Orientadores: José Luiz Tatagiba Lamas, Elenice Valentim Carmona / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-25T17:30:23Z (GMT). No. of bitstreams: 1 Souza_MarianaCastrode_M.pdf: 1304206 bytes, checksum: 84130c8f696f83ae053b3e21d61d43e2 (MD5) Previous issue date: 2014 / Resumo: A medida da pressão arterial é o procedimento de enfermagem mais realizado no mundo, importante para o diagnóstico da hipertensão arterial. Apesar de normalmente ser diagnosticada na fase adulta, a hipertensão pode ter origem na infância. Assim, é imprescindível que o diagnóstico e tratamento adequados sejam realizados precocemente, especialmente nos pacientes classificados nos grupos de risco, como neonatos prematuros e criticamente doentes. Apesar de sua utilização ser de extrema importância e estar bastante difundida nas unidades de terapia intensiva, a medida é realizada muitas vezes sem alguns cuidados: a padronização dos passos a serem seguidos, cuidados quanto ao preparo do paciente para a técnica e a escolha de materiais e equipamentos adequados para um resultado fidedigno. Geralmente os valores de pressão arterial são obtidos pelo método oscilométrico a partir de monitores não validados para a população neonatal. Frente aos diferentes métodos existentes para a medida da pressão e a necessidade do aprimoramento destes para a adequação às particularidades desta população, optou-se por estudar o método auscultatório, questionando: a medida de pressão por método auscultatório pode ser empregada em neonatos? Quais são os procedimentos que devem ser adotados para a obtenção de níveis pressóricos confiáveis nessa população? Os objetivos do estudo são: propor uma técnica de medida da pressão por método auscultatório em neonatos a termo, realizar a validação de conteúdo da técnica proposta, testar sua confiabilidade interobservador e verificar as associações entre estado comportamental e a sucção com o sucesso na obtenção de valores de pressão. Trata-se de pesquisa não experimental, descritiva, metodológica e transversal, realizada com 26 neonatos a termo, adequados para a idade gestacional. O instrumento de coleta de dados e o procedimento de medida foram construídos pela pesquisadora e equipe de pesquisa e submetidos à validação de conteúdo. Foram realizadas três medidas com o uso de um estetoscópio duplo pediátrico antecedida pela aplicação de 1 mL de solução glicosada a 25% no dorso da língua do neonato. Para a verificação da confiabilidade, foi calculado o grau de concordância dos pares de medidas por meio do Coeficiente de Correlação Intraclasse. As associações entre a obtenção dos valores de PA e as características dos sujeitos foram estudadas por meio de regressão linear. O Coeficiente de Correlação Intraclasse apontou repetibilidade excelente nos valores sistólicos e diastólicos, fortalecendo a possibilidade de reprodução da técnica proposta e permitindo considerá-la confiável. O procedimento de medida é facilitado quando o neonato está tranquilo, acordado ou dormindo. Contraindica-se a medida durante o choro. Não foi encontrada associação estatística significativa entre sucção ou sua ausência na medida. Entretanto, a sucção esteve mais presente nos casos de sucesso que nos casos de insucesso. O neonato apresentou adaptação ao procedimento, tornando-se mais calmo a cada medida. Assim, recomenda-se descartar os valores da primeira medida. Uma vez que a medida de pressão é bastante frequente em neonatos sob cuidados intensivos, consideramos premente estudar a aplicação deste procedimento neste contexto de assistência, visando obter evidências científicas a respeito da técnica e dos valores obtidos / Abstract: Blood pressure measurement, is one of the most applied nursing procedures worldwide, crucial for the systemic hypertension diagnosis. Although usually diagnosed during adult age, hypertension can be originated in childhood. So, it¿s early diagnosis and treatment are really important, especially for risk group patients, such as premature and severely ill newborns. In spite of the importance of arterial pressure measurement as well as its dissemination in intensive care units, it is usually performed without some cautions, like the following of standardized steps, patient preparation to the measurement and selection of adequate equipments for a reliable result. In general, the measurement is made by oscilometry, using multiparametric monitors, not validated for newborn population. Considering the different methods for measuring arterial pressure and their lack of adequacy to newborns, questions were formulated: is it possible to apply blood pressure measurement by auscultatory method on newborns? What are the