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1.
Medicina (Kaunas) ; 57(6)2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34200448

RESUMO

Background and Objectives: In this paper, we investigated the efficacy of statin therapy on cardiovascular disease (CVD) reduction in adults with no known underlying health conditions by undertaking a meta-analysis and systematic review of the current evidence. Materials and Methods: We performed a systematic search to identify Primary Prevention Randomized Controlled Trials (RCTs) that compared statins with a control group where CVD events or mortality were the primary end point. Identified RCTs were evaluated and classified into categories depending on relevance in order to determine which type of meta-analysis would be feasible. Results: No differences were observed between categories with the exception of relative risk for all CVD events combined which showed a 12% statistically significant difference favouring studies which were known to include participants without underlying health conditions. Strong negative correlations between number-need-to-treat (NNT) and LDL-C reduction were observed for all Coronary Heart Disease (CHD) outcomes combined and all CVD outcomes combined. Conclusions: This project highlights the need for further research on the effects of statins on participants who do not suffer from underlying health conditions, given that no such studies have been conducted.


Assuntos
Doenças Cardiovasculares , Doença das Coronárias , Inibidores de Hidroximetilglutaril-CoA Redutases , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/prevenção & controle , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Prevenção Primária
2.
Lima; Perú. Ministerio de Salud; 20210600. 9 p. tab.
Monografia em Espanhol | MINSAPERÚ | ID: biblio-1252699

RESUMO

El documento contiene los criterios de priorización, los mecanismos de coordinación y articulación intersectorial e intergubernamental, y otras disposiciones administrativas relacionadas a la distribución de mascarillas faciales textiles de uso comunitario y mascarillas descartables quirúrgicas para uso comunitario, a que se refiere el Decreto de Urgencia 042-2021.


Assuntos
População , Prevenção Primária , Infecções por Coronavirus , Atenção à Saúde , Máscaras
3.
Medicine (Baltimore) ; 100(22): e26184, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087883

RESUMO

ABSTRACT: The aim of this study was to assess the physical activity level of health care professionals, as well as the differences by sex, age, academic background, and among different health care professions.This is an cross-sectional study.Health care settings in the Valencian Community, Spain.A total of 647 health care professionals.Physical activity was assessed with the European Health Interview Survey-Physical Activity Questionnaire (EHIS-PAQ) that includes the assessment of work-related physical activity, transport-related physical activity, health-enhancing physical activity, muscle-strengthening physical activity, and total physical activity.93.51% of all health care professionals were physically active at work. Transport-related physical activity and health-enhancing physical activity were significantly lower in women (21.62% vs 41.86%, P < .001; and 50.19% vs 68.99%, P < .001, respectively). In addition, compliance with health-enhancing and muscle-strengthening physical activity guidelines were lower in older professionals (42.7% vs 61.84%, P < .001; and 47.57% vs 61.84%, P < .001, respectively). Those with higher education were more compliant with health-enhancing and muscle-strengthening physical activity guidelines (58.55% vs 45.69%, P = .002; and 60.24% vs 48.28%, P = .003, respectively). Moreover, 67.98% of physiotherapists performed health-enhancing physical activity and 67.54% muscle-strengthening physical activity regularly, and significant differences in all outcomes were observed compared to the rest of health care professionals (P < .05). Technicians showed lower work-related and total physical activity than nurses and nursing assistants (74.55% vs 90.37%, P = .002; and 83.64% vs 95.72%, P < .001, respectively). Additionally, nursing assistants showed higher work-related physical activity compared to nurses (97.18% vs 90.37%, P = .008).Most health care professionals showed an appropriate level of physical activity. Men performed more transport-related and health-enhancing physical activity than women. Younger professionals and those with higher education were more compliant with health-enhancing and muscle-strengthening physical activity guidelines. Physiotherapists were more physically active when compared to the rest of health care professionals.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Exercício Físico/fisiologia , Pessoal de Saúde/estatística & dados numéricos , Fisioterapeutas/estatística & dados numéricos , Prevenção Primária/métodos , Adulto , Comportamento Cooperativo , Estudos Transversais , Terapia por Exercício/métodos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Espanha/epidemiologia , Inquéritos e Questionários
4.
Int J Mol Sci ; 22(10)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068335

RESUMO

Intrauterine adhesion (IUA), and its severe form Asherman syndrome (Asherman's syndrome), is a mysterious disease, often accompanied with severe clinical problems contributing to a significant impairment of reproductive function, such as menstrual disturbance (amenorrhea), infertility or recurrent pregnancy loss. Among these, its correlated infertility may be one of the most challenging problems. Although there are many etiologies for the development of IUA, uterine instrumentation is the main cause of IUA. Additionally, more complicated intrauterine surgeries can be performed by advanced technology, further increasing the risk of IUA. Strategies attempting to minimize the risk and reducing its severity are urgently needed. The current review will expand the level of our knowledge required to face the troublesome disease of IUA. It is separated into six sections, addressing the introduction of the normal cyclic endometrial repairing process and its abruption causing the formation of IUA; the etiology and prevalence of IUA; the diagnosis of IUA; the classification of IUA; the pathophysiology of IUA; and the primary prevention of IUA, including (1) delicate surgical techniques, such as the use of surgical instruments, energy systems, and pre-hysteroscopic management, (2) barrier methods, such as gels, intrauterine devices, intrauterine balloons, as well as membrane structures containing hyaluronate-carboxymethylcellulose or polyethylene oxide-sodium carboxymethylcellulose as anti-adhesive barrier.


