Out-of-Hospital Cardiac Arrest

(Circulation. 2010;121:709-729.)
© 2010 American Heart Association, Inc. 

AHA Policy Statement

Regional Systems of Care for Out-of-Hospital Cardiac Arrest

A Policy Statement From the American Heart Association

Graham Nichol, MD, MPH, FAHA, Chair; Tom P. Aufderheide, MD, FAHA; Brian Eigel, PhD;Robert W. Neumar, MD, PhD; Keith G. Lurie, MD; Vincent J. Bufalino, MD, FAHA; Clifton W. Callaway, MD, PhD;Venugopal Menon, MD, FAHA; Robert R. Bass, MD; Benjamin S. Abella, MD, MPhil; Michael Sayre, MD;Cynthia M. Dougherty, PhD, FAHA; Edward M. Racht, MD; Monica E. Kleinman, MD; Robert E. O'Connor, MD;John P. Reilly, MD; Eric W. Ossmann, MD; Eric Peterson, MD, MPH, FAHA, on behalf of the American Heart Association Emergency Cardiovascular Care Committee; Council on Arteriosclerosis, Thrombosis, and Vascular Biology;Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular Nursing;Council on Clinical Cardiology; Advocacy Committee; Council on Quality of Care and Outcomes ResearchOut-of-hospital cardiac arrest continues to be an important public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with out-of-hospital cardiac arrest by emergency medical services and among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post–cardiac arrest care. Effective hospital-based interventions for out-of-hospital cardiac arrest exist but are used infrequently. Barriers to implementation of these interventions include lack of knowledge, experience, personnel, resources, and infrastructure. A well-defined relationship between an increased volume of patients or procedures and better outcomes among individual providers and hospitals has been observed for several other clinical disorders. Regional systems of care have improved provider experience and patient outcomes for those with ST-elevationmyocardial infarction and life-threatening traumatic injury. This statement describes the rationale for regional systems of care for patients resuscitated from cardiac arrest and the preliminary recommended elements of such systems. Many more people could potentially survive out-of-hospital cardiac arrest if regional systems of cardiac resuscitation were established. A national process is necessary to develop and implement evidence-based guidelines for such systems that must include standards for the categorization, verification, and designation of components of such systems. The time to do so is now./.../

MAKE POVERTY HISTORY

Gleneagles promises kept     Five years ago today (3 February) Nelson Mandela challenged world leaders to make poverty history before a crowd in Trafalgar Square, London. "Sometimes it falls upon a generation to be great," he told those assembled. "You can be that great generation." His words were to echo around the world. In the UK and across the world they mobilised the Make Poverty History campaign – one of the biggest grass roots movements ever seen.

Pressão Arterial

(Artigo enviado para o Jornal Zero Hora que provavelmente não vai mais ser publicado)

A notícia do problema de saúde do Presidente chamou atenção, provocando muitas especulações. É oportunidade para contribuir com alguns esclarecimentos (obviamente não sobre o paciente, mas sobre pressão arterial). O assunto interessa muita gente (de um e meio a três milhões de gaúchos, dependendo do critério adotado como ponto de corte) e sobre o qual devem existir ainda questionamentos, apesar das informações veiculadas pela mídia, muitas focadas na agenda de trabalho.

Em 1978, sob a coordenação geral do Dr. Eduardo de Azeredo Costa, fizemos uma pesquisa cobrindo amostras representativas de toda a população adulta do Estado. Na época a primeira e maior pesquisa do gênero no hemisfério sul. Passados mais de trinta anos, estudos posteriores não mostraram grandes mudanças nas proporções. Encontramos níveis médios de pressão arterial progressivos com a idade, bem como a prevalência de hipertensão arterial; mais mulheres do que homens, mais no cinturão metropolitano do que no interior rural, mais entre iletrados e com baixa escolaridade do que em gente com formação superior; inversamente proporcional ao status social, e tendência à agregação familiar. Somente uma quarta parte daqueles considerados hipertensos tinha níveis controlados, e um bom número de entrevistados, embora com diagnóstico médico no passado e mesmo sem efeito de remédios, tinham pressão normal no momento da pesquisa. Com a idade diminuía a proporção de fumantes e aumentavam as médias de pressão e a prevalência de hipertensão em não fumantes (os hipertensos que simultaneamente fumavam já haviam saído da população...).

