Bridging the divide: global governance of trade and health

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia@paho.org>
crossposted from: EQUIDAD@listserv.paho.org

Bridging the divide: global governance of trade and health

 

Kelley Lee, Devi Sridhar, Mayur Patel

This is the second in a Series of six papers on trade and health Centre on Global Change and Health, London School of Hygiene and Tropical Medicine,

London, UK (K Lee DPhil); and All Souls College, Department of Politics and International Relations (D Sridhar DPhil) and Department of International

Development (M Patel MPhil), University of Oxford, Oxford, UK

Volume 373, Issue 9661, Pages 353-432 - 31 January 2009-6 February 2009

 

Abstract:  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61776-6/abstract

 

The main institutions responsible for governing international trade and health—the World Trade Organization (WTO), which replaced the General Agreement on Tariff s and Trade (GATT) in 1995, and WHO—were established after World War 2. For many decades the two institutions operated in isolation, with little cooperation between them.

The growth and expansion of world trade over the past half century amid economic globalisation, and the increased importance of health issues to the functioning of a more interconnected world, brings the two domains closer together on a broad range of issues. Foremost is the capacity of each to govern their respective domains, and their ability to cooperate in tackling issues that lie at the intersection of trade and health. This paper discusses how the governance of these two areas relate to one another, and how well existing institutions work together…"

 

Trade and Health SERIES – The Lancet

Launched in London, UK, Jan 21, 2009

"The fact that trade directly and indirectly affects the health of the global population with an unrivalled reach and depth undoubtedly makes it a key health issue", states a Comment introducing the Series.

Executive summary

Many health professionals perceive trade as complex or unrelated to their practice. The Series on trade and health provides timely analysis of the key challenges to achieving an appropriate balance between trade and health across a diverse range of issues. This six-part Series examines differences in structures of the World Trade Organization and the World Health Organization that promote wealth before health. Issues of global trade governance, effects of trade practices on health of workers and the implications of intellectual property rights for access to live-saving medicines are all explored.

 

Series Comments

Trade and health: time for the health sector to get involved

Rhona MacDonald, Richard Horton

Full Text | PDF

Trade agreements and health in developing countries

Joseph E Stiglitz

Full Text | PDF

Health before profits? Learning from Thailand's experience

Mongkol Na Songkhla

Full Text | PDF

Trade and health: the need for a political economic analysis

David Legge, David Sanders, David McCoy

Full Text | PDF

Series Papers

Managing the pursuit of health and wealth: the key challenges

David P Fidler, Nick Drager, Kelley Lee

Summary | Full Text | PDF

Bridging the divide: global governance of trade and health

Kelley Lee, Devi Sridhar, Mayur Patel

Summary | Full Text | PDF

Trade and social determinants of health

Chantal Blouin, Mickey Chopra, Rolph van der Hoeven

Summary | Full Text | PDF

Trade in health-related services

Richard D Smith, Rupa Chanda, Viroj Tangcharoensathien

Summary | Full Text | PDF

Trade, TRIPS, and pharmaceuticals

Richard D Smith, Carlos Correa, Cecilia Oh

Summary | Full Text | PDF

Trade and health: an agenda for action

Richard D Smith, Kelley Lee, Nick Drager

Summary | Full Text | PDF

State of the World's Forests 2007 Food and Agriculture Organization of the United Nations  Rome, 2007

---

The designations employed and the presentation of material in this information product do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations concerning the legal or development status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

The designations employed and the presentation of material in the maps do not imply the expression of any opinion whatsoever on the part of FAO concerning the legal or constitutional status of any country, territory or sea area, or concerning the delimitation of frontiers./.../

Alcoolismo causa 57 mortes por dia no Brasil

Data: 20/01/2009

Estado: MS

A taxa de mortalidade por doenças associadas ao alcoolismo subiu de 10,7 para 12,64 óbitos por 100 mil habitantes em seis anos. 

Os dados, revelados em uma pesquisa feita pelo Ministério da Saúde, comparam os números registrados em 2000 e 2006 e, na avaliação de especialistas, pode ser ainda maior. 

“Esta é uma mostra do grave problema de saúde pública provocado pelo excesso de bebida”, assegura a coordenadora do Departamento de Análise de Situação de Saúde do Ministério da Saúde, Deborah Malta. 

Global Warming May Be Irreversible

Global Warming May Be Irreversible

Written by Nancy Atkinson

A new paper published by a leading researcher says many effects of climate change are already irreversible. Susan Solomon, a leader of the International Panel on Climate Change and a scientist with National Oceanic and Atmopheric Association (NOAA) said even if carbon emissions were stopped, temperatures around the globe will remain high until at least the year 3000. And if we continue with our current carbon dioxide emissions for just a few more decades, we could see permanent "dust bowl" conditions.Global Warming May Be Irreversible
Written by Nancy Atkinson

Early Life Stress May Have Consequences for Immune Function

By Todd Neale, Staff Writer, MedPage Today
Published: January 27, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

MADISON, Wis., Jan. 27 -- Children who go through stressful situations early in life may have weakened immune systems as they enter adolescence, researchers found.

