Impossible to estimate pandemic deaths

MSNBC - WHO: Impossible to estimate pandemic deaths: "WHO: Impossible to estimate pandemic deaths
'You could pick almost any number,' health official warns
Updated: 11:45 a.m. ET Sept. 30, 2005
GENEVA - The U.N. health agency on Friday said it was impossible to estimate how many people would die from a new influenza pandemic, adding that it has warned countries to prepare for a death toll of up to 7.4 million.
"We think that this is the most reasoned position," said World Health Organization spokesman Dick Thompson, warning that "you could pick almost any number."/.../

End of Life: the humanitarist view

The Lancet 2005; 366:1235-1237
DOI:10.1016/S0140-6736(05)67486-7
Recommended by Marcelo Gustavo Colominas [mgcolominas@gigared.com] Full text available on request
End of life: the humanist view
Julian Baggini and Madeleine Pym
This is the seventh and final Viewpoint in a series about end-of-life issues for different religions.
A central tenet of humanist thought is that this world and this life are the only ones we have, and that, in the absence of an after-life and a soul, death brings a natural end to our existence. Broadly defined, a humanist is a morally concerned person who is not religious. However, individual humanist beliefs vary immensely—from atheists, who regard God as a human creation, to agnostics who might merely assert that although they can neither prove nor disprove God's existence, it is of no practical concern to them. But all humanists will tend to share a scepticism toward, and a rejection of, traditional religion and religious ritual, and a positive commitment to living a morally responsible life.
In view of this practical emphasis on the world, the community, and the individual, rather than a transcendental emphasis on God and the after-life of the soul, how can those in the medical profession best meet the needs of humanists as they approach death? In answering this question, we will begin with a brief introduction to humanism and its main tenets, going on to consider what differentiates the humanist approach to death from the religious one. We will explain the main criteria for what might constitute a good death for humanists and how medical staff can help them achieve this end.
The key issues are: the fundamental requirement to accord the needs and beliefs of humanists the same respect given to religious believers; the need to recognise that humanists vary in their attitude towards their own death and might or might not want to be informed of the full facts of their case, despite a genuine respect for truth and honesty in all matters; and the need for autonomy and control over the means of death and the treatment of their body after death. We also will discuss some of the difficulties incurred when the dying person's family neither respects nor shares his or her beliefs. We will include recommendations about how the needs of humanists can best be accommodated in the hospital.

Warming Causes Record Arctic Ice Melt

ENN: Environmental News Network [[Today's News Full Story ]]: "Warming Causes Record Arctic Ice Melt, U.S. Report Says

September 29, 2005 — By Timothy Gardner, Reuters

NEW YORK — The Arctic ice shelf has melted for the fourth straight year to its smallest area in a century, driven by rising temperatures that appear linked to a buildup of greenhouse gases, U.S. scientists said Wednesday.

Scientists at NASA and the National Snow and Ice Data Center, which have monitored the ice via satellites since 1978, say the total Arctic ice in 2005 will cover the smallest area since they started measuring.

It is the least amount of Arctic ice in at least a century, according to both the satellite data and shipping data going back many more years, according to a report from the groups.

As of Sept. 21, the Arctic sea ice area had dropped to 2.05 million square miles , the report said.
"

Prêmio Objetivos de Desenvolvimento do Milênio

Prêmio Objetivos de Desenvolvimento do Milênio
O Prêmio ODM Brasil visa estimular ações e projetos que ajudem o país a cumprir os Objetivos de Desenvolvimento do Milênio. A iniciativa é do Governo Federal, do Programa das Nações Unidas para o Desenvolvimento (PNUD) e de um conjunto de organizações do setor privado e da sociedade civil reunidas no Movimento Nacional pela Cidadania e Solidariedade.

Serão premiadas ações voltadas a um ou mais Objetivos de Desenvolvimento do Milênio, implantadas por prefeituras, organizações (órgãos públicos ou do setor privado, associações da sociedade civil, fundações e universidades públicas e particulares) e pessoas ou entidades de destaque./.../

International Team Issues Avian Flu Recommendations

Teaching Brief - MedPage Today
CHARLOTTESVILLE, Va. Sept. 28-As the avian flu, the H5N1 virus, continues to spread in Asia and threaten Europe's borders, an international team of physicians has issued clinical guidelines on detecting and managing the disease and containing transmission.

Writing in The New England Journal of Medicine, the clinicians offered advice on dealing with the evolving threat and the possible trajectory of the understudied pathogen.

So far, all the reported human infections have been from exposure to infected animals, and there have been no confirmed reports of efficient human-to-human transmission. Nevertheless, experts fear that risk could eventually materialize, said team leader Frederick G. Hayden, M.D., a professor of internal medicine and pathology at the University of Virginia Health Sciences Center here.

Avian Influenza A (H5N1) Infection in Humans

NEJM -- Avian Influenza A (H5N1) Infection in Humans: "An unprecedented epizootic avian influenza A (H5N1) virus that is highly pathogenic has crossed the species barrier in Asia to cause many human fatalities and poses an increasing pandemic threat. This summary describes the features of human infection with influenza A (H5N1) and reviews recommendations for prevention and clinical management presented in part at the recent World Health Organization (WHO) Meeting on Case Management and Research on Human Influenza A/H5, which was held in Hanoi, May 10 through 12, 2005.1 Because many critical questions remain, modifications of these recommendations are likely.

