Global email discussion groups

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: terça-feira, 28 de novembro de 2006 17:05
Para: procor@healthnet.org
Assunto: [ProCOR] HIFA2015 and CHILD2015: Global email discussion groups

Greetings,
HIFA2015 and CHILD2015 are relatively new global email discussion groups with a focus on the information and learning needs of primary and district-level healthcare providers in developing countries. They are open to anyone with an interest and membership is free.

The goal of HIFA2015 (Healthcare Information For All by 2015)is that "By 2015, every person worldwide will have access to an informed healthcare provider." The discussion group is moderated by Global Healthcare Information Network and the
HIFA2015 Steering Group. The HIFA2015 campaign was launched at the AHILA10 conference in Kenya in October and ProCOR actively supports the campaign. Currently the list includes 300 members. Visit the archives at:
www.dgroups.org/groups/hifa2015

CHILD2015 (Child Healthcare Information and Learning Discussion group) was created to ensure that "By 2015, every child worldwide will have access to an informed healthcare provider." It was launched in July 2006 and currently includes 376 members. It is moderated by Global Healthcare Information Network and International Child Health Group. Visit the archives at
www.dgroups.org/groups/child2015

Why join?
* Be part of a worldwide community dedicated to meet the information and learning needs of healthcare providers
* Learn from others
* Share your experience
* Make new contacts and collaborations
* Let others know about your interests, activities, services, publications
* Find out about funding and training opportunities, useful websites, new publications
* Collaborate to achieve common goals

You can join either of these groups free of charge to sending an email containing your name, organization, and brief desription of your professional interests, to the appropriate email address:
HIFA2015-admin@dgroups.org
and/or CHILD2015-admin@dgroups.org
For further details, see www.hifa2015.org or contact the moderators at HIFA2015-admin@dgroups.org

Catherine Coleman
Editor in Chief
ProCOR
Lown Cardiovascular Research Foundation
21 Longwood Avenue, Brookline, MA 02446 USA
617 732 1318 x3332
www.procor.org
ccoleman5@partners.org

Worldmapper: The world as you've never seen it before

Worldmapper: The world as you've never seen it before: "Worldmapper is a collection of world maps, where territories are re-sized on each map according to the subject of interest.
Maps and extra information will be added during 2006. Use the menu above or click on a thumbnail image below to view a map."

Philadelphia Consensus Statement » Statement

Philadelphia Consensus Statement » Statement: "According to the World Health Organization, about ten million people—most of them in developing countries—die needlessly every year because they do not have access to existing medicines and vaccines. Countless others suffer from neglected tropical diseases, such as sleeping sickness, lymphatic filariasis, and blinding trachoma. Because these neglected diseases predominantly affect the poor, they attract very little research and development funding, which leads directly to a paucity of safe and effective treatment options.
We believe that access to medical care and treatment is a basic human right.1 Lack of access to medical treatment in developing countries stems from several factors, including high prices for medicines, underfunded health care systems, and a global biomedical research agenda poorly matched to the health needs of the world’s destitute sick. Comprehensive solutions are thus needed to increase both access to existing medicines and research on neglected diseases. "

RSNA: Got Milk? Get a CT

RSNA: Got Milk? Get a CT - CME Teaching Brief® - MedPage Today: "CHICAGO, Nov. 29 -- Milk does a bowel good -- or at least as good as a pricey commercial contrast agent that produces only marginally better results for abdominal CT scans.

A study comparing the barium-based agent, VoLumen, to whole milk found that VoLumen was slightly better at bowel distention, said Lisa Shah-Patel, M.D., of St. Luke's-Roosevelt Hospital in New York."

Many Clinical Trial Overseers Have Conflicts of Interest

Many Clinical Trial Overseers Have Conflicts of Interest - CME Teaching Brief® - MedPage Today: "BOSTON, Nov. 29 -- More than a third of clinical trials watchdogs have financial relationships with industry, calling into question the objectivity of institutional review boards, according to investigators here."

NEJM -- Management of Menopausal Symptoms

NEJM -- Management of Menopausal Symptoms: "All healthy women transition from a reproductive, or premenopausal, period, marked by regular ovulation and cyclic menstrual bleeding, to a postmenopausal period, marked by amenorrhea (Table 1). The onset of the menopausal transition is marked by changes in the menstrual cycle and in the duration or amount of menstrual flow.1 Subsequently, cycles are missed, but the pattern is often erratic early in the menopausal transition. Menopause is defined retrospectively after 12 months of amenorrhea. "

The African Regional Health Report: The Health of the People

WHO The African Regional Health Report: The Health of the People:
Referred by: Coleman, Catherine [CCOLEMAN5@PARTNERS.ORG]
"The Health of the People is the first report to focus on the health of the 738 million people living in the African Region of the World Health Organization. While acknowledging that Africa confronts the world's most dramatic public health crisis, the report offers hope that over time the region can address the health challenges it faces, given sufficient international support."

Projections of Global Mortality and Burden of Disease from 2002 to 2030

PLoS Medicine - Projections of Global Mortality and Burden of Disease from 2002 to 2030: "Background
Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. These projections, which are based on 1990 data, continue to be widely quoted, although they are substantially outdated; in particular, they substantially underestimated the spread of HIV/AIDS. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, we have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data, and results."

