Awareness of psychosocial intervention care among healthcare professionals Abstract Aims, research questions and hypotheses: The aim of the research is to evaluate the awareness of healthcare professionals about psychosocial intervention care. Goal 1: Identify the real situation in psychosocial intervention care. Goal 2: Identify the possibilities of offering and using psychosocial intervention care in healthcare facilities. Methods and research file: Quantitative and qualitative data collection techniques were used. A quantitative survey was conducted using questionnaires distributed to healthcare professionals in selected organizations (Liberec and Jičín Regional Hospital and University Hospital Hradec Králové). The size of the research group is 170 respondents. A qualitative part was realized with semi-structured interviews with peers in the same organizations. In total, we reached five peers. Results and conclusions: The research shows that health professionals perceive their work as mentally and physically demanding. The difficulty of the healthcare profession is perceived through all age categories, across disciplines and regardless of the length of practice. Half of the respondents considered a change of a job due to mental and/or physical demands. More than half of health care professionals are aware of psychosocial intervention care system. The survey further shows that healthcare professionals find themselves in extreme mental stress that would potentially require psychosocial intervention care. Only a low percentage of healthcare professionals will use this service. A qualitative survey shows that healthcare professionals are afraid of loss of anonymity when using psychosocial intervention care. This is related to mistrust in peers. From a peer point of view, it is important to be more aware of this service, helping healthcare professionals in their psychologically demanding occupation, which will increase their use and efficiency. The output of this thesis will be a proposal to include topics on psychosocial intervention care in regular training for employees.

Syftet med denna studie var att undersöka om samtidiga höga krav och låg kontroll vid användning av informations- och kommunikationsteknik (IKT) är associerat med en upplevelse av mental stress hos individer som arbetar i kontorsmiljö. Metoden som användes var en kvantitativ tvärsnittsstudie med ett deskriptivt förhållningssätt och undersökte 40 yrkesverksamma individer som mestadels arbetade stillasittande på kontor där arbetet innebär att de dagligen använde sig av IKT-verktyg. Resultaten bearbetades i statistikprogrammet SPSS med hjälp av en deskriptiv beskrivande statistik. Resultatet från studien visade att respondenter upplever mer stress vid samtidiga höga krav och låg kontroll vid användning av IKT än respondenter som inte upplever höga krav och låg kontroll när de använder IKT.   Slutsats: Om resultat som framkommit i denna studie kan styrkas i framtida liknade studier bör insatser syfta till att öka anställdas känsla av delaktighet och möjlighet till att styra över användningen samt inlärning av IKT-verktyg. Vidare forskning för att undersöka hur socialt stöd på arbetsplatsen påverkar upplevelsen av krav och kontroll kopplat till stress vid användning av IKT skulle vara av intresse.

INTRODUÇÃO: Frente às evidências de que a depressão associa-se a eventos cardíacos, morte súbita, desenvolvimento de coronariopatia, e maior mortalidade por causas cardiovasculares, torna-se muito importante estudar as possíveis causas das alterações cardiovasculares na depressão. Alterações de sistema nervoso autonômico (SNA) vêm sendo descritas em pacientes deprimidos. Os estudos sobre funcionamento do SNA têm utilizado a dosagem de catecolaminas séricas e urinárias e análise de VFC, que são avaliações indiretas do funcionamento do SNA. Avaliações diretas, como a microneurografia, aparentemente ainda não foram utilizadas no estudo do funcionamento do SNA em pacientes com depressão maior. MÉTODOS: Neste estudo o comportamento do sistema nervoso simpático em indivíduos deprimidos, em período basal e após teste de estresse mental, foi comparado com controles. Realizaram as avaliações: 19 pacientes com depressão maior e 15 controles, com 18 a 45 anos de idade. Indivíduos que apresentassem condições médicas e/ou uso de medicamentos que pudessem interferir com o comportamento do sistema nervoso autonômico não foram incluídos. A avaliação psiquiátrica