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1.  Cardiovascular responses induced by Catalase Inhibitior into the Fourth Cerebral Ventricle is changed in Wistar rats exposed to sidestream cigarette smoke 
Objectives
This experimental study aimed to evaluate the effects of central catalase inhibition on cardiovascular responses in rats exposed to sidestream cigarette smoke (SSCS) for 3 weeks.
Methodology
A total of 20 males Wistar rats (320–370g) were implanted with a stainless steel guide cannula into the fourth cerebral ventricle (4thV). Femoral artery and vein were cannulated for mean arterial pressure (MAP) and heart rate (HR) measurement and drug infusion, respectively. Rats were exposed to SSCS for three weeks, 180 minutes per day, 5 days/week [carbon monoxide (CO): 100–300 ppm)]. Baroreflex was tested with one pressor dose of phenylephrine (PHE, 8 μg/kg, bolus) and one depressor dose of sodium nitroprusside (SNP, 50 μg/kg, bolus). Cardiovascular responses were evaluated before and 15 minutes after 3-amino-1, 2, 4-triazole (ATZ, catalase inhibitor, 0.001g/100μL) injection into the 4th V.
Results
Vehicle treatment into the 4th V did not change cardiovascular responses. Central catalase inhibition increased tachycardic peak, attenuated bradycardic peak and reduced HR range at 15 minutes, increased MAP at 5, 15 and 30 min and increased HR at 5 and 15 min. In rats exposed to SSCS, central ATZ increased basal MAP after 5 min and increased HR at 5, 15 and 30 minutes, respectively, and attenuated bradycardic peak at 15 minutes.
Conclusion
This study suggests that brain oxidative stress caused by SSCS influences autonomic regulation of the cardiovascular system.
PMCID: PMC3883609  PMID: 24421748
Baroreflex; Oxidative Stress; Catalase inhibition; Medulla Oblongata; sidestream cigarette smoking
2.  Auditory stimulation with music influences the geometric indices of heart rate variability in men 
Background
Chronic classical music was reported to increase parasympathetic activitywhen evaluating heart rate variability (HRV). It is poor in the literature investigation of the acute effects of baroque and heavy metal styles of musical auditory stimulation on HRV. In this study we evaluated the acute effects of relaxant baroque and excitatory heavy metal music on the geometric indices of HRV in healthy men.
Method
The study was performed in 12 healthy men between 18 and 30 years old. We excluded persons with previous experience with music instrument and those who had affinity with the song styles. We analyzed the following indices: RRtri, TINN and Poincaré plot (SD1, SD2 and SD1/SD2 ratio). HRV was recorded at rest for ten minutes. Subsequently they were exposed to relaxant baroque or excitatory heavy metal music for five minutes through an earphone. After the first music exposure they remained at rest for more five minutes and them they were exposed again to Baroque or Heavy Metal music (65–80 dB). The sequence of songs was randomized for each individual.
Results
The RRTri and SD2 indices were reduced during the heavy metal musical auditory stimulation (p < 0.05). No changes were observed regarding TINN, SD1 and SD1/SD2 ratio (p > 0.05).The qualitative Poincaré plot analysis indicated that during relaxant classical baroque music there was observed a higher beat-to-beat dispersion of RR intervals compared with no music exposure and during excitatory heavy metal musical auditory stimulation, showing higher HRV.
Conclusion
We suggest that excitatory heavy metal music acutely decreases global HRV.
doi:10.1186/1755-7682-7-27
PMCID: PMC4039650  PMID: 24883104
Autonomic nervous system; Auditory stimulation; Cardiovascular system; Music
3.  Fractal correlation property of heart rate variability in response to the postural change maneuver in healthy women 
Background
We evaluated the effects of the PCM on the fractal analysis of the HRV in healthy women
Method
We evaluated healthy women between 18 and 30 years old. HRV was analyzed in the time (SDNN, RMSSD, NN50 and pNN50) and frequency (LF, HF and LF/HF ratio) domains as well as short and long-term fractal exponents (alpha-1 and alpha-2) of the detrended fluctuation analysis (DFA). HRV was recorded at rest for ten minutes at seated rest and then the women quickly stood up from a seated position in up to three seconds and remained standing for 15 minutes. HRV was recorded at the following time: rest, 0–5 min, 5–10 min and 10–15 min during standing.
