GALERIA DE VOZES

GALERIA DE VOZES

Refer�ncia recebida de Rosa Sampaio Vila-Nova [rosa.sampaio@superig.com.br]
http://www.vozesbrasileiras.com.br/html/galeria.html

The Year in Medicine (2005)

TIME.com Print Page: TIME Magazine -- The Year in Medicine: "Sunday, Nov. 27, 2005
The Year in Medicine
By SORA SONG, ALICE PARK, COCO MASTERS
-- A --

ACUPUNCTURE There is growing scientific evidence that acupuncture, a pillar of Chinese medicine, can relieve many kinds of pain, but there's no clear agreement about how it works. That was underscored by a German study of migraines: it found that inserting needles at various acupuncture points in the body relieved pain just as effectively as inserting them in the points that are supposed to affect migraines. Both therapies cut the number of episodes more than 50% over a 12-week period; a control group that did not receive either treatment continued to suffer as before.

AIDS This was the year that the World Health Organization (WHO), under the banner of its innovative '3 by 5' campaign, was supposed to put 3 million AIDS patients in the developing world on life-saving antiretroviral drugs. With only a month left in 2005, the WHO is expected to fall short of its goal, but most experts still consider the plan a success. Fourteen of the countries hardest hit by the epidemic now provide therapies to at least half their patients who need them. Such aggressive treatment programs are critical as the AIDS virus continues to spread and mutate. The WHO and U.N. last week reported that an estimated 40 million people are HIV-positive, including a record 1 million in the U.S. In New York City, doctors were alarmed to discover a particularly powerful strain of HIV in a sexually active gay man. Resistant to all but one of the classes of anti-AIDS drugs, that fast-working virus appears to lead to full-blown AIDS in a matter of months. "/.../

Intellectual Property Watch: UN Committee Adopts Position On IP And Human Rights

Intellectual Property Watch UN Committee Adopts Position On IP And Human Rights: "UN Committee Adopts Position On IP And Human Rights


Filed under:English United Nations Human Rightsposted by William New @ 11:28 pm

Comment on this article
A half-decade after it began, a United Nations committee on 21 November adopted a document intended to clarify nations? responsibilities on intellectual property and human rights. The text, while not legally binding, could bolster legal disputes in other international and national bodies, committee members said afterward.
The still-confidential adopted text, referred to as a General Comment, aims to identify key human rights principles deriving from the International Covenant on Economic, Social and Cultural Rights. The latest General Comment is limited to Article 15.1.c of the covenant, which requires the protection of authors of written, music, art and other works. "/.../

Resistance to antimicrobials in humans and animals -- Soulsby 331 (7527): 1219 -- BMJ

Resistance to antimicrobials in humans and animals -- Soulsby 331 (7527): 1219 -- BMJ: "Resistance to antimicrobials in humans and animals

Recomendado por Moacyr Saffer [safferm@terra.com.br]
Overusing antibiotics is not the only cause and reducing use is not the only solution
Warning signs of antimicrobial resistance, chinks in the antimicrobial armour, began to appear in the middle of the last century, and by the 1990s various reports had signalled the dangers of excessive or inappropriate use of antibiotics in clinical medicine and of the use of antibiotics in animal feed as growth promoters.1-3 Overuse of antimicrobials emerged as the main culprit, and reducing their use was seen as the answer. But it may not be that simple. "/.../

WHO - Survey: How healthy is your world?

WHO | Survey: How healthy is your world?
Opportunity to give your opinion

WHO Multi-country Study on Women's Health and Domestic Violence against Women

WHO | WHO Multi-country Study on Women's Health and Domestic Violence against Women: "WHO Multi-country Study on Women's Health and Domestic Violence against Women
Initial results on prevalence, health outcomes and women's responses

This report presents initial results based on interviews with 24 000 women by carefully trained interviewers. The study was implemented by WHO, in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM), PATH, USA, research institutions and women's organizations in the participating countries. This report covers 15 sites and 10 countries: Bangladesh, Brazil, Ethiopia, Japan, Peru, Namibia, Samoa, Serbia and Montenegro, Thailand and the United Republic of Tanzania.
Report findings document the prevalence of intimate partner violence and its association with women's physical, mental, sexual and reproductive health. Data is included on non-partner violence, sexual abuse during childhood and forced first sexual experience. Information is also provided on women's responses: Whom do women turn to and whom do they tell about the violence in their lives? Do they leave or fight back? Which services do they use and what response do they get?
The report concludes with 15 recommendations to strengthen national commitment and action on violence against women.
Data from the report show that violence against women is widespread and demands a public health response.

PNAD 2004 - IBGE

PNAD 2004: ocupação cresceu e rendimento ficou estável

(Atualizado em 25/11/2005 às 16:22)

Em queda desde 1997, o rendimento médio real da população ocupada estabilizou-se em R$ 733 e a concentração das remunerações continuou em declínio: enquanto a metade com os menores rendimentos da população ocupada teve ganho real de 3,2%, a outra metade teve perda de 0,6%. Já o nível da ocupação – percentual de pessoas ocupadas na população de dez anos ou mais de idade – foi o maior desde 1996. Estas são algumas das informações levantadas pela Pesquisa Nacional por Amostra de Domicílios do IBGE que, em 2004, entrevistou quase 400 mil pessoas e visitou pouco mais de 139 mil domicílios em todo o Brasil. Pela primeira vez, a PNAD investigou também as áreas rurais de Rondônia, Acre, Amazonas, Roraima, Pará e Amapá. Além dos resultados com a cobertura completa da pesquisa em 2004, são apresentados dados harmonizados com a abrangência geográfica dos anos anteriores, para viabilizar as séries históricas.

A PNAD também constatou que o nível de instrução das mulheres que trabalhavam continuou maior que o dos homens e que menos de 3% dos jovens de 7 a 14 anos encontravam-se fora da escola em 2004. Verificou-se, também, que 5,3 milhões de crianças e adolescentes na faixa de 5 a 17 anos de idade estavam trabalhando.

Entre 2003 e 2004, cresceu em mais de 50% o número de domicílios que tinham exclusivamente o telefone celular e em 11% o daqueles onde havia computadores conectados à internet. Em 2004, as pessoas com 60 anos ou mais de idade já representavam quase 10% da população do País, e 46,5% dos trabalhadores tinham cobertura previdenciária. No entanto, somente 18% das pessoas ocupadas eram sindicalizados. A seguir, os principais dados da PNAD 2004./.../

Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study

Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study
Ana Maria B Menezes , Rogelio Perez-Padilla, JoséRoberto B Jardim, Adriana Muiño, Maria Victorina Lopez, Gonzalo Valdivia, Maria Montes de Oca, Carlos Talamo, Pedro C Hallal and Cesar G Victora, for the PLATINO Team

Ao menos dois dos autores são membros da lista AMICOR e Ana Maria B. Menezes certamente proverá por uma copia do artigo a quem solicitar.

Summary
Background
Both the prevalence and mortality attributable to chronic obstructive pulmonary disease (COPD) seem to be increasing in low-income and middle-income countries, but few data are available. The aim of the PLATINO study, launched in 2002, was to describe the epidemiology of COPD in five major Latin American cities: São Paulo (Brazil), Santiago (Chile), Mexico City (Mexico), Montevideo (Uruguay), and Caracas (Venezuela).

Methods
A two-stage sampling strategy was used in the five areas to obtain probability samples of adults aged 40 years or older. These individuals were invited to answer a questionnaire and undergo anthropometry, followed by prebronchodilator and postbronchodilator spirometry. We defined COPD as a ratio less than 0·7 of postbronchodilator forced expiratory volume in the first second over forced vital capacity.

Findings
Complete information, including spirometry, was obtained from 963 people in São Paulo, 1173 in Santiago, 1000 in Mexico City, 885 in Montevideo, and 1294 in Caracas. Crude rates of COPD ranged from 7·8% (78 of 1000; 95% CI 5·9–9·7) in Mexico City to 19·7% (174 of 885; 17·2–22·2) in Montevideo. After adjustment for key risk factors, the prevalence of COPD in Mexico City remained significantly lower than that in other cities.

Interpretation
These results suggest that COPD is a greater health problem in Latin America than previously realised. Altitude may explain part of the difference in prevalence. Given the high rates of tobacco use in the region, increasing public awareness of the burden of COPD is important.

