Friday, December 29, 2006
To submit information about an event to the calendar, email details to firstname.lastname@example.org."
If you like we, from AMICOR, may intermediate the information to insert your programmed scientific activity into the calendar
What seems clear is that Web 2.0 brings people together in a more dynamic, interactive space. This new generation of internet services and devices—often referred to as social software—can be leveraged to enrich our web experience, as information is continually requested, consumed, and reinterpreted. The new environment features a highly connected digital network of practitioners (medical or otherwise), where knowledge exchange is not limited or controlled by private interests. For me, the promise of open access in Web 2.0—freed of publishing barriers and multinational interests—is especially compelling.
Web 2.0 is primarily about the benefits of easy to use and free internet software./.../"
Thursday, December 28, 2006
Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus. A Scientific Statement From the American Heart Association and the Ame
Wednesday, December 27, 2006
Triglycerides and the Risk of Coronary Heart Disease. 10 158 Incident Cases Among 262 525 Participants in 29 Western Prospective Studies -- Sarwar et
Background--Many epidemiological studies have reported on associations between serum triglyceride concentrations and the risk of coronary heart disease, but this association has not been reliably quantified. In the present study, we report 2 separate nested case-control comparisons in 2 different prospective, population-based cohorts, plus an updated meta-analysis of 27 additional prospective studies in general Western populations.
Methods and Results--Measurements were made in a total of 3582 incident cases of fatal and nonfatal coronary heart disease and 6175 controls selected from among the 44 237 men and women screened in the Reykjavik and the European Prospective Investigation of Cancer (EPIC)-Norfolk studies. Repeat measurements were obtained an average of 4 years apart in 1933 participants in the EPIC-Norfolk Study and an average of 12 years apart in 379 participants in the Reykjavik study. The long-term stability of log-triglyceride values (within-person correlation coefficients of 0.64 [95% CI, 0.60 to 0.68] over 4 years and 0.63 [95% CI, 0.57 to 0.70] over 12 years) was similar to those of blood pressure and total serum cholesterol. After adjustment for baseline values of several established risk factors, the strength of the association was substantially attenuated, and the adjusted odds ratio for coronary heart disease was 1.76 (95% CI, 1.39 to 2.21) in the Reykjavik study and 1.57 (95% CI, 1.10 to 2.24) in the EPIC-Norfolk study in a comparison of individuals in the top third with those in the bottom third of usual log-triglyceride values. Similar overall findings (adjusted odds ratio, 1.72; 95% CI, 1.56 to 1.90) were observed in an updated meta-analysis involving a total of 10 158 incident coronary heart disease cases from 262 525 participants in 29 studies.
Conclusions--Available prospective studies in Western populations consistently indicate moderate and highly significant associations between triglyceride values and coronary heart disease risk. Because these associations depend considerably on levels of established risk factors, however, further studies are needed to help assess the nature of any independent associations."
Tuesday, December 26, 2006
JAMA -- Theme Issue on Poverty and Human Development: Call for Papers on Interventions to Improve Health Among the Poor, December 27, 2006, Flanagin a
Poverty is an inveterate consequence and cause of ill health.1 Without financial resources, people cannot pay for basic human needs: food, water, sanitation, housing, and health care services. In addition, poor people often live in poor countries that have limited or deteriorating health care systems and not enough physicians, nurses, and other trained health care workers. Others live in countries with governments that ignore or are too ineffectual to address the health care needs of the poor. Individuals who are poor also lack adequate education to make appropriate decisions about health and prevention of disease and often lack equity and empowerment to attain education, employment, and skills needed to escape the cycle of poverty.
The first of the United Nation's 8 Millennium Development Goals, determined by 189 countries in 2000, is to eradicate extreme poverty and hunger.2 This specific goal is to halve the proportion of people living on less than $1 a day (the World Bank's definition of extreme poverty) and those who suffer from hunger by the year 2015.2-3 This goal cannot be achieved without improving the level of human development—the opportunity to escape poverty through "the choices that come with a sufficient income, an education, good health, and living in a country that is not governed by tyranny"—among the poor.4 Such development requires careful evaluation and study of interventions aimed to address the needs of poor individuals within their unique local conditions and socioeconomic context, with sufficient follow-up to determine whether effects are sustainable.