incluiu a administração da Escala de avaliação para depressão de Montgomery e Asberg (MADRS) e Entrevista Clínica Estruturada para o DSM-IV - Transtornos do Eixo I - Versão 2.0 (SCID-I /P). Atividade nervosa simpática muscular (ANMS) foi medida pela microneurografia. Fluxo sangüíneo muscular (FSM) no antebraço foi medido pela técnica de peltismografia de oclusão venosa. A pressão arterial (PA) foi monitorizada de forma não invasiva por um manguito inflado automaticamente, e a freqüência cardíaca (FC) foi medida por eletrocardiograma. O registro basal foi realizado por 3 minutos, seguido de teste de cores, que foi realizado por 4 minutos. RESULTADOS: Os grupos de pacientes deprimidos e controles não diferiram significativamente em relação a idade, peso e índice de massa corpórea. Os grupos de pacientes deprimidos e controles não apresentaram diferenças significativas nos valores de ANSM, PA sistólica, PA diastólica, PA média, FC, FSM e condutância vascular no antebraço no período basal. Não houve diferença significativa na reatividade ao estresse mental entre os grupos. Houve correlação positiva e significativa (0,84; p=0,0001) entre os valores de MADRS e de ANSM média no período basal dos pacientes com depressão. Houve correlação positiva e significativa (0,70; p=0,01) entre os valores do item tensão da MADRS e de ANSM média no período basal dos pacientes com depressão. CONCLUSÕES: Não foram encontradas diferenças nas medidas basais de atividade simpática entre indivíduos deprimidos e controles. Também não foram encontradas diferenças na reatividade cardiovascular a teste de estresse mental entre os grupos. Houve uma correlação positiva e significativa entre sintomas depressivos e atividade nervosa simpática muscular (ANSM), medida por microneurografia. Houve também uma correlação positiva e significativa entre sintomas ansiosos e ANSM. / INTRODUCTION: It is well established that depression is associated with cardiac events, sudden death, higher cardiovascular mortality and higher incidence of coronary artery disease (CAD). A number of biological mechanisms linking depression and CAD have been identified, including dysregulation of autonomic nervous system (ANS). Studies with heart rate variability and catecholamines measures have been perfomed in depressed patients. Microneurography is a direct and efficient method to measure sympathetic nerve traffic in humans. To our knowledge, there is no previous study with microneurography in depressed patients. METHODS: ANS functioning, during rest and mental stress, in depressed patients was compared to controls. Nineteen depressed patients and 15 controls (18 to 45 years old) were involved in the study. Subjects with medical conditions and/or use of medications that could interfere on ANS were not included. Psychiatric evaluation included the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P, Version 2.0) and the Montgomery and Asberg Depression Rating Scale (MADRS). Muscle sympathetic nervous activity (MSNA) was directly measured from the peroneal nerve using microneurography. Forearm blood flow (FBF) was measured by venous occlusion pletysmography. Blood pressure (BP) was monitored noninvasively by an automatic BP cuff, and heart rate (HR) was measured by electrocardiogram. Baseline register was performed by 3 minutes and Stroop color word test was performed for 4 minutes. RESULTS: There was no difference in age, weight and body mass index between the two groups studied. No significant difference was found between groups in regard to systolic BP (SBP), diastolic BP (DBP), mean BP (MBP), HR, MSNA, FBF and forearm vascular conductance at baseline. All parameters significantly increased during mental stress in the two groups. The reactivity to mental stress showed no difference between groups. There was a significant positive correlation between MADRS total scores and mean baseline MSNA (0,84; p=0,0001) among depressed patients. There was also a significant positive correlation between MADRS tension scores and mean baseline MSNA (0,70; p=0,01) among depressed patients. CONCLUSIONS: There were no differences in baseline measures of sympathetic activity between depressed patients and controls. The reactivity to mental stress between the groups did not differ as well. There was a positive significant correlation between depressive symptoms and mean baseline MSNA. There was a positive significant correlation between anxiety symptoms and mean baseline MSNA.

