Background: The mortality rate of Brazilian people with haemophilia (PwH) is decreasing, but the relative incidence of deaths associated with cardiovascular disease (CVD) is increasing.Objectives:... Show moreBackground: The mortality rate of Brazilian people with haemophilia (PwH) is decreasing, but the relative incidence of deaths associated with cardiovascular disease (CVD) is increasing.Objectives: We aimed to describe the CVD risk score of PwH according to Pooled Cohort Equations Risk (PCER) Calculator tool and its treatment recommendations. We also compared the PCER estimates with the respective Framingham Risk Score (FRS).Methods: This cross-sectional study included male PwH = 40 years treated at the Comprehensive Haemophilia Treatment Centre of Pernambuco (Recife/Brasil). PwH with a previous CVD event or a low-density lipid cholesterol = 5.0 mmol/L were excluded. Interviews, medical file reviews, and blood tests were performed. The PCER tool was used to estimate the CVD risk and compare it with the respective FRS. A p-value < 0.05 was accepted as statistically significant.Results: Thirty PwH were included. Median age was 51.5 [interquartile range-IQR; 46.0-59.5] years. The prevalence of obesity, systemic arterial hypertension, diabetes mellitus, hypertriglyceridaemia, hypercholesterolaemia, and hypoHDLaemia were 20%, 67%, 24%, 14%, 47%, and 23%, respectively. The median PCER score was 6.9% [IQR; 3.1-13.2], with 50% having a high risk (PCER = 7.5%). Statin use was suggested for 54% of PwH. Blood pressure was poorly controlled in 47% of PwH. The agreement between PCER and FRS was 80% (? = 0.60; p = 0.001).Conclusions: Half of the male people with haemophilia aged 40 years or older had a 10-year high risk of developing CVD with strong recommendations to improve control of dyslipidaemia and blood pressure. Show less
Raising a child is no easy task. Nevertheless Dutch parents do not get offered help with childrearing untill they ask for it or demonstrable problems have developed – at the expense of the child.... Show moreRaising a child is no easy task. Nevertheless Dutch parents do not get offered help with childrearing untill they ask for it or demonstrable problems have developed – at the expense of the child. Particularly parents with ‘excess bagage’ – for instance a troubled childhood, personal problems or a small social network – may benefit from preventive childrearing support to avoid psychosocial problems in their children or even child maltreatment. Such support, consisting of six homevisits during the first 18 months after birth, provided to families with an increased risk for childrearing difficulties by a trained nurse from a Well Baby Clinic has been researched in this study. Through a brief questionnaire 14% of all 9000 parents were found to be at risk. A total of 500 families participated, half of them received home visits, the other half received regular care. After two years both parents and children display better outcomes due to the home visits and the risk for child maltreatment has decreased. One mother said: “It is liberating to discuss your problems with a stranger in the safe environment of your own home. I am now seeing a psychologist which has very positive consequences both for me ánd my family”. Show less
