ANTIBIÓTICOS e DROGAS.

Artigo escrito para ZH no dia 29, mas que não sei se será publicado.

ANTIBIÓTICOS e DROGAS.

Aloyzio Achutti. Médico.

Desde o fim de semana não basta mais ter dinheiro para comprar antibióticos no balcão da farmácia. Agora, como já acontecia com psicotrópicos, opiáceos e outras drogas capazes de provocar dependência, é preciso ter uma receita médica.

Uma das explicações para a restrição está no surgimento de resistência bacteriana, superbactérias mais rapidamente adaptadas aos antibióticos, do que nossa capacidade de encontrar armas mais poderosas para combatê-las. Outra está na destruição de nossa flora normal e necessária para a vida, dando chance para oportunistas tomarem conta do território conflagrado, aproveitando-se do desequilíbrio provocado entre nossos comensais.

Os antibióticos - como está expresso em seu nome - são armas mortíferas, contra a vida, destinadas a matar micro-organismos vivos, na presunção de liquidá-los antes do hospedeiro.

Logo depois da descoberta destes remédios houve uma euforia (originada de arrogante ignorância), achando que doenças infeciosas haviam desaparecido...

Nossas origens estão nestas formas microscópicas de vida, e delas depende ainda hoje nosso sustento, de parceira com a digestão e o equilíbrio ecológico. Precederam-nos neste mundo a cerca de três bilhões de anos, enquanto somente a um milhão surgiram seres como nós. Temos mais delas em nossos corpos do que de nossas próprias células. Precisamos delas para sobreviver, para manter condições de troca com o meio ambiente, e limpar nossos estragos.

Nós médicos aprendemos uma lição: o equilíbrio, a manutenção de condições adequadas de vida, e a prevenção de doenças são essenciais. Não somos capazes de restabelecer o equilíbrio e a saúde com a violência de armas – farmacológicas ou de qualquer outra natureza - por mais poderosas que sejam.

A mesma lição não poderia servir também para tratar organismos sociais doentes?

A dependência e o tráfico de drogas são sintomas como a febre e a dor, num organismo vivo em desequilíbrio e infectado. No caso da enfermidade social é ainda pior: os usuários dependentes, como células doentes, fazem parte do tecido e se constituem na própria razão do tráfico. Forma-se uma rede complexa cuja inteligência não se encontra na favela, e seus maiores beneficiários estão em geral muito bem escondidos, e intimamente entranhados nas estruturas de poder, e no fluxo do dinheiro.

Não podemos mais prescindir dos antibióticos, cujo uso precisa ser controlado, mas sem a ilusão de que estas armas sejam suficientes para controlar as doenças infecciosas.

As drogas, seu tráfico e seus comandantes, encontraram na própria natureza humana e no desequilíbrio social um mercado, embora ilegal, extremamente sólido e rentável, cuja erradicação passa pelo controle do usuário, pela oportunidade de educação, identidade, integração social e emprego digno, capaz de competir com as oportunidades oferecidas pelo tráfico.

Tanques, fuzis e estratégia militar, assim como os antibióticos, também podem causar mais estragos e favorecer oportunistas. Não podemos nos iludir sobre a solução de problemas há tanto tempo tolerados e consentidos, especialmente porque a razão de sua existência não está localizada onde a guerra hoje se desenvolve.

Worldwide burden of disease from exposure to second-hand smoke: data from 192 countries

"Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries"
M Oberg, M Jaakkola, A Woodward, A Peruga, and A Pruss-Ustun
The Lancet 2010; published online 26 November 2010 (open access online)
http://bit.ly/h9N4Iw (ProCOR)

