Monday, January 31, 2005

Cardiovascular Disease And Global Health: Threat And Opportunity

Cardiovascular Disease And Global Health: Threat And Opportunity -- Greenberg et al., 10.1377/hlthaff.w5.31 -- Health Affairs: "Cardiovascular Disease And Global Health: Threat And Opportunity
Cardiovascular disease is a new problem
for the less developed world to contemplate.

By Henry Greenberg, Susan U. Raymond, and Stephen R. Leeder
ABSTRACT:

The transition in global health from infectious to chronic disease, especially cardiovascular disease, poses a threat to the economies of the less developed world. As a more sophisticated workforce becomes a highly valued and harder-to-replace economic investment, the increasing prevalence of cardiovascular risk factors becomes a threat to economic development. The next two decades offer a critical period for intervention to blunt the impact of these diseases. The response of the global assistance community has been inadequate and without impact. A new global health assistance paradigm is needed to support long-term prevention strategies to combat this epidemic."

Mario Maranhão, Maria Ines Reinert Azambuja and Aloyzio Achutti are working with these authors and other colleagues form India, China, South Africa end Russia in a wider project on the same issue: "Economic Impact of Cardiovascular Diseases in Developing Coutries".
In 2004 a preliminary document "A Race against Time. The Challenge of Cardiovascular Disease in Developing Economies" was published and may be accessed through the hyperlink.

Nonphysicians eager to pick up prescription pad

AMNews: Feb. 7, 2005. Nonphysicians eager to pick up prescription pad ... American Medical News: "Nonphysicians eager to pick up prescription pad
Empowered by recent victories, nonphysicians gear up for 2005 legislative efforts to expand their scope.
By Myrle Croasdale, AMNews staff. Feb. 7, 2005.


Nonphysicians such as naturopaths and psychologists, having seen their colleagues in other states win the right to prescribe or otherwise expand their scope of practice, are expected to push hard for the same authority in more states in 2005. Meanwhile, organized medicine is getting ready to fight their efforts."

Bush Offers High-Tech Health Care Prescription

Bush Offers High-Tech Health Care Prescription
By David Morgan

CLEVELAND (Reuters) Jan 28 - President Bush on Thursday proposed increasing federal funds to promote computerized medical records, which he said would save patients' lives and money as he touted plans to overhaul the health care industry.

On the first trip of his second term, Bush said a standardized information technology system for doctors' offices and hospitals would help save lives endangered by poor or incomplete record-keeping, prescription errors and other problems.

Sunday, January 30, 2005

[2232 - AMICOR - 30/01/2005] Treating individuals 5; Health US 2004; Obesity:Posture; Fumo: BR; Medicina: História; Weinstein C.2005; Compos.A

Tenho pensado muito sobre nossa lista AMICOR (em breve completando oito anos) e como torna-la mais útil, adaptando-nos a novos estilos disponíveis.
Opiniões e sugestões serão benvindos.
Nesta época do ano, considerando carnaval e alguns dias de férias, estarei com a atividade reduzida, mas é um bom tempo para pensar e sugerir.
O material que vou selecionando da INTERNET, será continuamente colocado no Blog a medida que for captado e pode aí ser consultado a qualquer momento. Sobre as mensagens de alerta por e-mail entretanto, gostaria de saber com que frequência gostariam de recebe-las.

I have had concerns about our list AMICOR (soon completing eight years old) and how make it more useful, adapting new available styles.
Opinions and suggestions are welcome.
At this time of the year, considering Carnival and hollydays, I will be in a reduced activity, but it is a good time to meditate and to make suggestions.
The references selected in the INTERNET, will be permanently bloged whenever picked up and may be visited in the AMICOR.blogspot.com whenever you wish it. On the e-mail alert messages, however I wish to know which the frequency you would like to receive them.

Treating Individuals 5: Treatment with drugs to lower blood pressure and blood cholesterol: individual's absolute risk

The Journal : Current Issue: "Treating Individuals 5: Treatment with drugs to lower blood pressure and blood cholestero based on individual's absolute cardiovascular risk "
Rod Jackson, Carlene M M Lawes, Derrick A Bennett, Richard J Milne, Anthony Rodgers
In this review, we outline the rationale for targeting blood pressure and blood cholesterol lowering drug treatments to patients at high absolute cardiovascular risk, irrespective of their blood pressure or blood cholesterol levels. Because the specific levels of blood pressure and cholesterol are of little clinical relevance when considered in isolation from other risk factors, terms such as hypertension or hypercholesterolaemia have limited value. Separate management guidelines for raised blood pressure and blood cholesterol need to be replaced by integrated cardiovascular risk management guidelines, and absolute cardiovascular risk prediction scores should be used routinely. Since cardiovascular risk factors interact with each other, moderate reductions in several risk factors can be more effective than major reductions in one. An affordable daily pill combining low doses of various drugs could be useful for the many individuals with slightly abnormal cardiovascular risk factors.

Health, United States, 2004

N C H S - Publications and Information Products - Health, United States, 2004
(Reference from Dennis Raphael)
Health, United States is an annual report on trends in health statistics. The report consists of two main sections: A chartbook containing text and figures that illustrates major trends in the health of Americans; and a trend tables section that contains 153 detailed data tables. The two main components are supplemented by an executive summary, a highlights section, an extensive appendix and reference section, and an index.

Interindividual Variation in Posture Allocation: Possible Role in Human Obesity

Science -- Abstracts: Levine et al. 307 (5709): 584: "Interindividual Variation in Posture Allocation: Possible Role in Human Obesity
James A. Levine,* Lorraine M. Lanningham-Foster, Shelly K. McCrady, Alisa C. Krizan, Leslie R. Olson, Paul H. Kane, Michael D. Jensen, Matthew M. Clark
Obesity occurs when energy intake exceeds energy expenditure. Humans expend energy through purposeful exercise and through changes in posture and movement that are associated with the routines of daily life [called nonexercise activity thermogenesis (NEAT)]. To examine NEAT's role in obesity, we recruited 10 lean and 10 mildly obese sedentary volunteers and measured their body postures and movements every half-second for 10 days. Obese individuals were seated, on average, 2 hours longer per day than lean individuals. Posture allocation did not change when the obese individuals lost weight or when lean individuals gained weight, suggesting that it is biologically determined. If obese individuals adopted the NEAT-enhanced behaviors of their lean counterparts, they might expend an additional 350 calories (kcal) per day. "

A NEAT Way to Control Weight?

Science -- Ravussin 307 (5709): 530: "A NEAT Way to Control Weight?
Eric Ravussin*In a tradition that originated in Babylon 4000 years ago, millions of us make New Year's resolutions. Such resolutions are often to lose weight by exercising more and eating less. No doubt, before January is out, most of us who swore to take a daily walk and pass up that extra snack have slunk back to our old habits. On page 584 of this issue, Levine et al. (1) suggest an alternative strategy for weight control. They offer evidence that differences in postural habits account for variations in body weight between the lean and the mildly obese. They propose that fidgeting, may be an unusual method of weight control."

Saturday, January 29, 2005

Brasil tenta adiar acordo antifumo

Cruzeironet: "Brasil tenta adiar acordo antifumo para convencer Senado a ratificar convenção
[ 27/01 - 23:25 ]

O governo brasileiro vai tentar retardar a primeira reunião de implementação da Convenção Quadro para Eliminação do Tabaco, promovida pela Organização Mundial da Saúde (OMS). A idéia é ganhar tempo para que o Senado ratifique a convenção e, com isso, o Brasil tenha também direito a participar do encontro, inicialmente previsto para abril"
...............................

A história da medicina como componente da identidade profissional

SIMERS - Sindicato Médico do Rio Grande do Sul
Referência de Maria Inês Reinert Azambuja. Autor: Professor Renato de Oliveira, Departamento de Sociologia, Programa de Pós-Graduação em Sociologiada Universidade Federal do Rio Grande do Sul (UFRGS)
Jacques Derrida, numa conferência que intitulou “O mal dos arquivos”, chama a atenção sobre o poder que se guarda nos arquivos. Que se guarda mas não se “arquiva”. Pelo contrário, lastreado pelas informações contidas nos arquivos, o poder pode expandir-se e tornar-se capaz de controlar a tudo e a todos informadamente, “cientificamente”.
................................

Wednesday, January 26, 2005

Weinstein Conference 2005

Weinstein Conference 2005
The 12th annual Weinstein Cardiovascular Development Conference to be held May 19-22, 2005 in Tucson, AZ is now open for registration (http://www.weinsteinmeeting.org). As you probably know this is the premiere meeting for the study of the development of the heart and vascular system in the United States. Dr. Patrick Mastin from the NIEHS is leading a push for more research into environmental causes of cardiovascular disease. This may include exposures to toxins, drugs or dietary factors that may cause congenital heart defects in humans or animal models. As you know this topic has not received much attention at the Weinstein or other national meetings, and generally is under- represented in cardiovascular research. Anyone working in this field is encouraged to submit their best research to the Weinstein organizers. If enough high quality abstracts are received they may be organized into a single session devoted to environmental causes of congenital heart defects. This exposure could be a first step in attempting to lure researchers and research money into this important field of research.

Thank you for your time and consideration, and I hope to see you in Tucson, at the always fun Westward Look Resort, in May 2005.

