6 países maioria de líderes é mulher

Nova York, 06/03/2009
Só em 6 países maioria de líderes é mulher
Relatório do PNUD aponta que apenas na Jamaica, Filipinas, Dominica, Santa Lúcia, Lesoto e Fiji elas são a maioria em funções de poder

DAYANNE SOUSA
da PrimaPagina

As mulheres são maioria à frente de cargos importantes em apenas seis países do mundo, de acordo com dados do RDH (Relatório de Desenvolvimento Humano) 2009, do PNUD. Nos outros 114 – de um total de 120, para os quais existem dados disponíveis – os homens são mais de 50% dos legisladores, gerentes e funcionários públicos de alto escalão.

Os seis países em que elas são maioria nos cargos mais altos não são as maiores economias mundiais e nem as nações mais desenvolvidas. São eles: Jamaica, Filipinas, Dominica, Santa Lúcia, Lesoto e Fiji. Na Jamaica, as mulheres são 59% dos líderes; nas Filipinas, 58%; em Dominica, 57%; em Santa Lúcia e em Lesoto, 52%; e, em Fiji, 51%. No índice jamaicano, porém, o dado foi somado ao número de mulheres em profissões técnicas, o que distorce um pouco o índice.

Dia Internacional da Mulher

Repasso a todas as AMICOR
De: 

Maria Fátima Sousa

Prezad@s
Para refletimos no dia Internacional da Mulher.
Com carinho
Profa. Dra. Maria Fátima de Sousa
Universidade de Brasília
Faculdade de Ceilândia
Núcleo de Estudos de Saúde Pública
(55++61) 8147-5050

Amanhã, simbolicamente, é o nosso dia. Embora o façamos a cada minuto.

E com isso merecemos mais que homenagens. Merecemos renovar nossos conceitos, valores e princípios sobre o mundo que nos cerca.

Um mundo sem fronteiras conquistado pela sabedoria, generosidade e firmeza de muitas que souberam enfrentar as diversidades de suas vidas privadas para que no público fosse apreciado o que nelas havia de melhor.

O melhor de Margaret Mee, que nasceu na Inglaterra em 1929 e veio para o Brasil onde registrou em suas gravuras centenas de flores e plantas da flora brasileira.

O melhor de Maria Rita de Souza Brito Lopes Pontes, mais conhecida como Irmã Dulce.

O melhor de Isabel Cristina Leopoldina Augusta Miguela Gabriela Rafaela Gonzaga de Bragança e Bourbon, a princesa Izabel, a que aboliu a escravidão no Brasil.

O melhor de Johanna Sigurdardottir, assumidamente homossexual que foi, aos 66 anos, a primeira mulher à frente do Executivo da Islândia, além de primeira mulher no país a ocupar o cargo de primeira-ministra.

Essas e tantas outras anônimas fazem ecos de histórias silenciosas, a exemplo das milhares de Agentes Comunitárias de Saúde que desbravam nosso país. A estas, rendo minha homenagem maior em 2009, quando o Programa de Agentes Comunitários de Saúde e o Saúde da Família fortalecem suas trilhas para uma segunda década.

Que essa nova década sinalize as mudanças no ir e vir em paz com a natureza, com o meio ambiente, em sinergia com os sinais de paz que estão sob nossos olhos e muitas vezes não os vemos. Em sintonia com os sons do universo clamando por justiça social e saúde para todos. Em

busca de uma vida com qualidade e prosperidade para as mais remotas famílias do nosso planeta Terra.

Que esse dia não seja mais um. Seja a continuidade no caminho da diferença.

Maria Fátima de Sousa

Women’s Heart Health

Learn more about Women’s Heart Health on ProCor's website. You can filter what you find by country or region. Visit: www.procor.org/issues/issues_list.htm?attrib_id 152.
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"Health is linked to status in society. It benefits from equality and suffers from discrimination. For women, the rapid rise in noncommunicable diseases not only affects their health directly, it can also severely impact on their assumed gender role as unpaid carers of the sick." (1)

Nearly everywhere in the world, women live longer than men. But a longer life is not necessarily a healthier life. A woman's health is affected by her role in her society, the culture in which she lives, unique female biological characteristics, the choices she makes, and an array of socio-economic factors. In turn, women's health has an enormous effect on the health of those around them. Women give birth to and nurture the next generation. They procure and cook food for their families, friends, and communities. In some cultures, girls begin caring for other family members at a very young age. As women grow older, they often find themselves taking care of their own children, their children's children, their older parents, their in-laws, and their male partners--who often are less healthy. Focused on taking care of others, women may necessarily neglect taking care of themselves physically or financially. Poverty disproportionately affects women's lives and their health, according to WHO, which estimates that 70% of the 1.2 billion people living in poverty are female. Twice as many women as men are illiterate.

