Do heart rate variability indices present potential to predict late postmenopausal? A retrospective study

SUMMARY OBJECTIVES: This study aimed to compare heart rate variability indices in early and late postmenopausal women and assess their correlation and prognostic value to predict late postmenopausal. METHODS: An observational and retrospective study was performed with the medical records of patients from Hospital das Clínicas, Faculdade de Medicina da Universidade de Sao Paulo between 2018 and 2019. We selected medical records of women with menopause, over 40 years old, which were divided into two groups, according to postmenopausal time, i.e., early and late postmenopausal. RESULTS: We analyzed data from 123 women (55 in the early and 68 in the late postmenopausal group). RRtri (triangular index) was lower in the late postmenopausal group (8.68 vs. 7.15, p=0.040). There was a significant weak negative correlation in SDNN, RRtri, and SD2 and postmenopausal time. RRtri presented the potential to predict late postmenopausal. CONCLUSION: The increase in postmenopausal time decreases global heart rate variability indices. The geometric index RRtri was significantly lower in late postmenopausal women and presented the potential to predict late postmenopausal.

Complexity theory in the management of patients with pain

Nonlinear systems are not susceptible to being investigated with reductionist methods. In this sense, complexity theory offers an alternative approach to quantify the importance of contextual factors (CFs) in the patient with pain. The result of the positive (placebo) or negative (nocebo) use of CFs in the therapeutic setting could be responsible for a large part of a non-specific component of the efficacy of the treatment, directly affecting the quality of the results related to the patient's health (for example, pain, disability, or satisfaction). In recent years, understanding of the value of these effects has increased. Despite growing interest, knowledge, and awareness of them is currently limited and heterogeneous among health professionals, reducing their translational value in the field of health.Keywords: complexity, contextual factors, pain, health professionals, placebo, nocebo.

Los sistemas no lineales no son susceptibles de ser investigados con métodos reduccionistas. En este sentido, la teoría de la complejidad ofrece un enfoque alternativo para cuantificar la importancia de los factores contextuales (FCs) en el paciente con dolor. El resultado del uso positivo (placebo) o negativo (nocebo) de FCs en el tratamiento podría ser responsable de gran parte de un componente no específico de la eficacia del tratamiento, afectando directamente la calidad de los resultados relacionados con la salud del paciente (por ejemplo, dolor, funcionalidad o satisfacción).En los últimos años se ha incrementado la comprensión del valor de estos efectos. A pesar del creciente interés, el conocimiento y la conciencia de ellos es actualmente limitado y heterogéneo entre profesionales de la salud, lo que reduce su valor traslacional en el campo de la salud.Palabras clave: complejidad; factores contextuales; profesionales de la salud; dolor; placebo; nocebo.

Do heart rate variability indices present potential to predict late postmenopausal? A retrospective study.

OBJECTIVES: This study aimed to compare heart rate variability indices in early and late postmenopausal women and assess their correlation and prognostic value to predict late postmenopausal. METHODS: An observational and retrospective study was performed with the medical records of patients from Hospital das Clínicas, Faculdade de Medicina da Universidade de Sao Paulo between 2018 and 2019. We selected medical records of women with menopause, over 40 years old, which were divided into two groups, according to postmenopausal time, i.e., early and late postmenopausal. RESULTS: We analyzed data from 123 women (55 in the early and 68 in the late postmenopausal group). RRtri (triangular index) was lower in the late postmenopausal group (8.68 vs. 7.15, p=0.040). There was a significant weak negative correlation in SDNN, RRtri, and SD2 and postmenopausal time. RRtri presented the potential to predict late postmenopausal. CONCLUSION: The increase in postmenopausal time decreases global heart rate variability indices. The geometric index RRtri was significantly lower in late postmenopausal women and presented the potential to predict late postmenopausal.

Autonomic cardiac modulation in postmenopausal women with dry eye syndrome: a cross-sectional analytical study.

