Challenges in secondary prevention of cardiovascular diseases: A review of the current practice

With the changing demography of populations and increasing prevalence of co-morbidity, frail patients and more complex cardiac conditions, the modern medicine is facing novel challenges leading to rapid innovation where evidence and experiences are lacking. This scenario is also evident in cardiovascular disease prevention, which continuously needs to accommodate its ever changing strategies, settings, and goals. The present paper summarises actual challenges of secondary prevention, and discusses how this intervention should not only be effective but also efficient. By this way the paper tries to bridge the gaps between research and real-world findings and thereby may find ways to improve standard care.

Study on risk assessment and management and prevention of conflicts of interest in the prevention and fight against betting-related match fixing in the EU 28: Final Report

This report concerns the provisions and practices on betting-related match fixing in sports
within the 28 Member States. Carried out in late 2013/early 2014, respondents in each Member
State reported on that state’s gambling-related provisions in respect of football and tennis and
(in each country) a third sport determined on the basis of either its popularity (in terms of
participation or television viewing) or the existence of betting-related “scandals” in that sport
within that particular jurisdiction. Those reports helped the authors to compare the Member
States’ regulatory and self-regulatory frameworks relating to risk assessment and conflict of
interest management, with a view to indicating areas of best practice, identifying particularly
good legislative frameworks and highlighting areas where change was either desirable or
necessary. While some individual Member States have legislation which might provide
templates that others could adapt for their own use, the authors were not convinced that “more
law”, whether at the national or European level, was desirable. Rather, more effective
cooperation among the stakeholders was identified as being more likely to provide tangible
benefits than would new legal frameworks.

Evaluating early administration of the hydroxymethylglutaryl-CoA reductase inhibitor simvastatin in the prevention and treatment of delirium in critically ill ventilated patients (MoDUS trial): Study protocol for a randomized controlled trial

Background: The incidence of delirium in ventilated patients is estimated at up to 82%, and it is associated with longer intensive care and hospital stays, and long-term cognitive impairment and mortality. The pathophysiology of delirium has been linked with inflammation and neuronal apoptosis. Simvastatin has pleiotropic properties; it penetrates the brain and, as well as reducing cholesterol, reduces inflammation when used at clinically relevant doses over the short term. This is a single centre randomised, controlled trial which aims to test the hypothesis that treatment with simvastatin will modify delirium incidence and outcomes. 

Methods/Design: The ongoing study will include 142 adults admitted to the Watford General Hospital Intensive Care Unit who require mechanical ventilation in the first 72 hours of admission. The primary outcome is the number of delirium- and coma-free days in the first 14 days. Secondary outcomes include incidence of delirium, delirium- and coma-free days in the first 28 days, days in delirium and in coma at 14 and 28 days, number of ventilator-free days at 28 days, length of critical care and hospital stay, mortality, cognitive decline and healthcare resource use. Informed consent will be taken from patient's consultee before randomisation to receive either simvastatin (80 mg) or placebo once daily. Daily data will be recorded until day 28 after randomisation or until discharge from the ICU if sooner. Surviving patients will be followed up on at six months from discharge. Plasma and urine samples will be taken to investigate the biological effect of simvastatin on systemic markers of inflammation, as related to the number of delirium- and coma-free days, and the potential of cholinesterase activity and beta-amyloid as predictors of the risk of delirium and long-term cognitive impairment. 

Discussion: This trial will test the efficacy of simvastatin on reducing delirium in the critically ill. If patients receiving the statin show a reduced number of days in delirium compared with the placebo group, the inflammatory theory implicated in the pathogenesis of delirium will be strengthened. 

A Reappraisal of the Safety and Cost-Effectiveness of Statin Therapy in Primary Prevention

Statins are among the most investigated drugs of all time. There is now a wealth of evidence supporting their use in the primary and secondary prevention arenas. The reduction in event recurrence has since been demonstrated across all levels of risk and in elderly patients. As a result, it is now accepted practice for statins to be prescribed universally in secondary prevention unless contraindicated. The extension of this policy into the primary prevention setting is more problematic, with moral and financial issues arising from the long-term treatment of many young apparently healthy individuals. For these reasons it is necessary to prove not only the financial sustainability of such a strategy but also the long-term safety of statins and the degree of benefit that might be expected.

