Inês Lancarotte

The effect of São Paulo's smoke-free legislation on carbon monoxide concentration in hospitality venues and their workers

Background Studies have shown that there is no safe level of secondhand smoke (SHS) exposure and there is a close link between SHS and the risk of coronary heart disease and stroke. Carbon monoxide (CO) is one of the most important components present in SHS. Objective To evaluate the impact of the smoking ban law in the city of Sao Paulo, Brazil, on the CO concentration in restaurants, bars, night clubs and similar venues and in their workers. Methods In the present study we measured CO concentration in 585 hospitality venues. CO concentration was measured in different environments (indoor, semi-open and open areas) from visited venues, as well as, in the exhaled air from approximately 627 workers of such venues. Measurements were performed twice, before and 12 weeks after the law implementation. In addition, the quality of the air in the city during the same period of our study was verified. Results The CO concentration pre-ban and pot-ban in hospitality venues was indoor area 4.57 (3.70) ppm vs 1.35 (1.66) ppm (p<0.0001); semi-open 3.79 (2.49) ppm vs 1.16 (1.14) ppm (p<0.0001); open area 3.31(2.2) ppm vs 1.31 (1.39) ppm (p<0.0001); smoking employees 15.78 (9.76) ppm vs 11.50 (7.53) ppm (p<0.0001) and non-smoking employees 6.88 (5.32) ppm vs 3.50 (2.21) ppm (p<0.0001). The average CO concentration measured in the city was lower than 1 ppm during both pre-ban and post-ban periods. Conclusion São Paulos smoking-free legislation reduced significantly the CO concentration in hospitality venues and in their workers, whether they smoke or not.

Estilo de vida e saúde cardiovascular em adolescentes de escolas do município de São Paulo

BACKGROUND Cardiovascular disease is the leading cause of mortality worldwide. There is evidence demonstrating the association of this disease with cardiovascular risk factors related to lifestyle, incorporated in adolescence. OBJECTIVE To identify, in adolescents, the prevalence of overweight and lifestyle factors associated with risk for developing cardiovascular diseases, and the factors that influence them. METHODS It was conducted an observational study of individual cross-sectional data with adolescents enrolled in public and private schools in São Paulo, covering grades 5 to 8 of elementary school. The information was obtained through the application of an anonymous questionnaire and weight and height measurements. RESULTS 2,125 adolescents with mean age of 12.9 years were studied. From the total sample: 14.4% to 32.1% did not practice sports or competitions; 56.0% to 73.6% remained more than two hours watching TV, playing video game or working on the computer; approximately 80% consumed fruits and vegetables improperly; 34.9% to 45.3% reported high salt consumption; and 60.9% to 74.4% reported consumption of soft drinks. Prevalence of overweight ranged from 18.7% to 41.6%. CONCLUSION In school adolescents, this study found high prevalence of risk factors associated with the development of cardiovascular disease in adults. Further studies are required to better understand how these risk factors are related and thus enable the implementation of preventive measures in adolescence in order to prevent cardiovascular disease in adults.

Lifestyle and cardiovascular health in school adolescents from São Paulo

BACKGROUND Cardiovascular disease is the leading cause of mortality worldwide. There is evidence demonstrating the association of this disease with cardiovascular risk factors related to lifestyle, incorporated in adolescence. OBJECTIVE To identify, in adolescents, the prevalence of overweight and lifestyle factors associated with risk for developing cardiovascular diseases, and the factors that influence them. METHODS It was conducted an observational study of individual cross-sectional data with adolescents enrolled in public and private schools in São Paulo, covering grades 5 to 8 of elementary school. The information was obtained through the application of an anonymous questionnaire and weight and height measurements. RESULTS 2,125 adolescents with mean age of 12.9 years were studied. From the total sample: 14.4% to 32.1% did not practice sports or competitions; 56.0% to 73.6% remained more than two hours watching TV, playing video game or working on the computer; approximately 80% consumed fruits and vegetables improperly; 34.9% to 45.3% reported high salt consumption; and 60.9% to 74.4% reported consumption of soft drinks. Prevalence of overweight ranged from 18.7% to 41.6%. CONCLUSION In school adolescents, this study found high prevalence of risk factors associated with the development of cardiovascular disease in adults. Further studies are required to better understand how these risk factors are related and thus enable the implementation of preventive measures in adolescence in order to prevent cardiovascular disease in adults.