Heart disease and stroke are already the leading causes in women in developed countries and will be the leading causes of death in women in poor countries by 2020. CVD currently causes about one-third of women's deaths globally, with a majority of these deaths occurring in low- and middle-income countries. Unfortunately, the enormous global toll of cardiovascular disease among women, is not generally recognized. Heart disease and stroke are responsible for twice as many deaths as all cancers combined, but many women are more aware and more fearful of cancer than CVD.

The need for increased awareness, education, and action is clear, not only to promote women's health and well-being, but for the health and well-being of our communities and countries.

A comprehensive overview of determinants and challenges relevant to women's heart health, and an outline of opportunities and recommendations on which we can act, are presented in "Women and the Rapid Rise of Noncommunicable Diseases." Published by the World Health Organization in 2002, its contents are illuminating, useful, and highly relevant. Thank you to Derek Yach, one of the report's authors, for bringing it to our attention as we highlight women's heart health issues in anticipation of International Women's Day on Sunday, 8 March 2009. The report should be included, as a valuable reminder and a useful, usable resource, in everyone's library of CVD literature, and can be downloaded at no cost at: (PDF 111 KB) http://whqlibdoc.who.int/hq/2002/WHO_NMH_02.01.pdf.

The report advocates several specific responses to the challenges we face in addressing women's health issues globally:
- Obtain more and better gender-sensitive information with data collection and analysis that seeks to understand gender differences in morbidity, mortality, and risk.
- Create linkages among existing programs that address infectious disease and maternal and child health with programs preventing chronic disease-for example, by promoting tobacco cessation in TB clinics, or providing nutritional advice to new mothers that can help prevent CVD in adulthood.
- Develop policies that address the determinants of noncommunicable diseases. Global and national interventions that are affordable can effectively reduce risk factors for chronic diseases. Banning tobacco advertising requires political will rather than funding; in countries like Poland, Iran, and Thailand, tobacco taxes generate fiscal resources that are used to support health programming.
- Refocus health systems on chronic disease and primary health care instead of acute disease. Implicit in this is the need to reduce barriers' to women's access to care in terms of cost, convenience, service provider genders, etc.
- Expand partnerships among programs that address the full range of issues affecting women's health, like gender equality and sexual and reproductive rights.

As International Women's Day approaches, let's all take a moment to honor the contributions of women everywhere, as well as to take a look at what more our organizations or projects can do to promote women's health and wellbeing.

Catherine Coleman
Editor in Chief, ProCor

Citation:
1. Yach D, Brands A. Women and the rapid rise of noncommunicable disease. World Health Organization: NMH Reader, Issue 1, January 2002, http://whqlibdoc.who.int/hq/2002/WHO_NMH_02.01.pdf

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HHS-Special Report on Health Reform + Newhealthreform.gov Web Site

Ruggiero, Mrs. Ana Lucia (WDC)  to EQUIDAD

show details 11:59 AM (4 hours ago)

Reply

HHS Issues Special Report on Health Reform and Launches Newhealthreform.gov Web Site

“…American People Say Health Care System is Broken, Highlight Need for Action This Year on Health Reform..”

March 5, 2009 Press release: http://www.hhs.gov/news/press/2009pres/03/20090305a.html


The Department of Health and Human Services (HHS) has issued a report, Americans Speak on Health Reform: Report on Health Care Community Discussions. The report summarizes comments from Americans who hosted and participated in Health Care Community Discussions across the country and highlights the need for immediate action to reform health care.