Incidence

The occurrence of human influenza A (H5N1) in Southeast Asia (Table 1) has paralleled large outbreaks of avian influenza A (H5N1), although the avian epidemics in 2004 and 2005 have only rarely led to disease in humans. The largest number of cases has occurred in Vietnam, particularly during the third, ongoing wave, and the first human death was recently reported in Indonesia. The frequencies of human infection have not been determined, and seroprevalence studies are urgently needed. The expanding geographic distribution of avian influenza A (H5N1) infections, with recent outbreaks in Kazakstan, Mongolia, and Russia, indicates that more human populations are at risk.2,3"/.../

8th. Brazilian Congress on Collective Health and 11th. World Congress on Public Health

8th. Brazilian Congress on Collective Health and 11th. World Congress on Public Health: "The World Federation of Public Health Associations (WFPHA) – in a 2004 policy resolution - defined “public health as an art and a science; and also a movement dedicated to the equitable improvement of health and well-being (of communities with their full participation). First and foremost, public health leaders must be catalysts for the public health movement. Individually and collectively around the world, public health leaders must maintain and strengthen their roles and capacities as advocates for public health. The Federation recognizes as “key challenges having a global dimension: the promotion of human rights; the reduction of the burden of disease; the guarantee of appropriate nutrition; the education on all aspects of health promotion; the protection of the environment; and the achievement of worldwide access to essential drugs at reasonable cost” (1).

Although technical and scientific progress provides broad-ranging preventative, and curative resources, and economic and social progress in many developed countries has extended life expectancy and enhanced the quality of life of large segments of the population, yet poverty, hunger, preventable diseases and violence continue to threaten the health and livelihoods of over three quarters of the population of the planet. (2)


There is growing consensus that “to tackle the major global health challenges effectively, the practice of public health will need to change. It is not sufficient to focus only on urgent health priorities, for example, HIV/AIDS, tuberculosis, and malaria in sub-Saharan Africa, or just the Millennium Development Goals. Programs and policies are required that respond to poverty—the basic cause of much of the global burden of disease—prevent the emerging epidemics of non-communicable disease, and address global environmental change, natural, and man-made disasters, and provide for sustainable health development. The justification for action is that health is both an end in itself—a human right—as well as a prerequisite for human development.” (3)

Today’s smaller and faster world -- brought about by advancements in communications and information technology -- has yet to address the daunting task of breaking down the barriers that stand in the way of promoting health and delivering appropriate care to hundreds of millions of human beings. Ethical principles need to be revisited and reinforced. Public health leaders have an enormous challenge to draw attention to these social, economic and political barriers and focus their talents and energy in engaging political and social forces as part of a global and united commitment to actively pulling down these barriers.

The World Federation of Public Health Associations (WFPHA) and the Brazilian Association of Collective Health (ABRASCO) invite the public health leadership from all parts of the world to come to Rio de Janeiro, Brazil, and join the 11th World Congress on Public Health, and the 8th Brazilian Congress on Collective Health in addressing the Congress theme: “Public Health in a Globalized World: Breaking down Political, Social and Economic Barriers”."

Mediasite Presentation Catalog

Mediasite Presentation Catalog: "Welcome to Mediasite at the University of Pittsburgh
Mediasite is a tool for recording and storing rich-media classroom and conference presentations. These presentations can be viewed as a live stream or as an archive via the World Wide Web. Mediasite is frequently used to supplement traditional classes and distance learning applications.

If you are looking for a LIVE webcast, click on the LIVE WEBCASTS link located to the left of this screen.

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Note: Dependant upon the Application Pack installed on your Windows PC, the lower portion of the presentation banners may not be fully visible. If you wish to correct this problem in an Internet Explorer browser, select the Tools menu, then “Internet Options.' On the “Security” tab select the “Trusted Sites” icon and click the “Sites” button. Make sure that the “Require server verification (https:) for all sites in this zone” checkbox is NOT selected and add the URL http://mediasite.cidde.pitt.edu to the list of trusted sites.

For questions and scheduling, please contact Michael Arenth via email at arenth@cidde.pitt.edu, or by telephone at 412-648-7236."

El imperio del celibato

Página/12 Web :: Buenos Aires, Argentina:
Por Leonardo Moledo
enviado por Marcelo Gustavo Colominas [mgcolominas@hotmail.com]
El pedido hecho por sacerdotes (o ex sacerdotes) para que sea abolido el celibato eclesiástico en el sínodo de octubre en Roma tiene pocas chances, pero promete revolver el avispero de un problema que afecta a la Iglesia que ahora conduce Benedicto XVI. Los argumentos que se esgrimen son los de siempre: por empezar, que el celibato es contra natura, que está restando vocaciones a la Iglesia Católica (la única que lo exige), que no hay indicación alguna en los evangelios que lo imponga y que se trata de una cuestión no de dogma sino procedimental, o de derecho canónico que bien puede ser modificada. Del lado ortodoxo se citan fragmentos de las epístolas de San Pablo, escritos de San Agustín y otros padres de la Iglesia y, supremo argumento entre los argumentos, que el celibato es esencial para que los sacerdotes católicos no se distraigan con complicaciones de familia y puedan dedicarse solamente a su Dios (desde ya, este argumento es poco sólido a menos que se admita que la religión es la profesión suprema... ¿por qué no exigirlo a los cirujanos, para evitar que los problemas con su cónyuge lo perturben en el medio de una incisión? ¿O a los carniceros? ¡Qué deliciosas achuras, qué cortes perfectos tendríamos si no fuera por el colegio de los chicos!).
La historia del celibato sacerdotal católico es bastante sinuosa y ambigua, por cierto: en el siglo VII en Francia, los documentos demuestran que la mayoría de los sacerdotes eran hombres casados y en el siglo VIII San Bonifacio informa al Papa que en Alemania casi ningún obispo o sacerdote es célibe./.../

CONFIANÇA

Publicado no jornal ZH hoje
Artigo
Confiança
ALOYZIO ACHUTTI/ Membro da Academia Sul-Rio-Grandense de Medicina