procedures that should be adopted to obtain reliable pressure levels by auscultatory method on this population? Therefore, this study aims are: to propose a blood pressure auscultatory measurement technique on term neonates, carry out the content validation of the proposed technics, test its inter-observer reliability and verify associations among behavioral state, suction and the success of obtaining blood pressure values. This is a non-experimental, descriptive, methodological and transversal research, carried out with 26 term newborns, adequate for gestational age. The data collection form and the measurement technique were elaborated by the main researcher and a researcher team and submitted to content validation. Three blood pressure measurements were done for each newborn, using a pediatric double stethoscope. The procedure occurred after the application of 1mL glucose solution at 25% on the newborn tongue. To check the reliability, the degree of concordance of pairs of values was calculated by Intraclass Correlation Coefficient. The association between blood pressure values and newborns' characteristics were studied by linear regression. Intraclass Correlation Coefficient indicated an excellent repeatability for diastolic and systolic blood pressures, reinforcing that it is a reproducible and reliable technique. The procedure of blood pressure measurement is more easily performed when the newborn is relaxed, either awake or sleeping. When the newborn is crying, the measurement is not recommended. Significant statistical association between suction or its absence in the measurement was not found. However, the suction was more frequent in the successful cases than failure ones. The newborn presented adaptation the procedure, behaving more and more calm as measurements were done. Thus, we recommend to ignore the first measurement values. Once the blood pressure measurement is an usual procedure for newborns in intensive care units, it is indispensable to study this procedure at this set of care for getting scientific evidences on techniques and arterial blood pressure values / Mestrado / Enfermagem e Trabalho / Mestra em Ciências da Saúde

Orientador: Luiz Cláudio Martins / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T00:45:51Z (GMT). No. of bitstreams: 1 Coelho_ThaisCristina_M.pdf: 3269478 bytes, checksum: 5e326edaaa0674d80421fe3a0d0f7f0e (MD5) Previous issue date: 2013 / Resumo: A presença da hipertensão arterial sistêmica, doença arterial periférica e de outras comorbidades, podem potencializar as chamadas síndromes geriátricas, como a síndrome da fragilidade. Embora seja um fator de risco modificável para doenças cardiovasculares, o percentual de controle da pressão arterial é baixo, sendo uma das causas, a baixa adesão ao tratamento. Tendo em vista que estas condições estão relacionadas ao desenvolvimento de incapacidades, piora da qualidade de vida dos idosos e aumento dos custos para os serviços de saúde, o objetivo desse trabalho foi investigar as relações entre hipertensão arterial, risco cardiovascular e adesão ao tratamento medicamentoso anti-hipertensivo na fragilidade do idoso. Participaram do estudo 111 idosos hipertensos, usuários de um ambulatório de atenção secundária. Foram realizadas medidas da pressão arterial e do índice tornozelo-braço (ITB), índice de massa corporal, avaliação da adesão ao tratamento medicamentoso anti-hipertensivo através do Teste de Morisk-Green e dos critérios de fragilidade (perda de peso não intencional, fadiga, diminuição da força de preensão manual, lentidão de marcha e inatividade física). Idosos que apresentaram 3 ou mais critérios de fragilidade foram considerados frágeis, 1 ou 2 critérios foram considerados pré-frágeis e os que não apresentaram critério, não-frágeis. A média de idade foi de 73,4 ± 7,37 anos, sendo 85,6% dos idosos do sexo feminino. As médias da pressão arterial sistólica sentado e em pé foram de 129,96 ±20,46 mmHg e 139,37± 22,58 mmHg, respectivamente. A médias da pressão arterial diastólica sentada e em pé foram 68,12 ± 11,24 e 76,78 ± 10,91 mmHg. A média da pressão de pulso foi 61,84 ± 17,19 e do ITB foi de 1,10±0,10. A adesão ao tratamento medicamentoso foi de 56,7%. Foram considerados frágeis 13,5%, pré-frágeis 64% e não-frágeis 22,5% dos indivíduos. Houve diferença significativa entre os 3 grupos de fragilidade para as variáveis idade (p<0,001) e pressão arterial sistólica (p<0,041). Não foram encontradas diferenças significativas com relação ao índice tornozelobraço, índice de massa corporal e adesão ao tratamento medicamentoso. Maior faixa etária e maiores valores de pressão arterial sistólica foram encontrados em idosos