Friday, February 29, 2008

Cholesterol Con

(Referred by Dr. Maria Ines Reinert Azambuja)

http://www.healthbeatblog.org/

February 29, 2008

The Origins of the Cholesterol Con, Part II

Last week, I wrote about the "cholesterol con," the widespread belief that "bad Cholesterol" ( LDL cholesterol) is a major factor driving heart disease, and that cholesterol-lowering drugs like Lipitor and Crestor can protect us against fatal heart attacks. These drugs, which are called "statins," are the most widely-prescribed pills in the history of human medicine. In 2007 world-wide sales totaled $33 billion. They are particularly popular in the U.S., where 18 million Americans take them.

We thought we knew how they worked. But last month, when Merck/Schering Plough finally released the dismal results of a clinical trial of Zetia, a cholesterol-lowering drug prescribed to about 1 million people, the medical world was stunned. Dr. Steven E. Nissen, chairman of cardiology at the Cleveland Clinic called the findings "shocking." It turns out that while Zetia does lower cholesterol levels, the study failed to show any measurable medical benefit. /…/


Thursday, February 28, 2008

WIKILEAKS: site for whistleblowers


... could become as important a journalistic toolas the Freedom of Information Act.
— Time Magazine
Wikileaks
global defense of sources and press freedoms, circa now—
Friday 29 February, 2008
Have documents the world needs to see?
>> We protect your identity while maximizing political impact << class="external text" title="http://news.google.com/news?q=" href="http://news.google.com/news?q=wikileaks&scoring=d" rel="nofollow" scoring="d">Google news
Wikileaks is developing an uncensorable system for untraceable mass document leaking and public analysis. Our primary interests are in Asia, the former Soviet bloc, Latin America, Sub-Saharan Africa and the Middle East, but we expect to be of assistance to peoples of all countries who wish to reveal unethical behavior in their governments and corporations. We aim for maximum political impact...(more)
Interested in how you can help out? Need to contact us as a media representative? Visit our collaborative portal for more information.

Sunday, February 24, 2008

Childhood Stress: Effects on Health across the lifespan.

The Effects of Childhood Stress on Health Across the Lifespan

Stress is an inevitable part of life. It helps children develop the skills they need to cope with and adapt to new and potentially threatening situations throughout life. However, the beneficial aspects of stress diminish when it is severe enough to over­whelm a child's ability to cope effectively. Intensive and prolonged stress can lead to a variety of short- and long-term negative health effects. It can disrupt early brain development and compromise functioning of the nervous and immune systems. In addition, childhood stress can lead to health problems later in life including alcoholism, depression, eating disorders, heart disease, cancer, and other chronic diseases.

The Effects of Childhood Stress on Health Across the Lifespan summarizes the research on childhood stress and its implications for adult health and well-being. Of particular interest is the stress caused by child abuse, neglect, and repeated exposure to intimate partner violence (IPV). This publication provides violence prevention practitioners with ideas about how to incorporate information on childhood stress into their work.

Thursday, February 21, 2008

Cancer: US Statistics

(Referred by Dr. Maria Ines Reinert Azambuja)
Statistics for 2008
The ACS tracks cancer occurrence, including the number of deaths, cases, and how long people survive after diagnosis. ACS also tracks data regarding behaviors that influence the risk of developing cancer and the use of screening tests.
Caution: It is very important to note the information below.
1) Beginning with Cancer Facts & Figures 2007, estimated new cancer cases were computed using a new, more accurate method developed by researchers at the National Cancer Institute and the American Cancer Society. Improvements in the new model include use of data from a much larger percentage of the US population, allowance for geographical variation in cancer incidence, adjustment for delays in reporting, and the inclusion of many socio-demographic, medical facility, lifestyle, and cancer screening behavior variables. Comparisons of estimates produced by the old and new methods were generally similar for all cancers combined but differ substantially for some sites. For more information, see: A New Method of Estimating US Incidence; Projected and Observed Cancer Cases for 2003, New Method; Estimated New Cancer Cases for Selected Cancer Sites by State, US, 2007, Old Method.
2) Beginning with Cancer Facts & Figures 2003, the incidence and mortality data have been age adjusted to the 2000 population standard of the US. This change in method will affect the comparability of the new report's data with that of previous years. The new approach will result in an increase of about 20% in age-adjusted annual incidence rates for all cancers combined and for the most common cancer sites. It will also somewhat affect racial and ethnic differences.

Wednesday, February 20, 2008

Atlas do Desenvolvimento Humano da Região Metropolitana de Porto Alegre

Documento de Análise preliminar. CD completo estará disponível a partir de março próximo.

Tuesday, February 19, 2008

Poverty Is Poison - New York Times

Referencia enviada por Maria Inês Reinert Azambuja
Poverty Is Poison - New York Times
By PAUL KRUGMAN
Published: February 18, 2008
“Poverty in early childhood poisons the brain.” That was the opening of an article in Saturday’s Financial Times, summarizing research presented last week at the American Association for the Advancement of Science.

