Decrease in U.S. Deaths from Coronary Disease

To the Editor: Ford et al. (June 7 issue)1 have developed a statistical model, called IMPACT, which explains almost 90% of the observed decrease in deaths from coronary heart disease in the United States in the 20 years from 1980 to 2000. This model, which has been validated and reproduced mainly in developed countries, is so robust that some of its findings are similar to those of the earlier Nurses' Health Study,2 especially the proportional contributions of smoking and obesity to heart disease (13% and 8%, respectively). However, the model does not explain almost 10% of the observed decrease in deaths. The reduction in particulate air pollution, for example, explains from 18 to 76% of the decline in deaths from both coronary heart disease and coronary vascular disease.3,4 No doubt the U.S. outdoor air quality has improved substantially since 1980. An Irish study performed after the ban on burning coal showed a 10% decline in deaths from coronary vascular disease.5 Therefore, it would be worth considering air pollution in the IMPACT model, data that could be integrated into a comprehensive Chronic Disease Risk Model, thereby using such "gold standard" dynamic epidemiologic models as population-specific, evidence-based policy models.


Zubair Kabir, M.D., Ph.D.
Harvard School of Public Health
Boston, MA 02115
zkabir@hsph.harvard.edu

Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000

Earl S. Ford, M.D., M.P.H., Umed A. Ajani, M.B., B.S., M.P.H., Janet B. Croft, Ph.D., Julia A. Critchley, D.Phil., M.Sc., Darwin R. Labarthe, M.D., M.P.H., Ph.D., Thomas E. Kottke, M.D., Wayne H. Giles, M.D., M.S., and Simon Capewell, M.D.
ABSTRACT

Background Mortality from coronary heart disease in the United States has decreased substantially in recent decades. We conducted a study to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed to changes in cardiovascular risk factors.

Methods We applied a previously validated statistical model, IMPACT, to data on the use and effectiveness of specific cardiac treatments and on changes in risk factors between 1980 and 2000 among U.S. adults 25 to 84 years old. The difference between the observed and expected number of deaths from coronary heart disease in 2000 was distributed among the treatments and risk factors included in the analyses.

Results From 1980 through 2000, the age-adjusted death rate for coronary heart disease fell from 542.9 to 266.8 deaths per 100,000 population among men and from 263.3 to 134.4 deaths per 100,000 population among women, resulting in 341,745 fewer deaths from coronary heart disease in 2000. Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively).

Conclusions Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies.

Physical Activity and Public Health in Older Adults: Recommendation From

Physical Activity and Public Health in Older Adults
Recommendation From the American College of Sports Medicine and the
American Heart Association
Miriam E. Nelson, PhD, FACSM; W. Jack Rejeski, PhD; Steven N. Blair, PED, FACSM, FAHA; Pamela W. Duncan, PhD; James O. Judge, MD; Abby C. King, PhD, FACSM, FAHA;
Carol A. Macera, PhD, FACSM; Carmen Castaneda-Sceppa, MD, PhDObjective—To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults.
Participants—A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology.
Evidence—The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. Process: After drafting a recommendation for the older adult population and reviewing
drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults.
Summary—The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older
adult’s aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving
recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing
sedentary behavior, and risk management. (Circulation. 2007;116:1094-1105.)
Key Words: older adults
physical activity
benefits
risks
heal

Physical Activity and Public Health: Updated Recommendation for Adults From

De: Timoteo [mailto:timoteo@celafiscs.org.br]
Enviada em: segunda-feira, 27 de agosto de 2007 12:26

Olá Prof. Achutti!!

Recentemente a Circulation publicações os artigos de Reavaliação das Recomndações de AF x Saúde Pública (Adultos e idoso).

Physical Activity and Public Health
Updated Recommendation for Adults From the American College of
Sports Medicine and the American Heart Association
William L. Haskell, PhD, FAHA; I-Min Lee, MD, ScD; Russell R. Pate, PhD, FAHA; Kenneth E. Powell, MD, MPH; Steven N. Blair, PED, FACSM, FAHA; Barry A. Franklin, PhD, FAHA; Caroline A. Macera, PhD, FACSM; Gregory W. Heath, DSc, MPH, FAHA; Paul D. Thompson, MD; Adrian Bauman, PhD, MD Summary—In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and
clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical
activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and
circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation.
Primary Recommendation—To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for
a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice
during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical
activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)] (Circulation. 2007;116:1081-1093.)
Key Words: benefits
risks
physical activity dose
physical activity intensity