The report is available on a new Web site dedicated to health reform:http://www.healthreform.gov

Table of Contents

Executive Summary and Highlights /.../

Oseltamivir After Influenza:Associated With Reduced Incidence of Recurrent Adverse Cardiovascular Outcomes

Use of Oseltamivir After Influenza Infection Is Associated With Reduced Incidence of Recurrent Adverse Cardiovascular Outcomes Among Military Health System Beneficiaries With Prior Cardiovascular Diseases

S. Ward Casscells, MD; Elder Granger, MD, FACP, FACPE; Amii M. Kress, MPH; Andrea Linton, MS;Mohammad Madjid, MD, MSc and Linda Cottrell, BS

From Health Affairs (S.W.C.), TRICARE Management Activity (E.G.), and Health Program Analysis and Evaluation (A.M.K., A.L., L.C.), West Falls Church, Va; and Texas Heart Institute and Baylor College of Medicine (M.M.), Houston, Tex.

Correspondence to Andrea Linton, MS, TRICARE Management Activity/Health Program Analysis and Evaluation, 5111 Leesburg Pike, Suite 810, Falls Church, VA 22041-3206. E-mail andrea.linton@wowway.com

Background: Influenza infection has been associated with increased risk of adverse cardiac and cerebral vascular outcomes. Oseltamivir, a treatment for influenza, has been shown to decrease the severity of an influenza episode, but few data exist regarding its potentiallyprotective effect against recurrent vascular outcomes among influenza patients with a history of vascular disease.

Methods and Results: Electronic healthcare service and pharmacy records for 37 482 TRICARE beneficiaries, aged 18 and older, with a coded history of cardiovascular (CV) disease and a subsequent diagnosis of influenza from October 1, 2003, through September 30, 2007, were examined. Subjects were grouped according to whether they had filled a prescription for oseltamivir within 2 days of their influenza diagnosis. The incidence of recurrent CV events within 30 days after the influenza diagnosis among oseltavmivir-treated and untreated subjects was 8.5% and 21.2%, respectively (P<0.005). Subject age was a persistent and significant contributor to the likelihood of recurrent CV outcomes. After controlling for the differences in demographics among treated and untreated cohorts using a propensity-scored logistic regression model, a statistically significant protective effect was associated with oseltamivir treatment (odds ratio, 0.417; 95% CI, 0.349 to 0.498).

Conclusions: Our findings suggests that oseltamivir treatment for influenza is associated with significant decrease in the risk of recurrent CV events in subjects with a history of CV disease. These findings merit confirmation in further prospective and controlled studies. Meanwhile, in patients with CV disease, strict adherence withcurrent practice guidelines for prevention and treatment of influenza is recommended.

Philip Poole-Wilson dies unexpectedly

(Poole-Wilson was President of the World Heart Federation two year after my leave of the Scientific Board where I have had some closer contact with him)

Philip Poole-Wilson dies unexpectedly

MARCH 5, 2009 | Lisa Nainggolan

London, UK - Dr Philip Poole-Wilson, an expert on heart failure and coronary heart disease prevention across the globe, collapsed and died on his way to work in London on March 4, from a suspected MI, his colleagues at the Imperial College London have told heartwire.

Dr Philip Poole-Wilson

A man of many talents and admired by many, Poole-Wilson considered cardiovascular medicine his passion and said in a recent interview with Circulation [1]: "I am unbelievably fortunate that my work is my hobby." He was a month short of his 66th birthday when he died and had retired only six months ago, although he was still working as an honorary consultant at Imperial College three days a week and continuing with many other projects.

Although it is difficult to pick out career highlights, among his greatest achievements were: his pioneering work in bringing heart failure out of the closet; being one of the founders of the European Society of Cardiology (ESC) as it is today; his basic research; and his involvement with the World Heart Federation (WHF). He was a past president of the WHF (2003-2005) and of the ESC (1994-1996) and the founding chair of the British Society for Heart Failure./.../

A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults

From: 

Ruggiero, Mrs. Ana Lucia (WDC)

 

A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults

  Andrew P. Wilper, MD, MPH; Steffie Woolhandler, MD, MPH; Karen E. Lasser, MD, MPH; Danny McCormick, MD, MPH; David H. Bor, MD; and David U. Himmelstein, MD

Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts.

August 2008 | Volume 149 Issue 3 | Pages 170-176

The Annals of Internal Medicine - American College of Physicians

 Available online at: http://www.annals.org/cgi/content/full/149/3/170

 Editor Notes:

Context

·         Although many Americans lack health insurance, some policymakers claim that persons without insurance are largely healthy. However, the rates of chronic illness among those without insurance have not been well documented./.../

Towards responsible use of cognitive-enhancing drugs by the healthy

Society must respond to the growing demand for cognitive enhancement. That response must start by rejecting the idea that 'enhancement' is a dirty word, argue Henry Greely and colleagues.