OBJECTIVE: The aim of this study was to assess cardiac autonomic modulation in postmenopausal women with and without dry eye syndrome (DES) and to identify associations between clinical and socioeconomic factors. METHODS: A cross-sectional study was carried out at the Institute of Ocular Surgery of the Northeast (ICONE), Brazil. Convenience sample of postmenopausal women, over 40 years old, who were divided into two groups: with and without DES. Clinical, sociodemographic, and ophthalmological characteristics of these women were assessed. Capture of RR intervals was performed using a cardio frequency meter. Differences between the groups were analyzed using the Chi-square test, the Student's t test, and the Mann-Whitney test. RESULTS: Women with DES were present in 60.4% (n=58), highest median age (63.5 years, 95%CI 62.0-67.9; p<0.001), median length of time menopause (19 years old, 95%CI 10.4-24.0; p<0.001). There was a difference in the standard deviation of all normal-to-normal index between the groups. However, when the differences were adjusted to the clinical model, no association was found between DES and heart rate variability (HRV). CONCLUSIONS: The analysis of cardiac autonomic modulation in postmenopausal women is similar in the presence or absence of DES. Clinical factors, time of menopause, and intensity of symptoms were not associated with HRV indices.

Autonomic cardiac modulation in postmenopausal women with dry eye syndrome: a cross-sectional analytical study

SUMMARY OBJECTIVE The aim of this study was to assess cardiac autonomic modulation in postmenopausal women with and without dry eye syndrome (DES) and to identify associations between clinical and socioeconomic factors. METHODS A cross-sectional study was carried out at the Institute of Ocular Surgery of the Northeast (ICONE), Brazil. Convenience sample of postmenopausal women, over 40 years old, who were divided into two groups: with and without DES. Clinical, sociodemographic, and ophthalmological characteristics of these women were assessed. Capture of RR intervals was performed using a cardio frequency meter. Differences between the groups were analyzed using the Chi-square test, the Student's t test, and the Mann-Whitney test. RESULTS Women with DES were present in 60.4% (n=58), highest median age (63.5 years, 95%CI 62.0-67.9; p<0.001), median length of time menopause (19 years old, 95%CI 10.4-24.0; p<0.001). There was a difference in the standard deviation of all normal-to-normal index between the groups. However, when the differences were adjusted to the clinical model, no association was found between DES and heart rate variability (HRV). CONCLUSIONS The analysis of cardiac autonomic modulation in postmenopausal women is similar in the presence or absence of DES. Clinical factors, time of menopause, and intensity of symptoms were not associated with HRV indices.

Linear and Nonlinear Heart Rate Variability Analysis in Gonadal Dysgenesis (Swyer Syndrome): A Case Report

Abstract Swyer syndrome is one of the disorders of sexual differentiation. Previous studies have demonstrated increased sympathetic activity with heart rate variability (HRV) analysis with decreasing estradiol levels. One patient presented a pure 46, XY gonadal dysgenesis with female phenotype. Cardiac autonomic modulation was assessed through HRV analysis while at rest. This research analyzed linear and nonlinear indexes. HRV analysis showed reduced parasympathetic and global modulation with an apparent increase in sympathetic tone and a loss of HR fractal dynamics toward correlated behavior, characterized by low entropy and high determinism of time series.

Is the p-value properly interpreted by critical care professionals? Online survey. / O valor de p é adequadamente interpretado pelos profissionais de terapia intensiva? Uma pesquisa on-line.

OBJECTIVE: To determine the prevalence of and risk factors for insufficient knowledge related to p-values among critical care physicians and respiratory therapists in Argentina. METHODS: This cross-sectional online survey contained 25 questions about respondents' characteristics, self-perception and p-value knowledge (theory and practice). Descriptive and multivariable logistic regression analyses were conducted. RESULTS: Three hundred seventy-six respondents were analyzed. Two hundred thirty-seven respondents (63.1%) did not know about p-values. According to the multivariable logistic regression analysis, a lack of training on scientific research methodology (adjusted OR 2.50; 95%CI 1.37 - 4.53; p = 0.003) and the amount of reading (< 6 scientific articles per year; adjusted OR 3.27; 95%CI 1.67 - 6.40; p = 0.001) were found to be independently associated with the respondents' lack of p-value knowledge. CONCLUSION: The prevalence of insufficient knowledge regarding p-values among critical care physicians and respiratory therapists in Argentina was 63%. A lack of training on scientific research methodology and the amount of reading (< 6 scientific articles per year) were found to be independently associated with the respondents' lack of p-value knowledge.

