Abstract The aim of this study was to verify whether obesity and acute physical exercise could influence the reactivity to mental stress. Twelve normal weight (NW) and ten obese (Ob) (31.82% women), normotensive individuals between 18 and 40 years old were evaluated. The Stroop color test was performed under two conditions: 1) Baseline and 2) 30 min after the end of aerobic physical exercise. Individuals performed 30 min of physical exercise (NW: 3.38 and Ob: 2.99 km·h-1; p< 0.05) between 50-60% of heart rate reserve (NW: 139±7 and Ob: 143±7 bpm). The reactivity to mental stress for systolic blood pressure - SBP (Δ2 min) and diastolic blood pressure - DBP (Δ2 and Δ4 min) was lower (p< 0.05) in Ob compared to NW group. The SBP reactivity to mental stress was less (p< 0.05) post-exercise in all moments (Δ2 and Δ4 min), regardless of obesity, while the DBP reactivity to mental stress was less post-exercise, only in NW. BP reactivity to stress correlated negatively with obesity indicators (r/Rho = - 0.42 to - 0.64), under the baseline condition, but not post-physical exercise. Obesity blunted BP reactivity to mental stress in normotensive young adults. Moderately-intensity acute aerobic exercise reduced SBP reactivity to mental stress, regardless of obesity, while it reduced DBP reactivity to mental stress, only in NW. In summary, acute physical exercise may be a one means to prevent cardiovascular changes.

Resumo O objetivo deste estudo foi verificar se a obesidade e o exercício físico agudo podem influenciar a reatividade ao estresse mental. Foram avaliados 12 indivíduos eutróficos (E) e dez obesos (Ob) (31,82% mulheres), normotensos entre 18 e 40 anos. O teste de cor Stroop foi realizado em duas condições: 1) Linha de base e 2) 30 min após o término do exercício físico aeróbio. Os indivíduos realizaram 30 min de exercício físico (E: 3,38 e Ob: 2,99 km•h-1; p<0,05) entre 50-60% da frequência cardíaca de reserva (E 139±7 e Ob: 143±7 bpm). A reatividade ao estresse mental para pressão arterial sistólica - PAS (Δ2 min) e pressão arterial diastólica - PAD (Δ2 e Δ4 min) foi menor (p< 0,05) no grupo Ob comparado ao grupo E. A reatividade da PAS ao estresse mental foi menor (p< 0,05) pós-exercício em todos os momentos (Δ2 e Δ4 min), independente da obesidade, enquanto a reatividade da PAD ao estresse mental foi menor pós-exercício, apenas no E. A reatividade da PA ao estresse correlacionou-se negativamente com os indicadores de obesidade (r/Rho = - 0,42 a - 0,64), na condição basal, mas não pós-exercício físico. A obesidade embotou a reatividade da PA ao estresse mental em adultos jovens normotensos. O exercício aeróbico agudo de ientesidade moderada reduziu a reatividade da PAS ao estresse mental, independentemente da obesidade, enquanto reduziu a reatividade da PAD ao estresse mental, apenas no E. Em resumo, o exercício físico agudo pode ser um meio de prevenir alterações cardiovasculares.

RESUMO Objetivo: compreender as percepções dos estudantes finalistas de uma escola superior de enfermagem de Lisboa sobre as competências de tomada de decisão clínica adquiridas na formação inicial. Métodos: estudo qualitativo de caráter exploratório e descritivo. A colheita de dados foi realizada por meio de um focus group, com 8 estudantes finalistas do curso de licenciatura em enfermagem. Na aná lise dos dados, recorreu-se à análise de conteúdo pelo software webQDA®. Resultados: os dados foram analisados segundo as quatro dimensões do modelo de tomada de decisão de Tanner, destacando-se a Percepção e a Interpretação como as mais influentes na tomada de decisão clínica. Emergiram como competências mais representativas: o conhecimento teórico e clínico, a validação do planejamento dos cuidados, a priorização e a capacidade de discussão e argumentação sobre as situações. Considerações Finais: os estudantes tomam decisões por meio de um processo complexo usando o conhecimento e as competências adquiridas na formação.

