Objetivo: Evaluar la eficacia de la musicoterapia en la reducción de los niveles de ansiedad en los niños de 5 a 12 años de edad, con necesidades especiales durante la atención odontológica en el Centro Ann Sullivan del Perú.  Materiales y métodos: Estudio cuasi experimental. Se evaluó a 40 pacientes, los cuales fueron divididos aleatoriamente en 2 grupos: grupo de expuestos y no expuestos a musicoterapia. El nivel de ansiedad fue registrado por la escala de imagen facial antes y después de la atención clínica, el comportamiento durante la atención a través de la escala de Frankl y el nivel de ansiedad de los padres a través de la escala modificada de Corah. Asimismo, se registraron los cambios en las funciones vitales de ambos grupos antes y después de dicha atención.  Resultados: Se encontraron diferencias estadísticamente significativas en todos los valores de la presión arterial (sístole, p<0.001 y diástole, p=0.007) y frecuencia cardiaca final (p= 0.001) en ambos grupos. Los valores de las funciones vitales finales fueron menores en el grupo expuesto en contraste al grupo no expuesto. Se encontró diferencias estadísticamente significativas entre los niveles de ansiedad final en ambos grupos, observándose una proporción mayor de casos con niveles de ansiedad en el grupo no expuesto a musicoterapia. (p=0.001) Conclusión: El empleo de la musicoterapia es eficaz en la reducción de los niveles de ansiedad durante la atención odontológica en pacientes con necesidades especiales. / Objective: To evaluate the efficacy of music therapy in reducing anxiety levels in children with special needs between 5 and 12 years of age during dental attention at the Ann Sullivan Center of Peru. Materials and methods: This is a quasi-experimental study. 40 patients were randomly divided in two groups: exposed and not exposed to music therapy.  The level of anxiety was registered using the Facial Image Scale before and after clinical attention, the patient behavior during the attention was measured by the Frankl Scale, and the level of anxiety of the was measured by the Modified Corah Scale.  Likewise, the vital functions of both groups were registered before and after dental attention and the differences were evaluated. Results: Statistically significant differences were found in both blood pressure values (systole, p = 0.000 and diastole, p = 0.007) and final heart rate (p = 0.001). The values of the final vital functions were minors in the exposed group in contrast to the unexposed group. Statistically significant differences were found between the levels of final anxiety in both groups, with a higher proportion of cases of anxiety levels in the unexposed group (p = 0.001). Conclusion: The use of music therapy is effective in the reduction of anxiety levels during dental atention in pacients with special needs. / Tesis

Analysis of care in patiens at risk for arterial hypertension in pharmacy I. Author: Stanislav Gregor1 Tutor: Josef Malý1 Consultant: Stanislav Havlíček2 1 Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové 2 Czech Chamber of Pharmacists, Prague Introduction: Arterial hypertension represents a serious health problem. Despite of the fact that great attention is paid to an early diagnosis and therapy of arterial hypertension, it remains compensated insufficiently in a number of patients. Objectives: The aim of the thesis was to analyse the possibilities of pharmaceutical care provided to patients who are at risk of arterial hypertension. Methodology: Blood pressure was measured from the beginning of October till December 2012 in a public pharmacy in Moravská Třebová. The blood pressure was measured by a pharmacist by means of a validated and calibrated tonometer. Other data were collected from a directed interview with the pharmacy client. The data were evaluated in Microsoft Excel 2007 and processed by means of the frequency analysis. A retrospective analysis of drug problems was further performed in patients who have been using pharmacotherapy or food supplements. Results: The data were obtained from 196 pharmacy clients (31 % of men and...

Analysis of care in patients at risk for arterial hypertension in pharmacy II. Author: Kateřina Panáčková Tutor: PharmDr. Josef Malý, Ph.D.1 Consultant: PharmDr. Stanislav Havlíček2 1 Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové 2 Pharmacy Luna, Plzeň Introduction: Arterial hypertension is one of the most common illnesses in the Czech Republic. Not only this should be the reason for proper health education and early detection of clients endangered by this illness. Objectives: The objective of the thesis was to perform and evaluate consultancy activities in a pharmacy focusing on clients with a risk of arterial hypertension or with already diagnosed arterial hypertension. Methodology: Collection of data took place in a public pharmacy in Česká Lípa between 1 May 2013 and 27 June 2014. Measuring of blood pressure was a part of controlled interview with clients of the pharmacy. Following data was recorded into a form: social-demographic characteristics of the respondend, his/her attitude towards measuring blood pressure in the pharmacy, incidence of risk factors of arterial hypertension, respectively atherosclerosis and other illnesses in the anamnesis, medication including nutrition supplements, results of own measurings and proposed...