Assuntos
Endométrio/patologia , Doenças Uterinas/prevenção & controle , Útero/patologia , Feminino , Humanos , Gravidez , Prevenção Primária , Aderências Teciduais , Doenças Uterinas/etiologia , Doenças Uterinas/patologia
5.
JAMA ; 325(22): 2294-2306, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34100866

RESUMO

Importance: General health checks, also known as general medical examinations, periodic health evaluations, checkups, routine visits, or wellness visits, are commonly performed in adult primary care to identify and prevent disease. Although general health checks are often expected and advocated by patients, clinicians, insurers, and health systems, others question their value. Observations: Randomized trials and observational studies with control groups reported in prior systematic reviews and an updated literature review through March 2021 were included. Among 19 randomized trials (906 to 59 616 participants; follow-up, 1 to 30 years), 5 evaluated a single general health check, 7 evaluated annual health checks, 1 evaluated biannual checks, and 6 evaluated health checks delivered at other frequencies. Twelve of 13 observational studies (240 to 471 415 participants; follow-up, cross-sectional to 5 years) evaluated a single general health check. General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For example, in the South-East London Screening Study (n = 7229), adults aged 40 to 64 years who were invited to 2 health checks over 2 years, compared with adults not invited to screening, experienced no 8-year mortality benefit (6% vs 5%). General health checks were associated with increased detection of chronic diseases, such as depression and hypertension; moderate improvements in controlling risk factors, such as blood pressure and cholesterol; increased clinical preventive service uptake, such as colorectal and cervical cancer screening; and improvements in patient-reported outcomes, such as quality of life and self-rated health. In the Danish Check-In Study (n = 1104), more patients randomized to receive to a single health check, compared with those randomized to receive usual care, received a new antidepressant prescription over 1 year (5% vs 2%; P = .007). In a propensity score-matched analysis (n = 8917), a higher percentage of patients who attended a Medicare Annual Wellness Visit, compared with those who did not, underwent colorectal cancer screening (69% vs 60%; P < .01). General health checks were sometimes associated with modest improvements in health behaviors such as physical activity and diet. In the OXCHECK trial (n = 4121), fewer patients randomized to receive annual health checks, compared with those not randomized to receive health checks, exercised less than once per month (68% vs 71%; difference, 3.3% [95% CI, 0.5%-6.1%]). Potential adverse effects in individual studies included an increased risk of stroke and increased mortality attributed to increased completion of advance directives. Conclusions and Relevance: General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment, risk factor control, preventive service uptake, and improved patient-reported outcomes. Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection or inadequate access to primary care.


Assuntos
Exame Físico , Atenção Primária à Saúde , Prevenção Primária , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Doença Crônica , Neoplasias Colorretais/diagnóstico , Depressão/diagnóstico , Exercício Físico , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Observacionais como Assunto/estatística & dados numéricos , Exame Físico/efeitos adversos , Serviços Preventivos de Saúde/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
6.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(3): 460-466, 2021 Jun 18.
Artigo em Chinês | MEDLINE | ID: mdl-34145845

RESUMO

OBJECTIVE: To evaluate the potential effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population from economically developed area of China. METHODS: Totally 202 179 adults aged 40 to 74 years without cardiovascular diseases at baseline (January 1, 2010) were enrolled from the Chinese electronic health records research in Yinzhou (CHERRY) study. Three scenarios were considered: the screening strategy based on risk charts recommended by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases in Chinese adults aged 40-74 years (Strategy 1); the screening strategy based on the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) models recommended by the 2019 Guideline on the assessment and management of cardiovascular risk in China in Chinese adults aged 40-74 years (Strategy 2); and the screening strategy based on the China-PAR models in Chinese adults aged 50-74 years (Strategy 3). According to the guidelines, individuals who were classified into medium- or high-risk groups after cardiovascular risk assessment by the corresponding strategies would be introduced to lifestyle intervention, while high-risk population would take medication in addition. Markov model was used to simulate different screening scenarios for 10 years (cycles), using parameters mainly from the CHERRY study, as well as published data, Meta-analyses and systematic reviews for Chinese populations. The life year gained, quality-adjusted life year (QALY) gained, number of cardiovascular disease events/deaths could be prevented and number needed to be screened (NNS) were calculated to compare the effectiveness between the different strategies. One-way sensitivity analysis on uncertainty of cardiovascular disease incidence rate and probabilistic sensitivity analysis on uncertainty of distributions for the hazard ratios were conducted. RESULTS: Compared with non-screening strategy, QALYs gained were 1 433 [95% uncertainty interval (UI): 969-1 831], 1 401 (95%UI: 936-1 807), and 716 (95%UI: 265-1 111) for the Strategies 1, 2, and 3; and the NNS per QALY in the above strategies were 141 (95%UI: 110-209), 144 (95%UI: 112-216), and 198 (95%UI: 127-529), respectively. The Strategies 1 and 2 based on different guidelines showed similar effectiveness, while more benefits were found for screening using China-PAR models in adults aged 40-74 years than those aged 50-74 years. The results were consistent in the sensitivity analyses. CONCLUSION: Screening for cardiovascular diseases in Chinese adults aged above 40 years seems effective in coastal developed areas of China, and the different screening strategies based on risk charts by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases or China-PAR models by the 2019 Guideline on the assessment and management of cardiovascular risk in China may have similar effectiveness.