ABSTRACT Objectives: to understand the perceptions of senior students in an undergraduate nursing course at a nursing college in Lisbon regarding skills related to clinical decision-making learned during their initial training. Methods: qualitative study, of an exploratory and descriptive nature. Data collection occurred by carrying out a focus group with eight senior students in an undergraduate nursing course. Data treatment applied content analysis, performed with twebQDA® software. Results: data were analyzed according to the four dimensions of Tanner’s model of clinical judgment, and noticing and interpreting stood out as the most influential in clinical decision-making. Theoretical and clinical knowledge, validation of care planning, prioritization, and capacity to discuss and debate about situations emerged as the most representative skills. Final considerations: students make decisions by means of a complex process by using the knowledge and skills learned during their training.

RESUMEN Objetivo: comprender las percepciones de estudiantes avanzados de una escuela superior de enfermería de Lisboa sobre las competencias de toma de decisiones clínicas adquiridas en la formación inicial. Métodos: estudio cualitativo, exploratorio y descriptivo. Datos recolectados mediante focus group con 8 estudiantes avanzados de la carrera de licenciatura en enfermería. Datos analizados por análisis de contenido, utilizándose software webQDA® . Resultados: los datos fueron analizados según las cuatro dimensiones del modelo de toma de decisiones de Tanner, destacándose la Percepción y la Interpretación como las más influyentes en la toma de decisiones clínicas. Surgieron como competencias más representativas: el conocimiento teórico y clínico, la validación de la planificación de cuidados, la priorización y la capacidad de discusión y argumentación sobre las situaciones. Consideraciones Finales: los estudiantes toman decisiones aplicando un proceso complejo, utilizando el conocimiento y las competencias adquiridas durante su formación.

Abstract The aim of this study was to evaluate the effect of periodontal treatment on the salivary cytokine levels and clinical parameters of individuals with cerebral palsy (CP) with gingivitis. A non-randomized, clinical trial was conducted in individuals diagnosed with spastic CP. Thirty-eight individuals were enrolled in the study and were categorized according to gingival index scores between 0-1 or 2-3, assigned to groups G2 or G1, respectively. Periodontal treatment comprised oral hygiene instructions, conventional mechanical treatment and 0.12% chlorhexidine applied as an adjunct. Clinical parameters and saliva samples were collected at baseline and at the 15-day follow-up visit. Bleeding on probing and periodontal screening and recording were determined. Non-stimulated saliva samples were obtained, and the salivary flow rate, the osmolality and the levels of cytokines IL-1β, IL-6, IL-8, IL-10, TNF-α and IL-12p70 were evaluated by a cytometric bead array. The Wilcoxon test, the Mann-Whitney test, Spearman correlation analysis, Poisson regression analysis and an adjusted analysis were performed (α = 0.05). The groups differed significantly in periodontal clinical parameters at baseline and at follow-up. Salivary flow rate and osmolality were similar in both groups at both timepoints. However, TNF-α and IL-1β levels were higher in G1 than in G2 at baseline. Mechanical treatment resulted in improved clinical parameters for both groups. Furthermore, mechanical treatment resulted in a significant reduction in salivary IL-1β and IL-8 levels for both groups after treatment. Periodontal treatment performed in individuals with CP and gingivitis reduces the levels of TNF-α, IL-1β, IL-6 and IL-8.