hipertensos frágeis do que em idosos hipertensos não-frágeis. É necessário aprimorar o conhecimento sobre a relação entre doenças cardiovasculares e fragilidade para elaboração de estratégias de prevenção e controle de desfechos adversos nessa população / Abstract: Hypertension, peripheral arterial disease and other comorbidities, can potentiate the geriatric syndromes such as frailty. Although it is a modifiable risk factor for cardiovascular disease and even with evidence that antihypertensive treatment is effective, the percentage of blood pressure control is low due to poor adherence to treatment. Considering that these conditions are related to development of disabilities, decreased quality of life of older people and increased costs for health services, the objective of this study is to investigate the relationship between hypertension, cardiovascular risk and adherence to antihypertensive drug treatment in the frailty. The study included 111 hypertensive elderly users of an outpatient secondary care. There were performed blood pressure, ankle-brachial index and body mass index measurements, evaluation of adherence to antihypertensive drug treatment through the Morisk-Green test and frailty criteria (unintentional weight loss, fatigue, decreased grip strength, slowness of gait and physical inactivity). Elderly who presented three or more characteristics were considered frail, 1 or 2 characteristics were considered prefrail and none characteristics were not frail. The mean age was 73.4 ± 7.37 years, and 85.6% were women. As average systolic blood pressure sitting and standing were 129.96 ± 20.46 mmHg and 139.37 ± 22.58 mmHg, respectively. The average diastolic blood pressure sitting and standing were 68.12 ± 11.24 and 76.78 ± 10.91 mmHg. The average pulse pressure was 61.84 ± 17.19 and the ABI was 1.10 ± 0.10. Adherence to medication was 56.7%. 13.5% were considered frail, 64% pre-frail and 22.5% non-frail. There was significant differences among the 3 groups of frailty for age (p <0.001) and for systolic blood pressure (p <0.041). Significant differences were not found in the ankle brachial index, neither in body mass index nor in medication adherence. Higher age and higher systolic blood pressure were found in frail hypertensive elderly than in not frail hypertensive's elderly. It is necessary to improve the knowledge about the relationship between cardiovascular disease and frailty to develop strategies for prevention and control of adverse outcomes in this population / Mestrado / Gerontologia / Mestra em Gerontologia

A Na+K+-ATPase (NKA) é uma proteína de membrana que participa de mecanismos de transporte nos túbulos renais para a reabsorção de sódio e outros substratos. Sabe-se que a administração de ouabaína (OUA), um inibidor da NKA, induz hipertensão arterial em ratos. No entanto, o papel dos rins nesse modelo de hipertensão não está bem elucidado. Desta forma, o objetivo do presente estudo foi avaliar as possíveis alterações na função renal induzidas pelo tratamento crônico com OUA por 5 ou 20 semanas. Sendo assim, foi observado que o tratamento com OUA promoveu hipertensão de mesma magnitude nos dois grupos avaliados. Além disso, a administração de OUA induziu o aumento da ingestão de água, do fluxo urinário e da expressão protéica da isoforma 1 da NKA. Porém, não foi capaz de alterar de maneira significativa o ritmo de filtração glomerular, assim como a fração de excreção de Na+ e K+. Pode-se concluir que, o tratamento crônico com OUA induz hipertensão, porém parece que os rins não contribuem de forma importante para o processo hipertensivo neste modelo de hipertensão. / Na+K+-ATPase (NKA) is an integral membrane protein that participates in transport mechanisms along renal tubules for sodium reabsorption and other substrates. Its known that ouabain (OUA) administration, a NKA inhibitor, induces hypertension in Wistar rats. However, the role of kidneys in this model of hypertension is not elucidated. So, the aim of this study was to evaluate the possibles alterations in renal function induced by chronic treatment with OUA by 5 or 20 weeks. Chronic treatment with OUA induced hypertension in a similar magnitude in both experimental groups. Moreover, OUA administration was able to increase water intake, urinary flow, and protein expression of 1 isoform of NKA. However, OUA treatment did not alter significantly the glomerular filtration rate, likewise the fractional excretion of Na+ and K+. In summary, chronic OUA treatment induces mild hypertension independent of the period of administration, but the kidneys dont play an important role in the hypertensive process in this model of hypertension.

