José Mesquita Bastos

Plastic Optical Fiber Sensor for Noninvasive Arterial Pulse Waveform Monitoring

Central arterial pulse pressure monitoring has been considered a key factor in hypertension assessment and cardiovascular prevention. In this paper, it is presented an intensity-based plastic optical fiber sensor for noninvasive monitoring of the carotid pulse waveform. The advantages of this sensing method are the low implementation cost, high robustness, and the signal processing simplicity. The sensor showed a suitable sensitivity to movements up to 370 μm, with a displacement resolution of 0.1 μm. As preliminary proof of concept, the sensor was used to detect the arterial pulse waveform in some human subjects, allowing the assessment of key indexes for heart and arterial stiffness evaluation, such as augmentation index, subendocardial viability ratio, and ejection duration.

Prognostic Value of Subdivisions of Nighttime Blood Pressure Fall in Hypertensives Followed Up for 8.2 Years. Does Nondipping Classification Need to Be Redefined

J Clin Hypertens(Greenwich). 2010;12:508–515.

1B.05: IN HYPERTENSION THE CHANGE FROM A NON-DIPPER TO A DIPPER PATTERN IS ASSOCIATED WITH A BETTER CARDIOVASCULAR PROGNOSIS THAN THE PERSISTENCE WITHIN THE NON-DIPPER PATTERN.

Objective: It is known that the non dipping pattern of systolic blood pressure (ND) circadian rhythm determined by ambulatory blood pressure monitoring (ABPM) is a predictor of cardiovascular (CV) events. However it is not known if changing to a dipper pattern changes the CV prognosis. Methods: Retrospective observational analysis of hypertensive outpatients who repeated ABPM during the period of 1994 until 2013. Follow-up was defined from first appointment to 31st of December 2014 or cardiovascular event (CV) (acute coronary syndrome, stroke, heart failure or arrhythmia and sudden death). Design and method: 226 patients were included, 181 female (48,9%), mean age 56,4+/− 16,4 years. Each patient had at least 2 ABPM in a total of 634 ABPM. During a mean follow-up of 4,7 +/−1.37 years, 28 patients (7,6%) had CV event and there were 16 deaths (37,5% cardiovascular). When comparing patients with vs. without events, patients with events were older (69,0+/−13,4 vs. 55,4 +/− 16,2 years p < 0,01), had higher 24 h SBP (136,8+/− 15,6 vs. 129,8+/− 12,4 mmHg; p 0,005) and casual diastolic blood pressure (DBP) (82,6+/− 17,2 vs. 89,0+/−13,6 mmHg: p 0,02) but lower 24 h DBP (71,3+/− 11,0 vs. 75,5+/− 9,8 mmHg; p 0,03). Nocturnal fall of SBP was less pronounced in patients with events (5,9+/− 9,4 vs. 10,5+/− 7,5 mmHg; p 0,03). Analyzing the SBP pattern of nocturnal fall, in 52,7% of ABPM the pattern remained the same. When we selected only patients with a ND pattern in the initial ABMP, the Kaplan Meier free of events survival curves showed that, comparing those who stayed ND with those who changed to dipper (D) and to reverted dipper (RD), those who changed to D had significantly less CV events then those who remained ND and those who changed to RD (log rank 6,2 p < 0,05). Conclusion: In our study the modification from ND to D vs the persistence of ND is associated with less CV events. These results suggest that SBP nocturnal dipping is not only a static marker of CV risk but can undergo therapeutic intervention to improve prognosis.

Central arterial pulse waveform acquisition with a portable pen-like optical fiber sensor.

ObjectivePulse waveform features related to cardiovascular pathologies and arterial stiffness have been extensively studied, and optical fiber sensors have been studied with an aim to simplify the pulse waveform acquisition in the carotid artery. In this paper, a novel optical fiber sensor to record pulse waveform in the carotid artery has been proposed. MethodsThe pulse waveform optical fiber sensor design, based on fiber Bragg gratings, is presented. The probe was characterized, and its response to controlled waveforms was studied. Finally, tests were performed on human subjects. ResultsThe developed sensor has a displacement sensitivity of 21.2 pm/&mgr;m, with ability to detect the carotid pulse wave in the neck surface, with a resolution of 1.3 mmHg. ConclusionThis study revealed a new technological approach for acquisition of the central pulse waveform.