Abstract Serum hepcidin levels may increase in response to infection and inflammation. The present study investigated the effect of nonsurgical periodontal therapy (NSPT) on levels of serum hepcidin, inflammatory markers, and iron markers. An interventional study was conducted on 67 patients (age 30–65 years) without other diseases, except for chronic periodontitis (CP). Patients were allocated to either CP or control groups. The CP group received supragingival and subgingival scaling and root planing procedures, whereas the control group received supragingival scaling. Probing depth (PD), bleeding on probing, clinical attachment level (CAL), visible plaque index (VPI), serum hepcidin and interleukin-6 (IL-6) levels, high-sensitivity C-reactive protein (hs-CRP), hematological markers, and iron markers were measured at baseline and at 90 days after NSPT. The CP group had statistically significant lower mean values for mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) (p ≤ 0.05). The control group had statistically significant reductions in hemoglobin, hematocrit, MCV, and MCH (p ≤ 0.05). Serum hepcidin, IL-6, and erythrocyte sedimentation rate (ESR) levels were significantly decreased in both groups after NSPT. Periodontal markers were more markedly reduced in the CP group compared with the control group (p ≤ 0.05). These findings suggest that NSPT may reduce the serum levels of IL-6, hepcidin, and periodontal parameters.

FUNDAMENTO: Alterações cardíacas são muito frequentes nos indivíduos portadores de doença renal crônica terminal e estão associadas com a morbimortalidade. OBJETIVOS: Avaliar as alterações evolutivas cardíacas após o transplante renal. MÉTODOS: Foram avaliados prospectivamente 40 pacientes com doença renal crônica terminal, imediatamente antes e com um mês, três meses e seis meses após o transplante renal, por meio de estudo ecocardiográfico com Doppler tecidual. Os parâmetros de massa ventricular, função sistólica e diastólica foram analisados. RESULTADOS: A média da idade foi 31,6 anos e 40% eram do sexo feminino. Observamos redução do diâmetro diastólico do VE (52,23 para 49,95 mm, p = 0,021) e do índice de massa do VE (131,48 para 113,039 g/m², p = 0,002) após o transplante renal. A razão E/e' média reduziu no terceiro e no sexto meses após o transplante renal em relação ao exame basal (8,13 e 7,85 vs 9,79, p < 0,05). A fração de ejeção aumentou a partir do primeiro mês do transplante renal em relação a exame basal (69,72% vs 65,68%, p < 0,05). A prevalência de disfunção diastólica reduziu 43% no período avaliado. A fração de ejeção e a razão E/e' média basais estiveram associadas com redução do índice de massa do VE após o transplante renal. O índice de massa do VE basal, o sexo feminino e a redução do fósforo sérico apresentaram associação com a redução da razão E/e' média após o transplante renal. CONCLUSÃO: O transplante renal promoveu alterações significativas nos parâmetros ecodopplercardiográficos de massa do VE, função sistólica e função diastólica nos pacientes com doença renal crônica terminal.

BACKGROUND: Cardiac disorders are very common in individuals with chronic kidney disease and are associated with morbimortality. OBJECTIVE: To evaluate cardiac alterations after kidney transplantation. METHODS: We prospectively evaluated 40 patients with chronic kidney disease, immediately before and one month, three months and six months after kidney transplantation, using tissue Doppler echocardiographic study. The left ventricular mass, systolic and diastolic function parameters were analyzed. RESULTS: The mean age was 31.6 years and 40% of patients were female. We observed a reduction in left ventricular diastolic diameter (52.23 to 49.95 mm, p = 0.021) and LV mass index (131.48 to 113.039 g/m2, p = 0.002) after kidney transplantation. The mean E/e' decreased in the third and sixth months after kidney transplantation, when compared to basal values (8.13 and 7.85 vs. 9.79, p <0.05). The ejection fraction increased from the first month after kidney transplantation compared to basal assessment (69.72% vs. 65.68%, p <0.05). The prevalence of diastolic dysfunction decreased 43% during the evaluated period. The basal ejection fraction and mean E/e' were associated with reduced LV mass index after kidney transplantation. The LV mass index at baseline, female sex and decrease in serum phosphorus were associated with a reduction in the mean E/e ' ratio after kidney transplantation. CONCLUSION: Kidney transplantation resulted in significant alterations in Doppler echocardiographic parameters of LV mass, systolic and diastolic function in patients with chronic kidney disease.