Background
 Exposure to second-hand smoke is common in many countries but the magnitude of the problem worldwide is poorly described. We aimed to estimate the worldwide exposure to second-hand smoke and its burden of disease in children and adult non-smokers in 2004.
Methods
 The burden of disease from second-hand smoke was estimated as deaths and disability-adjusted life-years (DALYs) for children and adult non-smokers. The calculations were based on disease-specifi c relative risk estimates and area-specifi c estimates of the proportion of people exposed to second-hand smoke, by comparative risk assessment methods, with data from 192 countries during 2004.
Findings Worldwide, 40% of children, 33% of male non-smokers, and 35% of female non-smokers were exposed to second-hand smoke in 2004. This exposure was estimated to have caused 379 000 deaths from ischaemic heart disease, 165 000 from lower respiratory infections, 36 900 from asthma, and 21 400 from lung cancer. 603 000 deaths were attributable to second-hand smoke in 2004, which was about 1·0% of worldwide mortality. 47% of deaths from second-hand smoke occurred in women, 28% in children, and 26% in men. DALYs lost because of exposure to secondhand smoke amounted to 10·9 million, which was about 0·7% of total worldwide burden of diseases in DALYs in 2004. 61% of DALYs were in children. The largest disease burdens were from lower respiratory infections in children younger than 5 years (5 939 000), ischaemic heart disease in adults (2 836 000), and asthma in adults (1 246 000) and children (651 000).
Interpretation 
These estimates of worldwide burden of disease attributable to second-hand smoke suggest that substantial health gains could be made by extending eff ective public health and clinical interventions to reduce passive smoking worldwide.

Alzheimer's disease: Revising Definition

The Lancet Neurology, Volume 9, Issue 11, Pages 1118 - 1127, November 2010

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doi:10.1016/S1474-4422(10)70223-4Cite or Link Using DOI

Published Online: 11 October 2010

Revising the definition of Alzheimer's disease: a new lexicon

Prof Bruno Dubois MD a , Prof Howard H Feldman MD b c d, Claudia Jacova PhD b, Jeffrey L Cummings MD e, Prof Steven T DeKosky MD f, Pascale Barberger-Gateau MD g, André Delacourte PhD h, Prof Giovanni Frisoni MD i, Prof Nick C Fox MD j*, ProfDouglas Galasko MD k, Prof Serge Gauthier MD l, Prof Harald Hampel MD m, Gregory A Jicha MD n, Kenichi Meguro MD o, John O'Brien DM p, Prof Florence Pasquier MD q, Prof Philippe Robert MD r, Prof Martin Rossor MD j, Prof Steven Salloway MD s, Marie Sarazin MD a, Leonardo C de Souza MD a, Prof Yaakov Stern PhD t, Pieter J Visser MD u v, Prof Philip Scheltens MD v

Summary

Alzheimer's disease (AD) is classically defined as a dual clinicopathological entity. The recent advances in use of reliable biomarkers of AD that provide in-vivo evidence of the disease has stimulated the development of new research criteria that reconceptualise the diagnosis around both a specific pattern of cognitive changes and structural/biological evidence of Alzheimer's pathology. This new diagnostic framework has stimulated debate about the definition of AD and related conditions. The potential for drugs to intercede in the pathogenic cascade of the disease adds some urgency to this debate. This paper by the International Working Group for New Research Criteria for the Diagnosis of AD aims to advance the scientific discussion by providing broader diagnostic coverage of the AD clinical spectrum and by proposing a common lexicon as a point of reference for the clinical and research communities. The cornerstone of this lexicon is to consider AD solely as a clinical and symptomatic entity that encompasses both predementia and dementia phases./.../

Can We Count on Global Health Estimates?

Citation: The PLoS Medicine Editors (2010) Can We Count on Global Health Estimates? PLoS Med 7(11): e1001002. doi:10.1371/journal.pmed.1001002

Published: November 30, 2010

Copyright: © 2010 PLoS Medicine Editors. 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.

Funding: The authors are each paid a salary by the Public Library of Science, and they wrote this editorial during their salaried time.

Competing interests: The authors' individual competing interests are athttp://www.plosmedicine.org/static/edito​rsInterests.action. PLoS is funded partly through manuscript publication charges, but the PLoS Medicine Editors are paid a fixed salary (their salary is not linked to the number of papers published in the journal).

* E-mail: medicine_editors@plos.org

The PLoS Medicine Editors are Virginia Barbour, Jocalyn Clark, Susan Jones, and Emma Veitch.

Referred by the AMICOR Dr. Maria Inês Reinert Azambuja

Your brain on culture

The burgeoning field of cultural neuroscience is finding that culture influences brain development, and perhaps vice versa.