Sincerely,

Steven A. Fisher, M.D.
Associate Professor of Medicine and Physiology
422 BRB; 2109 Adelbert Rd; Case Western Reserve School of Medicine; Cleveland, OH 44106-4958
Tel 216-368-0488; Fax 216-368-0507
email: saf9@po.cwru.edu

Tabela Brasileira de Composição de Alimentos (TACO)

TACO
(Referência de Reginaldo Albuquerque)Confira abaixo, na integra, a primeira Tabela Brasileira de Composição de Alimentos (TACO) oficialmente reconhecida pelo Ministério da Saúde. Na coluna Diabetes Hoje, entenda a importância deste acontecimento que, entre outros fatores, representa uma preocupação com a fome, a qualidade da alimentação infantil e o crescimento da obesidade entre a população menos instruída.

Documentação;
Composição de alimentos por 100 gramas de parte comestível: Centesimal, minerais, vitaminas e colesterol;
Composição de alimentos por 100 gramas de parte comestível: Ácidos graxos

Tuesday, January 25, 2005

[2231 - AMICOR - 25/01/2005] Degeneration & Inflamation; Non-Communicable Diseases & Social Security; Síndrome Metabólica

From degeneration to infection/inflammation,

From degeneration to infection/inflammation,
and from individual-centered to ecologic
approaches to investigation of evolving patterns
of diseases occurrences in populations
Da degeneração à infecção e da abordagem centrada
no indivíduo à investigação ecológica dos padrões
de ocorrência de enfermidades nas populações
Maria Inês Reinert Azambuja
Abstract Variation in attributes of CHD cases
over time suggests a temporal change in the source
sub-population of cases. It is proposed that an
early 20th century expansion of a CHD-prone
sub-population, characterized by high-serum cholesterol
phenotype and high case-fatality – and
which contributed with most of the CHD cases
and deaths during the 1960s – may have followed
the 1918 Influenza Pandemic. The extinction of
those birth-cohorts would have resulted in a relative
increase in cases coming from a second source
sub-population, characterized by insulin resistance
and chronic expression of low grade inflammation
markers, comparatively less vulnerable to
acutely die from CHD. This re-interpretation of
the CHD trend, and the abandonment of the idea
of degeneration for inflammation/infection calls
for a change in epidemiology. Besides exposures
(diet, infection...), temporal variations in proportional
representations of inherited and acquired
phenotypes associated with individual resistance/
vulnerability, would be important determinants
of evolving patterns of diseases occurrences
in populations...............

Replica dos autores

The authors reply
Os autores respondem
Como seria de se esperar encontramos concordância
nos aspectos mais gerais levantados pela
dra. Carmen F. Teixeira. Nessa discussão, a ênfase
em um ou outro ponto depende, basicamente,
da preocupação de cada interlocutor com
seu objeto imediato de estudo. É assim que
caminha a humanidade e não há outra maneira
de se progredir nesse terreno tão complexo e
dinâmico, influenciado não somente pelas tensões
da arquitetura interna do conhecimento
como de pressões externas intercorrentes.

Debatedor Paulo Lotufo

Por que não vivemos uma epidemia
de doenças crônicas: o exemplo
das doenças cardiovasculares?
Why Brazil does not have an outbreak
of chronic diseases: lessons from
cardiovascular diseases?
Paulo Andrade Lotufo
O texto de Achutti e Azambuja apresenta um
dilema importante em todas as sociedades: o
aumento da população idosa e a dificuldade da
sociedade prover os recursos de previdência. As
causas podem ser meramente demográficas ou
econômicas, como redução da atividade econômica,
mais desemprego e trabalho informal
com a queda da receita previdenciária. Em todas
as sociedades onde se estabeleceu o contrato
social democrático, como no caso do Brasil,
esse problema ocorre com maior ou menor
determinação demográfica ou econômica. No
caso brasileiro, com grande chance a questão
demográfica tem importância menor do que a
econômica, porque a proporção maior de idosos
é decorrente da diminuição da natalidade
em razão da queda abrupta das taxas de fecundidade,
e não em decorrência do aumento da
longevidade (Carvalho & Garcia, 2003).

Debatedora Carmen Fontes Teixeira

Transição epidemiológica, modelo
de atenção à saúde e previdência social
no Brasil: problematizando tendências
e opções políticas
Epidemiological transition, health care
model, and social security in Brazil:
an analysis of trends and policy options
Carmen Fontes Teixeira
O artigo de Aloysio Achutti e Maria Inês R.
Azambuja nos convida a refletir sobre as tendências
que configuram a situação epidemiológica
da população brasileira e suas relações
com as políticas que incidem sobre o modelo
de atenção à saúde e o modelo previdenciário.
Nesse sentido, constitui-se em um exercício de
construção de cenários, apontando a necessidade
e a possibilidade de se articularem informações
de diversas naturezas, com o objetivo
de contribuir para a tomada de decisões que
levem em conta os problemas e desafios que se
apresentam aos dirigentes de instituições públicas
com atuação nesses setores

Debatedor Sebastião Loureiro

Modelos assistenciais podem diminuir o
impacto das DCNT na seguridade social?
Can health care models decrease
the impact of CNCD on social security?
Sebastião Loureiro
O artigo desenvolvido por Aloysio Achutti e
Maria Inês Azambuja sobre o possível impacto
das Doenças Crônicas Não-Transmissíveis sobre
a Seguridade Social constitui um excelente
exercício de raciocínio científico de como gerar
hipóteses, a partir da revisão de dados empíricos
e da reflexão sobre teorias explicativas da
configuração histórica (e dinâmica) de um dado
perfil epidemiológico de uma sociedade
concreta.......

Chronic non-communicable diseases in Brazil: the health care system and the social security sector

Ciência & Saúde Coletiva - Chronic non-communicable diseases in Brazil: the health care system and the social security sector
Aloyzio Achutti; Maria Inês Reinert Azambuja
Resumo:
A seguridade social envolve ações do poder público e da sociedade sobre direitos à previdência social, à assistência social e à própria saúde. Este artigo traça um esboço de cada um desses elementos. Muitas doenças crônicas não-transmissíveis têm fatores de risco comuns e demandam assistência continuada de serviços. Comparando-se nossa população com a dos EUA, vê-se que é praticamente do mesmo tamanho até a faixa dos 15 aos 24 anos. A americana é duas vezes maior dos 35 aos 44 anos e mais de quatro vezes maior acima dos 75 anos. Tais diferenças explicam porque o número de mortes por DCNT é muito mais baixo no Brasil: nossa população é mais jovem e morre antes. Na medida em que o processo de envelhecimento avance, especialmente, via redução da mortalidade precoce, aumentará a prevalência das DCNT e sua repercussão na seguridade social. Assim como a atenção à saúde, a previdência social e a assistência social sofrem pressões políticas, econômicas e culturais. Na tentativa de imaginar um cenário futuro possível para a seguridade social no Brasil discute-se a necessidade de reformular o orçamento do País, visando ao equilíbrio financeiro.
........................

Diretrizes de Síndrome Metabólica

.:: www.sbh.org.br ::. SBH lança Diretrizes
Referência de Carlos Alberto Machado [carlos.a.machado@uol.com.br]
A Sociedade Brasileira de Hipertensão anuncia a conclusão da I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. A Síndrome Metabólica é reconhecida como o conjunto dos principais fatores de risco relacionados ao aumento da mortalidade cardiovascular, estimado em 2,5 vezes. São eles a hipertensão arterial, o diabetes, a obesidade e as alterações lipídicas.

As Diretrizes já estão disponíveis para download e serão também publicadas nas revistas científicas das sociedades relacionadas.

I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica



Monday, January 24, 2005

[2230 - AMICOR - 24/01/2005] Folate & Hypertension; Update on CHD Prevention and Rehabilitation

Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease: An AHA Scientific Statement

Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease: An American Heart Association Scientific Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Coun
Arthur S. Leon et al.
This article updates the American Heart Association (AHA) 1994 scientific statement on cardiac rehabilitation. It provides a review of the recommended components of optimal rehabilitation/secondary prevention programs, ways to deliver these services, recommended future research directions, and the rationale for these recommendations, with emphasis on the exercise training component. Secondary prevention is an essential part of the contemporary care of the patient with cardiovascular disease (CVD). The term cardiac rehabilitation refers to coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality. As such, cardiac rehabilitation/secondary prevention programs provide an important and efficient venue in which to deliver effective preventive care. In 1994, the AHA declared that cardiac rehabilitation should not be limited to an exercise training program but also should include multifaceted strategies aimed at reducing modifiable risk factors for CVD. Since then, detailed guidelines have been published that clearly specify each of the core components of cardiac rehabilitation/secondary prevention programs, along with information about the evaluation, intervention, and expected outcomes in each area. Thus, cardiac rehabilitation/secondary prevention programs currently include baseline patient assessments, nutritional counseling, aggressive risk factor management (ie, lipids, hypertension, weight, diabetes, and smoking), psychosocial and vocational counseling, and physical activity counseling and exercise training, in addition to the appropriate use of cardioprotective drugs that have evidence-based efficacy for secondary prevention. Candidates for cardiac rehabilitation services historically were patients who recently had had a myocardial infarction or had undergone coronary artery bypass graft surgery, but candidacy has been broadened to include patients who have undergone percutaneous coronary interventions; are heart transplantation candidates or recipients; or have stable chronic heart failure, peripheral arterial disease with claudication, or other forms of CVD. In addition, patients who have undergone other cardiac surgical procedures, such as those with valvular heart disease, also may be eligible.
..........(Full text free access).............

Folate for Everybody?