A enxurrada recente de notícias nacionais sobre corrupção, sobrepondo-se à disseminada e crescente onda de violência, faz lembrar o livro A Sociedade de Confiança. Ensaio sobre as origens e a natureza do desenvolvimento, do escritor francês Alain Peyrefitte, falecido em 1999, membro da Academia Francesa, e várias vezes ministro de governo. À parte qualquer polarização ideológica, parece não haver dúvida de que um clima de confiança faz bem para a qualidade de vida e para a saúde. Não há dúvida também de que esta seja uma condição essencial para qualquer tipo de negociação. Negociar não é só importante no comércio e na economia. Negócio é uma transação bilateral. Vive-se de trocas e de tomadas de decisões de interesse para a subsistência e o bem-estar: com o meio ambiente, com os fornecedores, com parceiros, e também na vida afetiva de cada um. Quando se escolhe não se faz de olhos fechados, não se entrega um mandato cegamente, não se adquire um produto sem testar sua qualidade. Mas é preciso um mínimo de confiança para subsistir e desenvolver, e não ficar paralisado ou paranóico. Há um clima mundial contagioso de terrorismo multilateral, no qual todos desconfiam de todo mundo. Vivemos numa sociedade na qual foi rompido o pacto social e onde a violência substituiu a negociação. A mídia, ao mesmo tempo em que facilita a transparência e presta um grande serviço de comunicação e denúncia, reverbera a notícia escandalosa e o clima de insegurança e de desconfiança. Esse tipo de notícia tem demanda porque atende à exigência de alerta e porque fecha o círculo ao mexer com os mediadores químicos naturais que maquiam a depressão causada pela própria insegurança e frustração. Será que não existe mais ninguém confiável? Líderes políticos mentem e escondem a verdade, se aproveitam dos mandatos para roubar ou para se perpetuar no poder, em vez de buscar o interesse da população. Na indústria e no comércio, descobrem-se falcatruas pelas quais quem nada tem a ver termina pagando. A polícia e o Judiciário ou se dizem impotentes ou estão comprometidos. Profissionais da saúde não mais preservam o contrato básico da relação pessoal com o paciente, mas têm intermediários, estão submetidos a tentações e interesses secundários. Da religião, descobrem-se mistificações e desvios impensados no comportamento de seus ministros. Os ladrões não têm mais cara de bandido, não são mais maltrapilhos, nem têm características étnicas específicas, nem mais aparecem somente na calada da noite. Quem sabe a resposta está no que se aprende na prática médica: a maioria da população ainda é formada de gente saudável, em que pese haver uma concentração de doentes entre aqueles que buscam os consultórios e hospitais. É muito comum a distorção profissional do médico, olhando a todos como se doentes fossem... Provavelmente a maioria ainda acredita nos valores éticos e os preserva, e se esta maioria exercer o seu poder, for vigilante e estabelecer uma rede de confiança, ainda é capaz de evitar o descalabro. Não se pode ser ingênuo. É preciso ter cuidado com o conto-do-vigário, com a falsa propaganda, com o discurso vazio e aliciador, com o maneirismo político, com a especulação comercial e financeira. É preciso ter cautela e escolher bem com quem negociar e em quem confiar. É preciso continuar vivendo, negociando e trocando, na expectativa de ser este apenas um rito de passagem por uma fase de catarse capaz de nos conduzir a uma sociedade mais limpa, mais equânime, mais transparente e desenvolvida.

Using Search Engines to Find Online Medical Information

PLoS Medicine: Using Search Engines to Find Online Medical Information
Conclusion

All of these freely available search engines have their limitations, and they rarely give you the perfect answer to your clinical query. But they do at least help to reduce the obstacles to finding medical information online. Kahle would certainly approve./.../

Computerized Physician Order Entry Systems: The Coming of Age for Outpatient Medicine

PLoS Medicine: Computerized Physician Order Entry Systems: The Coming of Age for Outpatient Medicine
Regardless of their limitations, observational studies such as the one by Steele et al. that compare nonrandomized physicians' behavior before interventions to behavior after interventions, and that depend largely on surrogate outcomes, provide powerful evidence on the effectiveness of computerized systems to reduce medication errors and improve patient safety. Similar studies will likely continue to be an important means used to evaluate many future developments in CPOE technology./.../

NASA - Home

NASA - Home

Empathy

The Lancet: "Empathy
Rhodri Hayward a
Empathy is widely seen as the essential corrective to the modern dehumanisation of the patient. In his Harveian Oration on "Science, Society and the Perplexed Physician" at London's Royal College of Physicians, UK, in 2000, Lord Turnberg suggested that development of empathy was increasingly important because of the desensitising effects of clinical training. Yet this nostalgia for a lost empathic relationship between doctor and patient is curious, since the word was only invented at the beginning of the 20th century."/.../

Series, PowerPoint slides, and folders now available on bmj.com

Series, PowerPoint slides, and folders now available on bmj.com -- Delamothe 331 (7518): 650 -- BMJ: "Series, PowerPoint slides, and folders now available on bmj.com
Helping readers to file and reuse BMJ articles and illustrations
Delamothe 331 (7518): 650 -- BMJ
Three new services have been added recently to the BMJ's website, bmj.com. The first gives users what they've been asking for: links to all the series that have appeared in the BMJ. A button on bmj.com's home page, labelled 'Series,' takes users to a page with links to the 35 ABC series we've published since 1998 as well as other old favourites such as Statistics notes. This page also lists links to newer series such as 10 minute consultations, ethical debates, and interactive case reports (http//:bmj.com/series). "

The Disease Management

Cardiosource: "The mission of the American College of Cardiology is to advocate for quality cardiovascular care – through education, research promotion, and the development and application of standards and guidelines – and to influence health care policy. (For details of the ACC Mission, Goals, and Objectives, click here)

The constant tension between quality of care, costs, and the logistics of medical practice has created some of the greatest challenges facing modern medicine. One approach, which remains controversial, is disease management (DM).