OBJETIVO: Determinar a prevalência e os fatores de risco para conhecimento insuficiente sobre valores de p entre médicos e terapeutas respiratórios atuantes em terapia intensiva na Argentina. MÉTODOS: Levantamento transversal on-line com 25 questões relativas às características dos participantes, autopercepção e conhecimento sobre valores de p (teoria e prática). Realizaram-se análises de estatística descritiva e regressão logística multivariada. RESULTADOS: Analisaram-se 376 participantes. Não tinham conhecimento a respeito dos valores de p 237 participantes (63,1%). Segundo análise de regressão logística multivariada, falta de treinamento em metodologia científica (RC ajustadas 2,50; IC95% 1,37 - 4,53; p = 0,003) e a quantidade de leitura (< 6 artigos científicos por ano; RC ajustadas 3,27; IC95% 1,67 - 6,40; p = 0,001) foram identificados como independentemente associados com a falta de conhecimento sobre valores de p por parte dos participantes. CONCLUSÃO: A prevalência de conhecimento insuficiente com relação a valores de p entre médicos e terapeutas respiratórios na Argentina foi de 63%. Falta de treinamento em metodologia científica e quantidade de leitura (< 6 artigos científicos por ano) foram identificados como independentemente associados com a falta de conhecimento sobre valores de p por parte dos participantes.

O valor de p é adequadamente interpretado pelos profissionais de terapia intensiva? Uma pesquisa on-line / Is the p-value properly interpreted by critical care professionals? Online survey

RESUMO Objetivo: Determinar a prevalência e os fatores de risco para conhecimento insuficiente sobre valores de p entre médicos e terapeutas respiratórios atuantes em terapia intensiva na Argentina. Métodos: Levantamento transversal on-line com 25 questões relativas às características dos participantes, autopercepção e conhecimento sobre valores de p (teoria e prática). Realizaram-se análises de estatística descritiva e regressão logística multivariada. Resultados: Analisaram-se 376 participantes. Não tinham conhecimento a respeito dos valores de p 237 participantes (63,1%). Segundo análise de regressão logística multivariada, falta de treinamento em metodologia científica (RC ajustadas 2,50; IC95% 1,37 - 4,53; p = 0,003) e a quantidade de leitura (< 6 artigos científicos por ano; RC ajustadas 3,27; IC95% 1,67 - 6,40; p = 0,001) foram identificados como independentemente associados com a falta de conhecimento sobre valores de p por parte dos participantes. Conclusão: A prevalência de conhecimento insuficiente com relação a valores de p entre médicos e terapeutas respiratórios na Argentina foi de 63%. Falta de treinamento em metodologia científica e quantidade de leitura (< 6 artigos científicos por ano) foram identificados como independentemente associados com a falta de conhecimento sobre valores de p por parte dos participantes.

ABSTRACT Objective: To determine the prevalence of and risk factors for insufficient knowledge related to p-values among critical care physicians and respiratory therapists in Argentina. Methods: This cross-sectional online survey contained 25 questions about respondents' characteristics, self-perception and p-value knowledge (theory and practice). Descriptive and multivariable logistic regression analyses were conducted. Results: Three hundred seventy-six respondents were analyzed. Two hundred thirty-seven respondents (63.1%) did not know about p-values. According to the multivariable logistic regression analysis, a lack of training on scientific research methodology (adjusted OR 2.50; 95%CI 1.37 - 4.53; p = 0.003) and the amount of reading (< 6 scientific articles per year; adjusted OR 3.27; 95%CI 1.67 - 6.40; p = 0.001) were found to be independently associated with the respondents' lack of p-value knowledge. Conclusion: The prevalence of insufficient knowledge regarding p-values among critical care physicians and respiratory therapists in Argentina was 63%. A lack of training on scientific research methodology and the amount of reading (< 6 scientific articles per year) were found to be independently associated with the respondents' lack of p-value knowledge.