Affiliations

Correspondence to: Prof Ana Maria Menezes, Faculdade de Medicina, Universidade Federal de Pelotas, Duque de Caxias, 250 – 3° piso - 96030-002 - Pelotas, RS, Brazil

Measuring impact: Improving the health and wellbeing of people in mid-life and beyond

Measuring impact: Improving the health and wellbeing of people in mid-life and beyond: "Measuring impact: Improving the health and wellbeing of people in mid-life and beyond
Measuring impact is the third in a series of publications commissioned by the Health Development Agency from the mid-life programme of work, which seeks to improve the health and wellbeing of people in the mid-life age group and reduce inequalities. The publications Making the case (HDA, 2003) and Taking action (HDA, 2004), and now Measuring impact, aim to support practitioners and policy makers at a local level in implementing and using the evidence of what works to develop mainstream practice and influence policy formulation in this population group.
Measuring impact: Improving the health and wellbeing of people in mid-life and beyond
22 August 2005
(714.9Kb 04min 08sec @ 28.8Kbps)"

Diabetes Atlas - IDF

IDF Diabetes Atlas - About e-Atlas: "The e-Atlas is currently being upgraded and updated to provide you with an even more useful site on diabetes. It will be your one-stop source of information on diabetes: compare the latest data on diabetes prevalence and health expenditure in some 212 countries and territories; find out why people are dying from the lack of access to insulin; learn about the link between diabetes and cardiovascular disease and why the explosion in obesity prevalence is causing a parallel rise in type 2 diabetes. The e-Atlas aims to communicate the global impact of diabetes and to underline the need for intervention now.
Visit the e-atlas regularly as new topics will be added to the site over the next few months. "

Donald Rumsfeld y los negocios de la gripe aviar

De: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]
Enviada em: quinta-feira, 24 de novembro de 2005 15:04
Assunto: Donald Rumsfeld y los negocios de la gripe aviar
Donald Rumsfeld y los negocios de la gripe aviar


“El secretario de Defensa, Donald H. Rumsfeld, optó por abstenerse de participar en decisiones de gobierno relacionadas con los medicamentos para prevenir o tratar la gripe aviar, en lugar de vender sus acciones en la compañía que patentó el agente antiviral Tamiflu de acuerdo a un memorando del Pentágono emitido este jueves.” El Pentágono informa que el secretario de Defensa no tomará parte “en ninguna decisión que pudiera afectar sus intereses financieros en la empresa Gilead Sciences Inc” (New York Times, 4/11).

Rumsfeld fue miembro del directorio y es el principal accionista de Gilead, la empresa de biotecnología que patentó el Tamiflu, el medicamento más codiciado del mundo porque sería el único capaz de actuar contra la gripe aviar, una enfermedad transmitida por las aves que –dicen– podría matar a 200 millones de personas. Los laboratorios Roche compraron los derechos de fabricación y ventas del Tamiflu.

La CNN (31/10) comentó que el pánico por la pandemia “ha hecho a Rumsfeld, uno de los miembros más ricos del gabinete Bush, todavía más rico”. George Schultz, secretario de Estado con Ronald Reagan, también integra el consejo de administración de Gilead Sciences.

El gobierno de Bush es el primer comprador mundial de Tamiflu, y en julio el Pentágono compró 58 millones de dosis para el “tratamiento” (sic) de las tropas estadounidenses. Gilead Sciences recibe regalías de 10 por ciento de las ventas de Roche, que este año alcanzarán mil millones, comparadas a la cuarta parte de 2004. Estados Unidos ha librado una orden de compra por 20 millones de dosis de Tamiflu. A 100 dólares la dosis, arroja una cifra de venta de dos mil millones de dólares. A la vez, el Senado votó un fondo de emergencia por ocho mil millones de dólares para comprar vacunas, antivirales y mejorar los sistemas de detección de la “súper influenza”.

Importantes científicos han puesto en duda no sólo la verosimilitud de la amenaza de la gripe aviar sino la eficacia de Tamiflu y se preguntan por qué el gobierno de Bush ha decidido “santificar” al Tamiflu, en desmedro de otros antivirales. John Macfarlane, especialista en medicina respiratoria, escribe en la prestigiosa revista científica británica BMJ (24/10): “La ausencia de una transmisión sostenida de humano a humano sugiere que este virus aviar H5N1 no posea actualmente la capacidad de provocar una pandemia humana”. Macfarlane resalta que “la aparición de un virus aviar modificado capaz de desencadenar una pandemia humana es improbable: ha habido más de 3.300 brotes en aves, con 150 millones fallecidas, y sólo 118 casos humanos,
y la enfermedad aviar ha probado ser contenible con buena vigilancia y pronta acción”.

Diversas páginas de Internet alternativas citan notas del China Daily, que “es muy probable que expresen el punto de vista oficioso del gobierno chino”. A saber: “Durante el brote de la encefalopatía espongiforme británica, los políticos trataron deliberadamente de suprimir la noticia.
Ahora con un poco más de 100 casos en el mundo, los timadores (sic) piden que todo el mundo sea vacunado. Quizá haya llegado el colapso de la economía occidental, por lo que necesitan generar alguna actividad económica”. Según el China Daily: “El Tamiflu solamente modera, no cura, los efectos de la fiebre aviar y no ha sido probada plenamente en el virus que Rumsfeld ha desarrollado de una gripe aviar proveniente de Sudamérica (sic)”.

Prison Planet (24/10) ofrece un prontuario de Rumsfeld con relación a negociados de los laboratorios: “Debe recordarse que Rumsfeld adora los engaños farmacológicos. Como anterior mandamás de GD Searle, presionó a la Administración Federal de Medicamentos (FDA) para el uso de aspartamo. Se presume que Rumsfeld obtuvo 12 millones de dólares por la venta de GD Searle a Monsanto”. La venta del aspartamo había sido prohibida durante una década en EEUU por sus efectos cancerígenos.

Rumsfeld se ha visto inmiscuido en los últimos 29 años con asuntos de “gripe” proveniente de los animales, como sucedió con la muerte por “gripe porcina” de un recluta militar en 1976 en Nueva Jersey. El presidente Ford urgió a la producción y distribución de vacunas. Como algunos lotes estaban contaminados, 52 personas murieron y medio millar se intoxicaron. Esto obligó a suspender inmediatamente la vacunación. Curiosamente, no se conoció ningún otro caso de muerte por “gripe porcina” (Knight Ridder Newspapers, 4/11).

Olga Cristóbal

The Origins of Pandemic Influenza -- Lessons from the 1918 Virus

NEJM -- The Origins of Pandemic Influenza -- Lessons from the 1918 Virus: "The completion of the genetic sequencing of the 1918 influenza A virus by Taubenberger et al.1 and the subsequent recovery of the virus by Tumpey et al.2 using reverse genetic techniques are spectacular achievements of contemporary molecular biology and provide important insights into the origin of pandemic influenza. The three pandemic viruses that emerged in the 20th century ? the 1918 ('Spanish influenza') H1N1 virus, the 1957 ('Asian influenza') H2N2 virus, and the 1968 ('Hong Kong influenza') H3N2 virus ? all spread rapidly around the world, but only the 1918 virus was associated with mortality measured in the thousands per 100,000 population. "

De: Rosa Maria Sampaio Vilanova de Carvalho [mailto:rosa.sampaio@saude.gov.br]
Enviada em: terça-feira, 22 de novembro de 2005 15:34
Assunto: novo site da Atenção básica

http://dtr2004.saude.gov.br/dab/atencaobasica.php
Oi pessoal,
novo site da Atenção Básica, ainda em construção. Criticas e sugestões serão benvindas.
Clicar em Hipertensão e Diabetes.
Obrigada e um abraço,
ROSA SAMPAIO VILA-NOVA
Coordenadora Nacional de
Hipertensão Arterial e Diabetes Melitus
Departamento de Atenção Básica
Secretaria de Atenção à Saúde
Ministério da Saúde

JAMA -- Recommended Adult Immunization Schedule--United States, October 2005-September 2006, November 23/30, 2005, 294 (20): 2569

JAMA -- Recommended Adult Immunization Schedule--United States, October 2005-September 2006, November 23/30, 2005, 294 (20): 2569: "Recommended Adult Immunization Schedule. United States, October 2005 -September 2006
JAMA. 2005;294:2569-2572.
MMWR. 2005;54:Q1-Q4
The Advisory Committee on Immunization Practices (ACIP) annually reviews the recommended Adult Immunization Schedule to ensure that the schedule reflects current recommendations for the use of licensed vaccines. In June 2005, ACIP approved the Adult Immunization Schedule for October 2005 - September 2006. This schedule has also been approved by the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists. "/.../

The State of Food Insecurity in the World - Report 2005

De: Equity, Health & Human Development [mailto:EQUIDAD@LISTSERV.PAHO.ORG] Em nome de Ruggiero, Mrs. Ana Lucia (WDC)
Enviada em: terça-feira, 22 de novembro de 2005 13:45
Para: EQUIDAD@LISTSERV.PAHO.ORG
Assunto: [EQ] The State of Food Insecurity in the World - Report 2005

The State of Food Insecurity in the World

Food and Agriculture Organization of the United Nations
FAO, Rome, Italy 2005

Full report available online as PDF file [40p.] at: ftp://ftp.fao.org/docrep/fao/008/a0200e/a0200e.pdf

“…..Hunger slows progress towards Millennium Development Goals
New FAO report on world hunger urges governments to accelerate hunger reduction

22 November 2005, Rome – “….Hunger and malnutrition are killing nearly six million children each year – a figure that roughly equals the entire pre-school population of a large country such as Japan, FAO said in a new edition of its annual hunger report, The State of Food Insecurity in the World, published today.