Assuntos
Doenças Cardiovasculares , Adulto , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , China/epidemiologia , Análise Custo-Benefício , Humanos , Programas de Rastreamento , Prevenção Primária , Anos de Vida Ajustados por Qualidade de Vida
7.
Enferm. foco (Brasília) ; 12(1): 105-110, jun. 2021. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1255227

RESUMO

Objetivo: Avaliar medidas aplicadas pela enfermagem para prevenir Lesões Por Pressão (LPP) em pacientes de uma unidade de terapia intensiva pediátrica, antes e após treinamento. Método: Estudo quantitativo, descritivo, transversal, desenvolvido em um hospital de nível terciário. A amostra foi composta por 118 pacientes. A coleta de dados foi realizada no formato de checklist de acordo com 3 variáveis: I) Relacionadas às características da amostra; II) Relacionadas à avaliação de risco para LPP e III) Relacionadas à identificação do risco de LPP. Posteriormente foi realizado um treinamento e, em seguida realizada nova coleta, com comparação dos dados. Resultados: As LPP no setor corresponderam a 7,5% antes do treinamento e 2,0% após. Pode-se identificar que 57,4% dos pacientes estavam expostos ao risco de LPP antes e 60,9% após. Foi observado na beira do leito que antes do treinamento, 46,2% dos pacientes apresentavam-se na posição adequada estabelecida pelo setor naquela hora do dia e, após o treinamento, eram 92,1% dos pacientes. Conclusão: Verificou-se a melhora na realização dessas medidas preventivas e a necessidade de treinamento frequente com os profissionais da saúde. Os enfermeiros devem trabalhar no aprimoramento dessas ferramentas para melhor avaliação do risco das LPP, bem como medidas preventivas. (AU)


Objective: To evaluate measures applied by nursing to prevent Pressure Ulcers in patients in pediatric intensive care unit, before and after training. Method: Quantitative, descriptive, cross-sectional study, developed in tertiary-level hospital. The sample consisted of 118 patients. Data collection was performed in the checklist format according to 3 variables: I) Related to sample characteristics; II) Related to risk avaluation for LPP and III) Related to risk identification for LPP. Subsequently, training was carried out and then a new collection, comparing the data. Results: LPP in the sector corresponded to 7.5% before training and 2.0% after. It can be identified that 57.4% of patients were exposed to the risk of pressure ulcers before and 60.9% after. It was observed at the bedside that, before training, only 46.2% of the patients were in the appropriate position established by the sector at that time of the day and after 92.1% were. Conclusion: There was an improvement in the performance of these preventive measures and the need for frequent training with health professionals. Nurses should work on improving these tools to better the evaluation of risk of pressure ulcers, as well as preventive measures. (AU)


Objetivo: Evaluar medidas aplicadas por la enfermería para prevenir lesiones por presión (LPP) en pacientes en una unidad de cuidados intensivos pediátricos, antes y después del entrenamiento. Método: Estudio cuantitativo, descriptivo, transversal, desarrollado en un hospital de tercer nivel. La muestra consistió en 118 pacientes. La recolección de datos se realizó en el formato de lista de verificación de acuerdo con 3 variables: I) Las características de la muestra; II) La evaluación de riesgos para LPP y III) La identificación del riesgo de LPP. Posteriormente, se llevó a cabo la capacitación y luego se realizó una nueva colección, comparando así los datos. Resultados: LPP en el sector correspondió a 7.5% antes del entrenamiento y 2.0% después. Se puede identificar que el 57.4% de los pacientes estuvieron expuestos al riesgo de LPP antes y el 60.9% después. Se observó en la cabecera que antes del entrenamiento, solo el 46.2% de los pacientes estaban en la posición apropiada establecida por el sector a esa hora del día y después 92.1% estaban. Conclusión: Hubo una mejora en el desempeño de estas medidas preventivas y la necesidad de capacitación frecuente con profesionales de la salud. Las enfermeras deberían trabajar en mejorar estas herramientas para evaluar mejor el riesgo de LPP, así como medidas preventivas. (AU)


