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BACKGROUND AND PURPOSE: Head and neck cancer patients frequently develop radiation dermatitis (RD) during radiotherapy. We compared liposomal gel with and without chamomile extract for the prevention and management of RD in head and neck cancer patients undergoing radiotherapy. MATERIALS AND METHODS: Sixty participants undergoing radiotherapy for the first time for head and neck cancer were recruited in a double-blind randomized clinical trial. Primary outcomes were the occurrence of dry desquamation and the cumulative dose of ionizing radiation at the first occurrence of dry desquamation. Secondary outcomes were the occurrence of erythema, moist desquamation, global RD, and participant self-reported symptoms. RESULTS: Dry desquamation occurred in 76.9 % (95 % CI: 57.9, 89.0) of participants in the chamomile liposomal gel group and in 88.9 % (95 % CI: 71.9, 96.1) in the liposomal gel group (p = 0.43). The median cumulative dose of ionizing radiation when dry desquamation occurred was 48.0 Gy in the chamomile liposomal gel group and 40.0 Gy in the liposomal gel group. Fewer symptoms were reported in the chamomile liposomal gel group. CONCLUSION: No statistically significant differences in outcomes were found between the two groups, though the chamomile liposomal gel group presented with lower grades of RD than the liposomal gel group. In addition, when compared to the literature on other topical interventions to manage RD, our results show that chamomile liposomal gel has potential for better management and prevention of RD in this population, which should be further tested. This study provides crucial information to design future studies. Clinical Trials Registration (REBEC): RBR-92cts3.

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BACKGROUND: During the COVID-19 pandemic, there was a shortage of filtering facepiece respirators (FFR), leading to prolonged use and reuse of FFRs. METHODS: FFRs were collected in 3 hospitals after extended use (up to 15 or 30days). We assessed the physical characteristics and filtration levels of worn FFRs, before sterilization. Respirators that achieved at least 94% filtration of aerosol particles, nasal clip still attached, had no tears, had preserved elastic bands, and had no dirt were randomized to receive or not receive cleaning before being submitted to hydrogen peroxide plasma gas sterilization. RESULTS: A total of 1,055 FFRs were collected. Over 85% of them exhibited secured nose clips, preserved strap elasticity, and no tears. However, more than 78% of samples contained dirt, leaving only 101 (19.6%) eligible to undergo sterilization. After sterilization, none of the FFRs in either group achieved minimum filtration, although 72% without cleaning and 80% with cleaning had filtration between 90.0% and 93.9%. DISCUSSION: A large proportion of FFRs were ineligible for sterilization due to factors unrelated to health care (eg, dirt from makeup). CONCLUSIONS: Prolonged reuse of FFRs significantly reduced aerosol filtration efficiency. Eligible FFRs did not maintain 94% filtration after sterilization with or without cleaning.

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Background and Purpose: The Langer Mindfulness Scale (LMS) is distinguished from other mindfulness scales by its dimensions, which are closely related to the awareness and experience of novelty, and by being a scale derived from a cognitive perspective of information processing. There are no mindfulness instruments of this type available in Brazil. Therefore, this study aimed to carry out a translation and cultural adaptation of the LMS into Brazilian Portuguese and to validate and assess the internal consistency and convergent construct validity of the translated instrument. Methods: The study had two distinct stages: (a) translation and cultural adaptation of the LMS into Brazilian Portuguese and (b) validation of the adapted instrument using a sample of 543 participants. Results: The Brazilian version of the LMS demonstrated acceptable internal consistency, with confirmatory factor analysis supporting the original four-factor model. Correlations between LMS, and the Five Facets of Mindfulness Questionnaire and the Mindfulness Attention Awareness Scale were statistically significant and in the expected directions. Conclusions: Our findings suggest that the Brazilian version of LMS, with its four dimensions, presents acceptable psychometric properties and seems to be a reliable and valid instrument for assessing the state of mindfulness in a Brazilian cultural context.

