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.

BackgroundStudies 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.ObjectiveTo 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.MethodsIn 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.ResultsThe 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.ConclusionSão Paulo's smoking-free legislation reduced significantly the CO concentration in hospitality venues and in their workers, whether they smoke or not.

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.

Objective -As a consequence of new therapeutical schedules inducing a great reduction in morbidity and mortality, the treatment of heart failure has recently been modified. The publication of studies on spironolactone and beta-blockers has led to the conclusion that these drugs should be added to the conventional treatment for heart failure with angiotensin-converting enzyme inhibitors, digitalis, and diuretics, because with this association, patients become less symptomatic, decompensate less, require less hospitalization, and have a lower mortality rate as the disease progresses 1-4 . Epidemiological studies carried out in several countries, however, have shown that this management has not been adopted by most cardiologists for many reasons 5,6 . As no consistent Brazilian data on this topic exist, we assessed, for 1 month, how physicians in a tertiary hospital in São Paulo were treating heart failure and how many were adopting the guidelines currently recommended. MethodsDuring October '99, we reviewed and analyzed the prescriptions of 199 patients with ventricular dysfunction (ejection fraction <0.50) and symptomatic heart failure classified as functional classes II, III, and IV according to the criteria of the New York Heart Association. These patients were being treated by different teams of medical specialists at the outpatient clinics of the Instituto do Coração of the HC-FMUSP (InCor).These 199 patients comprised all patients with ventricular dysfunction, who sought the ambulatory clinics of general cardiology, coronary artery diseases, geriatrics, valvar heart diseases, and heart failure at 16 (40%) time periods of a total of 40 possible time periods during the month. In this study we named the services with letters (service A, B, C, D, and E), which do not correspond to the above presenting order. These outpatient clinics were chosen because almost all patients with ventricular dysfunction followed up at InCor were treated at them.The age of the patients ranged from 25 to 86 years (mean 58.4±13.8 years), and 142 were males and 57 were females.