2361 - AMICOR10 - 26/08/2007

Caríssimos AMICOR,
Um dos motivos para demora de mais de um mês da última mensagem, é devida em parte à busca de um formato mais adequado para nossa comunicação.
As postagens nos BLOGs AMICOR, continuam e podem ser acessados diretamente como sempre ou assinando gratuitamente Feedblitz ou ourto sistema SSR

Dear AMICOR,
The delay (more than one month) from the last message was due to the search for a more appropriate format for our communication.
The regular posts in the AMICOR BLOGs, follow as ever, and may be accessed directly or signing (free) Feedblitz or other SSR systems.

Here are the latest updates for achutti@gmail.com
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World Health Report 2007
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World Health Report 2007
The world health report 2007: A safer future23 August 2007 -- More than ever before, global public health security depends on international cooperation and the willingness of all countries to take steps to tackle new and emerging threats. That is the message of this year's World health report entitled A safer future: global public health security in the 21st century, which is launched today.
Read the news release
The world health report 2007
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More Recent Articles
US Death Rate Hits All-Time Low
History, principles and practice of health and human rights
Trabalhador está acima do peso
Pierre Levy : Inteligência Colectiva
Waist-Hip Ratio Tops BMI and Waist Alone for Predicting Atherosclerosis
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AMICOR na presidência da SBC 2010-2011

Resultado Eleição Presidente da SBC 2010/2011

Candidato
Votos

Chapa 2 - Jorge Ilha
1132

Chapa 1 - Cláudio P. Cunha
884

Brancos
12

Nulos
16
TOTAL
2044

World Health Report 2007

The world health report 2007: A safer future23 August 2007 -- More than ever before, global public health security depends on international cooperation and the willingness of all countries to take steps to tackle new and emerging threats. That is the message of this year's World health report entitled A safer future: global public health security in the 21st century, which is launched today.Read the news release The world health report 2007

US Death Rate Hits All-Time Low

U.S. Death Rate Hits All-Time Low

By Michael Smith, Senior Staff Writer, MedPage Today August 22, 2007
Add Your Knowledge™
Additional Public Health Coverage HYATTSVILLE, Md., Aug. 22 -- The U.S. death rate fell to a historic low in 2004 and the life expectancy at birth hit a record high, according to the National Center for Vital Statistics here.
Final totals for the year show 2,397,615 deaths and an age-adjusted death rate of 800.8 deaths per 100,000 people.
That was 50,673 fewer deaths than in 2003 and represented the largest single-year decline in raw death counts since 1938, when deaths fell by 69,036 from the previous year.
At the same time, life expectancy at birth hit 77.8 years, continuing an increasing trend in the population as a whole and among both blacks and whites, according to the agency, part of the CDC.

History, principles and practice of health and human rights

Series, Health and Human Rights
History, principles, and practice of health and human rights
Sofia Gruskin JD a , Edward J Mills PhD b and Daniel Tarantola MD c
See CommentSee CommentSee World ReportSee World ReportSee PerspectivesSee Perspectives
Summary
Introduction
A brief history of health and human rights
Human rights and health policy
Applying human rights to health
Concerns for the future
Steps forward
References
Summary
Individuals and populations suffer violations of their rights that affect health and wellbeing. Health professionals have a part to play in reduction and prevention of these violations and ensuring that health-related policies and practices promote rights. This needs efforts in terms of advocacy, application of legal standards, and public-health programming. We discuss the changing views of human rights in the context of the HIV/AIDS epidemic and propose further development of the right to health by increased practice, evidence, and action.Back to top
This is the first in a Series of four papers about health and human rights
Introduction
Blatant violation of human rights affecting the health of both individuals and populations continues. Examples include the torture of detainees in Abu-Ghraib prison in Iraq;1 systematic rapes and murders in the Balkans,2 Rwanda,3 Chechnya,4 and Darfur;5 physician involvement in torture,6 botched executions;7 inhumane experimentation;8 and questionable interrogation techniques in the so-called war on terror.1,9,10 Such violations of human rights can be engineered by or endorsed by governments, institutions of power, and individuals. These deplorable violations exist alongside more subtle activities that also have severe and longlasting effects on health and human rights such as absence of basic health-care systems;11 policies keeping medicines unaffordable;12 and tolerance of discrimination against groups such as injecting drug users,13 people with mental-health disorders,14,15 illegal immigrants,16 or homeless people.17 The continuing and foreseeable absence of access to effective care for most people living with most diseases in poor countries can also be viewed as a violation of human rights.18 Therefore human rights should be imperative in delivery of care and implementation of public-health programmes.
Three main relations between health and human rights exist: the positive and negative effects on health of promotion, neglect, or violation of human rights; the effect of health on the delivery of human rights; and the effects of public-health policies and programmes on human rights.19 Despite the advances in the study and advocacy of health and human rights we still do not fully understand the nature of these relationships, how they interact, or their value to medicine and public-health practice. In this article we address the public health aspects of these relations, and highlight where further research and action are needed./.../