Assuntos
Prevenção Primária , Pediatria , Enfermagem , Lesão por Pressão , Educação Continuada , Unidades de Terapia Intensiva
8.
Arch. argent. pediatr ; 119(3): 177-184, Junio 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1222947

RESUMO

Introducción. Los cambios sociales y culturales están alterando los hábitos de los jóvenes. Existen encuestas para medir dichas conductas, pero son de difícil interpretación. El objetivo del estudio fue diseñar y validar un cuestionario homogéneo para estudiar los hábitos en adolescentes de 12-14 años.Población y métodos. Estudio descriptivo y transversal para validación de un cuestionario. Los ítems fueron seleccionados tras revisión de la literatura y evaluación por expertos. El pretest fue administrado a una muestra piloto. Se determinó la fiabilidad mediante el alfa de Cronbach, y la validez del constructo, mediante un análisis factorial. Se aplicó a una muestra de padres de alumnos de cuatro centros de secundaria.Resultados. El coeficiente de Cronbach mostró valores próximos a 0,7 en tres de las cuatro subescalas y un valor global de 0,629, que demostró precisión y estabilidad. El análisis factorial determinó una validez de constructo adecuada, que mostró 4 factores: alimentación, actividad física, nuevas tecnologías y entorno. El cuestionario final tuvo 26 ítems y se aplicó a 421 participantes. Un 24,8 % presentaron hábitos deficientes, y un 3,4 %, muy poco saludables. Las adolescentes mostraron peores puntuaciones en actividad física (p < 0,001), y los adolescentes, en nuevas tecnologías, aunque no significativo.Conclusiones. Se obtuvo un instrumento válido, fiable y de fácil aplicación para evaluar conductas modificables en adolescentes. La inclusión de tecnologías y entorno adapta el cuestionario a los cambios actuales. Las dimensiones sobre uso de tecnologías y actividad física fueron las más deficitarias; las adolescentes se mostraron más sedentarias.


Introduction. Social and cultural changes are altering young people's habits. Some surveys measure such behaviors, but are hard to interpret. The objective of this study was to design and validate a homogeneous questionnaire to study habits among adolescents aged 12-14 years.Population and methods. Descriptive and cross-sectional study to validate a questionnaire. Items were selected after a bibliographic review and expert assessment. The pre-test was administered to a pilot sample. Reliability was established using Cronbach's alpha coefficient, and construct validity, using a factor analysis. It was administered to a sample of parents of students from 4 secondary schools.Results. Cronbach's coefficient showed values close to 0.7 in 3/4 subscales and an overall value of 0.629, showing accuracy and stability. Factor analysis determined an adequate construct validity, with 4 factors: eating, physical activity, new technologies, and environment. The final questionnaire included 26 items and was administered to 421 participants. Poor habits were observed in 24.8 % and very unhealthy, in 3.4 %. Girls had poorer scores in physical activity (p < 0.001), and boys, in new technologies, although it was not significant.Conclusions. The final instrument was valid, reliable, and easily administered to assess modifiable behaviors in adolescents. The inclusion of technologies and environment helps to adapt the questionnaire to current changes. The greatest deficit was observed in the technology use and physical activity domains; and girls were more sedentary.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Estilo de Vida Saudável , Pais , Prevenção Primária , Espanha , Saúde da Criança , Estudos Transversais , Inquéritos e Questionários , Obesidade Pediátrica
9.
World J Gastroenterol ; 27(19): 2325-2340, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34040325

RESUMO

Pancreatic cancer (PC) is a devastating malignancy with fewer than 10% of patients being alive at 5 years after diagnosis. Venous thromboembolism (VTE) occurs in approximatively 20% of patients with PC, resulting in increased morbidity, mortality and significant health care costs. The management of VTE is particularly challenging in these frail patients. Adequate selection of the most appropriate anticoagulant for each individual patient according to the current international guidelines is warranted for overcoming treatment challenges. The International Initiative on Thrombosis and Cancer multi-language web-based mobile application (downloadable for free at www.itaccme.com) has been developed to help clinicians in decision making in the most complex situations. In this narrative review, we will discuss the contemporary epidemiology and burden of VTE in PC patients, the performances and limitations of current risk assessment models to predict the risk of VTE, as well as evidence from recent clinical trials for the primary prophylaxis and treatment of cancer-associated VTE that support up-dated clinical practice guidelines.


