Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Extending breastfeeding duration through primary care: a systematic review of prenatal and postnatal interventions.

This literature review provides an overview of the effectiveness of strategies and procedures used to extend breastfeeding duration. Interventions carried out during pregnancy and/or infant care conducted in primary health care services, community settings, or hospital clinics were included. Interventions covering only the delivery period were excluded. Interventions that were most effective in extending the duration of breastfeeding generally combined information, guidance, and support and were long term and intensive. During prenatal care, group education was the only effective strategy reported. Home visits used to identify mothers' concerns with breastfeeding, assist with problem solving, and involve family members in breastfeeding support were effective during the postnatal period or both periods. Individual education sessions were also effective in these periods, as was the combination of 2 or 3 of these strategies in interventions involving both periods. Strategies that had no effect were characterized by no face-to-face interaction, practices contradicting messages, or small-scale interventions

Amamentação em crianças com síndrome de Down: a percepção das mães sobre a atuação dos profïssionais de saúde Breast feeding in Down's syndrome children: mother's perception about the practices, of health profìssionals

O objetivo deste estudo foi entender a percepção de mães de crianças com Síndrome de Down sobre o aleitamento materno, sua relação com essa prática e a atuação do profissional de saúde nesse contexto. Ametodologia utilizada foi a da pesquisa qualitativa. A amostra foi composta por 14 mães de crianças com Síndrome de Down. O instrumento de coleta de dados foi a entrevista semi-estruturada, organizada através de um protocolo que continha questões sobre a percepção das entrevistadas quanto ao aleitamento, seu significado, seus anseios, dificuldades ou facilidades. Os principais resultados revelaram que, além dos aspectos relacionados à criança, o impacto causado pela notícia de um filho deficiente, bem como, a presença ou não de profissionais de saúde capacitados e sensíveis na orientação e apoio à essas mulheres, podem ser fatores inibidores ou facilitadores do processo de lactação.<br>The purpose of this study was to understand the perception of mothers of children with Down's Syndrome about breast feeding, their relationship with this practice and the health professional performance in this context. The methodology used was the qualitative one. The sample was composed of forteen (14) mothers of children with Down's Syndrome. The technique used to collect the data was the semi-structured interview. The interview schedule had questions related to mothers' feeling about breast feeding, its meaning, their longings, difficulties or habilities. The main results revealed that, besides the problems related to the child, the impact caused by the news of having a child with deficiency, as well as the presence or not of capable and sensitive health profissionals in the orientations to these mothers, can be factors which contribute to inhibit or to facilitate the lactation process