Trabalhador está acima do peso

Resultado de pesquisa da AMICOR Dra. Sandra Fuchs
Trabalhador está acima do peso
MARCELA DONINI

Acima do peso adequado e comendo mal, grande parte dos industriários do país deve mudar seus hábitos se quiser evitar doenças cardiovasculares.A recomendação é resultado do Estudo Sesi - Perfil Epidemiológico de Fatores de Risco para Doenças Não-transmissíveis em Trabalhadores da Indústria do Brasil, apresentado no sábado, durante o 15° Congresso Brasileiro de Hipertensão, em Recife (PE).O excesso de peso é a característica mais preocupante entre os 4.818 trabalhadores entrevistados, segundo a epidemiologista da pesquisa e professora da Universidade Federal do Rio Grande do Sul (UFRGS) Sandra Fuchs. Comparável ao índice referente à população geral dos Estados Unidos, país com maior número de obesos no mundo, os 49,7% dos industriários de mal com a balança surpreenderam os pesquisadores.- Os trabalhadores deveriam ser mais saudáveis do que o restante da população justamente por terem saúde para trabalhar - observa.Estudo deve mudar rotina nas empresasSegundo o Estudo Sesi, 51,3% dos homens industriários e 45,1% das mulheres estão acima do peso ideal. A hipertensão arterial, outro fator de alto risco para doenças do coração, foi registrada em 26,3% dos entrevistados. Com o excesso de peso, o padrão alimentar inadequado forma uma péssima combinação. A pesquisa revelou que 46,1% dos homens e 34,5% das mulheres não comem nenhuma porção de frutas ou legumes por dia, quando a recomendação da Organização Mundial da Saúde é de cinco porções diárias para prevenir alguns tipos de câncer e doenças do coração. Após a coleta de informações, os entrevistados foram submetidos a intervenções, como palestras de conscientização sobre a redução de peso, atividades físicas e dieta balanceada. O objetivo é ampliar as ações a todos industriários do Brasil.Em fase de correção, o estudo se iniciou em 2001 e foi desenvolvido pelo Serviço Social da Indústria, em parceria com a Sociedade Brasileira de Cardiologia, a Organização Pan-americana de Saúde e o Ministério da Saúde. O texto deve ser publicado este ano e apresentado à Confederação Nacional das Indústrias para que, definido o perfil dos trabalhadores, seja possível mudar algumas rotinas nas empresas.( mailto:%20marcela.donini@zerohora.com.br )

Pierre Levy : Inteligência Colectiva

Assistimos (Valderês e eu) hoje uma conferência de Pierre Levy na Série de "Fronteiras do Pensamento"
http://www.fronteirasdopensamento.com.br/?menu=conferencistas&act=25#25
Ao chegar em casa, casualmente Maria Inês Reinert Azambuja havia nos enviado esta referência de um livro seu traduzido pela OPAS.
Ela dizia em sua mensagem: Parece que isto é o futuro...
Penso que precisamos ver como baseados no presente, podemos alcançar este futuro.
Segundo ele já temos muitos instrumentos e uma rede em franco desenvolvimento (sendo que a maior taxa de crescimento da rede no último ano se deu na China, na Índia e no Brasil).
Vejamos como juntos podemos caminhar neste sentido...
************************************
Es con gran satisfacción que la Organización Panamericana de la Salud, a través de la Unidad de Promoción y Desarrollo de la Investigación y el Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud (BIREME), pone a la disposición de los usuarios de la BVS/Ciencia y Salud (BVS/CyS) la versión electrónica en español del consagrado libro de Pierre Lévy “La inteligencia colectiva”. La traducción a partir del original francés fue hecha por el Centro Nacional de Información de Ciencias Médicas (INFOMED) de Cuba y Pierre Lévy autorizó la traducción y publicación de su libro sin costo alguno.