In 1990, more than 28% of the developing world's population (1.2 billion people) lived in extreme poverty.2-3 By 2002, this proportion had decreased to 19% but still represented more than 1 billion people.2-3 While substantial declines in extreme poverty have been reported for Eastern and Southern Asia between 1990 and 2002 (from a rate of 33% to 14% in Eastern Asia and from 39% to 31% in
Among all regions of the world other measures demonstrate some progress toward achieving the Millennium Development Goals, including declines in the proportion of people with insufficient food and sanitation, increased enrollments in education, increased proportion of women employed, decreases in child mortality rates, increases in measles vaccination rates, and increased proportion of births attended by skilled health care workers.2 Each of these successes will contribute to reducing poverty and promoting human development, but some of this progress has been only marginal and much additional work, aid, funding, and research are needed.2-3,5
Despite huge increases in wealth and prosperity throughout the world in the last several decades, the gap between the wealthy and the poor has widened, with more than 1 billion people still living in extreme poverty.3, 5 The United Nations Human Development Index is a composite of 3 dimensions of human development: living a long and healthy life (measured by life expectancy), being educated (measured by adult literacy and enrollment in primary, secondary, and tertiary schools), and having a decent standard of living (measured by purchasing power parity and income).4 According to the most recent report,
Substantial efforts have been directed at reducing poverty, addressing health needs, and ultimately improving human development during the last few decades.3-5 However, much of the early work begun in the 1960s and 1970s lost support in the mid-1980s following severe economic downturns in many poor countries, the demise of previously state-run approaches to development and the provision of health care, and overall pessimism about the ability to actually reduce poverty and provide health care for all.6 In addition, acts of violence, conflicts, and mass disasters have led to social upheaval and long-term displacement, rendering the most basic health care impossible to deliver. Signs of renewed concern and attention began in the late 1990s with recognition by agencies such as the World Bank of the connection between health, poverty reduction, equity, and economic success as well as increased governmental and private aid and funding of research into poverty and health.6 However, most aid still falls far short of promises and what is needed.5
A vast literature discusses poverty and its associations and effects. A recent search of MEDLINE using the key term "poverty" resulted in more than 22 000 citations, while results in Google Scholar included about 1.3 million articles. However, the MEDLINE citations represent less than 0.002% of the database's 14 million total citations.7 Furthermore, despite the large number of articles, the effectiveness of many interventions to improve health in poor countries remains untested and unproven.8 In fact, compared with costly interventions and therapies that are mostly available to those who can pay for them, relatively few health interventions targeted to serve the poor are evidence-based.8 A systematic review of 286 randomized controlled trials (RCTs) on topics relevant to 35 leading causes of global burden of disease published in 6 leading general medical journals in 1999 found that 124 (43%) of these trials addressed 1 of the 35 leading causes of global burden of disease. Of these, ischemic heart disease, HIV/AIDS, and cerebrovascular disease were the most commonly studied.9 One third of these trials studied 1 of 10 top causes of global burden of disease, but 7 (20%) of the leading causes of global burden of disease were not addressed by any trial.
However, progress is being made in efforts to conduct reliable research on the health needs of the poor and to provide evidence-based solutions. Since 1971, 404 reports of RCTs on interventions related to poverty have been included in MEDLINE, with 57% of these published in the last 6 years. Recent studies have examined a range of interventions, some successful and some not, including strategies to reduce inequalities in access to care; microcredit programs; sustainable health care financing alternatives for the poor; strategies to provide access to essential drugs, vaccines, and therapies; strategies to reduce infant and maternal mortality rates; nutritional interventions; behavioral interventions to improve health and adherence with therapeutic regimens and to prevent disease; educational programs; family planning services; interventions to increase access to clean water and sanitation; and primary care treatments for preventable diseases, chronic diseases, and mental health disorders. The success of microcredit was recognized with this year's award of the Nobel Peace Prize to Muhammad Yunus and Grameen Bank for their "efforts to create economic and social development from below."10
To help disseminate research into interventions that specifically address the needs of the poor, JAMA will publish a theme issue on poverty and human development in October 2007. JAMA is 1 of more than 140 scientific journals participating in plans to simultaneously publish papers on this topic under the coordination of the Council of Science Editors.11 For this theme issue, JAMA will consider manuscripts that report original research of interventions targeted to address poverty, hunger, access to care, and prevention of disease that are based on careful consideration and analysis of local context, evidence, and environments and that are directly targeted to serve the poor. We are also interested in assessments of interventions that are both scalable and sustainable. We are primarily interested in receiving reports of randomized or cluster controlled trials, but we will also consider cohort studies, case-control studies, and other observational studies as well as systematic reviews, meta-analyses, and commentaries. Manuscripts received by May 1, 2007, will have the best chance of consideration for the issue. Please see JAMA's Instructions for Authors for information on preparing and submitting manuscripts.12
Trends in Incidence, Lifetime Risk, Severity, and 30-Day Mortality of Stroke Over the Past 50 Years, December 27, 2006, Carandang et
" Context Prior estimates of long-term trends in the incidence and severity of stroke have varied; trends in lifetime risk have not been reported.