Les antiangiogéniques (AAD) représentent une classe relativement récente d’anticancéreux indiqués dans un nombre croissant de cancers solides avancés. Ces traitements inhibent la voie du VEGF en amont avec le bevacizumab, un anticorps monoclonal dirigé contre le VEGF et en aval avec les inhibiteurs des tyrosines kinases des récepteurs impliqués dans cette voie de signalisation (sorafenib et sunitinib). Les AAD s’accompagnent d’effets secondaires dont le plus fréquent est l’hypertension artérielle. Ma thèse a pour objectif de mieux comprendre la physiopathologie de l’hypertension artérielle iatrogène induite par les AAD, notamment en mesurant l’effet des AAD sur les grosses artères. Le deuxième objectif est de déterminer des marqueurs précoces d’efficacité et d’optimisation de ces traitements, notamment avec un suivi thérapeutique pharmacologique (STP). Pour remplir ces objectifs nous avons mis en place une étude clinique prospective, observationnelle monocentrique dans laquelle nous avons suivi l’évolution de paramètres artériels au cours du traitement AAD avec des techniques non-invasives chez des patients atteints d’un cancer. Dans un premier travail nous avons montré qu’il y avait une augmentation précoce et cliniquement significative de la pression brachiale et centrale, de la rigidité artérielle et du diamètre carotidien sous AAD et que ces modifications étaient en partie indépendantes de la pression artérielle. Nous avons également montré que la présence d’ondes de réflexion amples et d’une rigidité aortique basse de base avant l’introduction des AAD prédisaient une augmentation de pression artérielle systolique (PAS) à un stade précoce d’exposition (coefficients de régression : 0.37[0.04-0.70] et -1.27[-2.43 ; -0.11], p<0.05 respectivement) alors qu’après une exposition chronique aux AAD, seule une rigidité artérielle basse de base prédisait une augmentation de la PAS (-2.46 [-4.02 ; -0.90], p<0.01). L’atteinte des grosses artères est positivement associée à l’évolution carcinologique. En effet une augmentation précoce de la rigidité aortique et carotidienne sous AAD étaient associées à un haut risque de progression (HR : 1.24 [1.01 ; 1.51], p=0.042 et 1.34 [1.03-1.73], p=0.027 respectivement). Dans la deuxième partie, nous avons montré à l’aide d’un modèle pharmacocinétique de population, que l’atteinte artérielle observée lors de la prise d’AAD était due à un effet pharmacologique des AAD sur les grosses artères indépendamment de l’augmentation de pression induite par les AAD. L’augmentation de rigidité artérielle était proportionnelle à la concentration plasmatique d’AAD et à l’augmentation de la pression artérielle (coefficient de corrélation standardisé : 0.37 et 0.35, p<0.01, respectivement), expliquant respectivement 13% et 11% de la variance. Nous avons également montré que la progression et la mortalité liées au cancer étaient moindre chez les patients les plus exposés aux AAD (HR : 0.60 [0.38 ; 0.97], p=0.035 et HR=0.38 [0.19-0.79], P=0.01 respectivement) et enfin, nous avons pu déterminer une concentration sérique cible qui permettra aux cliniciens d’avoir un objectif à atteindre pour optimiser l’efficacité des AAD. En conclusion, nous avons pu démontrer l’existence d’une atteinte précoce des grosses artères se traduisant par une augmentation de la rigidité artérielle et un remodelage carotidien sous traitement AAD. Cette atteinte artérielle est directement liée à un effet pharmacologique des AAD de manière indépendante de l’augmentation de pression induite par ces traitements. Nous avons montré que les altérations de la paroi artérielle ainsi que le suivi thérapeutique pharmacologique prédisaient le pronostic carcinologique. Le suivi des propriétés artérielles combinée au STP des AAD pourraient optimiser les chances d’efficacité de ces traitements. / Antiangiogenic drugs (AAD) are a relatively new class of anti-cancer therapy indicated in an increasing number of advanced solid tumors. By inhibiting the VEGF pathway, upstream with an anti-VEGF monoclonal antibody, bévacizumab, and downstream with tyrosine kinase inhibitors of receptors involved in this signaling pathway (sorafenib and sunitinib), AAD induce arterial hypertension which is the most common side effect. The principal objective of my thesis is to improve the understanding of the pathophysiology of hypertension induced by AAD, by determining the effect of AAD on large arteries. The second objective is to determine early marker of efficacy and optimization of AAD, by the use of therapeutic drug monitoring. To fulfill those objectives, we set up a clinical prospective, observational, single center study in which we followed