Waist-Hip Ratio Tops BMI and Waist Alone for Predicting Atherosclerosis

Waist-Hip Ratio Tops BMI and Waist Alone for Predicting Atherosclerosis

By Charles Bankhead, Staff Writer, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco August 13, 2007
Add Your Knowledge™
Additional Coronary Artery Disease Coverage


Amit Khera, M.D., M.Sc.Southwestern Medical
DALLAS, Aug. 13 -- For assessing obesity's impact on atherosclerosis risk, the waist-to-hip ratio tops body mass index and waist

Aortic Arch Atheroma Progression and Recurrent Vascular Events in Patients With Stroke or Transient Ischemic Attack

Aortic Arch Atheroma Progression and Recurrent Vascular Events in Patients With Stroke or Transient Ischemic Attack
Souvik Sen MD, MS*, Alan Hinderliter MD, Pranab K. Sen PhD, Jennifer Simmons BSW, James Beck PhD, Steven Offenbacher DDS, PhD, MMSc, E. Magnus Ohman MD, and Stephen M. Oppenheimer MD, PhD
Background—It is not known whether progression of aortic arch (AA) atheroma is associated with vascular events in patients with stroke or transient ischemic attack (TIA).
Methods and Results—AA atheroma was detected on baseline transesophageal echocardiogram in 167 consecutive patients who had prevalent stroke or TIA. Of these, 125 consented to a follow-up transesophageal echocardiogram at 12 months. Adequate paired AA images were obtained in 117 (78 with strokes, 39 with TIAs), which allowed detailed measurements of plaques. On admission for their index stroke or TIA, patients were assessed for stroke risk factors, stroke subtypes, baseline AA plaque characteristics, and laboratory parameters. Progression of AA atheroma was observed in 33 patients (28%) on 12-month follow-up transesophageal echocardiogram. It was determined that the progression group had significantly higher adjusted homocysteine levels (P<0.0001) and neutrophil counts (P<0.0001) than the no-progression group. These patients were followed up for a median of 1.7 years from the index stroke/TIA (range 0.5 to 4.5 years) for vascular events including stroke, TIA, myocardial infarction, and death due to vascular causes. Kaplan-Meier curves showed fewer patients with AA atheroma progression remained free of the composite vascular end point (49% compared with 89% in the no-progression group; P<0.0001). AA atheroma progression was associated with composite vascular events (hazard ratio 5.8, 95% confidence interval 2.3 to 14.5, P=0.0002) after adjustment for a propensity score based on confounders.
Conclusions—In this preliminary study of stroke/TIA patients with AA atheroma on transesophageal echocardiogram, AA atheroma progression was associated with recurrent vascular events.
Key words: aorta • atherosclerosis • disease progression • echocardiography • stroke

Family History of Premature Coronary Heart Disease and Coronary Artery Calcification

Background— A family history of premature coronary heart disease (CHD) is a known risk factor for CHD events. The purpose of this study was to assess the strength of the association between a family history of premature CHD and coronary artery calcification (CAC) in a multiethnic cohort of asymptomatic individuals. We also sought to determine whether individuals with a reported family history of premature CHD have an increased atherosclerotic burden among those classified as being at low to intermediate risk on the basis of the conventional Framingham risk score.
Methods and Results— The association of family history of premature CHD with CAC was assessed in 5347 asymptomatic individuals (47% men; mean age 62±10 years) in the Multi-Ethnic Study of Atherosclerosis (MESA). The demographics (age, gender, and race)–adjusted OR for CAC >0 with versus without a family history of premature CHD was 1.94 (95% CI, 1.64 to 2.29). On adjustment for CHD risk factors, the association was slightly attenuated to an OR of 1.84 (95% CI, 1.55 to 2.19). Family history of premature CHD was significantly associated with CAC in all ethnic groups. The age-, gender-, and race-adjusted prevalence of CAC >0 was significantly higher with presence of any family history of premature CHD than for those with no family history of premature CHD among individuals classified as low risk (35% versus 23%, P<0.0001) and among those at intermediate risk (70% versus 60%, P=0.01). Similarly, the prevalence of age-gender-race–based CAC 75th percentile in low-risk (24% versus 14%, P=0.0003) and intermediate-risk (34% versus 20%, P<0.001) individuals was also higher among those with a family history of premature CHD. Compared with those without a family history of premature CHD, the association with the presence of CAC was strongest in participants reporting such history in both a parent and a sibling (odds ratio, 2.74; 95% CI, 1.64 to 4.59), followed by those reporting a family history in a sibling only (odds ratio, 2.06; 95% CI, 1.64 to 2.58) and those reporting a family history of premature CHD only in a parent (odds ratio, 1.52; 95% CI, 1.19 to 1.93).
Conclusions— An association between family history of premature CHD and the presence of any CAC, as well as advanced CAC, was observed in the present population-based multiethnic study. The relationship was independent of other risk factors and Framingham risk score, which supports the utility of including information on family history of premature CHD in current methods of global risk assessment and practice guidelines.

