Safe practices for bed bathing in the intensive care unit: validation of a checklist / Prácticas seguras para baño en el lecho en la unidad de cuidados intensivos: validación de un checklist / Práticas seguras para banho no leito na unidade de terapia intensiva: validação de um checklist

ABSTRACT Objective: To validate a checklist for safe bathing in critically ill patients. Methods: This is a methodological and quantitative study. Researchers developed a checklist for safe bathing in critically ill patients consisting of 41 items, which were submitted to the apparent and content validation process, evaluated by eleven judges, and interobserver reliability. For reliability analysis, the instrument was applied in 54 bed bath procedures in the ICU; Kappa and CHF tests were used. Results: In the apparent and content validation, adjustments were made according to the judges' suggestions. Kappa values ranged from moderate to almost perfect (0.462 to 0.962), and, in some items, there was 100% agreement; the reliability of the instrument was excellent (ICC = 0.962). Conclusion: The instrument proved to be dependable and easy to apply. Its use will contribute to safe bed bathing and subsidize interventions aimed at increasing the quality of care.

RESUMEN Objetivo: Validar lista de verificación para el baño seguro en pacientes críticos. Métodos: Estudio metodológico y cuantitativo. Se elaboró una lista de verificación para baño seguro en paciente crítico compuesta por 41 ítems, que fue sometida al proceso de validación aparente y de contenido, evaluada por 11 jueces, y confiabilidad interobservadores. Para el análisis de confiabilidad, el instrumento fue aplicado en 54 procedimientos de baño en el lecho en UTI; utilizados las pruebas de Kappa e ICC. Resultados: En la validación aparente y de contenido, fueron realizados ayustes conforme sugestiones de los jueces. Los valores de Kappa variaron de moderado a casi perfecto (0,462 a 0,962); y, en algunos ítems, hubo 100% de concordancia; la confiabilidad del instrumento fue excelente (ICC = 0,962). Conclusión: El instrumento se demostró confiable y de fácil aplicación. Su utilización contribuirá para el baño en el lecho seguro y subsidiará intervenciones que objetiven aumentar la calidad asistencial.

RESUMO Objetivo: Validar uma lista de verificação para o banho seguro em pacientes críticos. Métodos: Estudo metodológico e quantitativo. Elaborou-se uma lista de verificação para banho seguro no paciente crítico composta por 41 itens, que foi submetida ao processo de validação aparente e de conteúdo, avaliada por 11 juízes, e confiabilidade interobservadores. Para a análise de confiabilidade, o instrumento foi aplicado em 54 procedimentos de banho no leito em UTI; utilizaram-se os testes de Kappa e ICC. Resultados: Na validação aparente e de conteúdo, foram realizados ajustes conforme sugestões dos juízes. Os valores de Kappa variaram de moderado a quase perfeito (0,462 a 0,962); e, em alguns itens, houve 100% de concordância; a confiabilidade do instrumento foi excelente (ICC = 0,962). Conclusão: O instrumento demonstrou-se confiável e de fácil aplicação. Sua utilização contribuirá para o banho no leito seguro e subsidiará intervenções que visem aumentar a qualidade assistencial.

Safe practices for bed bathing in the intensive care unit: validation of a checklist.

OBJECTIVE: To validate a checklist for safe bathing in critically ill patients. METHODS: This is a methodological and quantitative study. Researchers developed a checklist for safe bathing in critically ill patients consisting of 41 items, which were submitted to the apparent and content validation process, evaluated by eleven judges, and interobserver reliability. For reliability analysis, the instrument was applied in 54 bed bath procedures in the ICU; Kappa and CHF tests were used. RESULTS: In the apparent and content validation, adjustments were made according to the judges' suggestions. Kappa values ranged from moderate to almost perfect (0.462 to 0.962), and, in some items, there was 100% agreement; the reliability of the instrument was excellent (ICC = 0.962). CONCLUSION: The instrument proved to be dependable and easy to apply. Its use will contribute to safe bed bathing and subsidize interventions aimed at increasing the quality of care.

Presenteísmo em profissionais de saúde / Presenteeism in health professionals / El Presentismo en los profesionales de la salud

Objetivo: analisar as evidências científicas sobre presenteísmo em profissionais da saúde publicadas entre 2008 e 2018. Métodos: revisão integrativa, utilizando os seguintes descritores controlados: presenteísmo, pessoal de saúde e saúde do trabalhador, nos idiomas português e inglês, nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, US National Library of Medicine National Institutes of Health e Cumulative Index to Nursing and Allied Health Literature. Resultados: os artigos selecionados foram publicados nos últimos 4 anos da pesquisa e todos apresentaram abordagem quantitativa. Os achados foram: três diferentes conceitos de presenteísmo; diferentes períodos recordatórios; cinco instrumentos de mensuração e fatores que influenciam no presenteísmo. Conclusão: estudos que investigam o presenteísmo em profissionais de saúde ainda são escassos, e a falta de padronização de instrumentos e períodos recordatórios ocasionam vieses nos resultados encontrados na literatura e prejudicam a investigação e aplicação da temática

Objective: analysis as scientific evidence on presenteeism in health professionals published between 2008 and 2018. Methods:integrative review, using the following controlled descriptors: presenteeism, health personnel and worker's health, in Portuguese and English, in the Latin American and Caribbean Literature in Health Sciences databases, US National Library of Medicine National Institutes of Health and Cumulative Index to Nursing and Allied Health Literature. Results: selected articles were published in the last 4 years of the research and all presented a quantitative approach. The findings were: three different concepts of presenteeism; different recall periods; five measuring instruments and factors that influence presenteeism. Conclusion: studies investigating presenteeism in health professionals are still scarce, and the lack of standardization of instruments and recall periods cause biases in the results found in the literature and hinder the investigation and application of the theme

