Tuesday, July 31, 2012

Serviço público e Desenvolvimento

De nossa AMICOR: Maria Inês Reinert Azambuja

Serviço público e desenvolvimento – uma questão para Dilma

julho 31, 2012 em Destaques por Equipe do Blog

Maria Inês Azambuja: “Se o Setor Saúde não é usualmente percebido pela sua força econômica, e sim – equivocadamente – como gerador de despesa, o mesmo ocorre com os funcionários públicos”.

Por Maira Inês Azambuja, médica e professora do Depto. de Medicina Social da UFRGS.

O proximo Congresso da Associação Brasileira de Saúde Coletiva (ABRASCO) irá ocorrer em Porto Alegre, nas dependências da UFRGS, entre os dias 14 e 18 de Novembro. O tema deste Congresso é “Saúde é Desenvolvimento”. Com ele, a ABRASCO quer chamar a atenção para o fato de que a relação “saúde – desenvolvimento” tem duas mãos: desenvolvimento afetando a saúde (para o bem e o mal) e a Saúde, como setor econômio, também motor de desenvolvimento – entrando nesta conta a produção científica (inclusive a editorial), a inovação e o desenvolvimento tecnológico, a produção de equipamentos, fármacos e insumos para o atendimento ao mercado interno e para exportação, o estímulo à alimentação saúdável e ao exercício (e o que eles implicam em termos de produção de alimentos, equipamentos, vestuário, restaurantes, praças e academias), sem falar na assistência em si – que ocupa profissionais das 14 profissões na área da Saúde, e também auxiliares de saúde, profissionais da nutrição, de lavanderias, eletrecistas, pessoal de informática e sistemas, de mídia e marketing, cuidadores, motoristas, seguranças, todo o pessoal administrativo necessário para a organização e manutenção de sistemas de atenção à saúde, e todos os envolvidos na construção da infraestrutura dos serviços (industria da construção, bancos, financeiras…).

Se o Setor Saúde não é usualmente percebido pela sua força econômica, e sim – equivocadamente – como gerador de despesa, o mesmo ocorre com os funcionários públicos.

Abro a Zero Hora de hoje e leio que a Presidente Dilma prepara um novo pacote de corte de impostos para o setor privado, no momento em que quase 500 mil funcionários públicos estão em greve. Como professora universitária, uma das categorias que está em greve e para a qual o governo propõe um reajuste parcelado até 2015 que não cobrirá a inflação do período, tenho que perguntar à Presidente Dilma… Não há um equívoco sendo cometido aquí?

Para quem o governo deveria entregar dinheiro? Diretamente ao setor privado – privilegiando os desde sempre privilegiados e em particular algumas categorias reiteradamente eleitas como motores da economia? – Ou a seus funcionários, trabalhadores em serviços públicos essenciais como Saúde e Educação, e que com os merecidos reajustes, e ao exercitarem suas escolhas individuais de consumo, farão a economia girar e de maneira mais equilibrada, com mais consumo e geração de empregos distribuídos para grandes e pequenos empresários em todos os setores?

Urban Mental Health

Summary

/2012 Conference

/Institute on Social Exclusion

/Institutes + Centers

About the Conference

Today, more than half of all global humanity lives in urban areas. That figure is projected to grow to more than 60 percent by 2050. Although cities possess conditions that promote good mental health, they also possess conditions - poverty, conflict, and social isolation - that are harmful to mental health. In fact, research demonstrates that city living is linked to increased risk for mental health problems.

Join healthcare professionals, government officials, scholars, and philanthropists in discussions about how to create cities that promote the mental health and well-being of their residents.

Featuring keynote speaker:

Professor Sir Michael G. Marmot MBBS, MPH, PhD
Director, University College London Institute of Health Equity (Marmot Institute)
Chair, European Review on the Social Determinants of Health and the Health Divide
Sir Michael Marmot has led a research group on health inequalities for 35 years. He was Chair of the Commission on Social Determinants of Health, established by the World Health Organization in 2005, and produced the report titled "Closing the Gap in a Generation" in August 2008. Principal investigator on the seminal Whitehall Studies of British Civil Servants in which he has documented the inverse social gradient in morbidity and mortality, Professor Marmot is a leading global scholar on the social causation of health inequalities.