Dinheiro bom...

28 de janeiro de 2009 |Jornal Zero Hora N° 15862
ARTIGOS
Dinheiro bom...,
por Aloyzio Achutti *
Há uma expressão popular que diz: Não se coloca dinheiro bom em cima de coisa ruim.

Entendidos no assunto têm, repetidas vezes, afirmado que a tão falada, e sentida, crise econômica tem sua origem em defeitos na aplicação do sistema econômico. Há quem considere até como autodefesa do capitalismo contra os abusos que vêm sendo tolerados e acobertados – particularmente onde o volume de dinheiro rola mais livre.

Problemas estruturais e de macropolítica são evidentes, basta lembrar a enorme e progressiva desigualdade socioeconômica espalhada pelo mundo, degradação do meio ambiente (chegando a ameaçar o clima global e a vida), a necessidade de inventar guerras para incrementar a indústria de material bélico para destruir e depois reconstruir, sem falar no pretexto de invasões para controlar insumos estratégicos...

Se perguntarem por que um médico mete sua colher torta em assunto que não é de sua especialidade, eu diria que além de sentir no bolso, e na consciência de cidadão do mundo, também a prática da medicina está contaminada, e favorece associar os feitos da economia com situações semelhantes de nossa experiência.

O decantado progresso da medicina tem se feito (principalmente a partir do modelo americano) através de investimentos em intervenções caríssimas e pouco eficientes, voltadas para pequeno número com doenças avançadas – atingindo hoje US$ 1 trilhão por ano nos EUA – e deixando 30 milhões sem cobertura.

Ninguém pode dizer que faltam médicos no Brasil. A falta de saúde não será resolvida injetando mais médicos onde faltam condições socioeconômicas para a população, acesso aos serviços e melhores condições de trabalho para os profissionais.

Ao modo da indústria bélica, a farmacêutica e de equipamentos também influem na percepção das necessidades e na definição das prioridades na pesquisa, na formação profissional e no serviço.

Recursos econômicos não faltam nos países onde a crise se desencadeou. Injetar mais dinheiro público é parecido com propiciar mais comida para quem já tem excesso de peso, ou sofre de complicações da obesidade (uma das causas mais importantes de doenças crônicas no mundo de hoje).

Há mais de 50 anos, o diretor da OMS já dissera que, se nenhum avanço tecnológico se fizesse, mas se melhorasse a distribuição dos cuidados básicos, com o que já se conhece, haveria mais saúde no mundo.

Da mesma forma, suspeito que se tanto dinheiro junto como nunca se viu (podendo chegar a US$ 3 trilhões) fosse empregado para a reforma do sistema, a busca de soluções energéticas renováveis e menos poluentes, teríamos mais chance de encontrar melhores saídas para a saúde global – incluindo a financeira – e para o equilíbrio macropolítico e do poder.

*MÉDICO

Relative Child Poverty, Income Inequality, Wealth, and Health

Eric Emerson, PhD
JAMA. 2009;301(4):425-426.

Abundant evidence now suggests that living in relative poverty and exposure to relative income inequality, especially in childhood, may have a detrimental influence on health and well-being during childhood and across the life course. This Commentary discusses the importance of relative poverty in childhood and the implications of income inequality for population health.

Child relative poverty (ie, children living in a household with relative income poverty) appears to be a potentially important indicator for children's health. Relative income poverty is commonly defined as having equivalized household income of less than 50% of the national median.1 Equivalization is calculated by dividing household income by an indicator of household composition or need, for example, the square root of the number of individuals living in the household.2 Child relative poverty is strongly related to overall income inequality as measured by the Gini coefficient, which reflects inequalities in the distribution of income and wealth for the population of a nation; a lower Gini coefficient suggests more equal income or wealth distribution, whereas a high Gini coefficient reflects more unequal distribution of income and wealth.3 For instance, the United States has both the highest national wealth and the highest Gini coefficient.3 Thus, in the United States, as with many of the world's richest countries, there is little or no association between national wealth and the levels of income inequality evident within those nations.

A conceptual framework for public health: NICE's emerging approach

Ruggiero, Mrs. Ana Lucia (WDC) to EQUIDAD
show details 1:33 PM (6 hours ago)

M.P. Kelly, E. Stewart, A. Morgan, A. Killoran, A. Fischer, A. Threlfall and J. Bonnefoy

Centre for Public Health Excellence, National Institute for Health and Clinical Excellence, London, UK; Greater Manchester Public Health Network, Manchester, UK ;Division of Healthy Public Policies, Ministry of Health, Santiago, Chile

Public Health 123 (2009) e14–e20 December 2008 - The Royal Society for Public Health - . e-Supplement

“….This paper outlines the National Institute for Health and Clinical Excellence's (NICE) emerging conceptual framework for public health. This is based on the experience of the first 3 years of producing public health guidance at NICE (2005–2008).