By Beth Azar

November 2010, Vol 41, No. 10 

Print version: page 44

When an American thinks about whether he is honest, his brain activity looks very different than when he thinks about whether another person is honest, even a close relative. That’s not true for Chinese people. When a Chinese man evaluates whether he is honest, his brain activity looks almost identical to when he is thinking about whether his mother is honest.

That finding — that American and Chinese brains function differently when considering traits of themselves versus traits of others (Neuroimage, Vol. 34, No. 3) — supports behavioral studies that have found that people from collectivist cultures, such as China, think of themselves as deeply connected to other people in their lives, while Americans adhere to a strong sense of individuality.

The study also shows the power of cultural neuroscience, the growing field that uses brain-imaging technology to deepen the understanding of how environment and beliefs can shape mental function. Barely heard of just five years ago, the field has become a vibrant area of research, and the University of Michigan, the University of California, Los Angeles, and Emory University have created cultural neuroscience centers. In addition, in April a cultural neuroscience meeting at the University of Michigan attracted such psychology luminaries as Hazel Markus, PhD, Michael Posner, PhD, Steve Suomi, PhD, and Claude Steele, PhD, to discuss their work in the context of cultural neuroscience./.../

Mortality Resulting From Congenital Heart Disease Among Children and Adults in the United States, 1999 to 2006

Suzanne M. Gilboa, PhD; Jason L. Salemi, MPH; Wendy N. Nembhard, PhD;David E. Fixler, MD; Adolfo Correa, MD, PhD From the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Ga (S.M.G., A.C.); Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa (J.L.S., W.N.N.); and Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (D.E.F.). Correspondence to Suzanne M. Gilboa, PhD, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Mail Stop E-86, 1600 Clifton Rd, Atlanta, GA 30333. E-mail sgilboa@cdc.gov

Background— Previous reports suggest that mortality resulting from congenital heart disease (CHD) among infants and young children has been decreasing. There is little population-based information on CHD mortality trends and patterns among older children and adults.
Methods and Results— We used data from death certificates filed in the United Statesfrom 1999 to 2006 to calculate annual CHD mortality by age at death, race-ethnicity, and sex. To calculate mortality rates for individuals 1 year of age, population counts from the US Census were used in the denominator; for infant mortality, live birth counts were used. From 1999 to 2006, there were 41 494 CHD-related deaths and 27 960 deaths resulting from CHD (age-standardized mortality rates, 1.78 and 1.20 per 100 000, respectively). During this period, mortality resulting from CHD declined 24.1% overall. Mortality resulting from CHD significantly declined among all race-ethnicities studied. However, disparities persisted; overall and among infants, mortality resulting from CHD was consistently higher among non-Hispanic blacks compared with non-Hispanic whites. Infant mortality accounted for 48.1% of all mortality resulting from CHD; among those who survived the first year of life, 76.1% of deaths occurred during adulthood (18 years of age).
Conclusions— CHD mortality continued to decline among both children and adults; however, differences between race-ethnicities persisted. A large proportion of CHD-related mortality occurred during infancy, although significant CHD mortality occurred during adulthood, indicating the need for adult CHD specialty management.

Associations Between Childhood Risk Factors and Carotid Intima-Media Thickness in Adulthood

Influence of Age on, 

The Cardiovascular Risk in Young Finns Study, the Childhood Determinants of Adult Health Study, the Bogalusa Heart Study, and the Muscatine Study for the International Childhood Cardiovascular Cohort (i3C) Consortium. Markus Juonala, MD, PhD^*; 