Many of these children die from a handful of treatable infectious diseases including diarrhoea, pneumonia, malaria and measles. They would survive if their bodies and immune systems had not been weakened by hunger and malnutrition.

Hunger and malnutrition are among the root causes of poverty, illiteracy, disease and mortality of millions of people in developing countries, the report said….”

More hungry in Africa than in '90s

Nola.com's Printer-Friendly Page: "
U.N.: More hungry in Africa than in '90s
11/22/2005, 10:47 a.m. CT
By MARIA SANMINIATELLI
The Associated Press
ROME (AP) � Hunger and malnutrition kill nearly 6 million children a year, and more people are malnourished in sub-Saharan Africa this decade than in the 1990s, according to a U.N. report released Tuesday.
Many of the children die from diseases that are treatable, including diarrhea, pneumonia, malaria and measles, said the report by the Rome-based U.N. Food and Agriculture Organization.
In sub-Saharan Africa, the number of malnourished people grew to 203.5 million people in 2000-02 from 170.4 million 10 years earlier, the report states, noting that hunger and malnutrition are among the main causes of poverty, illiteracy, disease and deaths in developing countries.
The U.N. food agency said the goal of reducing the number of the world's hungry by half by the year 2015, set by the World Food Summit in 1996 and reinforced by the Millennium Development Goals in 2000, remains distant but attainable.
'If each of the developing regions continues to reduce hunger at the current pace, only South America and the Caribbean will reach the Millennium Development Goal target,' Jacques Diouf, the agency's director-general, wrote in the report, the agency's annual update on world hunger.
The food agency said the Asia-Pacific region also has a good chance of reaching the targets 'if it can accelerate progress slightly over the next few years.'
'Most, if not all of the ... targets can be reached, but only if efforts are redoubled and refocused,' Diouf said. 'To bring the number of hungry people down, priority must be given to rural areas and to agriculture as the mainst"

The Lancet

The Lancet: "Autopsy
Michael J Clark a
Derived from the Greek and Latin autopsia, meaning "seeing for oneself", the word "autopsy" has been in use since the 17th century to refer to post-mortem examination of the human body to reveal evidence of organic disease or to discover medical causes of death. Before the late 18th century, anatomical dissections were fairly commonplace, but it was rare for autopsies to be done purely to investigate disease processes or ascertain cause of death. Not until the 20th century did post-mortem examinations become the preserve of hospital and forensic pathologists, by which time the word autopsy had displaced the hitherto preferred term "necropsy".
Far from seeing for oneself, as coroners and coroners' juries had formerly done in inquest cases, pathologists now did all the necessary "seeing" on society's behalf in specially designed mortuaries. The "view" of the body to confirm the identity of the deceased thus became separated from the autopsy to find the cause of death. From the mid-19th century, pathologists also began to lay down protocols for the conduct of autopsies "rules about how to "see", what to look for, where, and in what order. Increasingly, they came to distinguish "true" post-mortem appearances from "artifacts" and other misleading phenomena that occurred after death, and, more reluctantly, to accept that even "true" post-mortem appearances did not always reveal the cause of death.
In the 20th century, as different ways of investigating disease processes multiplied, the art of "seeing" on the basis of pathological changes became increasingly divorced from diagnostic practice. Once regarded as the fount of all knowledge about causes of disease and death, the autopsy has now largely been pre-empted by the biopsy and a raft of othe"

CIDRAP >> Center for Infectious Disease Research and Policy

CIDRAP >> Center for Infectious Disease Research and Policy
NET RESOURCES: Disease Daily
The bird flu virus (H5N1) spreading from Asia to Europe has the world worried about a possible human flu pandemic. For the latest on avian influenza and other microbial threats, click over to the Web site of the Center for Infectious Disease Research and Policy at the University of Minnesota, Minneapolis. The clearinghouse holds information on more than a dozen illnesses, from SARS to potential bioterrorism weapons such as bubonic plague. Visitors can read daily news reports, abstracts of recent papers, and other documents. For some diseases, you'll find backgrounders that describe symptoms, epidemiology, diagnosis, and treatment.

www.cidrap.umn.edu

Tellymedicine -- Claassen 331 (7526): 1185 -- BMJ

Tellymedicine -- Claassen 331 (7526): 1185 -- BMJ
In the past, doctors had to see a patient before they could make a diagnosis. Doctors were also restricted in whom they could tell about this diagnosis?the patient and his or her trusted next of kin, the nurse, and perhaps the odd interested colleague. Recent advances in technology first brought us telemedicine, where doctors can assist other doctors in making a diagnosis, guide surgical procedures, or even perform surgery themselves, without being physically near the patient.

Improving services with informatics tools -- Sullivan and Wyatt 331 (7526): 1190 -- BMJ

Improving services with informatics tools -- Sullivan and Wyatt 331 (7526): 1190 -- BMJ: "This article describes how many sources of data can be linked, interpreted, and analysed before being presented to decision makers to improve care. It also discusses the legal issues surrounding data protection and freedom of information.
A huge volume of data flows across the desk of a director of public health (see box opposite). One of the director's problems is to know which signals to act upon and what 'noise' to ignore. If the numbers being considered are small, as they probably will be in the case described here, a critical incident analysis may be all that is needed. An individual prescriber, or group, may have an erroneous belief or inadequate training. Critical incidents or other signals often indicate that more data (such as data on prescribing steroids for paediatric asthma in primary care and outpatients) are needed. "

Closing the Health Inequalities Gap: An International Perspective

Closing the Health Inequalities Gap: An International Perspective
from PAHO/EQUITY List
The report was authored by Iain K. Crombie, Linda Irvine, Lawrence Elliott and Hilary Wallace of the University of Dundee, Scotland, UK. It was commissioned by NHS Health Scotland and published by the WHO European Office for Investment for Health and Development.

The Regional Office for Europe of the World Health Organization, 2005

Available online as PDF file [81p.] at: http://www.euro.who.int/Document/E87599.pdf

The report "Closing the health inequalities gap: an international perspective61; presents an analysis of official documents on government policies to tackle inequalities in health from 13 developed countries. All countries recognize that health inequalities are caused by adverse socioeconomic and environmental circumstances. However they differ in their definitions of inequalities and in their approaches to tackling the problem.

Sweden and Northern Ireland have structured their overall public health policy to tackle the underlying determinants of inequalities in health. England is the only country with a separate comprehensive policy. Most countries also have policies on poverty, social inclusion, and social justice.

These are motivated by a concern for human rights and dignity and deal primarily with the underlying causes of health inequalities. While broadly setting the same overarching goal, policies on health inequalities show many different features. Policymakers face two challenges: to ensure that strategies to tackle the macroenvironmental factors feature in policy on inequalities in health, and to ensure that health becomes a prominent issue in social justice policy. Few countries have a coordinated approach to tackling inequalities in health.

progresso é uma ilusão

O peso das ilusões
(Entrevista na Veja)
Para o pensador inglês John Gray a fé no progresso é uma ilusão, o homem não é dono de seu destino e os avanços científicos nada têm a ver com a ética. "Somos a espécie dominante simplesmente porque eliminamos boa parte da biosfera."

Health and the Millennium Development Goals 2005 keep the promise

World Health Organization 2005

PDF online [84p.] at: http://www.who.int/mdg/publications/MDG_Report_08_2005.pdf
Recommended by Ana Lucia Ruggiero, PAHO
“……The eight Millennium Development Goals represent a unique global compact. Derived from the Millennium Declaration, which was signed by 189 countries, the MDGs benefit from international political support. As such, they reflect an unprecedented commitment by the world’s leaders to tackle the most basic forms of injustice and inequality in our world: poverty, illiteracy and ill-health.

The health-related MDGs do not cover all the health issues that matter to poor people and poor countries. But they do serve as markers of the most basic challenges ahead: to stop women dying during pregnancy and child birth; to protect young children from ill-health and death; and to tackle the major communicable diseases, in particular HIV/AIDS…..”