No ECG Screens for Low-Risk Adults

É de se considerar esta recomendação já que em nossa prática geralmente está incluída a realização de ECG em todo o paciente mesmo assintomático que nos procure?!

Lembrei-me do tempo em que iniciei há 54 anos- e havia aprendido antes durante minha formação - que a rotina era: Anamnese, Exame físico, Eletrocardiograma e Fluoroscopia (Não havia ainda intensificador de imagem...)?!...

USPSTF: Still No ECG Screens for Low-Risk Adults

By Todd Neale, Senior Staff Writer, MedPage Today

Published: July 30, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

The U.S. Preventive Services Task Force continues to recommend against using electrocardiography (ECG) to screen asymptomatic adults at low risk for coronary heart disease.

The recommendation, published online in theAnnals of Internal Medicine, is consistent with the task force's 2004 guidance and is based on a update of a review published last September that showed a lack of evidence supporting a reduction in coronary heart disease events from screening a low-risk population.

The guidance applies to men and women who do not have any symptoms and have not received a diagnosis of cardiovascular disease. According to the Framingham Adult Treatment Panel III calculator, individuals with a 10-year risk of cardiovascular events of less than 10% are considered to have a low risk.

After reviewing studies published since 2004, the authors concluded that resting ECG can detect abnormalities that are related to a greater risk of serious coronary heart disease events -- including ST segment and T wave abnormalities, left ventricular hypertrophy, left axis deviation, and bundle branch block.

They also concluded that exercise ECG can detect abnormalities associated with subsequent cardiac events including ST depression with exercise, failure to reach 85% or 90% of maximum predicted heart rate, and abnormal heart rate recovery after exercise.

However, they concluded that the information added by ECG is unlikely to change risk stratification based on traditional cardiovascular risk factors or spur interventions to prevent clinical events.

In addition, there was evidence that screening asymptomatic, low-risk adults could result in some harms, such as unnecessary invasive testing and procedures, overtreatment, and labeling.

"Therefore, the USPSTF concluded with moderate certainty that screening ECG provides no net benefit to asymptomatic, low-risk patients," the guidance stated.

Guidelines from the American College of Cardiology and the American Heart Association suggest that a resting ECG is "reasonable for cardiovascular risk assessment in asymptomatic adults with hypertension or diabetes."

They also suggest that an exercise ECG "may be considered for cardiovascular risk assessment in intermediate-risk asymptomatic adults (including sedentary adults considering starting a vigorous exercise program), particularly when attention is paid to non-ECG markers such as exercise capacity."

The USPSTF document also addressed the use of ECG to screen asymptomatic adults at intermediate or high risk, with the task force concluding that there is insufficient evidence to recommend for or against the practice.

The authors noted, however, that certain factors should be taken into account when a clinician is considering screening adults in those categories with ECG, including potential harms and preventable burden.

Individuals at intermediate risk, for example, likely have the greatest potential to derive a benefit from screening because getting placed into a higher risk category might lead to more intensive medical management that has been shown to lower the risk for coronary heart disease events.

Those already at high risk based on traditional cardiovascular risk factors, on the other hand, should already be receiving intensive management.

An individual's occupation can also be considered because screening might make sense for people whose sudden incapacitation or death could harm others, including pilots and heavy equipment operators.

Virginia A. Moyer, MD, MPH, from Baylor College of Medicine in Houston, was the chair of the task force when this recommendation was finalized.

Members of the USPSTF must have no substantial conflicts of interest that would impair the scientific integrity of the work of the task force, including financial, intellectual, or other conflicts. All members are expected to provide full disclosure of their interests related to all topics.