The framework has been used to shape the revisions to NICE's public health process and methods manuals for use post 2009, and will inform the public health guidance which NICE will produce from April 2009. The framework is based on the precept that both individual and population patterns of disease have causal mechanisms.

These are analytically separate. Explanations of individual diseases involve the interaction between biological, social and related phenomena. Explanations of population patterns involve the same interactions, but also additional interactions between a range of other phenomena working in tandem. These are described.

The causal pathways therefore involve the social, economic and political determinants of health, as well as psychological and biological factors.
Four vectors of causation are identified:
- population,
- environmental,
- organizational and
- social.

The interaction between the vectors and human behaviour are outlined. The bridge between the wider determinants and individual health outcomes is integration of the life course and the life…”

Funding: NICE and the Universidad del Desarrollo, Santiago Chile received funding to establish the Measurement and Evidence Knowledge Network which was one of nine knowledge networks established by WHO to support the WHO Commission on the Social Determinants of Health. This paper is not a statement of the views of WHO or the Commission.

É o SUS – ou é a pobreza?

No Jornal ZH de Hoje Moacyr Scliar comenta desigualdade e cita nosso trabalho que foi premiado como o melhor na área de Epidemiologia de 2008 nos Arquivos Brasileiros de Cardiologia.

27 de janeiro de 2009 | N° 15861
MOACYR SCLIAR


Na semana passada um estudo realizado pelo Instituto do Coração de São Paulo e publicado nos Arquivos Brasileiros de Cardiologia deu manchete em vários jornais do país. Segundo a pesquisa, pacientes que sofreram infarto do miocárdio e são atendidos pelo Sistema Único de Saúde, SUS, têm 36% mais chances de morrer do que aqueles que são acompanhados por médicos particulares ou de convênios.

Lendo esta frase, leitores, qual é a conclusão que se tira de imediato? Que o SUS não funciona, vocês dirão; que é um sistema ruim, precário. Mas será que é mesmo?

Indo um pouco adiante no trabalho descobrimos que na fase de internação a proporção de óbitos é praticamente a mesma nos dois grupos. A mortalidade maior em pacientes do SUS ocorre após a alta, quando a pessoa retorna a seu ambiente habitual. E isto enseja uma reflexão não apenas sobre infarto do miocárdio, como sobre o Brasil em geral. Em primeiro lugar é preciso dizer que, por paradoxal que pareça, uma maior mortalidade por doença cardíaca pode ser sinal de progresso – um progresso meio estranho, mas progresso de qualquer jeito. No passado, os brasileiros pobres não morriam de infarto, porque nem chegavam à idade em que o problema ocorre: faleciam antes, não raro na infância, de desnutrição, de diarreia, de doença respiratória. A expectativa de vida cresceu, e cresceu nos países ricos e pobres. As mortes por desnutrição e por doenças infecciosas, causadas por micróbios, diminuíram. Mas isto tem um preço. Viver mais não quer dizer viver de forma mais saudável. O pobre hoje tem mais comida, mas é comida calórica, gordurosa – pobre não come salmão nem caras saladas, nem frutas. Pobre fuma mais, e pobre é mais sedentário – passou a época em que trabalho implicava necessariamente movimento e trabalho físico, e academia de ginástica não é para qualquer um. Pobre tem menos acesso à informação sobre saúde, pobre consulta menos, às vezes porque não tem sequer como pagar a condução que o levará ao posto de saúde. Aliás, temos evidências disto em nossa própria cidade de Porto Alegre: um trabalho recentemente realizado pelos doutores Sérgio L. Bassanesi, Maria Inês Azambuja e Aloysio Achutti mostrou que a mortalidade precoce por doença cardiovascular foi 2,6 vezes maior nos bairros mais humildes da Capital.

Tudo isto explica a conclusão a que chegou o simpósio internacional sobre desigualdade em saúde reunido em Toronto, Canadá: “A pobreza, e não os fatores médicos, é a principal causa de doença cardiovascular”. Um artigo publicado no importante periódico médico Circulation salienta o fato de que 80% dos óbitos por doença cardíaca ocorrem em países pobres e acrescenta: “Os fatores de risco para doença cardiovascular aumentam primeiro entre os ricos, mas à medida que estes aprendem a lição e corrigem o estilo de vida os riscos concentram-se nos mais pobres. A suscetibilidade para esses problemas também cresce por causa do estresse psicológico.” Quando falamos no estresse psicológico não podemos esquecer aquele que está se tornando cada vez mais frequente, o desemprego. Vários estudos mostram que problemas cardíacos são mais comuns em desempregados.

Estas coisas não diminuem a responsabilidade dos serviços de saúde, públicos ou privados, ao contrário, aumentam-na. A questão da informação e da educação em saúde hoje é absolutamente crucial.

SUS e sistemas privados não são antagônicos, são complementares. É claro que a tarefa do SUS é muito maior – afinal, o sistema atende cerca de 80% da população – e é mais difícil: este é um país pobre, que tem poucos recursos inclusive para a saúde. Mesmo assim, e o próprio trabalho o mostra, estamos no caminho. Apesar de tudo, as coisas melhoram.