Including older people in clinical research -- McMurdo et al. 331 (7524): 1036 -- BMJ

Including older people in clinical research -- McMurdo et al. 331 (7524): 1036 -- BMJ

Sent by: Marcelo Gustavo Colominas [mailto:mgcolominas@hotmail.com]
Enviada em: domingo, 13 de novembro de 2005 21:47
Para: cardtran@fac.org.ar; epi-pcvc@fac.org.ar
Assunto: Including older people in clinical research

BMJ 2005;331:1036-1037
Including older people in clinical research

Benefits shown in trials in younger people may not apply to older people

http://bmj.bmjjournals.com/cgi/content/full/331/7524/1036

There are more old people alive today than at any time in history. Older
people are, quite rightly, "the core business of the NHS."1 The need to be
able to draw on the results of good quality research to inform best practice
in the specific management of older people is compelling. So we might expect
that researchers would have eagerly embraced the participation of older
people in clinical trials. Yet this is not the case. What do clinicians and
researchers have to do to redress the serious bias against older people in
clinical research?
[...]

__________________

Marcelo G. Colominas
SCChaco

desconstrucción del caos del hospital

criticamedicina: "deconstrucci�n del caos del hospital
Deconstrucción del caos del hospital

Según Jacques Derrida: "De la gramatología", 1967, deconstrucción es un concepto de arquitectura: deposición/ descomposición de una estructura.
Es un trabajo del pensamiento inconsciente en deshacer, sin destruirlo jamás, un sistema de pensamiento hegemónico o dominante.
Es resistir a la tiranía del Uno, del logo, de la metafísica.
También es un trastorno en la construcción de las palabras en la frase.
En nuestro país, Argentina los sinónimos de caos son: lío, quilombo, bardo...
Planteo que "los elementos en el hospital tienen una funcionalidad ca�tica".
Y que " la institución hospitalaria configura un sistema caótico" ( teoremas de Wajner)
"/.../

Build a face...

National Geographic Channel
Se voc� pudesse desenhar seu pr�prio rosto, qual seria a sua apar�ncia? Agora voc� pode construir o tipo de visual que acha mais atraente com nosso jogo exclusivo, o Gerador de Rostos (em ingl�s).

Diabetic Foot

Recommended by: Marcelo Gustavo Colominas [mailto:mgcolominas@gigared.com]
Enviada em: sábado, 12 de novembro de 2005 04:53
Para: chaco@fac.org.ar
Assunto: Pie diabético (The Lancet)
Diabetic Foot
Coinciding with World Diabetes Day (Monday 14 November, 2005) which this year focuses on foot complications, the majority of The Lancet November 12-18 issue has been devoted to diabetic foot disease.
In connection with this issue, a collection of accounts from selected countries about treatment and control of the diabetic foot are published online... These pieces tell of the current management systems of diabetes in each country, the personal experiences of patients after diagnosis, and the specific problems faced by these individuals when coping with the disorder.

http://www.thelancet.com/collections/diabetic_foot

The diabetic foot in Barbados
The diabetic foot in Brazil
The diabetic foot in Moscow
The diabetic foot in Tanzania

Einstein Online English

Einstein Online English: "Welcome to Einstein-Online,
a website about Einstein's theories of relativity!
Elementary Einstein
Confused by curved spaces? Baffled by black holes? Then it's time to read our online introduction to relativity, Elementary Einstein!
Schwarzschild, LISA & Co.
Ready for more Einstein? Our Spotlights on relativity deal with selected topics in relativity - from modern research to age-old questions:
Journey into a black hole
Einstein and soap bubbles
Extra dimensions, and how to hide them
...and more!"

Methods to assess the costs and health effects of interventions for improving health in developing countries -- Evans et al. 331 (7525): 1137 -- BMJ

Methods to assess the costs and health effects of interventions for improving health in developing countries -- Evans et al. 331 (7525): 1137 -- BMJ: "Assessment of the cost effectiveness of interventions designed to achieve the millennium development goals for health is complex. The methods must be capable of showing the efficiency with which current and possible new resources are used, and incorporating interactions between concurrent interventions and the effect of expanding coverage on unit costs.1 They should also allow valid comparisons across a wide range of interventions. Here we describe how the standardised cost effectiveness methods used in the World Health Organization's Choosing Interventions that are Cost Effective (CHOICE) project have tackled these issues. "

Keeping up: learning in the workplace -- Wyatt and Sullivan 331 (7525): 1129 -- BMJ

Keeping up: learning in the workplace -- Wyatt and Sullivan 331 (7525): 1129 -- BMJ: "The amount of biomedical knowledge doubles every 20 years, and new classes of drug (such as phosphodiesterase 4 inhibitors) become available when lectures at medical school are over. Therefore, a practice risks fossilising after doctors finish professional training. Many continuing medical education or continuing professional development activities help doctors carry on learning and improving their skills. These activities include courses, conferences, mailed educational materials, weekly grand rounds, journal clubs, and using internet sites. In many countries, evidence of this process is needed for doctors to continue to practice. Although these activities may increase knowledge, their impact on clinical practice is variable
The aim of traditional medical education is to commit knowledge to memory and then use this knowledge in the workplace. The way knowledge is learnt influences its recall and application to work. One tactic to improve the process is to ensure that learning happens in the clinical workplace. Lessons are learnt faster and recalled more reliably when they originate in everyday experience. "/.../

Researchers investigate potential use of plant as a pain killer -- Marwick 331 (7525): 1104 -- BMJ

Researchers investigate potential use of plant as a pain killer -- Marwick 331 (7525): 1104 -- BMJ: "Researchers investigate potential use of plant as a pain killer
Washington, DC Charles Marwick
Researchers at the National Institutes of Health have enlisted one of the oldest known medicinal plants as a potent painkiller. Euphorbia resinfera, a cactus-like plant, is a member of the euphorb family, of which there about 2000 species. The active ingredient, resiniferatoxin, was isolated in the 1970s. It is a potent analogue of capsaicin, the substance that gives chilli peppers their pungency.
The work is a novel approach to pain management because it elliminates nerve cells involved in chronic pain but does not damage other nerve cells. Opioid analgesics, currently the main tool for treating moderate to severe chronic pain, do not provide relief in all cases."

Sweet foods increase breast cancer risk -- Dobson 331 (7525): 1102 -- BMJ

Sweet foods increase breast cancer risk -- Dobson 331 (7525): 1102 -- BMJ: "Sweet foods increase breast cancer risk
Abergavenny Roger Dobson
Regularly eating sweet foods, including biscuits, ice cream, honey, and chocolate, may increase the risk of breast cancer. Results from a large case control study of more than 5000 Italian women have shown that the effects may be significant: "If real, the excess risk for frequent sweet consumption may account for 12% of breast cancer cases in this Italian population and, therefore, is far from negligible on a public health level," say researchers in a report in Annals of Oncology (published online on 25 October; http://annonc.oxfordjournals.org, doi: 10.1093/annonc/mdj051)"/.../

UN Millennium Development Goals

bmj.com -- Article series on the issue

Five years ago, the United Nations set eight millennium development goals, which ranged from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education, all by the target date of 2015. Researchers from the World Health Organization examine strategies to achieve these goals for health in the developing world, in a new series of articles starting this week. Read more

JAMA -- Abstract: Antibiotic Treatment of Children With Sore Throat, November 9, 2005, Linder et al. 294 (18): 2315

JAMA -- Abstract: Antibiotic Treatment of Children With Sore Throat, November 9, 2005, Linder et al. 294 (18): 2315
Results Physicians prescribed antibiotics in 53% (95% confidence interval [CI], 49%-56%) of an estimated 7.3 million annual visits for sore throat and nonrecommended antibiotics to 27% (95% CI, 24%-31%) of children who received an antibiotic. Antibiotic prescribing decreased from 66% of visits in 1995 to 54% of visits in 2003 (P = .01 for trend). This decrease was attributable to a decrease in the prescribing of recommended antibiotics (49% to 38%; P = .002). Physicians performed a GABHS test in 53% (95% CI, 48%-57%) of visits and in 51% (95% CI, 45%-57%) of visits at which an antibiotic was prescribed. GABHS testing was not associated with a lower antibiotic prescribing rate overall (48% tested vs 51% not tested; P = .40), but testing was associated with a lower antibiotic prescribing rate for children with diagnosis codes for pharyngitis, tonsillitis, and streptococcal sore throat (57% tested vs 73% not tested; P<.001).

Conclusions Physicians prescribed antibiotics to 53% of children with sore throat, in excess of the maximum expected prevalence of GABHS. Although there was a decrease in the proportion of children receiving antibiotics between 1995 and 2003, this was due to decreased prescribing of agents recommended for GABHS. Although GABHS testing was associated with a lower rate of antibiotic prescribing for children with diagnosis codes of pharyngitis, tonsillitis, and streptococcal sore throat, GABHS testing was underused.