Portuguese Adaptation of Students Engagement in Schools International Scale (SESIS)

The importance of student’s engagement has been recently pointed out in research. However, there has been a lack of engagement assessment instrument, pertaining psychometric qualities. Objective: This paper presents the Portuguese adaptation of the “Student’s Engagement in School International Scale” (SESIS), drawn up from a12 countries international study (Lam et al., 2012; Lam et al., in press). Method: Psychometric properties of this scale were examined with data from 685 students from different grades (6th, 7th, 9th and 10th), from both sexes, and different regions of the country. Results: Factorial analysis of the results, with varimax rotation, lead to three different factors which explain 50.88% of the variance. The scale integrates the original 33 items, and cognitive, affective and behavioural dimensions. For the external validity study, the relationship between student’s engagement in school results and other school variables — academic performance, self-concept — was considered, and significant relations were observed, as expected. Conclusion: The data presented highlights the qualities of SESIS, as well as its usefulness for research purposes. Suggestion: It is suggested the investigation of the extension of SESIS’s three-dimensionality, in future studiesKeywords: Innovation, technology, research projects, etc. [Arial 10-point, justified alignment].

Students´ Engagement In Schools: Differentiation and Promotion

The objective of this work is to present elements of the project Student engagement in Schools (SES). The team consists of 10 researchers from six Universities. Student engagement in schools is a multidimensional construct that unites affective, behavioural, and cognitive dimensions of student adaptation in the school and has influence on students‘outcomes. The team of researchers conceptualized two major studies, a differential study to analyze the relations between SES and contextual factors, personal factors, student’s outcomes, and a quasi-experimental study to analyze the effects on SES of a specific intervention programmes. In study 1, the sample size is around 600 students (150 6th graders, 150 7th graders, 150 9th graders, and 150 10th graders). We shall focus on years of school transition, with rural and urban populations, on different regions of the country, and on students with different family background. We shall conduct questionnaires with national and international scales. The study 2 will involve students in 7th and 9th grade, from four classes, two of the experimental group and two of the control group. Patterns of verbal communications between a teacher and students can influence the classroom environment and SES. This model of communication would result in more effective student management and more time on-task for learning.

Portuguese Adaptation of Students Engagement in Schools International Scale (Sesis)

The importance of student’s engagement has been recently pointed out in research. However, there has been a lack of engagement assessment instruments, showing psychometric qualities, such as reliability and validity. Objective: This paper presents the Portuguese adaptation of the “Student’s Engagement in Schools International Scale” (SESIS), drawn up from 12 countries international study (Lam et al., 2012; Lam et al., in press). Method: Psychometric properties of this scale were examined using data from 685 students, of both sexes, and from different grades (6th, 7th, 9th and 10th), and regions of the country. Results: Factorial analysis of the results, with varimax rotation, conducted to three different factors which explain 62,19% of the variance. The scale integrates the original 33 items, and cognitive, affective and behavioural dimensions. For the external validity study, the relationship between student’s engagement in school results and other school variables — academic performance, school conduct — was considered, and significant relations were observed, as expected. Conclusion: The data presented highlights the qualities of SESIS, as well as its usefulness for research purpose. Suggestion: It is suggested the investigation of the extension of SESIS’s three-dimensionality, in future studies

Searching biocompounds in marine natural extracts with potential use in tumor prevention and treatment

Cancer is a multistage process characterized by three stages: initiation, promotion and progression; and is one of the major killers worldwide. Oxidative stress acts as initiator in tumorigenesis; chronic inflammation promotes cancer; and apoptosis inactivation is an issue in cancer progression. In this study, it was investigated the antioxidant, antiinflammatory and antitumor properties of hexane, ether, chloroform, methanol and water extracts of five species of halophytes: A. macrostachyum, P. coronopus, J. acutus, C. edulis and A. halimus. Antioxidant activity was assessed by DPPH• and ABTS•+ methods, and the total phenolics content (TPC) was evaluated by the Folin-Ciocalteau method. The anti-inflammatory activity of the extracts was determined by the Griess method, and by evaluating the inhibition of NO production in LPS-stimulated RAW- 264.7 macrophages. The cytotoxic activity of the extracts against HepG2 and THP1 cell lines was estimated by the MTT assay, and the results obtained were further compared with the S17 non-tumor cell line. The induction of apoptosis of J. acutus ether extract was assessed by DAPI staining. The highest antioxidant activities was observed in C. edulis methanol and the J. acutus ether extracts against the DPPH• radical; and J. acutus ether and A. halimus ether extracts against the ABTS•+ radical. The methanol extracts of C. edulis and P. coronopus, and the ether extract of J. acutus revealed a high TPC. Generally the antioxidant activity had no correlation with the TPC. The A. halimus chloroform and P. coronopus hexane extracts demonstrated ability to reduce NO production in macrophages (> 50%), revealing their anti-inflammatory capacity. The ether extract of J. acutus showed high cytotoxicity against HepG2 cancer cells, with reduced cellular viability even at the lowest concentrations. This outcome was significantly lower than the obtained with the non-tumor cells (S17). This result was complemented by the induction of apoptosis.