Results
We observed decrease (p < 0.05) in the time-domain indices of HRV between seated and 10–15 minutes after the volunteer stood up. The LF (ms2) and HF (ms2) indices were also reduced (p < 0.05) at 10–15 minutes after the volunteer stood up compared to seated while the LF (nu) was increased at 5–10 min and 10–15 min (p < 0.05). The short-term alpha-1 exponent was increased (p < 0.05) at all moments investigated compared to seated. Increase in the properties of short-term fractal correlations of heart rate dynamics accompanied by a decrease in the parasympathetic modulation and global HRV was observed in response to the postural change maneuver.
Conclusion
We suggest that fractal analysis of HRV is more sensitive than frequency and time-domain analysis of HRV during the postural change maneuver.
doi:10.1186/1755-7682-7-25
PMCID: PMC4030044  PMID: 24910714
Autonomic nervous system; Cardiovascular system; Nonlinear dynamics; Physiology
4.  Evolution of female urinary continence after physical therapy and associated factors 
Background
Urinary incontinence (UI) is defined as any involuntary loss of urine that can influence the quality of life, personal hygiene and social interaction. The types of UI that most affect women are stress urinary incontinence, urge incontinence and mixed urinary incontinence. There are several risk factors that result in specific treatments. We aimed to investigate the evolution of female urinary continence after physical therapy intervention and its associated factors.
Method
A retrospective cross-sectional study was conducted with 71 participants who were discharged from physiotherapy sector from August 2006 to April 2012 and met the inclusion criteria.
Results
Among the studied variables, the number of sessions and completion of home pelvic floor exercises showed a significant association. The urinary continence appeared in 43.7% of the cases, and factors, performance of home exercises, and number of sessions showed a significant association.
Conclusion
The number of sessions and completion of home pelvic floor exercises showed a significant relationship with each other.
doi:10.1186/1755-7682-7-24
PMCID: PMC4024111  PMID: 24839462
Urinary incontinence; Patient outcome assessment; Urogynecology; Women’s health
5.  Prevalence of burnout syndrome in clinical nurses at a hospital of excellence 
Background
Burnout syndrome can be defined as long-term work stress resulting from the interaction between constant emotional pressure associated with intense interpersonal involvement for long periods of time and personal characteristics. We investigated the prevalence/propensity of Burnout syndrome in clinical nurses, and the factors related to Burnout syndrome-associated such as socio-demographic characteristics, work load, social and family life, leisure activities, extra work activities, physical activities, and work-related health problems.
Method
We conducted a cross-sectional, quantitative, prospective epidemiological study with 188 surgical clinic nurses. We used the Maslach Burnout Inventory (MBI), which is a socio-demographic questionnaire and the most widely used instrument to assess Burnout syndrome (three basic dimensions: emotional exhaustion, despersonalization and professional underachievement). The socio-demographic profile questionnaire wascomposed of questions regarding identification, training, time at work, work characteristics and personal circumstances.
Results
The prevalence of Burnout syndrome was higher (10.1%) and 55, 4% of subjects had a propensity to develop this syndrome. The analysis of the socio-demographic profile of the nurse sample studied showed that most nurses were childless married women, over 35 years of age, working the day shift for 36 hours weekly on average, with 2-6 years of post-graduation experience, and without extra employments. Factors such as marital status, work load, emotion and work related stress aggravated the onset of the syndrome.
Conclusion
The prevalence and propensity of Burnout syndrome were high. Some factors identified can be useful for the adoption of preventive actions in order to decrease the prevalence of the clinical nurses Burnout syndrome.
doi:10.1186/1755-7682-7-22
PMCID: PMC4031323  PMID: 24860618
Burnout; Professional; Syndrome; Nursing
6.  Association between central auditory processing mechanism and cardiac autonomic regulation 
Background
This study was conducted to describe the association between central auditory processing mechanism and the cardiac autonomic regulation.
Methods
It was researched papers on the topic addressed in this study considering the following data bases: Medline, Pubmed, Lilacs, Scopus and Cochrane. The key words were: “auditory stimulation, heart rate, autonomic nervous system and P300”.
Results
The findings in the literature demonstrated that auditory stimulation influences the autonomic nervous system and has been used in conjunction with other methods. It is considered a promising step in the investigation of therapeutic procedures for rehabilitation and quality of life of several pathologies.
Conclusion
The association between auditory stimulation and the level of the cardiac autonomic nervous system has received significant contributions in relation to musical stimuli.
doi:10.1186/1755-7682-7-21
PMCID: PMC4022404  PMID: 24834128
Auditory stimulation; Autonomic nervous system; Heart rate; P300
7.  Analysis of cardiac autonomic modulation of children with attention deficit hyperactivity disorder 
Background
Attention deficit hyperactivity disorder (ADHD) is characterized by decreased attention span, impulsiveness, and hyperactivity. Autonomic nervous system imbalance was previously described in this population. We aim to compare the autonomic function of children with ADHD and controls by analyzing heart rate variability (HRV).