The Disease Management Association of America defines DM as “a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant.”"/.../

Physicians and Industry: How should we behave?

Cardiosource: " Physicians and Industry: How should we behave?
Author: Alfred A. Bove, M.D., Ph.D, F.A.C.C.
Author Disclosure: Stock Options, Consulting Fees: Insight Telehealth.
Date: 9/21/2005

Much has been written in the public press over the past several months regarding conflicts of interest between physicians and the drug and device industries. This has been peppered with examples of physicians providing inside information regarding results of clinical trials to investment managers, sale of stock by physicians with inside information regarding a drug or device recall or clinical problem, and substantial withholding of important information about adverse effects of drugs or devices that ultimately resulted in severe losses for the companies. From the beginning of a medical career, industry is visible through gifts, conferences, and the ubiquitous "Drug Rep." (How many of us have a pen in our pocket with an imprinted product name?) We solicit funds for training of our fellows, and when properly managed, feel that this donation is a worthwhile educational endeavor as long as there is no content dictated by the granting company. We are often funded by pharmaceutical companies to conduct basic research, small and large clinical trials. Many investigators have built a career on research funding from drug or device companies."/.../

WHO warns of increase in obesity problem

FT.com / World / International economy - WHO warns of increase in obesity problem
By Frances Williams in Geneva
Published: September 22 2005 20:47 |

The number of overweight people in the world will rise from 1bn today to 1.5bn by 2015, with many developing countries showing the most dramatic increases, the World Health Organisation said on Thursday.

Releasing the estimates ahead of World Heart Day on Sunday, the WHO presaged an alarming increase in chronic diseases, especially heart disease, strokes and type 2 diabetes. Cardiovascular disease is already the world's biggest killer, accounting for 17m deaths a year, 80 per cent ofthem in the developing world.

“The sheer magnitude of the overweight and obesity problem is staggering,” said Catherine Le-Gal's Camus, WHO assistant director-general for non-communicable diseases.

The World Clock Meeting Planner

The World Clock Meeting Planner: "The World Clock Meeting Planner

Need to make a call to someone far away? Need to arrange a videoconference, telephone- or net-based meeting with several people spread around the globe? This utility should help you find a convenient time, so that no one has to be up during the middle of the night.

(If you have set the time for the meeting already, use the Fixed Time-tool instead.)
For up to 6 cities, and a greater range of cities, try The Advanced Meeting Planner instead."

cuándo se empieza a envejecer?

LA NACION LINE: "
Recomendado por Marcelo Gustavo Colominas [mgcolominas@gigared.com]
La pregunta que más desvela: cuándo se empieza a envejecer?

Cada vez más tarde, dicen los expertos

Cuando en el Festival de Ciencias de la Asociación Británica para el Avance de la Ciencia, que acaba de finalizar en Dublín, se dijo que la vejez había mudado su comienzo a los 80 años, algunos asistentes sintieron alivio y otros no ocultaron su asombro.

“La nueva edad adulta oscila entre los 50 y los 80 años, un período mayor que el de la juventud, antes de que se instale la vejez propiamente dicha”, sentenció el profesor Ian Robertson, decano de investigación del Instituto de Neurociencias del Trinity College, durante su presentación sobre cómo mantener en forma el cerebro después de los 50."

Diabetes Global guideline - IDF - International Diabetes Federation -

IDF - International Diabetes Federation - Global guideline: "
Athens, Greece – Today at the European Association for the Study of Diabetes (EASD) congress the International Diabetes Federation (IDF) launches the first ever evidence-based Global Guideline for Type 2 Diabetes. The Guideline calls for a more aggressive approach to the management of type 2 diabetes across the globe, setting new standards for diabetes care to reduce its life-threatening complications. The Guideline was developed by leading diabetes experts from all IDF regions, including representatives from countries in very different states of economic development.

Type 2 diabetes is reaching epidemic proportions across the world. Europe alone counts more than twenty-five million people with diabetes.  In most countries, diabetes is now one of the leading causes of death through its effects on cardiovascular disease: 70-80% of people with diabetes die of cardiovascular disease.2 Diabetes is ranked among the leading causes of blindness, renal failure and lower limb amputation with type 2 diabetes accounting for 85-95% of cases of diabetes.2 The total cost of caring for people with diabetes in Europe* is estimated between 28 billion and 53 billion Euros per year.1

As Professor Philip Home, Joint Chair of the IDF Task Force on Clinical Guidelines, explained: “Estimations and projections all concur that the number of people with diabetes which may be reached in the next 25 years would qualify as the largest epidemic humanity has ever experienced. IDF recognizes that immediate action is required and that by sharing evidence-based practice globally we can help alleviate the burden of type 2 diabetes by improving people’s lives and reducing costs to health-care systems. We must ensure all people with type 2 diabetes in Europe and in the world have access to cost-effective evidence-based health-care, and call on immediate action.”

Professor Stephen Colagiuri, Joint Chair of the IDF Task Force on Clinical Guidelines added: “The guideline is globally applicable as it is sensitive to resource and cost-effectiveness. It adopts a new and innovative approach by advising on three standards of care that can be applied depending on the level of health-care resources available in each country.”

The Global Guideline recommends maintaining blood glucose levels (HbA1c) below 6.5% to minimize the risk of complications developing, and supports this with clear recommendations over patient education, self-monitoring of glucose levels by patients, and active use of tablets and insulin to attain target levels. This reflects evidence that despite established benefit of lowering blood glucose (in terms of reducing the risk of complications to the eyes, heart, kidneys and feet)� and evidence that a 1.0 % reduction in HbA1c is associated with a 37% reduction in microvascular complications, two thirds of people with diabetes in Europe are not currently achieving target blood sugar levels. As well as blood glucose, the evidence that blood pressure and blood fat lowering is beneficial in people with diabetes is found to be overwhelming, and appropriate recommendations made for monitoring and treating those modalities are also included.