International Policy Centre for Inclusive Growth (IPC-IG)

Welcome to IPC-IG

The International Policy Centre for Inclusive Growth (IPC-IG) is a joint project between the United Nations Development Programme and the Brazilian Government to promote South-South Cooperation on applied poverty research and training. It specializes in analyzing poverty and inequality and offering research-based policy recommendations on how to reduce them. IPC is directly linked to the Institute for Applied Economic Research (IPEA), which does research for the Brazilian Ministry of Strategic Affairs, and the Bureau for Development Policy, UNDP. More...

Publications

IPC publications include Working Papers, Policy Research Briefs, issues of Poverty In Focus magazine, One Pagers and Country Studies.
All publications, by Country and Region and by Thematic Area.

ODM de todos os municípios

Reportagens


Belém, 20/01/2009
Site mapeará
Portal de monitoramento dos Objetivos do Milênio das 5.654 cidades do país será lançado durante Fórum Social Mundial realizado em Belém


DAYANNE SOUSA
da PrimaPagina
O lançamento de um portal de acompanhamento dos Objetivos de Desenvolvimento do Milênio (ODM) marcará a participação do PNUD e do UNICEF no Fórum Social Mundial, evento anual de movimentos e organizações da sociedade civil que nasceu como contraponto ao Fórum Econômico Mundial de Davos, na Suíça. Os ODM são uma série de metas socioeconômicas que os países da ONU se comprometeram a atingir até 2015. Durante o Fórum, serão discutidas formas de as metas serem incorporadas não só em nível federal, mas também pela administração dos municípios brasileiros.

No terceiro dia do evento, que ocorre em Belém de 27 janeiro a 1 de fevereiro, o Portal ODM será apresentado ao público. O site, que por enquanto conta com apenas algumas informações sobre as metas, reunirá índices sobre todos os 5.564 municípios do Brasil, o que permitirá saber o quanto falta para cada localidade atingir os ODM. Além disso, vídeos, artigos e notícias relacionadas aos Objetivos do Milênio poderão ser acessados pelo endereço. “O Fórum é o lugar ideal para a gente iniciar uma estratégia para incentivar ações locais em prol dos ODM”, afirma Luciana Brenner, uma das coordenadoras do projeto que deu origem ao portal.

Cognitive Impairment in Older Persons Linked to Vitamin D Deficiency

By Kristina Fiore, Staff Writer, MedPage Today Published: January 26, 2009 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

CAMBRIDGE, England, Jan. 26 -- A low level of vitamin D in older patients is associated with a higher risk of cognitive impairment, researchers here said. Those with the lowest levels were more than twice as likely to have cognitive impairment (P<0.001),>Journal of Geriatric Psychology and Neurology. "Our results suggest that high levels of serum 25-hydroxyvitamin D are associated with lower odds of cognitive impairment," the researchers said./.../

Heart Association Recommends Daily Intake of Omega-6 Fatty Acids

By Kristina Fiore, Staff Writer, MedPage Today Published: January 26, 2009 Reviewed by Zalman S. Agus, MD; Emeritus Professor  University of Pennsylvania School of Medicine.

VERMILLION, S.D., Jan. 26 -- At least 5% to 10% of daily caloric intake should come from omega-6 fatty acids, according to an American Heart Association science advisory that emerged from a literature review.  Consumption of this level of omega-6 polyunsaturated fatty acids was associated with a reduced risk of coronary heart disease, William S. Harris, Ph.D., of the University of South Dakota, and colleagues reported in the advisory, published in the Feb. 17 issue of Circulation: Journal of the American Heart Association.  "Aggregate data from randomized trials, case-control and cohort studies, and long-term animal feeding experiments indicate that the consumption of at least 5% to 10% of energy from omega-6 fatty acids reduces the risk of coronary heart disease relative/.../

Plavix

Clopidogrel bisulfate (marketed as Plavix) 
Audience: Cardiovascular healthcare professionals, Pharmacists

FDA notified healthcare professionals that the makers of Plavix have agreed to work with FDA to conduct studies to obtain additional information that will allow a better understanding and characterization of the effects of genetic factors and other drugs (especially the proton pump inhibitors (PPIs)) on the effectiveness of clopidogrel. FDA is aware of published reports that clopidogrel is less effective in some patients than it is in others. Differences in effectiveness may be due to genetic differences in the way the body metabolizes clopidogrel or that using certain other drugs with clopidogrel can interfere with how the body metabolizes clopidogrel. These studies should lead to a better understanding about how to optimize the use of clopidogrel. The FDA recognizes the importance of obtaining these data promptly. The drug manufacturers have agreed to a timeline for completing the studies and FDA will review the new information expeditiously and will communicate its conclusions and any recommendations to the public at that time. It could take several months to complete the studies and analyze the results. Until further information is available FDA recommends the following:

• Healthcare providers should continue to prescribe and patients should continue to take clopidogrel as directed, because clopidogrel has demonstrated benefits in preventing blood clots that could lead to a heart attack or stroke.
• Healthcare providers should re-evaluate the need for starting or continuing treatment with a PPI, including Prilosec OTC, in patients taking clopidogrel. 
• Patients taking clopidogrel should consult with their healthcare provider if they are currently taking or considering taking a PPI, including Prilosec OTC.