Title: Diabetes mellitus in Equistrian Sport in Czech Republic Objectives: The aim of the literature review part of the thesis was to give an introduction to the issue of diabetes mellitus as well as the effect of sport on the decompensation of the disease, to search for available sources on a narrowly focused topic - the impact of horse riding on diabetes mellitus, and to process the findings in a clear form into the first (literature review) part of the work. The goal of the second (research) part was to map, with the use of questionnaires and interviews, the situation of diabetes patients in the Czech Republic who do equestrian sport actively. In the case study their subjective feelings were reviewed. The main aim was to prove the positive impact of horse riding on diabetes mellitus, or more precisely to find out if it is stress or physical exertion that has a greater effect on the blood glucose (BG) level. Furthermore, the thesis focuses on the issue of public awareness of disease management as well as first aid. Methods: The first part of the thesis was carried out in the form of a literature review, for which research articles and other literature sources were found primarily on electronic information portals (mainly Web of Science, etc.) For the second (research) part a questionnaire (on the...

This study tested the hypothesis that coronary artery disease (CAD) patients with high depressed mood scores differ in sympatho-vagal balance during mental stress compared to patients with low depressed mood scores. Using electrocardiographic monitoring, heart variability data from spectral analysis and hemodynamic parameters were obtained prior to and during mental stress from 34 men and 7 women. A public speaking task was used as the mental stressor. Patients were grouped by a median split of their Minnesota Multiphasic Personality Inventory-Depression score. During mental stress, patients with higher depression scores had greater changes in peak heart rate (p < .05) and low frequency to high frequency power ratio (p < 0.05) than patients with lower scores suggesting a shift toward more sympathetic activity during mental stress. These findings may be related to the reported relation between depression and survival risk in patients with CAD.

Wird Arbeit heute als anstrengend und belastend bezeichnet, so sind damit weniger körperlich schwere Arbeiten, sondern zunehmend psychische Anforderungen gemeint, die den Einzelnen fordern bzw. überfordern. Seit 2013 besteht laut Arbeitsschutzgesetz die gesetzliche Pflicht des Arbeitgebers, psychische Belastungen am Arbeitsplatz für Beschäftigte im Rahmen einer Gefährdungsbeurteilung zu erfassen. Auch am Arbeitsplatz von Musikschullehrkräften treffen eine Vielzahl psychischer Belastungen zu, die zu einem erhöhten Gesundheitsrisiko führen. Allein die Definition desselben stellt schon die erste Herausforderung dar, denn in der Regel gibt es mehrere. Mangelnde Wertschätzung durch Gesellschaft, Politik, Vorgesetzte, durch Schüler und Eltern, mangelnde Sichtbarkeit in der Öffentlichkeit, mangelnde Anerkennung des Berufsstandes belasten einen Großteil stark. Hinzu kommt die mangelhafte finanzielle Ausstattung von Musikschulen. Personalmangel im pädagogischen Bereich, in der Verwaltung und im technischen Bereich, eine unzufriedenstellende Vergütungssituation für Angestellte, prekäre Beschäftigungsverhältnisse für freie Mitarbeiter und eine mangelhafte Ausstattung mit benötigten Arbeitsmitteln sind das Ergebnis. Arbeitsplatzalternativen sind kaum vorhanden, Entwicklungsmöglichkeiten rar. Viele finden letztere eher außerhalb der