Vale insistir em algumas informações já que as pressões, por se expressarem por números, podem dar uma falsa impressão de precisão e segurança. Um diagnóstico de doença hipertensiva não pode se basear exclusivamente neles. O que mais interessa é a permanência dos níveis elevados e não sua elevação transitória. A pressão arterial varia normalmente com o esforço e com as emoções (pode chegar normalmente a momentos de 200 mm Hg); a massa corporal, o sal na alimentação, a temperatura ambiente, certos medicamentos, agitação, ansiedade, e até a técnica utilizada podem influir sobre as medidas. Os exercícios em geral são benéficos, e repouso só se faz necessário frente a complicações ou para esclarecer dúvidas.

Chamou atenção um vídeo feito momentos antes de o Presidente se sentir mal. Ele dizia que estava com uma gripe ou sinusite e com perturbação de voz. Drogas vasoconstritoras e anti-inflamatórias - freqüentemente usadas (ou abusadas) com finalidade meramente sintomática – podem anular o efeito do tratamento, elevam a pressão arterial e podem causar uma “crise hipertensiva”, nesta hipótese, iatrogênica.

Por falar em gripe e em doença crônica, até recentemente esta relação era cientificamente pouco valorizada. As viroses, e o estado inflamatório por elas provocado, podem desencadear ou desestabilizar doenças relacionadas com arterioesclerose (infarto, trombose cerebral) e complicar a doença hipertensiva.

Vem daqui também a valorização das complicações da gripe e de outras doenças inflamatórias no contexto de doenças crônicas (entre elas a hipertensão arterial), anteriormente rotuladas como degenerativas, como se pertencessem a outro “departamento”. Mais uma vez, faz-se jus homenagear a prata da casa pela contribuição de nossa pesquisadora e professora da UFRGS – hoje a reconhecida internacionalmente Dra. Maria Inês Reinert Azambuja, há vários anos defendendo esta tese.

Nesta perspectiva nossa pressão arterial é somente mais uma variável de um conjunto orgânico, socialmente interdependente, em permanente interação com o meio (físico-bio-psico-social) onde se vive.

Aloyzio Achutti. Médico.

Iniquidade menor não freia crise no Brasil

Brasília, 29/01/2010'Iniquidade menor não freia crise no Brasil'
Pesquisador do IPEA afirma que, apesar da redução da pobreza e da desigualdade, economia ainda é sustentada por 30% da população

Leia também

Transferências fizeram a desigualdade cair

da PrimaPagina
Apesar da redução da pobreza nos últimos anos, a economia brasileira ainda é sustentada pelo consumo de uma pequena parcela da população, afirma o economista Sergei Dillon Soares, do IPEA (Instituto de Pesquisa Econômica Aplicada). Em entrevistapara um boletim do CIP-CI (Centro Internacional de Políticas para o Crescimento Inclusivo), ele defende que a melhoria da desigualdade de renda aumentou o peso dos mais pobres no mercado, mas não a ponto de blindar o Brasil contra crises econômicas — esse processo ajudou apenas “um pouco” a diminuir os efeitos da recessão de 2009, por exemplo.

“O que podemos dizer é que, para além das muito prudentes políticas macroeconômicas que foram seguidas no passado recente, e todo o resto que foi feito corretamente — e o Brasil fez muitas coisas corretamente — talvez a melhoria na desigualdade ajudou um pouco, foi um fator adicional, mas certamente não o principal”, diz Soares./.../

Remédio para Chagas

Tóquio, 28/01/2010Remédio para Chagas será testado em 2010
Novo medicamento é visto como uma das maiores descobertas contra a doença em 40 anos; teste em humanos poderá ser feito no Brasil
MARCELO OSAKABE
da PrimaPagina
Um novo medicamento para o tratamento da doença de Chagascomeçará a ser testado em seres humanos a partir deste ano. Chamada Ravuconazol, a droga até agora mostrou bastante eficácia em impedir a multiplicação e invasão das células pelo protozoário Trypanosoma cruzi, causador da enfermidade.

