advancement of Medical Instrumentation. This could facilitate a new role for non-invasive sphygmographic devices, to be used not only for feature estimation but as alternatives to invasive arterial pressure sensors in the measurement of continuous blood pressure.

Abstract not available