Musikschule. Eine wesentliche Eigenschaft von Musikschularbeit besteht darin, dass die Verteilung der Arbeitszeit extremen Schwankungen unterliegt und besonders in Stoßzeiten die zur Verfügung stehende Regenerationszeit nicht ausreicht. Überdies wird nur ein Teil der Arbeitszeit, i.d.R. die Unterrichtstätigkeit erfasst, jedoch nicht oder nur teilweise Tätigkeiten, die damit im Zusammenhang stehen. Die Grenzen zwischen Arbeits- und Freizeit verschwimmen zunehmend. Die Lage der Arbeitszeit erschwert eine Vereinbarkeit von Familien- und Berufsleben überdies. Zunehmende Digitalisierung im Musikschulbereich führen zu Arbeitsverdichtung, Beschleunigung, hohem Erwartungs- und Flexibilitätsdruck, Aktualitätszwang sowie einer beständig wachsenden Fülle an zu verarbeitenden Informationen. Zusätzlich findet eine weitere Entgrenzung der Arbeitszeit statt. Aufgrund schwieriger Rahmenbedingungen wird die Tätigkeit in Kooperationen mit Schulen und Kindertagesstätten als besonders belastend erlebt, zumal eine Ausweitung in Anbetracht des gesetzliches Anspruchs auf Ganztagesbetreuung ab 2026 zu erwarten ist. An keiner der Musikschulen, an der die Befragten arbeiten, wurde eine Gefährdungsbeurteilung zur psychischen Belastung erstellt. Unterweisungen dazu fanden ebenfalls nicht statt. In 23 leitfadenbasierten Experteninterviews habe ich zum einen die jeweiligen psychischen Belastungen in den verschiedenen Merkmalsbereichen nach GDA-Checkliste“ sowie zusätzliche Belastungen ermittelt, die bisher noch keine Berücksichtigung finden. Zum anderen wurde erforscht, wie Fragestellungen formuliert sein müssen, um das Tätigkeitsfeld von Musikschullehrkräften umfassend abzubilden und vom Großteil der Zielgruppe beantwortet werden zu können. Die Auswertung der Interviews erfolgte nach der Methode der qualitativen Inhaltsanalyse von Experteninterviews nach Gläser und Laudel. Im Ergebnis meiner Vorstudie habe ich Fragebogenitems für die einzelnen Merkmalsbereiche konstruiert, die in jeweils adaptierter Form für Musikschulen bei der Erstellung einer passgenauen Gefährdungsbeurteilung hilfreich sein können. Die Aufgabe der einzelnen Institutionen besteht nun darin, im Anschluss Maßnahmen gezielter betrieblicher Gesundheitsförderung abzuleiten und dabei besonders interne und externe Ressourcen in den Blick zu nehmen.

In der vorliegenden Arbeit erfolgte ein Vergleich einer Patientengruppe im Hinblick auf ihre Zahnbehandlungsangst und weiterer psychischer Parameter. In einer Vielzahl von Studien wurden bereits Patienten in Zahnarztpraxen / Zahnkliniken zu ihrem psychischen Befinden in der Situation der Zahnbehandlung befragt. Eine Studie im zahnärztlichen Setting setzt allerdings voraus, dass das Angstniveau dieser Personen es zulässt, sich einer Zahnbehandlung zu unterziehen. Insgesamt haben 102 Patienten aus dem Vogtland an der Studie zur Zahnbehandlungsangst teilgenommen, die die gleichen Fragebögen zur Beurteilung ihrer psychischen Situation ausfüllten. Im deutschsprachigen Raum befanden sich beide Praxen im Vogltlandkreis. Die Zahnbehandlungsangst wurde mit der Dental Anxiety Scale (DAS) gemessen sowie mit zwei Items zur Angst vor der Behandlung mittels der Amsterdam Properative Anxiety Scale (APAIS). Die beiden Instrumente korrelierten signifikant stark miteinander (Spearman: r = 0,67, p = 0,000). Das Durchschnittsalter aller Teilnehmer betrug 40,3 (SD 15,74) Jahre. Auffällig war, dass mit einem Wert von 58,8 % mehr weibliche Personen als männliche Patienten an der Studie teilgenommen haben. Das Bildungsniveau der Patientengruppe befand sich unter den deutschen Durchschnitt (Statistisches