Assuntos
Neoplasias Pancreáticas , Tromboembolia Venosa , Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular , Humanos , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/epidemiologia , Prevenção Primária , Medição de Risco , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
10.
Obesity (Silver Spring) ; 29(6): 1022-1035, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33950583

RESUMO

OBJECTIVE: This study aimed to test the effectiveness of the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS Childhood Obesity) for behavioral, health-related quality of life (HRQoL), and BMI outcomes. METHODS: This was a cluster randomized trial of 10 communities randomly allocated (1:1) to start intervention in 2015 (step 1) or in 2019 (after 4 years) in South West Victoria, Australia. Data were collected from participating primary schools in April to June of 2015 (73% school participation rate), 2017 (69%), and 2019 (63%). Student participation rates were 80% in 2015 (1,792/2,516 invited), 81% in 2017 (2,411/2,963), and 79% in 2019 (2,177/2,720). Repeat cross-sectional analyses of measured height and weight (grades two, four, and six [aged approximately 7 to 12 years]), self-reported behavior, and HRQoL (grades four and six) were conducted. RESULTS: There was an intervention by time interaction in BMI z scores (P = 0.031) and obesity/overweight prevalence (P = 0.006). BMI z score and overweight/obesity prevalence decreased between 2015 and 2017 and increased between 2017 and 2019 in intervention communities. The intervention significantly reduced takeaway food consumption (P = 0.034) and improved physical (P = 0.019), psychosocial (P = 0.026), and global (P = 0.012) HRQoL. Water consumption increased among girls (P = 0.033) in the intervention communities, as did energy-dense, nutrient-poor snack consumption among boys (P = 0.006). CONCLUSIONS: WHO STOPS had a positive impact on takeaway food intake and HRQoL.


Assuntos
Índice de Massa Corporal , Obesidade Pediátrica/prevenção & controle , Prevenção Primária , Qualidade de Vida , Adolescente , Criança , Comportamento Infantil/fisiologia , Análise por Conglomerados , Estudos Transversais , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde/fisiologia , Humanos , Masculino , Sobrepeso/epidemiologia , Sobrepeso/terapia , Obesidade Pediátrica/epidemiologia , Prevalência , Prevenção Primária/métodos , Prevenção Primária/organização & administração , Avaliação de Programas e Projetos de Saúde , Instituições Acadêmicas/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Vitória/epidemiologia , Programas de Redução de Peso/métodos
11.
Eur J Endocrinol ; 185(1): R13-R21, 2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-33989173

RESUMO

Iodine deficiency has multiple adverse effects on growth and development. Diets in many countries cannot provide adequate iodine without iodine fortification of salt. In 2020, 124 countries have legislation for mandatory salt iodization and 21 have legislation allowing voluntary iodization. As a result, 88% of the global population uses iodized salt. For population surveys, the urinary iodine concentration (UIC) should be measured and expressed as the median, in µg/L. The quality of available survey data is high: UIC surveys have been done in 152 out of 194 countries in the past 15 years; in 132 countries, the studies were nationally representative. The number of countries with adequate iodine intake has nearly doubled from 67 in 2003 to 118 in 2020. However, 21 countries remain deficient, while 13 countries have excessive intakes, either due to excess groundwater iodine, or over-iodized salt. Iodine programs are reaching the poorest of the poor: of the 15 poorest countries in the world, 10 are iodine sufficient and only 3 (Burundi, Mozambique and Madagascar) remain mild-to-moderately deficient. Nigeria and India have unstable food systems and millions of malnourished children, but both are iodine-sufficient and population coverage with iodized salt is a remarkable 93% in both. Once entrenched, iodine programs are often surprisingly durable even during national crises, for example, war-torn Afghanistan and Yemen are iodine-sufficient. However, the equity of iodized salt programs within countries remains an important issue. In summary, continued support of iodine programs is needed to sustain these remarkable global achievements, and to reach the remaining iodine-deficient countries.


Assuntos
Deficiências Nutricionais/prevenção & controle , Endocrinologia , Saúde Global , Iodo/deficiência , Cloreto de Sódio na Dieta/uso terapêutico , Adulto , Criança , Deficiências Nutricionais/epidemiologia , Endocrinologia/história , Endocrinologia/métodos , Endocrinologia/organização & administração , Endocrinologia/tendências , Feminino , Saúde Global/história , Saúde Global/tendências , História do Século XXI , Humanos , Recém-Nascido , Iodo/provisão & distribuição , Iodo/uso terapêutico , Desnutrição/dietoterapia , Desnutrição/epidemiologia , Programas Nacionais de Saúde/história , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/tendências , Gravidez , Prevenção Primária/história , Prevenção Primária/métodos , Prevenção Primária/organização & administração , Prevenção Primária/tendências , Cloreto de Sódio na Dieta/provisão & distribuição
13.
Monaldi Arch Chest Dis ; 91(2)2021 May 04.
Artigo em Inglês | MEDLINE | ID: covidwho-1215533

RESUMO

To the Editor COVID-19 (COrona VIrus Disease) patients with cardiovascular (CV) disease, multiple CV risk factors or comorbidities (i.e., arterial hypertension and diabetes) were shown to be more prone to a worse prognosis. SARS-CoV-2 is a still unknown enemy and the role of concomitant cardiovascular therapies has been controversial in the early stages, particularly with regard to Angiotensin-Converting Enzyme inhibitors...