Background— Atherosclerosis has its roots in childhood. Therefore, defining the age when childhood risk exposure begins to relate to adult atherosclerosis may have implications for pediatric cardiovascular disease prevention and provide insights about the early determinants of atherosclerosis development. The aim of this study was to investigate the influence of age on the associations between childhood risk factors and carotid artery intima-media thickness, a marker of subclinical atherosclerosis.
Methods and Results— We used data for 4380 members of 4 prospective cohorts—Cardiovascular Risk in Young Finns Study (Finland), Childhood Determinants of Adult Health study (Australia), Bogalusa Heart Study (United States), and Muscatine Study (United States)—that have collected cardiovascular risk factor data from childhood (age 3 to 18 years) and performed intima-media thickness measurements in adulthood (age 20 to 45 years). The number of childhood risk factors (high [highest quintile] total cholesterol, triglycerides, blood pressure, and body mass index) was predictive of elevated intima-media thickness (highest decile) on the basis of risk factors measured at age 9 years (odds ratio [95% confidence interval] 1.37 [1.16 to 1.61], P=0.0003), 12 years (1.48 [1.28 to 1.72],P<0.0001), 15 years (1.56 [1.36 to 1.78], P<0.0001), and 18 years (1.57 [1.31 to 1.87], P<0.0001). The associations with risk factors measured at age 3 years (1.17 [0.80 to 1.71], P=0.42) and 6 years (1.20 [0.96 to 1.51], P=0.13) were weaker and nonsignificant.
Conclusions— Our analyses from 4 longitudinal cohorts showed that the strength of the associations between childhood risk factors and carotid intima-media thickness is dependent on childhood age. On the basis of these data, risk factor measurements obtained at or after 9 years of age are predictive of subclinical atherosclerosis in adulthood.

Aprendendo a esquecer

Estudos com ratos sugerem que é possível eliminar de modo mais eficaz a memória de um evento desagradável

Ricardo Zorzetto

Edição Online - 29/11/2010 

© EDUARDO CESAR

Ratos ajudam a desvendar esquecimento

Eliminar um fato da memória não significa apagá-lo, mas aprendê-lo de outra forma, propôs no início do século passado o fisiologista russo Ivan Pavlov, o mesmo que condicionou cães a salivar sempre que ouviam o toque de uma sineta. Quase cem anos mais tarde experimentos com ratos feitos por pesquisadores do Brasil e da Argentina indicam que Pavlov aparentemente estava certo. Ao menos no que se refere ao esquecimento de eventos desagradáveis ou aterrorizantes, como deparar na esquina com um assaltante portando uma arma./.../

Health professionals for a new century

Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

Prof Julio Frenk MD a ‡, Dr Lincoln Chen MD b ‡, Prof Zulfiqar A Bhutta PhD c, Prof Jordan Cohen MD d, Nigel Crisp KCB e,Prof Timothy Evans MD f, Harvey Fineberg MD g, Prof Patricia Garcia MD h, Prof Yang Ke MD i, Patrick Kelley MD g, Barry Kistnasamy MD j, Prof Afaf Meleis PhD k, Prof David Naylor MD l, Ariel Pablos-Mendez MD m, Prof Srinath Reddy MD n, Susan Scrimshaw PhD o, Jaime Sepulveda MD p, Prof David Serwadda MD q, Prof Huda Zurayk PhD r

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Executive summary

Problem statement

100 years ago, a series of studies about the education of health professionals, led by the 1910 Flexner report, sparked groundbreaking reforms. Through integration of modern science into the curricula at university-based schools, the reforms equipped health professionals with the knowledge that contributed to the doubling of life span during the 20th century.
By the beginning of the 21st century, however, all is not well. Glaring gaps and inequities in health persist both within and between countries, underscoring our collective failure to share the dramatic health advances equitably. At the same time, fresh health challenges loom. New infectious, environmental, and behavioural risks, at a time of rapid demographic and epidemiological transitions, threaten health security of all. Health systems worldwide are struggling to keep up, as they become more complex and costly, placing additional demands on health workers.
Professional education has not kept pace with these challenges, largely because of fragmented, outdated, and static curricula that produce ill-equipped graduates. The problems are systemic: mismatch of competencies to patient and population needs; poor teamwork; persistent gender stratification of professional status; narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labour market; and weak leadership to improve health-system performance. Laudable efforts to address these deficiencies have mostly floundered, partly because of the so-called tribalism of the professions—ie, the tendency of the various professions to act in isolation from or even in competition with each other.