CONTROLADORES

(ZH publica hoje artigo meu. Segue abaixo nova versão melhorada)
CONTROLADORES
Aloyzio Achutti. Membro da Academia Sul-Rio-Grandense de Medicina

É fácil adaptar-se à rotina e perder a capacidade de se maravilhar com as coisas boas, ou de se escandalizar com o que não anda bem. Um susto ou um desastre podem ajudar no caminho de volta à realidade.
O recente desastre no qual morreram mais de 150 pessoas chocou a todos e trouxe a baila o caso dos controladores de vôo, capaz de suscitar muitas reflexões sobre as quais vale a pena discutir.
A primeira reação foi a de buscar um culpado pelo evento. Em seguida surgiu o caos no tráfego aéreo, porque o problema era muito mais extenso, complexo e grave, e os controladores deixaram de fazer concessões, passando a observar estritamente as normas de segurança.
O risco de voar era muito maior do que o imaginado...
Estendendo o olhar, vê-se que, em terra, as estradas também estão esburacadas; no mar os portos estão superlotados; o transporte ferroviário foi desmontado; as fontes de energia limitam o crescimento da produção; os rios poluídos, e flora e fauna devastadas; a população carente de educação e de perspectiva na vida. Só a violência (do tráfego e do crime) denuncia os desacertos, embora quase entrando para a rotina.
Contemplando especificamente o setor saúde - mesmo sabendo que as causas das causas dos problemas de saúde têm origem fora do setor - é preciso reconhecer que há muito tempo concessões inapropriadas estão sendo feitas: profissionais atendendo em condições precárias, com falta de equipamento e medicamentos, salários defasados (incomparavelmente inferiores aos do judiciário e dos políticos), hospitais quebrando, sanguessugas, ambulâncias, erro médico, conflito de interesse com a indústria, propaganda enganosa, e tantas outras distorções e corrupção, causas inequívocas e inaceitáveis de risco.
A insegurança e as mortes não naturais são chocantes. No Brasil, cerca de 400 mil mortes, mais de 40% de todas registradas anualmente (ou o equivalente a sete “Boeings” caindo todos os dias), ocorrem em pessoas com menos de 60 anos, portanto com alta probabilidade de não serem assim tão naturais, e passíveis de serem evitadas através de políticas públicas e cuidados que dependem do comportamento de cada indivíduo e dos hábitos culturais nos quais estão inseridos. Estas mortes não deveriam ser encaradas como simples fatalidade e sem solução. A capacidade de adaptação à rotina, as concessões, a entrega do controle e das decisões maiores a políticos não confiáveis e venais, propiciam a ilusão conformista de que é assim mesmo e de que está tudo bem.
Aprendendo com os controladores de vôo, cada cidadão deveria deixar de fazer concessões. Não se pode mais ceder a interesses subalternos, a falácias e imposições que terminam pondo em risco a própria vida e a dos outros.

Doctors must not be lapdogs to drug firms

BMJ 2006;333:1027 (11 November), doi:10.1136/bmj.39024.654086.59
(Reginaldo Alguquerque enviou artigo completo)

Doctors must not be lapdogs to drug firms
Adriane Fugh-Berman
ajf29{at}georgetown.edu
Last month I gave a talk at Presbyterian Hospital in Albuquerque, New Mexico, about the influence of the drug industry on continuing medical education. As usual, pharmaceutical companies contributed funds to the conference, and there was a small exhibition area with the usual monopoly of drug firms.
Immediately after my talk, one pharmaceutical company representative announced to a conference organiser that her company would no longer support the annual conference. Another packed up his exhibit and walked out. Other drug representatives were observed muttering angrily into their cell phones, which may, or may not, have been related to the near total exhibitor boycott the next day. Only one exhibitor showed up, prompting a physician friend of mine to remark, "Maybe he missed your talk."
I had been so thrilled to receive my first United States invitation (outside of my university) to speak about how pharmaceutical companies manipulate prescribing. OK, to be entirely accurate, I was invited to speak about herb-drug interactions. But my "buy one get one free" lecture offer was taken up, and the organisers arranged a debate with a sales representative on whether pharmaceutical companies should fund continuing medical education for physicians.
The drug representative who agreed to the debate later backed out on the advice of "legal." Despite having been offered equal time, this is the same person who announced that her company would not support future conferences.
My talk covered the costs of drugs, the costs of promoting drugs to doctors, the salaries of drug representatives, the funding of continuing medical education, and the connection between polypharmacy and adverse drug events. I also covered psychological profiling and monitoring of physicians, including prescription tracking.
The audience of physicians, nurses, and allied health professionals seemed immensely interested—and acutely aware of the rarity of an occasion in which the relationship between medicine and the drug industry was questioned. Several physicians noted on their comment forms that the organisers were brave to address the subject. Some delegates even offered to pay higher registration fees in the future to offset the drug firms' defection.
However, the conference organisers were inclined to mollify the miffed companies, perhaps by explaining that my talk was important to prescribers. That will not work, of course, because the pharmaceutical firms are not interested in presenting information important to prescribers, unless it is also important to the drug industry. The suggestion that we need only soothe ruffled feathers gives drug representatives the status of offended friends. The notion that explaining our stand will buy forgiveness gives drug representatives the status of colleagues. Grovelling might work, says a colleague who used to be a drug rep. An apology, for example, could persuade drug companies to restore funding to the conference at Presbyterian—in exchange for, say, a promise never to invite me to speak again, and the inclusion in future talks of several speakers preferred by the drug companies.
Corporate support of continuing medical education courses, meals, and treats are not merely our just rewards for being hardworking, dedicated doctors. The illusion that the relationship between medicine and the drug industry is collegial, professional, and personal is carefully maintained by the drug industry, which actually views all transactions with physicians in finely calculated financial terms. Drug representatives are paid to be nice to us, as long as we cooperate, sustaining our market share of targeted drugs and limiting our continuing medical education lectures to messages that increase drug sales. This is an unspoken agreement, but no less clear for being covert.
The drug industry is happy to play the generous and genial uncle until physicians want to discuss subjects that are off limits, such as the benefits of diet or exercise, or the relationship between medicine and pharmaceutical companies. Any subject with the potential to reduce drug sales is anathema. Fair enough. He who pays the piper calls the tune. If we remain dependent on pharmaceutical companies for sponsoring continuing medical education, then these courses will remain under the control of the drug industry. This control is not contractual, but it is enforced through psychological manipulation.
If corporate sponsorship of medical meetings is deemed indispensable, why limit sponsorship to pharmaceutical companies? Surely the manufacturers of cars, luggage, and travel services would pony up for the opportunity to sell their goods to physicians. Conference organisers could solicit sponsorship from firms that market practice management software, office furniture, or other business related goods. As a last resort, we physicians could actually pay for our continuing education, as do lawyers, accountants, business people, and aerobics teachers, to mention a few. Medicine must shed both its docility and the corporate leash. Let us not be a lapdog to the pharmaceutical industry. Rather than sitting contentedly in our master's lap, let us turn around and bite something tender. Freedom calls.
The drug industry is happy to play the genial uncle until physicians want to discuss subjects that are off limits
Competing interests: see bmj.com
Rapid Responses:
TRIPS and access to medicines for all
Kawaldip Sehmi
bmj.com, 10 Nov 2006 [Full text]
Are Doctors Really Lap Dogs
mike harvey
bmj.com, 11 Nov 2006 [Full text]
All Fluff and no substance: Doctor's as Lapdogs
Peter Lavine, MD
bmj.com, 11 Nov 2006 [Full text]
The beast is ourselves
Aubrey Blumsohn
bmj.com, 12 Nov 2006 [Full text]
Doctors must not be lapdogs to drug firms: even more relevant in the Third World
Felix ID Konotey-Ahulu
bmj.com, 12 Nov 2006 [Full text]
Physicians must not succumb to pharmaceutical pressure
Rajan TD
bmj.com, 12 Nov 2006 [Full text]
Independence from drug companies: Perhaps the most cost effective way to improve health care.
Peter R Mansfield
bmj.com, 12 Nov 2006 [Full text]
Not lapdogs, not pit bulls
Augusto Pimazoni bmj.com, 15 Nov 2006 [Full text]