Taking action at local level: a resource for improving health and well-being in mid-life. Part 1: Developing local standards

Taking action at local level: a resource for improving health and well-being in mid-life. Part 1: Developing local standards:
"Taking action at local level: a resource for improving health and well-being in mid-life. Part 1: Developing local standards
Taking action at local level: a resource for improving health and well-being in mid-life. Part 1: Developing local standards
10 June 2005 (152.8Kb 01min 53sec @ 28.8Kbps)"

prevention of chronic diseases

The Lancet: "The scientific knowledge to achieve a new global goal for the prevention of chronic diseases "a 2% yearly reduction in rates of death from chronic disease over and above projected declines during the next 10 years" already exists. However, many low-income and middle-income countries must deal with the practical realities of limited resources and a double burden of infectious and chronic diseases. This paper presents a novel planning framework that can be used in these contexts: the stepwise framework for preventing chronic diseases. The framework offers a flexible and practical public health approach to assist ministries of health in balancing diverse needs and priorities while implementing evidence-based interventions such as those recommended by the WHO Framework Convention on Tobacco Control and the WHO Global Strategy on Diet, Physical Activity and Health. Countries such as Indonesia, the Philippines, Tonga, and Vietnam have applied the stepwise planning framework: their experiences illustrate how the stepwise approach has general applicability to solving chronic disease problems without sacrificing specificity for any particular country."/.../

Submit online to The Lancet

The Lancet
Submit online to The Lancet
Sabine Kleinert and Mark Harrington

From today, The Lancet has a dedicated online submission and peer-review website known as EES—a customised version of Editorial Manager, one of the main commercially available systems.

Authors can submit manuscripts online and track their progress through the editorial process. Reviewers will be invited through EES and can use the system to send editors their comments on the paper they have been invited to review. Although our intention is for most papers to be received by the journal online, authors without access to email or the internet will still be able to send a paper manuscript to the journal office in London.

For the time being, letters for publication in our Correspondence columns should still be sent by email to correspondence@lancet.com.

Editors and the journal office will offer assistance to authors and reviewers who may be unfamiliar with EES. Authors and reviewers can also use a 24-h telephone service for support on the following numbers:


USA and Canada: +1 888 834 7287 (toll-free for US and Canadian callers)

Asia and Pacific: +81 3 5561 5032

Europe and rest of world: +353 61 709 190


In September, 2005, an important EES landmark was reached as Tetrahedron Letters became the 750th journal to go live in the system. By the end of 2005, 1000 titles should be live in EES. Roll-out of Editorial Manager has also progressed. During the past few years, over 40 publishers have adopted Editorial Manager with a combined user-base of over 1 million.1 Development of EES and Editorial Manager continues through user feedback at the annual meetings of the Editorial Manager User Group,2 and through regular contact with publishers.

On Nov 5, The Lancet Infectious Diseases will also go live in EES, and we plan to add the other Lancet specialty titles in the coming months.

We hope you will enjoy using this new service and we are happy to hear any feedback you might have.


Information for authors:http://www.thelancet.com/authors/lancet/authorinfo

EES site for The Lancet:http://ees.elsevier.com/thelancet

EES site for The Lancet Infectious Diseases:http://ees.elsevier.com/thelancetid


References
1. Ware M. Worthing: Association of Learned and Professional Society Publishers, 2005:
http://www.alpsp.org/publications/pub10.htm
(accessed Oct 24, 2005).

2. Editorial Manager
http://www.editorialmanager.com/homepage/emusergroup.ht...
(accessed Oct 12, 2005).

Is public health coercive health?

The Lancet: "Is public health coercive health?"
Lancet 2005; 366:1592-1594

DOI:10.1016/S0140-6736(05)67644-1

Is public health coercive health?
Rachel Cottam

Historically, governments have been unwilling to countenance the use of taxation to encourage desired behaviours (eg, by making cigarettes more expensive) or legislation to coerce the population into a healthier way of living. Yet a recent population-based study in Poland showed that deaths from cardiovascular disease were reduced substantially by economic and agricultural policies rather than by health initiatives.1 In the UK, public-health policy is now at the top of the social and political agenda, and looks set to expand the scope of prophylactic government. After the success of Mary Creagh, member of Parliament, in the Private Members' Ballot, the Children's Food Bill will now be put forward as possible legislation. The purpose of the bill is to prevent ill-health related to food and drink, such as childhood obesity, through active intervention by the state, including the prohibition of marketing certain foods and drinks to children and the introduction of regulations on the sale or provision in schools of any foods and drinks other than those which form part of set school-meals.2 Allowing voluntary self-regulation of the food industry may be akin to Dracula guarding the blood bank. But the avowedly interventionist Children's Food Bill recognises that it is in corporate boardrooms and marketing suites that appetites are cooked up: “individual choices” are never natural nor a priori, but have always been manipulated or at least carefully directed.

Although a 2004 WHO paper points to the need for a more comprehensive approach to the regulation of marketing techniques,3 in the UK the fear of “nanny” is still so strong that the draft legislation in the Children's Food Bill appears unconscionably radical. It was Margaret Thatcher who, in 1979, coined the phrase “Nanny State”, in a speech announcing her plans to dismantle it. Tony Blair has also called for a “change to the way the Government and the state relate to the individual citizen”.4 British libertarians and “small-state” conservatives argue that compulsion leads to “the end of autonomous self-control and the strangling of self-reliance”5—in short, to a morally flabby society. For such people, the State should be there to provide the basic framework that allows us to flourish … or go to hell in a handcart. For others, including some communitarians, government interventions, such as those proposed in the Children's Food Bill, blur the distinction between civil society and the State.

Arguments about the pervasiveness of the nanny state persist because there is no broad agreement about the lineaments of government, or about the appropriate boundaries between public and private. Thus, when public health addresses the supposed freedoms articulated by lifestyle choices, the temperature begins to soar. Legislation opens a Pandora's box, but this should excite rather than dismay public-health policymakers. The policymakers have before them an opportunity to reformulate legal debates which reach to the core of what it is to be a subject in contemporary UK. As Blair implies, a reordering of the public's contract with the government is an urgent task. Yet such progress has been impeded by the absence of a consensual working definition of the polity, embodied in a written constitution, which would act as a framework setting the limits of government.

Rather than being configured as the baffling intrusion of arbitrary authority, state intervention could be conceptualised as “intelligent government”.6 Such intervention has been welcomed in the past—from the Factory Act (1833),7 which set minimum standards for working conditions and compelled employers to provide at least 2 h of education to child employees, through to advice from the Department of Health on how to put your baby to sleep to reduce the risk of cot death.8 Often, however, it is only retrospectively, when legislation has become internalised, that it is seen as a force for good. Few people would now think twice about tobacco legislation and, at least in younger people, seat-belt legislation is now common sense. Research across 16 European countries shows the extent to which legal statute acts as a powerful tool to change behaviour, as “people start integrating it into their own behaviour and value set”.9 Even if legislation acts only as a guideline, as the new English law against smacking children perhaps does,10 it gives out an unequivocal message, showing society's views which everyone then begins to accept. In Denmark and Sweden, the logic of abstaining from smacking is now second nature.

An expanded definition of public health should seek to maximise not only liberty but also what Aristotle coined “virtue”.11 In a contemporary setting, virtue is a compact between society and the individual which results in a trained habit of choice. It is an explicitly political formula in which the State plays a crucial role. “Nanny” need not infantilise us, but offer succour and guidance. Similarly, the interventions of the government make it possible to be virtuous by protecting us from that version of ourselves that is preyed on by the worst excesses of the market.

I decalre that I have no conflict of interest.

References
1. Zatonski WA, Willett W. Changes in dietary fat and declining coronary heart disease in Poland: population based study. BMJ 2005; 331: 187-188. CrossRef

2. Children's Food Bill. London: Stationery Office, February, 2005:.

3. Hawkes C. Marketing food to children: the global regulatory environmentGeneva: World Health Organization, 2004:
http://whqlibdoc.who.int/publications/2004/9241591579.p...
(accessed Aug 10, 2005).

4. Tony Blair's speech on the economy. Napier University, Scotland, Dec 3, 2004
http://www.number-10.gov.uk/output/Page6712.asp
(accessed Aug 10, 2005).

5. George Jones. Echoes of Thatcher as Fox states his claim as a future party leader (Liam Fox's speech). Daily Telegraph Oct 5 2004;
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/20...
(accessed Aug 16, 2005).

6. Herbert N. Gordon's Swedish model. Spectator Dec 4 2004;
http://www.reform.co.uk/website/pressroom/articles.aspx...
(accessed Aug 16, 2005).

7. Hobsbawm EJ. Industry and empireHarmondsworth: Penguin, 1969:.

8. Department of Health. Reduce the risk of cot death: an easy guideLondon: Department of Health, February, 2004:
http://www.dh.gov.uk/assetRoot/04/08/27/08/04082708.pdf
(accessed Aug 10, 2005).

9. EuroPHEN. Attitudes to government intervention in public health issues: overview of findings of qualitative research across Europe. December, 2003/January, 2004:
http://www.sheffield.ac.uk/content/1/c6/02/10/08/TRBI%2...
(accessed Aug 10, 2005).