Monday, February 18, 2008

Saturday, February 16, 2008

2378 – AMICOR10 – 16/02/2008

Friday, February 15, 2008

ProCOR-Resources for Health Promotion

ProCOR-Discussion Forum:
Extensa lista de endereços na INTERNET com recursos úteis particularmente voltados para a ação e Promoção da Saúde
"ProCor Resource Update: February 2008

Wednesday, February 13, 2008

Diabete Mélito: Convite para debate

De: Reginaldo Albuquerque [mailto:reginaldo.albuquerque@gmail.com]
Enviada em: quarta-feira, 13 de fevereiro de 2008 15:42
Assunto: A perigosa volatilidade do conhecimento médico

Achutti: no site publicamos um interessante artigo do colega Augusto Pimazzoni sobre a suspensão pelo FDA do estudo ACCORD.
Discute-se a validade dos trial, os equívocos das amostras, etc. Gerou um debate muito interessante e que está publicado no link:
http://www.diabetes.org.br/Colunistas/Debates/index.php?id=1424
Ficaria feliz se mais algum dos AMICORS participassem da discussão.
Um grande abraço
Reginaldo
O nosso e-book eletrônico "Diabetes na Prática Clínica" foi finalizado. Veja como ficou bonito e como o "conceito" foi desenvolvido.
Ele está editado no site
www.diabetesebook.org.br

Tuesday, February 12, 2008

Developmental Determinants of Disease/Health

Available online at: http://www.blackwell-synergy.com/doi/full/10.1111/j.1742-7843.2007.00169.x

The proceedings (the Faroes statement and 25 invited papers) are now freely available at the journal website:
http://www.blackwell-synergy.com/toc/pto/102/2

The articles demonstrate that the issue of adverse effects during early development is becoming a crucial issue also in toxicology and environmental health. While developmental biologists, nutritionists, and physiologists have explored the science of "developmental programming", the related perspective in regard to adverse effects of environmental stressors is only now becoming apparent. This means that we need to look for causal factors also far back in the past, and that we may easily have missed that goal by several decades. - Philippe Grandjean, MD…."


 

Trends and Cardiovascular Mortality Effects of State-Level Blood Pressure and Uncontrolled Hypertension in the United States

Trends and Cardiovascular Mortality Effects of State-Level Blood Pressure and Uncontrolled Hypertension in the United States
Majid Ezzati PhD*, Shefali Oza SB, Goodarz Danaei MD, and Christopher J.L. Murray MD, DPhil

Monday, February 11, 2008

Study focuses on publication bias in journals

Study focuses on publication bias in journals
Requirements that clinical trials be registered in databases may give physicians a clearer picture of a drug's efficacy, but some argue that more action is needed.

By Susan J. Landers, AMNews staff. Feb. 18, 2008.

Illicit trade in tobacco products

Illicit trade in tobacco products

Thursday, February 07, 2008

WHO: Tobacco Control Efforts

New report on global tobacco control efforts
7 FEBRUARY 2008 NEW YORK -- WHO today released new data showing that while progress has been made, not a single country fully implements all key tobacco control measures, and outlined an approach that governments can adopt to prevent tens of millions of premature deaths by the middle of this century.
Related links
::
Tobacco: topical overview ::
WHO Report of the Global Tobacco Epidemic and related documents

Wednesday, February 06, 2008

Nutrition: The Lancet

The Lancet: Maternal and Child Undernutrition
Website: http://go.worldbank.org/7Q8VB5QK90

The new Lancet series on nutrition, co-authored and co-financed by the World Bank, depicts the lamentable state of under-nutrition worldwide, and a corresponding negligence on the part of the development community to meet the challenge decisively. Under-nutrition represents the non-income face of poverty. And the world is off track on meeting this goal.

Deaths Force NHLBI to Abandon Intensive Glucose- Lowering as Cardiovascular Strategy

BETHESDA, Md., Feb. 6 -- The National Heart, Lung, and Blood Institute has halted the intensive glucose-lowering arm of the ACCORD trial, a cardiovascular-endpoint study of type 2 diabetes.

ACCORD was designed to evaluate the impact of different glucose and lipid-lowering strategies on cardiovascular events in more than 10,251 participants with type 2 diabetes.

According to a press release, there have been 257 deaths in the intensive-treatment group and 203 in the standard treatment group, which is an excess of 54 deaths, or three per 1,000 participants each year, over an average of fours years of treatment./.../

Tuesday, February 05, 2008

Esquizofrenia?...

Artigo meu publicado pelo jornal Zero Hora.

Esquizofrenia?..., por Aloyzio Achutti *

Thursday, January 31, 2008

DIABETES ATLAS – 3rd Edition

Tuesday, January 29, 2008

The State of the World's Children 2008 – Child Survival

http://www.unicef.org/sowc08/docs/sowc08.pdf

Monday, January 28, 2008

What works in Health Care

Washington, DC: The National Academies Press

Available online at: http://www.nap.edu/catalog.php?record_id=12038

Longevidade: novos indicadores

Novos padrões de envelhecimento
Pesquisadores criam indicadores para melhor avaliar a longevidade da população

Sunday, January 27, 2008

A PRÓXIMA GUERRA

Recebi uma mensagem com o documento que segue, do José Azambuja, esposo da Dra. Maria Inês. Como há definitivamente determinação sócio-econômica na saúde/doença, se isto tudo for verdade - e ao menos é plausível – está dentro dos objetivos deste Blog AMICOR.