Developing, integrating, and perpetuating new ways of applying sociology

Developing, integrating, and perpetuating new ways of applying sociology
to health, medicine, policy, and everyday life
Jeffrey Michael Clair, Cullen Clark, Brian P. Hinote, Caroline O.
Robinson, Jason A. Wasserman. University of Alabama at Birmingham, Birmingham, AL, USA
Abstract
As a framework for presenting ideas on developing ways to make sociology
more applicable, we focus on the recent state of medical sociology research. Data for this paper were generated through a content analysis of a twelve-year period
(1993?2004) of the Journal of Health and Social Behavior (JHSB) and Social Science & Medicine (SSM). The analysis aims to determine if the content of JHSB and SSM reflect the breadth of the sub-discipline of medical sociology as well as the stated goals of the journals. The selected issues of JHSB and SSM were coded on the basis of the following attributes:
(1) Primary Substantive Topic, (2) Methodology, (3) Data Type and Analytic Technique, and (4) Research and Policy Recommendations. We found that the orientation of JHSB articles was towards generating research and theory that shy away from policy, interdisciplinary approaches, and applied issues. SSM content tends to display more interdisciplinary breadth and variety, but also reflects a dearth of applied recommendations. Our discussion focuses on what JHSB and SSM could be. We present ideas on how the sociological discipline in general?and JHSB and SSM in particular?can help generate and nourish new forms of inquiry that can impact the way research questions are framed. We conclude that such a shift is needed in order to maximize the applicability of social scientific evidence to everyday life, and we share examples situated within a socio-medical context, where there is a particular need for the application of social evidence to practice.
Keywords: Medical sociology; Content analysis; Practice; Interdisciplinary; Policy; Social science & medicine; Journal of health and social behavior

Doctors must not be lapdogs to drug firms -- Fugh-Berman 333 (7576): 1027 -- BMJ

From: Reginaldo Albuquerque <reginaldo.albuquerque@gmail.com
Date: Nov 24, 2006 10:27 PM
Doctors must not be lapdogs to drug firms -- Fugh-Berman 333 (7576): 1027 -- BMJ: "Last month I gave a talk at Presbyterian Hospital in Albuquerque, New Mexico, about the influence of the drug industry on continuing medical education. As usual, pharmaceutical companies contributed funds to the conference, and there was a small exhibition area with the usual monopoly of drug firms.
Immediately after my talk, one pharmaceutical company representative announced to a conference organiser that her company would no longer support the annual conference. Another packed up his exhibit and walked out. Other drug representatives were observed muttering angrily into their cell phones, which may, or may not, have been related to the near total exhibitor boycott the next day. Only one exhibitor showed up, prompting a physician friend of mine to remark, 'Maybe he missed your talk.'/.../ "

What should we do about climate change?: Health professionals need to act now, collectively and individually -- Stott and Godlee 333 (7576): 983 -- BMJ