Heart rate variability in individuals with Down syndrome - A systematic review and meta-analysis.

INTRODUCTION: Down syndrome (DS) results in many changes, including dysfunction in cardiac autonomic modulation. Heart rate variability (HRV) analysis evaluates the autonomic function and it is a predictor of adverse cardiovascular events. OBJECTIVE: To present results of a systematic review and a meta-analysis about heart rate variability in individuals with DS. METHOD: A systematic review was performed on PubMed, PubMed Central and Web of science databases. We included articles that exhibited all the terms: "Down Syndrome", "heart rate variability", "autonomic nervous system", "autonomic dysfunction" and "cardiac autonomic modulation". We conducted the meta-analysis to compare "DS" to "controls" during rest. Random effects models were used, as were appropriate tests for heterogeneity. RESULTS: From 271 studies, 13 were included in our review. These are conducted with volunteers from a wide age range, of either gender, and not taking medications. Meta-analysis displayed that there were no significant differences between the groups at rest, except the RMSSD, which revealed a significant (Z = -2.80, p = 0.005) main effect (Hedge's g = -0.55, 95% CI [-0.93; -0.16]), indicating difference in individuals with DS compared with controls. CONCLUSION: There is autonomic dysfunction in individuals with DS, which may or may not be expressed at rest, but it is usually demonstrated in an autonomic task. Meta-analysis specified that there was no significant alteration between DS and the controls during rest, except RMSSD index which was lower in DS than controls. PROSPERO: CRD42017068647.

Complexity of autonomic nervous system function in individuals with COPD.

OBJECTIVE: To evaluate autonomic modulation in individuals with COPD, compared with healthy controls, via recurrence plots (RPs) and linear heart rate variability (HRV) indices. METHODS: We analyzed data on 74 volunteers, who were divided into two groups: COPD (n = 43) and control (n = 31). For calculation of HRV indices, heart rate was measured beat-by-beat during 30 min of supine rest using a heart-rate meter. We analyzed linear indices in the time and frequency domains, as well as indices derived from the RPs. RESULTS: In comparison with the control group, the COPD group showed significant increases in the indices derived from the RPs, as well as significant reductions in the linear indices in the time and frequency domains. No significant differences were observed in the linear indices in the frequency domains expressed in normalized units or in the low frequency/high frequency ratio. CONCLUSIONS: Individuals with COPD show a reduction in both sympathetic and parasympathetic activity, associated with decreased complexity of autonomic nervous system function, as identified by RPs, which provide important complementary information in the detection of autonomic changes in this population.

Complexity of autonomic nervous system function in individuals with COPD / Complexidade do sistema nervoso autônomo em indivíduos com DPOC

ABSTRACT Objective: To evaluate autonomic modulation in individuals with COPD, compared with healthy controls, via recurrence plots (RPs) and linear heart rate variability (HRV) indices. Methods: We analyzed data on 74 volunteers, who were divided into two groups: COPD (n = 43) and control (n = 31). For calculation of HRV indices, heart rate was measured beat-by-beat during 30 min of supine rest using a heart-rate meter. We analyzed linear indices in the time and frequency domains, as well as indices derived from the RPs. Results: In comparison with the control group, the COPD group showed significant increases in the indices derived from the RPs, as well as significant reductions in the linear indices in the time and frequency domains. No significant differences were observed in the linear indices in the frequency domains expressed in normalized units or in the low frequency/high frequency ratio. Conclusions: Individuals with COPD show a reduction in both sympathetic and parasympathetic activity, associated with decreased complexity of autonomic nervous system function, as identified by RPs, which provide important complementary information in the detection of autonomic changes in this population.