Objetivo: analizar la evidencia científica sobre presentismo en profesionales de la salud publicada entre 2008 y 2018. Métodos:revisión integradora, utilizando los siguientes descriptores controlados: presentismo, personal de salud y salud del trabajador, en portugués e inglés, en las bases de datos de Literatura Latinoamericana y del Caribe en Ciencias de la Salud, US National Library of Medicine National Institutes of Health e Cumulative Index to Nursing and Allied Health Literature. Resultados: los artículos seleccionados fueron publicados en los últimos 4 años de la investigación y todos presentaron un enfoque cuantitativo. Los hallazgos fueron: tres conceptos diferentes de presentismo; diferentes períodos de recuperación; cinco instrumentos de medida y factores que influyen en el presentismo. Conclusión: los estudios que investigan el presentismo en los profesionales de la salud aún son escasos, y la falta de estandarización de instrumentos y periodos de recordación provocan sesgos en los resultados encontrados en la literatura y dificultan la investigación y aplicación del tema

Elaboração e Avaliação de uma Cartilha sobre os Cuidados para Realizar uma Alimentação Segura na Clínica de Cuidados Paliativos Oncológicos / Elaboration and Appraisal of a Booklet on Care for Safe Eating at an Oncology Palliative Care Clinic / Elaboración y Evaluación de Cartilla de Cuidados para una Alimentación Segura en la Clínica de Cuidados Paliativos Oncológicos

Introdução: Cuidados paliativos são uma abordagem que busca compreender e auxiliar pacientes com comorbidades que ameaçam a vida. O fonoaudiólogo paliativista atua na interação entre paciente e familiar por meio da reabilitação da comunicação e manutenção da alimentação por via oral. Manter os pacientes, cuidadores e a própria equipe de saúde informados sobre os cuidados com a alimentação e prevenção do risco de broncoaspiração é de extrema importância, e a utilização de materiais impressos, como cartilhas educativas, é uma grande aliada na educação em saúde. Objetivo: Elaborar e avaliar uma cartilha educativa sobre os cuidados para realizar uma alimentação segura para cuidadores de pacientes em cuidados paliativos. Método: Pesquisa de campo com a participação de dez cuidadores/ acompanhantes de pacientes em cuidados paliativos e dez profissionais de saúde de um hospital oncológico que trabalham nas clínicas de cuidados paliativos. Para a avaliação da cartilha proposta, todos os participantes responderam a questionários que continham perguntas referentes ao entendimento, linguagem utilizada, compreensão dos cuidados com a alimentação, entre outras informações pertinentes para sua avaliação. Em seguida, realizou-se a estatística descritiva para tratamento dos dados obtidos. Resultados: A média de aprovação da cartilha foi de 9,65 para o grupo de profissionais de saúde e 10,00 para os cuidadores/acompanhantes. Conclusão: A cartilha intitulada "Guia de Cuidados para Realizar uma Alimentação Segura" obteve alta aprovação pelo público pesquisado e foi considerada válida para ser utilizada pela população

Introduction: Palliative care is an approach that seeks to understand and help patients who have life-threatening comorbidities. The palliative speech therapist acts in the interaction between patient and family through the rehabilitation of communication and maintenance of oral feeding. Keeping patients, caregivers and the health team informed about care with nutrition and prevent the risk of bronchoaspiration is extremely important, and the utilization of printed materials, such as educational booklets, are great allies in health education. Objective: To develop and evaluate an educational booklet on care for safe eating for caregivers of patients in palliative care. Method: A field survey was carried out with the participation of ten caregivers/companions of patients in palliative care and ten health professionals from an oncology hospital who work in palliative care clinics. For the evaluation of the proposed booklet, all participants responded to a questionnaire addressing topics as comprehension, language utilized, understanding of food care, among other relevant information to their evaluation. Afterwards, descriptive statistics was performed to treat the data obtained. Results: The average approval of the booklet by the group of health professionals was 9.65 and by caregivers/companions, 10.00. Conclusion: The booklet entitled "Care guide for safe eating" was highly approved by the public investigated and considered valid to be adopted by the population

Introducción: Los cuidados paliativos son un abordaje que busca comprender y ayudar a los pacientes que presentan comorbilidades que amenazan su vida. El fonoaudiólogo paliativo actúa en la interacción entre paciente y familia mediante la rehabilitación de la comunicación y el mantenimiento de la alimentación oral. Mantener informados a los pacientes, cuidadores y al equipo de salud sobre los cuidados con la nutrición y la prevención del riesgo de broncoaspiración es de suma importancia, y el uso de materiales impresos, como cartillas educativas, es un gran aliado en la educación en salud. Objetivo: Desarrollar y evaluar una cartilla educativa sobre cuidados para realizar una alimentación segura para cuidadores de pacientes en cuidados paliativos. Método: Se realizó una encuesta de campo con la participación de diez cuidadores/acompañantes de pacientes en cuidados paliativos y diez profesionales de la salud de un hospital oncológico que laboran en clínicas de cuidados paliativos. Para la evaluación de la cartilla propuesta, todos los participantes respondieron cuestionarios que contenían preguntas sobre comprensión, lenguaje utilizado, comprensión del cuidado con la alimentación, entre otras informaciones relevantes para su evaluación. Después, se realizó estadística descriptiva para el tratamiento de los datos obtenidos. Resultados: El promedio de aprobación de la cartilla fue de 9,65 para el grupo de profesionales de la salud y de 10,00 para los cuidadores/ acompañantes. Conclusión: La cartilla titulada "Guía de cuidados para una alimentación segura" fue altamente aprobada por el público encuestado y considerada válida para su uso por la población

