Divorce is a stressor associated with long-term health risk, though the mechanisms of this effect are poorly understood. Cardiovascular reactivity is one biological pathway implicated as a predictor of poor long-term health after divorce. A sample of recently separated and divorced adults (N = 138) was assessed over an average of 7.5 months to explore whether individual differences in heart rate variability—assessed by respiratory sinus arrhythmia—operate in combination with subjective reports of separation-related distress to predict prospective changes in cardiovascular reactivity, as indexed by blood pressure reactivity. Participants with low resting respiratory sinus arrhythmia at baseline showed no association between divorce-related distress and later blood pressure reactivity, whereas participants with high respiratory sinus arrhythmia showed a positive association. In addition, within-person variation in respiratory sinus arrhythmia and between-persons variation in separation-related distress interacted to predict blood pressure reactivity at each laboratory visit. Individual differences in heart rate variability and subjective distress operate together to predict cardiovascular reactivity and may explain some of the long-term health risk associated with divorce.

<p>Traumatic brain injury (TBI) is a major cause of death and disability. Intracranial secondary insults (e.g. intracranial haematoma, brain oedema) and systemic secondary insults (e.g. hypotension, hypoxaemia, hyperthermia) lead to secondary brain injury and affect outcome adversely. In order to minimise secondary insults and to improve outcome in TBI-patients, a secondary insult program and standardised neurointensive care (NIC) was implemented. The aim of this thesis was to describe patient outcome and to explore the occurrence and prognostic value of secondary insults after the implementation.</p><p>Favourable outcome was achieved in 79% and 6% died of the 154 adult TBI patients treated in the NIC unit 1996-97. In an earlier patient series from the department, 48% made a favourable outcome and 31% died. Hence, the outcome seems to have improved when NIC was standardised and dedicated to avoiding secondary insults. </p><p>Secondary insults counted manually from hourly recordings on surveillance charts did not hold any independent prognostic information. When utilising a computerised system, which enables minute-by-minute data collection, the proportion of monitoring time with systolic blood pressure > 160 mm Hg decreased the odds of favourable outcome independent of admission variables (odds ratio 0.66). Hyperthermia was related to unfavourable outcome. Hypertension was correlated to hyperthermia and may be a part of a hyperdynamic state aggravating brain oedema. </p><p>Increased proportion of monitoring time with cerebral perfusion pressure (CPP) < 60 mm Hg increased the odds of favourable outcome (odds ratio 1.59) in patients treated according to an intracranial pressure (ICP)-oriented protocol (Uppsala). In patients given a CPP-oriented treatment (Edinburgh), CPP <60 mm Hg was coupled to an unfavourable outcome. It was shown that pressure passive patients seem to benefit from an ICP-oriented protocol and pressure active patients from a CPP-oriented protocol. The overall outcome would improve if patients were given a treatment fit for their condition.</p>

Traumatic brain injury (TBI) is a major cause of death and disability. Intracranial secondary insults (e.g. intracranial haematoma, brain oedema) and systemic secondary insults (e.g. hypotension, hypoxaemia, hyperthermia) lead to secondary brain injury and affect outcome adversely. In order to minimise secondary insults and to improve outcome in TBI-patients, a secondary insult program and standardised neurointensive care (NIC) was implemented. The aim of this thesis was to describe patient outcome and to explore the occurrence and prognostic value of secondary insults after the implementation. Favourable outcome was achieved in 79% and 6% died of the 154 adult TBI patients treated in the NIC unit 1996-97. In an earlier patient series from the department, 48% made a favourable outcome and 31% died. Hence, the outcome seems to have improved when NIC was standardised and dedicated to avoiding secondary insults. Secondary insults counted manually from hourly recordings on surveillance charts did not hold any independent prognostic information. When utilising a computerised system, which enables minute-by-minute data collection, the proportion of monitoring time with systolic blood pressure &gt; 160 mm Hg decreased the odds of favourable outcome independent of admission variables (odds ratio 0.66). Hyperthermia was related to unfavourable outcome. Hypertension was correlated to hyperthermia and may be a part of a hyperdynamic state aggravating brain oedema. Increased proportion of monitoring time with cerebral perfusion pressure (CPP) &lt; 60 mm Hg increased the odds of favourable outcome (odds ratio 1.59) in patients treated according to an intracranial pressure (ICP)-oriented protocol (Uppsala). In patients given a CPP-oriented treatment (Edinburgh), CPP &lt;60 mm Hg was coupled to an unfavourable outcome. It was shown that pressure passive patients seem to benefit from an ICP-oriented protocol and pressure active patients from a CPP-oriented protocol. The overall outcome would improve if patients were given a treatment fit for their condition.

