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Monday, February 28, 2011

Forecasting the Future of Cardiovascular Disease in the United States

Paul A. Heidenreich, MD, MS, FAHA, Chair, et al.
Background— Cardiovascular disease (CVD) is the leading cause of death in the United States and is responsible for 17% of national health expenditures. As the population ages, these costs are expected to increase substantially.
Methods and Results— To prepare for future cardiovascular care needs, the American Heart Association developed methodology to project future costs of care for hypertension, coronary heart disease, heart failure, stroke, and all other CVD from 2010 to 2030. This methodology avoided double counting of costs for patients with multiple cardiovascular conditions. By 2030, 40.5% of the US population is projected to have some form of CVD. Between 2010 and 2030, real (2008$) total direct medical costs of CVD are projected to triple, from $273 billion to $818 billion. Real indirect costs (due to lost productivity) for all CVD are estimated to increase from $172 billion in 2010 to $276 billion in 2030, an increase of 61%.
Conclusions— These findings indicate CVD prevalence and costs are projected to increase substantially. Effective prevention strategies are needed if we are to limit the growing burden of CVD./.../

Sunday, February 27, 2011

Moacyr Scliar

Editoria de arte

No domingo passado enviei o artigo abaixo para ZH mas não foi publicado. Vai agora como homenagem póstuma ao amigo, colega e ex-chefe. Certamente nossa interação naquela época foi muito importante para podermos alcançar nossas pretensões e dele vou guardar saudosa memória.
MOACYR SCLIAR

Aloyzio Achutti. Médico.

Cheguei a pensar num mundo onde, médicos - particularmente os dedicados à saúde pública - fossem isentos ou tivessem algum privilégio frente às taxas de morbidade a que cidadãos comuns estão sujeitos. Assim como uma vez algumas categorias sociais não pagavam imposto de renda, ou políticos e seus parentes têm direito a passaporte especial, ou salário vitalício de governador, assim também poderíamos reivindicar algum tipo de vantagem ou proteção especial para quem se dedicasse durante tantos anos a promover saúde...
Não passa de um delírio de inconformidade frente ao mal no mundo. Este devaneio é apenas uma liberdade frente a tanta desigualdade em saúde e social, às quais já nos acomodamos, e não custa dar asas à fantasia.
Nas décadas de 70 e 80 trabalhei ao lado dele no Departamento de Saúde Pública da Secretaria da Saúde e do Meio Ambiente, por vezes até respondendo por sua função. Certamente sua visão e seu apoio, cercado por uma equipe excepcional (tanto que estenderam sua missão pelo Brasil e pelo mundo a fora), foi fundamental nas definições de política de saúde para que nos tornássemos uma verdadeira incubadora, e fossemos pioneiros em programas que serviram de modelo e de experimento operacional para o país e para o mundo.
Só para citar alguns daqueles com os quais estive envolvido: programa de prevenção da febre reumática na comunidade, prevenção do tabagismo - a partir da população escolar, controle da doença hipertensiva, do diabete, da obesidade do sedentarismo, e uma pesquisa com a maior amostra populacional do hemisfério sul na época, sobre pressão arterial e fatores de risco na população adulta de todo o Rio Grande do Sul.
Reparem que foi há mais de 30 anos, lutando contra problemas que hoje ocupam a mídia em todo o mundo, englobados no conjunto das doenças crônicas, agora chamadas de a “real epidemia” dos dias atuais.
Companheiros daquelas lides, dos cursos de saúde pública, dos treinamentos de chefias e de recursos humanos, das avaliações de impacto dos programas, das discussões sobre prioridades e planejamento, todos nós nos sentimos roubados com a doença - pode-se, dizer precoce - de nosso amigo, parceiro, e chefe.
Outros dotes e outros feitos não precisam ser alardeados porque todo mundo lia seus artigos, seus livros, e o contemplava como membro da Academia Brasileira de Letras.
Embora muito ainda nos venha à memória, de quem foi também colega de faculdade de minha esposa, penso com este depoimento estar ajudando a iluminar uma de suas facetas, quem sabe, tão ou mais importantes do que as que o tornaram mais conhecido, especialmente se contarmos quantas pessoas se beneficiaram e ainda seguirão gozando dos reflexos de sua participação na política de saúde de nosso Estado.
Uma das lições aprendidas com ele ajuda-me a encerrar por aqui. Lembro-me bem do momento em que me deu o conselho, ao descermos de um voo internacional. Eu começava a enviar alguns artigos para Zero Hora. Disse-me ele: “tenta dar o teu recado numa única página somente. É melhor para preservar a atenção dos leitores, e espaço em jornal tem preço”...
Já que ele não goza de isenções e imunidade para doenças crônicas, nos resta rezar pela recuperação do colega, companheiro e amigo.