Presenteísmo e sua influência sobre a capacidade para o trabalho em profissionais de saúde / Presenteeism and its influence on health personnel's capacity for work / El presentismo y su influencia en la capacidad para el trabajo en profesionales de la salud

Objetivo: identificar a prevalência de presenteísmo em profissionais de saúde e analisar a influência de variáveis sociodemográficas e ocupacionais sobre esse fenômeno, bem como sua influência sobre o índice de capacidade para o trabalho. Método: estudo observacional, transversal com abordagem quantitativa, realizado com 299 profissionais de saúde de um hospital público de ensino. Utilizou-se os instrumentos: Índice de Capacidade para o Trabalho e a Escala de Presenteísmo de Stanford. Aplicaram-se testes de Regressão linear múltipla e de regressão logística. Resultados: a análise de regressão logística revelou que as mulheres tiveram chance 1,88 vezes maior (1,06-3,32 e p=0,03) de apresentar presenteísmo. A regressão linear múltipla mostrou influência dos seguintes preditores na capacidade para o trabalho: presenteísmo (ß=-0,35, p<0,001), sexo (ß=-0,28, p<0,001) e categoria profissional (ß=-0,12, p=0,03). Conclusão: o presenteísmo prevaleceu entre os profissionais de saúde e exerceu influência na sua capacidade para o trabalho.

Objective: to identify the prevalence of presenteeism among health personnel and to examine the influence of sociodemographic and occupational variables on this phenomenon, as well as its influence on the work ability index. Method: this quantitative, observational, cross-sectional study was conducted with 299 health personnel from a public teaching hospital. The Work Ability Index and the Stanford Presenteeism Scale were used. Multiple linear regression and logistic regression tests were applied. Results: logistic regression analysis revealed that women were 1.88 times more likely (1.06-3.32 and p=0.03) to display presenteeism. Multiple linear regression showed following predictors influenced work ability: presenteeism (ß ¬= 0.35, p<0.001), gender (ß= 0.28, p<0.001) and professional category (ß= 0.12, p=0.03). Conclusion: presenteeism was prevalent among health personnel and influenced their ability to work.

Objetivo: identificar la prevalencia del presentismo entre profesionales de la salud y analizar la influencia de variables sociodemográficas y ocupacionales sobre este fenómeno, así como su influencia en el índice de capacidad para el trabajo. Método: estudio observacional transversal con enfoque cuantitativo, realizado con 299 profesionales de la salud de un hospital público de enseñanza. Se utilizaron los siguientes instrumentos: Índice de Capacidad para el Trabajo y la Escala de Presentismo de Stanford. Se aplicaron pruebas de regresión lineal múltiple y regresión logística. Resultados: El análisis de regresión logística reveló que las mujeres tenían 1,88 veces más probabilidades (1,06-3,32 y p=0,03) de presentismo. La regresión lineal múltiple mostró la influencia de los siguientes predictores sobre la capacidad laboral: presentismo (ß=-0.35, p<0.001), género (ß=-0.28, p<0.001) y categoría profesional (ß=-0,12, p=0.03). Conclusión: el presentismo prevaleció entre los profesionales de la salud e influyó en su capacidad de trabajo.

Fatigue due to compassion in health professionals and coping strategies: a scoping review.

OBJECTIVES: to identify the current state of knowledge on compassion fatigue in the work context of healthcare professionals; and how coping strategies are established in this scenario. METHOD: a scoping review with search applied to the databases: MEDLINE, LILACS, CINAHL, Scopus. Temporal limit: 2009 to 2019. The data was analyzed and synthesized in narrative form. RESULTS: thirty articles were selected, synthesized into two categories: a) Health work and compassion fatigue: conceptual analysis, context, and manifestations; b) Coping strategies for compassion fatigue. CONCLUSIONS: this study presented: a descriptive and general panorama about compassion fatigue in healthcare professionals, identifying a greater consolidation of the concept between 2015 and 2018; and some coping strategies. The association between health and spirituality is highlighted as one of the strategies in this scenario, enabling new research to be conducted in view of the importance of the theme in life, health work.

Fatigue due to compassion in health professionals and coping strategies: a scoping review / Desgaste por empatía en el contexto de los profesionales de salud y estrategias de enfrentamiento: scoping review / Fadiga por compaixão no contexto dos profissionais da saúde e estratégias de enfrentamento: scoping review

ABSTRACT Objectives: to identify the current state of knowledge on compassion fatigue in the work context of healthcare professionals; and how coping strategies are established in this scenario. Method: a scoping review with search applied to the databases: MEDLINE, LILACS, CINAHL, Scopus. Temporal limit: 2009 to 2019. The data was analyzed and synthesized in narrative form Results: thirty articles were selected, synthesized into two categories: a) Health work and compassion fatigue: conceptual analysis, context, and manifestations; b) Coping strategies for compassion fatigue. Conclusions: this study presented: a descriptive and general panorama about compassion fatigue in healthcare professionals, identifying a greater consolidation of the concept between 2015 and 2018; and some coping strategies. The association between health and spirituality is highlighted as one of the strategies in this scenario, enabling new research to be conducted in view of the importance of the theme in life, health work.

