Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

La detección de la lepra y la humanización de la atención: acciones de enfermería en el programa de salud de la familia / No disponible

El municipio de São Gonçalo, en la Región Metropolitana de Río de Janeiro - Brasil es considerado una zona endémica de la lepra de acuerdo con el Ministerio de Salud. De esta observación, hemos tratado de identificar con este trabajo cuáles son las acciones realizadas por las enfermeras en El Programa de Salud Familiar (PSF) para detectar la lepra y qué tipo de atención prestan a las personas afectadas por la enfermedad, centrándose en la humanización. Así, se realizó investigación descriptiva, cualitativa y de campo en las unidades de salud de la familia de esa ciudad, con treinta y un enfermeros a través de entrevistas con preguntas abiertas. Emergiendo dos categorías: las acciones de detección de la enfermera del PSF, la atención prestada a las personas afectadas y la necesaria humanización de esos cuidados. Se concluyó que las medidas adoptadas por las enfermeras no siguen un estándar único y que algunas no tienen la capacitación necesaria para desenvolverse con los usuarios del PSF afectadas por la lepra (AU)

The Municipality of São Gonçalo in the Metropolitan Region of Rio de Janeiro - Brazil is considered an endemic area for leprosy according to the Ministry of Health. From this observation, we sought to identify with this work which actions are performed by nurses from Family Health Program (PSF) to detect leprosy and what care they provide to people affected by the disease, with the focus on humanization. Thus, we performed descriptive, qualitative and field units in the health of the family of that city, with thirty-one nurses through interviews with open questions. Two categories emerged: the detection actions made by the nurse, the care given to people affected and the humanization of care needed. It was concluded that the actions taken by the nurses do not follow a single standard and that some lack the necessary training to function with users of PSF affected by leprosy (AU)

Causas de abandono del tratamiento antirretroviral (TARV) y eficacia de la entrevista motivacional en la mejora de la adherencia / Reasons for relinquishing antiretroviral (ARV) treatment and the effectiveness of the motivational interview in improving adherence

Objetivo: Estudiar en internos que abandonan el TARV la causa de abandono y la eficacia de la entrevista motivacional en la mejora del cumplimiento del tratamiento. Material y Métodos: Estudio observacional, prospectivo, realizado en la prisión de Quatre Camins (Barcelona). Se recogen las variables: edad, país de origen, estudios, adicción activa, tratamiento con metadona, conducta sexual, caso “SIDA”, “naïve” versus otros, número de comprimidos y número de dosis del tratamiento. Se realizó una entrevista a los 7 días para conocer las causas de abandono, ofrecer alternativas y motivar el cumplimiento. Se estudió la adherencia 4 y 12 semanas después. Se calcula la tasa de abandono, la eficacia de la intervención y la influencia de las variables estudiadas. Para la comparación de proporciones se utilizó la prueba exacta de Fisher (2 colas). Para el análisis de variables cuantitativas se utiliza la prueba de Mantel y Haenszel. Se consideraron estadísticamente significativos los valores de p < 0,05. Resultados: Hubo 232 pacientes en tratamiento y 59 abandonos (25,4%). Las principales causas de abandono fueron el olvido y/o la intolerancia al tratamiento. En los primeros 7 días se entrevistó a 58 (1 había fallecido). Tras la entrevista, 37 reiniciaron tratamiento, manteniéndolo el 97,3% a las 4 semanas y el 67,6% 12 semanas después. La única variable que se asoció significativamente tanto al reinicio del tratamiento como al mantenimiento posterior fue la adicción (menor reinicio y cumplimiento en los adictos activos; p = 0,004 y p = 0,04, respectivamente). Discusión: La entrevista motivacional es un método sencillo, útil y a nuestro alcance para mejorar la adherencia al TARV en un gran número de casos, y que tan sólo requiere interés y motivación, aunque se tendrían que diseñar estrategias específicas para colectivos concretos como los adictos activos (AU)

Objective: To study the reasons why inmates relinquish ARV treatment, and the effectiveness of the motivational interview in improving treatment compliance. Materials and Methods: Observational and prospective study, carried out in the Quatre Camins prison in Barcelona. The following variables were taken: age, country of origin, education, active addiction, treatment with methadone, sexual behaviour, AIDS history, “naive” versus others, number of pills and number of doses. An interview was conducted after 7 days to determine the reasons for relinquishment, offer alternatives and motivate compliance. Adherence was studied 4 and 12 weeks later. The rate of relinquishment was calculated, as was the effectiveness of the intervention and the influence of the variables studied. For comparison of the proportions, the Fisher’s Exact test (2 cells) was used. For the analysis of the quantitative variables, the Mantel-Haenszel test was used. Values of p < 0,05 were considered statistically significant. Results: There were 232 patients in treatment and 59 relinquishments (25,4%). The main causes of relinquishment were forgetting to take the medicine and/or intolerance to the treatment. In the first 7 days 58 inmates were interviewed (1 had died). After the interview, 37 resumed treatment, of whom 97,3% were still taking it after 4 weeks and 67,6% 12 weeks later. The only variable that was significantly associated to resumption of treatment and subsequent maintenance was addiction (lower incidence of resumption and compliance in active addicts; p = 0,004 and p = 0,04, respectively). Discussion: The motivational interview is a method that is simple, useful and easily available to improve ARV treatment adherence in a good many cases, requiring only interest and motivation, although specific strategies would be needed for certain groups, such as active addicts (AU)