Modificações no Google

logo googleCom a proposta de melhorar qualidade da seleção nas buscas, Google anunciou que vai modificar o protocolo de classificação das páginas da Internet. Aqueles endereços que forem cópia de outras páginas serão rejeitados.
Como a proposta inicial do grupo AMICOR era de apontar para os amigos aqueles endereços que eu ou membros do grupo achásssemos interessante, como para guardar para nos mesmos, de certa forma me senti incluído na categoria dos rejeitos...
Penso que o maior problema hoje na Internet é a seleção de conteúdos e a disponibilidade de tempo para fazê-lo. Este parece ser o principal motivo que tem sustentado o interesse em nosso Blog AMICOR.
De qualquer forma estou atento para sugestões e críticas, se ainda persistir o interesse em manter por mais alguns anos AMICOR, além dos laços afetivos que temos criado.
Um abraço a todos
AA

Google actualiza algoritmos para “enterrar” páginas de baixa qualidade

Google acabou recentemente de modificar os seus algoritmos qua classificam as páginas de baixa e alta qualidade no seu motor de busca. A gigante das buscas está sempre a fazer alterações no seu motor de busca, mas sem muita publicidade e na maioria das vezes essas alterações passam despercebidas pelo público. No entanto, esta última atualização afecta cerca de 11,2% de todas as pesquisas, pelo que a empresa achou importante informar todos.
A Google lançou uma atualização que reduz a contagem das páginas de baixa qualidade e aumenta a classificação para as páginas de boa qualidade. A empresa define as páginas de baixa qualidade aquelas que copiam conteúdo de outras páginas que simplesmente "não são muito úteis". No entanto, a empresa reconhece que sites de alta qualidade são aqueles que produzem conteúdo original e de informação que incluam pesquisa, análise e outro conteúdo original.
"A Google depende do conteúdo de alta qualidade criado por maravilhosas páginas de todo o mundo, e nós temos a responsabilidade de incentivar um ecossistema web saudável. Por isso, é importante que as páginas de alta qualidade sejam recompensadas, e é exatamente isso que essa mudança faz"./.../

Saturday, February 26, 2011

Encyclopédie

Google do Século 18
Encyclopédie
ENC 1-NA5 600px.jpegEncyclopédie, ou dictionnaire raisonné des sciences, des arts et des métiers (EnglishEncyclopedia, or a Systematic Dictionary of the Sciences, Arts, and Crafts) was a general encyclopedia published in France between 1751 and 1772, with later supplements, revised editions, and translations. As of 1750 the full title was Encyclopédie, ou Dictionnaire raisonné des sciences, des arts et des métiers, par une société de gens de lettres, mis en ordre par M. Diderot de l'Académie des Sciences et Belles-Lettres de Prusse, et quant à la partie mathématique, par M. d'Alembert de l'Académie royale des Sciences de Paris, de celle de Prusse et de la Société royale de Londres. The title page was amended as D'Alembert acquired more titles.
The Encyclopédie was an innovative encyclopedia in several respects. Among other things, it was the first encyclopedia to include contributions from many named contributors, and it was the first general encyclopedia to lavish attention on the mechanical arts. Still, the Encyclopédie is famous above all for representing the thought of the Enlightenment. According to Denis Diderot in the article "Encyclopédie," the Encyclopédie's aim was "to change the way people think".[1]

Origins

The Encyclopédie was originally conceived as a French translation of Ephraim Chambers's Cyclopaedia (1728).[2] In 1743, the translation was entrusted by the Parisian book publisher André Le Breton to John Mills, an English resident in France. In May 1745, Le Breton announced the work as available for sale, but to his dismay, Mills had not done the work he was commissioned to do; in fact, he could barely read and write French and did not even own a copy of Cyclopaedia. Furious at having been swindled, Le Breton beat Mills with a cane. Mills sued for assault, but Le Breton was acquitted in court as being justified.[3] For his new editor, Le Breton settled on the mathematician Jean Paul de Gua de Malves. Among those hired by Malves were the young Étienne Bonnot de CondillacJean le Rond d'Alembert, and Denis Diderot. Within thirteen months, in August 1747, Gua de Malves was fired for being an ineffective leader. Le Breton then hired Diderot and Jean d'Alembert as the new editors. Diderot would remain editor for the next twenty-five years, seeing the Encyclopédiethrough to completion.