Assuntos
COVID-19/imunologia , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco de Doenças Cardíacas , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , COVID-19/complicações , COVID-19/mortalidade , COVID-19/fisiopatologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/tratamento farmacológico , Desprescrições , Humanos , Hiperlipidemias/complicações , Prevenção Primária , SARS-CoV-2 , Prevenção Secundária
14.
Med J Aust ; 214(9): 434-439, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33960402

RESUMO

INTRODUCTION: This position statement considers the evolving evidence on the use of coronary artery calcium scoring (CAC) for defining cardiovascular risk in the context of Australian practice and provides advice to health professionals regarding the use of CAC scoring in primary prevention of cardiovascular disease in Australia. Main recommendations: CAC scoring could be considered for selected people with moderate absolute cardiovascular risk, as assessed by the National Vascular Disease Prevention Alliance (NVDPA) absolute cardiovascular risk algorithm, and for whom the findings are likely to influence the intensity of risk management. (GRADE evidence certainty: Low. GRADE recommendation strength: Conditional.) CAC scoring could be considered for selected people with low absolute cardiovascular risk, as assessed by the NVDPA absolute cardiovascular risk algorithm, and who have additional risk-enhancing factors that may result in the underestimation of risk. (GRADE evidence certainty: Low. GRADE recommendation strength: Conditional.) If CAC scoring is undertaken, a CAC score of 0 AU could reclassify a person to a low absolute cardiovascular risk status, with subsequent management to be informed by patient-clinician discussion and follow contemporary recommendations for low absolute cardiovascular risk. (GRADE evidence certainty: Very low. GRADE recommendation strength: Conditional.) If CAC scoring is undertaken, a CAC score > 99 AU or ≥ 75th percentile for age and sex could reclassify a person to a high absolute cardiovascular risk status, with subsequent management to be informed by patient-clinician discussion and follow contemporary recommendations for high absolute cardiovascular risk. (GRADE evidence certainty: Very low. GRADE recommendation strength: Conditional.) CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: CAC scoring can have a role in reclassification of absolute cardiovascular risk for selected patients in Australia, in conjunction with traditional absolute risk assessment and as part of a shared decision-making approach that considers the preferences and values of individual patients.


Assuntos
Calcinose/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Prevenção Primária/organização & administração , Calcificação Vascular/diagnóstico por imagem , Austrália , Doenças Cardiovasculares/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/prevenção & controle , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Sociedades Médicas/organização & administração , Calcificação Vascular/prevenção & controle
15.
Am J Cardiol ; 150: 65-68, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34001339

RESUMO

The sodium-glucose cotransporter 2 inhibitors (SGLT2i) empagliflozin, canagliflozin, and dapagliflozin reduce the risk of heart failure (HF) events in patients with diabetes mellitus (DM) at high risk for HF. Differences in HF outcomes between SGLT2i were demonstrated in a recent-published meta-analysis. Nevertheless, comparative cost-effectiveness analyses of SGLT2i provided for this indication have not been published yet. Therefore, we aimed to provide a preceding economic comparison of the costs required for improving HF outcomes by these three SGLT2i. The primary outcome was the cost needed to treat (CNT) to prevent one event of hospitalization for HF or cardiovascular mortality. CNT is calculated by multiplying the annualized number needed to treat to prevent one event by the annual cost of therapy. Clinical outcome data were extracted from pre-specified cohorts of HF-naïve patients in the pivotal randomized controlled trials (RCTs). Costs of interventions were estimated as 75% of the US National Average Drug Acquisition Cost listing. Sensitivity analysis was performed to mitigate differences between the RCT's populations. We figured the CNT for the primary prevention of HF events in DM patients to be $542,328 ($409,044-$905,412) for empagliflozin, $2,347,488 ($1,066,208-∞) for canagliflozin and $2,128,374 ($1,204,740-$48,140,518) for dapagliflozin. Sensitivity analysis confirmed the cost benefit of empagliflozin. Our findings suggest that between the available SGLT2i, the cost of primary prevention of HF in patients with DM at high risk for HF is lowest with empagliflozin. These findings may help choose an SGLT2i until head-to-head RCTs, and comprehensive cost-effective analyses for this indication are available.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/prevenção & controle , Prevenção Primária , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Compostos Benzidrílicos/uso terapêutico , Canagliflozina/uso terapêutico , Feminino , Glucosídeos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inibidores do Transportador 2 de Sódio-Glicose/economia
16.
Vasc Health Risk Manag ; 17: 227-237, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34054297