Wednesday, January 23, 2008

La Critica Medicina

http://lacriticamedicina.blogspot.com/
Dr. Alejandro H. Wajner y Dr. Ernesto Augusto Guidos
Visitem e colaborem.


 

Staying active...

Staying active and drinking moderately is the key to a long life

Friday, January 18, 2008

Investment for Health: Integrating Health in All Policies

Investment for Health: Integrating Health in All PoliciesVenice, 9th-14th, March 2008

Hereditary Hemochromatosis Linked to Iron Overload Mainly in Men - in Public Health & Policy, Genetics from MedPage Today

Medical News: Hereditary Hemochromatosis Linked to Iron Overload Mainly in Men - in Public Health & Policy, Genetics from MedPage Today: "MELBOURNE, Australia, Jan 17 -- In hereditary hemochromatosis with HFE mutations, iron overload developed in a substantial proportion of men but in only a small number of women, according to researchers here. Action Points

U.S. Mortality Rate Hits Record Low in 2005 - in Infectious Disease, Public Health from MedPage Today

Medical News: U.S. Mortality Rate Hits Record Low in 2005 - in Infectious Disease, Public Health from MedPage Today: "HYATTSVILLE, Md., Jan. 17 -- The age-adjusted death rate in the U.S. reached an all-time low in 2005, according to the CDC's National Center for Health Statistics.
The rate dropped 0.2% to 798.8 per 100,000 population, the agency found. In 2004, the rate was 800.8 per 100,000, which had been the previous record low.
Life expectancy held steady at 77.8 years for the entire population, the report said. It increased by 0.1 year for the black population as a whole and by 0.2 years for black females."

Friday, February 15, 2008

ProCOR-Resources for Health Promotion

ProCOR-Discussion Forum:
Extensa lista de endereços na INTERNET com recursos úteis particularmente voltados para a ação e Promoção da Saúde
"ProCor Resource Update: February 2008

ProCor’s monthly “Resource Update' highlights relevant materials, many of which are newly available, in a variety of formats. More resources are available in the Resources section of the ProCor website, www.procor.org. Please share your favorite resources by emailing Juan Ramos, ProCor Program Coordinator, at jramos3@partners.org."

Wednesday, February 13, 2008

Diabete Mélito: Convite para debate

De: Reginaldo Albuquerque [mailto:reginaldo.albuquerque@gmail.com]
Enviada em: quarta-feira, 13 de fevereiro de 2008 15:42
Assunto: A perigosa volatilidade do conhecimento médico

Achutti: no site publicamos um interessante artigo do colega Augusto Pimazzoni sobre a suspensão pelo FDA do estudo ACCORD.
Discute-se a validade dos trial, os equívocos das amostras, etc. Gerou um debate muito interessante e que está publicado no link:
http://www.diabetes.org.br/Colunistas/Debates/index.php?id=1424

Ficaria feliz se mais algum dos AMICORS participassem da discussão.
Um grande abraço
Reginaldo

O nosso e-book eletrônico "Diabetes na Prática Clínica" foi finalizado. Veja como ficou bonito e como o "conceito" foi desenvolvido.
Ele está editado no site www.diabetesebook.org.br

Tuesday, February 12, 2008

developmental determinants of disease/health

Available online at: http://www.blackwell-synergy.com/doi/full/10.1111/j.1742-7843.2007.00169.x

“…….Foetal and early postnatal development likely constitutes the most vulnerable time period of human life, in regard to adverse effects of environmental hazards. Subtle effects during early life can lead to functional deficits and increased disease risks later in life. The programming hypothesis (i.e. that early development determines subsequent organ functions and disease risks), has gathered much support from both experimental and epidemiological studies. The prenatal and early postnatal environment affects gene expression, and epigenetic changes may constitute an important mechanism for the programming effects. All of this information suggests that the timing of exposure to environmental chemical is crucial in determining the toxicity effects. These important insights are likely to be of importance for new research in environmental health and related fields, and for health promotion and prevention purposes.


An international conference was therefore organized to review the current research frontline and stimulate cross-disciplinary research and collaboration in regard to developmental programming caused by environmental chemical exposures. The meeting was held on 20–24 May 2007, and the venue was the Nordic Conference Centre in Tórshavn, the capital city of the Faroe Islands. Over 120 scientific papers were presented, half of them as lectures. All abstracts and most of the posters are available at the conference website (http://www.pptox.dk). ….”

“……just published report on the impact of Prenatal programming and toxicity. It is based on a conference held last May. This volume (and the conference) were sponsored by WHO HQ, by NIH and the U.S.EPA.

In collaboration with the journal editor, the publisher has provided open access to thsi special issue. One outcome of the conference was the "Faroes statement", which received wide attention in the news media last year.

