O impacto da espiritualidade na saúde física

BACKGROUND: The implications of spirituality in ones health have been studied and registered in hundreds of articles, demonstrating its relationship with several aspects of physical and mental health,probably positive and possibly causal. OBJECTIVE: To present the recent evidences of the role of spirituality and religiosity in daily clinical practice. METHODS: The articles were selected based on Medline database, through the keywords: "religiosity", "religion", "spiritual" and "spirituality". The articles were evaluated by analysis of method and determination of limitations of studiesdesign. RESULTS: The major findings originated from the association of spirituality, religiosity and immunological activity, mental health, neoplasias, cardiovascular diseases and mortality, besides aspects regarding the intervention of the intercessory prayer, were presented in a descriptive and concise way. CONCLUSIONS: The relationship between the religiosity/spirituality and the physical health has been confirmed but the evidences are not sufficiently conclusive. So, this has become a very promising field of study.CONTEXTO: As implicações da espiritualidade na saúde vêm sendo cientificamente avaliadas e documentadas em centenas de artigos, demonstrando sua relação com vários aspectos das saúdes física e mental, provavelmente positivos e possivelmente causais. OBJETIVO: Apresentar de forma concisa as evidências recentes do papel da espiritualidade e da religiosidade em diversos campos da prática clínica diária. MÉTODOS: Para uma revisão descritiva foram selecionados artigos no banco de dados Medline, por meio dos unitermos: "religiosity", "religion", "spiritual" e "spirituality". Os artigos foram avaliados por análise de método e determinação de limitações de desenho. RESULTADOS: Foram apresentados de forma descritiva e concisa relevantes achados referentes às associações entre a espiritualidade/religiosidade e atividade imunológica, saúde mental, neoplasias, doenças cardiovasculares e mortalidade, além de aspectos de intervenção com uso de prece intercessória. CONCLUSÕES: Há crescente acúmulo de evidências sobre a relação entre religiosidade/espiritualidade e saúde física, mas por essas evidências ainda não serem adequadamente robustas, este se constitui em promissor campo de investigação

Rivaroxaban to prevent major clinical outcomes in non-hospitalised patients with COVID-19 : the CARE – COALITION VIII randomised clinical trial

Background: COVID-19 progression is associated with an increased risk of arterial and venous thrombosis. Randomised trials have demonstrated that anticoagulants reduce the risk of thromboembolism in hospitalised patients with COVID-19, but a benefit of routine anticoagulation has not been demonstrated in the outpatient setting. Methods: We conducted a randomised, open-label, controlled, multicentre study, evaluating the use of rivaroxaban in mild or moderate COVID-19 patients. Adults ≥18 years old, with probable or confirmed SARS-CoV-2 infection, presenting within ≤7 days from symptom onset with no clear indication for hospitalization, plus at least 2 risk factors for complication, were randomised 1:1 either to rivaroxaban 10 mg OD for 14 days or to routine care. The primary efficacy endpoint was the composite of venous thromboembolic events, need of mechanical ventilation, acute myocardial infarction, stroke, acute limb ischemia, or death due to COVID-19 during the first 30 days. ClinicalTrials.gov: NCT04757857. Findings: Enrollment was prematurely stopped due to sustained reduction in new COVID-19 cases. From September 29th, 2020, through May 23rd, 2022, 660 patients were randomised (median age 61 [Q1-Q3 47–69], 55.7% women). There was no significant difference between rivaroxaban and control in the primary efficacy endpoint (4.3% [14/327] vs 5.8% [19/330], RR 0.74; 95% CI: 0.38–1.46). There was no major bleeding in the control group and 1 in the rivaroxaban group. Interpretation: On light of these findings no decision can be made about the utility of rivaroxaban to improve outcomes in outpatients with COVID-19. Metanalyses data provide no evidence of a benefit of anticoagulant prophylaxis in outpatients with COVID-19. These findings were the result of an underpowered study, therefore should be interpreted with caution

Associations of outdoor fine particulate air pollution and cardiovascular disease in 157 436 individuals from 21 high-income, middle-income, and low-income countries (PURE): A prospective cohort study