What should we do about climate change?: Health professionals need to act now, collectively and individually -- Stott and Godlee 333 (7576): 983 -- BMJ: "Action on climate change has been likened to teenage sex. Everyone claims to be in on the action, but only a few are, and those not very effectively. Given the scientific consensus that global warming—the underlying cause of climate change—is mainly caused by human beings1 2 and its effects are likely to be seriously damaging to global health,3 4 citizens and governments must take much more effective action. This sense of urgency has been confirmed by the Stern report, commissioned by the UK chancellor, Gordon Brown, and published last week.5 It concludes that the cost of doing something to combat climate change is likely to be 1% of global gross domestic product, but the cost of doing nothing will be up to 20% of global gross domestic product. It also concludes that the cost to the environment of each ton of carbon dioxide emitted is £50 (75; $95), a figure that gives us a financial yardstick of the damage we are doing by our continued reliance on fossil fuels.
Health professionals have a track record of identifying and helping resolve serious public health issues. We are well placed to play a leadership role. Indeed it is a role that we cannot shirk. So what should we do? The BMJ has set up a carbon council with the objective of harnessing the intelligence and imagination of health professionals to expedite the transition to a low carbon world (see bmj.com for list of council members).
The council's strategy is fourfold. Firstly, to recruit as many health professional as possible to act and act now. Although the global effects of climate change and benefits of resolving these are well known,6 7 many doctors and other health professionals have not articulated for themselves and others the public health priority of climate change compared, for example, with smoking and inequalities in health. This is alarming, given that climate change related rises in sea level and changing food growing patterns will lead to massive social disruption, with the increased likelihood of resource wars, the spread of many "tropical" diseases, and a greatly increased burden of ill health. The BMJ's contribution will be to present the evidence for the health damaging impacts of climate change, both in the developed and developing world, and the health benefits of moving towards low carbon living.
Secondly, we want to identify the most effective low carbon policies that when implemented will reduce greenhouse gas emissions. The BMJ's climate change issue in June of this year offered examples of such policies,8 which must ensure welfare development for the global poor at the same time as controlling carbon emissions. Of several possible approaches, contraction and convergence is our favoured option.9 10 Adoption of this policy would create a global carbon budget, with a phased reduction over the next 30 years (to tackle global warming), and an equal per capita allocation of carbon entitlements. Frugal emitters, essentially the world's poor, could sell their unused entitlements to excessive emitters, the rich, thereby enhancing the welfare of the poor as well as creating incentives for the excessive emitters to reduce emissions. Another professionally concerned group, the Royal Institute of British Architects, has recently adopted contraction and convergence as its favoured framework.11 We welcome readers' views on the workability of this policy option compared with other options you may be aware of.
Thirdly, we aim to establish a coalition of health professionals to act as policy advocates nationally and internationally. Advocacy will be directed at the organisations within which we work—particularly the health service—at governments, and at business, all of which have good reason to tackle climate change. The BMJ is already exploring how best to become carbon neutral and will encourage all other health facilities to do likewise. We will invite other medical journals, the UK royal colleges and health related professional associations, academics, and policy makers to work together to create what will be a powerful force for change.
Finally, the council will encourage individual lifestyle change among health professionals around the world. This is part of the strategy—not because we have any illusions about the contribution of individual behavioural change to the overall problem of global climate change—but because it is vital that health professionals lead by example. As a start, we invite you to estimate the carbon emissions for which you are personally responsible by registering on www.rsacarbonlimited.org and signing up to CarbonDAQ, and then to commit to reducing your emissions each year. To make this commitment stick, and to ensure that it brings appropriate benefit, we are establishing a scheme in conjunction with the Royal Society of Arts. This scheme asks you to reduce your individual emissions by 5% a year and to pay £25 for each ton of carbon dioxide you emit in excess of the average UK personal emission of five tons into a development fund. The money raised will support low carbon projects in the yet to be industrialised world. We will contact those of you who complete the Royal Society of Arts profile and ask you to join this part of the scheme.
By personal and collective action health professionals can contribute to the health of our own and future generations. By contributing your ideas, deploying your advocacy skills, and making your personal commitment you will join us to create a new breed of climate concerned health professionals. We can then justly say to our descendants that we played our part in preserving the integrity of our beautiful but fragile world.
Robin Stott, chair BMJ carbon council1, Fiona Godlee, editor2
1 Medact, London N19 4DJ, 2 BMJ, London WC1H 9JR
fgodlee@bmj.com
'//-->
"

PandemicFlu.gov

PandemicFlu.gov: "One-stop access to U.S. Government avian and pandemic flu information. Managed by the Department of Health and Human Services.One-stop access to U.S. Government avian and pandemic flu information. Managed by the Department of Health and Human Services."

Health Statistics from the Americas, 2006 Edition

: "Health Statistics from the Americas, 2006 Edition is the sixth in a series begun in 1991 to complement the quadrennial publication Health in the Americas. This is the second edition to be produced only in an electronic format, and includes a special topic on the ten leading causes of death in 31countries of the Americas.
The 2006 edition contains mortality data for all country-years received after publication of the 2003 Edition of this series. This volume presents a large number of country-years of available data –155 data years from 42 countries. It includes 45 country-years of mortality data coded with the Ninth Revision (ICD-9) and 110 Country-years with the Tenth Revision (ICD-10). These data are presented for cause groups according to the PAHO 6/61 List for tabulation of ICD-9 and the PAHO 6/67 List for tabulation of ICD-10 coded mortality.
As countries strive to meet the growing demands for good data to monitor progress towards the Millennium Development Goals (MDGs), mortality data have become a key component with two MDGs expressing targets in terms of mortality.
The publication serves to display the extensive availability of detailed mortality data in countries of the Americas. It also highlights the importance of addressing deficiencies in data coverage and quality in order to improve the reliability and usefulness of registered mortality information. Despite improvements over the years, much more needs to be done to strengthen the civil registration and vital statistics systems in countries where they are deficient.
The Pan American Health Organization gratefully acknowledges the continued cooperation and support of its Member States in providing this information for dissemination. I am confident that this information can contribute toward health situation analyses used by policymakers to make decisions that improve the health of the populations of the Americas.
Mirta Roses PeriagoDirector"

Reflections on 20th Anniversary of the Signing of the Ottawa Charter

De: Social Determinants of Health [mailto:SDOH@YORKU.CA] Em nome de Brian Fleming
Enviada em: quarta-feira, 22 de novembro de 2006 00:29
Para: SDOH@YORKU.CA
Assunto: Reflections on 20th Anniversary of the Signing of the Ottawa Charter
Certainly the Ottawa Charter included strong equity principles. However, while the 1978 Declaration of Alma Ata resulted from the participation of developing nations, only industrialised countries attended the First International Conference on Health Promotion in 1986, which resulted in the Ottawa Charter.
In the interim, the idea of ‘lifestyle’ and its impact on health became prominent and ‘lifestyle’ took distinctly different forms in Anglophone and non-Anglophone countries. A WHO European publication in 1985 devoted a chapter to lifestyle but emphasised ‘structural influences on behaviour’, … where Anglophone countries tended to emphasise individuals. (Canada?) . So, where in Alma Ata there is a framework called Primary Health Care, this is replaced by Health Promotion in 1986. By 1997 the Jakarta Declaration refers to lifestyle as a characteristic of the person and the conference was attended by a health promotion workforce which is overwhelmingly individualist in practice, if not in ideals.
I think the drift to an individualist orientation of ‘health promotion’ in Anglophone countries was assisted by the separation of developed countries from developing countries, in international health conferences. In retrospect, Ottawa marks the point. Separating from developing countries assumes a threshold model of material circumstances' impact on health that developed countries have passed, which is contradicted by familiar evidence from states/ countries like Kerala, Cuba etc. This underlying assumption is at odds with the evidence of a social gradient in health in all countries.
Brian Fleming
Adelaide

People's Charter for Health - People's Health Movement PHM

People's Charter for Health - People's Health Movement PHM: "
Health is a social, economic and political issue and above all a fundamental human right. Inequality, poverty, exploitation, violence and injustice are at the root of ill-health and the deaths of poor and marginalised people. Health for all means that powerful interests have to be challenged, that globalisation has to be opposed, and that political and economic priorities have to be drastically changed.