RESUMEN Objetivos: identificar el estado actual del conocimiento sobre desgaste por empatía en el contexto laboral de profesionales de salud; y como las estrategias de enfrentamiento se establecen en ese escenario. Métodos: scoping review con búsqueda aplicada en las bases de datos: MEDLINE, LILACS, CINAHL, Scopus. Límite temporal: 2009 a 2019. Datos analizados y sintetizados de manera narrativa. Resultados: seleccionaron 30 artículos, sintetizados en dos categorías: a) Trabajo en salud y desgaste por empatía: análisis conceptual, contexto y manifestaciones; b) Estrategias de enfrentamiento del desgaste por empatía. Conclusiones: estudio presentó: un panorama descriptivo y general sobre desgaste por empatía en profesionales de salud, identificando una mayor consolidación del concepto entre 2015 y 2018; y algunas estrategias de enfrentamiento. Resaltando la relación entre salud y espiritualidad como una de las estrategias en ese escenario, posibilitando que nuevas investigaciones sean realizadas delante importancia del tema en la vida, en el trabajo en salud.

RESUMO Objetivos: identificar o estado atual do conhecimento sobre fadiga por compaixão no contexto do trabalho de profissionais de saúde; e como as estratégias de enfrentamento se estabelecem nesse cenário. Métodos: scoping review com busca aplicada nas bases de dados: MEDLINE, LILACS, CINAHL, Scopus. Limite temporal: 2009 a 2019. Os dados foram analisados e sintetizados de forma narrativa. Resultados: selecionaram-se 30 artigos, sintetizados em duas categorias: a) Trabalho em saúde e fadiga por compaixão: análise conceitual, contexto e manifestações; b) Estratégias de enfrentamento da fadiga por compaixão. Conclusões: o estudo apresentou: um panorama descritivo e geral sobre fadiga por compaixão em profissionais de saúde, identificando uma maior consolidação do conceito entre 2015 e 2018; e algumas estratégias de enfrentamento. Ressalta-se a associação entre saúde e espiritualidade como uma das estratégias nesse cenário, possibilitando que novas pesquisas sejam realizadas diante da importância do tema na vida, no trabalho em saúde.

Strength exercise suppresses STZ-induced spatial memory impairment and modulates BDNF/ERK-CAMKII/CREB signalling pathway in the hippocampus of mice.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that has generated scientific interest because of its prevalence in the population. Studies indicate that physical exercise promotes neuroplasticity and improves cognitive function in animal models and in human beings. The aim of the present study was to investigate the effects of strength exercise on the hippocampal protein contents and memory performance in mice subjected to a model of sporadic AD induced by streptozotocin (STZ). Swiss mice received two injections of STZ (3 mg/kg, intracerebroventricular). After 21 days, they began physical training using a ladde. Mice performed this protocol for 4 weeks. After the last exercise training session, mice performed the Morris Water Maze test. The samples of hippocampus were excised and used to determine protein contents of brain-derived neurotrophic factor (BDNF), extracellular signal-regulated kinase-Ca2+ (ERK), calmodulin-dependent protein kinase (CAMKII) and cAMP-response element-binding protein (CREB) signalling pathway. Strength exercise was effective against the decrease in the time spent and distance travelled in the target quadrant by STZ-injected mice. Strength exercise was also effective against the reduction of mature BDNF, tropomyosin receptor kinase B and neuronal nuclear antigen (NeuN) hippocampal protein levels in STZ mice. The decrease in the hippocampal ratio of pERK/ERK, pCAMKII/CAMKII and pCREB/CREB induced by STZ was reversed by strength exercise. Strength exercise decreased Bax/Bcl2 ratio in the hippocampus of STZ-injected mice. The present study demonstrates that strength exercise modulated the hippocampal BDNF/ERK-CAMKII/CREB signalling pathway and suppressed STZ-induced spatial memory impairment in mice.

Pre-clinical evaluation of a P. berghei-based whole-sporozoite malaria vaccine candidate.

Whole-sporozoite vaccination/immunization induces high levels of protective immunity in both rodent models of malaria and in humans. Recently, we generated a transgenic line of the rodent malaria parasite P. berghei (Pb) that expresses the P. falciparum (Pf) circumsporozoite protein (PfCS), and showed that this parasite line (PbVac) was capable of (1) infecting and developing in human hepatocytes but not in human erythrocytes, and (2) inducing neutralizing antibodies against the human Pf parasite. Here, we analyzed PbVac in detail and developed tools necessary for its use in clinical studies. A microbiological contaminant-free Master Cell Bank of PbVac parasites was generated through a process of cyclic propagation and clonal expansion in mice and mosquitoes and was genetically characterized. A highly sensitive qRT-PCR-based method was established that enables PbVac parasite detection and quantification at low parasite densities in vivo. This method was employed in a biodistribution study in a rabbit model, revealing that the parasite is only present at the site of administration and in the liver up to 48 h post infection and is no longer detectable at any site 10 days after administration. An extensive toxicology investigation carried out in rabbits further showed the absence of PbVac-related toxicity. In vivo drug sensitivity assays employing rodent models of infection showed that both the liver and the blood stage forms of PbVac were completely eliminated by Malarone® treatment. Collectively, our pre-clinical safety assessment demonstrates that PbVac possesses all characteristics necessary to advance into clinical evaluation.