RESUMO Objetivo: Avaliar a modulação autonômica de indivíduos com DPOC, comparados com um grupo controle saudável, por meio do plot de recorrência (PR) associado a métodos lineares da variabilidade da frequência cardíaca (VFC). Métodos: Foram avaliados dados de 74 voluntários, os quais foram divididos em grupos DPOC (n = 43) e controle (n = 31). Para a análise dos índices de VFC, a frequência cardíaca dos voluntários foi registrada, batimento a batimento, por meio de um cardiofrequencímetro com os voluntários em repouso na posição supina por 30 min. Foram avaliados índices lineares nos domínios de tempo e de frequência, assim como índices obtidos por meio do PR. Resultados: No grupo DPOC, em comparação com o grupo controle, houve aumentos significativos em índices obtidos do PR, assim como houve reduções significativas nos índices lineares nos domínios de tempo e de frequência. Não foram observadas diferenças significativas nos índices lineares nos domínios de frequência em unidades normalizadas e na relação entre os componentes de alta e baixa frequência. Conclusões: Indivíduos com DPOC apresentam uma diminuição tanto da atividade simpática quanto da parassimpática, associada a uma redução da complexidade do sistema nervoso autônomo, identificada pelo PR, que fornece informações complementares importantes na detecção de alterações autonômicas nessa população.

Heart rate variability measure in breast cancer patients and survivors: A systematic review.

PURPOSE: In the current study, we aimed to review literature findings showing the clinical importance of cardiac autonomic modulation assessed by heart rate variability analysis in breast cancer (BC) patients and survivors. METHODS: We conducted a systematic review according to The PRISMA Statement in Medline, Scopus and Web of Science (_-2015) databases. The search was limited to articles in English language, published in peer-reviewed journals, and with adult age samples only (e.g., women, patients, or survivors, diagnosed with BC in any stage). We included observational studies and randomized trials. Detailed heart rate variability analysis (instruments, data collection protocol, and analysis methods) was required. Search terms included autonomic nervous system, heart rate variability, sympathetic and parasympathetic nervous system, autonomic dysfunction, vagal nervous and breast neoplasms, breast cancer and breast tumor. RESULTS: Twelve studies were included in this review. The clinical importance of cardiac autonomic modulation assessed by heart rate variability analysis in BC patients and survivors is demonstrated by association with effects of BC surgery, and treatments, and the adverse effects of surgery and treatments on survivors (e.g., cardiotoxicity, fatigue, and stress). LIMITATIONS: The strength of evidence of included studies is low: small samples size and heterogeneity, presence of confounders, and observational studies design. CONCLUSIONS: The heart rate variability analysis could be used as a complementary non-invasive tool for the early diagnosis and better prognosis of autonomic dysfunction, and survival in BC patients. There are many potential clinical applications of heart rate variability analysis in BC patients, and the employment of such approaches could lead to lower impairment of autonomic function in this individuals.

Higuchi fractal dimension applied to RR intervals in children with Attention Deficit Hyperactivity Disorder

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is categorized by a lowered attention span, recklessness, and hyperactivity. Autonomic nervous system inequality has previously been studied using the same data by chaotic global techniques. We aim to compare the autonomic function of children with ADHD and controls by analyzing heart rate variability (HRV) METHODS: 28 children with ADHD (22 boys, mean age 10.0 years ± 1.9 years) and 28 controls (15 boys, mean age 9.9 years ± 1.8 years) rested in supine position with spontaneous breathing for 20 minutes. Heart rate was recorded beat by beat. HRV analysis was performed by Higuchi Fractal Dimension technique. RESULTS: ADHD promoted an increase in the Higuchi Fractal Dimension. The optimum value of Kmax was 10. CONCLUSION: ADHD significantly altered cardiac autonomic modulation as measured by the Higuchi fractal dimension of HRV. It can therefore be stated that ADHD has increased the complexity of the HRV signal through cardiac autonomic modulation.