This Charter builds on perspectives of people whose voices have rarely been heard before, if at all. It encourages people to develop their own solutions and to hold accountable local authorities, national governments, international organisations and corporations.

VISION

Equity, ecologically-sustainable development and peace are at the heart of our vision of a better world - a world in which a healthy life for all is a reality; a world that respects, appreciates and celebrates all life and diversity; a world that enables the flowering of people's talents and abilities to enrich each other; a world in which people's voices guide the decisions that shape our lives.

There are more than enough resources to achieve this vision. "

November 21 marks the 20th Anniversary of the signing of the Ottawa Charter for Health Promotion

November 21 marks the 20th Anniversary of the signing of the Ottawa Charter for Health Promotion
Toronto, Ontario - November 21, 2006 is a significant day for public health, community health and social services, in Canada and internationally. It marks the 20th anniversary of the signing of the Ottawa Charter for Health Promotion, at the first World Health Organization (WHO) International Conference on Health Promotion in Ottawa, on November 21, 1986.
That conference happened because of growing pressure for a new international public health movement. Health promotion is about enabling people to gain control over and improve their health and it goes way beyond just health care. "The Ottawa Charter is an important guidepost for our work. It puts health squarely on the agenda of policy makers in all sectors and at all levels", says Connie Clement, Executive Director of the Ontario Prevention Clearinghouse, Ontario’s leading bilingual health promotion organization.
Despite regularly landing in the United Nations’ top five or ten countries, in terms of social development, Canada has more work to do to improve health for all. For example, Canada’s deplorable record on the health of its Aboriginal people is criticized internationally. Canada still has one in six children living in poverty. And, we waste millions treating chronic diseases instead of investing to prevent them.
"Our goals are the same today as they were 20 years ago, says Suzanne Jackson, Director of the Centre for Health Promotion at the University of Toronto, a WHO Collaborating Centre in Health Promotion, "We need to build healthy public policy, create supportive environments, strengthen community action, develop personal skills and reorient health services. All of these actions must go hand in hand in order to create healthier individuals and communities both in Canada and abroad."
Media contact: Krissa Fay, Ontario Prevention Clearinghouse, 416-408- 6902
For more information please click on this link to read an OP-Ed article prepared by OPC on this topic.

Human Rights

BECAUSE OF THEIR UNIVERSALITY, SOVEREIGNTY MUST SOMETIMES COME SECOND TO HUMAN RIGHTS.

Are we here to make a point
or are we here to make
a difference? (Kul Gautam)

1. NGOs purporting to promote the human rights-based framework (HRBF) are actually often using an incremental-change-approach too slow to really lead to the paradigm shift needed to put human rights (people’s rights) center stage in development work. In practice, this ends up being more a rhetorical incorporation of the HRBF. Such NGOs must be made to look critically at themselves. Very few of them have actually changed at all as a result of this ‘gradual’ or partial adoption of a HRBF.

2. Even if they promote a new development ethics, they seldom use human rights principles as its underpinning. Do they still regard human rights (HR) as too ‘political’…? The true problem, I contend, is that such NGOs lack the familiarity or are reluctant to analyze the politics of what they do.

3. But it is ethics, as well as politics that underlie the HR discourse. HR are all human constructs; true; they have all been made up by society, they have not been discovered. (This is the essential difference between science and ethics). I wonder, may this be the barrier these NGOs have a problem overcoming? Or do they find it difficult to accept the universality of HR as overarching human and social values? [But the HR discourse demands (not only appreciates) diversity with regard to the values of others…].

4. [To set the record straight, HR are yet more: they are an ethical, political and legal matter! This is another difference between the human rights-based framework and development ethics. In fact, access to the legal system for people who are poor, to demand justice and fairness, is as important as the laws themselves].

5. Let’s face it: Many NGOs are not truly democratic and will not be able to contribute to democratization and the realization of HR if they continue to do business as usual. We have to identify and confront those NGOs, because the aid they manage influences governance and human rights positively or negatively; it all depends on their attitude (their vision and their mission) and, of course, on the context. Moreover, trade-offs, we had said in earlier Readers are, in general, not accepted in a HRBF For example, saying that ‘some-sacrifice-is-necessary-in-order-to-make-it-better-for-future-generations’ ís not a valid HR argument.

6. NGOs cannot forget that there is a difference between ‘having a right’ and ‘having a right realized’. All human beings have all rights all the time! However, in order to have a right realized, there must be a mechanism the claim holders can (and do) use to enforce the realization of their rights. If such a mechanism is missing --even if a desirable outcome has been achieved (e.g., access to primary health care)-- it is no longer about a realized right, but about having received a privilege. The role of committed NGOs is to help set up such mechanisms so as to develop the capacity of duty bearers and claim-holders bringing up their responsibility and the attributes of their power (i.e., their authority, influence and control over needed resources).

7. [Caveat No.1: Be clear that not all ‘social struggles’ are progressive and contribute to the realization of human rights. HR have to be made explicit to pave the way for people’s claims to be enforced].

8. We have often said that HR work of NGOs and of others has to focus both on process and outcomes. But little progress has been made in monitoring the quality of such processes --largely because ‘good process’ has seldom been defined. In the HR discourse, process criteria include all human rights principles (i.e., non-discrimination, participation, gender equality, etc.).

9. The training of NGO staff comes out as perhaps the single most important action in a more in-depth introduction of the HR-based framework. In almost all past cases, the training has been too short, pedagogically sub-standard and sometimes simplistic. Two to three 5-days workshops per year for 3-4 years are probably needed to be capable of understand, internalize and apply the HRBF to development work. (UNICEF has produced a CD with proposed training contents).

10. In this training, there is now a growing consensus that capacity development for the ‘progressive realization of human rights’ is a better approach than an approach primarily centered around denunciating the different HR violations --at least as far as economic, social and cultural rights are concerned. In reality, perhaps a mix of or a harmonization between both approaches is needed.