the time-course of several arterial parameters after AAD by the use of non-invasive techniques in patients with metastatic solid tumors. In a first work we showed that brachial and central blood pressure, arterial stiffness and carotid diameter significantly increased after AAD, partly independently of blood pressure changes. We also showed that high reflection waves and low aortic stiffness at baseline (i.e. before AAD initiation) predicted early systolic blood pressure (SBP) increase (regression coefficients: 0.37[0.04; 0.70] and -1.27[-2.43; -0.11], P<0.05 respectively) while only low aortic stiffness predicted SBP increase after chronic AAD exposure (-2.46 [-4.02 ; -0.90], P<0.01). Large arteries damage under AAD is positively associated with cancer progression. Indeed, early increase of aortic and carotid stiffness after AAD were associated with a higher risk of cancer progression (HR: 1.24 [1.01; 1.51], P=0.042 and 1.34 [1.03; 1.73], P=0.027 respectively). In a second part, using a pharmacokinetic model of population, we showed that large arteries damage observed after AAD was partly due to a pharmacological effect of AAD on large arteries independently of blood pressure increase. Arterial stiffness increase was proportional to AAD blood concentration and blood pressure increase (standardized correlation coefficients: 0.37 and 0.35, P<0.01, respectively), explaining 13% and 11% of the variance respectively. We also showed that progression and mortality related to cancer were lower in patients high AAD blood concentrations (HR: 0.60 [0.38; 0.97], P=0.035 and HR=0.38 [0.19; 0.79], P=0.01 respectively). And finally, we determined a target AAD blood concentration which will allow the clinicians to have an objective to reach in order to optimize the efficacy of AAD. In conclusion, we were able to demonstrate the existence of large arteries damage translated by large arteries stiffening and a remodeling of carotid artery after AAD. This arterial damage is directly related to a pharmacological effect of AAD independently of blood pressure changes induced by these treatments. We showed that infringement of the arterial wall and the therapeutic drug monitoring predicted tumor prognosis. Thus, the monitoring of arterial properties monitoring and the therapeutic drug monitoring might optimize the chances of efficiency of AAD.

Background. This dissertation focuses on two major epidemics, Waterpipe (WP) and Cigarette tobacco smoking, as two considerable global public health issues. It consists of three papers that were published in international peer review journals. We aimed at evaluating the acute and chronic effects of WP and cigarette smoking on the cardiovascular and respiratory systems, as well as evaluating the patient's acceptability of shocking pictorial versus actual textual warnings on tobacco packages as an effective control intervention towards smoking cessation".Methods. In the first part of the study, patients were recruited from restaurants in Beirut and Mount Lebanon in order to evaluate the acute (after 45 minutes of waterpipe smoking or immediately following one cigarette smoking) and chronic (before the smoking session) effects on the Forced Expiratory Volume at 1 second (FEV1), Forced Expiratory Volume at 6 seconds (FEV6), FEV1/FEV6, Diastolic Blood Pressure (DBP), Systolic Blood Pressure (SBP) and heart rate (HR). The second part of the study recruited patients from 5 outpatient clinics located in 5 hospitals in Lebanon. The purpose was to evaluate the acceptability of shocking pictorial health warnings versus the actual textual warnings on packages as an effective tobacco control intervention by evaluating their impact on smoking behaviors and motivation.Results. Mean values of FEV1, FEV6, FEV1/FEV6, DBP, SBP in the acute effect of smoking WP and cigarette smokers were very close. There was a trend to significant acute variation between the three groups for DBP (p=0.05) and a significant variation for HR (p˂0.001): DBP increased in WP smokers while it decreased in cigarette smokers. However, the HR increased in both WP and cigarette smokers after the smoking session, but much more with WP. The pulmonary functions (FEV1, FEV6 and FEV1/FEV6) and the cardiovascular values (DBP, SBP and HR) were significantly associated with the following factors: duration of smoking, age at first WP and quantity of smoking. Among the 127 WP smokers, a higher effect of the shocking pictorial warnings was observed in the highly motivated group versus the lower motivated group (OR=4.47, p=0.001); indeed, a higher switching in their favorite tobacco brand was observed in the highly motivated group versus