INTRODUÇÃO: O transtorno de deficit de atenção e hiperatividade (TDAH) é caracterizado por um período reduzido de atenção, impulsividade e hiperatividade. O desequilíbrio na função do sistema nervoso autônomo (SNA) tem sido previamente estudado utilizando-se técnicas globais da teoria do caos. OBJETIVO: comparar a função autonômica de crianças com TDAH e controles por meio da análise da variabilidade da frequência cardíaca (VFC) MÉTODO: 28 crianças com TDAH (22 meninos, com média de idade de 10,0 anos ± 1,9 anos) e 28 controles (15 meninos, com média de idade de 9,9 anos ± 1,8 anos) permaneceram em decúbito dorsal, com respiração espontânea por 20 minutos. A frequência cardíaca foi registrada batimento a batimento e a análise da VFC foi realizada pela técnica de Dimensão Fractal Higuchi. RESULTADOS: TDAH promoveu um aumento na Dimensão Fractal Higuchi. O valor ideal de Kmax foi 10. CONCLUSÃO: O TDAH alterou significantemente a modulação autonômica cardíaca, como demonstrado pela Dimensão Fractal Higuchi da VFC. Assim, pode-se afirmar que crianças com TDAH apresentaram aumento das respostas caóticas neste tipo de análise da modulação autonômica cardíaca.

Relação entre a regulação autonômica cardíaca e mecanismos auditivos: importância para o crescimento e desenvolvimento / Relationship between cardiac autonomic regulation and auditory mechanisms: importance for growth and development

A literatura já demonstrou que a estimulação auditiva por meio de música influencia o sistema cardiovascular. Neste estudo, foi realizada uma revisão da literatura, a fim de investigar a relação entre os mecanismos auditivos e a regulação autonômica cardíaca. Os estudos selecionados indicaram forte correlação entre a intensidade do ruído e o equilíbrio simpatovagal. Além disso, foi relatado que a terapia com música melhorou a variabilidade da frequência cardíaca em pacientes com câncer de mama tratados com antraciclinas. Postula-se que a dopamina liberada no sistema estriatal, induzida por canções alegres, está envolvida na regulação autonômica. Estudos posteriores sãonecessários para adicionar novos elementos na literatura, para melhorar a novas terapias e para o tratar doenças cardiovasculares.

Correlação entre a dor lombar e as alterações posturais em gestantes / Correlation between low back pain and postural alterations during pregnancy

INTRODUÇÃO: A dor lombar é uma queixa comum na população em geral e é sintoma frequentemente relatado durante a gestação. OBJETIVO: Verificar a correlação entre a dor lombar e as alterações posturais em gestantes. MÉTODO: A amostra constituiu-se de 54 voluntárias, com faixa etária variando entre 20 e 30 anos, sendo 27 gestantes. As gestantes foram divididas em três grupos de acordo com o período gestacional: sete no primeiro trimestre (GI), 11 no segundo trimestre (GII), nove no terceiro trimestre (GIII); para ser analisada a incidência de dor ou desconforto relacionada a alterações posturais apresentadas no período gestacional. O grupo controle (GC) foi constituído por 27 voluntárias não grávidas. A análise das fotos foi realizada com o software de Análise Postural (SAPO), e a análise estatística foi feita através dos testes ANOVA e Regressão Linear Simples com nível de significância de 5%. RESULTADOS: Em relação à idade gestacional, a prevalência de dor lombar foi maior nas gestantes com até 13 semanas. Referente à intensidade da dor na região lombar, o GII foi o grupo que apresentou a maior média, com dor moderada, seguido dos grupos GIII, GC e GI, com uma dor leve. Com relação às modificações da curvatura da coluna lombar, não foi possível estabelecer correlação estatisticamente significativa das alterações posturais apresentadas com a presença da dor lombar durante a gestação por meio da análise postural de todas as mulheres. CONCLUSÃO: Não houve correlação entre a sintomatologia de dor lombar e as alterações posturais no período gestacional.