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We report the successful closure of Phase I clinical trials, comprising Phases Ia and Ib, of the vaccine candidate against human schistosomiasis: the Schistosoma mansoni 14 kDa fatty acid-binding protein (Sm14) + glucopyranosyl lipid A in squalene emulsion (GLA-SE). Shown here are the results of Phase Ib, an open, non-placebo-controlled, standardized-dose immunization trial involving 10 healthy 18-49-year-old women. Fifty micrograms of the Sm14 protein plus 10 µg GLA-SE per dose was given intramuscularly thrice at 30-day intervals. Participants were assessed clinically, biochemically, and immunologically for up to 120 days. In preambular experiments involving vaccinated pregnant female rabbits, we did not find any toxicological features in either the offspring or mothers, and the vaccine induced adaptive immunity in the animals. In women, no adverse events were observed, and vaccination induced high titers of anti-Sm14 serum IgG antibody production. Vaccination also elicited robust cytokine responses, with increased TNFα, IFNγ, and IL-2 profiles in all vaccinees on days 90 and 120. The completion of Phase I clinical trials, which were performed to the highest standards set by Good Clinical Research Practice (GCP) standards, and preclinical data in pregnant rabbits enabled the vaccine candidate to proceed to Phase II clinical trials in endemic areas.

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OBJECTIVES: To evaluate the effect of reinforcing an educational programme through telephone follow-up on health-related quality of life and anxiety and depression symptoms in individuals starting warfarin therapy. BACKGROUND: Educational interventions have improved quality of life in individuals using warfarin. Few studies have examined the addition of telephone follow-up to enhance educational interventions. DESIGN: Randomised controlled trial in outpatient setting. METHODS: Hospitalised adults starting warfarin therapy who agreed to participate received an educational programme about the warfarin treatment. At discharge, they were randomised to receive either five telephone follow-up calls (intervention) or no telephone calls (controls). Both groups were evaluated for health-related quality of life (using Duke Anticoagulation Satisfaction Scale) and symptoms of anxiety and depression (using Hospital Anxiety and Depression Scale) at three and six months post-discharge. Groups were compared at each time by independent-samples t test, and over time by repeated-measures analysis of variance, with time (three and six months), groups (intervention and control) and an interaction between time and group as factors. Level of significance was set at 0.05. The Consolidated Standards of Reporting Trials was used for reporting. RESULTS: Fifty-two individuals (26 per group) completed the study. There were no statistical differences between groups in health-related quality of life, anxiety and depression symptoms, at both times post-discharge. Participants who received follow-up telephone calls reported better positive psychological impact (a subscale of quality of life) than controls. CONCLUSIONS: Reinforcing an educational programme with telephone follow-ups did not have an overall effect on health-related quality of life of individuals using warfarin but promoted positive psychological impact. RELEVANCE TO CLINICAL PRACTICE: The low cost of reinforcing educational programmes with telephone calls and the improvement in positive psychological aspects indicate that this type of intervention is still a promising intervention that could be further investigated and improved.

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BACKGROUND/OBJECTIVE: After wearing powdered gloves, healthcare workers (HCW) are supposed to wash their hands instead of using alcohol-based hand-rub (ABHR). Washing hands takes longer than using ABHR, and the use of powdered gloves may be an obstacle to hand-hygiene compliance. This study aimed to evaluate the impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among HCW of an intensive care unit (ICU). METHODS: A quasi-experimental study was conducted in a general ICU of a tertiary care university hospital in Brazil. From June 1st to July 15th, 2017, all HCW were provided with powdered latex gloves only for all clinical procedures. From July 15th to August 31st, 2017, HCW were provided with nitrile powder-free gloves only. Hand-hygiene compliance was assessed through direct observation, and evaluated according to the World Health Organization Hand Hygiene guidelines. We calculated that a sample size of 544 hand hygiene opportunities needed to be observed per period. Data analysis were performed using the STATA SE® version 14, and we compared the individual's percentage of compliance using the t test for paired data before and after the intervention. RESULTS: Overall, 40 HCW were assessed before and after the introduction of nitrile powder-free gloves, with 1114 and 1139 observations of hand hygiene opportunities, respectively. The proportion of compliance with hand hygiene was 55% (95% confidence interval [CI] 51-59%) using powdered latex gloves and 60% (95% CI 57-63%) using powder-free gloves. The difference in proportions between the two types of gloves was 5.1% (95% CI 2.5-7.6%, p < 0.001). CONCLUSION: Our data indicate that replacing powdered gloves with powder-free gloves positively influenced hand-hygiene compliance by HCW in an ICU setting.

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We assessed safety and potential efficacy of a chamomile gel compared with urea cream to prevent acute radiation dermatitis in head and neck cancer patients. We assessed safety and potential efficacy of the chamomile gel in escalating concentrations of 2.50%, 5.00% and 8.35% of chamomile. Concentration of 8.35% was chosen for a randomized trial comparing chamomile gel (8.35%) with urea cream (n = 24 per group), for potential efficacy to delay or prevent radiation dermatitis in these patients. Preliminary results demonstrate a delayed onset of dermatitis, with onset of Grade 2 dermatitis at 5.1 (1.3) weeks in the chamomile group and 4.5 (1.3) weeks in the urea group (effect size of 0.46). Itching, burning and hyperpigmentation were more frequently reported in the urea group. Results indicates a potential efficacy of the chamomile gel. Further studies are needed to confirm the effect of the chamomile gel in reducing or delaying the occurrence of radiation dermatitis.