Background: Most studies of long-term exposure to outdoor fine particulate matter (PM2·5) and cardiovascular disease are from high-income countries with relatively low PM2·5 concentrations. It is unclear whether risks are similar in low-income and middle-income countries (LMICs) and how outdoor PM2·5 contributes to the global burden of cardiovascular disease. In our analysis of the Prospective Urban and Rural Epidemiology (PURE) study, we aimed to investigate the association between long-term exposure to PM2·5 concentrations and cardiovascular disease in a large cohort of adults from 21 high-income, middle-income, and low-income countries.Methods: In this multinational, prospective cohort study, we studied 157 436 adults aged 35-70 years who were enrolled in the PURE study in countries with ambient PM2·5 estimates, for whom follow-up data were available. Cox proportional hazard frailty models were used to estimate the associations between long-term mean community outdoor PM2·5 concentrations and cardiovascular disease events (fatal and non-fatal), cardiovascular disease mortality, and other non-accidental mortality.Findings: Between Jan 1, 2003, and July 14, 2018, 157 436 adults from 747 communities in 21 high-income, middle-income, and low-income countries were enrolled and followed up, of whom 140 020 participants resided in LMICs. During a median follow-up period of 9·3 years (IQR 7·8-10·8; corresponding to 1·4 million person-years), we documented 9996 non-accidental deaths, of which 3219 were attributed to cardiovascular disease. 9152 (5·8%) of 157 436 participants had cardiovascular disease events (fatal and non-fatal incident cardiovascular disease), including 4083 myocardial infarctions and 4139 strokes. Mean 3-year PM2·5 at cohort baseline was 47·5 μg/m3 (range 6-140). In models adjusted for individual, household, and geographical factors, a 10 μg/m3 increase in PM2·5 was associated with increased risk for cardiovascular disease events (hazard ratio 1·05 [95% CI 1·03-1·07]), myocardial infarction (1·03 [1·00-1·05]), stroke (1·07 [1·04-1·10]), and cardiovascular disease mortality (1·03 [1·00-1·05]). Results were similar for LMICs and communities with high PM2·5 concentrations (\u3e35 μg/m3). The population attributable fraction for PM2·5 in the PURE cohort was 13·9% (95% CI 8·8-18·6) for cardiovascular disease events, 8·4% (0·0-15·4) for myocardial infarction, 19·6% (13·0-25·8) for stroke, and 8·3% (0·0-15·2) for cardiovascular disease mortality. We identified no consistent associations between PM2·5 and risk for non-cardiovascular disease deaths.Interpretation: Long-term outdoor PM2·5 concentrations were associated with increased risks of cardiovascular disease in adults aged 35-70 years. Air pollution is an important global risk factor for cardiovascular disease and a need exists to reduce air pollution concentrations, especially in LMICs, where air pollution levels are highest.Funding: Full funding sources are listed at the end of the paper (see Acknowledgments)

Clinical Impact of the Polypill for Cardiovascular Prevention in Latin America: A Consensus Statement of the Inter-American Society of Cardiology.

The burden of cardiovascular diseases (CVD) is increasing, particularly in low-middle-income countries such as most of Latin America. This region presents specific socioeconomic characteristics, generating a high incidence of CVD despite efforts to control the problem. A consensus statement has been developed by Inter-American Society of Cardiology with the aim of answering some important questions related to CVD in this region and the role of the polypill in cardiovascular (CV) prevention as an intervention to address these issues. A multidisciplinary team composed of Latin American experts in the prevention of CVD was convened by the Inter-American Society of Cardiology and participated in the process and the formulation of statements. To characterize the prevailing situation in Latin American countries, we describe the most significant CV risk factors in the region. The barriers that impair the use of CV essential medications are also reviewed. The role of therapeutic adherence in CV prevention and how the polypill emerges as an effective strategy for optimizing adherence, accessibility, and affordability in the treatment of CVDs are discussed in detail. Clinical scenarios in which the polypill could represent an effective intervention in primary and secondary CV prevention are described. This initiative is expected to help professionals involved in the management of CVD and public health policymakers develop optimal strategies for the management of CVDs