the lower group (OR=2.76, p=0.008). In addition, smokers who had chronic cough were highly motivated to quit waterpipe smoking compared to smokers without chronic cough (OR=7.24, p=0.03).Higher motivation to quit cigarette smoking was seen among male smokers versus females (OR=1.8, p=0.02), among smokers who had stopped smoking for at least 1 month during the last year due the textual warning (OR=2.79, P˂0.001), among smokers who considered very important to report health warning on cigarette packs (OR=1.92, p=0.01), among smokers who had chronic expectorations (OR=1.81, P=0.06) and among smokers who would change their favorite cigarette pack if they put shocking images on the pack (OR=1.95, p=0.004).Conclusions. WP smokers seem as affected as cigarette smokers for the pulmonary values and that acute effect of WP immediately measured after the smoking session increases DBP and SBP; however, acute effect of cigarette decreases DBP and SBP, while both cigarette and WP smoking increase HR. The reduction of most Pulmonary Function Test (PFT) values could be due to the long duration of smoking, younger age of smoking the first WP and quantity of smoking. It differs between cigarette and WP, and between chronic and acute effect of smoking. Moreover, pictorial graphic warnings are more influencing on the behavior of waterpipe smokers than textual warning. On the other hand, low dependent and highly motivated to quit cigarette smokers appeared to be more hypothetically susceptible to shocking pictorial warnings. Motivation to quit cigarette smoking was affected by sensitivity to warnings, but not to the presence of all chronic respiratory symptoms. Thus, our study provides further reasons to the policymakers in Lebanon to incorporate more tobacco labeling policies in order to help in reducing the widespread of waterpipe and cigarette tobacco smoking and in increasing the awareness concerning the health symptoms effect of smoking. / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

Une consommation élevée de sodium et une faible consommation de potassium sont associées à la survenue de l'HTA et des MCV. Limiter la consommation de sel et encourager celle de « plus de fruits et légumes » sont des mesures efficaces pour réduire l’incidence de ces maladies. Ces interventions nécessitent des données épidémiologiques fiables. Elles doivent aussi tenir compte de la disponibilité adéquate de l’iode dans le sel pour assurer un statut optimal en iode aux populations. Il n’existe pas de données représentatives sur le niveau de consommation en sodium, potassium et iode en population adulte au Bénin. Nos travaux ont estimé à partir de prélèvements urinaires les niveaux d’apports de ces éléments et la teneur en iode des sels alimentaires en utilisant les méthodes de références. Les résultats ont montré un apport excessif en sodium, faible en potassium, une légère déficience en iode et une iodation inadéquate de la production locale de sel. Les déterminants de ces différents apports ont été identifiés. Nous avons par ailleurs validé l’usage du spot urinaire pour le dosage du sodium et du potassium dans les études épidémiologiques et du spectrophotomètre (WYD Iodine Checker) pour le dosage de la teneur en iode du sel. L’ensemble des résultats plaident en faveur de la mise en œuvre urgente de politiques de réduction du sel et de promotion de fruits et légumes, et d’un renforcement du programme de lutte contre les TDCI au Bénin. / High sodium and low potassium consumptions are associated with increased blood pressure and cardiovascular diseases. Limiting salt and encouraging more fruits and vegetables are important interventions to reduce these diseases. These interventions need reliable epidemiological data. Interventions should also take into account the availability of adequate iodine in salt to ensure an optimal iodine status for populations. There is no representative data on sodium and potassium intakes and iodine status in Beninese adults. Our studies estimated, using urine samples, the levels of sodium, potassium and iodine intakes, and iodine content in food salts whith reference methods. Results showed an excessive intake of sodium, low potassium, a mild iodine deficiency and inadequate iodination of local salt production. Factors associated with these intakes have been identified. Results also validated the use of spot urine to assay sodium and potassium in epidemiological studies and spectrophotometer (WYD iodine checker) for iodine content in salt. All the results argue for implementation of salt reduction policies and promotion of fruits and vegetables, and a strengthening of the Beninese program against IDD.