The proceedings (the Faroes statement and 25 invited papers) are now freely available at the journal website:
http://www.blackwell-synergy.com/toc/pto/102/2

The articles demonstrate that the issue of adverse effects during early development is becoming a crucial issue also in toxicology and environmental health. While developmental biologists, nutritionists, and physiologists have explored the science of "developmental programming", the related perspective in regard to adverse effects of environmental stressors is only now becoming apparent. This means that we need to look for causal factors also far back in the past, and that we may easily have missed that goal by several decades. - Philippe Grandjean, MD….”

Trends and Cardiovascular Mortality Effects of State-Level Blood Pressure and Uncontrolled Hypertension in the United States

Trends and Cardiovascular Mortality Effects of State-Level Blood Pressure and Uncontrolled Hypertension in the United States
Majid Ezzati PhD*, Shefali Oza SB, Goodarz Danaei MD, and Christopher J.L. Murray MD, DPhil

From the Harvard School of Public Health, Boston (M.E., G.D., C.J.L.M.), and Initiative for Global Health, Harvard University, Cambridge (M.E., S.O., G.D., C.J.L.M.), Mass, and Institute for Health Metrics and Evaluation, University of Washington (C.J.L.M.), Seattle.

* To whom correspondence should be addressed. E-mail: majid_ezzati@harvard.edu.

Background—Blood pressure is an important risk factor for cardiovascular disease and mortality and has lifestyle and healthcare determinants that vary across states. Only self-reported hypertension status is measured at the state level in the United States. Our aim was to estimate levels and trends in state-level mean systolic blood pressure (SBP), the prevalence of uncontrolled systolic hypertension, and cardiovascular mortality attributable to all levels of higher-than-optimal SBP.

Methods and Results—We estimated the relationship between actual SBP/uncontrolled hypertension and self-reported hypertension, use of blood pressure medication, and a set of health system and sociodemographic variables in the nationally representative National Health and Nutrition Examination Survey. We applied this relationship to identical variables from the Behavioral Risk Factor Surveillance System to estimate state-specific mean SBP and uncontrolled hypertension. We used the comparative risk assessment methods to estimate cardiovascular mortality attributable to higher-than-optimal SBP. In 2001–2003, age-standardized uncontrolled hypertension prevalence was highest in the District of Columbia, Mississippi, Louisiana, Alabama, Texas, Georgia, and South Carolina (18% to 21% for men and 24% to 26% for women) and lowest in Vermont, Minnesota, Connecticut, New Hampshire, Iowa, and Colorado (15% to 16% for men and {approx}21% for women). Women had a higher prevalence of uncontrolled hypertension than men in every state by 4 (Arizona) to 7 (Kansas) percentage points. In the 1990s, uncontrolled hypertension in women increased the most in Idaho and Oregon (by 6 percentage points) and the least in the District of Columbia and Mississippi (by 3 percentage points). For men, the worst-performing states were New Mexico and Louisiana (decrease of 0.6 and 1.3 percentage points), and the best-performing states were Vermont and Indiana (decrease of 4 and 3 percentage points). Age-standardized cardiovascular mortality attributable to higher-than-optimal SBP ranged from 200 to 220 per 100 000 (Minnesota and Massachusetts) to 360 to 370 per 100 000 (District of Columbia and Mississippi) for women and from 210 per 100 000 (Colorado and Utah) to 370 per 100 000 (Mississippi) and 410 per 100 000 (District of Columbia) for men.

Conclusions—Lifestyle and pharmacological interventions for lowering blood pressure are particularly needed in the South and Appalachia, and with emphasis on control among women. Self-reported data on hypertension diagnosis from the Behavioral Risk Factor Surveillance System can be used to obtain unbiased state-level estimates of blood pressure and uncontrolled hypertension as benchmarks for priority setting and for designing and evaluating intervention programs.


Key words: blood pressure • cardiovascular diseases • hypertension • models, statistical • mortality • risk factors • United States

Monday, February 11, 2008

Study focuses on publication bias in journals

Study focuses on publication bias in journals
Requirements that clinical trials be registered in databases may give physicians a clearer picture of a drug's efficacy, but some argue that more action is needed.

By Susan J. Landers, AMNews staff. Feb. 18, 2008.

Washington -- Physicians trying to keep up with the latest journal articles have their work cut out for them in more ways than one. First, there is the massive number of articles to read. Second, the possibility of publication bias must be considered. Both pose significant challenges when weighing the risks and benefits of therapeutic treatments.

"Evidence shows that even if physicians were to do their darndest to keep up with all of the literature ... and even if they were just keeping up with the quality journals, they would still have to read 19 articles a day, 365 days a year. They just can't do it," said Kay Dickersin, PhD, professor of epidemiology and director of the Center for Clinical Trials at Johns Hopkins University's Bloomberg School of Public Health in Baltimore.
With this article
* How selective?

* Discuss on SermoDiscuss on Sermo

* See related content

Plus, a study in the Jan. 17 New England Journal of Medicine, which quantified the previously recognized problem of publication bias, shows that it can be difficult to gather all the information needed to properly assess a medication by reviewing journal articles, since negative data are not always accessible.