10. Children's Act 2004. London: Stationery Office, November, 2004:.

11. Broadie S, Rowe C. Aristotle: Nicomachean ethics—translation, introduction, commentaryOxford: Oxford University Press, 2002:.

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Brain Facts and Figures

Brain Facts and Figures

Brain & Spine Foundation - Brain and Spine Booklets

Brain & Spine Foundation - Brain and Spine Booklets: "Brain and Spine Booklets
The following is a list of booklets currently available from the Brain and Spine Foundation. All booklets are available as html pages which you can scroll through page by page, and as pdf files which you can download free of charge. Printed bound versions can be ordered through the Brain and Spine Helpline. "

MJM Wardrounds

MJM Wardrounds
Medical Blog

Robert Boyle

Welcome to the homepage of the Robert Boyle Project
(from Science)
While living through civil war and revolution, the British scientist Robert Boyle (1627-91) managed to forge the modern experimental method by investigating a broad array of topics, including human circulation and the nature of air. Learn more about Boyle's contributions and check out some of his writings at this site from the University of London.
Although he began as a nonscientific writer, Boyle proved himself a whiz in the lab. In one set of experiments, he used a vacuum pump to remove the air from a vessel containing a candle. The flame went out, and he deduced that air contained something necessary to sustain fire. At the site, you can peruse selections from 11 volumes of Boyle's papers (including pages from his treatise on blood). A timeline puts Boyle's life and accomplishments in context with British history and intellectual developments. Boyle was one of the first scientists to publish experimental details. At a linked site, you can page through 44 years of his work diaries.

The Millenium Development Goals Report 2005

The Millenium Development Goals Report 2005

This report is based on a master set of data that has been compiled by an Inter-Agency and Expert Group on MDG Indicators led by the Department of Economic and Social Affairs of the United Nations Secretariat, in response to the wishes of the General Assembly for periodic assessment of progress towards the MDGs. The Group comprises representatives of the international organizations whose activities include the preparation of one or more of the series of statistical indicators that were identified as appropriate for monitoring progress towards the MDGs, as reflected in the list below. A number of national statisticians and outside expert advisers also contributed.

United Nations Statistics Division - Statistical Databases

United Nations Statistics Division - Statistical Databases: "Statistical Databases
Subscriber access
Commodity Trade Statistics Database (COMTRADE)
Comtrade provides commodity trade data for all available countries and areas since 1962. Currently, it contains almost 700 millions records. more...

Free access for guest user (up to 1000 records / query).

Monthly Bulletin of Statistics Online (MBS Online)
This Internet database presents current monthly economic statistics for most of the countries and areas of the world. more...

United Nations Common Database (UNCDB)
UNCDB provides selected series from 30 specialized international data sources for all available countries and areas. more...

Unrestricted access
Demographic Yearbook system
Statistics on population size and composition, births, deaths, marriage and divorce, more...

Distat, the United Nations Disability Statistics Database
Basic statistics on human functioning and disability, more...

Good practices database
View this valuable source of information in good practices in official statistics, more...

InfoNation
Experience this global learning project for middle and secondary students with statistical information on countries
more...

Millennium Indicators Database
48 indicators, to measure progress towards the achievement of the Millennium Declaration development goals. more...

National Accounts Main Aggregates Database
Contains a complete and consistent set of time series of main national accounts aggregates from 1970 onwards, more...

Population of capital cities and cities of 100,000 and more inhabitants
Population of city proper urban agglomeration, more...

Population and housing censuses: census dates
Population and housing "

Social Determinants of Health

Social Determinants of Health
Michael Marmot (Editor), Richard Wilkinson (Editor)
Paperback - (October 10, 2005) 328 pages

Book Description
Social Determinants of Health, 2nd Edition gives an authoritative overview of the social and economic factors which are known to be the most powerful determinants of population health in modern societies. Written by acknowledged experts in each field, it provides accessible summaries of the scientific justification for isolating different aspects of social and economic life as the primary determinants of a population's health.

The new edition takes account of the most recent research and also includes additional chapters on ethnicity and health, sexual behaviours, the elderly, housing and neighbourhoods.

http://www.amazon.co.uk/exec/obidos/tg/stores/detail/glance/-/books/0198565895/202-0089066-4688631

Preventing chronic diseases: taking stepwise action

The Lancet:
"The scientific knowledge to achieve a new global goal for the prevention of chronic diseases "a 2% yearly reduction in rates of death from chronic disease over and above projected declines during the next 10 years" already exists. However, many low-income and middle-income countries must deal with the practical realities of limited resources and a double burden of infectious and chronic diseases. This paper presents a novel planning framework that can be used in these contexts: the stepwise framework for preventing chronic diseases. The framework offers a flexible and practical public health approach to assist ministries of health in balancing diverse needs and priorities while implementing evidence-based interventions such as those recommended by the WHO Framework Convention on Tobacco Control and the WHO Global Strategy on Diet, Physical Activity and Health. Countries such as Indonesia, the Philippines, Tonga, and Vietnam have applied the stepwise planning framework: their experiences illustrate how the stepwise approach has general applicability to solving chronic disease problems without sacrificing specificity for any particular country."/.../

Influenza Vaccination in Cardiovascular Disease

E-Journal - Volume 4 - vol4n8:

Topic: Cardiovascular Disease Prevention - Risk Assessment and Management
Influenza Vaccination in Cardiovascular Disease
Dr N. Werner* and Prof. M. Böhm**
*Bonn, and ** Homburg-Saar , Germany
**Board member of Heart Failure Association of the ESC
Influenza infection has been associated with increased rates of cardiovascular events. Various studies have demonstrated the important role of vaccination with a concomitant decrease in all-cause mortality and cardiovascular mortality and morbidity. The arrival of the avian influenza A (H5N1) virus among poultry in Europe, underlines the importance of a consequent vaccination of patients and health care providers according to current guidelines.
Introduction

The recent detection of the influenza virus subtype H5N1 in Europe has focused public attention on influenza and its prevention and treatment. In contrast to the H5N1 virus which is primarily pathogenic for poultry and can only rarely cause human infections and deaths, the human influenza A virus infection (subtypes H1N1, H1N2, and H3N2) leads to thousands of deaths each year. Several studies have underlined the importance of influenza vaccination, especially in patients with cardiovascular disease. In expectation of the next influenza season 2005/2006, the evidence for the need of consequent immunization particularly in high-risk patients and in patients with cardiovascular disease is reviewed.

Influenza and Cardiovascular Disease – Underlying Pathophysiology

Iapolipoprotein E (ApoE)-deficient mice infections with influenza A lead to a marked increase in inflammation, plaque thrombosis, smooth muscle cell proliferation, and fibrin deposition1. Interestingly, in this model only plaque regions are inflamed but not normal aortic segments. It is postulated that the consequences of systemic inflammation including the release of inflammatory cytokines, the development of endothelial dysfunction, changes in plasma viscosity as well as endogenous catecholamines, dehydration, and induction of pro-coagulative activity of infected endothelial cells contribute to the development of instable plaques and plaque rupture2. The infection of monocytes with influenza especially has been associated with the release of IL-6 and IL-8, both interleukins, which are known to trigger plaque rupture and atherosclerosis2.

Influenza and Cardiovascular Event Rates

Influenza infections have been suggested as an explanation for the peak of acute myocardial infarction (AMI) during the winter season 3;4. Death rates due to cardiovascular causes were similar to the rates of death due to influenza and pneumonia - with a two week delay for the subsequent cardiovascular events.
In a recently published study by Smeeth et al. in 20,486 persons with a first AMI and 19,063 patients with a first stroke, no increase in the risk of AMI and stroke was noted after influenza, tetanus, or pneumococcal vaccination5. However, the risk for both events was significantly higher after a systemic respiratory tract infection with a peak during the first 3 days. This observation supports the concept that systemic inflammatory diseases may be associated with increased cardiovascular event rates.

The Role of Vaccination

All-cause Mortality

Influenza vaccination has been associated with a 50% reduction in all-cause mortality in healthy elderly persons6. In a Swedish sample of 260,000 individuals >65 years of age, a combined influenza/pneumococcal vaccination resulted in a 57% decrease in all-cause mortality7. A meta-analysis of 20 cohort studies confirmed a reduction in death rates of 68%8. Recently, these results were extended to persons younger than 65 years with high risk medical conditions. In this study, vaccination prevented 78% of deaths (95%CI, 39%-92%)9.

