Primary prevention of cardiovascular disease: an umbrella review.

BACKGROUND: The aim of this study is to determine the effectiveness of non-pharmacological interventions for prevention of cardiovascular disease (CVD) events and mortality in healthy adults or those at high risk of CVD. METHODS: An umbrella review about primary prevention of non-pharmacological interventions was undertaken in key databases as PubMed Health, Effective Health Care Program AHRQ, McMaster University and the Cochrane Plus until July 2017. The primary outcomes were the relative risk of fatal and non-fatal CVD events, and mortality. Secondary outcomes were adverse events. RESULTS: Twenty-four reviews were included of which thirteen reported outcomes of interest. Four of these found a pooled statistically significant risk reduction: dietary supplements of vitamin D, increased consumption of omega 3 fatty acids, Qigong, and counselling or education to modify more than one cardiovascular risk factor. Seven studies reported adverse events but minor or insignificant with respect to the control group. CONCLUSIONS: Four non-pharmacological interventions have been shown to provide a statistically significant reduction in risk of CVD events or overall mortality, with minor adverse events if any. Further research should aim for higher methodological quality and longer follow-up of interventions to establish if these interventions, alone or in combination, translate into definite long-term health benefits.

Estado clínico y psicosocial de reclusos en tratamiento con antirretrovirales / Clinical and psychosocial state of inmates in treatment with antiretrovirals

Introducción: La mayoría de los estudios realizados en prisiones se han centrado en el estudio de la infección por VIH, la adherencia o la TBC. Sin embargo, llama la atención la escasez de estudios sobre las características psicosociales de esta población, como son por ejemplo la morbilidad psíquica, el apoyo social o el consumo de drogas. Objetivos: Describir el estado clínico y psicosocial de los reclusos en tratamiento con antirretrovirales en tres prisiones andaluzas (Córdoba, Granada y Huelva). Material y métodos: Mediante una encuesta transversal, con un cuestionario administrado por entrevistador, se entrevistaron a todos los reclusos en tratamiento con antirretrovirales de los tres centros. Las variables estudiadas fueron: datos sociodemográficos, variables del medio penitenciario, variables sobre la adherencia al tratamiento, variables de salud y variables de apoyo. Resultados: La frecuencia de morbilidad psíquica fue del 42% y el 64,4% refirió tener algún tipo de enfermedad crónica; de éstos, el 12,7% afirmó padecer tuberculosis. El 46,6% afirmaron contar con apoyo social dentro de la prisión, recibiéndolo de otros internos el 45% y de los profesionales de la prisión el 36,6%. El 54,8% fueron considerados no adherentes al tratamiento con antirretrovirales. El 89% consideraba que la comida era mala, y sólo al 29,9% se le facilitaban suplementos de comida. Por último, el 33,8% refería no tener flexibilidad para que le abrieran la celda en caso de olvido del tratamiento. El 31% refería peor salud autopercibida (AU)

Introduction: Most studies conducted in prisons have focused on the study of HIV infection, adherence to treatment or TBC. However, there is a surprisingly small number of studies on the psychosocial characteristics of this population, such as psychic morbidity, social support or drug use. Objective: To describe the clinical and psychosocial status of inmates in treatment with antiretrovirals in three Andalusian prisons (Córdoba, Granada and Huelva). Materials and method: All inmates in treatment with antiretrovirals in the three correctional facilities were interviewed using a heteroadministered questionnaire, with a cross-sectional design. The sociodemographic data, penitentiary, adherence to treatment, health and social support variables were studied. Results: The frequency of psychic morbidity was 42%, and 64,4% of the interviewed sample mentioned having some kind of chronic disease; of these, 12,7% admitted to suffering from tuberculosis. 46,6% stated that they had social support within the prison, receiving it from other inmates in 45% of the cases and 36,6% from professionals of the prison. 54,8% were considered non-adherent to antiretroviral treatment. 89% of the sample considered that the food was of bad quality, and only 29,9% were provided with food supplements. Finally, 33,8% stated that they were not able to have their cells opened if their medication was forgotten. 31% mentioned worse self-perceived health when compared with the previous year (AU)