Blood pressure control occurs through the interaction between the autonomic nervous system and substances secreted by different cell types, including endothelial cells, causing changes in any of these mechanisms, leading to the development of arterial hypertension. The practice of physical exercises is shown as a non-pharmacological treatment capable of significantly reducing both systolic and diastolic blood pressure, attenuating blood pressure reactivity and increasing the bioavailability of nitric oxide. The objective of the present study was to observe blood pressure, heart rate and vasoactive (nitric oxide) response after an interval aerobic exercise session in hypertensive women. Two protocols were used: one exercise interval (sequence alternating 30 sec/ 90% and 90 sec/ 60% maximal aerobic velocity) and one control session (without exercise). As a result, it was observed that the pressure and heart rate behavior in the post-exercise were similar to the control session, and no attenuation of pressure reactivity after stress test (CPT) was observed when systolic blood pressure was observed in relation to rest: CPT: 160.9 ± 32.27 mmHg x Rest: 122.4 ± 18.58 mmHg and after 60 minutes recovery: CPT: 160.9 ± 32.27 mmHg x 60 min: 121.4 ± 13.87 mmHg. As well as were not observed in relation to the diastolic blood pressure (CPT 99.3 ± 16.19 mmHg x Rest 75.4 ± 15.17 mmHg, moment immediately after exercise: 82.5 ± 9.42 mmHg, and after 60 Min of recovery: 76.3 ± 13.18 mmHg. Regarding the heart rate, no reactivity was noted in the post-exercise period, showing elevation, only when the moment immediately after exercise was observed. Similarly, no differences were observed between the pre and post values related to the bioavailability of nitric oxide, in both protocols. It is concluded that, in the intensity and volume evaluated, physical exercise is not able to attenuate vascular reactivity, nor does it influence nitric oxide concentrations. / O controle da pressão arterial se dá através da interação entre o sistema nervoso autônomo e substâncias secretadas por diferentes tipos de células, entre elas as endoteliais, fazendo com que alterações em algum desses mecanismos acarretem no desenvolvimento da hipertensão arterial. A prática de exercícios físicos se mostra como um tratamento não-farmacológico capaz de reduzir significativamente tanto a pressão arterial sistólica como a diastólica, atenuar a reatividade pressórica e aumentar a biodisponibilidade de óxido nítrico. O objetivo do presente estudo foi observar a resposta pressórica, da frequência cardíaca e de substância vasoativa (óxido nítrico) após uma sessão de exercício aeróbio intervalado em mulheres hipertensas. Para tanto foram realizados dois protocolos, sendo um de exercício intervalado (sequência alternando 30 seg/ 90% e 90 seg/ 60% da velocidade aeróbia máxima) e uma sessão controle (sem exercício). Como resultado, observou-se que o comportamento pressórico e da frequência cardíaca no pós-exercício mostraram-se semelhantes à sessão controle, não sendo evidenciada atenuação da reatividade pressórica pós teste de estresse (CPT) quando observadas a pressão arterial sistólica com relação ao repouso: CPT:160,9 ± 32,27 mmHg x Repouso: 122,4 ± 18,58 mmHg e após 60 minutos de recuperação: CPT:160,9 ± 32,27 mmHg x 60 min: 121,4 ± 13,87 mmHg. Bem como não foram observadas em relação à pressão arterial diastólica (CPT 99,3 ± 16,19 mmHg x Repouso 75,4± 15,17 mmHg; momento imediatamente após o exercício: 82,5± 9,42 mmHg; e, após 60 min de recuperação: 76,3± 13,18 mmHg. Com relação à frequência cardíaca, não foi apontada reatividade no pós exercício, tendo apresentado elevação, apenas, quando observado o momento imediatamente após o exercício. De igual modo, não foram observadas diferenças entre os valores pré e pós relacionados à biodisponibilidade do óxido nítrico, em ambos os protocolos. Conclui-se que, na intensidade e volume avaliados, o exercício físico não é capaz de atenuar a reatividade vascular, assim como não influencia nas concentrações de óxido nítrico. / São Cristóvão, SE