11. [Caveat No.2: The fact that introducing a HRBF needs ‘more than money’, does not mean that it will need less money. Money is as crucial in HR work as in any other development approach].

Claudio Schuftan, Ho Chi Minh City
claudio@hcmc.netnam,vn
­­­
Adapted from U. Jonsson, Comments on the book “Human Rights and Development” by Peter Uvin, mimeo, September 2006.

Health, United States, 2006

The latest report on the health of the population of the United States has been published. "Health, United States, 2006, is the 30th annual report on the health status of the Nation prepared by the Secretary of the DHHS for the President and Congress". The report presents trends in health status and health care utilization, resources and expenditure. As a PH practitioner these lines in the executive summary attracted my attention. "The health of
the nation continues to improve overall in many respects, in part because of the significant resources devoted to public health programmes, research, health care and health education".
I found the order in which the interventions are stated with public health programmes in the forefront very reassuring. US colleagues will be able to tell us whether this is simply a rhetoric or in fact a reality. Another interesting point is the reduction in the proportion of visits to office-based doctors that were made to general and family practice physicians by 10% over the last two decades.
The 559 page report is available on line @ http://www.cdc.gov/nchs/data/hus/hus06.pdf

Theobromine inhibits sensory nerve activation and cough -- Usmani et al., 10.1096/fj.04-1990fje -- The FASEB Journal

Theobromine inhibits sensory nerve activation and cough -- Usmani et al., 10.1096/fj.04-1990fje -- The FASEB Journal: "Cough is a common and protective reflex, but persistent coughing is debilitating and impairs quality of life. Antitussive treatment using opioids is limited by unacceptable side effects, and there is a great need for more effective remedies. The present study demonstrates that theobromine, a methylxanthine derivative present in cocoa, effectively inhibits citric acid-induced cough in guinea-pigs in vivo. Furthermore, in a randomized, double-blind, placebo-controlled study in man, theobromine suppresses capsaicin-induced cough with no adverse effects. We also demonstrate that theobromine directly inhibits capsaicin-induced sensory nerve depolarization of guinea-pig and human vagus nerve suggestive of an inhibitory effect on afferent nerve activation. These data indicate the actions of theobromine appear to be peripherally mediated. We conclude theobromine is a novel and promising treatment, which may form the basis for a new class of antitussive drugs. "

Directory of Grants and Fellowships in the Global Health Sciences - Funding - Fogarty International Center

Directory of Grants and Fellowships in the Global Health Sciences - Funding - Fogarty International Center:
"Directory RSS Feed Directory [PDF 1.28M]
Directory [HTML]
Since 1988, the Fogarty International Center, part of the National Institutes of Health, has published the Directory of International Grants and Fellowships in the Health Sciences. This current volume (NIH Publication 06-3027, February 2006), a comprehensive compilation of international funding opportunities in biomedical and behavioral research prepared by Ms. Hannah Leslie, should serve the individual or institution who seeks financial support.
This table separates the Grants and Fellowships into different categories. For example, those interested only in grants and fellowships for health professionals should click on the link in column 1 row 2.
Pre-doctoral/Graduate
Post-doctoral
Faculty
Health Professionals
Institutions
Addendum: Travel"

Natural chemical 'beats morphine'

BBC NEWS Health Natural chemical 'beats morphine': "The human body produces a natural painkiller several times more potent than morphine, research suggests.
When given to rats, the chemical, called opiorphin, was able to curb pain at much lower concentration than the powerful painkiller morphine.
The French team said their findings could be lead to new pain treatments.
But other scientists were unsure of the significance of the work, which is published in the Proceedings of the National Academy of Sciences./.../ "

Dia Mundial do Diabete: 14 de Novembro.

The Lancet: "Last month, a day after the US Food and Drug Administration (FDA) approved sitagliptin phosphate (Januvia) to treat type 2 diabetes, the US Federal Trade Commission (FTC) announced a collaborative effort by US regulators and government agencies in Canada and Mexico to stop deceptive internet advertisements and sales of products misrepresented as cures or treatments for diabetes. Warnings and advisories were sent to online outlets in all three countries. The FTC also launched a consumer education campaign on how to avoid phony diabetes cures using a bogus website that promotes a purported cure, Glucobate. When the visitor clicks to order the product, the site reveals information about avoiding ads for phony cure-alls in the future.
To help physicians better treat the burgeoning number of patients with diabetes, and to help patients help themselves, many websites offer useful information.
From the USA, the FDA's Diabetes Information site offers user-friendly information on glucose meters and other aspects of diabetes management. The robust National Diabetes Information Clearinghouse, a service of the US National Institute of Diabetes and Digestive and Kidney Diseases, includes links to clinical trials, and reports, guidelines, access to relevant databases, and education materials for patients. The American Diabetes Association Website offers extensive educational materials for the public and health professionals.
Useful UK sites include Diabetes UK, a charity that funds research and provides education for people with diabetes and health professionals. Highlights here are a diabetes awareness tool to help meet the needs of diverse communities and various reports and statistics. The National Library for Health's Diabetes Specialist Library is filled with relevant reviews, studies, and information. This website can be used in conjunction with the National Diabetes Support Team, which offers news, guidance, advice, information, and online forums for health-care professionals implementing the Diabetes National Service Framework.
For a global view of diabetes, visit WHO's non-communicable disease prevention and health promotion page and the diabetes section of the global strategy on diet, physical activity, and health.
FTC on diabetes products
http://www.cfsan.fda.gov/~dms/dialist.html
FTC site Glucobate
http://wemarket4u.net/glucobate/index.html
FDA Diabetes Information
http://www.fda.gov/diabetes
National Diabetes Information Clearinghouse
http://diabetes.niddk.nih.gov/
American Diabetes Association
http://www.diabetes.org/home.jsp
Diabetes UK
http://www.diabetes.org.uk/
Diabetes Specialist Library
http://www.library.nhs.uk/diabetes
National Diabetes Support Team
http://www.diabetes.nhs.uk/
WHO Fact Sheet Diabetes
http://www.who.int/hpr/gs.fs.diabetes.shtml"