Methods
Children rested in supine position with spontaneous breathing for 20 minutes. Heart rate was recorded beat by beat. HRV analysis was performed in the time and frequency domains and Poincaré plot.
Results
Twenty-eight children with ADHD (22 boys, aged 9.964 years) and 28 controls (15 boys, age 9.857 years) participated in this study. It was determined that the mean and standard deviation of indexes which indicate parasympathetic activity is higher in children with ADHD than in children without the disorder: high frequency in normalized units, 46.182 (14.159) versus 40.632 (12.247); root mean square of successive differences, 41.821 (17.834) versus 38.150 (18.357); differences between adjacent normal-to-normal intervals greater than 50 milliseconds, 199.75 (144.00) versus 127.46 (102.21) (P<0.05); percentage of differences between adjacent normal-to-normal intervals greater than 50 milliseconds, 23.957 (17.316) versus 16.211 (13.215); standard deviation of instantaneous beat-to-beat interval, 29.586 (12.622) versus 26.989 (12.983).
Conclusion
Comparison of the autonomic function by analyzing HRV suggests an increase in the activity of the parasympathetic autonomic nervous systems in children with ADHD in relation to the control group.
doi:10.2147/NDT.S49071
PMCID: PMC3990390  PMID: 24748797
attention deficit hyperactivity disorder; autonomic nervous system; children; heart rate variability
8.  Effects of physiotherapy on balance and unilateral vestibular hypofunction in vertiginous elderly 
Background
We aimed to analyze the effect of a physical therapy protocol on unilateral vestibular hypofunction and overall balance in elderly with vertigo.
Methods
The study included nine subjects, four male subjects (68.5 ± 11.09 years old) and five females (72.4 ± 7.09 years old). It was used the performance-oriented Mobility Assessment (POMA), to evaluate the balance and the Unterberger – Fukuda test for analysis of unilateral vestibular dysfunction through rotations and displacements of the body. We developed and applied a structured physical therapy protocol, consisting of group exercises.
Results
It was observed that after the protocol, all participants improved balance (33.9 ± 5.1 vs. 47.3 ± 7.6, p < 0.0001) and displacement (111.1 ± 38.0 vs. 53.3 ± 34.6, p = 0.0001). However, it was not found significant differences for rotation.
Conclusion
The proposed protocol has contributed to an improvement in balance and vestibular dysfunction of the aged.
doi:10.1186/1755-7682-7-8
PMCID: PMC3938970  PMID: 24576350
Aged; Postural balance; Physical therapy modalities; Vestibular diseases
9.  Vocal complaint in physical education teachers and its association with the cardiovascular system 
Background
We examined the vocal complaints and evaluated the correlation between the vocal handicap index (VHI) and heart rate variability (HRV) in physical education teachers. We evaluated 46 teachers.
Method
The subjects were investigated regarding voice complaint and the VHI was applied. HRV was recorded at seated rest for ten minutes and it was analyzed in the time, frequency domains, geometric indices and fractal exponents. The three domains of the VHI were correlated with the indices of HRV.
Results
The physical education teachers presented a VHI score much below the standard of the physiological normality. There was correlation of the organic domain of the VHI with the NN50 and pNN50 and correlation of the functional domain and organic domain of the VHI with the HF index of HRV.
Conclusion
The physical education teachers evaluated reported vocal complaints that affected their function and it is suggested to be related with the cardiac autonomic regulation.
doi:10.1186/1755-7682-7-7
PMCID: PMC3975969  PMID: 24571789
Functional performance; Health; Neuroscience; Teaching
10.  Characteristics of sexual violence against adolescent girls and adult women 
BMC Women's Health  2014;14:15.
Background
Sexual violence is considered a serious violation of human rights which affects mainly young women and adolescents. There is little information about the conditions under which sexual offences occur. We evaluated characteristics of sexual violence against adolescent girls and adult women.
Method
This is a quantitative, retrospective, descriptive study of sexual violence against adolescent girls and adult women. Analyses were carried out on data collected from 1118 women, 546 adolescents (10-19 years) and 572 adults (≥ 20 years), with a complaint of rape treated at Hospital Pérola Byington, São Paulo, between 1994 and 1999. The age limit of the adolescent sample met the World Health Organization’s (WHO) criteria. We analyzed the type of sexual contact, degree of intimidation, perpetrator and activity of the victim during the approach.