Read the complete MedWatch 2009 Safety summary, including a link to the Early Communication, at:

http://www.fda.gov/medwatch/safety/2009/safety09.htm#plavix

Heart Disease and Stroke Statistics—2009 Update

(Circulation. 2009;119:e21-e181.)
© 2009 American Heart Association, Inc. 

AHA Statistical Update

Heart Disease and Stroke Statistics—2009 Update

A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

WRITING GROUP: Donald Lloyd-Jones, MD, ScM, FAHA; et al.

Summary

Each year, the American Heart Association, in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on disease morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document. This year’s edition includes several areas not covered in previouseditions. Below are a few highlights from this year’s Update./.../

Improving Estimates of the Global Burden of Injuries:

Call for Contributors

Kavi Bhalla^*, James Harrison, Jerry Abraham, Nagesh N. Borse, Ronan Lyons, Soufiane Boufous, Limor Aharonson-Daniel, on behalf of the Global Burden of Disease Injury Expert Group

Funding: None of the members of the Global Burden of Disease Injury Expert Group derive any salary support from the Global Burden of Disease project. However, several members have ongoing funded research in closely associated areas. KB is supported by a grant from the World Bank Global Road Safety Facility, but this funder has played no role in study design, data analysis, decision to publish, or preparation of the manuscript.

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

Citation: Bhalla K, Harrison J, Abraham J, Borse NN, Lyons R, et al. (2009) Data Sources for Improving Estimates of the Global Burden of Injuries: Call for Contributors. PLoS Med 6(1): e1000001 doi:10.1371/journal.pmed.1000001

Published: January 20, 2009

Copyright: © 2009 Bhalla et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

An inauguration for the global community

From Catherine Colleman: ProCOR

On January 20, 2009, in the US and in many other countries around the world, people gathered around radios, cell phones, televisions, and computer screens to witness the inauguration of President Barack Hussein Obama--an inauguration as historic as it is hopeful, despite the unprecedented challenges he faces nationally and globally. In his inaugural address, President Obama spoke directly to the world's population, "from the grandest capitals to the small village where my father was born...We are ready to lead once more. America's patchwork heritage is a strength. We are shaped by every language and culture, drawn from every corner of the earth. As the earth becomes smaller, our common humanity grows stronger." He pledged to poor nations, "We will work alongside you." Read more

The U.S. Commitment to Global Health:

Recommendations for the New Administration

Authors:
Committee on the U.S. Commitment to Global Health 
Authoring Organizations

Description:

At this historic moment, the incoming Obama administration and leaders of the U.S. Congress have the opportunity to advance the welfare and prosperity of people within and beyond the borders of the United States through intensified and sustained attention to ...
Read More

The Clinical Utility of Genetic Data in CVD

Stanley S Wang MD JD MPH
Clinical Cardiologist, Austin Heart
Adjunct Assistant Professor of Medicine
University of North Carolina School of Medicine
Chapel Hill, NC

INTRODUCTION

At the American Heart Association 2008 Scientific Session (AHA 2008) entitled "Personalized Genomics: Ready for Primetime?" Dr Eric Topol, Director of the Scripps Translational Science Institute and Editor-in-Chief of theheart.org, shared his own genome-wide scan results; revealing that he has an above average lifetime risk for myocardial infarction (MI) and rheumatoid arthritis. While consumer genome-wide scans have received a lot of press attention, clinicians (and cardiologists in particular) are more concerned with the individual tests that are currently available, such as those identifying people at greater risk for coronary artery disease (CAD)/MI (9p21) and atrial fibrillation (4q25), or those used to predict response to pharmacotherapy such as warfarin (CYP2C9/VKORC1)./.../

Ambient Air Pollution: Adipose Inflammation

Ambient Air Pollution Exaggerates Adipose Inflammation and Insulin Resistance in a Mouse Model of Diet-Induced Obesity

Qinghua Sun MD, PhD, Peibin Yue MD, PhD, Jeffrey A. Deiuliis PhD, Carey N. Lumeng MD, Thomas Kampfrath MS, Michael B. Mikolaj MD, Ying Cai MD, Michael C. Ostrowski PhD, Bo Lu PhD, Sampath Parthasarathy MBA, PhD, Robert D. Brook MD, Susan D. Moffatt-Bruce MD, PhD, Lung Chi Chen PhD, and Sanjay Rajagopalan MD^*

From the Davis Heart and Lung Research Institute (Q.S., P.Y., J.A.D., T.K., M.B.M., Y.C., S.P., S.R.), Division of Environmental Health Sciences (Q.S.), Division of Biostatistics (B.L.), Department of Molecular and Cellular Biochemistry (M.C.O.), and Division of Cardiothoracic Surgery (S.D.M.-B.), Colleges of Medicine and Public Health, Ohio State University, Columbus; Life Sciences Institute (C.N.L.) and Department of Internal Medicine (R.D.B.), University of Michigan, Ann Arbor; and Department of Environmental Medicine (L.C.C.), New York University School of Medicine, New York.