Analysis of blood pressure measurement in Czech pharmacies I. Author: Jakub Prouza Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Introduction: Arterial hypertension is one of the most serious health problems of today and its therapy must be approached comprehensively. In addition to medical care, to the improvement of the health status of the patient significantly contribute properly implemented pharmaceutical care and blood pressure measurement in pharmacy. Objectives: The aim of the thesis was to describe and analyse conditions of blood pressure measurement in a sample of Czech pharmacies. Methods: Data were collected via questionnaire survey in 2012 and 2013 in three districts. The survey was conducted using two questionnaires, which were filled at pharmacies with possible help of trained interviewer. The first questionnaire was completed by the authorized employee representative of the pharmacy and included questions characterizing the pharmacy. Furthermore the question whether they provided blood pressure measurement in the pharmacy. If they did, further questions were on the frequency of measurement, instrumentation and space equipment in pharmacy. The second questionnaire was completed by the pharmacy...

While the association between blood pressure (BP) and brain health is increasingly strengthened by various clinical and epidemiologic research findings, less is known about the relationship between longitudinal patterns of BP across midlife and their impact on cognitive aging. Therefore, the current project used a large-scale, prospective longitudinal dataset of the Framingham Heart Study to model various long-term BP patterns using traditional methods and a novel machine-learning approach and investigated their impact on the development of dementia, as well as cognitive performance and brain volumes in late life. Study 1 examined intra-individual BP variability (BPV) across midlife and assessed its association with neuropsychological test performance, brain volumetric measures, and the development of dementia in late life. Contrary to previous findings in the elderly population, increased BP variability across midlife was not significantly associated with any brain aging measures. However, greater mean BP across midlife significantly predicted a greater risk of dementia. This finding led to the hypothesis that elevated BP in midlife, rather than BPV, may predict poorer brain and cognitive outcomes in late life. Study 2 investigated a long-term pattern of elevated BP using a cumulative exposure model, which has been well-recognized as a summary measure of longitudinal variation and cumulative burden associated with elevated cardiovascular risk. Consistent with the hypothesis driven from Study 1, elevated values of cumulative BP were associated with increased risk of dementia, along with poorer performance in most cognitive domains and reduced brain volume in areas including frontal, occipital, and temporal regions. Finally, Study 3 capitalized on a machine-learning approach, and namely, the dynamic time warping algorithm, to analyze BP data over the course of midlife using various pattern clusters. Although preliminary in nature, analyses using this novel approach detected various shapes of BP patterns across midlife. Clinical utility of these shapes and advantages of the machine-learning tool in BP research are discussed. Together, the results from these three studies suggest that BP pattern over the course of midlife, especially regarding long-term elevation of BP, is significantly associated with brain aging outcomes in late life.

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Metabolic syndrome is associated with pathologies that include type 2 diabetes, hypertension, and dyslipidemia, all of which increase the risks of heart disease. Glucagon-like peptide (GLP-1) is a hormone produced by intestinal enteroendocrine L‑cells. GLP-1 increases insulin sensitivity, augments glucose-dependent insulin secretion, and suppresses glucagon release. GLP-1 also works centrally to decrease appetite and increase metabolism. Evidence suggests that the beneficial effect is mediated by metabolically related sympathetic neurons within the hypothalamus. Although the hypothalamus contains neurons that control metabolism, there are also neurons that control cardiovascular activity. Considering that one main goal of obesity and diabetes treatments is to reduce cardiovascular-related comorbidities, any drug‑induced increase in blood pressure is unacceptable. Therefore, a better understanding of GLP-1 agonists on sympathetic activity and the role of the hypothalamus in central GLP‑1 activity is essential. In this study, we tested the hypothesis that the long‑acting FDA approved GLP-1 receptor agonist liraglutide activates both metabolic and cardiovascular‑related hypothalamic neurons and augments reflex cardiovascular sympathetic activity in rats. To test this hypothesis, we administered liraglutide (125 mg/kg, SC, n=10) or vehicle (saline, n=10) to rats for 15 days and measured food intake and body weight. Next, we recorded blood pressure and renal sympathetic nerve activity (RSNA) in the anesthetized rat before and after liraglutide treatment. Finally, to determine the activation of hypothalamic neurons we performed neuroanatomical tracing studies and turned metabolically-related (raphe‑projecting) neurons green, and cardiovascular-related (rostroventrolateral medulla, RVLM) neurons red. After treating rats with liraglutide, (75 mg/kg IV) we performed immunohistochemical (IHC) labeling to identify neurons expressing cFos, a marker of neuronal activation. Daily liraglutide significantly (p < 0.05) reduced both food intake and body weight from the pretreatment baseline. In vehicle-treated rats, the mean baseline food intake was 27.9 ± 0.5g. During vehicle treatment, the mean food intake was 28.6 ± 0.8 g and body weight was 110 ± 1.5% of its baseline. In liraglutide-treated rats, the mean baseline food intake was 29.9 ± 0.7g. During liraglutide treatment, the mean food intake was 22.7 ± 1.4g and body weight was 105 ± 1.1% of its baseline. At the end of liraglutide treatment, food intake and body weight returned to that of the vehicle-treated rats. In the anesthetized rat, liraglutide significantly (p < 0.05) increased basal RSNA and augmented baroreflex and chemoreflex activity. Lastly, our cFos data show that liraglutide activates metabolic, but not cardiovascular hypothalamic neurons. Collectively, these data suggest that although liraglutide elevates sympathetic activity, it is not by activation of pre-sympathetic hypothalamic neurons.