Results
Crimes without penetration were five times more frequent in adolescents and use of threats of death or intimidation was common in both groups. Mental illness was more prevalent in adult victims and the majority of adolescent victims were aged <14 years. Uncle and stepfather perpetrators were more frequent among adolescents and partners or former intimate partners in adult women. In most cases the approach occurred in public places, although sex crimes at the perpetrator’s residence were more frequent amongst adolescents.
Conclusions
Although children and adolescents require the same intervention measures and legal protection, a considerable proportion of adolescent sex offenders can face conditions similar to those of adult women.
doi:10.1186/1472-6874-14-15
PMCID: PMC3910688  PMID: 24450307
Sex offence; Criminal; Adolescent
11.  Evaluation of physiological parameters before and after respiratory physiotherapy in newborns with acute viral bronchiolitis 
Background
Acute viral bronchiolitis is a respiratory disease with high morbidity that affects newborn in the first two years of life. Its treatment with physiotherapy has been highlighted as an important tool, however, there is no consensus regarding its effects on patients improvement. We aimed to evaluate the physiological parameters before and after the procedure respiratory therapy in newborn with acute viral bronchiolitis.
Method
This was a cross sectional observational study in 30 newborns with acute viral bronchiolitis and indicated for physiotherapy care in a hospitalized Urgency and Emergency Unit. It was collected the clinical data of newborn through evaluation form, and we measured heart rate (HR), oxygen saturation (SpO2) and respiratory rate (RR). We measured the variables before physiotherapy treatment, 3, 6 and 9 minutes after the physiotherapy treatment.
Results
There has been no change in HR, however, we observed a decrease in RR at 6 and 9 min compared to 3 min and increase in SpO2 at 3, 6 and 9 min compared to before physiotherapy.
Conclusion
Respiratory physiotherapy may be an effective therapy for the treatment of newborn with Acute Viral Bronchitis.
doi:10.1186/1755-7682-7-3
PMCID: PMC3897977  PMID: 24401198
Bronchiolitis; Circulatory and Respiratory Physiology; Infant; Newborn; Physiotherapy (Techniques)
12.  The eleventh reported case of Mulvihill-Smith syndrome in the literature 
BMC Neurology  2014;14:4.
Background
The Mulvihill-Smith Syndrome was first recognized in 1975. After the recognition of the Mulvihill-Smith Syndrome, ten cases have been described.
Case presentation
This article describes the eleventh case of this syndrome in a male patient, 24 years-old with short stature and microcephaly with mild cognitive impairment, deafness and allergic conjunctivitis. The patient was hospitalized several times for repeated infections, and the presence of multiple melanocytic nevi on his skin was noticed.
Conclusions
Based on the entire set of signs and symptoms presented in our study, it was diagnosed the patient with Mulvihill-Smith Syndrome.
doi:10.1186/1471-2377-14-4
PMCID: PMC3890486  PMID: 24397283
Case reports; Rare diseases; Neurology
13.  Stabilometric parameters analysis in children with visual disorder 
Background
Although postural changes were already reported in blind adults, no previous study has investigated postural stability in blind children. Moreover, there are few studies which used a stabilometric instrument to measure postural balance. In this study we evaluated stabilometric paramaters in blind children.
Methods
We evaluated children between 7 to 12 years old, they were divided into two groups: Blind (n = 11) and age-matched control (n = 11) groups by using computerized stabilometry. The stabilometric examination was performed taking the gravity centers displacement of the individual projected into the platform. Thirthy seconds after the period in which this information was collected, the program defined a medium-pressure center, which was used to define x and y axes displacement and the distance between the pressure center and the platform center. Furthermore, the average sway rate and the body sway area were obtained by dividing the pressure center displacement and the time spent on the task; and by an ellipse function (95% percentille), respectively. Percentages of anterior, posterior, left and right feet weight also were calculated. Variables were compared by using the Student’s t test for unpaired data. Significance level was considered for p <0.05.
Results
Displacement of the x axis (25.55 ± 9.851 vs. -3.545 ± 7.667; p <0.05) and average sway rate (19.18 ± 2.7 vs. -10.55 ± 1.003; p <0.001) were increased in the blind children group. Percentage of left foot weight was reduced (45.82 ± 2.017 vs. 52.36 ± 1.33; p <0.05) while percentage of right foot weight was increased (54.18 ± 2.17 vs. 47.64 ± 1.33; p <0.05) in blind children. Other variables did not show differences.