TIME.com Print Page: TIME Magazine -- Folate for Everybody?
Megadoses of the vitamin lower blood pressure in women--and maybe in men
By SANJAY GUPTA

Folic acid is one of the more essential B vitamins, especially for women of childbearing age, and a little bit--100 micrograms a day--goes a long way toward preventing spina bifida and other birth defects. That's why the U.S. government requires that all grain products be fortified with enough folate to stave off these so-called neural-tube defects.

Now a major study published in the Journal of the American Medical Association has confirmed what smaller studies had only hinted at: that women who consume large amounts of folate (on the order of 1,000 micrograms a day) have a lower risk of developing hypertension--for younger women, significantly lower.

The report, part of the ongoing Nurses' Health Study, tracked the folate intake of nearly 94,000 women ages 27 to 44 over eight years and found that those who consumed at least 1,000 micrograms a day had a 46% lower risk of high blood pressure than women who took less than 200 a day. A parallel study of 62,000 women ages 43 to 70 found an 18% reduction.

It's not yet clear how folic acid does this, although the supplement is known to reduce levels of homocysteine, a blood component that can damage blood vessels. Women who got their folate eating foods naturally high in the vitamin--such as oranges, leafy greens and beans--didn't derive the same benefit as those who took folic acid supplements, perhaps because it's hard to eat enough vegetables in one day.

Men haven't yet been studied as thoroughly, but there's no reason to think they wouldn't get the same benefit from high doses of folate. Dr. John Forman of Brigham and Women's Hospital in Boston, the principal investigator, isn't ready to say that everybody should take 1,000 micrograms of folate a day. He wants to see his findings confirmed in a large, randomized trial in which half the subjects take the supplement and half take a placebo. Other scientists caution that early studies suggesting that large doses of vitamin E protect against heart disease haven't panned out.

But since 65 million Americans suffer from high blood pressure, and there isn't any known downside to taking folate, it might not be a bad idea for all adults to take the current recommended dose of 400 micrograms a day. --With reporting by Shahreen Abedin/New York

Sanjay Gupta is a neurosurgeon and CNN medical correspondent

Friday, January 21, 2005

[2229 - AMICOR - 21/01/2005] IT Technical support; Geriatric Web; Endocrinologic Source; Diabetes 2; Activity later in Life; Health Care 21 Century.

Comments, suggestions, contributions are welcome.
I would like to know if you wish the alert messages by e-mail with the keywords, dayly, weekly, or monthly.
Sincerely
AA

Comentários, sugestões e contribuições são benvidos.
Gostaria de saber se desejam receber o alerta com palavras chave de novo material postado diariamente, semanalmente ou mensalmente.
Saudações
AA

protonic.com : fast free technical support

protonic.com : fast free technical support
protonic.com is an online community that provides technical support to computer users for free. We prefer to call our users "Clients," because we have the philosophy that, despite our service being free, you should still receive the highest quality technical support.
Each protonic.com support Technician is a volunteer. We have been featured in many media publications including USA Weekend, Yahoo! Internet Life and .net magazine.

If you have a computer problem - anything from hardware to HTML problems - then submit your question to us for help! We support nearly everything: PCs, Macs, Unix and PDAs.

New... Get Tech Support delivered every two weeks. Subscribe to the protonic.com newsletter. Click the link to the left or click here to subscribe.

Still want to know more about protonic.com? Read our FAQ, and check out the discussion forums.

GeriatricWeb: Geriatric Resources for the Practicing Physician

GeriatricWeb: Geriatric Resources for the Practicing Physician
GeriatricWeb is a collaborative effort between the Division of Geriatrics at Palmetto Health Richland Hospital, University of South Carolina School of Medicine and the University of South Carolina, School of Medicine Library. The project was conceived in October 2002 and is funded by a grant from the National Library of Medicine. (Grant number 1 G07 LM07737-01)

The objective of the GeriatricWeb is to create a web-based geriatric digital library to be used in the education of health care professionals and in the clinical care of the older patient.

The procedure for selection, reviewing and posting resources may be reviewed under the Methodology section. In summary, a “Taxonomy” was derived from a list of Geriatric-specific topics that were matched to the National Library of Medicine’s Medical Subject Headings (MeSH). This taxonomy is a hierarchical list of terms indented to three levels of specificity and is used to search the Internet for resources and to create stored searches. (See Resource Identification) Once resources are identified, they are forwarded to the GeriatricWeb geriatricians or Editor-in-Chief. The resources are then forwarded to a reviewer from the Editorial Review Board (ERB). The review process assesses many attributes of the site, such as the author, audience and quality, using a Geriatric Online Assessment Tool (GO-AT). If the review meets our Acceptance Criteria (see Acceptance Criteria), the resource is posted on the GeriatricWeb with a brief description.

Endotext.org-Your Source on Clinical Endocrinology:

Endotext.org-Your Source on Clinical Endocrinology: authoritative, comprehensive, up-to-date, downloadable, and free
Your Comprehensive, Authoritative, Updated, Endocrine Web-textbook.
Endotext.org is the web-based source of information on endocrine disease directed to physicians around the world caring for patients with these problems. It is comprehensive, authoritative, constantly up-dated, and available without cost to physicians and trainees. All material may be freely downloaded for personal use. Our site covers the broad area of Clinical Endocrinology, emphasizing clinical endocrine practice, including the most current information on the manifestations of endocrine disease, diagnosis and treatment. Endotext.org intends to be the premier provider of well reviewed and organized clinical endocrine information on the Web. Endotext.org is solely responsible for all content. We are supported by Educational Grants and advertising, which consists uniquely of hyperlinks to company sites providing product information. For any comments on our site, advertising and information, email lesliedegroot@comcast.net.

Type 2 Diabetes: Science Online Special Collection

Type 2 Diabetes: Science Online Special Collection
Science Magazine and its online Knowledge Environments examine the vexing puzzle of type 2 diabetes -- a scourge expected nearly double in incidence, to some 300 million, over the next two decades. Viewpoint articles in Science overview the various molecular suspects that might underlie the disease, and explore the connections between diabetes and obesity. Science's Signal Transduction Knowledge Environment looks at insulin resistance mechanisms and pathways for stimulation of β-cell growth. And the Science of Aging Knowledge Environment offers a view on how studies of "the lowly spleen" are yielding insights on diabetes and aging-related diseases.

Thursday, January 20, 2005

Activity in later life

Activity in later life -- Young and Dinan 330 (7484): 189 -- BMJ
ABC of Sports and Exercise Medicine
Regular physical activity brings important health benefits at any age. Its importance for health in old age is highlighted repeatedly in the English national service framework for older people. Any potential hazards can be reduced by education and guidance of participants.
Prevention of disease Regular physical activity helps prevent conditions important in “old age,” notably osteoporosis, non-insulin dependent diabetes
mellitus, hypertension, ischaemic heart disease, stroke, and perhaps some cancers, specifically colon cancer.

NEJM -- Health Care in the 21st Century

NEJM -- Health Care in the 21st Century
William H. Frist, M.D.
I would like you to meet a patient from the year 2015. He lives in a world in which years ago America's leaders made tough but wise decisions. They built on the best aspects of American health care and unleashed the creative power of the competitively driven marketplace. These changes resulted in dramatic improvements to the U.S. health care system — lower costs, higher quality, greater efficiency, and better access to care.
........................................
American health care is at a crossroads. Rapidly advancing forms of technology are dramatically improving lives. Simultaneously, U.S. citizens face enormous inefficiencies, escalating costs, uneven quality, disparities in health care, and rising numbers of uninsured people. For decades, policymakers have debated and rejected a variety of solutions.
What we have never done in the health care economy, however, is foster the kind of competition that has made other industries the most successful, prosperous, and advanced in the world.
At this crossroads we now have a unique opportunity to use information technology to create a health care marketplace that will in turn produce the
transformed 21st-century health care system we must have.

Wednesday, January 19, 2005

[2228 - AMICOR - 19/01/2005] Tobacco Economy; AF & Pacing; Global Future.

Recalling:

This AMICOR.Blogspot is being permanently updated as new relevant material is picked up. So you may visit the site whenever you like to be updated on the selections.
Comment or suggestions are welcome. It is easy, just click in the appropriate link at the bottom of the post.
The comments will be incorporated into the AMICOR.Blogspot and you may read them too.
Periodically a message with the keywords of the period will be sent to your address.
The e-mail addresses plug-in and matrix are no longer working. Now: achutti@cardiol.br or aloyzio.achutti@terra.com.br
Thanks
AA

Tuesday, January 18, 2005

FAO - ISSUES IN THE GLOBAL TOBACCO ECONOMY (2)

FAO Document Repository: "ISSUES IN THE GLOBAL TOBACCO ECONOMY "
Tobacco is grown in two distinct areas: the northeast and the south. Approximately 135 000 family farmers in 656 municipalities in the three rich and industrialized states of the south have tobacco production as their main economic activity. In 2000/01, the harvest in the states of Paraná, Santa Catarina and Rio Grande do Sul was 504 728 tonnes of tobacco, with a gross income of $R 1.23 billion, implying an average gross income per family farm of $R 9 164.63, from average production of 3.74 tonne/ha - a record high. In the south, about half a million people work in tobacco-related activities.

The properties where tobacco is grown have an average area of 16.8 ha - a small farm by Brazilian standards - with 2.5 ha planted to tobacco, 9.4 ha under other crops, and the remainder being pasture, virgin or replanted forests, dams and fallow areas. About a quarter of the family farms growing tobacco in the south rent land or have sharecropping arrangements with landowners - contractual arrangements for renting land requiring all those farmers either to grow tobacco or to leave the farms. The small average size of farms in the south - between 1 and 10 ha - allows only limited alternatives to tobacco.