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AIMS AND OBJECTIVES: To compare mentholated popsicle with usual care (absolute fasting) in the change of thirst intensity and discomfort of patients in the preoperative fasting. BACKGROUND: Thirst is defined as the desire to drink water, and it is considered to be a multifactorial symptom. In the preoperative fasting, the patient may experience intense thirst, often for a long time, that can lead to feelings of suffocation, desperation, fear and anxiety. DESIGN: A randomised controlled trial. METHODS: Forty patients, aged between 18-60 years, were randomised to mentholated popsicle group or absolute fasting group (twenty in each). The primary outcomes were thirst intensity, evaluated by a numeric scale ranging from 0 (no thirst)-10 (the worst possible thirst), and discomfort from thirst (evaluated by the Perioperative Thirst Discomfort Scale), both measured twice (baseline and after 20 min of intervention). The CONSORT checklist was used to report this study. RESULTS: Mean age was similar in both groups (38 years in the mentholated popsicle group and 39 in the absolute fasting group). At baseline, the mentholated popsicle group had higher median for the scales of intensity (6.5) and discomfort (7.5) from thirst than the absolute fasting group (5.0 and 5.0, respectively). At the end of 20 min, the popsicle group had a statistically significant decrease in intensity and discomfort from thirst (median decreases of 5.0 and 7.0 points, respectively) when compared to the absolute fasting group (median increases of 0.5 and 1.0 points, respectively). CONCLUSIONS: The use of mentholated popsicle decreased the intensity and discomfort from thirst, and it is a viable strategy for the management of thirst in the preoperative fasting. RELEVANCE TO CLINICAL PRACTICE: In the preoperative fasting, making mentholated popsicles available to patients is an easy strategy to manage thirst, which might lead to better care.

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The study assessed if quadriceps femoris muscle performance of older women can be improved by applying photobiomodulation therapy after a resistance training program. This study is a randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blinded outcome evaluators. Forty-five healthy sedentary older women classified as active or insufficiently active were randomized to groups receiving 8 weeks of quadriceps femoris resistance training plus active group or placebo group, or a control group (no training or photobiomodulation). Surface electromyographic fatigue indexes of vastus medialis, rectus femoris, and vastus lateralis; one-maximum repetition (1-MR); and analysis of inflammatory biomarkers (IL-6, IL-8, and TNF-α cytokines, plus CK and LDH enzymes) were measured at baseline and twice in a 24 h-period after 8 weeks. No differences among the three groups were found in fatigue indexes for all three muscles, although in general, the active group presented improved fatigue indexes from baseline to 8-week outcome, while the other groups did not. Both training groups improved in 1-MR over the 8-week period. Inflammatory biomarkers were not different at long- or short-term among the three groups, except differences in groups for long-term IL-8 changes, differences in time for long-term LDH and short-term TNF-α changes, and interactions of time by group for short-term LDH changes. Quadriceps femoris performance of older women was not improved when photobiomodulation was associated to the proposed quadriceps femoris resistance training, when compared to training without photobiomodulation and a sedentary group.

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BACKGROUND: Removing an indwelling urinary catheter as soon as possible is the cornerstone of catheter-associated urinary tract infections (CAUTI) prevention. However, implementing this measure may be challenging in clinical settings. To evaluate the impact of implementing a healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications among critical patients on the incidence of CAUTI. METHODS: This was a quasi-experimental study performed in a general intensive care unit of a tertiary-care hospital over a 12 years period, from January 1, 2005 to December 31, 2016. Rates of urinary catheter use and incidence density of CAUTI were monthly evaluated following the Centers for Disease Control and Prevention (CDC) criteria throughout the study period. Phase I (2005-2006) was the pre-intervention period. In phase II (2007-2010), HCWs routine training on CAUTI prevention was performed twice-a-year. In phase III (2011-2014), we implemented a daily checklist for indwelling urinary catheter indications, in addition to the biannual training. In phase IV, (2015-2016) the biannual training was replaced by training only newly hired HCWs and the daily checklist was maintained. RESULTS: The mean rate of urinary catheter utilization decreased from phase I to phase IV (73.1%, 74.1%, 54.9%, and 45.6%, respectively). Similarly, the incidence density of CAUTI decreased from phase I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter-days, respectively). CONCLUSIONS: HCWs education and daily evaluation of indwelling urinary catheter indications were highly effective in reducing the rates of catheter utilization as well as the incidence density of CAUTI.