14 Novembro: Dia Mundial do DM

The Lancet: "World Diabetes Day is on Nov 14, and the theme chosen by the International Diabetes Federation for 2006 is diabetes in disadvantaged and vulnerable people, and the desperate need for better access to effective care in many communities and countries of the world. Type 2 diabetes is as much a disease of poor and disadvantaged people as it is of fat and unfit people, and the rate of increase of diabetes in developing nations is epidemic—with a situation as bad as, or even worse than, in developed countries.
The personal, social, and financial burden resulting from the chronic complications of type 2 diabetes, which become commonplace after 10–15 years of disease, will be enormous. Articles in today's Lancet highlight many facets of this problem, including the complex factors leading to the increasing prevalence of glucose intolerance in developing nations, the close association between blood glucose and vascular disease, and the evolution of interesting new treatments. Other articles draw attention to the fact that prevention and management should not rely on expensive options, and there should be greater focus—by both politicians and health professionals—on simpler solutions. Thus there is now much evidence that type 2 diabetes can be prevented in many of those at risk by a change in diet and lifestyle, while the health and welfare of many disadvantaged people who have established disease—whether type 1 or 2—could be radically improved by providing access to even the simplest of treatments.
The predictable conclusion is that much of the suffering and exploding costs that will result from global diabetes is preventable. The situation will remain unchanged unless those who care are successful in focusing the attention of those with the necessary political power. And those with power must then act to offset the many factors (including self-interest, misguided health-care planning, inefficiency, corruption, and lack of vision) that frustrate attempts to eliminate the deep disparities that persist in disease management in the world today.
The Lancet
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Stem cell cure hope for diabetes

NEWS Health Stem cell cure hope for diabetes: "Scientists have used stem cells from human bone marrow to repair defective insulin-producing pancreatic cells responsible for diabetes in mice.
The treatment also halted damage to the kidneys caused by the condition.
Researchers from New Orleans' Tulane University are hopeful it can be adapted to treat diabetes in humans.
The study, featured in Proceedings of the National Academy of Sciences, was welcomed as 'interesting work' by Diabetes UK./.../ "

Human Development Report 2006

Human Development Report 2006: "Throughout history water has confronted humanity with some of its greatest challenges. Water is a source of life and a natural resource that sustains our environments and supports livelihoods – but it is also a source of risk and vulnerability. In the early 21st Century, prospects for human development are threatened by a deepening global water crisis. Debunking the myth that the crisis is the result of scarcity, this report argues poverty, power and inequality are at the heart of the problem.
In a world of unprecedented wealth, almost 2 million children die each year for want of a glass of clean water and adequate sanitation. Millions of women and young girls are forced to spend hours collecting and carrying water, restricting their opportunities and their choices. And water-borne infectious diseases are holding back poverty reduction and economic growth in some of the world’s poorest countries.
Beyond the household, competition for water as a productive resource is intensifying. Symptoms of that competition include the collapse of water-based ecological systems, declining river flows and large-scale groundwater depletion. Conflicts over water are intensifying within countries, with the rural poor losing out. The potential for tensions between countries is also growing, though there are large potential human development gains from increased cooperation.
The Human Development Report continues to frame debates on some of the most pressing challenges facing humanity. Human Development Report 2006:"

Transparency International

en_2006-11-06 CPI 2006 / 2006 / press_releases / latest news / news room / home - Transparency International: "“Corruption traps millions in poverty,” said Transparency International Chair Huguette Labelle. “Despite a decade of progress in establishing anti-corruption laws and regulations, today’s results indicate that much remains to be done before we see meaningful improvements in the lives of the world’s poorest citizens.”
The 2006 Corruption Perceptions Index is a composite index that draws on multiple expert opinion surveys that poll perceptions of public sector corruption in 163 countries around the world, the greatest scope of any CPI to date. It scores countries on a scale from zero to ten, with zero indicating high levels of perceived corruption and ten indicating low levels of perceived corruption.
A strong correlation between corruption and poverty is evident in the results of the CPI 2006. Almost three-quarters of the countries in the CPI score below five (including all low-income countries and all but two African states) indicating that most countries in the world face serious perceived levels of domestic corruption. Seventy-one countries - nearly half - score below three, indicating that corruption is perceived as rampant. Haiti has the lowest score at 1.8; Guinea, Iraq and Myanmar share the penultimate slot, each with a score of 1.9. Finland, Iceland and New Zealand share the top score of 9.6. /.../"

Pesquisa Nacional por Amostra de Domicílios 2005

Pesquisa Nacional por Amostra de Domicílios 2005: "Em 2005, cerca de 20% da população com 10 anos ou mais de idade no País navegou pela Internet e, pela primeira vez, o Brasil tinha mais domicílios com telefone celular do que com linha fixa.
O analfabetismo vem diminuindo, mas ainda atingia 10,2% das pessoas de 10 anos ou mais de idade e 11,1% das de 15 anos ou mais. Já o número de crianças de 5 a 14 anos de idade que trabalhavam cresceu 10,3% em relação a 2004. Na Região Nordeste, também pela primeira vez, o número de pessoas com 60 anos ou mais de idade excedeu o de crianças de menos de 5 anos de idade.
O rendimento médio real de trabalho cresceu 4,6% em relação a 2004. Considerando-se a série harmonizada(* ) (com os resultados de 2004 e 2005 adaptados à cobertura geográfica da PNAD até 2003) trata-se da primeira alta no rendimento desde 1996. Mas, na mesma série harmonizada, o rendimento médio real de trabalho de 2005 está 15,1% abaixo do de 1996./.../"

Episodes of Rage Seen as Tip of the Iceberg for Steroid Abuse

Episodes of Rage Seen as Tip of the Iceberg for Steroid Abuse - CME Teaching Brief® - MedPage Today: "UPPSALA, Sweden, Nov. 6 -- Violent physical outbursts triggered by abuse of anabolic steroids, the so-called 'roid rage, may mask a more complicated criminal picture linked to the drugs. "

HEROES: 60 YEARS

TIME Europe Magazine -- Nov. 13, 2006 Vol. 168, No. 21: "
60 Years Of Heroes They've battled tyrants and conquered their own fears, scaled mountains and reached peaks of perfection. TIME looks back on 60 years of outstanding individuals, and celebrates their contribution to making the world a better place