^* To whom correspondence should be addressed. E-mail: Sanjay.Rajagopalan@osumc.edu.

Background—There is a strong link between urbanization and type 2 diabetes mellitus. Although a multitude of mechanisms have been proposed, there are no studies evaluating the impact of ambient air pollutants and the propensity to develop type 2 diabetes mellitus. We hypothesized that exposure to ambient fine particulate matter (<2.5>2.5) exaggerates diet-induced insulin resistance, adipose inflammation, and visceral adiposity.

Methods and Results—Male C57BL/6 mice were fed high-fat chow for 10 weeks and randomly assigned to concentrated ambient PM_2.5 or filtered air (n=14 per group) for 24 weeks. PM_2.5-exposed C57BL/6 mice exhibited marked whole-body insulin resistance, systemic inflammation, and an increase in visceral adiposity. PM_2.5 exposure induced signaling abnormalities characteristic of insulin resistance, including decreased Akt and endothelial nitric oxide synthase phosphorylation in the endothelium and increased protein kinase C expression. These abnormalilties were associated with abnormalities in vascular relaxation to insulin and acetylcholine. PM_2.5 increased adipose tissue macrophages (F4/80⁺ cells) in visceral fat expressing higher levels of tumor necrosis factor-/interleukin-6 and lower interleukin-10/N-acetyl-galactosamine specific lectin 1. To test the impact of PM_2.5 in eliciting direct monocyte infiltration into fat, we rendered FVBN miceexpressing yellow fluorescent protein (YFP) under control of a monocyte-specific promoter (c-fms, c-fms^YFP) diabetic over 10 weeks and then exposed these mice to PM_2.5 or saline intratracheally. PM_2.5 induced YFP cell accumulation in visceral fat and potentiated YFP cell adhesion in the microcirculation.

Conclusion—PM_2.5 exposure exaggerates insulin resistance and visceral inflammation/adiposity. These findings provide a new link between air pollution and type 2 diabetes mellitus.

Declining Severity of MI From 1987 to 2002

Declining Severity of Myocardial Infarction From 1987 to 2002. The Atherosclerosis Risk in Communities (ARIC) Study

Merle Myerson MD, EdD^*, Sean Coady MA, Herman Taylor MD, Wayne D. Rosamond PhD, David C. Goff Jr MD, PhD, for the ARIC Investigators

From the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.M., S.C.); University of Mississippi Medical Center, Cardiology Division, Jackson (H.T.); University of North Carolina Chapel Hill School of Public Health, Department of Epidemiology, Chapel Hill (W.D.R.); and Wake Forest University School of Medicine, Winston-Salem, NC (D.C.G.).

^* To whom correspondence should be addressed. E-mail: myersonM@optonline.net.

Background—Death rates for coronary heart disease have been declining in the United States, but the reasons for thisdecline are not clear. One factor that could contribute to this decline is a reduction in the severity of acute myocardial infarction (MI). We hypothesized that for those patients hospitalized in the Atherosclerosis Risk in Communities (ARIC) Study with acute incident MI, there was a decline in MI severity from 1987 to 2002.

Methods and Results—The community surveillance component of the ARIC Study consisted of tracking residents 35 to 74 years of age with hospitalized MI or fatal coronary heart disease in 4 diverse communities. For incident, hospitalized MI, a probability sample of hospital discharges was validated and an MI classification was assigned according to an algorithm consisting of chest pain, ECG evidence, and cardiac biomarkers. Severity indicators were chosen from abstracted hospital charts validated as a definite or probable MI. With few exceptions, the MI severity indicators suggested a significant decline in the severity of MI during the period of 1987 to 2002. The percent of MI cases with major ECG abnormalities decreased as evidenced by a 1.9%/y (P=0.002) decline in the proportion of those with initial ST-segment elevation, a 3.9%/y (P<0.001)> and a 4.5%/y (P<0.001)> wave. Maximum creatine kinase and creatine kinase-MB values declined (5.2% and 7.6%; P<0.001, P<0.001> although in the later years, maximum troponin I values remained stable (1.1%/y decline; P=0.66). The percent with shock declined (5.7%/y; P<0.001),> remained stable. A combined severity score, the Predicting Risk of Death in Cardiac Disease Tool (PREDICT) score, also declined (0.2%/y;P<0.001).> the entire group, as did results for women.

Conclusions—Evidence from ARIC community surveillance suggests that the severity of acute MI has declined among community residents hospitalized for incident MI. This reduction in severity may have contributed, along with other factors, to the decline in death rates for coronary heart disease.