RESUMO

Despite widespread evidence of the effectiveness of lipid modification for the reduction of cardiovascular disease (CVD) risk, lipid modification goals are commonly underachieved in the United Kingdom (UK). In order to understand current UK lipid management guidance and the corresponding attainment of recommended lipid lowering goals relating to treatment with statins and ezetimibe, a literature review was conducted using PubMed focusing on publications between January 2017 and February 2020 in order to capture the most up-to-date literature. Identified publications were reviewed against key clinical guidelines for lipid management in relation to CVD risk from the National Institute for Health and Care Excellence (NICE, CG181), the Scottish Intercollegiate Guidelines Network (SIGN, 149) and European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS). Cholesterol lowering goals are central to current lipid lowering therapy guidance, although specific goals vary depending on the guideline and patients' individual risk profile. Current guidance by NICE and SIGN specifies that treatment should achieve a greater than 40% reduction in non-high-density lipoprotein cholesterol (non-HDL-C) at 3 months of treatment, while the ESC/EAS place emphasis on the lowering of low-density lipoprotein (LDL-C) and total cholesterol. Yet, despite widespread availability of guidance and consistent messaging that lipid lowering goals should be ambitious, current evidence suggests a significant proportion of UK patients have sub-optimal reductions in cholesterol/non-HDL-C/LDL-C. The reasons for this are reported to be multifactorial, including a lack of compliance with guidelines, particularly regarding high-intensity statin prescribing, patient adherence, statin intolerance and statin reluctance as well as wider genetic factors. A number of possible strategies to improve current lipid management and attainment of lipid-lowering goals were identified, including improving the patient-healthcare professional partnership, conducting audits of local prescribing versus guidance, implementing plans for the refinement of current services and considering alternative options such as cost-effective single pill combinations for improving adherence.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dislipidemias/tratamento farmacológico , Ezetimiba/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lipídeos/sangue , Benchmarking , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Quimioterapia Combinada , Dislipidemias/sangue , Dislipidemias/diagnóstico , Ezetimiba/efeitos adversos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Prevenção Primária , Medição de Risco , Fatores de Risco , Prevenção Secundária , Resultado do Tratamento , Reino Unido
17.
Curr Cardiol Rep ; 23(6): 67, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33961154

RESUMO

PURPOSE OF REVIEW: The utility of aspirin and statins for primary prevention of atherosclerotic cardiovascular disease remains ambiguous in older adults. Current guidelines and recent data are vague and inconclusive. This review seeks to summarize the landscape of primary prevention of cardiovascular disease in older adults and explore the role of shared decision making. RECENT FINDINGS: Observational data suggest potential benefit of statin therapy in older adults. Aspirin is presently not recommended for primary prevention based on evidence from recent clinical trials. The implementation of shared decision making and decision aids in routine clinical practice remains challenging but may rise in coming years. Clinical trial data on the horizon may aid in solidifying guideline therapy for statin use. However, in the face of uncertainty, shared decision making between provider and patient should be utilized to determine whether pharmacotherapy may benefit older adults. Decision aids are an effective tool to guide this process.


Assuntos
Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Idoso , Aspirina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Tomada de Decisões , Tomada de Decisão Compartilhada , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Prevenção Primária , Incerteza
18.
Stud Health Technol Inform ; 279: 78-86, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33965922

RESUMO

BACKGROUND: Physical activity helps improve the overall quality of life. The correct execution of physical activity is crucial both in sports as well as disease prevention and rehabilitation. Little to no automated commodity solutions for automated analysis and feedback exist. OBJECTIVES: Validation of the Apple ARKit framework as a solution for automatic body tracking in daily physical exercises using the smartphones' built-in camera. METHODS: We deliver insights into ARKit's body tracking accuracy through a lab experiment against the VICON system as Gold Standard. We provide further insights through case studies using apps built on ARKit. RESULTS: ARKit exposes significant limitations in tracking the full range of motion in joints but accurately tracks the movement itself. Case studies show that applying it to measure the quantity of execution of exercises is possible. CONCLUSION: ARKit is a light-weight commodity solution for quantitative assessment of physical activity. Its limitations and possibilities in qualitative assessment need to be investigated further.


Assuntos
Exercício Físico , Aplicativos Móveis , Prevenção Primária , Terapia por Exercício , Humanos , Qualidade de Vida , Smartphone
19.
Kardiologiia ; 61(4): 24-31, 2021 May 04.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-33998405