Segundo Tânia Araújo Jorge, pesquisadora e diretora do Instituto Oswaldo Cruz, esta é uma das novidades mais promissoras no tratamento contra a doença, que mata cerca de 11 mil pessoas por ano segundo a OMS, mais do que a malária. No Brasil, foram 5.023 mortes em 2008, de acordo comdados preliminares do Ministério da Saúde — mais que malária e tuberculose, por exemplo. “De todos os medicamentos em fase pré-clinicas, esse é um dos melhores", afirma Tânia.

O motivo do otimismo está no fato de o Ravuconazol ter se mostrado eficaz no segundo estágio da doença, a chamada fase crônica. Os outros dois medicamentos existentes, descobertos há mais de 30 anos, não são muito eficientes nesse estágio, sendo mais aconselhados para a primeira fase da doença. O problema é que apenas 1% das pessoas apresentam sintomas na primeira fase, o que dificulta o tratamento. Além disso, a nova droga mostrou ser efetiva contra todas as cepas do parasita —ao contrário dos outros —, além de ser bem menos invasivo ao organismo humano. Atualmente, só há um medicamento que age na fase crônica, e ele causa muitos efeitos colaterais, como enjoo, alergia e problemas na medula óssea.

National Goals for Cardiovascular Health Promotion and Disease Reduction

The American Heart Association’s Strategic Impact Goal Through 2020 and Beyond
Donald M. Lloyd-Jones, MD, ScM, FAHA, Chair; et col.

This document details the procedures and recommendations of the Goals and Metrics Committee of the Strategic Planning Task Force of the American Heart Association, which developed the 2020 Impact Goals for the organization. The committee was charged with defining a new concept, cardiovascular health, and determining the metrics needed to monitor it over time. Ideal cardiovascular health, a concept well supported in the literature, is defined by the presence of both ideal health behaviors (nonsmoking, body mass index <25 kg/m², physical activity at goal levels, and pursuit of a diet consistent with current guideline recommendations) and ideal health factors (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, and fasting blood glucose <100 mg/dL). Appropriate levels for children are also provided. With the use of levels that span the entire range of the same metrics, cardiovascular health status for the whole population is defined as poor, intermediate, or ideal. These metrics will be monitored to determine the changing prevalence of cardiovascular health status and define achievement of the Impact Goal. In addition, the committee recommends goals for further reductions in cardiovascular disease and stroke mortality. Thus, the committee recommends the following Impact Goals: "By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." These goals will require new strategic directions for the American Heart Association in its research, clinical, public health, and advocacy programs for cardiovascular health promotion and disease prevention in the next decade and beyond. (Circulation. 2010;121:586-613.)

Davos 2010

World Economic Forum: Davos 2010

In Davos, signs of recovery for the economy — but it's not the same old world

Full List

10 THINGS I LEARNED IN DAVOS

1. Emerging Markets: Whoa, Have They Emerged
2. Unemployment Is The New Crisis
3. Bankers Are Not Repentant — Or Even Embarrassed
4. The Obama Administration is Stand Offish
5. West Coast Techies Are In Demand
6. Canada's Central Banker Is Smart and Sexy
7. Cell Phones Solve Social Problems
8. Capitalism Is Roughed Up, But Surviving
9. Financial Regulatory Fixes Remain a Mystery
10. We Should All Learn Chinese

MORE FROM DAVOS

1. Hopeful but Wary at Davos
2. The China vs. Google Dispute: Hold Fire
3. Seeing Light Through the Gloom in Davos
4. Big-City Shakeout: New York
5. Capital Gains: London
6. Guarding Against Complacency: Hong Kong
7. A Brief History of the World Economic Forum

Read more:http://www.time.com/time/specials/packages/completelist/0,29569,1955058,00.html#ixzz0eNtpsJiQ

Chronic Disease Risk

Future Chronic Disease Risk Goes Beyond BMI

By Crystal Phend, Senior Staff Writer, MedPage Today Published: February 01, 2010 Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner   Copy the code below to embed audio on your website or blog: Interview with: Sarah Appleton, Postgraduate student, University of Adelaide, Australia When it comes to predicting chronic disease, body mass index doesn't tell the whole story, according to a population-based study that found elevated risk with obesity and other metabolic risk factors independently. Metabolically-healthy obese people tended toward being at least twice as likely to develop multiple metabolic risk factors and diabetes as healthy, normal weight individuals over the subsequent 3.5 years of a study led by Sarah Appleton, a postgraduate student at the University of Adelaide, Australia. However, normal weight individuals with metabolic risk factors -- a group the researchers called "metabolically obese" -- were at greater risk, she told attendees at the International Congress on Abdominal Obesity in Hong Kong, a conference sponsored by the International Chair on Cardiometabolic Risk.