Unstable Angina

ACC/AHA 2007 Guidelines for the Management of
Patients With Unstable Angina/Non–ST-Elevation
Myocardial Infarction
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction)
Developed in Collaboration with the American College of Emergency Physicians, the Society for
Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine

Physical Activity and Public Health in Older Adults. Recommendation From the American College of Sports Medicine and the American Heart Association -- Nelson et al., 10.1161/CIRCULATIONAHA.107.185650 -- Circulation

Physical Activity and Public Health in Older Adults. Recommendation From the American College of Sports Medicine and the American Heart Association -- Nelson et al., 10.1161/CIRCULATIONAHA.107.185650 -- Circulation:
"Summary—The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult’s aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management."

Physical Activity and Public Health. Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association -- Haskell et al., 10.1161/CIRCULATIONAHA.107.185649 -- Circulation

Physical Activity and Public Health. Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association -- Haskell et al., 10.1161/CIRCULATIONAHA.107.185649 -- Circulation:
"Primary Recommendation—To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity."/.../

Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening

NEJM -- Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening:
Eloi Marijon, M.D., Phalla Ou, M.D., David S. Celermajer, Ph.D., F.R.A.C.P., Beatriz Ferreira, M.D., Ph.D., Ana Olga Mocumbi, M.D., Dinesh Jani, M.D., Christophe Paquet, M.D., M.P.H., Sophie Jacob, Ph.D., Daniel Sidi, M.D., Ph.D., and Xavier Jouven, M.D., Ph.D.
"Background Epidemiologic studies of the prevalence of rheumatic heart disease have used clinical screening with echocardiographic confirmation of suspected cases. We hypothesized that echocardiographic screening of all surveyed children would show a significantly higher prevalence of rheumatic heart disease.
Methods Randomly selected schoolchildren from 6 through 17 years of age in Cambodia and Mozambique were screened for rheumatic heart disease according to standard clinical and echocardiographic criteria.
Results Clinical examination detected rheumatic heart disease that was confirmed by echocardiography in 8 of 3677 children in Cambodia and 5 of 2170 children in Mozambique; the corresponding prevalence rates and 95% confidence intervals (CIs) were 2.2 cases per 1000 (95% CI, 0.7 to 3.7) for Cambodia and 2.3 cases per 1000 (95% CI, 0.3 to 4.3) for Mozambique. In contrast, echocardiographic screening detected 79 cases of rheumatic heart disease in Cambodia and 66 cases in Mozambique, corresponding to prevalence rates of 21.5 cases per 1000 (95% CI, 16.8 to 26.2) and 30.4 cases per 1000 (95% CI, 23.2 to 37.6), respectively. The mitral valve was involved in the great majority of cases (87.3% in Cambodia and 98.4% in Mozambique).
Conclusions Systematic screening with echocardiography, as compared with clinical screening, reveals a much higher prevalence of rheumatic heart disease (approximately 10 times as great). Since rheumatic heart disease frequently has devastating clinical consequences and secondary prevention may be effective after accurate identification of early cases, these results have important public health implications. "/.../

Rheumatic Heart Disease in Developing Countries

Jonathan R. Carapetis, Ph.D., F.R.A.C.P.