Friday, February 25, 2011

Poverty: Three Centuries

Ruggiero, Mrs. Ana Lucia 



The Two Poverty Enlightenments:
Historical Insights from Digitized Books Spanning Three Centuries

Martin Ravallion, Development Research Group, World Bank
Washington DC, USA – Policy Research Working Paper 5549- 2011
            Available online PDF [52p.] at: http://bit.ly/i8VrJ1

“…
Word searches of Google's library of digitized books suggest that two Poverty Enlightenments have occurred since 1700, one near the end of the 18th century and the other 200 years later.
The historical literature suggests that only the second enlightenment came with a widespread belief that poverty could, and should, be eliminated. After the first Poverty Enlightenment, references to "poverty" as a percentage of all words declined until 1960, after which a striking resurgence of interest occurred.
That came with rising attention to economics and more frequent references to poverty policies. Developing countries also became more prominent in the literature. Both enlightenments came with greater attention to human rights.
The written record reflects the push back against government intervention, as well as the retreat from leftist economics and politics since the late 1970s. Although many debates from 200 years ago continue today, there is little evidence that the modern revival of the classical 19th century views on the limitations of government has come with a repeat of the complacency about poverty that was common back then. ….”

Dependência: biblioteca


Biblioteca sobre abuso e dependência de
Fumo, Álcool e Drogas

Thursday, February 24, 2011

Health Behaviours, Socioeconomic Status, and Mortality:

From:
Ruggiero, Mrs. Ana Lucia
Further Analyses of the British Whitehall II and the French GAZEL Prospective Cohorts
Silvia Stringhini 1*, Aline Dugravot 1, Martin Shipley2, Marcel Goldberg1, Marie Zins1, Mika Kivima¨ ki 2,
Michael Marmot 2, Se´verine Sabia 1, Archana Singh-Manoux 1,2,3
INSERM U1018, Centre for Research in Epidemiology and Population Health, Hopital Paul Brousse, Villejuif, France, Department of Epidemiology and Public Health, University College London, London, United Kingdom, Centre de Ge´rontologie, Hoˆ pital Sainte Pe´rine, Assistance Publique-Hoˆ pitaux de Paris, Paris, France
PLoS Med 8(2): e1000419. doi:10.1371/journal.pmed.1000419 – February 22, 2011
Available online at: http://bit.ly/dXByVS
 
“……….Differences in morbidity and mortality between socioeconomic groups constitute one of the most consistent findings of epidemiologic research.
However, research on social inequalities in health has yet to provide a comprehensive understanding of the mechanisms underlying this association.
In recent analysis, we showed health behaviours, assessed longitudinally over the follow-up, to explain a major proportion of the association of socioeconomic status (SES) with mortality in the British Whitehall II study.
However, whether health behaviours are equally important mediators of the SES mortality association in different cultural settings remains unknown. In the present paper, we examine this issue in Whitehall II and another prospective European cohort, the French GAZEL study.
Methods and FindingsWe included 9,771 participants from the Whitehall II study and 17,760 from the GAZEL study. Over the follow-up (mean 19.5 y in Whitehall II and 16.5 y in GAZEL), health behaviours (smoking, alcohol consumption, diet, and physical activity), were assessed longitudinally. Occupation (in the main analysis), education, and income (supplementary analysis) were the markers of SES.

The socioeconomic gradient in smoking was greater (p,0.001) in Whitehall II (odds ratio [OR] = 3.68, 95% confidence interval [CI] 3.11–4.36) than in GAZEL (OR = 1.33, 95% CI 1.18–1.49); this was also true for unhealthy diet (OR = 7.42, 95% CI 5.19–10.60 in Whitehall II and OR = 1.31, 95% CI 1.15–1.49 in GAZEL, p,0.001).
Socioeconomic differences in mortality were similar in the two cohorts, a hazard ratio of 1.62 (95% CI 1.28–2.05) in Whitehall II and 1.94 in GAZEL (95% CI 1.58–2.39) for lowest versus highest occupational position. Health behaviours attenuated the association of SES with mortality by 75% (95% CI 44%–149%) in Whitehall II but only by 19% (95% CI 13%–29%) in GAZEL. Analysis using education and income yielded similar results.

Conclusions: 
Health behaviours were strong predictors of mortality in both cohorts but their association with SES was remarkably different. Thus, health behaviours are likely to be major contributors of socioeconomic differences in health only in contexts with a marked social characterisation of health behaviours.