INTRODUCTION: Low back pain is a common complaint in the population as a whole and is a symptom frequently reported during pregnancy. OBJECTIVE: To verify the correlation between low back pain and postural changes during pregnancy. METHOD: The sample consisted of 54 female volunteers, ages from 20 to 30 years, 27 pregnant. Women were sub-divided into three groups according to pregnancy age: seven in first quarter (GI), 11 in the second quarter (GII), nine in third trimester (GIII); to analyze the incidence of pain or discomfort related to abnormal postural alterations during pregnancy. The control group (GC) consisted of 27 non-pregnant volunteers. The image analysis was performed with the Postural Analysis Software (SAPO) and statistical analysis through ANOVA tests and regression analysis with significance level at 5%. RESULTS: Regarding the gestational age, the prevalence of lumbar pain was higher among those with up to 13 weeks. Referring to the intensity of pain in the lumbar region, the GII was the group that had the highest average, with moderate pain, followed by GIII, GC and GI with mild pain. Regarding changes in the curvature of the spine, it was not possible to establish a statistically significant relationship of postural alterations with the presence of lumbar back pain during pregnancy based postural analysis of all women. CONCLUSION: There was no association between low back pain postural changes during pregnancy.

Efeitos da shantala na interação entre mãe e criança com síndrome de down / Effects of shantala massage therapy on interaction between mother and child with Down's syndrome

O objetivo é verificar os efeitos da Shantala na interação entre mãe e criança com síndrome de Down. Utilizou-se por 60 dias, uma vez por semana, a técnica de massagem Shantala em três crianças com síndrome de Down, da instituição APAE, localizada em Itaquaquecetuba, SP, Brasil. Para a obtenção dos resultados foram aplicados dois questionários, um ao início, para se obter maiores informações sobre as crianças e outro ao final, para se verificar os resultados da técnica utilizada. Foi possível concluir que a Shantala beneficiou as crianças com síndrome de Down, proporcionando uma qualidade de vida melhor. Para as mães, a técnica permitiu uma melhor aceitação da doença e houve melhora no relacionamento entre as mães e as crianças

A epistemologia genética de Piaget e o construtivismo / Piaget's genetic epistemology and constructivism

A Epistemologia Genética defende que o indivíduo passa por várias etapas de desenvolvimento ao longo da sua vida. O desenvolvimento é observado pela sobreposição do equilíbrio entre a assimilação e a acomodação, resultando em adaptação. Assim, nesta formulação, o ser humano assimila os dados que obtém do exterior, mas uma vez que já tem uma estrutura mental que não está "vazia", precisa adaptar esses dados à estrutura mental já existente. O processo de modificação de si próprio é chamado de acomodação. Este esquema revela que nenhum conhecimento chega do exterior sem que sofra alguma alteração pelo indivíduo, sendo que tudo o que se aprende é influenciado por aquilo que já havia sido aprendido. A assimilação ocorre quando a informação é incorporada às estruturas já pré-existentes nessa dinâmica estrutura cognitiva, enquanto que a adaptação ocorre quando o organismo se modifica de alguma maneira de modo a incorporar dinamicamente a nova informação. Por fim, de um pensamento moderno que, buscando a síntese inusitada entre o biológico e o lógico-matemático, parece encontrar seus limites na desconstrução ainda mais inusitada a que tende sistematicamente todo o pensamento na atualidade: a de si mesmo se construindo de modo essencialmente esclarecido

Espondilolistese degenerativa: avaliação da qualidade de vida dos pacientes submetidos a tratamento cirúrgico / Degenerative spondylolisthesis: life quality evaluation of patients submitted to surgical treatment

Objetivo: Avaliar a mudança da qualidade de vida dos pacientes com espondilolistese degenerativa após tratamento cirúrgico (descompressão e artrodese posterolateral associadas com o uso de parafusos pediculares). Método: Trinta pacientes com espondilolistese degenerativa foram operados de janeiro de 2005 a março de 2007 tendo sido submetidos à descompressão com artrodese posterolateral com uso de parafusos pediculares. Todos os pacientes foram avaliados pela escala visual analógica de dor (EVA), pelo Índice de Incapacidade de Oswestry e pelo Questionário de Roland-Morris. Depois desse período, o método de Wilcoxon foi utilizado para a análise estatística da qualidade de vida dos pacientes após os procedimentos cirúrgicos. Resultados: Na escala analógica de dor houve uma melhora de 86% da dor. Na classificação de Oswetry, notamos uma melhora de 50% dos casos e utilizando o método de Roland-Morris, constatamos uma melhora de 22,91%. Conclusões: O tratamento cirúrgico com descompressão e artrodese posterolateral associado à instrumentação pedicular possibilitou melhora a qualidade de vida dos pacientes com espondilolistese degenerativa.