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Vieira, KVSG, Ciol, MA, Azevedo, PH, Pinfildi, CE, Renno, ACM, Colantonio, E, and Tucci, HT. Effects of light-emitting diode therapy on the performance of biceps brachii muscle of young healthy males after 8 weeks of strength training: a randomized controlled clinical trial. J Strength Cond Res 33(2): 433-442, 2019-We assessed the effect of adding light-emitting diode therapy (LEDT) to an 8-week strength training of biceps brachii in healthy young males. Forty-five participants were randomized into training plus LEDT, training plus sham LEDT, and control groups (n = 15 each). Individuals in the LEDT groups participated in strength training performed in a Scott machine at their maximum number of elbow flexion-extension repetitions. The LEDT was applied to biceps brachii of dominant limb at the end of training sessions (device "on" for LEDT and "off" for sham LEDT). Training loads were re-evaluated every 2 weeks. Controls did not receive training during 8 weeks. All groups were evaluated for 1 repetition maximum (1RM) and fatigue at baseline and 8 weeks. Additionally, the 2 LEDT groups were evaluated every 2 weeks for 1-RM and number of elbow flexion-extension repetitions. The groups were statistically different in mean difference and mean percent change of 1-RM from baseline to week 8 (p < 0.001). Analyzing the 2 LEDT groups, we found an interaction between group and time (p = 0.02), with a slightly faster increase in 1-RM for the LEDT than the sham LEDT. Over time, both groups decreased the number of repetitions of elbow flexion-extension (differences not statistically significant), possibly because of the increase of load over time. We found no difference in change of fatigue index among the 3 groups. Our study showed potential benefits to 1RM when LEDT is applied after a strength training session. Future studies might assess whether different doses of LEDT can reduce fatigue in strength training.

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BACKGROUND AND PURPOSE: The Family Questionnaire-Brazilian Portuguese Version (FQ-BPV) has been preliminarily validated in the Brazilian population. This study assessed the predictive validity of the FQ-BPV for relapse in patients with schizophrenia. METHODS: Ninety-four dyads (patients with schizophrenia and their relatives) were recruited from three mental health clinics. Expressed emotion was assessed using the FQ-BPV. Presence of relapse was assessed at 6-, 9-, 12-, and 18-month follow-ups and analyzed through logistic regressions. RESULTS: The critical comments (CC) domain of the FQ-BPV was statistically significant at 18 months. However, the model was not sufficiently robust to classify individuals correctly into relapse or no relapse categories. CONCLUSION: The FQ-BPV did not predict relapse well and we cannot recommend it for that purpose in Brazil without further studies.

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PURPOSE: The aim of this study is to compare cryotherapy made only with water and cryotherapy made with chamomile infusion for prevention and reduction of intensity of oral mucositis in patients with cancer receiving 5-fluorouracil and leucovorin. METHOD: This is a randomized pilot study with two groups: cryotherapy made only with water (control group, n = 18) and cryotherapy made with chamomile infusion (chamomile group, n = 20). Both groups were instructed to swish the ice around in their oral cavity for at least 30 min during chemotherapy. Assessment of oral mucosa occurred on days 8, 15, and 22 after the first day of chemotherapy. RESULTS: Fifty percent of the patients in the control and 30 % in the chamomile group developed oral mucositis. Mouth pain score was higher in patients in the control group on all evaluations (p = 0.02 for day 8, p = 0.09 for day 15, and p = 0.14 for day 22). Patients in the chamomile group never developed mucositis with grade 2 or higher. Presence of ulceration was statistically significant on day 8 (16 % in the control vs. 0 % in the chamomile group, p = 0.10), but not in days 15 and 22, although 11 % still had ulcerations in the control group and none in the chamomile group. CONCLUSION: The occurrence of oral mucositis was lower in patients in the chamomile group than in the control group. When compared to the controls, the chamomile group presented less mouth pain and had no ulcerations. Cryotherapy was well tolerated by both groups, and no toxicity related to chamomile was identified.