"Google Satellite" Will Have an Orbital View Over Obama's Inauguration

"Google Satellite" Will Have an Orbital View Over Obama's Inauguration

Written by Ian O'Neill

Washington D.C. from orbit. The Google Satellile GeoEye-1 will spy on Obama's inauguration (GeoEye)

President-elect Barack Obama's inauguration on Capitol Hill will be the place-to-be on Tuesday (January 20th). According to some news sources, tickets for the event were trading for a price exceeding 5 figures (in one case, according to CNN in November, an online vendor was asking for $20,095 for a single ticket - I hope they get a "free" bottle of Champagne with that!). It would appear that ticket demand outstripped supply, making the 44th presidential inauguration one of the hottest (and most costly) events to attend in 2009./.../

Dementia Risk

Easy-Going Personality Reduces Dementia Risk

By Crystal Phend, Staff Writer, MedPage Today Published: January 19, 2009 Reviewed by Zalman S. Agus, MD; Emeritus Professor  University of Pennsylvania School of Medicine.

STOCKHOLM, Sweden, Jan. 19 -- A relaxed approach to life may protect against dementia in older age regardless of social activity, researchers found. 

In a study of the Swedish population, older adults who were socially outgoing but not easily distressed by circumstances were 49% less likely to develop dementia over time than were people who were extroverted and neurotic. 

Obama on front lines in battle to stop smoking

Experts say his efforts to quit illustrate how difficult it is.

By Victoria Stagg Elliott, AMNews staff. Posted Jan. 19, 2009.

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Physicians and other smoking-cessation advocates have found a high-profile illustration of the challenges of quitting tobacco: President-elect Barack Obama.

"His honesty should help a lot of people, because it's just not that easy to quit smoking," said Anthony Atkins, MD, a family physician and director of minority health and community outreach for the Lima Community Health Center in Lima, Ohio./.../

U.S. health spending tops $2.2 trillion

A Medicare pay freeze and imaging fee cuts in 2007 helped constrain the rise in spending on physician services.

By Doug Trapp, AMNews staff. Posted Jan. 19, 2009.

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Washington -- National health spending in 2007 grew at its slowest pace since 1998, largely due to a sharp slowdown in the growth in spending on prescription drugs, according to federal actuaries. Growth in spending on physician services slowed slightly.

Overall health spending increased by only 6.1% in 2007 to reach $2.24 trillion, according to the annual Centers for Medicare & Medicaid Services report, published in the January/February issue of Health Affairs. Health expenditures last dipped below the 6% growth mark in 1998./.../

The Spreading of Disorder

Originally published in Science Express on 20 November 2008 Science 12 December 2008: Vol. 322. no. 5908, pp. 1681 - 1685 DOI: 10.1126/science.1161405

Prev | Table of Contents | Next

REPORTS

The Spreading of Disorder

Kees Keizer,^* Siegwart Lindenberg, Linda Steg

Imagine that the neighborhood you are living in is covered with graffiti, litter, and unreturned shopping carts. Would this reality cause you to litter more, trespass, or even steal? A thesis known as the broken windows theory suggests that signs of disorderly and petty criminal behavior trigger more disorderly and petty criminal behavior, thus causing the behavior to spread. This may cause neighborhoods to decay and the quality of life of its inhabitants to deteriorate. For a city government, this may be a vital policy issue. But does disorder really spread in neighborhoods? So far there has not been strong empirical support, and it is not clear what constitutes disorder and what may make it spread. We generated hypotheses about the spread of disorder and tested them in six field experiments. We found that, when people observe that others violated a certain social norm or legitimate rule, they are more likely to violate other norms or rules, which causes disorder to spread.

Faculty of Behavioral and Social Sciences, University of Groningen, 9712 TS Groningen, Netherlands.

^* To whom correspondence should be addressed. E-mail: K.E.Keizer@rug.nl

Welfare state regimes, unemployment and health:

Welfare state regimes, unemployment and health: a comparative study of the relationship between

unemployment and self-reported health in 23 European countries

C Bambra,1 T A Eikemo2

ABSTRACT

Background: The relationship between unemployment and increased risk of morbidity and mortality is well established. However, what is less clear is whether this relationship varies between welfare states with differing levels of social protection for the unemployed.

Methods: The first (2002) and second (2004) waves of the representative cross-sectional European Social Survey (37 499 respondents, aged 25–60 years). Employment status was main activity in the last 7 days. Health variables were self-reported limiting long-standing illness

(LI) and fair/poor general health (PH). Data are for 23 European countries classified into five welfare state regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern and Eastern).

Results: In all countries, unemployed people reported higher rates of poor health (LI, PH or both) than those in employment. There were also clear differences by welfare state regime: relative inequalities were largest in the Anglo-Saxon, Bismarckian and Scandinavian regimes. The negative health effect of unemployment was particularly strong for women, especially within the Anglo-Saxon (ORLI 2.73 and ORPH 2.78) and Scandinavian (ORLI 2.28 and ORPH 2.99) welfare state regimes.

Discussion: The negative relationship between unemployment and health is consistent across Europe but varies by welfare state regime, suggesting that levels of social protection may indeed have a moderating influence.