To Our Readers

H E R O E S R E B E L S & L E A D E R S
Nelson Mandela

Charles de Gaulle

Andrei Sakharov

Mikhail Gorbachev

Jean Monnet

Aleksandr Solzhenitsyn

Giovanni Falcone & Paolo Borsellino

Imre Nagy

Petra Kelly

Yitzhak Rabin

Helmut Kohl

Shirin Ebadi

Václav Havel

Lech Walesa

Linus Torvalds

Margaret Thatcher

King Juan Carlos

Simone de Beauvoir

H E R O E S B U S I N E S S & C U L T U R E
The Beatles

Rem Koolhaas

Galina Ulanova

Paul Bocuse

Pablo Picasso

Enzo Ferrari

Francis Bacon

Barbara Hulanicki & Mary Quant

Maria Callas

Rainer Werner Fassbinder

Naguib Mahfouz

J.K. Rowling

John Lydon

Henry Moore

Sophia Loren

Fela Kuti

Coco Chanel

Samuel Beckett

Nadine Gordimer

François Truffaut

Chinua Achebe

Vanessa Redgrave, Judi Dench, Glenda Jackson & Helen Mirren

Freddie Laker

Ole & Godtfred Kirk Christiansen

Hasso Plattner

H E R O E S I N S P I R A T I O N S & E X P L O R E R S
Princess Diana

Yuri Gagarin

Martina Navratilova

Natasa Kandic

Bernard Kouchner

Pope John Paul II

Queen Rania

Christiane Amanpour

Peter Benenson

Jean-Claude Killy

Reinhold Messner

Franz Beckenbauer

Jacques-Yves Cousteau

Abebe Bikila

Bono & Bob Geldof

Mother Teresa

Anna Politkovskaya "

WHO | Volume 84, Number 11, November 2006, 841-920

WHO Volume 84, Number 11, November 2006, 841-920: "Public-private partnerships for hospitals; Community health insurance in Burkina Faso; Regulating contracting in Chad, Madagascar and Senegal; Interview: contracting and health; Countries test new ways to finance health care; Public health classic: Rousseau's Social Contract
In this month's Bulletin [pdf 75kb] "

Dementia before Death in Ageing Societies— The Promise of Prevention and the Reality

PLoS Medicine: Dementia before Death in Ageing Societies— The Promise of Prevention and the Reality: "Changing global population structures require societies to face major issues raised by increasing numbers of the very old. Western societies have experienced sufficient change to be able to anticipate patterns of health and ill health in their ageing populations. These changes are likely to be echoed in a shorter time frame over the next decades in the less wealthy regions of the world because of their more rapid experience of demographic shift. This continuing change in life expectancy has been attributed to improved health and lower morbidity in early life, and to effective primary, secondary, and tertiary prevention in later life. Reductions in incidence have been seen in vascular disease, including cerebrovascular disease [1,2].
Increased life expectancy and improvement in many areas of health have been demonstrated, but sharp increases of morbidity with age are still observed in all populations [3]. Dementia and severe cognitive impairment are amongst the disorders with greatest increase with age in both incidence and prevalence [4,5]. Preventive action at the population level ideally eradicates risk of disease, but in reality much prevention reduces disease at a given age rather than eradicating its occurrence. The overall contribution of primary and secondary prevention to the reduction in cardiovascular disease mortality has been estimated at around half of the effect, with improved care for established disease resulting in the remaining improvement [6]. There is a global effort aimed at improving health in our older populations, and much of this effort hinges on the hope that extension of life expectancy will not be accompanied by increases in morbidity but by compression of morbidity "

How Did Social Medicine Evolve, and Where Is It Heading?

PLoS Medicine: How Did Social Medicine Evolve, and Where Is It Heading?: "The academic discipline of social medicine has struggled to find a precise definition for over a century. This struggle is exemplified by the classic social medicine course book, The Social Medicine Reader, edited by faculty from the Department of Social Medicine at the University of North Carolina, Chapel Hill, which offers an expansive view of social medicine's concerns [1–4]. These concerns range from early visions of the discipline, focusing on topics such as the social and economic structure of health-care provision, health policy, and clinical holism, through to evolving concepts of the field, such as concerns with doctor/patient relations in culturally diverse societies. The evolution of social medicine as an academic subject has been internationally diverse and a coherent definition of the discipline has remained elusive. In this essay, I briefly examine some of the diverse developments of social medicine as an academic discipline and its links to political conceptualizations of the role of medicine in society. I then analyze the possible future directions open to the discipline in the Anglo-American context. A better understanding of the evolution of social medicine could help to focus its role in responding to the health needs of a post-industrial, globalizing world./.../"

Social Medicine in the Twenty-First Century

PLoS Medicine: Social Medicine in the Twenty-First Century: "In its launch issue in October 2004, PLoS Medicine signaled a strong interest in creating a journal that went beyond a biological view of health to incorporate socioeconomic, ethical, and cultural dimensions. For example, that first issue contained a policy paper on how the health community should respond to violent political conflict [1], a debate on whether health workers should screen all women for domestic violence [2], and a study on the global distribution of risk factors for disease [3].
Two years on, our October 2006 issue takes our interest even further. It contains a special collection of ten magazine articles and five research papers devoted entirely to social medicine. We are delighted that the collection features many of the leaders in the field, including the renowned medical anthropologists Paul Farmer and Arthur Kleinman, the former United States Surgeon General David Satcher, and the Harvard professor of social medicine and psychiatry Leon Eisenberg.
Most of our readers have welcomed our inclusive view of what a medical journal should highlight. Some, however, have been critical, suggesting that we should publish “less soft stuff” and more “hard science.” These critics might argue that in this era of stem cell research and the human genome project, of molecular medicine and DNA microarray technology, the notion of social medicine seems irrelevant and outmoded.
But the ultimate role of a medical journal is surely to contribute to health improvement, and that means looking not just at molecules but at the social structures that contribute to illness. The stark fact is that most disease on the planet is attributable to the social conditions in which people live and work [4]. /.../"