Veterinary medicine is benefitted by technological advances in diagnostic area by the spreading of scientific knowlagement. In order that new technologies may be used, information about normal standards for each type of examination is necessary, so that they may be used routinely and adequately prescribed for each patient. The Doppler ultrasound is beginning to be used in veterinary medicine for diverse purposes. The objectives of this study were to verify the Doppler ultrasound flow of the external ophthalmic artery in mixed breed cats anesthetized with tiletamine and zolazepam, and to correlate the average mean arterial pressure (MAP) surveyed by direct method in the same animals. There were used 20 mixed breed cats, both male and female, with body mass between 2 and 4 kilograms, proceeding from the Sociedade de Auxílio aos Animais de Umuarama - PR (SAAU). The animals received intra-muscular anesthesia with tiletamine and zolazepam (6,0 mg/kg). The femoral artery was assepticale cannulated and a manometer connected to an air column was connected to the catheter. The MAP was surveyed before and every 15 minutes until the end of the ultrasound examination. The flow of the external ophthalmic artery was measured through the ultrasond equipment Toshiba Powervision ATLHDI 3500, with an echo-doppler and a sectorial transducer of 6.0 MHz, directly applied to the cornea. Each eye had the artery flow surveyed by the equipment s own device, 3 samples being taken. The vascular resistance index was calculated based on the mean values of systolic and diastolic flow of each vasses. The values were tabulated and Student t test was applied to verify differences between the averages. Test of logistic regression was applied to the values of the MAP and the means of the artery flow to verify the correlation between the surveyed values. An average value for the MAP of 144.9 ± 26.68 mmHg and a flow of 14.28 ± 41.3 cm/sec for the external ophthalmic artery in the right eye in systole, 23.95 ± 11.46 cm/sec in diastole and 42.75 ± 12.64 cm/sec in the left eye in systole, 25.45 ± 9.61 cm/sec in diastole, were verified, there being no significant difference between the eyes. Correlation was not evidenced between the values of the MAP and the blood flow in the ophthalmic artery in both the eyes. The calculated index of vascular resistance was of 0.4175 ± 0.0774 for the external ophthalmic artery in the right eye and 0,4015 ± 0.0719 for the left eye, without any significant difference between the eyes. The results point to an intrinsic mechanism of flow control, controlled by local factors in the external ophthalmic artery. The values of the resistance index denote a low flow artery. Concluding, this study revealed the reference values, above cited, for the MAP and the blood flow in the external ophthalmic artery in mixed breed cats, anesthetized with tiletamine and zolazepam, and the information that there is no correlation between these values. / A medicina veterinária vem se beneficiando dos avanços tecnológicos dos meios diagnósticos em medicina, e da facilitação da divulgação da ciência. Para que novas tecnologias sejam utilizadas são necessárias informações acerca dos padrões normais para cada tipo de exame, para que se possa utilizá-lo na rotina e destiná-lo adequadamente para cada paciente. A fluxometria ultra-sonográfica está começando a ser utilizada em medicina veterinária com propósitos e fins diversos. Para destiná-la a um fim específico, o presente trabalho teve por objetivos verificar a fluxometria ultra-sonográfica da artéria oftálmica externa em gatos sem raça definida e anestesiados com tiletamina e zolazepam, e correlacioná-la à pressão arterial média aferida por método direto. Para tanto foram utilizados 20 gatos sem raça definida, entre machos e fêmeas, com massa corpórea entre 2 e 4 quilogramas, hígidos, provenientes da Sociedade de Amparo aos Animais de Umuarama - PR (SAAU). Os animais receberam anestesia intramuscular com tiletamina e zolazepam na dose de 6,0 mg/kg. A artéria femoral foi canulada de forma asséptica e um manômetro acoplado a uma coluna de ar foi conectada ao cateter, a PAM foi aferida antes e a cada 15 minutos até o término do exame ultra-sonográfico. A fluxometria da artéria oftálmica externa foi obtida através do equipamento de ultra-sonografia Toshiba Powervision ATL-HDI 3500, dotado de eco-doppler, com transdutor setorial de 6,0 MHz, aplicado diretamente sobre a córnea. Cada olho teve o fluxo de sua artéria aferido pelo programa do próprio aparelho, sendo tomadas 3 amostras. O índice de resistência vascular foi calculado com base nos valores do fluxo sistólico e diastólico médio de cada vaso. Os valores foram tabulados e teste t de Student foi aplicado para verificação de diferenças entre as médias. Teste de regressão logística foi aplicado aos valores da PAM e aos do fluxo em cada artéria, para verificar a existência de correlação entre os valores aferidos. Obteve-se um valor médio para a PAM de 144,9 ± 26,68 mmHg e uma velocidade de fluxo de 41,3 ± 14,28 cm/seg para a artéria oftálmica externa no olho direito em sístole, 23,95 ± 11,46 cm/seg em diástole e 42,75 ± 12,64 cm/seg no olho esquerdo em sístole, 25,45 ± 9,61 cm/seg em diástole, não existindo diferença significativa entre os olhos. Não foi constatada correlação entre os valores da PAM e o fluxo sangüíneo na artéria oftálmica em nenhum dos olhos. O índice de resistência vascular calculado foi de 0,4175 para a artéria oftálmica externa no olho direito e 0,4015 para a do olho esquerdo, sem diferença significativa entre os olhos. Os resultados apontam para um mecanismo intrínseco de controle do fluxo, controlado por fatores locais na artéria oftálmica externa. Os valores do índice de resistência denotam uma artéria de baixo fluxo. Como conclusão têm-se os valores de referência acima citados para a PAM e para o fluxo sangüíneo na artéria oftálmica externa em gatos sem raça definida anestesiados com tiletamina e zolazepam, e a informação de que não existe correlação entre esses valores.