A Plasmodium berghei sporozoite-based vaccination platform against human malaria.

There is a pressing need for safe and highly effective Plasmodium falciparum (Pf) malaria vaccines. The circumsporozoite protein (CS), expressed on sporozoites and during early hepatic stages, is a leading target vaccine candidate, but clinical efficacy has been modest so far. Conversely, whole-sporozoite (WSp) vaccines have consistently shown high levels of sterilizing immunity and constitute a promising approach to effective immunization against malaria. Here, we describe a novel WSp malaria vaccine that employs transgenic sporozoites of rodent P. berghei (Pb) parasites as cross-species immunizing agents and as platforms for expression and delivery of PfCS (PbVac). We show that both wild-type Pb and PbVac sporozoites unabatedly infect and develop in human hepatocytes while unable to establish an infection in human red blood cells. In a rabbit model, similarly susceptible to Pb hepatic but not blood infection, we show that PbVac elicits cross-species cellular immune responses, as well as PfCS-specific antibodies that efficiently inhibit Pf sporozoite liver invasion in human hepatocytes and in mice with humanized livers. Thus, PbVac is safe and induces functional immune responses in preclinical studies, warranting clinical testing and development.

Lead toxicity promotes autonomic dysfunction with increased chemoreceptor sensitivity.

Mortality and morbidity by toxic metals is an important issue of occupational health. Lead is an ubiquitous heavy metal in our environment despite having no physiological role in biological systems. Being an homeostatic controller is expected that the autonomic nervous system would show a degree of impairment in lead toxicity. In fact, sympathoexcitation associated to high blood pressure and tachypnea has been described together with baroreflex dysfunction. However, the mechanisms underlying the autonomic dysfunction and the interplay between baro- and chemoreflex are not yet fully clarified. The angiotensinogenic PVN-NTS axis (paraventricular nucleus of the hypothalamus - nucleus tractus solitarius axis) is a particularly important neuronal pathway that could be responsible for the autonomic dysfunction and the cardiorespiratory impairment in lead toxicity. Within the current work, we addressed in vivo, baro- and chemoreceptor reflex behaviour, before and after central angiotensin inhibition, in order to better understand the cardiorespiratory autonomic mechanisms underlying the toxic effects of long-term lead exposure. For that, arterial pressure, heart rate, respiratory rate, sympathetic and parasympathetic activity and baro- and chemoreceptor reflex profiles of anaesthetized young adult rats exposed to lead, from foetal period to adulthood, were evaluated. Results showed increased chemosensitivity together with baroreceptor reflex impairment, sympathetic over-excitation, hypertension and tachypnea. Chemosensitivity and sympathetic overexcitation were reversed towards normality values by NTS treatment with A-779, an angiotensin (1-7) antagonist. No parasympathetic changes were observed before and after A-799 treatment. In conclusion, angiotensin (1-7) at NTS level is involved in the autonomic dysfunction observed in lead toxicity. The increased sensitivity of chemoreceptor reflex expresses the clear impairment of autonomic outflow to the cardiovascular and respiratory systems induced by putative persistent, long duration, alert reaction evoked by the long term exposure to lead toxic effects. The present study brings new insights on the central mechanisms implicated in the autonomic dysfunction induced by lead exposure which are relevant for the development of additional therapeutic options to tackle lead toxicity symptoms.

Reversing gene expression in cardiovascular target organs following chronic depression of the paraventricular nucleus of hypothalamus and rostral ventrolateral medulla in spontaneous hypertensive rats.

BACKGROUND: Chronic overexpression of an inwardly rectifying potassium channel (hKir2.1) in the paraventricular nucleus of the hypothalamus (PVN) and in the rostral ventrolateral medulla (RVLM) to suppress neuronal excitability, resulted in a long term decrease of blood pressure and sympathetic output in spontaneously hypertensive rats (SHR). OBJECTIVE: Evaluate gene expression in end-organs of SHR after a chronic overexpression of hKir2.1 channels in either the PVN or RVLM. METHODS: mRNA levels of 16 genes known to be involved with blood pressure regulation were evaluated using RT-PCR in tissues from the heart, common carotid artery and kidney of SHR submitted to chronic depression of PVN and RVLM excitability using a lentiviral vector (LVhKir2.1). RESULTS: In SHR hearts in which either the PVN or RVLM were injected with LVhKir2.1, there was a downregulation of angiotensin II receptor 1b (AT1), ATPase, Ca(2+)-transporter, troponin T2 and tropomyosin2 (only in RVLM) relative to the sham group. In the kidney of SHR with LVhKir2.1 injections in PVN and RVLM, angiotensinogen, angiotensin II receptor2 (AT2) and endothelin1 were all upregulated compared to sham. In the carotid artery, endothelin2, endothelin receptor A and B were up-regulated following LVhKir2.1 in to either the PVN or RVLM relative to sham. CONCLUSION: Chronic overexpression of hKir2.1 channels in PVN and RVLM, promoted a BP decrease with up-regulation of angiotensinogen and AT2 genes expression in the kidney and down-regulation of AT1 in the heart of SHR. Thus, we demonstrate the potential efficacy of central manipulation to protect against end-organ damage in essential hypertension.

SPEECH THERAPY INTERVENTION IN MORBIDLY OBESE UNDERGOING FOBI-CAPELL GASTROPLASTY METHOD.