Conclusions
Blind children present impaired stabilometric parameters.
doi:10.1186/1755-7682-7-1
PMCID: PMC3882287  PMID: 24387244
Postural balance; Visual disorders; Musculoskeletal system
14.  Association between oral variables and heart rate variability 
The heart rate variability is a useful method to assess cardiac autonomic modulation in patients undergoing dental procedures, because knowledge of physiological conditions provides greater security to the professional as well as the possibility of a better plan treatment to patient benefit. The aim of our study was to describe the association between cardiac autonomic control and dental variables. We consulted the databases Medline, SciELO, Lilacs and Cochrane, using the terms “autonomic”, “dentistry”, “heart rate variability”, “cardiovascular physiology.” The selected studies indicated a strong relationship between dental variables and HRV. There was an association between malocclusion, TMD, dental procedures cirugia and low HRV. Thus, they become more studies that relate to HRV in dental science, especially in clinical practice.
doi:10.1186/1755-7682-6-49
PMCID: PMC3879647  PMID: 24373329
Dentistry; Autonomic nervous system; Cardiovascular system
15.  Motor development of infants exposed to maternal human immunodeficiency virus (HIV) but not infected 
Background
To assess the motor development of infants exposed to maternal human immunodeficiency virus (HIV).
Methods
Thirty infants were assessed in the period from November 2009 to March 2010 at the AIDS Reference and Training Centre, in São Paulo, Brazil. The assessment instrument used in the research was the Alberta Infant Motor Scale (AIMS). All 30 infants used the antiretroviral drug properly for 42 consecutive days, in accordance with the protocol of the World Health Organization.
Results
Out of the total number of infants, 27 (90%) had proper motor performance and 3 (10%) presented motor delay, according to the AIMS.
Discussion
This study demonstrated that only 10% of the assessed group had developmental delay and no relation with environmental variables was detected, such as maternal level of education, social and economic issues, maternal practices, attendance at the day care center, and drug use during pregnancy. It is important to emphasize the necessity of studies with a larger number of participants.
doi:10.1186/1755-7682-6-45
PMCID: PMC3904463  PMID: 24171763
Motor development; Assessment; HIV/AIDS; Early intervention; Physiotherapy
16.  Median ages at stages of sexual maturity and excess weight in school children 
Reproductive Health  2013;10:56.
Background
We aimed to estimate the median ages at specific stages of sexual maturity stratified by excess weight in boys and girls.
Materials and method
This was a cross-sectional study made in 2007 in Florianopolis, Brazil, with 2,339 schoolchildren between 8 to 14 years of age (1,107 boys) selected at random in two steps (by region and type of school). The schoolchildren were divided into: i) those with excess weight and ii) those without excess weight, according to the WHO 2007 cut-off points for gender and age. Sexual maturity was self-evaluated by the subjects according to the Tanner sexual development stages, and utilizing median ages for the genitalia, breasts, and pubic hair stages.
Results
In the boys with excess weight, precocity was observed in the stages 4 for genitals and pubic hair and 2 for pubic hair, with the values for excess and normal weight. The median ages at the beginning of puberty (stage 2–sexual development) for boys and girls in Florianopolis were 10.8 and 10.3 years, respectively.
Conclusion
Excess weight is associated with lower median ages in the sexual maturity stages in boys and girls and that it should be taken into account when evaluating sexual maturity in children and adolescents.
doi:10.1186/1742-4755-10-56
PMCID: PMC3843500  PMID: 24139334
Adolescents; Obesity; Early puberty; Scholar children
17.  A new method to evaluate glenoid erosion in instable shoulder 
Background
We aimed to establish values and parameters using multislice reconstruction in axial computerized tomography (CT) in order to quantify the erosion of the glenoid cavity in cases of shoulder instability.
Methods
We studied two groups using CT. Group I had normal subjects and Group II had patients with shoulder instability. We measured values of the vertical segment, the superior horizontal, medial and inferior segments, and also calculated the ratio of the horizontal superior and inferior segments of the glenoid cavity in both normal subjects and those with shoulder instability. These variables were recorded during arthroscopy for cases with shoulder instability.
Results
The mean values were 40.87 mm, 17.86 mm, 26.50 mm, 22.86 mm and 0.79 for vertical segment, the superior horizontal, medial and inferior segments, and the ratio between horizontal superior and inferior segments of the glenoid cavity respectively, in normal subjects. For subjects with unstable shoulders the mean values were 37.33 mm, 20.83 mm, 23.07 mm and 0.91 respectively. Arthroscopic measurements yielded an inferior segment value of 24.48 mm with a loss of 2.39 mm (17.57%). The ratio between the superior and inferior segments of the glenoid cavity was 0.79. This value can be used as a normative value for evaluating degree of erosion of the anterior border of the glenoid cavity. However, values found using CT should not be used on a comparative basis with values found during arthroscopy.