Cardiovascular Mortality and Morbidity

Naghavi and colleagues demonstrated that in patients with manifest cardiovascular disease, vaccination against influenza was associated with a decreased rate in new onset AMI within the influenza season 1997/199810. In two cohorts with a total of 280,000 patients, Nichol et al. showed that vaccination against influenza was associated with a risk reduction for hospitalization due to cardiovascular disease, cerebrovascular disease, and all-cause mortality11. Interestingly, the FLUVACS study revealed that vaccination against influenza is associated with a significant reduction in the incidence of a single and composite endpoint of death, myocardial infarction or recurrent ischemia in patients with myocardial infarction and planned percutanous coronary intervention12;13. Surprisingly, the incidence for the primary endpoint cardiovascular death was at 1 year still significantly lower among vaccinated patients compared to controls13. Similar results for the 1 year follow-up were obtained for the combined endpoint (death, AMI, recurrent ischemia) which was mainly driven by a reduction in myocardial infarction.

Conclusion

There is convincing evidence that vaccination against influenza can significantly reduce all-cause mortality and cardiovascular mortality and morbidity in patients >65 years as well as in patients with high-risk medical conditions - including patients with atherosclerotic disease. The importance of influenza as a systemic inflammatory disease in triggering cardiovascular events has been demonstrated in various studies. However, the underlying molecular mechanisms are still poorly understood. We are currently facing a new situation in infectious disease in Europe: The worst scenario, a genetic mixture of the H5N1 virus with the common human influenza virus may allow the infection from person to person. Although there is no evidence for the occurrence of this scenario at present, it is most important that health care providers stick to the current guidelines: All patients with severe medical conditions - including patients with chronic heart or lung disease, patients in nursing homes as well as all patients>65 years of age (high risk group) should be immunized until October 24th according to the guidelines of the CDC (http://www.cdc.gov/flu/protect/keyfacts.htm). Finally, as a reminder: Health care providers themselves should receive influenza vaccination each year!

N. Werner1,2 and M. Böhm2
1 Medizinische Klinik und Poliklinik
Klinik für Innere Medizin II
Universitätsklinikum Bonn
53105 Bonn

2 Klinik für Innere Medizin III
Universitätsklinikum des Saarlandes
66421 Homburg-Saar

Correspondence:
Nikos Werner, MD
Medizinische Klinik und Poliklinik
Innere Medizin II
Universitätsklinikum Bonn
Sigmund-Freud-Str. 25
53105 Bonn
phone +49-228-287-5217/5218
fax +49-228-287-6423
Email: werner@med-in.uni-sb.de

1. Naghavi M, Wyde P, Litovsky S, Madjid M, Akhtar A, Naguib S, Siadaty MS, Sanati S, Casscells W. Influenza infection exerts prominent inflammatory and thrombotic effects on the atherosclerotic plaques of apolipoprotein E-deficient mice. Circulation. 2003;107:762-768.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12578882&query_hl=1
2. Madjid M, Naghavi M, Litovsky S, Casscells SW. Influenza and cardiovascular disease: a new opportunity for prevention and the need for further studies. Circulation. 2003;108:2730-2736.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14610013&query_hl=3
3. Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group. Lancet. 1997;349:1341-1346.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9149695&query_hl=5
4. Gordon T, Thom T. The recent decrease in CHD mortality. Prev Med. 1975;4:115-125.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1153392&query_hl=7
5. Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med. 2004;351:2611-2618.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15602021&query_hl=10
6. Nichol KL, Wuorenma J, von Sternberg T. Benefits of influenza vaccination for low-, intermediate-, and high-risk senior citizens. Arch Intern Med. 1998;158:1769-1776.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9738606&query_hl=12
7. Christenson B, Lundbergh P, Hedlund J, Ortqvist A. Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in adults aged 65 years or older: a prospective study. Lancet. 2001;357:1008-1011.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11293594&query_hl=14
8. Gross PA, Hermogenes AW, Sacks HS, Lau J, Levandowski RA. The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature. Ann Intern Med. 1995;123:518-527.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7661497&query_hl=16
9. Hak E, Buskens E, van Essen GA, de Bakker DH, Grobbee DE, Tacken MA, van Hout BA, Verheij TJ. Clinical effectiveness of influenza vaccination in persons younger than 65 years with high-risk medical conditions: the PRISMA study. Arch Intern Med. 2005;165:274-280.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15710789&query_hl=18
10. Naghavi M, Barlas Z, Siadaty S, Naguib S, Madjid M, Casscells W. Association of influenza vaccination and reduced risk of recurrent myocardial infarction. Circulation. 2000;102:3039-3045.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11120692&query_hl=20
11. Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med. 2003;348:1322-1332.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12672859&query_hl=22
12. Gurfinkel EP, de la Fuente RL, Mendiz O, Mautner B. Influenza vaccine pilot study in acute coronary syndromes and planned percutaneous coronary interventions: the FLU Vaccination Acute Coronary Syndromes (FLUVACS) Study. Circulation. 2002;105:2143-2147.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11994246&query_hl=24
13. Gurfinkel EP, Leon dlF, Mendiz O, Mautner B. Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS) Study. Eur Heart J. 2004;25:25-31.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14683739&query_hl=26

CartaCapital : SOLUÇÕES PARA “O PIOR DOS MUNDOS”

.: CartaCapital :.
Especial Saúde
RECOMENDADO POR Rosa Sampaio Vila-Nova [rosa.sampaio@superig.com.br]
SOLUÇÕES PARA “O PIOR DOS MUNDOS”
Países pobres ou em desenvolvimento importam maus hábitos dos ricos, mas não têm recursos suficientes para compensar, com programas de saúde pública, a proliferação de doenças crônicas
Por Riad Younes

Nas últimas duas décadas, os registros de óbito definitivamente confirmaram: as doenças consideradas crônicas – problemas cardíacos, derrame cerebral e câncer, entre outras – praticamente tomaram conta do cenário de saúde pública. Em paralelo, avanços e pesquisas médicas permitiram introduzir na rotina diária métodos, intervenções, medicamentos e técnicas que efetivamente reduzem as suas conseqüências deletérias, quando não fatais.


Fila do sus.
No Brasil, esses males matam mais de 400 mil por ano e o custo do tratamento beira os R$ 11 bilhões
Infelizmente, a distribuição das doenças e o acesso a esses avanços não são equilibrados nem disseminados por todos os países ou regiões de forma balanceada. Existe uma enorme diferença, um abismo, entre as realidades das doenças crônicas nos diferentes continentes, e até em diferentes camadas da mesma sociedade. Mais ainda, observa-se uma dissociação entre os dados estatísticos que descrevem a incidência e a distribuição dos problemas e a ação tomada pelos responsáveis.

Somente em 2005, a Organização Mundial da Saúde (OMS) estima que mais de 35 milhões de pessoas, em todo o mundo, vão morrer em decorrência de doenças crônicas. Apenas 20% dessas mortes deverão ocorrer em países ricos. O restante será contabilizado naqueles de baixa renda, do Hemisfério Sul. Não só a maior parte do número total de mortes ocorre em países pobres, mas também a taxa de mortalidade, ou seja, o número de óbitos em proporção à população estudada, é muito superior nessas regiões.

Estima-se que neste ano as doenças crônicas representarão 72% dos problemas de saúde de pessoas com mais de 30 anos de idade. A diferença da mortalidade por doenças crônicas entre países também é gritante. A Inglaterra e o Canadá registram, anualmente, taxas de 200 mortes por 100 mil habitantes, enquanto a Nigéria e a Tanzânia apresentam, no mesmo período, 800 óbitos. No Brasil esse número é de 700 mortes para o mesmo número de pessoas. Nesse aspecto, estamos, portanto, bem mais próximos da Tanzânia do que do Canadá.

Estatísticas oficiais do Ministério da Saúde do Brasil estimam que, apenas em 2003, mais de 400 mil óbitos foram resultado de doenças crônicas. Portadores desses problemas graves de saúde custam ao Brasil cerca de R$ 11 bilhões por ano em consultas, internações e cirurgias. Números astronômicos, principalmente se levarmos em consideração que a maioria dos casos é perfeitamente evitável.

A OMS estabeleceu objetivos de melhora da saúde mundial. Alcançando as metas globais de redução e de controle das doenças crônicas, projeta-se que, entre 2005 e 2015, cerca de 36 milhões de mortes serão prevenidas. Dessas, 28 milhões somente nos países pobres. Essa redução almejada pela OMS corresponde a uma queda de apenas 2% na taxa anual de óbito por essas doenças no mundo.

Existe uma percepção errada das graves conseqüências das doenças crônicas e dos seus fatores de risco. Tanto a sociedade quanto as autoridades médicas parecem ignorar dados epidemiológicos. Pelo menos é o que se pode supor quando se vê a distribuição de verbas dedicadas às doenças crônicas.

Muitos ainda crêem que essas doenças são basicamente problemas de comunidades ricas, idosas, com todos os riscos e hábitos inapropriados adquiridos na modernidade, como sedentarismo, fumo, obesidade e dietas não saudáveis. Trata-se de uma visão, no mínimo, inadequada. As doenças crônicas são, atualmente, um problema muito maior em países de baixa renda, especialmente naqueles que não possuem ou não destinam montantes razoáveis de recursos para a saúde pública.