Today, on university campuses around the world, students are striking deals to buy and sell prescription drugs such as Adderall and Ritalin — not to get high, but to get higher grades, to provide an edge over their fellow students or to increase in some measurable way their capacity for learning. These transactions are crimes in the United States, punishable by prison.

Many people see such penalties as appropriate, and consider the use of such drugs to be cheating, unnatural or dangerous. Yet one survey¹ estimated that almost 7% of students in US universities have used prescription stimulants in this way, and that on some campuses, up to 25% of students had used them in the past year. These students are early adopters of a trend that is likely to grow, and indications suggest that they're not alone²./.../

Implementing American Heart Association Pediatric and Adult Nutrition

Implementing American Heart Association Pediatric and Adult Nutrition Guidelines: A Scientific Statement From the American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Cardiovascular Disease in the Young, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on
Cardiovascular Nursing, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research
Samuel S. Gidding, Alice H. Lichtenstein, Myles S. Faith, Allison Karpyn, Julie A. Mennella, Barry Popkin, Jonelle Rowe, Linda Van Horn, and Laurie Whitsel
Circulation 2009;119 1161-1175
http://circ.ahajournals.org/cgi/content/extract/119/8/1161?etoc

Rheumatic Fever Prevention

Michael A. Gerber MD, Chair, Robert S. Baltimore MD, Charles B. Eaton MD, MS, Michael Gewitz MD, FAHA, Anne H. Rowley MD, Stanford T. Shulman MD, and Kathryn A. Taubert PhD, FAHA


Abstract—Primary prevention of acute rheumatic fever is accomplished by proper identification and adequate antibiotic treatment of group A -hemolytic streptococcal (GAS) tonsillopharyngitis. Diagnosis of GAS pharyngitis is best accomplished by combining clinical judgment with diagnostic test results, the criterion standard of which is the throat culture. Penicillin (either oral penicillin V or injectable benzathine penicillin) is the treatment of choice, because it is cost-effective, has a narrow spectrum of activity, and has long-standing proven efficacy, and GAS resistant to penicillin have not been documented. For penicillin-allergic individuals, acceptable alternatives include a narrow-spectrum oral cephalosporin, oral clindamycin, or various oral macrolides or azalides. The individual who has had an attack of rheumatic fever is at very high risk of developing recurrences after subsequent GAS pharyngitis and needs continuous antimicrobial prophylaxis to prevent such recurrences (secondary prevention). The recommended duration of prophylaxis depends on the number of previous attacks, the time elapsed since the last attack, the risk of exposure to GAS infections, the age of the patient, and the presence or absence of cardiac involvement. Penicillin is again the agent of choice for secondary prophylaxis, but sulfadiazine or a macrolide or azalide are acceptable alternatives in penicillin-allergic individuals. This report updates the 1995 statement by the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee. It includes new recommendations for the diagnosis and treatment of GAS pharyngitis, as well as for the secondary prevention of rheumatic fever, and classifies the strength of the recommendations and level of evidence supporting them.

Biblioteca Virtual da América Latina

http://www.bvmemorial.fapesp.br/php/index.php

endangered languages

UNESCO Atlas of the World's Languages in Danger

The new journal Amanar, in Tifinagh, is distributed in Agadez, Niger©Jacques Roure
UNESCO's Atlas of the World's Languages in Danger is intended to raise awareness about language endangerment and the need to safeguard the world’s linguistic diversity among policy-makers, speaker communities and the general public, and to be a tool to monitor the status of endangered languages and the trends in linguistic diversity at the global level.
The latest edition of the Atlas (2009) lists about 2,500 languages (among which 230 languages extinct since 1950), approaching the generally-accepted estimate of some 3,000 endangered languages worldwide. For each language, the Atlas provides its name, degree of endangerment (see below) and the country or countries where it is spoken.

Marcia Angell, M.D.

Marcia Angell, M.D.