Objective To determine long-term trends in the incidence, lifetime risk, severity, and 30-day mortality of clinical stroke.
Design, Setting, and Participants Prospective evaluation of the community-based Framingham Study original and offspring cohorts. Participants were 9152 men and women free of prevalent stroke and undergoing follow-up for up to 50 years over 3 consecutive periods (1950-1977, 1978-1989, and 1990-2004), with biennial ascertainment of stroke risk factor data and active surveillance for incident clinical stroke and cause-specific mortality.
Main Outcome Measures Incidence (age-adjusted, sex-specific), severity, 30-day mortality, and mortality-adjusted 10-year and lifetime risk of stroke in each of the specified periods.
Results There were 1030 incident clinical strokes (450 [44%] in men, 629 atherothrombotic brain infarctions [61%]) in 9152 persons 55 years or older over 174 917 person-years of follow-up. The age-adjusted incidence of first stroke per 1000 person-years in each of the 3 periods was 7.6, 6.2, and 5.3, respectively, in men (P = .02 for trend) and 6.2, 5.8, and 5.1 in women (P = .01 for trend). The lifetime risk at age 65 years decreased from 19.5% to 14.5% in men (P = .11) and from 18.0% to 16.1% in women (P = .61). Age-adjusted stroke severity did not vary across periods; however, 30-day mortality decreased significantly in men (from 23% to 14%; P = .01) but not significantly in women (from 21% to 20%; P = .32).Conclusions In this cohort of men and women free of prevalent clinical stroke at initial examination, incidence of stroke has decreased over the past 50 years but the lifetime risk has not declined to the same degree, perhaps due to improved life expectancy. The results of this study suggest that improved control of risk factors has lowered stroke incidence but emphasize the need for continued primary prevention efforts. "
Saturday, December 23, 2006
A strategic goal of the American Heart Association (AHA) is to reduce heart disease, stroke, and risk for both by 25%,1 and Healthy People 2010 (HP2010) established 4 national goals for heart disease and stroke prevention and management.2 However, the current health tracking systems (surveillance) in the United States cannot track progress toward these goals in a comprehensive
and systematic manner. This article provides a brief overview of these goals, prevention and management strategies, and the role of surveillance in monitoring the impact of prevention and treatment efforts. It also provides a review of the existing surveillance system for monitoring progress toward preventing heart disease and stroke in the United States and recommendations
for filling important gaps in that system. This information will serve as an important basis for advocacy to guide the development of a comprehensive surveillance system to support the current HP2010 and AHA goals and the likely future goal of eliminating the epidemic burden of heart disease and stroke.
Recommendations are categorized as overarching (fundamental recommendations that cut across goal areas) or as goal-specific.
They are further classified according to priority (P) (I for high priority and II for intermediate priority. No low-priority recommendations were made), staging (S) (I for early staging [1–2
years], II for intermediate staging [2–4 years], and III for later staging), and cost (C) ($ for items estimated to cost less than $10 million per year, $$ for estimates of $10 to $100 million, and $$$ for estimates exceeding $100 million). In addition, potential barriers to action are addressed.
1. A National Heart Disease and Stroke Surveillance unit should be established to produce annual reports on key indicators of progress in the prevention and management of heart disease and stroke. P I, S I, C $.
2. Cardiovascular disease (CVD), including cardiac arrests, acute coronary syndromes (heart attack and unstable angina), stroke, chronic heart failure (CHF), and related interventional procedures, should be classified as reportable conditions. P I, S III (although developmental
work should begin earlier), C $$$.
3. Data collection about patients’ encounters with the healthcare system should be revised to include collection of data on lipoprotein cholesterol concentrations, blood sugar, and glycohemoglobin values. P I, S I, C $.
4. Data elements should be standardized across surveys, and unnecessary duplication in data sources should be avoided. P I, S I, C $ (potentially cost saving).
5. The design and conduct of nationally representative surveillance programs should be revised to facilitate oversampling by states, territories, and tribal organizations and to provide meaningful estimates on ethnic subgroups in the populations. Sampling within states, territories, and tribal organizations should be designed to facilitate oversampling by counties. P I, S
II, C $$ to $$$ (depending on extent of oversampling achieved).