Role of Permanent Pacing to Prevent Atrial Fibrillation

Role of Permanent Pacing to Prevent Atrial Fibrillation: Science Advisory From the American Heart Association Council on Clinical Cardiology (Subcommittee on Electrocardiography and Arrhythmias) and the Quality of Care and Outcomes Research Interdis: "Role of Permanent Pacing to Prevent Atrial Fibrillation "
Bradley P. Knight, MD et al.
At present, permanent pacing to prevent AF is not indicated; however, additional studies are ongoing, which will help to clarify the role of permanent pacing for AF

Projections of Tobacco Production, Consumption & Trade to 2010

FAO Document Repository: "PROJECTIONS OF
TOBACCO PRODUCTION, CONSUMPTION, AND TRADE,
TO THE YEAR 2010"
FAO shares international concern over the harmful effects of tobacco smoking and the rising incidence of smoking-related diseases, which along with the resultant personal and social distress also lead to associated economic losses, not only in the developed countries but also in the developing world, where consumption continues to expand. FAO supports measures to curtail smoking, and within the context of interagency cooperation, particularly within the United Nations Ad Hoc Inter-Agency Task Force on Tobacco Control, FAO has undertaken a project involving a number of studies into various aspects of the global tobacco economy. This project, Tobacco Supply, Demand and Trade by 2010: Policy Options and Adjustment was supported by the Government of Sweden through its international development cooperation agency SIDA. These studies focus particularly on the potential effects, if any, that reductions in global demand might have on the economic conditions, earnings and food security of farming communities in developing countries particularly dependent on tobacco production for their livelihood. The underlying goal of this research is to provide a well defined and thoroughly researched analysis of economic issues as a basis for promoting the necessary international and national measures to achieve a healthier and more economically sustainable global environment.

This is the first of two volumes[1] to be published from the FAO project. It provides projections to the year 2010 of tobacco production, consumption and trade, and contains also a review of developments in the global patterns of production, consumption and trade since 1970.

More than any other agricultural commodity, the future of tobacco is likely to be influenced by the various policies adopted in individual countries to reduce smoking. These projections present the results of two alternative scenarios, one being a continuation of existing policies, the other the outcome of a more restrictive set of policies. However, we can only guess at the stance which governments around the world might adopt with respect to tobacco consumption in the course of the coming decade. Levels of production and consumption may prove to be much lower than these estimates in the event that aggressive anti-smoking policies are adopted, particularly in some of the major consuming countries in the developing world. Nevertheless, it is hoped that these projections will provide a useful framework by which to assess the likely future of the global tobacco economy.

Monday, January 17, 2005

NIC - Mapping the Global Future: Executive Summary

NIC - Mapping the Global Future: Executive Summary:
"With these and other new global actors, how we mentally map the world in 2020 will change radically. The arriviste powers China, India, and perhaps others such as Brazil and Indonesia have the potential to render obsolete the old categories of East and West, North and South, aligned and nonaligned, developed and developing. Traditional geographic groupings will increasingly lose salience in international relations. A state-bound world and a world of mega-cities, linked by flows of telecommunications, trade and finance, will co-exist. Competition for allegiances will be more open, less fixed than in the past."

[2227 - AMICOR - 17/01/2005] Millenium Project; Stroke; Treating individuals; Mortality; WIRE; Tobacco; Pharm. Industry

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UN - The Millennium Project

The Millennium Project
The Millennium Project's research focuses on identifying the operational priorities, organizational means of implementation, and financing structures necessary to achieve the MDGs. Ten thematically-orientated Task Forces perform the bulk of the research. They are comprised of representatives from academia, the public and private sectors, civil society organizations, and UN agencies with the majority of participants coming from outside the UN system. The 15-20 members of each Task Force are all global leaders in their area, selected on the basis of their technical expertise and practical experience.


January 17, 2005
U.N. Report Urges Rich Nations to Double Aid to Poor
By CELIA W. DUGGER
NITED NATIONS, Jan. 17 - An international team of experts sponsored by the United Nations proposed today a detailed, ambitious plan to halve extreme poverty and save the lives of millions of children and hundreds of thousands of mothers each year by 2015.

The 74-page report, which synthesizes 3,000 pages of findings by 265 experts, says that drastically reducing poverty in its many guises - hunger, illiteracy, disease - is "utterly affordable." Industrialized nations will need to double aid to poor countries, to 0.5 percent of their national incomes, it said.

The report of the United Nations Millennium Project, which was prepared under the stewardship of Prof. Jeffrey D. Sachs of Columbia University, advocates trade reforms to level the international playing field, as well a sweeping array of spending on, among other things, health, education, rural development, slum upgrading, roads and scientific research. Such an effort, the report said, would lift hundreds of millions of people out of poverty.


Multinational epidemiology of stroke

The Journal : Current Issue: "Multinational epidemiology of stroke"
'It did not start as a love affair. Rather, my first encounter with MONICA was a rescue operation to save the stroke component of the research'

Several years into the WHO MONICA (Multinational Monitoring of Determinants and Trends in Cardiovascular Disease) project, many centres were failing to record stroke. Indeed, some centres had not started. Kjell Asplund became a key contributor to the stroke component of MONICA. With 34 715 million years of observation in Europe and Asia, MONICA gave an unparalleled view of trends in stroke incidence and survival. In the January issue of The Lancet Neurology, Asplund outlines seven lessons he learned from his participation in the project. "Lesson one: a very large non-commercial international stroke study is extremely cumbersome . . . and possible".

Treating Individuals 3: From subgroups to individuals: general principles and the example of carotid endarterectomy

The Journal : Current Issue: "Treating Individuals 3: From subgroups to individuals: general principles and the example of carotid endarterectomy "
Peter M Rothwell, Ziyah Mehta, Sally C Howard, Sergei A Gutnikov, Charles P Warlow
Clinicians often have to make treatment decisions based on the likelihood that an individual patient will benefit. In this article we consider the relevance of relative and absolute risk reductions, and draw attention to the importance of expressing the results of trials and subgroup analyses in terms of absolute risk. We describe the limitations of univariate subgroup analysis in situations in which there are several determinants of treatment effect, and review the potential for targeting treatments with risk models, especially when benefit is probably going to be dependent on the absolute risk of adverse outcomes with or without treatment. The ability to systematically take into account the characteristics of an individual patient and their interactions, to consider the risks and benefits of interventions separately if needed, and to provide patients with personalised estimates of their likelihood of benefit is shown using the example of endarterectomy for symptomatic carotid stenosis.


"The most important thing about a treatment is that it is effective, not merely that it ought to be effective". Richard Asher, 19611

Historical keywords: Mortality

The Journal : Current Issue
Anne Hardy (a.hardy@ucl.ac.uk)

Mortality is derived from the Latin mortalitas, which comes from mortalis, subject to death, mortal, originally from mors, death. Alongside its use in such compounds as mortality rates, mortality is used to describe: the condition of being mortal; the death of an individual; death on a large scale; and the number of deaths in a given area, period, or from a particular disease.

The London Bills of Mortality were the first death statistics ever collected and were introduced in the early 16th century to predict outbreaks of bubonic plague. The recording of cause of death began in 1629. But by the 1820s such records were unreliable and so were abandoned with the creation of the General Register Office for England and Wales in 1837. The study of mortality now came into its own. William Farr (1807- 83), pioneer analyst of the new statistics, revealed the differences in mortality between, for example, town and country, and between north and south. Such statistics were vital to proponents of public health whose analysis of death and disease enabled them to pressure politicians and civic authorities to implement reform.

One result of the new registration system was that the modern scientific meaning of mortality became established: "The ratio of the total number of deaths in a year in a given population from a particular cause, group of causes, or all causes, to the total population" (WHO). Mortality rates can be subdivided into various categories. The crude mortality rate (number of deaths per 1000 population in a given year) is a clumsy descriptive tool and so death rates are commonly standardised for age and sex to reflect the relation between death and the structure of the population more accurately. Among age-specific rates, the infant mortality rate (deaths of babies aged under 1 year per 1000 livebirths) is of especial importance. Introduced in the late 19th century, it was soon recognised to be a sensitive indicator of social and environmental conditions, and has remained one of the key indices of the health status of whole populations. In the 20th century, standardised mortality rates became a major tool of demography and epidemiology. As death is a main determinant of population size, mortality rates have come to play a central part in debates over public health, population increase, and demographic transition. Thus, the word mortality now has complex layers of association so that the precise sense in which it is being used has always to be defined.

Threats to human survival: a WIRE to warn the world

Threats to human survival: a WIRE to warn the world

Yet the institutions that exist today cannot deliver that new approach. The UN has no single technical agency devoted to global risk assessment. The World Bank, International Monetary Fund, G8, and World Trade Organization are all inappropriate repositories for impartial analysis of global threats. Independent foundations may offer more neutral forums for risk judgments. But even foundations, such as that run by Bill and Melinda Gates, identify challenges from their own particular perspectives, producing solutions biased by their own specific ideologies.