Conclusions
Computerized tomographic measurements of the glenoid cavity yielded reliable values consistent with those in the literature.
doi:10.1186/1755-7682-6-42
PMCID: PMC3819511  PMID: 24134872
Shoulder joint; Arthroscopy; Tomography; Glenoid cavith; Grafting bone
18.  Verbal and visual stimulation effects on rectus femoris and biceps femoris muscles during isometric and concentric 
Background
Coactivation may be both desirable (injury prevention) or undesirable (strength measurement). In this context, different styles of muscle strength stimulus have being investigated. In this study we evaluated the effects of verbal and visual stimulation on rectus femoris and biceps femoris muscles contraction during isometric and concentric.
Methods
We investigated 13 men (age =23.1 ± 3.8 years old; body mass =75.6 ± 9.1 kg; height =1.8 ± 0.07 m). We used the isokinetic dynamometer BIODEX device and an electromyographic (EMG) system. We evaluated the maximum isometric and isokinetic knee extension and flexion at 60°/s. The following conditions were evaluated: without visual nor verbal command (control); verbal command; visual command and; verbal and visual command. In relation to the concentric contraction, the volunteers performed five reciprocal and continuous contractions at 60°/s. With respect to isometric contractions it was made three contractions of five seconds for flexion and extension in a period of one minute.
Results
We found that the peak torque during isometric flexion was higher in the subjects in the VVC condition (p > 0.05). In relation to muscle coactivation, the subjects presented higher values at the control condition (p > 0.05).
Conclusion
We suggest that this type of stimulus is effective for the lower limbs.
doi:10.1186/1755-7682-6-38
PMCID: PMC3973804  PMID: 24099489
Muscles; Electromyography; Knee; Auditory stimulation; Visual stimulation
19.  Leprosy treatment dropout: a sistematic review 
Background
Leprosy is a chronic infectious disease endemic in some undeveloped areas, and still represents a public health problem in Brazil. Therefore, the control of this endemic disease depends necessarily on the institution of correct treatment and containment of treatment dropout. This study aims to conduct a systematic review of published studies on treatment dropout of leprosy.
Methods
We conducted a systematic review of articles on treatment dropout of leprosy, published between january 2005 and april 2013, on MEDLINE and SciELO databases. The search was performed using the MeSH terms: “leprosy”; “patients dropouts” and the keywords: “leprosy, treatment” and “noncompliance, leprosy” in association, beside the equivalents in Portuguese.
Results
There were originally 196 references. After analyzing the titles and abstracts of articles, 20 articles were obtained and included in the final sample.
Discussion
Leprosy is a notifiable disease known as its disfiguring capability and the high rate of non-compliance to treatment. The low adhesion is responsible for the remaining potential sources of infection, irreversible complications, incomplete cure and, additionally, may lead to resistance to multiple drugs. Many factors are responsible for the interruption or dropout treatment: socioeconomic factors, education level, knowledge about the disease, lack of efficiency of health services, demographics, side effects of drugs, alcoholism, among others.
Conclusion
The recent scientific literature about the subject diverge regarding the factors that most affect the dropout problem in treating leprosy patients. However, better integration between professionals and users, and greater commitment of the patient, are common points among the authors of the studies.
doi:10.1186/1755-7682-6-34
PMCID: PMC3766109  PMID: 24000954
Leprosy; Patient dropout; Treatment; Adhesion
20.  Previous exposure to musical auditory stimulation immediately influences the cardiac autonomic responses to the postural change maneuver in women 
Background
Chronic exposure to musical auditory stimulation has been reported to improve cardiac autonomic regulation. However, it is not clear if music acutely influences it in response to autonomic tests. We evaluated the acute effects of music on heart rate variability (HRV) responses to the postural change maneuver (PCM) in women.
Method
We evaluated 12 healthy women between 18 and 28 years old and HRV was analyzed in the time (SDNN, RMSSD, NN50 and pNN50) and frequency (LF, HF and LF/HF ratio) domains. In the control protocol, the women remained at seated rest for 10 minutes and quickly stood up within three seconds and remained standing still for 15 minutes. In the music protocol, the women remained at seated rest for 10 minutes, were exposed to music for 10 minutes and quickly stood up within three seconds and remained standing still for 15 minutes. HRV was recorded at the following time: rest, music (music protocol) 0–5, 5–10 and 10–15 min during standing.