Bundesamt). Darüber hinaus bestand bei den Probanden kein signifikant schlechter Gesundheitszustand, welcher in Beziehung zu höherem Alter, dem Geschlecht oder dem Bildungsniveau gesetzt werden könnte. Darüber hinaus wiesen die Probanden anhand des GSI (BSI-18) eine allgemeine, signifikant höhere psychische Belastung auf. Auffällig war, dass die mittleren Werte in den Subskalen Depressivität, Somatisierung und Ängstlichkeit signifikant höher waren. Im Vergleich aller Skalen nach niedriger und hoher Ängstlichkeit lag der mittlere Wert der gesamten Gruppe von GSI bei 8,17 (SD 8,08) mit einer hohen Signifikanz von p = 0,003, einer Somatisierung mit 2,08 (SD 2,82) p = 0,030, einer Depressivität von 1,64 (2,30) p = 0,010 sowie Ängstlichkeit von 4,45 (3,97) p = 0,001. Der mittlere Wert der DAS lag bei 21,78 (SD 2,66). Die Mittelwerte der APAIS (Angst vor der Behandlung) befanden sich bei 6,43 (SD 2,14). Die Patientengruppen unterschieden sich somit weder im Allgemeinen (BSI-18) noch im Speziellen auf das die Zahnbehandlung bezogene Angstniveau (DAS, APAIS) signifikant voneinander. Dennoch bestanden Unterschiede in den mittleren Werten für die mundgesundheits-bezogene Lebensqualität (OHIP) der Probanden, da sich diese signifikant voneinander unterschieden. Auch in Hinblick auf Einschränkungen der mundgesundheitsbezogenen Lebensqualität (OHIP) war in der Gruppe der hoch Ängstlichen ein starker Zusammenhang zum Angstniveau wahrnehmbar. Hinsichtlich des zahnmedizinischen Vorsorgeverhaltens hatten die Patienten auch einen signifikant schlechteren Vorsorgeindex vorzuweisen. Es ließ sich zudem feststellen, dass bei den meisten Patienten seit dem letzten Zahnarztbesuch signifikant mehr Zeit vergangen war. Patienten, die anhand der DAS Kategorisierung ein erhöhtes Angstniveau aufwiesen, ließen sich demnach auch seltener Zahnstein entfernen und eine professionelle Zahnreinigung durchführen. In der Zahnarztpraxis gaben Patienten mit einem erhöhten DAS-Angstniveau hingegen an, seltener zum Zahnarzt zu gehen als Patienten mit niedrigerer Angstausprägung. Das Angstniveau (DAS) der Patienten war schließlich auch im hohen Maß von der Art des Zahnarztbesuches abhängig. Je invasiver die Behandlung, desto mehr Angst hatten die Patienten vor dem Zahnarztbesuch. Auch die allgemeine psychische Belastung (BSI-18) war bei Patienten, die sich für eine Prophylaxebehandlung in der Zahnarztpraxis befanden, signifikant geringer. Die These, dass Personen, nachdem sie über das zahnmedizinische Setting befragt wurden, ein höheres Angstniveau aufzuweisen haben und auch den Zahnarztbesuch unter Umständen meiden, konnte in der vorliegenden Studie bestätigt werden. Deshalb ist es wichtig, dass sich Zahnärzte/Zahnärztinnen für das Thema „Zahnbehandlungsangst“ sensibilisieren, um Patienten mit erhöhtem Angstniveau entsprechend begegnen zu können.:1 Einleitung 1.1 Allgemeine Definitionen und Ausführungen zum Thema Angst 1.2 Zahnbehandlungsangst und Angststörungen 1.3 Zahnbehandlungsangst und andere psychische Störungen 1.4 Zahnbehandlungsangst, Mundgesundheit und somatische Störungen 1.5 Prävalenz 1.6 Ätiologie 1.7 Diagnostik 1.7.1 ICD-10 Kriterien der spezifischen Phobie (F40.2) 1.8 Zahnärztliche Screeninginstrumente zur Erhebung von Zahnbehandlungsangst 1.8.1 Screeninginstrumente (Fragebögen) 1.9 Statement 1.10 Therapie 1.11 Rückfallprophylaxe 2 Fragestellungen 3 Material und Methoden 3.1 Studiendesign 3.1.1Fragebogen 3.2 Beschreibung der Instrumente 3.2.1 Patientendokumentationsbogen 3.2.2 Gesundheitszustand 3.2.3 DAS - Dental Anxiety Scale nach Corah (1969) 3.2.4 Dental Fear Survey (DFS) 3.2.5 Amsterdam Preoperative