Novas Vacinas

Introdução: As vacinas previnem mais casos de doença do que qualquer tratamento médico. A informação sobre novas vacinas introduzidas no mercado e não incluídas no Programa Nacional de Vacinação (PNV) é no entanto por vezes pouco divulgada, e o seu conhecimento limitado. Objectivos: Avaliar o conhecimento, geral e específico, dos pais de crianças saudáveis relativamente a três vacinas não incluídas no PNV: pneumocócica (PCV7), varicela (Var) e rotavírus (RV). Material e Métodos: Estudo descritivo transversal, realizado sob a forma de inquérito, aplicado de forma aleatória aos pais de crianças observadas em três centros de saúde de Portugal (Lisboa, Porto e Queluz), entre Março e Abril de 2007. Analisaram-se parâmetros sociodemográficos, grau de conhecimento (a existência e tipo de doença prevenível pelas as três vacinas), sua realização ou intenção de realização e disponibilidade de aquisição das mesmas por parte dos pais. Análise estatística pelos testes Qui-quadrado e t-Student (IC>95%). Considerou-se p <0,05 com significado estatístico. Resultados: Entrevistaram-se pais de 187 crianças com uma idade mediana de 13 meses. A maioria (82%) tinha ensino secundário incompleto e rendimento mensal médio de 1256€. Em 83% das entrevistas os pais conheciam pelo menos uma das vacinas: pneumocócica (72%), varicela (42%) e rotavírus (1,3%) e pela mesma ordem o tipo de doença que cada vacina prevenia: 118/135 (87%), 83/84 (99%) e 21/24 (87,5%). Em 80% dos casos a informação fora disponibilizada aos pais por profissionais de saúde: pediatra (67) e médico assistente (49). A maioria (96%) considerou a PCV7 a vacina mais importante. Das crianças avaliadas, o PNV estava actualizado em 93% dos casos; adicionalmente 39% tinham a vacina pneumocócica, 0,5% da varicela e 3% do rotavírus. O conhecimento sobre a vacina da varicela e rotavírus associou-se a um maior nível de escolaridade dos pais(40vs46,p=0,018; 8vs16,p=0,026) e a realização da vacina pneumocócica e do rotavírus a um melhor rendimento familiar (1506€vs1144€ p=0,04) e (2283€vs1162€; p=0,04). Conclusão: Á excepção da PCV7 as restantes vacinas são ainda insuficientemente conhecidas. Compete aos profissionais de saúde, divulgar informação e motivar as famílias para a vacinação.

Coronary Revascularization Induces a Shift From Cardiac Toward Noncardiac Mortality Without Improving Survival in Vascular Surgery Patient

OBJECTIVE: Although evidence has shown that ischemic heart disease (IHD) in vascular surgery patients has a negative impact on the prognosis after surgery, it is unclear whether directed treatment of IHD may influence cause-specific and overall mortality. The objective of this study was to determine the prognostic implication of coronary revascularization (CR) on overall and cause-specific mortality in vascular surgery patients. METHODS: Patients undergoing surgery for abdominal aortic aneurysm, carotid artery stenosis, or peripheral artery disease in a university hospital in The Netherlands between January 2003 and December 2011 were retrospectively included. Survival estimates were obtained by Kaplan-Meier and Cox regression analysis. RESULTS: A total of 1104 patients were included. Adjusted survival analyses showed that IHD significantly increased the risk of overall mortality (hazard ratio [HR], 1.50; 95% confidence interval, 1.21-1.87) and cardiovascular death (HR, 1.93; 95% confidence interval, 1.35-2.76). Compared with those without CR, patients previously undergoing CR had similar overall mortality (HR, 1.38 vs 1.62; P = .274) and cardiovascular mortality (HR, 1.83 vs 2.02; P = .656). Nonrevascularized IHD patients were more likely to die of IHD (6.9% vs 35.7%), whereas revascularized IHD patients more frequently died of cardiovascular causes unrelated to IHD (39.1% vs 64.3%; P = .018). CONCLUSIONS: This study confirms the significance of IHD for postoperative survival of vascular surgery patients. CR was associated with lower IHD-related death rates. However, it failed to provide an overall survival benefit because of an increased rate of cardiovascular mortality unrelated to IHD. Intensification of secondary prevention regimens may be required to prevent this shift toward non-IHD-related death and thereby improve life expectancy.

Validation of Two US Risk Scores for Percutaneous Coronary Intervention in a Single-Center Portuguese Population of Patients with Acute Coronary Syndrome

INTRODUCTION: New scores have been developed and validated in the US for in-hospital mortality risk stratification in patients undergoing coronary angioplasty: the National Cardiovascular Data Registry (NCDR) risk score and the Mayo Clinic Risk Score (MCRS). We sought to validate these scores in a European population with acute coronary syndrome (ACS) and to compare their predictive accuracy with that of the GRACE risk score. METHODS: In a single-center ACS registry of patients undergoing coronary angioplasty, we used the area under the receiver operating characteristic curve (AUC), a graphical representation of observed vs. expected mortality, and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analysis to compare the scores. RESULTS: A total of 2148 consecutive patients were included, mean age 63 years (SD 13), 74% male and 71% with ST-segment elevation ACS. In-hospital mortality was 4.5%. The GRACE score showed the best AUC (0.94, 95% CI 0.91-0.96) compared with NCDR (0.87, 95% CI 0.83-0.91, p=0.0003) and MCRS (0.85, 95% CI 0.81-0.90, p=0.0003). In model calibration analysis, GRACE showed the best predictive power. With GRACE, patients were more often correctly classified than with MCRS (NRI 78.7, 95% CI 59.6-97.7; IDI 0.136, 95% CI 0.073-0.199) or NCDR (NRI 79.2, 95% CI 60.2-98.2; IDI 0.148, 95% CI 0.087-0.209). CONCLUSION: The NCDR and Mayo Clinic risk scores are useful for risk stratification of in-hospital mortality in a European population of patients with ACS undergoing coronary angioplasty. However, the GRACE score is still to be preferred.