Effects of Aerobic Exercise Associated with Abdominal Microcurrent: A Preliminary Study

OBJECTIVE To analyze the short- and long-term effects of microcurrent used with aerobic exercise on abdominal fat (visceral and subcutaneous). METHODS Forty-two female students from a university population were randomly assigned into five group: intervention group (IG) 1 (n=9), IG2 (n=9), IG3 (n=7), IG4 (n=8), and placebo group (PG) (n=9). An intervention program of 10 sessions encompassing microcurrent and aerobic exercise (performed with a cycloergometer) was applied in all groups, with slightly differences between them. In IG1 and IG2, microcurrent with transcutaneous electrodes was applied, with different frequency values; 30-minute exercise on the cycloergometer was subsequently performed. IG3 used the same protocol as IG1 but with different electrodes (percutaneous), while in IG4 the microcurrent was applied simultaneously with the cycloergometer exercise. Finally, the PG used the IG1 protocol but with the microcurrent device switched off. All groups were evaluated through ultrasound and abdominal perimeter measurement for visceral and subcutaneous abdominal fat assessment; through calipers for skinfolds measurement; through bioimpedance to evaluate weight, fat mass percentage, and muscular mass; and through blood analyses to measure cholesterol, triglyceride, and glucose levels. RESULTS After intervention sessions, visceral fat decreased significantly in IG1 compared with the PG. Subcutaneous fat was reduced significantly in all groups compared with the PG. After 4 weeks, almost all results were maintained. CONCLUSION The addition of microcurrent to aerobic exercise may reduce fat more than does aerobic exercise alone.

Designing and evaluating a health education session on respiratory infections addressed to caregivers of children under three years of age attending day-care centres in Porto, Portugal: A community-based intervention

Abstract Background: Acute respiratory infections (ARI) are common in children, increasing the pressure on clinicians to prescribe antibiotics and affecting public health Objectives: This study aimed to design a health education session (HES) for caregivers of children, and to evaluate its effects on caregivers’ needs, as well as on their knowledge and attitudes concerning ARI. Methods: A generalized model of developing, implementing and evaluating a community-based intervention was followed, including caregivers of children under three years of age. Caregivers were randomly distributed into an intervention group (IG) (n = 41) and a control group (CG) (n = 51) and the HES was administered to the IG. The caregivers’ needs as well as knowledge of and attitudes to ARI were evaluated in both groups, before (M0) and two months after the HES (M1). Results: At M0 the caregivers from both groups had ‘some or great need’ about all HES domains; at M1 the caregivers in the IG expressed ‘no or low need’, whereas the CG maintained ‘some or great need’ about all HES domains (0.011 ≤ P ≤ .047). Concerning caregivers’ knowledge of and attitudes to ARI, at M1 there was a higher frequency of caregivers with right answers in the IG than in the CG (IG =7.5 ± 1 versus CG =6.0 ± 2; P = .000). Those differences occurred in domain (e) nasal clearance techniques, revealing a higher percentage of caregivers who used correctly nasal irrigation (P = .000), nasal aspirators (0.000 ≤P ≤ .001) and nebulization (P = .000) in IG. Conclusion: The HES met the caregivers’ needs regarding ARI and increased their knowledge and attitudes towards ARI, especially regarding nasal clearance techniques.

Effects of a Phase IV Home-Based Cardiac Rehabilitation Program on Cardiorespiratory Fitness and Physical Activity.

BACKGROUND Cardiovascular diseases are the leading cause of death globally and sedentary lifestyle is one of the main risk factors. Home-based cardiac rehabilitation (CR) programs appear to be effective to improve exercise tolerance. The aim of the study, therefore, was to evaluate the effects of a phase IV (maintenance) home-based CR program on cardiorespiratory fitness and daily physical activity of patients recovering from an acute myocardial infarction. METHODS This pilot study, with a sub-group randomised controlled trial, included 32 individuals recovering from a myocardial infarction, randomly divided into the experimental group (EG, n=16) and the control group (CG, n=16). The EG performed an exercise program, three times per week, at home during eight weeks. The two groups received health education sessions. Baseline and final assessments included cardiorespiratory fitness, resting and peak heart rate, blood pressure and rate pressure, heart rate recovery and daily physical activity. (ClinicalTrials.gov: NCT01887080). RESULTS At baseline no significant differences were observed between groups. After eight weeks of exercise, the EG significantly increased peak oxygen uptake (p=0.02), test duration (p=0.019), peak rate pressure (p=0.003), peak heart rate (p=0.003) and heart rate recovery (0.025) when compared to the CG. No changes were observed on daily physical activity in both groups. CONCLUSION This specific phase IV home-based exercise program seems to improve cardiorespiratory fitness, haemodynamics at peak exercise and heart rate recovery, an indicator of cardiac autonomic function.