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AIM: To compare a gel made with chamomile (Chamomilla recutita) with a cream of urea as an intervention to delay the time to occurrence of radiation dermatitis. BACKGROUND: Radiation dermatitis is one of the most common adverse effects of radiotherapy in patients with head and neck cancer. It is characterized by erythema, itching, pain, skin breakage and burning sensation, and there is no consensus on how to prevent it. DESIGN: The study is a randomized controlled clinical trial. METHODS: We will recruit 48 individuals with head and neck cancer who will be starting their radiotherapy and randomize them to receive either gel of chamomile or cream of urea, as an intervention for prevention of radiation dermatitis. Social-demographic data will be collected at baseline, and clinical data will be collected before the initiation of radiotherapy. Participants will be followed weekly to assess development of radiation dermatitis. The protocol is funded by Conselho Nacional de Pesquisa e Desenvolvimento Científico (Brazil). The study was approved by a research ethics committee. DISCUSSION: Given the clinical relevance of preventing radiation dermatitis and the lack of evidence supporting specific preventive interventions, it is important to study new products that might be efficacious to prevent this complication. This article presents the protocol of a randomized controlled trial comparing a gel made with chamomile (intervention) with a cream of urea (control) to prevent radiation dermatitis in patients with head and neck cancer undergoing radiotherapy.

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DESIGN: Safety and immunogenicity of a recombinant 14kDa, fatty acid-binding protein(FABP) from Schistosoma mansoni (rSm14) were evaluated through an open, non-placebo-controlled, dose-standardized trial, performed at a single research site. The vaccine was formulated with glucopyranosyl lipid A (GLA) adjuvant in an oil-in-water emulsion (SE) and investigated in 20 male volunteers from a non-endemic area for schistosomiasis in the state of Rio de Janeiro, Brazil. Fifty microgram rSm14 with 10 µg GLA-SE (rSm14/GLA-SE)/dose were given intramuscularly three times with 30-day intervals. Participants were assessed clinically, biochemically and immunologically for up to 120 days. METHODS: Participants were screened for inclusion by physical examination, haematology and blood chemistry; then followed to assess adverse events and immunogenicity. Sera were tested for IgG (total and isotypes) and IgE. T cell induction of cytokines IL-2, IL-5, IL-10, IFNγ and TNFα was assessed by Milliplex kit and flow cytometry. RESULTS: The investigational product showed high tolerability; some self-limited, mild adverse events were observed during and after vaccine administration. Significant increases in Sm14-specific total IgG, IgG1 and IgG3 were observed 30 days after the first vaccination with specific IgG2 and IgG4 after 60 days. An increase in IgE antibodies was not observed at any time point. The IgG response was augmented after the second dose and 88% of all vaccinated subjects had developed high anti-Sm14 IgG titres 90 days after the first injection. From day 60 and onwards, there was an increase in CD4(+) T cells producing single cytokines, particularly TNFα and IL-2, with no significant increase of multi-functional TH1 cells. CONCLUSION: Clinical trial data on tolerability and specific immune responses after vaccination of adult, male volunteers in a non-endemic area for schistosomiasis with rSm14/GLA-SE, support this product as a safe, strongly immunogenic vaccine against schistosomiasis paving the way for follow-up Phase 2 trials. Study registration ID: NCT01154049 at http://www.clinicaltrials.gov.

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AIMS: To test an educational programme with telephone follow-up to improve self-care in Brazilian patients who underwent percutaneous coronary intervention. BACKGROUND: Percutaneous coronary intervention has been established as a treatment for coronary disease. However, additional intervention is needed to improve self-care for individuals who undergo this procedure to reduce further disease. Telephone follow-up is one strategy that has been used to improve chronic disease self-care. DESIGN: Randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01341093. METHODS: Sixty patients who were preparing for their first percutaneous coronary intervention between 2011-2012 were randomly allocated to an educational programme with telephone follow-up (N = 30) or a control group (N = 30). Perceived health status was assessed with the Medical Outcomes Study 36-Item Short Form. Self-efficacy, symptoms of anxiety and depression and medication adherence were also assessed. Measures were collected before intervention (baseline) and 6 months later. RESULTS: Both groups improved from baseline to 6 months in the 'Physical Component Summary' and in the domains of 'Physical Functioning', 'Role-Emotional' and 'Role-Physical'. The educational programme group showed a reduction in anxiety from baseline to 6-month follow-up, while the control group showed a slight increase. No differences in symptoms in depression and self-efficacy were found and both groups reported high levels of medication adherence. CONCLUSION: The educational programme with telephone follow-up is a promising intervention as it led to reduction in anxiety for those receiving the educational programme. Further improvements in timing and focus of the educational programme, such as targeting emotional and social lifestyle changes, might be warranted.