Do cardiologists at a university hospital adopt the guidelines for the treatment of heart failure

OBJECTIVE To verify whether the guidelines for the treatment of heart failure have been adopted at a university hospital. The guidelines recommend the following: use of angiotensin-converting enzyme inhibitors for all patients with systolic ventricular dysfunction, use of digitalis and diuretics for symptomatic patients, use of beta-blockers for patients in functional classes II or III, use of spironolactone for patients in functional classes III or IV. METHODS We analyzed the prescriptions of 199 patients. All these patients had ejection fraction (EF) </=0.50, their ages ranged from 25 to 86 years, and 142 were males. Cardiomyopathy was the most frequent diagnosis: 67 (33.6%) patients had dilated cardiomyopathy, 65 (32.6%) had ischemic cardiomyopathy. RESULTS Angiotensin-converting enzyme inhibitors were prescribed for 93% of the patients. 71.8% also had a prescription for digitalis, 86.9% for diuretics, 27.6% for spironolactone, 12% for beta-blockers, 37.2% for acetylsalicylic acid, 6.5% for calcium channel antagonists, and 12.5% for anticoagulants. In regard to vasodilators, 71% of the patients were using captopril (85.2mg/day), 20% enalapril (21.4mg/day), 3% hydralazine and nitrates. In 71.8% of the cases, the dosages prescribed were in accordance with those recommended in the large studies. CONCLUSION Most patients were prescribed the same doses as those recommended in the large studies. Brazilian patients tolerate well the doses recommended in the studies, and that not using these doses may be a consequence of the physicians fear of prescribing them and not of the patients intolerance.

Primordial and primary prevention programs for cardiovascular diseases: from risk assessment through risk communication to risk reduction. A review of the literature

The aim of this study was to identify and reflect on the methods employed by studies focusing on intervention programs for the primordial and primary prevention of cardiovascular diseases. The PubMed, EMBASE, SciVerse Hub-Scopus, and Cochrane Library electronic databases were searched using the terms ‘effectiveness AND primary prevention AND risk factors AND cardiovascular diseases’ for systematic reviews, meta-analyses, randomized clinical trials, and controlled clinical trials in the English language. A descriptive analysis of the employed strategies, theories, frameworks, applied activities, and measurement of the variables was conducted. Nineteen primary studies were analyzed. Heterogeneity was observed in the outcome evaluations, not only in the selected domains but also in the indicators used to measure the variables. There was also a predominance of repeated cross-sectional survey design, differences in community settings, and variability related to the randomization unit when randomization was implemented as part of the sample selection criteria; furthermore, particularities related to measures, limitations, and confounding factors were observed. The employed strategies, including their advantages and limitations, and the employed theories and frameworks are discussed, and risk communication, as the key element of the interventions, is emphasized. A methodological process of selecting and presenting the information to be communicated is recommended, and a systematic theoretical perspective to guide the communication of information is advised. The risk assessment concept, its essential elements, and the relevant role of risk perception are highlighted. It is fundamental for communication that statements targeting other people’s understanding be prepared using systematic data.

Estilo de vida y salud cardiovascular en adolescentes de escuelas del municipio de São Paulo

BACKGROUND Cardiovascular disease is the leading cause of mortality worldwide. There is evidence demonstrating the association of this disease with cardiovascular risk factors related to lifestyle, incorporated in adolescence. OBJECTIVE To identify, in adolescents, the prevalence of overweight and lifestyle factors associated with risk for developing cardiovascular diseases, and the factors that influence them. METHODS It was conducted an observational study of individual cross-sectional data with adolescents enrolled in public and private schools in São Paulo, covering grades 5 to 8 of elementary school. The information was obtained through the application of an anonymous questionnaire and weight and height measurements. RESULTS 2,125 adolescents with mean age of 12.9 years were studied. From the total sample: 14.4% to 32.1% did not practice sports or competitions; 56.0% to 73.6% remained more than two hours watching TV, playing video game or working on the computer; approximately 80% consumed fruits and vegetables improperly; 34.9% to 45.3% reported high salt consumption; and 60.9% to 74.4% reported consumption of soft drinks. Prevalence of overweight ranged from 18.7% to 41.6%. CONCLUSION In school adolescents, this study found high prevalence of risk factors associated with the development of cardiovascular disease in adults. Further studies are required to better understand how these risk factors are related and thus enable the implementation of preventive measures in adolescence in order to prevent cardiovascular disease in adults.