The researchers determined that 94% of published studies on 12 antidepressants were positive. In contrast, an FDA analysis found that only 51% of all studies on the antidepressants, including those that were not published, were positive. "Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals and patients," the authors concluded.

The message is "Don't believe everything you don't read," said lead author Erick Turner, MD, assistant professor of psychiatry and assistant professor of pharmacology at the Oregon Health & Science University in Portland. He said he would welcome other researchers' efforts to apply his study technique to other drug classes.

When asked about the study's findings, the NEJM editors responded in a statement: "We published this paper because the authors went to such extremes to find all the previously unpublished data. It is critically important that physicians have all the available data when deciding which drugs to prescribe for their patients."

Pharmaceutical firms contested the findings. "We are definitely committed to full transparency," said Gwen Fisher, a spokeswoman for Wyeth Pharmaceutical, manufacturer of the antidepressant Effexor. "We make them available in a number of ways, through abstracts and presentations as well as through publication."

Eli Lilly and Co., manufacturer of Prozac, objected to implications in news stories about the study that seemed to suggest the company had suppressed negative trial results. The firm said in a statement, "We clearly have been transparent. The data is publicly available online; we've presented it -- more than once -- in peer-reviewed medical journals."

David Fassler, MD, clinical professor of psychiatry at the University of Vermont in Burlington, called the study useful and interesting, noting that publication bias presents "a significant problem for physicians, researchers and the general public."

"Published literature may overstate the efficacy or understate the risks of specific medications and/or other interventions," said Dr. Fassler, who also represents the American Academy of Child and Adolescent Psychiatry in the AMA House of Delegates.

David Shern, PhD, president of Mental Health America, formerly the National Mental Health Assn., also pointed out the value of the study but cautioned that people with depression should not be discouraged from seeking appropriate care. "It is critical that people understand that antidepressants do work and continue to help millions of Americans recover from depression and other mental health conditions."

Organized medicine has been in the forefront of addressing this issue, Dr. Fassler added. The AMA responded to concerns about the possibility of publication bias in pharmaceutical research in a 2004 report calling for a centralized, publicly accessible registry of all clinical trials. The recommendation received a boost from Congress and the president last fall. A new law now requires the expansion of an existing federal registry.

Also, major journals, including the Journal of the American Medical Association and the NEJM, require that clinical trials that serve as the basis for journal articles and evaluate therapeutic interventions be registered in a central, government-run database.

But a problem remains, Dr. Turner said. Databases do not include the drugs approved before this requirement was put in place. "What about all [those] drugs?" he asks. He cited top-selling Lipitor as an example of a drug in this category. "Are we just going to grandfather that in? We won't know the real data."

Instead, Dr. Turner suggests that an existing cache of data -- that assembled by the Food and Drug Administration for its review of new drug applications -- be made more readily available to the public. This solution would complement proposals by the AMA and others for clinical trial registries, wrote Dr. Turner in a December 2004 essay in the Public Library of Science Medicine, an open-access journal published online by a nonprofit organization of scientists.

Dr. Fassler suggests other steps be taken, too. "Journal editors need to ensure that well-designed studies with negative results are accepted for publication at the same rate as comparable studies with positive findings."

In addition, he urged physicians, the media and the general public to remain vigilant. "We need to read and interpret new studies with appropriate caution."

Discuss on Sermo Discuss on Sermo Back to top.

ADDITIONAL INFORMATION:
How selective?

Objective: To examine if a trial's outcome -- positive or negative -- influenced whether that study was published.

Methods: Researchers examined studies regarding 12 antidepressants that involved 12,564 patients.

Results: Based on their review of the published literature, 94% of the trials conducted appeared to be positive. By contrast, an FDA analysis of published and unpublished data found 51% to be positive.

Conclusions: The researchers determined that selective reporting of clinical trials may have adverse consequences for researchers, study participants, health care professionals and patients.

Source: "Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy," New England Journal of Medicine, Jan. 17

Back to top.
Copyright 2008 American Medical Association. All rights reserved.

RELATED CONTENT You may also be interested in:
IOM panel seeks program to evaluate research, guidelines Feb. 18
New law expands FDA monitoring, funds Oct. 22/29, 2007
Clinical trial data: Getting the complete picture Editorial June 27, 2005
Let sun shine on clinical results Editorial July 26, 2004
WHO plans global clinical trials registry July 26, 2004
Drug controversies prompt call for clinical trial registry July 5, 2004

American Medical Association - AMNews home - Latest issue - Site info - About - Contact

E-MAIL this page
PRINT this page
DISCUSS on Sermo
WRITE a letter about it
REPORT site problems
SITE CONTENT
Most content is available for 90 days. Full archives are reserved for AMA members and AMNews paid subscribers. Details
Log in
Top items
this week

GOVERNMENT Wellness programs can't discriminate over health
PROFESSION Ga. Blues sued under any-willing-provider law
BUSINESS United faces stiff fines
OPINION Path to better physician-hospital relationships
HEALTH Doctors take new look at hormone therapy sa