BACKGROUND: The rehabilitation of complications related to oral feeding, resulting from gastroplasty is the competence of the speech therapist, to intervene in mastication and swallowing functions, aiming at quality of life. AIM: Check in the postoperative period the efficiency of stimulation, independent judges in readiness for re-introduction of solid food in morbidly obese undergoing gastroplasty. METHOD: Cross-sectional study of descriptive and quantitative evaluated mastication and quality of life of 70 morbidly obese patients undergoing gastroplasty, and a group of 35 obese suffered speech therapy. RESULTS: In the evaluation of mastication for group 1 (pre and post speech therapy), the results show that, except for the lack of chewing, the other variables, such as food court, type of mastication, mastication rhythm, jaw movements, bolus size, excessive mastication and fluid intake, demonstrate statistical insignificance. In evaluating the quality of life when compared groups 1 and 2, the results from the questionnaire on quality of life in dysphagia (SWAL-QoL - Quality of Life in Swallowing) total and 11 domains assessed in the questionnaire, were statistically significant. With these results, the group 2 presented unfavorable conditions for quality of life. CONCLUSION: The stimulation protocol, independent judges in readiness for re-introduction of solid food of these patients in the postoperative period, applied in these conditions of the study, was not the distinguishing factor of the rehabilitation process for the observed period.

Speech therapy intervention in morbidly obese undergoing fobi-capell gastroplasty method / Intervenção fonoaudiológica em obesos mórbidos submetidos à gastroplastia pela técnica de fobi-capella

Background: The rehabilitation of complications related to oral feeding, resulting from gastroplasty is the competence of the speech therapist, to intervene in mastication and swallowing functions, aiming at quality of life. Aim: Check in the postoperative period the efficiency of stimulation, independent judges in readiness for re-introduction of solid food in morbidly obese undergoing gastroplasty. Method: Cross-sectional study of descriptive and quantitative evaluated mastication and quality of life of 70 morbidly obese patients undergoing gastroplasty, and a group of 35 obese suffered speech therapy. Results: In the evaluation of mastication for group 1 (pre and post speech therapy), the results show that, except for the lack of chewing, the other variables, such as food court, type of mastication, mastication rhythm, jaw movements, bolus size, excessive mastication and fluid intake, demonstrate statistical insignificance. In evaluating the quality of life when compared groups 1 and 2, the results from the questionnaire on quality of life in dysphagia (SWAL-QoL - Quality of Life in Swallowing) total and 11 domains assessed in the questionnaire, were statistically significant. With these results, the group 2 presented unfavorable conditions for quality of life. Conclusion: The stimulation protocol, independent judges in readiness for re-introduction of solid food of these patients in the postoperative period, applied in these conditions of the study, was not the distinguishing factor of the rehabilitation process for the observed period.

Racional: A reabilitação das complicações relacionadas à fase oral da alimentação decorrentes da gastroplastia é de competência do fonoaudiólogo para intervir nas funções de mastigação e deglutição, objetivando a qualidade de vida. Objetivo: Verificar a eficiência da estimulação da motricidade orofacial na prontidão para reintrodução da alimentação sólida em obesos mórbidos submetidos à gastroplastia no período pós-operatório. Método: Estudo do tipo transversal de caráter descritivo e quantitativo avaliou mastigação e qualidade de vida de 70 obesos mórbidos submetidos à gastroplastia, sendo que um grupo de 35 obesos sofreu intervenção fonoaudiológica. Resultados: Na avaliação da mastigação para o grupo 1 (pré e pós-intervenção fonoaudiológica), os resultados obtidos mostram que, à exceção da escassez de mastigação, as demais variáveis, como corte do alimento, tipo de mastigação, ritmo de mastigação, movimentos de mandíbula, tamanho do bolo alimentar, excesso de mastigação e ingestão de líquido, não demonstram significância estatística. Na avaliação da qualidade de vida, quando comparados os grupos 1 e 2, os resultados obtidos no questionário de qualidade de vida em disfagia (SWAL-QoL - Quality of Life in Swallowing) total e nos 11 domínios avaliados no questionário, demonstraram significância estatística. Com esses resultados, o grupo 2 apresentou condições desfavoráveis em relação à qualidade de vida. Conclusão: O protocolo de estimulação da motricidade orofacial na prontidão para reintrodução da alimentação sólida destes doentes no período pós-operatório não foi o fator diferencial do processo de reabilitação para o período observado.

Essential role of RVL medullary neuronal activity in the long term maintenance of hypertension in conscious SHR.

BACKGROUND: It is well established that sympathetic nervous system is responsible for the onset, development and maintenance of neurogenic hypertension. The rostroventrolateral medulla (RVLM) and medullo-cervical pressor area (MCPA) are important central sympathoexcitatory regions whose role on neurogenic hypertension remains unknown. OBJECTIVE: To establish RVLM and MCPA roles in the long-term regulation of blood pressure by depressing their neuron activity through the over-expression of hKir2.1-potassium channel in conscious spontaneously hypertensive rats (SHR). METHODS: In SHR, a lentiviral vector LVV-hKir2.1 was microinjected into RVLM or MCPA areas. A sham group was injected with LVV-eGFP. Blood pressure (BP) and heart rate (HR) were continuously monitored for 75 days. Baroreflex and chemoreflex functions were evaluated. Baroreflex gain, chemoreflex sensitivity, BP and HR variability were calculated. RESULTS: LVV-hKir2.1 expression in RVLM, but not in MCPA, produced a significant time-dependent decrease in systolic, diastolic, mean-BP and LF of systolic BP at 60-days post-injection. No significant changes were seen in LVV-eGFP RVLM injected SHR. CONCLUSION: Data show that chronic expression of Kir2.1 in the RVLM of conscious SHR caused a marked and sustained decrease in BP without changes in the baro- and peripheral chemoreceptor reflex evoked responses. This decrease was mostly due to a reduction in sympathetic output revealed indirectly by a decrease in the power density of the SBP-LF band. Our data are amongst the firsts to demonstrate the role of the RVLM in maintaining BP levels in hypertension in conscious SHR. We suggest that a decrease in RVLM neuronal activity is an effective anti-hypertensive treatment strategy.