RESUMO

Aim      Analysis of responses of cardioverter-defibrillators implanted in patients with cardiomyopathies (CMPs) of various origins and a high risk of sudden cardiac death (SCD) to assess the effectiveness of a modern strategy for primary prevention of SCD.Material and methods  In the Federal Center for High Medical Technologies in Kaliningrad from 2014 through 2018, implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRT-D) were installed in 165 patients. Major indications for device implantation in these patients included left ventricular (LV) systolic dysfunction with ejection fraction (EF) ≤35 %; chronic heart failure (CHF) consistent with the New York Heart Association (NYHA) functional class (FC) II-III (IV for CRT-D) without previous episodes of life-threatening ventricular arrhythmias, circulatory arrest and resuscitation, which was consistent with the current international strategy for primary prevention of SCD. The study patients were divided into two groups based on the CMP origin; group 1 included 101 (61.2 %) patients with CMP of ischemic origin (ICMP) and group 2 consisted of 64 (38.8 %) patients with CMP of non-ischemic origin (NCMP). Information about arrhythmic episodes and device activation was retrieved from the device electronic memory during visits of patients to the clinic and was also transmitted to the clinic by a remote monitoring system. This information was studied and evaluated for the validity and effectiveness of the device triggering. If necessary, the parameters of detection and treatment were adjusted taking into account the obtained information. Information was analyzed and statistically processed with the SPSS Statistics 20.0 software.Results The patients were followed up for 28.3 ± 15.6 months, during which the devices delivered therapy to 55 (33.3%) patients of the entire group. In the ICMP group, the devices were activated in 44 (26.7 %) patients and in the NCMP group, the devices were activated in 11 (6.7 %) patients. In group 1 (ICMP), appropriate triggering was observed in 33 (20.0%) patients and inappropriate triggering was observed in 11 (6.7%) patients. In group 2 (NCMP), appropriate triggering was observed in 2 (1.2 %) patients and inappropriate triggering was observed in 9 (5.5 %) patients. The main cause of inappropriate triggering was atrial fibrillation (AF). 17 (10.3 %) patients with ICMP had sustained ventricular tachycardia (VT), which did not reach the detection frequency for ICD therapy; these VTs were only detected by devices and terminated spontaneously. Intragroup differences in the number of patients who received an appropriate treatment were statistically significant: 33 (32.6 %) in the ICMP group vs. 2 (3.1 %) in the NCMP group (р<0.006). Differences in the number of patients who received an inappropriate treatment were not statistically significant although their number was greater in the NCMP group than in the ICMP group (9 (14.1 %) vs. 11 (10.9 %), р>0.05).Conclusion      A higher requirement for the ICD treatment was revealed in patients with ICMP compared to patients with NCMP. The low demand for the ICD treatment in patients with NCMP and the more frequent inappropriate actuation of the devices in this patient group due to AF allow a conclusion that the criteria for primary prevention of SCD with ICD (LV EF ≤35% and clinically significant CHF) are not equally effective indications for ICD implantation in patients with ICMP and NCMP. It can be assumed that life-threatening ventricular arrhythmias are evident in patients with NCMP before the development of hemodynamically significant LV dysfunction and CHF, which warrants further research in this direction.


Assuntos
Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Taquicardia Ventricular , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Humanos , Prevenção Primária , Taquicardia Ventricular/terapia
20.
Lancet ; 397(10285): 1625-1636, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933205

RESUMO

BACKGROUND: The effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure. METHODS: We did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat. FINDINGS: Data for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/89 mm Hg in participants without previous cardiovascular disease (n=186 988). There was substantial spread in participants' blood pressure at baseline, with 31 239 (19·8%) of participants with previous cardiovascular disease and 14 928 (8·0%) of individuals without previous cardiovascular disease having a systolic blood pressure of less than 130 mm Hg. The relative effects of blood pressure-lowering treatment were proportional to the intensity of systolic blood pressure reduction. After a median 4·15 years' follow-up (Q1-Q3 2·97-4·96), 42 324 participants (12·3%) had at least one major cardiovascular event. In participants without previous cardiovascular disease at baseline, the incidence rate for developing a major cardiovascular event per 1000 person-years was 31·9 (95% CI 31·3-32·5) in the comparator group and 25·9 (25·4-26·4) in the intervention group. In participants with previous cardiovascular disease at baseline, the corresponding rates were 39·7 (95% CI 39·0-40·5) and 36·0 (95% CI 35·3-36·7), in the comparator and intervention groups, respectively. Hazard ratios (HR) associated with a reduction of systolic blood pressure by 5 mm Hg for a major cardiovascular event were 0·91, 95% CI 0·89-0·94 for partipants without previous cardiovascular disease and 0·89, 0·86-0·92, for those with previous cardiovascular disease. In stratified analyses, there was no reliable evidence of heterogeneity of treatment effects on major cardiovascular events by baseline cardiovascular disease status or systolic blood pressure categories. INTERPRETATION: In this large-scale analysis of randomised trials, a 5 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular events by about 10%, irrespective of previous diagnoses of cardiovascular disease, and even at normal or high-normal blood pressure values. These findings suggest that a fixed degree of pharmacological blood pressure lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at blood pressure levels currently not considered for treatment. Physicians communicating the indication for blood pressure lowering treatment to their patients should emphasise its importance on reducing cardiovascular risk rather than focusing on blood pressure reduction itself. FUNDING: British Heart Foundation, UK National Institute for Health Research, and Oxford Martin School.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Doenças Cardiovasculares/prevenção & controle , Hipertensão/prevenção & controle , Doenças Cardiovasculares/tratamento farmacológico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/tratamento farmacológico , Análise de Intenção de Tratamento , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/mortalidade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/mortalidade , Prevenção Primária , Modelos de Riscos Proporcionais , Prevenção Secundária , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade
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