Results
In the control protocol the SDNN, RMSSD and pNN50 indexes were reduced at 10–15 minutes after the volunteers stood up, while the LF (nu) index was increased at the same moment compared to seated rest. In the protocol with music, the indexes were not different from control but the RMSSD, pNN50 and LF (nu) were different from the music period.
Conclusion
Musical auditory stimulation attenuates the cardiac autonomic responses to the PCM.
doi:10.1186/1755-7682-6-32
PMCID: PMC3765421  PMID: 23941333
Autonomic nervous system, Auditory stimulation; Cardiovascular system, Music
21.  Comparison between the six-minute walk test and the six-minute step test in post stroke patients 
Background
The Stroke remains one of the major chronic diseases worldwide, and is considered a major cause of disability, which results not only in persistent neurological deficits, but also in the high physical deconditioning, nevertheless there are not many forms of assessing functional capacity in this population. We aimed to investigate the feasibility of the Six Minute Walk Teste and the Six-Minute Step Test (6MST) in post-stroke patients and compare the behavior of physiological variables during the 6MST and the Six-Minute Walk Test (6MWT), by correlating the functional performance obtained in both tests.
Method
The 6MWT was carried out according to the American Thoracic Society (ATS) and the 6MST was performed in six minutes in order to compare it to the 6MWT in a 20 cm step. Was included post-stroke individuals able to walk without aid. All of them did the 6MWT and the 6MST.
Results
12 patients participated in the study. There was no statistical difference in the parameters analyzed when tests were compared. There was poor correlation between the functional performance in both tests.
Conclusion
The 6MWT and the 6MST is feasible for post-stroke patients and physiological responses are equal during the performance of both tests. However, there was no correlation with respect to functional performance, which was assessed by the distance walked in the 6MWT and by the number of steps climbed in the 6MST.
doi:10.1186/1755-7682-6-31
PMCID: PMC3750617  PMID: 23924407
Exercise test; Mobility limitation; Stroke
22.  The effects of auditory stimulation with music on heart rate variability in healthy women 
Clinics  2013;68(7):960-967.
OBJECTIVES:
There are no data in the literature with regard to the acute effects of different styles of music on the geometric indices of heart rate variability. In this study, we evaluated the acute effects of relaxant baroque and excitatory heavy metal music on the geometric indices of heart rate variability in women.
METHODS:
We conducted this study in 21 healthy women ranging in age from 18 to 35 years. We excluded persons with previous experience with musical instruments and persons who had an affinity for the song styles. We evaluated two groups: Group 1 (n = 21), who were exposed to relaxant classical baroque musical and excitatory heavy metal auditory stimulation; and Group 2 (n = 19), who were exposed to both styles of music and white noise auditory stimulation. Using earphones, the volunteers were exposed to baroque or heavy metal music for five minutes. After the first music exposure to baroque or heavy metal music, they remained at rest for five minutes; subsequently, they were re-exposed to the opposite music (70-80 dB). A different group of women were exposed to the same music styles plus white noise auditory stimulation (90 dB). The sequence of the songs was randomized for each individual. We analyzed the following indices: triangular index, triangular interpolation of RR intervals and Poincaré plot (standard deviation of instantaneous beat-by-beat variability, standard deviation of the long-term RR interval, standard deviation of instantaneous beat-by-beat variability and standard deviation of the long-term RR interval ratio), low frequency, high frequency, low frequency/high frequency ratio, standard deviation of all the normal RR intervals, root-mean square of differences between the adjacent normal RR intervals and the percentage of adjacent RR intervals with a difference of duration greater than 50 ms. Heart rate variability was recorded at rest for 10 minutes.
RESULTS:
The triangular index and the standard deviation of the long-term RR interval indices were reduced during exposure to both music styles in the first group and tended to decrease in the second group whereas the white noise exposure decreased the high frequency index. We observed no changes regarding the triangular interpolation of RR intervals, standard deviation of instantaneous beat-by-beat variability and standard deviation of instantaneous beat-by-beat variability/standard deviation in the long-term RR interval ratio.
CONCLUSION:
We suggest that relaxant baroque and excitatory heavy metal music slightly decrease global heart rate variability because of the equivalent sound level.
doi:10.6061/clinics/2013(07)12
PMCID: PMC3715016  PMID: 23917660
Autonomic Nervous System; Auditory Stimulation; Cardiovascular System; Music
23.  Potentially hazardous waste produced at home 
Background
The purpose of this study was to identify the sources of waste generation household consisting of biological material and to investigate the knowledge presented by those responsible for the generation of waste in the home environment on the potential health risk human and environmental.