Contribution of dopaminergic and adenosinergic systems in the antinociceptive effect of p-chloro-selenosteroid.

This study investigated the antinociceptive action of p-chloro-selenosteroid (PCS), administered by intragastric route (i.g.) to mice against acute models. The contribution of adenosinergic, dopaminergic, serotonergic, nitric oxide and opioid systems was investigated. It was evaluated if the administration of PCS triggers toxic effect. Treatment with PCS (10mg/kg) reduced writhing induced by acetic acid and its effect lasts up to 48 h after treatment. The compound caused an inhibition in neurogenic and inflammatory phases of nociception and in paw edema induced by formalin. The licking behavior triggered by glutamate was reduced by PCS. In the tail-immersion test, PCS elicited an increase in delta latency response. Pretreatment with caffeine (3mg/kg, intraperitoneally [i.p.]) and SCH58261 (3mg/kg, i.p.), antagonist at adenosinergic receptors, SCH23390 (0.05 mg/kg, i.p.) and sulpiride (5mg/kg, i.p.), antagonist at dopaminergic receptors, caused a reduction in the antinociceptive action of PCS in the glutamate test. By contrast, pretreatment with WAY100635 (0.7 mg/kg, i.p.), ketanserin (0.3mg/kg, i.p.), ondasentron (0.5mg/kg, i.p.), l-arginine (600 mg/kg, i.p.) and naloxone (1mg/kg, subcutaneous [s.c.]) did not abolish the antinociceptive effect caused by PCS (10mg/kg, i.g.) administration. The animals treated with PCS did not show alterations in locomotor and exploratory activities, in biochemical parameters evaluated, food and water consumption, as well as in the body weight. These results clearly showed the antinociceptive action of PCS in different animal models without causing acute toxic effects in mice. Adenosinergic and dopaminergic systems seem to be related to the mechanisms by which PCS elicits antinociception.

Chronic depression of hypothalamic paraventricular neuronal activity produces sustained hypotension in hypertensive rats.

Changes in the sympathetic nervous system are responsible for the initiation, development and maintenance of hypertension. An important central sympathoexcitatory region is the paraventricular nucleus (PVN) of the hypothalamus, which may become more active in hypertensive conditions, as shown in acute studies previously. Our objective was to depress PVN neuronal activity chronically by the overexpression of an inwardly rectifying potassium channel (hKir2.1), while evaluating the consequences on blood pressure (BP) and its reflex regulation. In spontaneously hypertensive rats (SHRs) and Wistar rats (WKY) lentiviral vectors (LVV-hKir2.1; LV-TREtight-Kir-cIRES-GFP5 4 × 10(9) IU and LV-Syn-Eff-G4BS-Syn-Tetoff 6.2 × 10(9) IU in a ratio 1:4) were stereotaxically microinjected bilaterally into the PVN. Sham-treated SHRs and WKY received bilateral PVN microinjections of LVV-eGFP (LV-Syn-Eff-G4BS-Syn-Tetoff 6.2 × 10(9) IU and LV-TREtight-GFP 5.7 × 10(9) IU in a ratio 1:4). Blood pressure was monitored continuously by radio-telemetry and evaluated over 75 days. Baroreflex gain was evaluated using phenylephrine (25 µg ml(-1), i.v.), whereas lobeline (25 µg ml(-1), i.v.) was used to stimulate peripheral chemoreceptors. In SHRs but not normotensive WKY rats, LVV-hKir2.1 expression in the PVN produced time-dependent and significant decreases in systolic (from 158 ± 3 to 132 ± 6 mmHg; P < 0.05) and diastolic BP (from 135 ± 4 to 113 ± 5 mmHg; P < 0.05). The systolic BP low-frequency band was reduced (from 0.79 ± 0.13 to 0.42 ± 0.09 mmHg(2); P < 0.05), suggesting reduced sympathetic vasomotor tone. Baroreflex gain was increased and peripheral chemoreflex depressed after PVN microinjection of LVV-hKir2.1. We conclude that the PVN plays a major role in long-term control of BP and sympathetic nervous system activity in SHRs. This is associated with reductions in both peripheral chemosensitivity and respiratory-induced sympathetic modulation and an improvement in baroreflex sensitivity. Our results support the PVN as a powerful site to control BP in neurogenic hypertension.

Perfil mastigatório de obesos mórbidos submetidos à gastroplastia / Masticatory profile of morbidly obese patients undergoing gastroplasty

OBJETIVO: traçar o perfil mastigatório do obeso mórbido. MÉTODO: estudo pareado por idade e sexo avaliou motricidade orofacial e mastigação de 40 obesos mórbidos submetidos à gastroplastia e 40 eutróficos sem queixas de mastigação e/ou deglutição. RESULTADOS: obesos mórbidos apresentaram: alteração de práxis e variáveis de lábios, língua, além de alteração no tamanho de mandíbula; na avaliação de mastigação habitual - ritmo rápido, movimentação vertical de mandíbula, tamanho grande do bolo, escassez de mastigação e necessidade de líquido durante a mastigação; nas avaliações de mastigações lateralizadas - ausência de corte do alimento, ritmo rápido, movimentação vertical de mandíbula, tamanho grande do bolo e escassez de mastigação. CONCLUSÃO: pacientes obesos mórbidos apresentam alterações de mastigação.