Wednesday, February 23, 2011

Foodborne Disease in 2011 — The Rest of the Story


PERSPECTIVE

Foodborne Disease in 2011 — The Rest of the Story

NEJM | February 23, 2011 | Topics: Drugs, Devices, and the FDA, Public Health
Michael T. Osterholm, Ph.D., M.P.H.
Recent media headlines might have you believe that our food supply is substantially more safe than it was a decade ago and about to get even safer. First, on December 15, 2010, the Centers for Disease Control and Prevention (CDC) announced a long-awaited reanalysis of the burden of foodborne illness in the United States and reported a substantial decrease in the estimated incidence of foodborne disease between 1999 and 2011. Then, on January 4, 2011, President Barack Obama signed into law the Food Safety Modernization Act, the first major legislation related to the food-safety authority of the Food and Drug Administration (FDA) since 1938. But as the late radio commentator Paul Harvey would say, “You know what the news is; in a minute, you’re going to hear . . . the rest of the story.”/.../

Dark Matter, Bright Stars: New Evidence on How Galaxies Are Born

By MICHAEL D. LEMONICK Wednesday, Feb. 23, 2011


This image from the Hubble Space Telescope indicates that a huge ring of dark matter likely exists surrounding the center of CL0024+17 that has no normal matter counterpart
NASA / ESA, M.J. Jee and H. Ford et al. (Johns Hopkins University)

If you think it's hard to swallow the concept of dark matter, you're not alone. Decades ago, a few astronomers began to suspect that the universe was swarming with some mysterious, invisible substance that was yanking galaxies around with its own powerful gravity. And for those same decades, most of those astronomers' colleagues dismissed the notion as pretty much nuts./.../

Read more: http://www.time.com/time/health/article/0,8599,2052614,00.html#ixzz1EmygKm56

Read more: http://www.time.com/time/health/article/0,8599,2052614,00.html#ixzz1EmyQXa7L

Tuesday, February 22, 2011

Statins are not associated with a decrease in all cause mortality in a high-risk primary prevention setting


  • Bernhard M Kaess1

  • Ramachandran S Vasan2

  • 1Framingham Heart Study and Klinik und Poliklinik für Innere Medizin II, University of Regensburg, Regensburg, Germany
    1. 2Framingham Heart Study and Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, USA
    1. Correspondence toBernhard M Kaess
      73 Mount Wayte Avenue, Suite 2, Framingham, MA 01702–5803, USA; kaess@bu.edu
    Commentary on:
     

    Context

    Low-density lipoprotein (LDL) cholesterol (LDL-C) is a risk factor for cardiovascular disease (CVD). Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) lower LDL-C concentrations by about 30–50% and have been shown to reduce mortality in patients with prevalent CVD. However, it is not clear whether statin treatment is beneficial in a primary prevention setting, that is in people without prevalent CVD who are at relatively lower risk. The recent results of the JUPITER trial1 have fuelled an intense debate whether statins should be given for primary prevention of CVD./.../

    Preserving the Lifesaving Power of Antimicrobial Agents

    James M. Hughes, MD

    [+] Author Affiliations
    1. Author Affiliations: Infectious Diseases Society of America, Arlington, Virginia, and Department of Medicine and Hubert Department of Global Health, School of Medicine and Rollins School of Public Health, Emory University, Atlanta, Georgia.
    1. Corresponding Author: James M. Hughes, MD, Emory University, 1462 Clifton Rd, Ste 446 Mailstop 1370/004/1AD, Atlanta, GA 30322 (jmhughe@emory.edu).
    Among the most important medicines ever discovered, antimicrobial agents have saved millions of lives and improved the outcomes for countless patients since these drugs were introduced in the early 1930s. However, the effectiveness of these lifesaving resources is at risk. Many medical advances that physicians and patients take for granted—including cancer treatment, surgery, transplantation, and neonatal care—are endangered by increasing antibiotic resistance and a distressing decline in the antibiotic research and development pipeline.1
    Antibiotic-resistant infections have been estimated to cost the US health care system more than $20 billion annually and result in more than 8 million additional days in the hospital.2,3 Drug resistance is both a public health and national security threat. Virtually all of the antibiotic-resistant pathogens that exist naturally today can be bioengineered through forced mutation or cloning, and existing pathogens could be genetically manipulated to make them resistant to currently available antibiotics. As underscored by recent reports of infections caused by strains of gram-negative bacteria producing the New Delhi metallo-beta-lactamase (NDM-1) enzyme, which confers multidrug resistance, antibiotic resistance is also a growing global public health threat./.../