Only 30 or 40 years ago, rheumatic fever was a common topic in the Journal. A PubMed search for articles on rheumatic fever published between 1967 and 1976 returned 55 New England Journal of Medicine articles — fewer than for endocarditis (77) but more than for stroke and syphilis (24 entries each). A similar PubMed search for the decade 1997 through 2006 yielded just eight entries for rheumatic fever. This trend holds for all Medline-indexed journals: an average of 516 articles on rheumatic fever per year from 1967 through 1976, but only 172 per year from 1997 through 2006. Most observers would probably consider this decrease to be a reasonable reflection of the waning incidence of the disease. After all, in the mid-20th century, children with rheumatic fever occupied many of the beds in pediatric wards in industrialized countries — indeed, entire hospitals were dedicated to the treatment of, and rehabilitation from, rheumatic fever. But in the latter half of the 20th century, rheumatic fever receded as an important health problem in almost all wealthy countries. Today, most physicians in these countries are unlikely ever to see a case of acute rheumatic fever, and their experience with rheumatic heart disease will be limited to heart-valve lesions in older patients who had rheumatic fever in their youth.
The reality, however, is that the decrease in publications reflects only the waning burden of disease among the less than 20% of the world's population living in high-income countries. For everyone else, rheumatic fever and rheumatic heart disease are bigger problems than ever. It was estimated recently that worldwide 15.6 million people have rheumatic heart disease and that there are 470,000 new cases of rheumatic fever and 233,000 deaths attributable to rheumatic fever or rheumatic heart disease each year.1 These are conservative estimates — the actual figures are likely to be substantially higher. Almost all these cases and deaths occur in developing countries.

Ten Years ProCOR

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org]
Em nome de Bernard Lown, MD
Enviada em: sexta-feira, 27 de julho de 2007 15:53
Para: procor@healthnet.org
Assunto: [ProCOR] Dr. Vikas Saini joins Lown Cardiovascular Research Foundation

Dear ProCor colleagues,
At this important point in ProCor's history--celebrating our tenth anniversary, launching the Ashanti-ProCor project to advance our understanding of how we can meet CVD information needs in Ghana and globally, and preparing to announce the first Louise Lown Heart Hero Award recipient, I am pleased to share with you the exciting and important news that Dr. Vikas Saini has been recruited as President of the Lown Cardiovascular Research Foundation. As President, Dr. Saini will work with ProCOR and the Lown Foundation's other programs and will participate in the Lown Group's cardiovascular practice.
When ProCOR was founded a decade ago, the primary intent was to rouse awareness of the mounting cardiovascular epidemic emerging in developing countries as well as to focus on prevention as the only effective remedy. A promissory note for success was the cresting information revolution worldwide. Another element we hoped would make our approach unique was bringing the Lown model of cardiovascular care to global attention by sharing the decades of experience of the Lown Group. The Lown Group, by individualizing care and placing a premium on listening to the patient, has minimized costly interventions, empowered patients to take control of their own health and encouraged them to more readily adopt healthy lifestyles.
Now the right individual has joined with us to address this challenge. Dr. Saini brings extraordinary credentials to this role. Born in Hoshiarpur, a small town in Punjab, India, Dr. Saini came to the US at the age of four. His educational background includes a scholarship to Upper Canada College, and at the extraordinarily young age of 16 he was accepted to Princeton University. Dr. Saini graduated with honors from medical school at Dalhousie University in Halifax, Nova Scotia, Canada, and completed his medical residency at Baltimore City Hospitals, a program of Johns Hopkins University School of Medicine.
With a strong interest in researching the physiology of mind-body interactions, Dr. Saini expressed the desire to study investigative techniques at our research lab in Boston. I offered him a fellowship at the Lown Laboratory at the Harvard School of Public Health, and he immersed himself in the research and clinical activities of the group. He later went on to co-found Aspect Medical Systems, Inc., where he served as its first Vice President of Research & Development and on its Board of Directors. As a founding partner of The Cardiovascular Specialists in Hyannis, Massachusetts, USA, Dr. Saini's experience includes a clinical cardiology practice specializing in conservative cardiovascular alternatives to invasive management. As Vice President of Primary Care, LLC, the largest network of independent primary care providers in Massachusetts, Dr. Saini worked with health plans to improve health care delivery within the network and to assess and develop the group's incorporation of health information technology.
Dr. Saini's research includes developing a hypothesis that anesthetic depth alters the body's inflammatory tone long term, which is currently being tested in clinical trials. Other research includes a clinical trial looking at post-operative inflammation and a project assessing the potential of certain dietary plant poly-phenols for cardiovascular prevention.
Dr. Saini complements all those who have helped sustain our vision over the years. Joining us is a vote of confidence; an affirmation of the Lown Group's potential.
Bernard Lown, MD
Founder and Chair, ProCor