From the American Heart Association:

2010 ACCF/AHA Guidelines for Cardiovascular Risk in Asymptomatic Adults

Primary source: Annals of Internal Medicine
Source reference:
USPSTF "Screening for coronary heart disease with electrocardiography: U.S. Preventive Services Task Force recommendation statement" Ann Intern Med 2012.

Sunday, July 29, 2012

Coffee

Coffee: The Original Wonder Drug?

July 24, 2012

01 of 13

Mental and Medical Benefits of Coffee: Introduction

The best part of waking up...is reducing your risk of neurodegeneration. And depression, and cancer, and cardiovascular disease... It's becoming increasingly clear that coffee is more than just a morning routine. The body of data suggesting that the world's most widely used stimulant is beneficial in a variety of mental and medical conditions is growing at a staggering rate. A recent study published in theNew England Journal of Medicine found that coffee consumption lowered all-cause mortality by over 10% at 13-year follow-up.^[1]Based primarily on recent Medscape Medical News coverage, the following slideshow reviews the potential medical and psychiatric benefits of coffee consumption.

Photo courtesy of Darbe Rotach

References

01 of 13

Inequality

From: Ruggiero, Mrs. Ana Lucia (WDC)

Divided We Stand: Why Inequality Keeps Rising

Organisation for Economic Co-operation and Development (OECD) 2012

Website: http://bit.ly/N2aE0n

“…….The gap between rich and poor in OECD countries has reached its highest level for over over 30 years, and governments must act quickly to tackle inequality, according to this OECD report.

The report notes that the average income of the richest 10% is now about nine times that of the poorest 10 % across the OECD. The income gap has risen even in traditionally egalitarian countries, such as Germany, Denmark and Sweden, from 5 to 1 in the 1980s to 6 to 1 today. The gap is 10 to 1 in Italy, Japan, Korea and theUnited Kingdom, and higher still, at 14 to 1 in Israel, Turkey and the United States.

In Chile and Mexico, the incomes of the richest are still more than 25 times those of the poorest, the highest in the OECD, but have finally started dropping. Income inequality is much higher in some major emerging economies outside the OECD area. At 50 to 1, Brazil's income gap remains much higher than in many other countries, although it has been falling significantly over the past decade.

“…….Globalisation and technological changes offer opportunities but also raise challenges that can be tackled with effective and well-targeted policies. Any policy strategy to reduce the growing divide between rich and poor should rest on three main pillars: more intensive human capital investment; inclusive employment promotion; and well-designed tax/transfer redistribution policies…..”

This report analyses the major underlying forces behind these developments:

Content:

- An Overview of Growing Income Inequalities in OECD Countries

- Special Focus: Inequality in Emerging Economies

- Part I. How Globalisation, Technological Change and Policies Affect Wage and Earnings Inequalities

- Part II. How Inequalities in Labour Earnings Lead to Inequalities in Household Disposable Income

- Part III. How the Roles of Tax and Transfer Systems Have Changed

World Children 2012

From: Ruggiero, Mrs. Ana Lucia (WDC)
Save the Children
Child Development Index 2012: Progress, Challenges and Inequality

Available online PDF [36p.] at: http://bit.ly/P6Pfmi

“…..The 2012 edition of the Child Development Index tells a story of success. This edition of the Index shows that substantial progress has been made in addressing the most basic threats to child survival and well-being. On average, the lives of children around the world in the indicators we measured improved by more than 30%.
This means that the chances of a child going to school were one-third higher, and the chances of an infant dying before their fifth birthday were one-third lower at the end of the 2000s than a decade before. During this period child well-being improved in 90% of the countries surveyed…..”

Content:

Executive summary

Box: Measuring children’s well-being

1 A decade of progress in child well-being

Developing countries accelerate progress

Inequalities between developed and developing countries remain

Box: The Child Development Index and the Human Development Index

2 Undernutrition: holding back progress

Under-five mortality

Primary school enrolment

Undernutrition

Box: The uncounted

3 Food and financial crises threaten increased undernutrition

Conclusions

Recommendations

Appendix

2561 - AMICOR 15

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