What is the answer? In one respect, Michael Crichton is correct. We do need a "non-partisan, blinded funding mechanism to conduct research to determine appropriate policy". The power of independent technical evidence is consistently undervalued. For instance, global policies towards child health have changed because of new data derived from sound epidemiological and experimental science.14 The case for putting science at the centre of development policy-making has been made before.15 It received renewed support last week from the task force on science, technology, and innovation, part of the UN Millennium Project. Calestous Juma, the task force report's author, argued that:

The tobacco industry and p53

The tobacco industry and p53

'An example of tobacco industry strategy to challenge the science linking smoking to adverse events'
Mutations in the p53 tumour suppressor gene are found in more than half of all human tumours, including 60% of lung cancers. In 1996, Denissenko and colleagues published evidence that benzo[a]pyrene, a carcinogen present in tobacco smoke, caused mutations in p53. Asaf Bitton and colleagues investigated the tobacco industry's response to this and subsequent research linking p53 mutations with smoking. Their findings, published early online this week, suggest that high-level executives and scientists in the tobacco industry anticipated and carefully monitored p53 research, and supported studies that seemed to cast doubt on the link. Furthermore, some of this counter-research was published without clear disclosure of tobacco industry connections.

The p53 tumour suppressor gene and the tobacco industry: research, debate, and conflict of interest

Asaf Bitton, Mark D Neuman, Joaquin Barnoya, Stanton A Glantz

Summary

Mutations in the p53 tumour suppressor gene lead to uncontrolled cell division and are found in over 50% of all human tumours, including 60% of lung cancers. Research published in 1996 by Denissenko and colleagues demonstrated patterned in-vitro mutagenic effects on p53 of benzo[a]pyrene, a carcinogen present in tobacco smoke. We investigated the tobacco industry's response to p53 research linking smoking to cancer. We searched online tobacco document archives, including the Legacy Tobacco Documents Library and Tobacco Documents Online, and archives maintained by tobacco companies such as Philip Morris and R J Reynolds. Documents were also obtained from the British American Tobacco Company depository in Guildford, UK. Informal correspondence was carried out with scientists, lawyers, and tobacco control experts in the USA and Europe. We found that executives and scientists at the highest levels of the tobacco industry anticipated and carefully monitored p53 research. The tobacco industry's own scientists conducted research which appeared to cast doubt on the link between smoking and p53 mutations. Researchers and a journal editor with tobacco industry ties participated in the publication of this research in a peer-reviewed journal without clear disclosure of their tobacco industry links. Tobacco industry responses to research linking smoking to carcinogenic p53 mutations mirror prior industry efforts to challenge the science linking smoking and lung cancer. The extent of tobacco industry involvement in p53 research and the potential conflict of interest discussed here demonstrate the need for consistent standards for the disclosure and evaluation of such potential conflicts in biomedical research.

Fumantes custam R$12 milhões

Fumantes custam $12 milhões
Darse Júnior. Da equipe do Correio Brasiliense
16/01/2005
10h07 - Os danos causados pelo tabaco não se limitam à saúde. Atingem também os cofres públicos. O fumo causa um prejuízo mensal de R$ 9 milhões para o Governo do Distrito Federal. Por mês, R$ 12 milhões são gastos no tratamento médico-hospitalar de fumantes. A arrecadação tributária para esta finalidade, entretanto, se restringe a R$ 3 milhões.

Dispute Puts a Medical Journal Under Fire

The New York Times > Business > Media & Advertising > Dispute Puts a Medical Journal Under Fire
By BARRY MEIER (NYT, Published: January 17, 2005)

Past year was an especially bad one for the pharmaceutical industry, which experienced controversies over how drug studies are disclosed and the implosion of the painkiller Vioxx. Now, as a result of the recent publication of an article about the antidepressant Prozac, it appears that the staid, usually methodical world of medical journals could suffer its own black eye.
On New Year's Day, the British medical journal BMJ published a news article suggesting that "missing" documents from a decade-old lawsuit indicated that Eli Lilly & Company, the maker of Prozac, had minimized data about the drug's risks of causing suicidal or violent behavior....

De: Maria Inês Reinert Azambuja [mailto:miazambuja@terra.com.br]
Enviada em: segunda-feira, 17 de janeiro de 2005 09:07
Assunto: do NYT de hoje...

Olhe só esta!

"You put something out on the newswire with the imprimatur of a medical journal and people think it is fact," said Dr. Alan Brier, the chief medical officer of Eli Lilly, which is based in Indianapolis. NYT de 17/1/2005

Ele estava se defendendo da acusação de que a Lilly sabia dos riscos de comportamento violento do Prozac há 10 anos, que saiu no BMJ e depois na imprensa.

Mas ele deve saber muito bem sobre o que está falado... É isto que a indústria farmacêutica faz o tempo todo!

Maria Inês


[2226 - AMICOR - 17/01/2005] Women Doc.; Physical Exercise; Hypocondria; Dietary Guidelines 2005; Nutrition & Demography - BR; Pharma Industry market

Estão todos convidados a contribuir, especialmente as mulheres AMICOR, lembrando nomes e histórias de Mulheres Médicas. Vejam comentário do dia 14 de janeiro.

ProCOR--a sister network to your AMICOR, focused on CVD prevention in developing countries--is launching a series of profiles of women worldwide who have made a major contribution to the field of medicine. I invite Amicor readers to email me their nominations of these pioneering women (ccoleman5@partners.org).
This article focuses on the US--are the same trends taking place in Latin America? What are the social, cultural, etc issues that influence women's decisions and opportunities?
Catherine Coleman
Editor in Chief
PrOCOR (www.procor.org)

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Tell patients to forget 'no pain, no gain'

AMNews: Jan. 24, 2005. Tell patients to forget 'no pain, no gain' ... American Medical News
Susan J. Landers, AMNews staff. Jan. 24, 2005.
Washington -- Many people who resolve to embark on fitness programs at the start of the new year abandon such healthy thoughts when aching knees and backs bring them into their physician's offices after just a few weeks.
But it doesn't have to be that way.
As rising levels of obesity threaten to undermine the health of young and old, increased exercise could provide a route, though not an easy one, out of this morass. Physicians can help patients develop programs that avoid some common pitfalls and could spell the difference between success and failure, say those who see the damage wrought by imprudent exercisers.

Worried sick: What can doctors do about hypochondria?

AMNews: Jan. 24, 2005. Worried sick: What can doctors do about hypochondria? ... American Medical News
Susan J. Landers, AMNews staff. Jan. 24, 2005.

They can try the patience of even the most calm, cool and collected physician with ongoing complaints of a headache that is certainly a brain tumor or an aching arm that signifies bone cancer. No degree of assurances to the contrary can diminish their fears. Ultimately, addressing their needs poses a considerable and time-consuming clinical challenge.

Mastering the care of them, however, is also a priority for primary care physicians, because the number of these patients is great -- on average, as many as one out of 20 sitting in waiting rooms across the country at any given moment is a hypochondriac.

Sunday, January 16, 2005

Dietary Guidelines for Americans 2005

Dietary Guidelines for Americans 2005 - Table of Contents
(refered by Mario de Camargo Maranhão)
Dietary Guidelines for Americans is published jointly every 5 years by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA). The Guidelines provide authoritative advice for people two years and older about how good dietary habits can promote health and reduce risk for major chronic diseases.

IBGE - A Medida da Nutrição no BR - 2002-2003

IBGE - Instituto Brasileiro de Geografia e Estatística
A freqüência do excesso de peso na população supera em oito vezes o déficit de peso entre as mulheres e em quinze vezes o da população masculina. Num universo de 95,5 milhões de pessoas de 20 anos ou mais de idade há 3,8 milhões de pessoas (4,0%) com déficit de peso e 38,8 milhões (40,6%) com excesso de peso, das quais 10,5 milhões são consideradas obesas. Esse padrão se reproduz, com poucas variações, na maioria dos grupos populacionais analisados no País. Esses resultados fazem parte da 2ª etapa da Pesquisa de Orçamentos Familiares 2002-2003 do IBGE, cujos capítulos sobre a composição da dieta alimentar e do estado nutricional foram feitos em parceria com o Ministério da Saúde.

IBGE - Tendências Demográficas - BR - 2000

IBGE - Instituto Brasileiro de Geografia e Estatística
"Tendências Demográficas" traz informações detalhadas sobre crescimento e perda populacional dos municípios brasileiros


O IBGE lança hoje a publicação "Tendências Demográficas: uma análise da amostra do Censo Demográfico 2000", que faz um retrospecto dos indicadores demográficos e socioeconômicos básicos revelados pelos censos e traça um recorte dos municípios brasileiros, analisando as tendências de crescimento ou declínio no período 1991/2000. Esses estudos demográficos somente serão atualizados com a realização do próximo censo de população, em 2010.

Dos 5507 municípios brasileiros existentes à época do último Censo, 1496, ou 27,2% do total, tiveram perda populacional entre 1991 e 2000, e quase 40% (2193 municípios) apresentaram um ritmo de crescimento anual de 0% a 1,5%, abaixo da média nacional de 1,6% ao ano.

Pfizer shares fall on news of heart disease risk from Celebrex arthritis drug

Pfizer shares fall on news of heart disease risk from Celebrex arthritis drug

Quais as consequências?
1-Apreender a lição e aumentar a transparência?
2-Retirada de medicamentos necessários, mesmo quando os riscos de parefeitos precisam ser enfrentados ou gerenciados?
3-Insegurança aumentada dos pacientes?
4-Compreensão da real dimensão e das dimensões das incertezas?
5-Aumento da particiapção dos pacientes na monitorização de suas doenças e dos parefeitos da medicação?

[2225 - AMICOR - 16/01/2005] PCR; Obesity; Crime prevention & Health Promotion; Sweden National PH; High Blood Pressure.