Obesity has risen 75% in the United States since 1980 and an estimated 80 million American adults are considered obese. Obesity activates the sympathetic nervous system and is associated with neurogenic hypertension. Leptin is an obesity-related neuropeptide released from fat cells which reduces appetite and increases metabolism. Leptin activates metabolic and cardiovascular responsive pre‑sympathetic neurons within the hypothalamus. Although leptin increases metabolism and curbs appetite, it also increases blood pressure. Considering that one main goal of obesity treatments is to diminish the cardiovascular-related co-morbidities this is an unacceptable side effect for potential treatments. Thus, a better understanding of the role hypothalamic sites involved in obesity-related hypertension is necessary for successful treatments. Our hypothesis is that leptin activates hypothalamic neurons that control metabolic (raphe pallidus) and cardiovascular activity (RVLM, rostroventrolateral medulla) within the brainstem. To test our hypothesis we created a line of transgenic mice using the cre-lox recombination system to express the reporter gene tdTomato under the control of the leptin (ObRb) receptor gene. First, we performed a behavioral study to verify the physiological effect and optimal dose of daily leptin treatment. To do this we implanted mini-osmotic pumps for continuous subcutaneous leptin (400 ng/hr) administration and measured food intake and body weight over 4 weeks. To determine if leptin activates pre‑sympathetic hypothalamic neurons we performed neuroanatomical tracer studies in these mice. At the end of the 4-week period, we injected fluorescent retrograde tracers into the raphe pallidus (green, metabolic center) and RVLM (magenta, cardiovascular). We then performed fluorescence immunohistochemical labelling to identify leptin-induced neuronal activation cFos a marker of neuronal activation of these neurons. Data from this behavioral, neurophysiological and neuroanatomical study will provide a better understanding of the role of the hypothalamus in controlling blood pressure and metabolism in obesity. Information from this study will provide groundwork for a better understanding of central autonomic mechanisms of cardiovascular risk as well as risk introduced by drugs intended to treat obesity.

In recent years, the traditional nuclear family, as defined by social role theory with mother at home and father in the workplace, is no longer the norm. Nearly three out of every four women with children under the age of 18 are part of the workforce. Mothers are frequently juggling multiple roles as well as most of the responsibilities that are inherent in these roles. The current project examined diurnal ambulatory blood pressure influences associated with the responsibility of having a greater number of roles. We investigate differences between a self-reported healthy population of 112 married stay-at-home and 112 married employed mothers, all of whom have children under the age of 18 currently living in the home. Using a mixed multilevel model analysis, we found that the perception of equity in the division of childcare responsibilities between mothers and their husbands significantly contributed to lower systolic ambulatory blood pressure. We also found that married couples in relationships containing high positivity and low negativity had lower systolic ambulatory blood pressure than those which contained simultaneously high positivity and negativity. Additionally, there was a crossover interaction between these variables such that effect of relationship quality on both systolic and diastolic ambulatory blood pressure was moderated by the perception of equity in the division of childcare responsibilities between spouses. Lastly, we found that there were no ambulatory blood pressure differences between the employed and SAH mother conditions. These findings have applicable implications regarding dynamics and processes within marital relationships. These results demonstrate important social and relational influences on mothers' cardiovascular health.

Author: Bc. Michaela Tejnecká Title: The effect of regularly applied Nordic walking on selected cardiorespiratory parameters in adults after heart valve surgery. Aim: The aim of this work was to analyze the effect of six months of Nordic walking intervention on selected casrdiorespiratory parameters in adults after heart valve surgery. Methods: The study included ten individuals (mean age 62 years) who were at least five years apart after heart valve surgery. Blood pressure (BP) was measured using a pulsed wrist tonometer, blood oxygen saturation (BOS) and heart rate (HR) were measured using a pulse oximeter, and the ejection fraction of the heart (EF) was evaluated echocardiographically. Nordic walking training units took plaxe once a week for 6 months. During this intervention, the level of training gradually increased both in distance and elevation of the terrain. Results: In all probands there was an average reduction in systolic blood pressure during exercise by an average of 10,3 mmHg and a reductionin heart rate during exercise by an average of 24 beats per minute. The resting ejection fraction increased by an average of 5,5% after six month intervention. These changes were statistically significant (p<0,01). The results of the work point to the benefits of Nordic walking for cardiac...