Impact of caregivers’ education regarding respiratory infections on the health status of day-care children: a randomized trial

BACKGROUND Acute respiratory infections are the most common illness in childhood, and caregivers often make an excessive use of medication and medical consultations. It is vital to design and implement educational interventions in order to minimize the burden of the disease. OBJECTIVE This study aimed to evaluate the impact of a health education session (HES) about respiratory infections on the indicators of individual health and health care utilization of day-care children. METHODS Randomized controlled trial in 10 day-care centres in Porto, including caregivers (parents or legal tutors) of children under 3 years of age. Childrens caregivers were randomly distributed into an Intervention Group (IG), who attended a HES, and a Comparison Group (CG). Childrens indicators of individual health and health care utilization were evaluated in both groups, during the month after HES. RESULTS Children whose caregivers attended to the HES had fewer lower respiratory tract infections (IG = 5.8%; CG = 19.0%; P = 0.050) and fewer acute otitis media (IG = 9.5%; CG = 27.0%; P = 0.030), as well as fewer medical consultations (IG = 38.5% versus CG = 61.9%; P = 0.015) and less antibiotic consumption (IG = 11.5% versus CG = 29.5%; P = 0.022). They were also less absent from day care (IG = 21 days versus CG = 59 days; P = 0.037) and their caregivers were less absent from work (IG = 15 days versus CG = 44 days; P = 0.046). Caregivers who attended HES made more use of nasal irrigation (IG = 79.6% versus CG = 53.3%; P = 0.011). CONCLUSIONS The HES about respiratory infections has positively influenced the indicators of individual health and health care utilization of children attending day-care centres in Porto.

Reprodutibilidade dos valores da pressurometria ambulatória de 24 horas e dos perfis circadiários de descida noturna registados com intervalo 1‐11 meses em indivíduos não medicados

OBJECTIVE To evaluate in untreated subjects the reproducibility of mean values and four circadian patterns between two ambulatory blood pressure monitoring (ABPM) recordings separated by 1-11 months. METHODS We performed a retrospective analysis of 481 individuals (59% women) evaluated by ABPM on two occasions, visit 1 (V1) and 2 (V2), separated by 5.5+0.2 months. Four circadian patterns were defined by night/day systolic blood pressure (SBP) ratios: reverse dippers (RD), ratio >1.0; non-dippers (ND), ratio 0.9-1.0; dippers (D), ratio 0.8-<0.9; and extreme dippers (ED), ratio <0.8. Coefficients of correlation and concordance between the ABPM values at V1 and V2 and the reproducibility of the RD, ND, D and ED patterns were calculated by the percentage of the same profile from V1 to V2. RESULTS Mean 24-h blood pressure (BP) at V1 and V2 was 126.8/75.9±0.5/0.5 vs. 126.5/75.7±0.5/0.4 mmHg (NS). Nighttime SBP fall was 9.8±0.4 (V1) and 9.6±0.3% (V2) (NS). The correlation coefficient of ABPM data at V1 vs. at V2 was 0.41-0.69 (p<0.001) and the concordance coefficient was 0.34-0.57 (p<0.01). At V1, 38 subjects were classified as ED (7.9%); D, n=216 (44.9%), 187 as ND (38.9%) and 40 as RD (8.3%). At V2 only 26.3% of ED, 44.9% of D, 54.5% of ND and 40% of RD maintained the same profile as at V1. CONCLUSION In untreated subjects ABPM has high reproducibility for mean values but only modest reproducibility for circadian profiles, thereby challenging the prognostic value of BP dipping patterns.

Efeitos da dieta mediterrânica e exercício físico em indivíduos com doença arterial coronária

INTRODUCTION The association of the Mediterranean diet and exercise appears to have a protective role, reducing cardiovascular risk. This study investigated the effects of education sessions on the Mediterranean diet and an exercise program in modifying eating behaviors, body composition and abdominal fat. METHODS An experimental study was performed on 20 subjects with known coronary heart disease randomly assigned to experimental (n=10) and control (n=10) groups. Both groups received education sessions on the Mediterranean diet, but the experimental group also followed an eight-week program of specific exercises. A semiquantitative food frequency questionnaire was administered to analyze food intake, bioimpedance was used to measure weight, fat mass and lean mass, and waist circumference was measured to calculate waist-to-height ratio. RESULTS After eight weeks, protein (p<0.05) and cholesterol (p<0.05) intake in the experimental group had decreased significantly compared with the control group. Between the beginning and end of the study, there were significant decreases in the control group in carbohydrate (p<0.05) and saturated fat intake (p<0.05). In both groups the percentage of total fat (p<0.05) and fat mass (p<0.05) was significantly decreased. In the experimental group the waist-to-height ratio was significantly reduced (p<0.05). CONCLUSION The Mediterranean diet reduced carbohydrate and saturated fat intake, reflected in reduced fat mass. The association of the exercise program showed additional benefits in reduction of protein and cholesterol intake and abdominal fat.