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Protein's Link to Heart Disease Is a Mystery

The New York Times > Health > Fitness & Nutrition > Protein's Link to Heart Disease Is a Mystery

Acho que eu estava e estou certa, com relação à interpretação da tendência temporal da ocorrência e mortalidade por Doença Isquêmica do Coração nos último século...
"It is proposed that an early 20th-century expansion of a coronary heart disease–prone subpopulation, characterized by high serum-cholesterol phenotype and high case-fatality—which contributed to most of the coronary heart disease cases and deaths during the 1960s—may have been a late result of the 1918 influenza pandemic. .... The extinction of those birth cohorts would result in a relative increase in cases coming from a 2nd subpopulation, which was characterized by insulin resistance and chronic expression of low-grade inflammation markers and was comparatively less vulnerable to die acutely from coronary heart disease."

Azambuja MIR. Spanish Flu and Early 20th-Century Expansion of a Coronary Heart Disease–Prone Subpopulation. Tex Heart Inst J. 2004; 31(1): 14–21. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15061621

Saturday, January 15, 2005

Beaches for the Svelte, Where the Calories Are Showing

The New York Times > International > Americas > Rio de Janeiro Journal: Beaches for the Svelte, Where the Calories Are Showing

By LARRY ROHTER
RIO DE JANEIRO, Jan. 6 - Fat Brazilians? In a body-conscious society whose gifts to global culture include the girl from Ipanema, the tanga bikini and Gisele Bündchen and other supermodels, the idea seems heretical. Yet a controversial government study released late last month confirms it: Brazil is experiencing an epidemic of obesity

Another look at the age-old question: Which came first, the elevated c-reactive protein or the atherothrombosis?*

Cardiosource
Marc S. Sabatine, Eugene Braunwald
Thus, in the early management of patients with ACS, it may not be sufficient simply to lower the level of low-density lipoprotein cholesterol, as all three statins did in these trials; the goal also must be to reduce inflammation, as reflected by lowering CRP.

Making The Links: What Do Health Promotion, Crime Prevention,


Dennis Raphael
I will examine the linkages between crime prevention, health promotion, and social development and show that there is much in common among the determinants of crime, health, and social development.

Sweden National PH Strategies


(reference from the list on Equity & health)

Friday, January 14, 2005

Study Warns of Growing BP Problem

Technology News: News: Study Warns of Growing BP Problem
Jaing He of Tulane University pooled data from 30 studies involving over 700,000 people from different regions of the world. The number of adults with high blood pressure was predicted to increase by 60 percent to a total of 1.56 billion in 2025.


[2224 - AMICOR - 14/01/2005] Chronic Diseases Management; Clinical Trials; More on Drugs

Case management to be used for people with chronic conditions -- Mayor 330 (7483): 112 -- BMJ
London Susan Mayor

A substantial overhaul of the care of patients with chronic diseases based on case management, coordinated by a new type of health professional—the community matron—was announced by the UK government last week.

The search for new systems aiming to improve efficiency, effectivity without rise costs, discriminating case management and distinguishing chronic from the eventual ones.

Trial results: the next battle

Trial results: the next battle -- Abbasi 330 (7483): 0 -- BMJ
Drug companies last week announced a plan to make results from clinical trials of new drugs publicly available (p 109). Summary results of completed, industry sponsored trials will be disclosed regardless of outcome, say trade associations of the world's drug companies. On the face of it, this move is one to be cautiously welcomed....
Kamran Abbasi, acting editor (kabbasi@bmj.com)


Chronic Disease

Chronic Disease: "Chronic diseases�such as heart disease, cancer, and diabetes�are the leading causes of death and disability in the United States. These diseases account for 7 of every 10 deaths and affect the quality of life of 90 million Americans. Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. Adopting healthy behaviors such as eating nutritious foods, being physically active, and avoiding tobacco use can prevent or control the devastating effects of these diseases.
CDC�s National Center for Chronic Disease Prevention and Health Promotion is at the forefront of the nation's efforts to prevent and control chronic diseases. The center conducts studies to better understand the causes of these diseases, supports programs to promote healthy behaviors, and monitors the health of the nation through surveys. Critical to the success of these efforts are partnerships with state health and education agencies, voluntary associations, private organizations, and other federal agencies. Together, the center and its partners are working to create a healthier nation."

A Gift for Drug Makers

The New York Times > Opinion > Op-Ed Columnist: A Gift for Drug Makers
By BOB HERBERT
(reference from Maria Inês Reinert Azambuja)
The drug companies have an incredible racket going, as Marcia Angell, the former editor in chief of The New England Journal of Medicine, documents in her book "The Truth About the Drug Companies."

"Now primarily a marketing machine to sell drugs of dubious benefit," she wrote, "this industry uses its wealth and power to co-opt every institution that might stand in its way, including the U.S. Congress, the Food and Drug Administration, academic medical centers, and the medical profession itself. (Most of its marketing efforts are focused on influencing doctors, since they must write the prescriptions.)".....

J.&J. Recalls 300 Heart Stents After Defects Are Found in 6

The New York Times > Business > J.&J. Recalls 300 Heart Stents After Defects Are Found in 6

Wednesday, January 12, 2005

[2223 - AMICOR - 12/01/2005] Clinical trial; Women & Medicine; Ilicit Weapons; French Medicine Reform

Caros amigos,
Lembretes:

1) O conteúdo amicor está acessível através nos seguintes endereços:

http://amicor.blogspot.com
ou
http://www.achutti.dynip.com

2) E-mail funcionantes:

achutti@cardiol.br
e
aloyzio.achutti@terra.com.br

Clinical Trial Registration

NEJM -- Clinical Trial Registration

Increase in women doctors changing the face of medicine

Chicago Tribune: Increase in women doctors changing the face of medicine
With women becoming doctors in ever-increasing numbers, medicine is generally becoming more patient friendly, treatment is improving and malpractice suits may become less common, experts say.

But, they add, the feminization of medicine is helping to lower physician salaries, encourage part-time doctoring and exacerbate a looming shortage of physicians.

The change in the medical field has been swift and dramatic. Since 1975 the percentage of female doctors has nearly tripled, from 9 percent to 25 percent. And the wave is far from cresting: 38 percent of doctors under age 44 are women, and half the students in U.S. medical schools are women, a change that is expected to intensify.

(Reference from Jorge Ossanai)

Search for Illicit Weapons in Iraq Ends

The New York Times > International > Middle East > Search for Illicit Weapons in Iraq Ends
WASHINGTON, Jan. 12 - The White House confirmed today that the search in Iraq for the banned weapons it had cited as justifying the war that ousted Saddam Hussein has been quietly ended after nearly two years, with no evidence of their existence.
.........................................
Representative Pelosi, in her statement today, said: "After a search that has consumed nearly two years and millions of dollars, and a war that has cost thousands of lives, no weapons of mass destruction have been found, nor has any evidence been uncovered that such weapons were moved to another country. Not only was there not an imminent threat to the United States, the threat described in such alarmist tones by President Bush and the most senior members of his Administration did not exist at all."

She added: "The primary justification for the invasion of Iraq was not supported by fact. Now that the search is finished, President Bush needs to explain to the American people why he was so wrong, for so long, about the reasons for war."

I suspect we will hear just the common expression: Sorry....

Médecin traitant : ce qu'il faut savoir sur la réforme

Médecin traitant : ce qu'il faut savoir sur la reforme
Son rôle est au cœur de la nouvelle convention de l'assurance-maladie. Mais ce dispositif suscite de nombreuses interrogations chez les assurés : le choix d'un médecin traitant est-il obligatoire ? Pourra-t-on encore recourir librement à un spécialiste ? Sur quelle base sera-t-on remboursé ?

vous est envoyé par Jorge Ossanai (jorge@ossanai.com).

Achutti: Esta é uma das reformas mais importantes na história da medicina francesa. A tendência à racionalização e a responsbilidade de um médico integrador dos cuidados é uma tendência mundial. Aqui nos USA, cerca de 80% das pessoas confiam num médico de família ou num clínico geral para isso. Esse percentual não é muito diferente do canadense, onde 85% tem um médico geral, conforme exige o sistema único daquele país. Abraços, Jorge Ossanai

Tuesday, January 11, 2005

[2222 - AMICOR - 11/01/2005] Olive Oil; Obesity; Quit Smoking; US Health 2004;

Xinhua - Olive Oil and Prevention

Caros amigos,
Lembretes:

1) O conteúdo amicor está acessível através do site:

http://amicor.blogspot.com
ou
http://www.achutti.dynip.com

2) E-mail funcionantes:

achutti@cardiol.br
e
aloyzio.achutti@terra.com.br

Monday, January 10, 2005

Obesity factors more complex than thought

AMNews: Jan. 17, 2005. Obesity factors more complex than thought ... American Medical News
It's time for a little fine-tuning when it comes to assessing the cardiovascular risk posed by excess pounds, according to new findings that could enable physicians to better identify those overweight patients at imminent peril.

A determination of body mass index might not be the only number that counts anymore. Where the fat is stored, an individual's fitness level, blood markers for inflammation and the presence of metabolic syndrome also should be considered.

Medicare coverage aims to snuff out smoking

AMNews: Jan. 17, 2005. Medicare coverage aims to snuff out smoking ... American Medical News
Washington -- Medicare soon will begin chipping in for counseling aimed at fighting some of the leading causes of seniors' premature deaths.

Health, US, 2004. Comments from Dennis Raphael

De: Social Determinants of Health [mailto:SDOH@YORKU.CA] Em nome de Dennis Raphael
Enviada em: domingo, 9 de janeiro de 2005 23:22
Para: SDOH@YORKU.CA
Assunto: Re: Health, US, 2004

Also... one step forward, one back...