Dados recentes, além de evidências de estudos científicos, sugerem que as mortes por doenças cardiovasculares e por câncer de pulmão estão ocorrendo em idades cada vez mais precoces nos países de baixa renda – exatamente onde os tratamentos eficientes são uma raridade e a prevenção não é estabelecida como política básica de saúde pública.

O problema com essa visão deturpada quanto à distribuição e aos danos das doenças crônicas é que os governos e as autoridades de saúde dedicam parte desproporcional – quase sempre menos que o mínimo razoável – dos recursos para essas enfermidades. Conseqüentemente, a população tem de arcar com esses gastos. A prevenção e o tratamento tornam-se um peso enorme para os indivíduos. Os custos pessoais ultrapassam a capacidade financeira das famílias, o que contribui para o seu empobrecimento progressivo.


África.
A OMS tem como meta evitar 28 milhões de mortes em países pobres nos próximos dez anos
Além de multiplicar dramas pessoais e familiares evitáveis, trata-se de uma abordagem de saúde pública ineficaz. Sociedades que dedicam poucos recursos para a prevenção de doenças crônicas fatalmente perderão somas mais elevadas na correção e no tratamento das conseqüências desses problemas.

Muitos especialistas desanimam diante da complexidade da tarefa de prevenir essas doenças orientando e ajudando as pessoas a mudar de hábitos. Mas recentes estudos mostram claramente que o comportamento humano pode ser modificado por influência de vários fatores. E vários deles estão ao alcance dos governos e dos profissionais de saúde.

Não surpreende saber que a melhora econômica e social de uma comunidade reduz progressivamente a incidência e a gravidade de doenças consideradas crônicas. Mas nem tudo depende da elevação dos padrões socioeconômicos. Experiências de países ricos demonstram que muito pode ser alcançado com intervenções adequadas e – o que é mais raro em países pobres – ininterruptas. Adiantam pouco campanhas pontuais que não se estabelecem como ação contínua.

A taxa de mortalidade por doenças cardíacas, por exemplo, tem caído mais de 60% nos últimos 30 anos em países como Austrália, Canadá, Japão e EUA. Nesse período, apenas nos EUA mais de 14 milhões de mortes foram evitadas com essas intervenções permanentes. Calcula-se que, na Inglaterra, 3 milhões de óbitos deixaram de ocorrer. Esses dados correspondem a uma redução nas taxas de morte por doenças crônicas entre 1% e 3% por ano nas últimas três décadas.

A pergunta básica é: como isso poderá ser alcançado também nas regiões mais pobres do planeta? Robert Beaglehole, da OMS, deixa muito claro que “o conhecimento científico para atingir essas metas nos próximos dez anos já existe. No entanto, muitos desses países têm recursos limitados e uma carga de problemas crônicos de saúde redobrada”.

Existem três componentes que, associados, podem ajudar na prevenção e no controle das doenças crônicas: intervenções individuais, intervenções baseadas na população e intervenções na macroeconomia. As três devem ser postas em ação de forma concatenada.

Segundo especialistas da OMS, trata-se de uma meta realista, e urgente. É pouco provável que um governo isoladamente consiga superar o desafio de levar a um país pobre pelo menos uma parte importante dos progressos alcançados pelos mais ricos. É necessário pôr em movimento um amplo processo de conscientização social.


Sofrimento e alto custo.
Na falta de prevenção, multiplicam-se as cirurgias e internações
Há a necessidade imperativa de uma associação de esforços. Aos serviços públicos cabe a responsabilidade de coordenar as ações da sociedade para reduzir a morbidade e a mortalidade por doenças crônicas de modo geral. Entre as medidas destacam-se a prevenção ao tabagismo, o incentivo à adoção de hábitos dietéticos saudáveis e campanhas intensivas e contínuas para detecção precoce, tratamento e controle de doenças como hipertensão arterial, diabetes, obesidade e câncer.

Recentemente, o Ministério da Saúde lançou o Projeto Brasil Saudável, que tem como objetivo estimular a população a adotar modos de vida diferentes, com ênfase na atividade física, na reeducação alimentar e no controle do tabagismo. O projeto envolve um conjunto de ações, desde campanhas publicitárias na mídia, com orientação à população para mudar seus hábitos, até a implantação de núcleos para a prática de atividades físicas em todas as capitais do País, até o fim de 2006.

A própria natureza complexa e multifatorial das causas e dos riscos das doenças crônicas exige uma abordagem múltipla, incluindo não somente governo e sociedades médicas especializadas, mas também empresas e organizações não-governamentais. Todos têm de ser envolvidos no processo da prevenção e no manejo das doenças crônicas. A meta final é nobre o suficiente para exigir a nossa imediata, e prioritária, atenção.


MITOLOGIA INSALUBRE
Especialistas internacionais desfazem equívocos perigosos

Um painel da Organização Mundial da Saúde discutiu o quadro das doenças crônicas existentes. Os especialistas divulgaram um resumo dos mitos que dificultam a abordagem mais agressiva do problema.

Mito 1: Doenças crônicas são problemas de ricos.
Fato: A maioria (80%) das mortes em decorrência de doenças crônicas acontece em países pobres. Os fatores de risco (como pressão alta, diabetes, fumo...) para essas doenças aumentam mais rapidamente em comunidades de baixa renda do que em regiões ricas

Mito 2: Por que essa preocupação? Afinal de contas, as pessoas têm de morrer de alguma coisa.
Fato: Sem dúvida, todo mundo vai morrer de alguma coisa, mas a morte não precisa ser precoce ou dolorosa nem o final da vida incapacitante. A maioria das doenças crônicas não causa morte imediata. Ao contrário, são anos de sofrimento e de gastos com tratamento e reabilitação.

Mito 3: As doenças crônicas levam anos para se instalar e se desenvolver, após longa exposição aos fatores de risco. É difícil reverter esse quadro. Levaria décadas.
Fato: As ações preventivas com redução da exposição a fatores de risco agem rápido. Muitos benefícios são detectados precocemente, tanto no plano individual quanto em termos de estatísticas populacionais.

Mito 4: As ações preventivas exigem muitos recursos e o seu custo-benefício é ruim.
Fato: A maioria das ações para prevenir doenças crônicas exige poucos gastos, e até podem aumentar a arrecadação dos cofres públicos. Diminuir o sal nos alimentos, por exemplo, tem custo ínfimo. Bastaria a conscientização da população e a adequação das indústrias de alimentação. Medidas como elevação de impostos sobre o cigarro podem contribuir para aumentar a arrecadação do governo.

how we can make partnerships work for health

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: quarta-feira, 2 de novembro de 2005 18:59
Para: procor@healthnet.org
Assunto: [ProCOR] The power of partnerships
Greetings,
The WHO Forum in Geneva, Switzerland October 26-28 was a dynamic, interactive three-day discussion of how we can make partnerships work for health. During the Forum, representatives from WHO Member states, NGOs, foundations, academia, the private sector, UN agencies, and finance institutions explored questions that are key to the establishment and support of partnerships.

Partnerships are especially critical to the prevention of the chronic disease pandemic.
As K. Srinath Reddy, MD, observed, "Chronic diseases involve multiple risk factors with multiple determinants--so multisectoral action is imperative.
Partners can bring different but complementary strengths, unite diverse constituencies, increase pathways of action, and create a synergy of effect."

There are many kinds of partnerships, each with its unique set of benefits and
challenges. One of the most necessary and complex partners with which we now must work is industry. Rather than combatting industry, as was the case in tobacco control, chronic disease prevention requires engaging with industry in positive action. Representatives from industry attending the Forum affirmed their commitment to promoting health and noted that private sector partners want to be engaged at every stage, from defining the problem to identifying and implementing solutions, rather than being engaged in a piecemeal manner.

Members of the ProCOR community are invited to share their examples, experiences, and ideas on partnerships. Questions posed at the Forum, which we can continue to discuss here, include:
What works?
How can we engage effectively with civil society, the private sector, UN
agencies, WHO Member states, to make partnerships work?
How can partnerships help move policy to practice?
How can partnership help mobilize resources at country level?

I'll report separately on the session on "enhancing partnerships through better knowledge sharing" and the challenges it identified for all of us who are participating in information networks.

WHO's new global report, "Preventing chronic diseases: a vital investment" was presented at the Forum. The report can be downloaded at http://www.who.int/chp/chronic_disease_report/en/


Catherine Coleman
Editor in Chief, ProCOR
www.procor.org
Lown Cardiovascular Research Foundation
21 Longwood Avenue
Brookline MA 02446 USA
Tel: 617-732-1318 x3332
Fax: 617-734-5763