The Global Guideline also identifies cost-effective methods for identifying problems with eyes, kidney and feet when preventative measures fail; early and proven treatments can then be started.

Eugene Hughes, Chairman of Primary Care Diabetes Europe commented: “The new IDF HbA1c target of 6.5% sets a daunting standard for glycaemic control that we will strive to achieve. We need to embrace the opportunity this Guideline gives us to deliver the best standard of care for all our patients wherever they are in Europe. With proper implementation of the Guideline we have the chance to improve the lives of people with diabetes by reducing complications and achieving a substantial reduction in future health-care costs that unchecked will devour our health-care budgets”."

Endocrine Glands

The Lancet: "Chandak Sengoopta

Gland, from the French glande (itself derived from Old French glandre), refers to clusters of cells that produce specific secretions. The word has had more exotic meanings beyond the realms of biology and medicine—the sleeves that encased Victorian piston rods, for instance, and the acorn-shaped lead missiles used by ancient Romans. In medicine, at least since the 19th century, glands have been of two types—with ducts and without. The ductless or endocrine (from the Greek endon, meaning “inside”) pour their secretions directly into the blood, and so affect the whole organism. In 1905, the British physiologist Ernest H Starling, after consultations with Cambridge classicists, named those secretions “hormones” (from the Greek hormao, meaning “to excite”).

Although the existence of endocrine glands had long been known to anatomists, little was known about their functions before the late 19th century. Research on endocrine glands took off after the sensational claim by the septuagenarian French-American physiologist Charles-Edouard Brown-S�quard (1817–94) that he had “rejuvenated” himself by injections of canine testicular extracts. Testicular substances had long been used in folk remedies to improve virility and that reputation now received a scientific boost. There was much serious research on endocrine physiology and the interest in rejuvenation also continued. By the 1920s, several procedures were available that purported to enhance the secretory powers of ageing testicles. Faith in glandular therapy was deepened by the undeniable efficacy of thyroid extract in myxoedema and insulin in diabetes. The endocrine system was thought to have much more to offer, and gland extracts were prescribed for disorders as diverse as learning difficulties, infertility, haemophilia, and obesity.

The futility of most of these treatments had become only too apparent by the late 1930s. By then, glandular interventions were being superseded by the administration of pure, standardised hormones. Although some of the grand therapeutic dreams of the 1920s survived into the new hormonal age, they were no longer associated with the word “gland”, which now retreated into the thickets of histological terminology from where it had been drawn out by Brown-S�quard and his successors barely half a century earlier."

MedlinePlus Health Information from the National Library of Medicine

MedlinePlus Health Information from the National Library of Medicine

The New York Review of Books: The Truth About the Drug Companies

The New York Review of Books: The Truth About the Drug Companies: "The Truth About the Drug Companies
By Marcia Angell

Every day Americans are subjected to a barrage of advertising by the pharmaceutical industry. Mixed in with the pitches for a particular drug—usually featuring beautiful people enjoying themselves in the great outdoors—is a more general message. Boiled down to its essentials, it is this: 'Yes, prescription drugs are expensive, but that shows how valuable they are. Besides, our research and development costs are enormous, and we need to cover them somehow. As 'research-based' companies, we turn out a steady stream of innovative medicines that lengthen life, enhance its quality, and avert more expensive medical care. You are the beneficiaries of this ongoing achievement of the American free enterprise system, so be grateful, quit whining, and pay up.' More prosaically, what the industry is saying is that you get what you pay for."/.../

Brazil 2005 Equity Posponed

brazil2005_eng.pdf (application/pdf Object)
Social policies are still subject to economic logic, and although President Lula’s government has encouraged civil society to participate in their construction, the big question is how to overcome inequality without making significant changes in the dominant neoliberal system. The priority given
to fiscal adjustment practically obliterates even the intention of creating equity in Brazil.

Katrina reveals fatal weaknesses in US public health

The Lancet: "Katrina reveals fatal weaknesses in US public health

The terrorist attacks that struck the USA on Sept 11, 4 years ago, obliterated the American people's trust in their intelligence services. Last week, Hurricane Katrina did the same for any illusions held by the people—or indeed the government—that the country was adequately prepared to cope with a large-scale public-health emergency.

Since 2001, fears for the future safety of the US population have focused on one thing alone: the potential dangers a bioterror attack could unleash. This obsession catapulted the issue of America's decaying public-health infrastructure from a state concern to a crisis that involved the entire nation. The worry was justified.

A damning report issued in 2002 by the Institute of Medicine claimed that governmental public-health agencies had long suffered “grave underfunding and political neglect”. It criticised the country's “obsolete and inconsistent laws and regulations” governing public health, and derided the fragmentation of health responsibility, shared among officials at all levels of government. The uneven distribution of resources within the “increasingly fragile” health sector meant, the report claimed, that the health system would be unable to manage a large-scale emergency. Ironically, of only five cities visited by the authors during the report's preparation, one was New Orleans." /.../

Trends in the Leading Causes of Death in the United States, 1970-2002, September 14, 2005, Jemal et al. 294 (10): 1255

JAMA -- Abstract: Trends in the Leading Causes of Death in the United States, 1970-2002, September 14, 2005, Jemal et al. 294 (10): 1255
Results The age-standardized death rate (per 100 000 per year) from all causes combined decreased from 1242 in 1970 to 845 in 2002. The largest percentage decreases were in death rates from stroke (63%), heart disease (52%), and accidents (41%). The largest absolute decreases in death rates were from heart disease (262 deaths per 100 000), stroke (96 deaths per 100 000), and accidents (26 deaths per 100 000).The death rate from all types of cancer combined increased between 1970 and 1990 and then decreased through 2002, yielding a net decline of 2.7%. In contrast, death rates doubled from chronic obstructive pulmonary disease over the entire time interval and increased by 45% for diabetes since 1987. Despite decreases in age-standardized death rates from 4 of the 6 leading causes of death, the absolute number of deaths from these conditions continues to increase, although these deaths occur at older ages.