Illicit trade in tobacco products

Illicit trade in tobacco products

Thursday, February 07, 2008

WHO: Tobacco Control Efforts

New report on global tobacco control efforts
7 FEBRUARY 2008 NEW YORK -- WHO today released new data showing that while progress has been made, not a single country fully implements all key tobacco control measures, and outlined an approach that governments can adopt to prevent tens of millions of premature deaths by the middle of this century.
Related links
:: Tobacco: topical overview :: WHO Report of the Global Tobacco Epidemic and related documents
In a new report which presents the first comprehensive analysis of global tobacco use and control efforts, WHO finds that only 5% of the world’s population live in countries that fully protect their population with any one of the key measures that reduce smoking rates. The report also reveals that governments around the world collect 500 times more money in tobacco taxes each year than they spend on anti-tobacco efforts. It finds that tobacco taxes, the single most effective strategy, could be significantly increased in nearly all countries, providing a source of sustainable funding to implement and enforce the recommended approach, a package of six policies called MPOWER (see below).

Wednesday, February 06, 2008

Nutrition: The Lancet

The Lancet: Maternal and Child Undernutrition

Website: http://go.worldbank.org/7Q8VB5QK90

The new Lancet series on nutrition, co-authored and co-financed by the World Bank, depicts the lamentable state of under-nutrition worldwide, and a corresponding negligence on the part of the development community to meet the challenge decisively. Under-nutrition represents the non-income face of poverty. And the world is off track on meeting this goal.

More than a third of child deaths and 11% of the total disease burden worldwide are due to maternal and child undernutrition. These and other stark findings are the conclusions of an international collaboration of investigators publishing their findings in The Lancet's maternal and child undernutrition series.

The series was launched in London on January 16, 2008 at the Science and Media Centre

Nutrition has slipped through the gap
Nutrition is a desperately neglected aspect of maternal, newborn, and child health. The reasons for this neglect are understandable but not justifiable. In a comment that opens the maternal and child undernutrition series, The Lancet Editor Dr Richard Horton draws together the themes of the series, and calls on agencies, donors and political leaders to step up to this very serious challenge. He says "Undernutrition is the largely preventable cause of over a third - 3.5 million - of all child deaths. Stunting, severe waste wasting and intrauterine growth restriction are among the most important problems. There is a golden interval for intervention: from pregnancy to 2 years of age. After age 2 years, undernutrition will have caused irreversible damage for future development towards adulthood". The comment concludes by saying that the international nutrition system is broken. Leadership is absent, resources are too few, capacity is fragile, and emergency response systems are urgently needed.

Over a third of child deaths and 11% of global disease burden due to maternal and child undernutrition
More than one third of child deaths and 11% of the total disease burden worldwide are due to maternal and child undernutrition. Authors of the first paper in the series say "Maternal and child undernutrition is highly prevalent in low-income and middle-income countries, resulting in substantial increases in mortality and overall disease burden." By doing an analysis that accounted for co-exposure of nutrition-related factors, the authors found that these factors were together responsible for 35% of child deaths globally and 11% of the total disease burden. The paper concludes by making a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences.

Poor fetal growth or stunting in first two years of life leads to huge negative consequences in later life
Authors of the second paper of the series conclude that poor fetal growth or stunting in the first two years of life can lead to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income and decreased offspring birthweight for women. The researchers analysed the association between child and maternal undernutrition with human capitol and risk of adult disease in low-and-middle-income countries, focussing on five long-standing studies in Brazil, Guatemala, India, the Philippines, and South Africa. They showed that indicators of undernutrition at age two years were related to adult outcomes. Further, they found that children who are undernourished in the first two years of life, and who put on weight rapidly later in childhood and in adolescence are at a high risk of chronic diseases related to nutrition. But they found no evidence that rapid weight gain or height gain in the first two years life increases the risk of chronic disease, even in children with poor fetal growth. The authors conclude by saying "...damage suffered in early life leads to permanent impairment, and might also affect future generations. Its prevention will probably bring about important health, educational, and economic benefits."

Maternal and child nutrition interventions could prevent a quarter of child deaths in poor communities
Implementation of existing maternal and child nutrition-related interventions could prevent a quarter of all child deaths in the 36 countries with the highest burden of undernutrition. Breastfeeding counselling and vitamin A supplementation are currently the nutrition strategies with the greatest potential to cut child deaths, comment the authors of the third paper in the series. The authors studied how a variety of nutritional factors affected children's growth patterns and risk of death. In populations with enough food, education about complimentary feeding increased the height-for-age score, while provision of food supplements increased the score further in food-insecure populations. Further, the authors also found that management of severe acute malnutrition using WHO guidelines can reduce case-fatalities related to this condition by 55%, but this requires admission to a health facility. The authors add that nutrition strategies on their own are not enough, concluding by saying "Attention to the continuum of maternal and child undernutrition is essential to attainment of several of the Millennium Development Goals and must be prioritised globally and within countries... What is needed is the technical expertise and the political will to combat undernutrition in the very countries that need it most."