Objective: To evaluate changes in quality of life of patients with degenerative spondylolisthesis after surgical treatment (decompression and posterolateral lumbar fusion with associated pedicular screws). Method: Between January 2005 and March 2007, 30 patients with degenerative spondilolisthesis who underwent decompression and posterolateral fusion with associated pedicular instrumentation were evaluated. All patients were assessed before and after surgery by the visual analog scale (VAS), Oswestry Disability Index and Roland-Morris Disability Questionnaire. After this period a statistical analysis by Wilcoxon test was done to evaluate changes in quality of life in these patients after surgical procedures. Results: Considering VAS, we assessed a pain improvement in all patients of 86%. Using the Oswestry Disability Index we noted an improvement of more than 50% of cases. About Roland-Morris Questionnaire this study showed 22,91%. Conclusions: Decompression with posterolateral lumbar fusion associated with pedicular instrumentation improves quality of life in patients with degenerative spondylolisthesis.

Estado atual das fraturas dos arcos costais / Current state of rib fractures

Os traumas torácicos são uma importante causa de hospitalização, morbidade e mortalidade na população jovem. Em muitas ocasiões, esses traumas torácicos se associam às fraturas dos arcos costais, consideradas benignas na maioria das vezes, mas que podem determinar uma maior gravidade em seus portadores, principalmente idosos. Neste trabalho de revisão, concluiu-se que o diagnóstico correto das fraturas deve ser realizado inclusive com o apoio da tomografia computadorizada, uma vez que a radiologia simples não é suficiente para a precisão diagnóstica. Em relação ao tratamento, muitos autores advogam a terapêutica cirúrgica, objetivando uma recuperação mais rápida dos pacientes internados com fratura de arcos costais.

The thoracic trauma is an important cause of hospitalization, morbidity and mortality in young population. In many occasions, this trauma is associated with rib fractures, considered as a benign problem, but they can determine a bigger gravity in its carriers, mainly in elderly. In this review, the authors concluded that the correct diagnosis of the fractures must be carried through with the support of computerized tomography scan, since simple radiology is not enough for the diagnostic precision. In relation to the treatment, many authors defend the surgical approach to obtain a faster recovery of the hospitalized patients with breaking of costal arcs.

Basic notions of heart rate variability and its clinical applicability.

Autonomic nervous system (ANS) plays an important role in the regulation of the physiological processes of the human organism during normal and pathological conditions. Among the techniques used in its evaluation, the heart rate variability (HRV) has arising as a simple and non-invasive measure of the autonomic impulses, representing one of the most promising quantitative markers of the autonomic balance. The HRV describes the oscillations in the interval between consecutive heart beats (RR interval), as well as the oscillations between consecutive instantaneous heart rates. It is a measure that can be used to assess the ANS modulation under physiological conditions, such as wakefulness and sleep conditions, different body positions, physical training and also pathological conditions. Changes in the HRV patterns provide a sensible and advanced indicator of health involvements. Higher HRV is a signal of good adaptation and characterizes a health person with efficient autonomic mechanisms, while lower HRV is frequently an indicator of abnormal and insufficient adaptation of the autonomic nervous system, provoking poor patient's physiological function. Because of its importance as a marker that reflects the ANS activity on the sinus node and as a clinical instrument to assess and identify health involvements, this study reviews conceptual aspects of the HRV, measurement devices, filtering methods, indexes used in the HRV analyses, limitations in the use and clinical applications of the HRV.