6. Mechanisms should be developed to enable linkage between healthcare data systems, including the national surveillance programs (eg, National Ambulatory Medical Care Survey [NAMCS], National Hospital Discharge Survey [NHDS], and National Death Index), and
electronic health records. P I, S II, C $$$ (startup) and $$ (maintenance).
7. Studies are needed to establish the validity of multiple measures collected by self-report and provider report in national databases. P II, S II, C $$.
Thursday, December 14, 2006
Around 500 people may die every year from sudden arrhythmic death syndrome, a study published in Heart shows.
SADS is linked to a genetic heart defect and family members should be screened to prevent more deaths, the researchers said.
The study also found that only one-third of cases had been correctly identified by post-mortem.
The researchers identified 56 cases of SADS from 115 coroners' reports of unascertained causes of death."
Sunday, December 10, 2006
Its scientists say 40% of the population have 'bad' fat around the heart, liver or pancreas, even though many appear thin.
They warn it is possible to be slim and yet still be at risk of conditions like diabetes because of 'hidden' fat.
Evidence suggests the precise location of fat has more of a bearing on health than simply being overweight. "
Tuesday, December 05, 2006
Ischemic Heart Disease Events Triggered by Short-Term Exposure to Fine Particulate Air Pollution -- Pope et al. 114 (23): 2443 -- Circulation
Methods and Results— A case-crossover study design was used to analyze ischemic events in 12 865 patients who lived on the Wasatch Front in Utah. Patients were drawn from the cardiac catheterization registry of the Intermountain Heart Collaborative Study, a large, ongoing registry of patients who underwent coronary arteriography and were followed up longitudinally. Ambient fine particulate pollution (particles with an aerodynamic diameter ≤2.5 µm; PM2.5) elevated by 10 µg/m3 was associated with increased risk of acute ischemic coronary events (unstable angina and myocardial infarction) equal to 4.5% (95% confidence interval, 1.1 to 8.0). Effects were larger for those with angiographically demonstrated/.../"
Sunday, December 03, 2006
By ALEX BERENSON
Published: December 3, 2006
"Pfizer announced last night that it had discontinued research on its most important experimental drug, a treatment for heart disease. The decision is a stunning development that is likely to seriously damage the company’s prospects through the next decades.
Preliminary research found that the drug, torcetrapib, appeared to be linked with deaths and heart problems in the patients who were taking it.
For people with heart disease, Pfizer’s decision to stop the trial represents the failure of a drug that many cardiologists had viewed as a potentially major advance in efforts to reduce heart attacks and strokes.
Torcetrapib is designed to raise levels of so-called good cholesterol. It was to be used in combination with older drugs called statins, like Lipitor and Zocor, which reduce so-called bad cholesterol.
As recently as Thursday, Pfizer executives had hailed the drug at a meeting with investors and analysts at the company’s research center in Groton, Conn.
“This will be one of the most important compounds of our generation,” said Jeffrey B. Kindler, Pfizer’s chief executive.
Pfizer is the world’s biggest drug company, with 106,000 employees and $51 billion in sales in 2005."
Saturday, December 02, 2006
Natural History of Atherosclerosis: A Critical Evaluation of the Current Understanding of the Natural History of Human Atherosclerosis
At a 2004 meeting in Paris, Renu Virmani, MD, FACC, medical director and founder of CVPath Institute, Gaithersburg, Maryland, warned that drug-eluting stents (DESs) could increase the risk of late thrombosis leading to MIs months or even years after the stents were implanted. Despite pathology slides vividly showing the victims’ stents totally occluded by clots, few of her colleagues showed much interest in her warning. Yet subsequent analyses of clinical trial and registry data suggest that late thrombosis is seen more often with DES placement than with older bare-metal stents (BMSs). The data – summarized in an AHA ’06 report featuring Robert S. Schwartz, MD, FACC (click here) – have renewed interest in the natural history of human atherosclerosis and what can be done clinically to reduce the risk of late thrombosis.
This week in the BMJ
Acute rheumatic fever is still a clinical challenge
Acute rheumatic fever, now rare in high income populations, remains highly prevalent in developing countries where access to health care is poor, says Cilliers (doi: 10.1136/bmj.39031.420637.BE) in her clinical review. Although it is known to be caused by humoral and cell mediated immune responses to group A beta haemolytic streptococcus antigens, the syndrome of carditis, polyarthritis, and skin or neurological changes is still not completely understood. Only 0.3-3% of patients with acute streptococcal pharyngitis develop rheumatic fever and a genetic predisposition is certain.
Rheumatic fever and its management
Antoinette M CilliersBMJ 2006 333: 1153-1156. [Extract] [Full Text]