80% of world's undernourished children live in just 20 countries
Authors of the fourth paper in the series highlight how 80% of the world's undernourished children live in just 20 countries, and intensified nutrition action in these countries can lead to achievement of the first Millennium Development Goal and greatly increase the chances of achieving goals for child and maternal mortality. They address seven key challenges for addressing undernutrition at national level, including; getting nutrition on the list of priorities, and also keeping it there. The paper looks at the varied situation within and across Latin American countries, which as a whole have experienced a large drop in stunting, being underweight, and wasting; and China, where a multisectoral approach has seen rapid nutritional improvement. The authors caution that nutrition resources should not be used to support actions unlikely to be effective in real life setting of a particular country, nor to support actions that have not been proven to have a direct effect on undernutrition They conclude by asking "What can be done?...there are no simple prescriptions to reduce undernutrition, although high coverage with four or five of the proven interventions would certainly have a sizeable effect", charging leaders at country level to review their existing strategies and programmes.

The international nutrition system: fragmented, dysfunctional and desperately in need of reform
The final paper in the series states that the international nutrition system - made up of international and donor organisations, academia, civil society, and the private sector - is fragmented and dysfunctional, and needs reform, say authors of the fifth and final paper in the series. They say: "Financial, intellectual, and personal linkages bind these organisations loosely together as components of an international nutrition system... we argue that such a system should deliver in four functional areas: stewardship, mobilisation of financial resources, direct provision of nutrition services at times of natural disaster or conflict, and human and institutional resource strengthening." Their analysis of evidence to date finds that currently, there are substantial shortcomings in each of the areas above. Fragmentation, lack of evidence for prioritised action, institutional inertia, and failure to join up with promising developments in parallel sectors are recurrent themes. Many problems are systemic within organisations in the field. They suggest five priority areas for action to create a much stronger international nutrition system, and call for research leadership in areas that matter. The authors conclude by saying "The moment is ripe for these reforms. Their implementation would transform the political salience of undernutrition, and offer the chance of a better, more productive life to the 67 million children born each year in the countries most severely afflicted by undernutrition."



Other Articles in the series:

The Challenge of hunger, Josette Sheeran.

Nutrition interventions need improved operational capacity, Geert Tom Heikens, Beatrice C Amadi, Mark Manary.

The speakers at the event were:

Dr Richard Horton, Editor, The Lancet
Professor Zulfiqar Bhutta, Department of Pediatrics and Child Health, Aga Khan University Pakistan
Professor Caroline Fall, Medical Research Council Epidemiology Resource Centre, University of Southampton, UK
Professor Simon Cousens, London School of Hygiene and Tropical Medicine, UK
Dr Denise Coitinho, WHO on temporary secondment to World Food Programme
Dr Bruce Cogill, UNICEF



* * * *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ IKM Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------

PAHO/WHO Website: http://www.paho.org/

EQUITY List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

Deaths Force NHLBI to Abandon Intensive Glucose- Lowering as Cardiovascular Strategy

BETHESDA, Md., Feb. 6 -- The National Heart, Lung, and Blood Institute has halted the intensive glucose-lowering arm of the ACCORD trial, a cardiovascular-endpoint study of type 2 diabetes.

ACCORD was designed to evaluate the impact of different glucose and lipid-lowering strategies on cardiovascular events in more than 10,251 participants with type 2 diabetes.

According to a press release, there have been 257 deaths in the intensive-treatment group and 203 in the standard treatment group, which is an excess of 54 deaths, or three per 1,000 participants each year, over an average of fours years of treatment./.../

Tuesday, February 05, 2008

Esquizofrenia?...

Artigo meu publicado pelo jornal Zero Hora.

05 de fevereiro de 2008 | N° 15501

Artigo

Esquizofrenia?..., por Aloyzio Achutti *

Dissociações conflitantes entre comportamento, afeto e conhecimento levam a desconfiar da saúde mental. A associação de delírios, surtos de agressividade e atitudes extravagantes e de risco, pode contribuir para um diagnóstico específico de esquizofrenia, mesmo em pessoas aparentemente normais em alguns momentos de suas vidas.

A cultura é a expressão de um cérebro coletivo - incluindo os nossos - assim como a junção dos neurônios compõe um cérebro individual.

Nosso desenvolvimento científico, tecnológico e artístico, com tantas conquistas e realizações maravilhosas, só fazem aumentar as dúvidas com relação à saúde mental de nossa sociedade, quando pareados com a violência, adição ao álcool, fumo e outras drogas, sexo irresponsável, comportamento de risco, desigualdade social, culto de fantasias e delírios coletivos.

Apregoamos o amor e a solidariedade, mas apreciamos a briga, a disputa e a guerra. Sabemos dos malefícios do abuso do álcool, e até organizamos campanhas e estabelecemos legislações restritivas, mas fazemos propaganda adoidada e altamente sugestiva do consumo de cerveja e de outras bebidas. Com relação ao fumo também nosso comportamento continua ambivalente: tentamos controlar o seu uso, mas apreciamos seus lucros. As outras drogas, embora oficialmente proscritas, continuam embalar nossas festas. A função básica destinada à perpetuação da espécie tem sido cada vez mais explorada irresponsavelmente, a ponto de ter se tornado um instrumento de transmissão de doenças. Nossos heróis têm sido aqueles que se arriscam para além dos limites toleráveis pela natureza. Nossas riquezas pouco têm servido para equilibrar o desenvolvimento humano e social. Muitos recursos midiáticos tem se dedicado ao fomento da fantasia alienante. Os rituais que têm reunido maiores massas abusam de técnicas que levam ao delírio coletivo.