Conclusions The absolute number of deaths and age at death continue to increase in the United States. These temporal trends have major implications for health care and health care costs in an aging population.

The Metabolic Syndrome: Time for a Critical Appraisal

The Metabolic Syndrome: Time for a Critical Appraisal
Joint statement from the American Diabetes Association and the European Association for the Study of Diabetes
RICHARD KAHN, PHD; JOHN BUSE, MD, PHD; ELE FERRANNINI, MD; MICHAEL STERN, MD
(Reference sent by Mario Camargo Maranhão and Ariel J. Reyes. Full text available on request)
The term “metabolic syndrome” refers to a clustering of specific cardiovascular disease (CVD) risk factors whose underlying pathophysiology is thought to be related to insulin resistance.
Since the term is widely used in research and clinical practice, we undertook an extensive review of the literature in relation to the syndrome’s definition, underlying pathogenesis, and association with CVD and to the goals and impact of treatment. While there is no question that certain CVD risk factors are prone to cluster, we found that the metabolic syndrome has been imprecisely defined, there is a lack of certainty regarding its pathogenesis, and there is considerable doubt regarding its value as a CVD risk marker. Our analysis indicates that too much critically important information is missing to warrant its designation as a “syndrome.” Until much needed research is completed, clinicians should evaluate and treat all CVD risk factors without regard to whether a patient meets the criteria for diagnosis of the “metabolic syndrome.”
Diabetes Care 28:2289–2304, 2005

From the Magazine | NATION

Places Where the System Broke Down

A TIME investigation shows how confusion, incompetence and, ironically, a fear of making mistakes hobbled the government at all levels

By AMANDA RIPLEY, KAREN TUMULTY, MARK THOMPSON & JAMES CARNEY

Posted Sunday, Sep. 11, 2005
Ten days after Hurricane Katrina trashed the Gulf Coast, a radio talk-show host in Los Angeles asked Secretary of State Condoleezza Rice if it was true that President Bush does not care about black people. (She said no.) A man standing in the ruins in Gulfport, Miss., told the Vice President, "Go f___ yourself." (He smiled.) And the mayor of New Orleans secretly decamped for much of the week to Dallas to install his family there, refusing most media interviews, although the bodies had only begun to be counted in his drowned city.

Even as soldiers swarmed into the Gulf Coast and residents scattered onto dry land around the country, the anger at the government's response to Katrina did not abate. In a TIME poll of 1,000 adults nationwide, 52% said the government had done a poor job preparing for Katrina at all levels. And 62% said the government had responded too slowly to those hardest hit. In this sample at least, Americans did not single out blame but spread it far and wide.

The accused preferred a cleaner narrative. The President's supporters put out the word that the mayor of New Orleans and the Governor of Louisiana had botched the response, and the feds were only cleaning up their mess. The locals seemed flabbergasted by such claims, insisting that the crisis had immediately overwhelmed their capacity and that the feds had failed to step into the vacuum.

Should blame be portioned out according to power—or proximity? And what about the legions of elected officials and bureaucrats stacked in between, the ones who are supposed to form a human chain from city hall to the Oval Office?

Already it's clear that this debacle was more than an act of God.

This country's emergency operations, awesome in their potential, are also frighteningly interdependent. The locals are in charge—until they get overwhelmed. Then they cede control to the feds—but not entirely. The scarier things get, the fuzzier the lines of authority become. As TIME's investigation shows, at every level of government, there was uncertainty about who was in charge at crucial moments.

Leaders were afraid to actually lead, reluctant to cost businesses money, break jurisdictional rules or spawn lawsuits. They were afraid, in other words, of ending up in an article just like this one.

The President's spokespeople have taken to calling this the "blame game." His critics call it "accountability." However you brand the process, you should get used to it. Republicans in Congress have announced a joint inquiry with Democrats. But the Democrats are refusing to cooperate because they want an independent commission. No matter how the reckoning goes, TIME's investigation reveals at least four places where the system broke down.

Global Arms trade

The Lancet:
"Prof Gene Feder and colleagues claim in this week's issue that The Lancet finds “itself connected to the profits of the global arms trade”, a situation that, they say, is “incompatible with The Lancet's guiding principles”. During Sept 13–16, 2005, Spearhead Exhibitions—a part of Reed Elsevier, The Lancet's current publishers—is hosting one of the largest military exhibitions in the world, the Defence Systems and Equipment international (DSEi). The Lancet has a long record of drawing attention to the adverse health consequences of war and violence. We reject completely any perceived connection between the journal and the arms trade, no matter how tangential it might be. The Lancet is an entirely independent publication, editorially and financially. It is not subsidised by profits from any other part of Reed Elsevier."

Internet Country Abbreviations

Internet Country Abbreviations: "Internet Country Abbreviations

You can usually tell what country someone is in by looking at their email address.

For instance, micky.mouse@ukonline.co.uk is in the United Kingdom. The trick is to look at the last two letter of the email address. They will usually be a fairly obvious abbreviation of the country name

In addition to explicit country codes, it is also helpful to know that '.com', '.net', '.edu', and '.org' are U.S. domains 99% of the time."

