The effect of long-term homocysteine-lowering on carotid intima-media thickness and flow-mediated vasodilation in stroke patients: a randomized controlled trial and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Experimental and epidemiological evidence suggests that homocysteine (tHcy) may be a causal risk factor for atherosclerosis. B-vitamin supplements reduce tHcy and improve endothelial function in short term trials, but the long-term effects of the treatment on vascular structure and function are unknown.</p> <p>Methods</p> <p>We conducted a sub-study of VITATOPS, a randomised, double-blind, placebo-controlled intervention trial designed to test the efficacy of long term B-vitamin supplementation (folic acid 2 mg, vitamin B₆25 mg and vitamin B₁₂0.5 mg) in the prevention of vascular events in patients with a history of stroke. We measured carotid intima-medial thickness (CIMT) and flow-mediated dilation (FMD) at least two years after randomisation in 162 VITATOPS participants. We also conducted a systematic review and meta-analysis of studies designed to test the effect of B-vitamin treatment on CIMT and FMD.</p> <p>Results</p> <p>After a mean treatment period of 3.9 ± 0.9 years, the vitamin-treated group had a significantly lower mean plasma homocysteine concentration than the placebo-treated group (7.9 μmol/L, 95% CI 7.5 to 8.4 versus 11.8 μmol/L, 95% CI 10.9 to 12.8, p < 0.001). Post-treatment CIMT (0.84 ± 0.17 mm vitamins versus 0.83 ± 0.18 mm placebo, p = 0.74) and FMD (median of 4.0%, IQR 0.9 to 7.2 vitamins versus 3.0%, IQR 0.6 to 6.6 placebo, p = 0.48) did not differ significantly between groups. A meta-analysis of published randomised data, including those from the current study, suggested that B-vitamin supplements should reduce CIMT (-0.10 mm, 95% CI -0.20 to -0.01 mm) and increase FMD (1.4%, 95% CI 0.7 to 2.1%). However, the improvement in endothelial function associated with homocysteine-lowering treatment was significant in short-term studies but not in longer trials.</p> <p>Conclusion</p> <p>Although short-term treatment with B-vitamins is associated with increased FMD, long-term homocysteine-lowering did not significantly improve FMD or CIMT in people with a history of stroke.</p> <p>Trial Registration</p> <p>Clinical Trial Registration URL: <url>http://www.actr.org.au/</url></p> <p>Trial Registration number: 12605000005651</p

Religião e espiritualidade no ensino e assistência de enfermagem Religión y espiritualidad en la educación y asistencia de enfermería Religion and spirituality in education and nursing assistance

Estudo da interseção entre o discurso da enfermagem e os preceitos que albergam a religião/religiosidade e espiritualidade, e como se deu a incorporação e o reflexo desse discurso nas práticas assistenciais, no ensino e no delineamento da organização da profissão. Para revisão bibliográfica, utilizaram-se as bases de dados LILACS e BDENF, da Biblioteca Virtual de Saúde. Um total de 57 artigos completos, publicados entre 1957 e 2007, foram analisados à luz das idéias sobre " memória coletiva" , de Maurice Halbwachs. Verificou-se que há uma raiz religiosa com ramificações profundas na conformação da enfermagem brasileira. Esta configuração está tão imbricada na memória coletiva que, mesmo com a expansão de instituições que não se declaram religiosas, os pressupostos cristãos se mantêm presentes e com vitalidade.<br>Estudio de la intersección entre el discurso del oficio de enfermera y preceptos que alojan la religión/el religiosidad y el espiritualidad, y como ha dado la incorporación y a la consecuencia de este discurso en los asistencias prácticos, la educación y la delineación de la organización de la profesión. Para la revisión bibliográfica, las bases de datos LILACS y BDENF de la Biblioteca Virtual de Salud, fueron utilizadas. Un total de 57 artículos completos, publicados entre 1957 y 2007, fueron analizados a la luz de las ideas en " memoria colectiva" , de Maurice Halbwachs. Se verificó que hay una raíz religiosa con ramificaciones profundas en la conformación del oficio de enfermera brasileño. Esta configuración es tan imbricada en la memoria colectiva que, mismo con la expansión de las instituciones que non se declaran religiosas, el presupuestos cristanos se mantiene presentes y con vitalidad.<br>Intersectional study between nursing discourse and precepts which embrace religion/religiousness and spirituality, and how these were incorporated and their reflection upon nursing practice, education and the history of the organization of the profession. For bibliographic review LILACS and BDENF databases of the Electronic Health Library were used. A total of 57 full-text articles, published from 1957 to 2007, were analyzed upon the light of the ideas of Maurice Halbwachs, about " collective memory" . The results show that Brazilian nursing has a religious root with profound ramifications on its development. This configuration is so embedded in the collective memory that, even with the expansion of non-religious institutions, the Christian precepts remain present and strong