Redesign of professional health education is necessary and timely, in view of the opportunities for mutual learning and joint solutions offered by global interdependence due to acceleration of flows of knowledge, technologies, and financing across borders, and the migration of both professionals and patients. What is clearly needed is a thorough and authoritative re-examination of health professional education, matching the ambitious work of a century ago.
That is why this Commission, consisting of 20 professional and academic leaders from diverse countries, came together to develop a shared vision and a common strategy for postsecondary education in medicine, nursing, and public health that reaches beyond the confines of national borders and the silos of individual professions. The Commission adopted a global outlook, a multiprofessional perspective, and a systems approach. This comprehensive framework considers the connections between education and health systems. It is centred on people as co-producers and as drivers of needs and demands in both systems. By interaction through the labour market, the provision of educational services generates the supply of an educated workforce to meet the demand for professionals to work in the health system. To have a positive effect on health outcomes, the professional education subsystem must design new instructional and institutional strategies./.../

poluição por material particulado inalável

No inverno, Porto Alegre é a segunda capital brasileira mais poluída por material particulado inalável

No inverno, depois de São Paulo, Porto Alegre é a capital que tem o ar mais poluído por material particulado inalável. Essa informação foi dada pela professora Cláudia Rohden durante reunião-almoço Saneamento Ambiental em Foco, promovida pela Abes-RS (Associação Brasileira de Engenharia Sanitária e Ambiental – seção Rio Grande do Sul) no salão nobre da Federasul, nesta sexta-feira (26), com o tema “Poluição do ar e efeitos sobre a saúde”. Depois de um breve relato sobre a situação mundial em relação à poluição atmosférica, a drª Rohden apresentou os resultados dos trabalhos que sua equipe vem realizando em parceria com a equipe do dr. Paulo Saldiva, da USP, a maior autoridade brasileira no setor. Com tecnologia simples – tendo como bioindicador uma planta de jardim chamada Tradescantia pallida – a equipe da professora investigou a qualidade do ar em diferentes pontos de Porto Alegre, identificando no bairro Humaitá uma área crítica no verão, possivelmente por estar sobre um lixão aterrado. Numa pesquisa que durou um ano e meio, feita também em outras cinco capitais brasileiras, monitorando apenas um poluente (o material particulado inalável, que se instala na parte baixa do pulmão), Porto Alegre se situou no nível de Belo Horizonte e Curitiba, mas durante o inverno a qualidade do ar da capital gaúcha foi considerada a pior do Brasil depois da de São Paulo. A drª Cláudia Rhoden é professora adjunta da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), onde coordena o Laboratório de Estresse Oxidativo e Poluição Atmosférica, e é pesquisadora associada ao Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo (USP).

Foto: Felipe Gaieski Assessoria de Imprensa da ABES-RS Contato: (51) 3212-1375 E-mail: imprensa@abes-rs.org.br

São Paulo's smoke-free legislation on carbon monoxide concentration

The effect of São Paulo's smoke-free legislation on carbon monoxide concentration in hospitality venues and their workers

• Jaqueline S Issa, 
• Tania M O Abe, 
• Alexandre C Pereira, 
• Maria Cristina Megid,
• Cristina E Shimabukuro, 
• Luis Sergio O Valentin, 
• Marizete M da C Ferreira, 
• Moacyr R C Nobre,
• Ines Lancarotte, 
• Antonio Carlos Pereira Barretto

Tob Control Published Online First: 25 November 2010 doi:10.1136/tc.2010.037614

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Results The CO concentration pre-ban and pot-ban in hospitality venues was indoor area 4.57 (3.70) ppm vs 1.35 (1.66) ppm (p<0.0001); semi-open 3.79 (2.49) ppm vs 1.16 (1.14) ppm (p<0.0001); open area 3.31(2.2) ppm vs 1.31 (1.39) ppm (p<0.0001); smoking employees 15.78 (9.76) ppm vs 11.50 (7.53) ppm (p<0.0001) and non-smoking employees 6.88 (5.32) ppm vs 3.50 (2.21) ppm (p<0.0001). The average CO concentration measured in the city was lower than 1 ppm during both pre-ban and post-ban periods.

Conclusion São Paulo's smoking-free legislation reduced significantly the CO concentration in hospitality venues and in their workers, whether they smoke or not/.../