Anxiety and Information Scale (APAIS) 3.2.6 BSI-18 (Brief Symptom Inventory 18) 3.2.7 The Oral Health Impact Profile (OHIP-5) 3.2.8 Mundgesundheit 3.2.9 L-1 – Kurzskala Lebenszufriedenheit – 1 3.2.10Skala Optimismus- Pessimismus-2 (SOP-2) 3.2.11OSS-3 – Oslo-3-Items Social Support Scale 3.3 Durchführung 3.4 Statistische Auswertung 4 Ergebnisse 4.1 Beschreibung des Patientenkollektivs 4.1.1 Soziodemografie 4.1.2 Zahnbehandlungsangst des Patientenkollektivs 4.1.3 Psychisches Befinden des Patientenkollektivs 4.2 Vorsorgeverhalten und Stellung der Mundgesundheit 4.2.1 Zusammenhang zwischen Zahnbehandlungsangst und anderen verwendeten Instrumenten 5 Diskussion 5.1 Patientenkollektiv 5.1.1 Soziodemographie der Gesamtgruppe 5.2 Soziodemographie - Vergleich der beiden Patientengruppen 5.2.1 Psychisches Befinden – Geschlechts-, Alters- und Bildungsspezifische Unterschiede 5.2.2 Vorsorgeverhalten und Einstellung zur Mundgesundheit – Vergleich der beiden Patientengruppen 5.2.3 Zahnbehandlungsangst im Zusammenhang mit anderen verwendeten Instrumenten 5.3 Kritische Betrachtung 5.4 Ausblick 5.4.1 Implikationen für die Forschung 5.4.2 Implikationen für die Praxis 6 Zusammenfassung Summary Literaturverzeichnis I Tabellenverzeichnis XVII Abbildungsverzeichnis XIX Abkürzungen XX Anhang XXI Danksagung XXIX Erklärungen XXX

In this thesis, I shall discuss the importance of supporting caregivers. I will focus primarily on the introduction and description of problematic phenomena related to caring, to the caregiver's role, then of delivering care and its species. In subsequent chapters I will focus on the pitfalls of care and the implications for caring. Next, I will dedicate the positive aspects of care. At work I will also support informal care from the state. I provide overview of options that can help them in caring for a related. At thesis I try to highlight the care provided by amateurish carers about the importance of their support and also to outline the positive aspects of care. Family carers deserve admiration. Their strength and conviction in many cases is unimaginable. Caregivers must overcome many obstacles and still manage most of the care.

O objetivo deste estudo foi comparar a resposta do vascular durante o teste de estresse mental em adultos sedentários (SED) e fisicamente ativos (FA) com apneia obstrutiva do sono (AOS). Os pacientes não tratados com AOS e sem outras comorbidades foram classificados em SED e FA de acordo com o Questionário Internacional de atividade física. A pressão sanguínea, a freqüência cardíaca, o fluxo sanguíneo do antebraço (FSA) (pletismografia) e a condutância vascular do antebraço (CVA = FSA/pressão sanguínea x 100) foram medidas continuamente em repouso (4 min), seguidas de 3 min do teste Stroop Color Word Test (SCWT) também conhecido como teste de estresse mental. Quarenta pacientes com AOS (homens = 24, idade = 50 ± 1 anos, índice de massa corporal = 29 ± 0,5 Kg/m2, índice de apneia hipopnéia = 39 ± 4 eventos/h) divididos em SED (n = 21) e FA (n = 19) apresentaram diferença significativa na quantidade de tempo gasto em atividade física (17 ± 9 vs. 245 ± 33 minutos/semana, respectivamente). Os grupos foram semelhantes em relação ao sexo, idade, índice de massa corporal, frequência cardíaca do nível educacional e pressão arterial média em repouso, bem como percepção de estresse no final do SCWT. Em contraste, FSA basal (1,7 ± 0,08 mL/min/100mL vs 2,5 ± 0,19 mL/min/100mL) e CVA (1,7 ± 0,07 vs 2,5 ± 0,2) foram significativamente menores no grupo SED quando comaprados a FA, respectivamente (p <0,05). A resposta de frequência cardíaca e