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PURPOSE: To evaluate health status, impact of event, anxiety, and depression in burn victims at five-to-seven months after hospital discharge, and to explore the association between those variables with age, body surface area burn (BSA), sex, and marital status. METHODS: Cross-sectional study involving 73 adults who were interviewed for general health status (BSHS-R), impact of event (IES), and anxiety and depression (HADS). RESULTS: Participants were mostly men (68.5%), with mean age 38.4 years (SD = 14.5), and mean hospital length of stay (LOS) 24.5 days (SD = 25.3). Mean scores were: 128.1 (SD = 18.9) for BSHS-R, 62.1(SD = 35.8) for IES, 5.5 (SD = 4.1) for anxiety, and 3.9 (SD = 3.9) for depression. Health status was highly and inversely correlated with impact of event, depression, anxiety, LOS, number of surgeries, and BSA. Men and women differed in the BSHS-R affect and body image domains, and depression. Individuals with larger BSA reported worse scores for BSHS-R (work domain). CONCLUSION: Burn victims reported good health status on average, which was negatively correlated with reported depression, anxiety, impact of event, LOS, number of operations, and BSA. These findings suggest that general health might be improved by interventions that target modifiable behavioral factors, such as support groups and cognitive behavioral therapies.

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AIM AND OBJECTIVES: To assess the construct validity and reliability of the Brazilian Portuguese versions of the 29- and 13-item scales of the Antonovsky's Sense of Coherence Scale (SOC-29 and SOC-13). BACKGROUND: Antonovsky's Sense of Coherence Questionnaire was developed to measure the main construct of the salutogenic theory, the sense of coherence. The use of the sense of coherence by health professionals might help identifying specific coping strategies used by person with chronic illness. DESIGN: Cross-sectional study. METHODS: The SOC-29 has been culturally adapted to Brazilian Portuguese language. In this study, we assessed its psychometric properties (construct validity and internal reliability) tested on 203 cardiac patients. The SOC-13 was tested on another 100 cardiac patients hospitalised in the same hospital. The construct validity of both versions was investigated through Pearson correlation between the measures of sense of coherence and of correlated constructs (self-esteem, depression and age), analysis of the principal components and comparison of distinct groups (male vs. female). The internal reliability for both versions was evaluated by Cronbach's alpha. RESULTS: For both versions, the construct validity assessments showed strong positive correlations between sense of coherence and self-esteem and strong negative correlations between sense of coherence and depression (convergent validity), and weak correlation between sense of coherence and age (divergent validity). Principal component analysis supported in part the presence of a single component (unidimensionality). Differences in sense of coherence were found by sex with SOC-29, but not with SOC-13. Cronbach's alpha coefficients showed satisfactory internal consistency in both versions. CONCLUSIONS: The Brazilian Portuguese versions of SOC-29 and SOC-13 can be considered valid and reliable for the populations studied. More studies need to be performed to assess these proprieties in other Brazilian populations. RELEVANCE TO CLINICAL PRACTICE: This scale can be used in research and clinical practice in Brazil to assess nursing interventions aimed at decreasing stress during cardiac rehabilitation.

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STUDY DESIGN: Controlled laboratory study. OBJECTIVE: To assess the activation of 7 shoulder muscles under 2 closed kinetic chain (CKC) tasks for the upper extremity using submaximal isometric effort, thus providing relative quantification of muscular isometric effort for these muscles across the CKC exercises, which may be applied to rehabilitation protocols for individuals with shoulder weakness. BACKGROUND: CKC exercises favor joint congruence, reduce shear load, and promote joint dynamic stability. Additionally, knowledge about glenohumeral and periscapular muscle activity elicited during CKC exercises may help clinicians to design protocols for shoulder rehabilitation. METHODS: Using surface electromyography, activation level was measured across 7 shoulder muscles in 20 healthy males, during the performance of a submaximal isometric wall press and bench press. Signals were normalized to the maximal voluntary isometric contraction, and, using paired t tests, data were analyzed between the exercises for each muscle. RESULTS: Compared to the wall press, the bench press elicited higher activity for most muscles, except for the upper trapezius. Levels of activity were usually low but were above 20% maximal voluntary isometric contraction for the serratus anterior on both tasks, and for the long head triceps brachii on the bench press. CONCLUSIONS: Both the bench press and wall press, as performed in this study, led to relatively low EMG activation levels for the muscles measured and may be considered for use in the early phases of rehabilitation.

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