Canadian Diabetes Association : Clinical Practice Guidelines

Canadian Diabetes Association : Clinical Practice Guidelines: "Welcome to the Canadian Diabetes Association e-guidelines.
This site is designed to enable healthcare professionals to:
Browse the entire Clinical Practice Guidelines document easily (click Browse on the menu).
Find quick answers to frequently asked clinical questions such as 'How do I diagnose diabetes ?' (click F.A.Q.).
Search for guidelines specifically related to particular clinical issues and activities (click Search). This unique function enables you to ask a customized question and receive only those guidelines relevant to the clinical scenario you have chosen (for example: Treatment of hypertension in the elderly or Screening for nephropathy in women with diabetes planning a pregnancy).
Within the Browse section the Table of Contents and the Index are intended to provide users with easy reference to key topics; more useful, we believe, than a simple key word text search that may return hundreds of irrelevant matches."

HDR 2005 - Country Fact Sheets

HDR 2005 - Country Fact Sheets: "Brazil

The Human Development Index – going beyond income
The human development index (HDI) focuses on three measurable dimensions of human development: living a long and healthy life, being educated and having a decent standard of living. Thus it combines measures of life expectancy, school enrolment, literacy and income to allow a broader view of a country’s development than does income alone.

Although the HDI is a useful starting point, it is important to remember that the concept of human development is much broader and more complex than any summary measure can capture, even when supplemented by other indices. The HDI is not a comprehensive measure. It does not include important aspects of human development, notably the ability to participate in the decisions that affect one’s life and to enjoy the respect of others in the community.

It is also important to note that the HDI is constructed using data from international sources. Sometimes more up-to-date data are available nationally, and sometimes there are slight differences in definitions between international and national data. For these and other reasons, discrepancies with national sources may occur. "

HDR - Statistics - BRAZIL

HDR - Statistics - Get Data - Country Sheet:
"Brazil - HDI Rank : 63

1. Human development index
Human development index (HDI) value, 2003 : 0.792
Life expectancy at birth (years) (HDI), 2003 : 70.5
Adult literacy rate (% ages 15 and above) (HDI), 2003 : 88.4
Combined gross enrolment ratio for primary,
secondary and tertiary schools (%), 2002/03 : 91
GDP per capita (PPP US$) (HDI), 2003 : 7,790
Life expectancy index : 0.76
Education index : 0.89
GDP index : 0.73
GDP per capita (PPP US$) rank minus HDI rank : 1
"
(and more...)

Human Development Reports

Human Development Reports:
"Human Development Report 2005. International cooperation at a crossroads: Aid, trade and security in an unequal world

This year’s Human Development Report takes stock of human development, including progress towards the MDGs. Looking beyond statistics, it highlights the human costs of missed targets and broken promises. Extreme inequality between countries and within countries is identified as one of the main barriers to human development—and as a powerful brake on accelerated progress towards the MDGs.

You need Acrobat PDF format (Download for free)"

The Larger Shame - New York Times

The Larger Shame - New York Times: "The Larger Shame

By NICHOLAS D. KRISTOF
Published: September 6, 2005
Recommended by Denys Raphael

The wretchedness coming across our television screens from Louisiana has illuminated the way children sometimes pay with their lives, even in America, for being born to poor families."

Drugs in Breast Milk Quick Reference Guide - uk medicines information

Drugs in Breast Milk Quick Reference Guide - uk medicines information
This guide is based on information compiled by the Trent and West Midlands Medicines Information Services. It contains a summary of the significance of the excretion of the commonly used drugs via breast milk, and their absorption by the infant.

It is intended to be used only to assess risk where the infant is normal, healthy, and born full-term. Infants born prematurely or who have serious illnesses present more complex problems, and such cases should be referred to one of the specialist centres above.

In the interests of clarity and easy reference this guide is limited to those drugs which are more commonly prescribed for breast-feeding mothers. It is not intended that it should include all drugs and non-inclusion does not imply safety.

The drugs have been listed in pharmacological groups and where available evidence suggests that members of generic groups behave similarly, the generic name is listed (e.g. phenothiazines, aminoglycosides).

The drugs have been classified in the light of currently available evidence and where information is scarce the drugs have been classified as requiring monitoring.

The Nobel Prize: 100 Years of Creativity

http://www.exploratorium.edu/nobel/funfacts.html

n

In 1926, the Nobel Prize for Medicine was awarded to Johannes Fibiger for “finding a cure for cancer”. That claim (and award) appears to have been overly optimistic.

nThe developer of the prefrontal lobotomy, Antonio Moniz, was awarded the Nobel Prize for Medicine in 1949. This treatment for schizophrenia was abandoned in the 1960's.

nA Nobel Prize for Medicine was awarded to Julius Wagner von Jauregg for “proving” that fevers cured mental illness. Ooops!

World Development Report 2007

WDR 2007
The theme of the World Development Report (WDR) 2007 is youth—young people between the ages of 12 to 24. As this population group seeks identity and independence, they make decisions that affect not only their own well-being, but that of others, and they do this in a rapidly changing demographic and socio-economic environment.

Development thinking and practice over the past couple of decades has focused on younger children, but relatively less attention has been paid to the generation beyond primary-school age. This generation is the leading edge of a large wave of young people. How these youth manage the transition to adulthood will have profound effects on their own welfare as well as the well-being of the subsequent generation.
— François Bourguignon, Sr. Vice President & Chief Economist, The World Bank

Supporting young people’s transition to adulthood poses important opportunities and risky challenges for development policy. Are education systems preparing young people to cope with the demands of changing economies? What kind of support do they get as they enter the labor market? Can they move freely to where the jobs are? What can be done to help them avoid serious consequences of risky behavior, such as death from HIV-AIDS and drug abuse? Can their creative energy be directed productively to support development thinking?

The report will focus on crucial capabilities and transitions in a young person's life: learning for life and work, staying healthy, working, forming families, and exercising citizenship. For each, there are opportunities and risks; for all, policies and institutions matter. More about the report and the team preparing it.