pressão arterial ao SCWT foram semelhantes e aumentou em ambos os grupos. O FSA (3,5 ± 0,2 mL/min/100mL vs 2,4 ± 0,14 mL/min/100mL) e a CVA (3,5 ± 0,2 vs 2,3 ± 0,1) durante SCWT foi significativamente menor no grupo SED quando comparados ao grupo FA (P <0,05). Houve uma correlação significativa entre a atividade física no tempo de lazer e FSA (r = 0,57; P <0,05) e CVA (r = 0,48; P <0,05). Conclui-se, que, a resposta vascular nos pacientes com AOS é influenciada pelo nível de atividade física de lazer. O alto nível de atividade física pode proteger a disfunção cardiovascular em repouso e na condição de estresse mental em pacientes com AOS moderado a severo / The objective of this study was to compare a vascular response during the mental stress test in sedentary (SED) and physically active (PA) patients with obstructive sleep apnea (OSA). Patients not treated with OSA and without other comorbidities were classified in SED and PA according to the International Questionnaire of Physical Action. Blood pressure, heart rate, forearm blood flow (plethysmography) and forearm vascular conductance (FVC = FBF / blood pressure x 100) were measured continuously at rest (4 min), followed by 3 min of the test Stroop Color Word Test (SCWT) also known as mental stress test. Forty patients with OSA (men = 24, age = 50 ± 1 years, body mass index = 29 ± 0.5 kg / m2, apnea hypopnea index = 39 ± 4 events / h) divided in SED (n = 19) and PA (n = 19) presented a significant difference in the amount of time spent in physical activity (17 ± 9 vs. 245 ± 33 minutes / week, respectively). The groups are similar in relation to gender, age, body mass index, heart rate at educational level, and mean resting blood pressure, as well as perceived stress at the end of SCWT. In contrast, baseline FBF (1.7 ± 0.08 mL/min/100mL vs 2.5 ± 0.19 mL/min/100mL) and FVC (1.7 ± 0.07 U vs 2.5 ± 0.2 U) were significantly lower without SED group when compared to PA, respectively (p <0.05). The heart rate and blood pressure response to SCWT were similar and increased in both groups. The FBF (3.5 ± 0.2 mL/min/100mL vs 2.4 ± 0.14 mL/min/100mL) and the FVC (3.5 ± 0.2 U vs 2.3 ± 0.1 U) during SCWT was much lower in the SED group when compared to the group PA (P <0.05). There was a significant correlation between physical activity without leisure time and FBF (r = 0.57, P <0.05) and FVC (r = 0.48, P <0.05). In conclusion, the vascular response in OSA patients is influenced by the level of leisure physical activity. The high level of physical activity may protect a cardiovascular dysfunction at rest and mental stress condition in patients with moderate to severe OSA

A obesidade é um dos maiores fatores de risco para o desenvolvimento de comprometimentos cardiovasculares. Essas alterações também são encontradas em crianças. Recentemente, estudos citam prejuízos cardiovasculares em crianças obesas. Estudos prévios in vitro e in vivo, sugeriram que alguns polimorfismos para o receptor beta 2-adrenérgico podem afetar de forma distinta as respostas à estimulação adrenérgica, levando a diferentes modulações cardiovasculares e metabólicas. No presente estudo, nós avaliamos a pressão arterial média, fluxo sangüíneo muscular e condutância vascular em resposta a estresse mental e exercício em crianças obesas homozigotas para Arg16 e Gln27 (Arg16/Gln27), Gly16 e Gln27 (Gly16/Gln27), e Gly16 e Glu27 (Gly16/Glu27) no receptor beta 2-adrenérgico. Inicialmente, foram pré-selecionadas 110 crianças obesas voluntárias do Ambulatório de Endocrinologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Essas crianças foram genotipadas para os