World day for physical activity

potential for reducing coronary heart disease mortality in the USA

Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of America

Simon Capewell ^a, Earl S Ford ^b, Janet B Croft ^c, Julia A Critchley ^d, Kurt J Greenlund ^c & Darwin R Labarthe ^c

a. Division of Public Health, University of Liverpool, Liverpool, L69 3GB, England.
b. Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America (USA).
c. Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
d. Institute of Health and Society, Newcastle University, Newcastle, England.

Correspondence to Simon Capewell (e-mail: capewell@liverpool.ac.uk).

(Submitted: 18 August 2008 – Revised version received: 30 December 2008 – Accepted: 07 June 2009 – Published online: 08 December 2009.)

Bulletin of the World Health Organization 2010;88:120-130. doi: 10.2471/BLT.08.057885

INTRODUCTION

Coronary heart disease (CHD) accounted for over 450 000 deaths in the United States of America in 2004.^1,2 The burden of CHD in the United States is enormous; more than 13 million people are affected, and the costs of direct health care exceed US$ 150 billion annually.^1,2

Since the late 1970s, age-adjusted CHD mortality rates have been halved in most industrialized countries, including the United States. However, between 1990 and 2000 this decrease diminished, and in younger age groups it nearly ceased.^1,2 Many adults in the United States are still at high risk for cardiovascular disease. Total blood cholesterol levels exceed 200 mg/dl among more than 100 million adults; approximately 70 million have or are being treated for high blood pressure (systolic blood pressure 140 mmHg or diastolic blood pressure 90 mmHg), and over 50 million people still smoke.^2–4

The Healthy People 2010 (HP2010) initiative promoted by the government of the United States contains targets for heart disease and stroke that explicitly address risk factor prevention, detection and management, along with prevention of recurrent events. HP2010 objectives include a 20% reduction in age-adjusted CHD mortality rates (from an overall rate of 203 per 100 000 population in 1998 to 162 per 100 000 in 2010).³ They also include specific targets for reducing mean total blood cholesterol (to 199 mg/dl), smoking (to 12% of the population), hypertension (to 16%), diabetes (to 6%), obesity (to 15%) and inactivity (to 20%).³ Inactivity was measured in the Behavioral Risk Factor Surveillance System of the United States Centers for Disease Control and Prevention as the proportion of adults engaging in no physical activity.⁵ If those targets are achieved, what reduction in CHD mortality might actually result by 2010?/.../

Flexner Report

Flexner Report Linked to Growth of Specialty Medicine

By Emily P. Walker, Washington Correspondent, MedPage Today Published: January 30, 2010 WASHINGTON -- A century ago, Abraham Flexner's pivotal report redefined medical education and laid the groundwork for the growth of academic medical centers, but increasing medical specialization was an unintended consequence and threatens patient care, according to a paper published in an anniversary issue of Academic Medicine The growing importance of academic medical centers during the last century has caused medicine's "social contract" to "erode," to be replaced by "a money culture that dominates the academic health system and has led to distortions in medical education and to our present maldistribution of physicians by specialty." So wrote Michael Prislin, MD, professor of family medicine at the University of California, and colleagues who authored the paper, one of a special series of articles commemorating the 100th anniversary of the Flexner Report./.../

populationwide salt-reduction policies

View all heartwire news »

Ripe for change: US ponders populationwide salt-reduction policies

5 COMMENTS - JAN 29, 2010 14:15 EST

Most experts agree that reducing salt intake will cut blood pressure and in turn reduce the number of heart attacks and strokes. But messages to limit the amount of salt added to food have had little impact on sodium intake in the West, as more than 75% of salt in the diet there is contained in readily prepared foods. The UK has recently gotten tough with the food industry and cut salt intake by 10%; is it time the US and others took a similar stance? heartwire examines the issues./.../

Health Data from Eight Global Health Agencies

From: 

Maria Inês Reinert Azambuja

Corporações dão salto para dominio do mercado global?

Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies

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Margaret Chan^1*, Michel Kazatchkine², Julian Lob-Levyt³,Thoraya Obaid⁴, Julian Schweizer⁵, Michel Sidibe⁶, Ann Veneman⁷, Tadataka Yamada⁸

1 World Health Organization, Geneva, Switzerland, 2 Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland, 3 Global Alliance for Vaccines and Immunisation (GAVI), Geneva, Switzerland, 4 United Nations Population Fund (UNFPA), New York, New York, United States of America, 5Human Development Network, World Bank, Washington, D.C., United States of America, 6 Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland, 7 United Nations Children's Fund (UNICEF), New York, New York, United States of America, 8 Global Health Program, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America

Citation: Chan M, Kazatchkine M, Lob-Levyt J, Obaid T, Schweizer J, et al. (2010) Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies. PLoS Med 7(1): e1000223. doi:10.1371/journal.pmed.1000223

Published: January 26, 2010

Copyright: © 2010 Chan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: No specific funding was received to write this piece.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: DHS, Demographic and Health Surveys; GAVI, Global Alliance for Vaccines and Immunisation; ICD, International Classification of Diseases and Related Health Problems; IHP+, International Health Partnership; M&E, monitoring and evaluation; MDG, Millennium Development Goal; MICS, Multiple Indicator Cluster Survey; NHA, National Health Accounts; SDMX, Standard Data and Metadata eXchange; UNAIDS, Joint United Nations Programme on HIV/AIDS; UNFPA, United Nations Population Fund; UNICEF, United Nations Children's Fund; WHO, World Health Organization

* E-mail: porria@who.int

Margaret Chan is Director-General of the World Health Organization. Michel Kazatchkine is Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Julian Lob-Levyt is Chief Executive Officer of GAVI. Thoraya Obaid is Executive Director of UNFPA. Julian Schweizer is Acting Vice President of the Human Development Network at the World Bank. Michel Sidibe is Executive Director of UNAIDS. Ann Veneman is Executive Director of UNICEF. Tadataka Yamada is President of the Global Health programme at the Bill & Melinda Gates Foundation.

Provenance: Not commissioned, externally peer reviewed.

Viaje a bilhões de anos-luz de distância neste vídeo | HypeScience

Viaje a bilhões de anos-luz de distância neste vídeo | HypeScience

Miguel Kramer em 29.01.2010 as 18:20

Is it already over for Obama?

Rick Salutin

Is it already over for Obama?

The change he brought was the election of a black man as president, full stop.

Não seria razoável nem real esperar que um milagre tivesse acontecido a partir da eleição de Obama.

Seja como for, pode ter sido um passo no longo caminha da transformação sonhada.

A dispersão do poder e da vontade na população não muda assim tão facilmente...

"Rethinking Poverty"

Report on the World Social Situation 2010

"Rethinking Poverty"

Click here for the Media Kit

Fifteen years ago, in Copenhagen, global leaders at the World Summit for Social Development described poverty eradication as an ethical, political and economic imperative, and identified it as one of the three pillars of social development. Poverty eradication has since become the overarching objective of development, as reflected in the internationally agreed development goals, including the Millennium Development Goals, which set the target of halving global extreme poverty by 2015. Rethinking Poverty, the 2010 issue of the Report on the World Social Situation seeks to contribute to rethinking poverty and its eradication. It affirms the urgent need for a strategic shift away from the market fundamentalist thinking, policies and practices of recent decades towards more sustainable development- and equity-oriented policies appropriate to national conditions and circumstances. Such national development strategies, as called for by the 2005 World Summit, should seek to achieve the development goals. Responsible development and counter-cyclical macroeconomic policies to foster productive investments and generate decent employment must be at the core of this effort. The Report makes a compelling case for rethinking poverty and poverty-reduction efforts, saying that over-reliance on market forces and economic liberalization have led to neglect of nationally designed and developmentally-oriented strategies, to the detriment of the world’s poor. The most important lesson, according is that governments need to play a developmental role, integrating economic and social policies that support inclusive output and employment growth, while attacking inequality and promoting justice.