Method
It is a quantitative survey performed in Parque Capuava, Santo André (SP). The questionnaire was administered by the community employers and nursing students during the consultation with nursing supervision through interview question/answer. The exclusion criteria were patients who were not in the area served by the Basic Health Unit which covers the area of Pq Capuava. The sample was consisted of 99 persons and the data collection a questionnaire was used.
Results
We observed that 63.3% of people said to use disposables, with the majority (58.7%) of these use the public collection as the final destination of these materials. It was reported that 73.7% of those surveyed reported having knowledge about the risk of disease transmission. Public awareness of the importance of proper packaging and disposal of potentially hazardous household waste may contribute significantly to the preservation of human and environmental health and this procedure can be performed and supervised by professional nurses.
Conclusion
We suggest implementation of workshops for community health workers and the general population in order to enhance their knowledge about the storage and disposal of potentially infectious waste generated at home, thereby reducing the potential risk of disease transmission by improper management.
doi:10.1186/1755-7682-6-27
PMCID: PMC3718708  PMID: 23806043
Medical waste; Housing; Environmental health
24.  Effects of the administration of a catalase inhibitor into the fourth cerebral ventricle on cardiovascular responses in spontaneously hypertensive rats exposed to sidestream cigarette smoke 
Clinics  2013;68(6):851-857.
OBJECTIVE:
Previous studies have demonstrated a relationship between brain oxidative stress and cardiovascular regulation. We evaluated the effects of central catalase inhibition on cardiovascular responses in spontaneously hypertensive rats exposed to sidestream cigarette smoke.
METHODS:
Male Wistar Kyoto (WKY) rats and spontaneously hypertensive rats (SH) (16 weeks old) were implanted with a stainless steel guide cannula leading into the fourth cerebral ventricle (4th V). The femoral artery and vein were cannulated for arterial pressure and heart rate measurement and drug infusion, respectively. The rats were exposed to sidestream cigarette smoke for 180 minutes/day, 5 days/week for 3 weeks (CO: 100-300 ppm). The baroreflex was tested using a pressor dose of phenylephrine (8 μg/kg, bolus) and a depressor dose of sodium nitroprusside (50 μg/kg, bolus). Cardiovascular responses were evaluated before and 5, 15, 30 and 60 minutes after injection of a catalase inhibitor (3-amino-1,2,4-triazole, 0.001 g/100 μL) into the 4th V.
RESULTS:
Vehicle administration into the 4th V did not affect the cardiovascular response, whereas administration of the central catalase inhibitor increased the basal HR and attenuated the bradycardic peak (p<0.05) to a greater extent in WKY rats exposed to sidestream cigarette smoke than in WKY rats exposed to fresh air. However, in spontaneously hypertensive rats, the effect of the catalase inhibitor treatment was stronger in the fresh air condition (p<0.05).
CONCLUSION:
Administration of a catalase inhibitor into the 4th V combined with exposure to sidestream cigarette smoke has a stronger effect in WKY rats than in SH rats.
doi:10.6061/clinics/2013(06)21
PMCID: PMC3674281  PMID: 23778493
Oxidative Stress; Catalase; Medulla Oblongata; Tobacco; Air Pollutants
25.  Nutritional strategies of physically active subjects with muscle dysmorphia 
Background
The aim of this study was to identify dietary strategies for physically active individuals with muscle dysmorphia based on a systematic literature review.
Method
References were included if the study population consisted of adults over 18 years old who were physically active in fitness centers. We identified reports through an electronic search ofScielo, Lilacs and Medline using the following keywords: muscle dysmorphia, vigorexia, distorted body image, and exercise. We found eight articles in Scielo, 17 in Medline and 12 in Lilacs. Among the total number of 37 articles, only 17 were eligible for inclusion in this review.
Results
The results indicated that the feeding strategies used by physically active individuals with muscle dysmorphia did not include planning or the supervision of a nutritionist. Diet included high protein and low fat foods and the ingestion of dietary and ergogenic supplements to reduce weight.
Conclusion
Physically active subjects with muscle dysmorphia could benefit from the help of nutritional professionals to evaluate energy estimation, guide the diet and its distribution in macronutrient and consider the principle of nutrition to functional recovery of the digestive process, promote liver detoxification, balance and guide to organic adequate intake of supplemental nutrients and other substances.
doi:10.1186/1755-7682-6-25
PMCID: PMC3680023  PMID: 23706013
Diet; Nutrition; Physical exercise; Muscle dysmorphia

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