This website will serve as the key locus for information on the WDR 2007. The Outline, followed by various drafts of the report will be posted here. The site will also host extensive related information, including consultations, events, and background papers.

Google Help : Search Features

Google Help : Search Features
Google Web Search Features

In addition to providing easy access to more than 8 billion web pages, Google has many special features to help you to find exactly what you're looking for. Click the title of a specific feature to learn more about it.

THE 2005 WORLD SUMMIT: AN OVERVIEW

overview2005summit.pdf (application/pdf Object)
THE 2005 WORLD SUMMIT: AN OVERVIEW
The 2005 World Summit, to be held from 14 to 16 September at United Nations Headquarters in New York, is expectedto bring together more than 170 Heads of State and Government: the largest gathering of world leaders in history. It is a once-in-a-generation opportunity to take bold decisions in the areas of development, security, human rights and reform of the United Nations. The agenda is based on an achievable set of proposals outlined in March by Secretary- General Kofi Annan in his report In Larger Freedom (www.un.org/largerfreedom). These have since been reviewed by Governments in a series of informal consultations conducted by General Assembly President Jean Ping, who released on 5 August a third draft outcome document for the Summit. It is anticipated that another draft will be issued in late August. The latest version and additional details can be found at www.un.org/ga/59/hl60_plenarymeeting.
FREEDOM FROM WANT
Proposals in the area of development call for breakthroughs in debt relief and trade liberalization, and increases in aid to revitalize infrastructure and improve health and education services, in order to achieve the Millennium Development Goals (MDGs), including cutting extreme poverty in half by 2015 (www.un.org/millenniumgoals).
Developing countries are being asked to devise national strategies to meet the MDG targets and to facilitate transparent and accountable governance, while developed countries are being urged to increase aid and reduce trade barriers, debt and other burdens that hamper development. It has been proposed to set up an International Financing Facility that would make official development assistance (ODA) more predictable and accessible. Many donors are on track to meet the target of dedicating 0.7 per cent of gross national income to ODA by the year 2015.
Others have promised to make substantial increases in ODA over the next ten years. Leaders meeting at the Group of 8 Summit in early July agreed to increase annual aid flows by at least $50 billion as of 2010, with at least half of that increase to be directed at Africa, and to write off the debts of eighteen of the world’s poorest countries.
FREEDOM FROM FEAR
Another major focus of the Summit agenda is to make the world safer by improving collective security arrangements.
Proposals include initiatives to prevent catastrophic terrorism and the proliferation of weapons of mass destruction. Member States are being urged to reach agreement on a universal definition of terrorism and to sign on to a comprehensive convention against terrorism. A comprehensive convention against nuclear terrorism has already been approved by the General Assembly and will be opened for signature at the World Summit. Another area under decision regards the establishment of a Peacebuilding Commission that would support countries during their transitions from armed conflict to lasting peace and reduce the risks of war. Governments are also being asked to take action against organized crime, as well as to contain illicit trade in small arms and landmines.
FREEDOM TO LIVE IN DIGNITY
The three-pronged approach to collective action hinges on the idea that there can be no development without security, no security without development, and neither without the universal application and protection of human rights. The Secretary-General recently announced the creation of an independent and self-financing Democracy Fund to help Governments strengthen their democratic practices and institutions. Another key step calls for the acceptance of a universal principle of the responsibility to protect civilian populations from crimes against humanity when Governments are unwilling or unable to do so. In addition, the draft outcome document urges strengthening the Office of the UN High Commissioner for Human Rights. Another proposal under consideration would transform the largely discredited Human Rights Commission into a smaller standing body, a new Human Rights Council.Membership on the Council would be subject to approval by two-thirds of the General Assembly.
STRENGTHENING THE UNITED NATIONS
It is widely agreed that the United Nations must adapt itself to meet the needs of today’s geopolitics and global challenges. Although the UN continues to streamline and renew its internal structure, efforts need to be intensified to make it more effective, transparent and accountable.
Key among the proposals is the expansion of the Security Council to make it more inclusive and representative of the UN’s current membership. Two models for expanding the Council from 15 to 24 members are among those now on the table: one creates six new permanent seats and three new non-permanent ones; the other creates nine new non-permanent seats. Although consensus is desirable, it is not mandatory as long as two-thirds of UN
Member States agree on the formula. An invigorated role for the Economic and Social Council is also envisioned among the reform proposals. ECOSOC
would play a more active role in coordinating system-wide development policies and hold high-level ministerial meetings biennially to assess progress and make recommendations about how to achieve the MDGs.
The General Assembly itself is also under scrutiny. Proposals for its renewal include measures to streamline its committee structure and speed up the deliberative process, as well as to rationalize the Assembly’s lengthy agenda to give priority to the most critical issues of the day.
Other proposals include steps to realign the Secretariat’s structure and staffing with the proposed reforms, including approval for a one-time staff buyout and a comprehensive review of budget and human resources. The changes aim to make the culture and organization of the Secretariat more efficient, open and accountable. For more information on Secretariat reform, visit: www.un.org/reform.
SUMMIT FORMAT AND OUTCOME
The 2005 World Summit will feature plenary meetings continuing over the three days, where Heads of State or Government and other senior officials will make statements. There will be a special meeting on Financing for Development on the morning of 14 September. The plenary meetings will be presided over by the Heads of State or Government of the home countries of the Presidents of the 59th and 60th sessions of the General Assembly —
Gabon and Sweden, respectively. Four closed, interactive roundtables will also be held over the three days, each one covering the broad Summit agenda and chaired by two Heads of State or Government selected by regional groupings.
Summaries of the discussions will be presented during a closing plenary meeting on 16 September. Selected Observers and members of non-governmental and regional organizations may also address the plenary. Member States are expected to adopt a final outcome document containing a number of decisions and recommendations for action. For more information, visit the Summit website at www.un.org/summit2005.