Health Status and Determinants

... In 2002 the overall percent of Americans living in poverty
was 12.1 percent, up from 11.7 percent in 2001 and
11.3 percent in 2000, the first increase in the poverty rate
since 1993. In 2002 more than one-half of black and Hispanic
children under 18 years and more than one-half of the black
and Hispanic population age 65 years and over were either
poor or near poor (figures 4 and 5 and table 2).

Health Behaviors and Risk Factors
Health behaviors and risk factors have a significant effect
on health outcomes. Cigarette smoking increases the risk
of lung cancer, heart disease, emphysema, and other
respiratory diseases. Overweight and obesity increase the
risk of death and disease as well as the severity of
disease. Regular physical activity lessens the risk of
disease and enhances physical functioning. Heavy and
chronic use of alcohol and use of illicit drugs increase the
risk of disease and injuries.

Since 1990 the percent of adults who smoke cigarettes has
declined only slightly. In 2002, 25 percent of men and
20 percent of women were smokers. Cigarette smoking by
adults is strongly associated with educational attainment.
Adults with less than a high school education were three
times as likely to smoke as were those with a bachelor’s
degree or more education in 2002 (figure 12 and tables 60
and 61)...

Health, United States, 2004


Health, United States, 2004 is the 28th report on the health status of the Nation and is submitted by the Secretary of the Department of Health and Human Services to the President and Congress of the United States in compliance with Section 308 of the Public Health Service Act. This report was
compiled by the National Center for Health Statistics (NCHS),
Centers for Disease Control and Prevention (CDC). The
National Committee on Vital and Health Statistics served in a
review capacity.
The Health, United States series presents national trends in
health statistics. Each report includes highlights, a chartbook,
trend tables, extensive appendixes, and an index. An
Executive Summary presents major findings.
(Reference from Maria Ines Reinert Azambuja)

Saturday, January 08, 2005

[2221 - AMICOR - 08/01/2005] Trials; Tobacco research; Medicine & Business; Alcohol; Conflict of interest.

Subgroup analysis in randomised controlled trials: importance, indications, and interpretation
Treating individuals 2: Subgroup analysis in randomised controlled trials: importance, indications, and interpretation -- Peter M Rothwell
Second article from a Series on Randomized Controlled trials.
Large pragmatic trials provide the most reliable data about the effects of treatments, but should be designed, analysed, and reported to enable the most effective use of treatments in routine practice. Subgroup analyses are important if there are potentially large differences between groups in the risk of a poor outcome with or without treatment, if there is potential heterogeneity of treatment effect in relation to pathophysiology, if there are practical questions about when to treat, or if there are doubts about benefit in specific groups, such as elderly people, which are leading to potentially inappropriate undertreatment. Analyses must be predefined, carefully justified, and limited to a few clinically important questions, and post-hoc observations should be treated with scepticism irrespective of their statistical significance. If important subgroup effects are anticipated, trials should either be powered to detect them reliably or pooled analyses of several trials should be undertaken. Formal rules for the planning, analysis, and reporting of subgroup analyses are proposed.

Friday, January 07, 2005

Is Tobacco Research Turning Over a New Leaf?

Science -- Grimm 307 (5706): 36
Scientists developing reduced-harm tobacco products increasingly rely on tobacco industry funding, but some universities and grant organizations want to forbid it.

The problem is not just nicotine...

How Health Care in America Became Big Business & Bad Medicine --

Critical Condition: How Health Care in America Became Big Business & Bad Medicine -- Woods 330 (7482): 99 -- BMJ

Alcohol in the body

Alcohol in the body -- Paton 330 (7482): 85 -- BMJ

Holding people indefinitely causes mental health problems

Holding people indefinitely causes mental health problems -- Mayor 330 (7482): 60 -- BMJ
É ainda possível acreditar que algúm país se arvore como defensor ou guardião dos direitos humanos?!...

Need for expertise based randomised controlled trials

Need for expertise based randomised controlled trials -- Devereaux et al. 330 (7482): 88 -- BMJ
Surgical procedures are less likely to be rigorously evidence based than drug treatments because of difficulties with randomisation. Expertise based trials could be the way forward.
Quality of the tryal is obviously the great challenge to get a good scientific based reference. But even satisfying this premise the application of theory to an individual case may be difficult.


A Quandary in Good News

The New York Times > Health > A Quandary in Good News
By GINA KOLATA
Published: January 7, 2005


A ciência biológica já tem suas incertezas.
Sua aplicação médica muito mais.
Com os conflitos de interesse, tudo fica mais difícil.
Isto tudo demonstra o terreno inseguro no qual temos que andar...


Thursday, January 06, 2005

[2220 - AMICOR - 06/01/2005] PAHO-Health Services; First World Social Forum; PCR; Deep Venous Trombosis.

Caros amigos,
Lembretes:
1)O conteúdo amicor está sendo acessível através do site:
http://amicor.blogspot.com
2) E-mail funcionantes:
achutti@cardiol.br
e
aloyzio.achutti@terra.com.br

Portal de Serviços de Saúde

Portal de Serviços de Saúde
(Referência do Reginaldo Hollanda Albuquerque)
Através deste portal é possível acessar muitos documentos e informações relaciconados particularmente com Serviços de Saúde nas Américas.
É possível assinar um Boletim periódico e também dá acesso a um tabulador de variáveis de Saúde, demográficas e socio-econômicas para todos os maíses da América.

FIRST WORLD SOCIAL FORUM ON HEALTH

FIRST WORLD SOCIAL FORUM ON HEALTH
(Reference from Maria Inês Reinart Azambuja)

Fourth International Forum in Defense of the Peoples Health
Porto Alegre – Brasil, from the 23rd to the 25ht of January 2005

Antecedents

Previously to the past three World Social Forums in Porto Alegre and Mumbai, there were organized international forums dedicated to the defense of the peoples rights to health.
The main purpose of that initiative was to call for action all the social movements around the universal right to health and health care.

In a progressive march we achieved to have in Mumbai around 700 participants from 50 countries. The Mumbai Forum reinforce the idea approved in Porto Alegre in 2003, were we decided to organize this First World Social Forum on Health with the purpose of an agenda building for action where the main goal will be the designing and building of alternative health system reforms processes oriented for the organization of national public health and social security systems....(more).....

The coordinator of this Forum is Dr. Armando De Negri Filho. He was member of the AMICOR list.

NEJM -- Statin Therapy, LDL Cholesterol, C-Reactive Protein, and Coronary Artery Disease

NEJM -- Statin Therapy, LDL Cholesterol, C-Reactive Protein, and Coronary Artery Disease
Steven E. Nissen, M.D., E. Murat Tuzcu, M.D., Paul Schoenhagen, M.D., Tim Crowe, B.S., William J. Sasiela, Ph.D., John Tsai, M.D., John Orazem, Ph.D., Raymond D. Magorien, M.D., Charles O'Shaughnessy, M.D., Peter Ganz, M.D., for the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) Investigators
Conclusions For patients with coronary artery disease, the reduced rate of progression of atherosclerosis associated with intensive statin treatment, as compared with moderate statin treatment, is significantly related to greater reductions in the levels of both atherogenic lipoproteins and CRP.

C-Reactive Protein Levels and Outcomes after Statin Therapy

NEJM -- C-Reactive Protein Levels and Outcomes after Statin Therapy
Paul M Ridker, M.D., Christopher P. Cannon, M.D., David Morrow, M.D., Nader Rifai, Ph.D., Lynda M. Rose, M.S., Carolyn H. McCabe, B.S., Marc A. Pfeffer, M.D., Ph.D., Eugene Braunwald, M.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22) Investigators
Conclusions Patients who have low CRP levels after statin therapy have better clinical outcomes than those with higher CRP levels, regardless of the resultant level of LDL cholesterol. Strategies to lower cardiovascular risk with statins should include monitoring CRP as well as cholesterol.

Protein Has a Big Role in Heart Disease

The New York Times > Health > Two Studies Suggest a Protein Has a Big Role in Heart Disease
By GINA KOLATA
(From Maria Inês Reinert Azambuja)

Reducing the levels of a certain protein secreted by the body may be as powerful a tool in slowing heart disease and preventing heart attacks and cardiac-related death as lowering cholesterol, two teams of researchers are reporting today.

The studies, being published in The New England Journal of Medicine, provide the strongest evidence yet that the protein - known as CRP, for C-reactive protein - plays a role in heart disease.

The participants were patients with severe heart disease who were taking high doses of statin drugs, which reduce both cholesterol and CRP. Lower CRP levels, the researchers found, were linked to a slower progression of atherosclerosis and fewer heart attacks and deaths. And this effect was independent of the effect of lowering cholesterol.

"What we now have is hard clinical evidence that reducing CRP is at least as important as lowering cholesterol," said Dr. Paul Ridker of Brigham and Women's Hospital in Boston, the lead author of one of the studies.


Há sempre uma esperança ou uma ilusão de que atrás dos interesses econômicos e de mercado haja novas conquistas com benefício para a saúde da população.

There is an expectation or ilusion, behid the economic and market interests to get new achievements with benefit to humankind.