PURPOSE: to trace a profile of morbidly obese patient chewing. METHOD: study matched for age and sex evaluated oral motor and chew of 40 morbidly obese patients undergoing bariatric surgery and 40 eutrophic with no complaints of chewing and/or swallowing. RESULTS: morbidly obese showed: change in praxis and variables of lips and tongue and change in mandible size upon evaluating the mastication process - fast pace, vertical movement of the jaw, large size of the pie, chewing scarcity and need for fluid during chewing; in evaluations of lateralized chewing - no food cut, fast pace, the vertical movement of the jaw, large size of the cake and a shortage of mastication. CONCLUSION: morbidly obese patients show chewing alterations.

Senescência e senilidade: novo paradigma na atenção básica de saúde / Senescence and senility: the new paradigm in primary health care / Senectud y senilidad: nuevo paradigma en la atención básica de salud

A senescência e a senilidade são temas cada vez mais explorados, considerando o crescente aumento da população idosa no mundo, principalmente no Brasil. A assistência ao idoso deve prezar pela manutenção da qualidade de vida, considerando o processo de perdas próprias do envelhecimento e as possibilidades de prevenção, manutenção e reabilitação do seu estado de saúde. Conhecer o cotidiano dos idosos tem sido um desafio para os profissionais de saúde para implementar programas e ações que visem alcançar a manutenção do equilíbrio no processo saúde-doença, e é nessa busca que temos envidado esforços para contribuir, de forma efetiva, nas estratégias de fortalecimento dos idosos e seus familiares, de forma a tornar possível o desencadeamento de ações na promoção da saúde, principalmente considerando que o desafio para este milênio é construir uma consciência coletiva para alcançar uma sociedade para todas as idades, com justiça e garantia plena de direitos.

Senescence and senility are themes of growing interest, considering the inxrease of the elderly population in the wrold, particularly in Brazil. Health care for the edlery should value to maintain quality of life, considering the loss process particular of aging and the possiblities to prevent, maintenain and rehabilitate their health condition. Knowing the everyday lives of the elderly has been a challenge for health care professsionals regardint the implementation of programs and actions that aim to maintain the balance of the health-disease process, and it is in this search that we have made efforts to constibute, effectively, with the strategies to strengthen the edlerly and their relatives so it becomes possible to trigger health promotion actions, especially considering that the challenge for the millenium is to build collective awareness to achieve a society for all ages, with justice and the guarantee of full rights.

La senectud y senilidad constituyen temas ampliamente investigados, considerando el aumento de la población anciana en el mundo, principalmente en Brasil. La atención al anciano debe velar por el mantenimiento de su calidad de vida, estimando el proceso de pérdidas propias del envejecimiento y las posibilidades de prevención, mantenimiento y rehabilitación de su salud. Conocer la rutina del anciano se ha tornado un desafío para los profesionales de salud en lo que atañe a implementar programas y acciones que apunten a alcanzar el equilibrio del proceso salud-enfermedad, y en tal búsqueda hemos efectuado esfuerzos para contribuir efectivamente en las estrategias de mejoramiento integral del anciano y sus familiares, a fin de hacer posible el desencadenamiento de acciones promotoras de salud, considerando principalmente que el desafío para este milenio es construir una conciencia colectiva que alcance a una sociedad para todas las edades, con justicia y plena garantía de derechos.

Nado submerso ondulatório: uma visão sobre o quinto nado / Underwater undulatory swimming: a vision about the fifth swim

Este trabalho de revisão tem como objetivo analisar o Nado Submerso Ondulatório (NSO) que é considerado pelos atletas e treinadores como o “quinto nado”. Este nome surgiu devido aos quatro nados já conhecidos (crawl/livre, costas, peito e borboleta). Em qualquer um destes quatro nados, o NSO é utilizado nos momentos da saída do bloco e nos momentos de viradas devido a sua eficiência. Sabe-se que esses momentos são importantíssimos e que contribuem para a classificação dos nadadores durante as competições. Apesar da grande utilização desta técnica e de sua importância, poucos estudos vêm sendo realizados com a intenção de estudar as variáveis relacionadas ao NSO. Assim, esta revisão serve como uma tentativa de preenchimento dessa lacuna importante para área da Educação Física. Além disso, pretende-se com este trabalho levantar questões referentes ao NSO que servirão tanto para a aplicação prática como para a melhor compreensão desta técnica.

This review aims to examine the underwater undulatory swimming (UUS) that is considered by athletes and coaches as the fifth swim. This name came about due to the four already known swims (crawl/freestyle, backstroke, breaststroke and butterfly). In any of these four swims, the UUS is used in the moments of output of the block and in the moments of turns because of their efficiency. It is known that these moments are very important and contribute to the classification of swimmers during the competition. Despite the wide use of this technique and its importance, few studies have been done with the intent to study the variables related to the UUS. This review serves as an attempt to fill this important gap for the Physical Education area. Furthermore, to pretend of this work raise questions concerning the UUS that will serve both the practical application and to better understand this technique.