The especially strong negative relationship among women may well be because unemployed women are likely to receive lower than average wage replacement rates.

Policy-makers’ attention therefore needs to be paid to income maintenance, and especially the extent to which the welfare state is able to support the needs of an increasingly feminised European workforce.

Preventing Chronic Illness

Health Affairs, 28, no. 1 (2009): 36  doi: 10.1377/hlthaff.28.1.36  © 2009 by Project HOPE

A core truth about chronic conditions is that most are preventable. As Susan Brink’s Report from the Field recounts, the multiyear trial known as the Diabetes Prevention Program (DPP) demonstrated that lifestyle modifications alone could produce sharp reductions in the development of diabetes in high-risk people with prediabetic conditions. Moreover, a few key strategies—such as improved diet, exercise, and weight loss, along with smoking cessation—can simultaneously reduce the risk of several conditions such as cardiovascular disease and cancers. So it’s no surprise that policymakers say that prevention should assume a far more prominent role in U.S. health care./.../

Inauguration Special: NY Times

UNNATURAL CAUSES

A statement from the Executive Producer

LARRY ADELMAN
Series Executive Producer & Co-Director of California Newsreel

It often appears that we Americans are obsessed with health. Media outlets trumpet the latest gene and drug discoveries, dietary supplements line shelf after shelf in the supermarket and a multi-billion dollar industry of magazines, videos and spas sells healthy "lifestyles." We spend more than twice what the average rich country spends per person on medical care.

Yet we have among the worst disease outcomes of any industrialized nation - and the greatest health inequities. It's not just the poor who are sick. Even the middle classes die, on average, almost three years sooner than the rich./.../

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/01/16/BUBP15B33C.DTL

Health Situation in the Americas

Health Situation in the Americas - Basic Indicators 2008

 Pan American Health Organization (PAHO/WHO)

             Available online:

     English: http://devserver.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=308&Itemid= 

    Spanish: http://devserver.paho.org/hq/index.php?option=com_docman&task=doc_download&gid=307&Itemid=

 “……..Information on 56 basic indicators for 48 countries and territories, as well as for groupings of countries or sub-regions. This year the publication includes an analysis of the quality of mortality data based on the proportion of mortality under-registration and on the proportion of deaths assigned to ill-defined and unknown causes. This information was used to develop an index for classifying the quality of mortality data.

The results show that of the 32 countries studied, 19 (59%) have good quality mortality data, and 7 countries (22%) have poor or very poor quality mortality data. In addition to problems with data quality, 2 countries from Central America and 14 Caribbean countries were excluded from the analysis due to their critical situation in the availability of mortality data.

There is also a comparison between estimated infant and maternal mortality using the World Health Organization methodology and those calculated from data reported by the countries. This comparison allows for better visualization of differences between different ways of measuring the same indicator and provides a parameter for discussing the validity of these important health indicators.

Information required for decision-making must be available, but also accurate and timely. In this publication we want to emphasize those aspects that reveal differences in the quality of data observed among the different countries in the Region. By doing so, it is expected that those responsible for health statistics in the countries of the Americas will be encouraged to implement improvements in the collection, validation, analysis and dissemination of data….”

[Mirta Roses Periago PAHO Director]

Darwin's Gift

Surgical Safety Checklist

Published at www.nejm.org January 14, 2009 (10.1056/NEJMsa0810119)

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

Alex B. Haynes, M.D., M.P.H., Thomas G. Weiser, M.D., M.P.H., William R. Berry, M.D., M.P.H., Stuart R. Lipsitz, Sc.D., Abdel-Hadi S. Breizat, M.D., Ph.D., E. Patchen Dellinger, M.D., Teodoro Herbosa, M.D., Sudhir Joseph, M.S., Pascience L. Kibatala, M.D., Marie Carmela M. Lapitan, M.D., Alan F. Merry, M.B., Ch.B., F.A.N.Z.C.A., F.R.C.A., Krishna Moorthy, M.D., F.R.C.S., Richard K. Reznick, M.D., M.Ed., Bryce Taylor, M.D., Atul A. Gawande, M.D., M.P.H., for the Safe Surgery Saves Lives Study Group

ABSTRACT

Background Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a program to implement a 19-item surgical safety checklist designed to improve team communication and consistency of care would reduce complications and deaths associated with surgery.

Methods Between October 2007 and September 2008, eight hospitals in eight cities (Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London, England; and Seattle, WA) representing a variety of economic circumstances and diverse populations of patients participated in the World Health Organization's Safe Surgery Saves Lives program. We prospectively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery. We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist. The primary end point was the rate of complications, including death, during hospitalization within the first 30 days after the operation.

Results The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001).

Conclusions Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals./.../

"Os terroristas preferem o amor à guerra"

"Os terroristas preferem o amor à guerra"

Em entrevista a ÉPOCA, o médico e cientista inglês Malcolm Potts diz que, se fossem oferecidas oportunidades, os palestinos prefeririam casar e ter famílias a se matar em atentados suicidas/.../