Risk factors associated with acute myocardial infarction in the São Paulo metropolitan region: a developed region in a developing country

Objective To identify the risk factors associated with acute myocardial infarction (AMI) and their respective powers of association in the São Paulo metropolitan region. Methods The cases comprised patients diagnosed with first AMI with an ST segment elevation. The controls were individuals with no known cardiovascular disease. The study comprised 271 cases and 282 controls from 12 hospitals. Risk factors were as follows: ethnic group; educational level; marital status; family income; family history of coronary artery disease; antecedents of arterial hypertension and of diabetes mellitus; hormonal replacement in women; smoking; physical activity; alcohol consumption; total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, and glucose levels; body mass index; and waist-hip ratio (WHR). Results The following risk factors showed and independent association with AMI: smoking [odds ratio (OR)=5.86; 95% confidence interval (CI) 3.25-10.57; P < 0.00001); waist-hip ratio (first vs. third tertile) (OR=4.27; 95% CI 2.28-8.00; P<0.00001); antecedents of arterial hypertension (OR=3.26; 95% CI 1.95-5.46; P< 0.00001); waist-hip ratio (first vs second tertile) (OR=3.07; 95% CI 1.66-5.66; P=0.0003); LDL-cholesterol level (OR=2.75; 95% CI 1.45-5.19; P=0.0018); antecedents of diabetes mellitus (OR= 2.51; 95% CI 1. 45-5.19; P=0.023); family history of coronary artery disease (OR=2.33; 95% CI 1. P=0.0005); P=0.011). Conclusion Smoking, waist-hip ratio, antecedents of arterial hypertension and of diabetes mellitus, family history of coronary artery disease, and LDL-cholesterol and HDL-cholesterol levels showed to be independently associated with AMI within the São Paulo metropolitan region

Challenges and Opportunities to Scale Up Cardiovascular Disease Secondary Prevention in Latin America and the Caribbean.

In the Americas, CVD represents about 38% of noncommunicable disease deaths. A roadmap for secondary prevention in Latin America and the Caribbean is warranted. Simple and practical guidelines should be developed and implemented. PAHO proposes a realistic and efficient prevention coalition plan in Latin America to fight CVD. The inclusion of the health system through health workers is highly recommended for a successful nationwide preventive program

Brazilian Sepsis Epidemiological Study (BASES study)

INTRODUCTION: Consistent data about the incidence and outcome of sepsis in Latin American intensive care units (ICUs), including Brazil, are lacking. This study was designed to verify the actual incidence density and outcome of sepsis in Brazilian ICUs. We also assessed the association between the Consensus Conference criteria and outcome METHODS: This is a multicenter observational cohort study performed in five private and public, mixed ICUs from two different regions of Brazil. We prospectively followed 1383 adult patients consecutively admitted to those ICUs from May 2001 to January 2002, until their discharge, 28th day of stay, or death. For all patients we collected the following data at ICU admission: age, gender, hospital and ICU admission diagnosis, APACHE II score, and associated underlying diseases. During the following days, we looked for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock criteria, as well as recording the sequential organ failure assessment score. Infection was diagnosed according to CDC criteria for nosocomial infection, and for community-acquired infection, clinical, radiological and microbiological parameters were used. RESULTS: For the whole cohort, median age was 65.2 years (49–76), median length of stay was 2 days (1–6), and the overall 28-day mortality rate was 21.8%. Considering 1383 patients, the incidence density rates for sepsis, severe sepsis and septic shock were 61.4, 35.6 and 30.0 per 1000 patient-days, respectively. The mortality rate of patients with SIRS, sepsis, severe sepsis and septic shock increased progressively from 24.3% to 34.7%, 47.3% and 52.2%, respectively. For patients with SIRS without infection the mortality rate was 11.3%. The main source of infection was lung/respiratory tract. CONCLUSION: Our preliminary data suggest that sepsis is a major public health problem in Brazilian ICUs, with an incidence density about 57 per 1000 patient-days. Moreover, there was a close association between ACCP/SCCM categories and mortality rate