Houve época em que os indivíduos alienados eram encerrados em manicômios com o pretexto de escondê-los ou de proteger a sociedade. Hoje temos especialistas e drogas que podem controlá-los. Entretanto, não aprendemos ainda a assumir o diagnóstico social, particularmente daqueles desvios somente perceptíveis quando examinados coletivamente.

Ou será que nossa insanidade chega ao ponto de priorizar o lucro auferido explorando as fragilidades do ser humano, e do sucesso conseguido com a captação de clientela cativa através dos mecanismos de dependência psicológica e física?

Ao mesmo tempo em que vasculhamos a biologia de cada indivíduo em busca da explicação para o que nos deixa perplexos, não podemos nos distrair e perder a perspectiva do macro onde se constrói em grande parte a doença, onde ela se monta, e do que ela se alimenta.

Enquanto pessoas mais centradas tentam cuidar dos desviantes, nosso grande dilema é conseguir que uma sociedade esquizofrênica cuide de si mesma...

* Médico

Monday, February 04, 2008

2008 Louise Lown Heart Hero Award: Call for Applications.

Greetings Dr. Achutti,


 

I have started to distribute the call for applications for the 2008 Louise Lown

Heart Hero Award. I would greatly appreciate if you could mention the award on

the Amicor blog. All the information for the award is below, as well as on the

ProCor website, www.procor.org.


 

Let me know if you have any questions.


 

Regards,


 

Juan Ramos

ProCor Program Coordinator

Lown Cardiovascular Research Foundation

21 Longwood Ave.

Brookline MA 02446 USA

1 (617) 732 1318 ext. 3319

jramos3@partners.org

www.ProCor.org


 

MEDWATCH: Varenicline and others


 

Varenicline (marketed as Chantix)

Audience: Neuropsychiatric and other healthcare professionals, consumers
[Posted 02/01/2008] FDA informed healthcare professionals and consumers of important revisions to the WARNINGS and PRECAUTIONS sections of the prescribing information for Chantix regarding serious neuropsychiatric symptoms experienced in patients taking Chantix. These symptoms include changes in behavior, agitation, depressed mood, suicidal ideation, and attempted and completed suicide. While some patients may have experienced these types of symptoms and events as a result of nicotine withdrawal, some patients taking Chantix who experienced serious neuropsychiatric symptoms and events had not yet discontinued smoking. In most cases, neuropsychiatric symptoms developed during Chantix treatment, but in others, symptoms developed following withdrawal of Chantix therapy. See the FDA Information for Healthcare Professionals Sheet for recommendations and considerations for healthcare professionals on using Chantix therapy for patients.

[February 01, 2008 -
Public Health Advisory - FDA]
[February 01, 2008 - Prescribing Information - Pfizer]
[February 01, 2008 - Healthcare Professional Information Sheet - FDA]

Return to Top | MedWatch Home | MedWatch Safety Info | Online MedWatch Report | Contact MedWatch


 

Antiepileptic Drugs

Audience: Neuropsychiatric healthcare professionals, other healthcare professionals, patients
[Posted 01/31/2008] FDA informed healthcare professionals that the Agency has analyzed reports of suicidality (suicidal behavior or ideation) from placebo-controlled clinical studies of eleven drugs used to treat epilepsy as well as psychiatric disorders, and other conditions. In the FDA's analysis, patients receiving antiepileptic drugs had approximately twice the risk of suicidal behavior or ideation (0.43%) compared to patients receiving placebo (0.22%). The increased risk of suicidal behavior and suicidal ideation was observed as early as one week after starting the antiepileptic drug and continued through 24 weeks. The results were generally consistent among the eleven drugs. The relative risk for suicidality was higher in patients with epilepsy compared to patients who were given one of the drugs in the class for psychiatric or other conditions.

Healthcare professionals should closely monitor all patients currently taking or starting any antiepileptic drug for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.

The drugs included in the analyses include (some of these drugs are also available in generic form):

Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR)
Felbamate (marketed as Felbatol)
Gabapentin (marketed as Neurontin)
Lamotrigine (marketed as Lamictal)
Levetiracetam (marketed as Keppra)
Oxcarbazepine (marketed as Trileptal)
Pregabalin (marketed as Lyrica)
Tiagabine (marketed as Gabitril)
Topiramate (marketed as Topamax)
Valproate (marketed as Depakote, Depakote ER, Depakene, Depacon)
Zonisamide (marketed as Zonegran)

Although the 11 drugs listed above were the ones included in the analysis, FDA expects that the increased risk of suicidality is shared by all antiepileptic drugs and anticipates that the class labeling changes will be applied broadly.

[January 31, 2008 -
Healthcare Professional Information Sheet - FDA]

Return to Top | MedWatch Home | MedWatch Safety Info | Online MedWatch Report | Contact MedWatch