alelos Arg 16, Gly16, Glu27 e Gln27 do beta 2-adrenoreceptor. No estudo, foram detectadas 40 crianças obesas em homozigoze para os alelos 16 e 27 do receptor beta 2-adrenérgico. Vinte e três eram homozigotas para Arg16/Gln27, 7 para Gly16/Gln27 e 10 para Gly16/Glu27. Quando os três grupos foram comparados em condições basais, não houve diferenças nas variáveis antropométricas (idade, peso, IMC e Z-score), nos parâmetros metabólicos (glicemia, colesterol total, LDL - colesterol, HDL - colesterol, triglicérides, leptina, insulina, área de glicose e insulina e HOMA - IR) e nas variáveis hemodinâmicas (freqüência cardíaca, pressão arterial, fluxo sangüíneo muscular e condutância vascular). Durante o exercício, a resposta vasodilatadora foi maior nas crianças obesas homozigotas para Gly16 e Glu27 quando comparada às crianças obesas homozigotas para Gly16 e Gln27 e Arg16 e Gln27. Da mesma maneira, a resposta vasodilatadora ao estresse mental, foi maior nas crianças obesas homozigotas para Gly16 e Glu27 quando comparadas às crianças dos outros dois grupos. Pelos resultados, concluímos que a presença de homozigoze para Gly16 e Glu27 do receptor beta 2-adrenérgico favorece a melhor resposta vasodilatadora durante manobras fisiológicas. É razoável pensar que estas crianças estarão mais protegidas contra injúrias cardiovasculares. / Obesity is one major risk factor for development of vascular disorders. These alterations are also found in children, since recent studies reported vascular disorders in childhood obesity. Previous studies in vivo and in vitro, suggested that these variants of beta 2-adrenoceptors (ADRB2) may differently affect functional responses to adrenergic stimulation, leading to distinct modulations on cardiovascular and metabolic phenotypes. In the present investigation we report the mean blood pressure, forearm blood flow and forearm vascular conductance response during mental stress and exercise in obesity children who were homozygous for Arg16 and Gln27 (Arg16/Gln27), Gly16 and Gln27 (Gly16/Gln27), and Gly16 and Glu27 (Gly16/Glu27) of the beta 2-adrenoceptors. Initially, we screened one hundred and ten pre-selected obese children volunteers, from the Clinical Endocrinology Ambulatory Clinic of University of São Paulo. These children were genotyped for the Arg16, Gly16, Gln27, and Glu27 beta 2-adrenoceptor alleles. Forty subjects who were homozygous for the alleles 16 and 27 were involved in the study. Twentythree were homozygous for Arg16/Gln27, 7 for Gly16/Gln27, and 10 for Gly16/Glu27. When the three groups were compared, in basal conditions, there were no difference in terms of anthropometry (age, weight, height, BMI, Z-score), metabolic variables (glucose, cholesterol, LDL-cholesterol, HDLcholesterol, triglycerides, leptin, insulin, glucose area, insulin area and HOMA-IR) and hemodynamics variables (heart rate, blood pressure, forearm blood flow and forearm vascular conductance). During exercise, vasodilatory responsiveness was greater in obese children homozygous for Gly16 and Glu27 than in obese children homozygous for Gly 16 and Gln 27, and Arg 16 and Gln 27. Similarly, during mental stress vasodilatory responsiveness was greater in obese children homozygous for Gly 16 and Glu 27, than in obese children for Gly 16 and Gln 27, and Arg 16 and Gln 27. In conclusion, our results obtained in the obese children support the view that the homozygous for Gly16/Glu27 of the beta 2-adrenoceptor favors the greater vasodilatory response during physiological maneuvers; it is reasonable to think that they will be more protected against cardiovascular disorders.