Wednesday, January 05, 2005

Prevention of Venous Thromboembolism Among Hospitalized Medical Patients

Prevention of Venous Thromboembolism Among Hospitalized Medical Patients -- Goldhaber and Turpie 111 (1): e1 -- Circulation
Despite multiple educational initiatives for healthcare providers, venous thromboembolism prophylaxis remains underused.12 Often, ineffective preventive regimens are prescribed. Some clinicians continue to perceive pharmacological prophylaxis as excessively risky because of the possibility of bleeding complications. Others find established guidelines to be too cumbersome for practical everyday use. A minority believe that small asymptomatic DVT is simply not worth the effort to prevent because these tiny thrombi cannot directly cause clinically significant pulmonary embolism.

Artigo de revisão a partir de um caso clínico de Trombose venosa profunda.

[2219 - AMICOR - 05/01/2005] AMICOR; E-mail update; Medical Research; Blogs; Cardiopediatria.

Caros AMICOR,
1) A experiência com a utilização deste recurso no formato Blog parece estar sendo favorável, o que me leva a tentar mais um passo, enviando na mensagem de alerta apenas as palavras chave e o hyperlink que se visitado dará todas as informações anteriormente enviadas por e-mail.
Com isto espero maior flexibilidade, mais rapidez, menos volume no e-mail, mais liberdade para a diversidade de interesses.
2) Muitas mensagens tem voltado por caixa cheia, identificação com SPAM ou troca de endereço sem comunicação. Se souberem de AMICOR que teve comunicação interrompida, peçam que me enviem uma mensagem para restabelece-la.
3) Não esqueçam que os endereços com Matrix e Plug-in não estão mais funcionando. Agora somente achutti@cardiol.br ou aloyzio.achutti@terra.com.br
4) Recebi mensagem da AMICOR Isabela Giuliano [mailto:isabelag@uol.com.br], de SC que está fazendo um trabalho muito bom em Cardiopediatria que vale a pena divulgar.
Ela disse o seguinte:

Formamos uma rede que se chama amigos do peito das crianças, que discute especificamente prevenção em cardiologia pediátrica, nosso foco principal. A proposta é trocarmos informações sobre prevenção primordial (mudança de hábitos na população geral), primária (tto de crianças com riscos: obesos, hipertensos, dislipidêmicos) e secundária (reabilitação de crianças em pos- operatório de cirurgia cardíaca e com riscos para aterosclerose). Atualmente temos pessoas de 21 estados, com profissionais de diversas áreas: cardiologistas pediátricos, de adulto, nutricionistas, fisioterapeutas, psicólogos, professores de educação física, todas as áreas afins para o tratamento interdisciplinar.
A partir do congresso brasileiro de cardiolgia do Rio estamos organizando um grupo de estudos em cardiologia pediátrica preventiva pelo departamento de cardiologia pediátrica, da qual sou a atual coordenadora. A proposta é discutir temas e casos de prevenção, promovê-la em nível populacional e desenvolver pesquisas multicêntricas sobre o assunto.
Temos um projeto, que se chama "Brasil Saudável 2040" que deve ser abraçado a partir de fevereiro pelo FunCor, o qual será provavelmente fundido com o "Corações Saudáveis 2020".
Aqui em Florianópolis temos desenvolvido algumas ações: .Fizemos um estudo populacional dos fatores de risco (lípides já foi aceito para publicação no ABC) e estamos mandando agora hipertensão para outra revista. Deve seguir obesidade,
sedentarismo e obesidade truncal em seguida.
. Desenvolvemos um trabalho educacional nas escolas (nos dias temáticos do FunCor) com um teatro (da qual sou uma das atrizes) sobre prevenção de aterosclerose, endereçado a crianças de até 9 anos.
. Na Universidade para o Desenvolvimento do Estado de Santa Catarina estamos com um programa de reabilitação, com 2 grupos: um de pos-operatório de cirurgia cardíaca pediátrica (o mais antigo do Brasil) e um de crianças de alto risco para
aterosclerose (a maioria com síndrome metabólica).
. A partir de setembro estamos com uma campanha estadual de prevenção da obesidade infantil pela Secretaria do Estado da Saúde, em todas as TVs, rádios e jornais, com propagandas, receitas e orientações (segue anexo uma que saiu no jornal).
. A partir de março teremos o um programa regular numa favela que se situa atrás do Hospital Infantil Joana de Gusmão (pediátrico onde trabalho) no qual teremos ações semanais com pais, crianças e professores sobre os diversos aspectos de
prevenção(não só de doença coronariana, mas também de acidentes, violência, vacinas, câncer, entre outros).
O Dr Berenson esteve no Brasil (em Florianópolis) em agosto, quando nos presenteou com sua esperiência. A partir desta data, temos tido muito contato. Ele enviou-nos todo o seu material do Heart Smart, que será traduzido pelo FunCor e adaptado para a nossa realidade. O material está todo disponível no nosso site e estará também no site do DECAPE.

HARLOT plc: an amalgamation of the world's two oldest professions

HARLOT plc: an amalgamation of the world's two oldest professions --
Sackett and Oxman 327 (7429): 1442 -- BMJ

Tired of being good but poor, the authors have amalgamated the world's two oldest professions in a new niche company, HARLOT plc, specialising in How to Achieve positive Results without actually Lying to Overcome the Truth
(Refered by Murilo Foppa)


Tuesday, January 04, 2005

Blogs take on the mainstream

BBC NEWS | Technology | Blogs take on the mainstream
By Roberto Belo
BBC News website technology reporter


Web logs or blogs are everywhere, with at least an estimated five million on the web and that number is set to grow.
(Reference from Catherine Colleman)
We are addopting this format as the best to communicate with the AMICOR. I hope it may fullfil our needs and satisfy as a practical instrument.

Monday, January 03, 2005

Exceptional Matters. Harveian Oration.

Exceptional matters Keith Peters
Medical researchers in universities, research institutes and industry today are struggling to promote translational research--the catchphrase is from bench to bedside. The achievements of basic biomedical research and its potential in the postgenomic era are evident, but this Oration is in praise of clinical research. Archibald Garrod, the pioneer of clinical research of the past century, was greatly influenced by the Cambridge biologist and apostle of mendelism, William Bateson, whom I quote:

"A word of counsel to beginners, it is: Treasure your exceptions! When there are none, work gets so dull that no one cares to carry it further. Keep them always uncovered and in sight. Exceptions are like the rough brick-work of a growing building which tells that there is more to come and shews where the next construction is to be."

(Article suggested by Prof. Dr. Bruno Caramelli [bcaramel@usp.br] and Isabela Giuliano [isabelag@uol.com.br])

[2218 - AMICOR - 03/01/2004] e-mail update; Centenário do major Mário Maranhão; Circadian Rhythm; Addiction; 2004 Top Facts; Pain menagement.

Remember e-mail: achutti@cardiol.br or aloyzio.achutti@terra.com.br
No more matrix nor plug-in.
Thanks,
AA

Centenário do Major Mário Maranhão

Dia 30 de dezembro último ocorreu o Centenário de Nascimento do pai do AMICOR e ex-presidente da WHF Mário de Camargo Maranhão. O Major Mario Maranhão faleceu em 1995. Natural de Corumbá, MS e filho de José Pinheiro de Albuquerque Maranhão e de Maria Umbelina de Almeida Maranhão, ao falecer aos 89 anos, era viuvo de Avany Loyola de Camargo Maranhão, deixando tres filhos: Eny, Cleani e Mário.Em sua vida, foi militar,tendo servido ao Exercito Nacional e se reformado na patente de Major e depois exerceu funções administrativas no Serviço Social da Industria(SESI) do PR.,como Chefe do Departamento do Pessoal, no qual se aposentou

(Nota: fatos ou comemorações que membros da lista AMICOR julgarem relevantes para serem divulgados na lista, serão benvindos)

Endogenous circadian rhythm in an index of cardiac vulnerability

Endogenous circadian rhythm in an index of cardiac vulnerability independent of changes in behavior -- Hu et al. 101 (52): 18223 -- Proceedings of the National Academy of Sciences
(Apud Mario Maranhão)

ADDICTION

The Journal : Current Issue
Este pequeno artigo de revisão faz parte de uma série que publica a revista The Lancet sobre Historical Keywords ou conceitos básicos.

AMNews: 2004 top facts ...

AMNews: 2004 top facts ... American Medical News
Embora o enfoque seja dos EEUU, pode-se ter uma idéia da percepção deles sobre os fatos de maior impacto do ano que passou.

AMA Pain Management: The Online Series,

AMA (CME Select) Pain Management: The Online Series, American Medical Association, pain, CME, free, complementary, continuing medical education, physician education, continuing education, CE
Embora saibamos que nossa primeira missão é aliviar a dor e o sofrimento, nem sempre usamos todos os recursos disponíveis ou ficamos confusos frente a complexidade do problema e as inúmeras opções existentes.
Este artigo pode nos ser útil.


Sunday, January 02, 2005

[2217 - AMICOR - 02/01/2005] Evidence-based practice and the individual; UP-DATE E-MAIL; Fast-food & obesity and DM

The Journal : Current Issue
The Lancet thanks Peter Rothwell and colleagues for their detailed five-part series on applying trial data to individual patients. Focus on the individual patient was central to the development of evidence-based practice (EBP)1 and it is important that this context is emphasised throughout the series. In the first paper, the generalisability of clinical trials is called into question and medical journals are challenged to publish results in such a way that applicability is clear. Subsequent articles will reflect common clinician concerns about subgroups, meta-analyses, and risk.

e-mail update

Please communication just through the following addresses:

achutti@cardiol.br
or
aloyzio.achutti@terra.com.br

The two Internet providers I used before:
matrix and plug-in are not more accessible
Please update your address book
AA