Inledning: Livsstilssjukdomar är idag den största orsaken till dödsfall i världen. De påverkas av livsstilen med avsaknad av fysisk aktivitet och förhöjt energiintag, vilket leder till övervikt, fetma och högt blodtryck. Syfte: Syftet med litteraturöversikten var att beskriva hur vanliga riskfaktorer för livsstilssjukdomar påverkas av interventioner med fysisk yoga. Metod: En litteraturöversikt med 12 artiklar som valdes ut utifrån att de inkluderade en intervention med fysisk yoga för att studera effekten på de vanligaste riskfaktorerna för livsstilssjukdomar på vuxna. Resultat: Valda artiklar visade till övervägande del på att yoga som intervention kan vara effektivt för att minska riskfaktorer för livsstilssjukdomar genom att sänka blodtrycket och leda till viktminskning, men samtidigt visar några artiklar inga effekter. Yoga är holistiskt och flera studier innehåller kostrådgivning och stresshantering, vilket kan påverka effekten. Diskussion: Samlade slutsatser om effekten av fysisk yoga kan inte dras utifrån artiklarna. Studierna har haft flera faktorer som påverkat resultatet såsom andningsövningar, kostrådgivning och stresshantering. Fortsatt forskning bör fokusera på att genomföra studier där yoga-gruppen jämförs med en aktiv kontrollgrupp som utför annan fysisk aktivitet eller får kostrådgivning. Det skulle möjliggöra en bättre analys av den fysiska yogans effekter på riskfaktorer för livsstilssjukdomar. / Introduction: Noncommunicable diseases are one of the main causes of death in the world today. They are affected by a lifestyle with lack of physical activity and increased energy intake which leads to overweight and high blood pressure. Objective: The objective of this literature review was to describe how common risk factors for lifestyle diseases are effected by physical yoga, yoga asana, interventions. Methods: A literature review with 12 reviewed articles, where the studies included an intervention withyoga asana, to study the effects on risk factors for lifestyle diseases on adults. Results: A majority of the selected articles showed that yoga can be effective in reducing risk factors, lowering blood pressure and weight, but some studies showed no effect of the intervention. All studies included other factors that might have affected the outcome, such as dietary advice. Discussion: Clear conclusions of the effect of yoga asana practice cannot be based on these articles. Continued research should focus on conducting studies in which the yoga group is compared with an active control group. That would enable an analysis of the effects of yoga asana in relation to interventions with healthy diet or regular exercise.

Whereas the effects of a long-term activity of head-down tilt (HDT) in the angle between 3ř and 12ř were examined in details in cosmic medicine as the model of a state of weightlessness, literature concerning effect of HDT on cardiovascular control in the angle over 30ř is scarce. The aim of the thesis is to examine acute reaction of systolic, diastolic, mean arterial blood pressure and heart rate during three minutes of 30ř, 50ř and 70ř HDT, realized on a tilt (inversion) table with fixed legs. For the combination of HDT and head-up tilt (HUT), the following protocol was chosen: 5 minutes lying in a horizontal position (HOR), 3 minutes of 70ř HUT, 3 minutes of 30ř HDT, 3 minutes of HOR, 3 minutes of 50ř HDT, 3 minutes HOR, 3 minutes of 70ř HDT, 3 minutes HOR and 3 minutes of 70ř HUT. A non-invasive continuous Peňáz method, using Finapres Ohmeda, was used to monitor beat-by-beat blood pressure and heart rate. Blood pressure was also measured by sphygmomanometer each minute for calibration. In the angle of 30ř HDT, there was a significant decline of heart frequency (p < 0,01). During the 50ř HDT, there was a significant rise of systolic blood pressure in the third minute, of diastolic and mean arterial pressure each minute and the heart rate dropped significantly (all p < 0.05). In the 70ř HDT,...

M.A. (Psychology) / Please refer to full text to view abstract