Marcia Angell, M.D. (born 1939) is an American physician, author, and the first woman to serve as editor-in-chief of the New England Journal of Medicine (NEJM). She currently is a Senior Lecturer in theDepartment of Social Medicine at Harvard Medical School, in Boston, Massachusetts.^[1]

Contents  [hide] 1 Biography 2 Tenure as NEJM editor-in-chief 3 Critic of U.S. healthcare system 4 Critic of the pharmaceutical industry 5 Critic of alternative medicine 6 Awards and honors 7 References 8 External links

Author of the article appointed in this Blog recently, in last January.
Drug Companies & Doctors: A Story of Corruption 
Volume 56, Number 1 · January 15, 2009 New York Review of Books

Eduardo Costa (AMICOR) e Farmanguinhos

(Artigo apontado por Maria Inês Reinert Azambuja)
São Paulo, terça-feira, 17 de fevereiro de 2009
COQUETEL ANTI-AIDS Farmanguinhos entrega 1º lote de Efavirenz nacional ITALO NOGUEIRA DA SUCURSAL DO RIO
A entrega das primeiras unidades do Efavirenz -remédio do coquetel contra a Aids- de produção brasileira serviu como palanque para o diretor da Farmanguinhos, Eduardo Costa, defender mudanças na gestão da unidade da Fiocruz. Costa listou dificuldades na produção do medicamento e pediu que a Farmanguinhos deixe "de ser suporte ao programa de atenção básica para desenvolver e produzir medicamentos de alto valor". O ministro José Gomes Temporão (Saúde) criou um grupo de trabalho para estudar a flexibilização da gestão da unidade. O Efavirenz, um dos 17 medicamentos do coquetel anti-Aids, foi produzido pela Farmanguinhos com o laboratório Lafepe e consórcio privado após polêmico licenciamento compulsório. Criado pelo laboratório Merck, foi declarado objeto de interesse público pelo governo federal em 2007. Neste ano, serão produzidos 15 milhões de comprimidos, metade da demanda nacional (completada com produto da Índia, usado desde 2007) -todo o consumo deve ser atendido em 2010. A produção brasileira será 32,6% mais cara do que a indiana (R$ 1,35 o preço do comprimido contra R$ 1,04), mas Temporão diz que, com a iniciativa, o Brasil "reduz a dependência de tecnologia de fora e passa a desenvolver a sua própria".
Demanda federal A Farmanguinhos só pode produzir sob demanda do ministério e vender o raro excedente dessa produção. Costa afirma que, com uma produção em larga escala, os remédios ficariam mais baratos e poderiam ser enviados para a África e vendidos a baixo custo para países do Mercosul, além de outros Estados e municípios. A unidade é vinculada à Fiocruz -fundação ligada ao Ministério da Saúde-, que tem verba definida pelo orçamento e depende da liberação por parte do governo federal. Ele está estimado neste ano em R$ 1,5 bilhão, dos quais R$ 250 milhões para a Farmanguinhos. O governo pretende produzir outros dois medicamentos do coquetel anti-Aids: o tenofovir e o atazanavir -este último patenteado.

Coffee Consumption : Lower Stroke Risk for Women

High Coffee Consumption Linked to Lower Stroke Risk for Women

By Todd Neale, Staff Writer, MedPage Today Published: February 17, 2009 Reviewed by Zalman S. Agus, MD; Emeritus Professor  University of Pennsylvania School of Medicine.

MADRID, Feb. 17 -- Drinking caffeinated coffee regularly may lower the stroke risk for women, according to data from the Nurses' Health Study. Action Points   Explain to interested patients that although this study found an inverse association between coffee consumption and stroke risk, adjusting for high blood pressure, hypercholesterolemia, and type 2 diabetes attenuated the relationship. Point out that the association was significant only in women who had never smoked or who had quit. Women who drank two to three cups a day had a 19% reduction in the risk of all strokes, with greater consumption lowering the risk even further (P=0.003 for trend), found Esther Lopez-Garcia, Ph.D., of the Universidad Autonoma de Madrid, and Harvard colleagues. The association was weakened after adjusting for high blood pressure, hypercholesterolemia, and type 2 diabetes, and was not statistically significant among current smokers, the investigators reported in the Feb. 17 issue of Circulation: Journal of the American Heart Association. "These results should be supported by further research before the possible implications for public health and clinical practice are considered," the researchers said. Previous studies have linked coffee consumption to a lower risk of diabetes. (See: Perk Up -- Coffee May Give a Break on Type 2 Diabetes)/.../

Inadequate Dissemination of Phase I Trials:

Inadequate Dissemination of Phase I Trials: A Retrospective Cohort Study

Evelyne Decullier^1,2,3,4, An-Wen Chan⁵, François Chapuis^1,2,4,6*

1 Hospices Civils de Lyon, Pôle Information Médicale et Evaluation en Recherche, Lyon, France, 2 Université de Lyon, Laboratoire Santé Individu Société (EA SIS), Lyon, France, 3 Université Lyon 1, Lyon, France, 4 Comité de Protection des Personnes, CPP Sud-Est III, Lyon, France, 5 Mayo Clinic, Rochester, Minnesota, United States, 6 Université Lyon 1, Réseau d'Épidémiologie Clinique International Francophone (RECIF), Lyon, France

Background

Drug development is ideally a logical sequence in which information from small early studies (Phase I) is subsequently used to inform and plan larger, more definitive studies (Phases II–IV). Phase I trials are unique because they generally provide the first evaluation of new drugs in humans. The conduct and dissemination of Phase I trials have not previously been empirically evaluated. Our objective was to describe the initiation, completion, and publication of Phase I trials in comparison with Phase II–IV trials./.../

Smoking bigger cause of premature death than poverty

Smoking bigger cause of premature death than poverty 

Smoking is a much more significant cause of health inequalities than wealth or social class, research claims. A new study shows well-off smokers die earlier than poor non-smokers, plus women smokers die earlier than male non-smokers cancelling out the life expectancy advantage women usually have over men.

Researchers also found that quitting smoking, even if in middle-age, can have a huge impact on life expectancy, with ex-smokers' survival rates closer to non-smokers than those who continue to smoke. An inquiry by the Commons health select committee into health inequalities, due to be published soon, is also expected to flag up the importance of quitting smoking in order to narrow the health gap between rich and poor.

Commenting on the today's report, ASH chief executive, Deborah Arnott, said: "The measures in the health bill to deter children from taking up smoking such as a ban on the display of tobacco products in shops and a ban on tobacco vending machines are a welcome step forward. But this study shows that if the government is to succeed in reducing health inequalities in the next generation it needs to have a comprehensive strategy to drive down smoking rates. This should include sufficient resources to ensure people who want to stop smoking are given all the help they need."

The study was based on the residents of Scottish towns Renfrew and Paisley. In 1972 residents, then aged between 45 and 64 years, from the towns were invited to participate. After 28 years of follow-up, 56 per cent of women and 36 per cent of men who had never smoked in social classes IV and V were still alive, compared with only 41 per cent of women and 24 per cent of men who smoked in social classes I and II.

********************

Published 17 February 2009, doi:10.1136/bmj.b480
Cite this as: BMJ 2009;338:b480

Research

Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study

Laurence Gruer, director of public health science¹, Carole L Hart, research fellow², David S Gordon, head of public health observatory division¹, Graham C M Watt, professor of general practice³

¹ NHS Health Scotland, Elphinstone House, Glasgow G2 2AF, ² Public Health and Health Policy, Division of Community-based Sciences, University of Glasgow, Glasgow G12 8RZ, ³ General Practice and Primary Care, Division of Community-based Sciences, University of Glasgow, Glasgow G12 9LX

Correspondence to: L Gruer Laurence.Gruer@health.scot.nhs.uk

Objective To assess the impact of tobacco smoking on the survival of men and women in different social positions.

Design A cohort observational study.

Setting Renfrew and Paisley, two towns in west central Scotland.

Participants 8353 women and 7049 men aged 45-64 years recruited in 1972-6 (almost 80% of the population in this age group). The cohort was divided into 24 groups by sex (male, female), smoking status (current, former, or never smokers), and social class (classes I + II, III non-manual, III manual, and IV +V) or deprivation category of place of residence.

Main outcome measure Relative mortality (adjusted for age and other risk factors) in the different groups; Kaplan-Meier survival curves and survival rates at 28 years.

Results Of those with complete data, 4387/7988 women and 4891/6967 men died over the 28 years. Compared with women in social classes I + II who had never smoked (the group with lowest mortality), the adjusted relative mortality of smoking groups ranged from 1.7 (95% confidence interval 1.3 to 2.3) to 4.2 (3.3 to 5.5). Former smokers’ mortalities were closer to those of neversmokers than those of smokers. By social class (highest first), age adjusted survival rates after 28 years were 65%, 57%, 53%, and 56% for female never smokers; 41%, 42%, 33%, and 35% for female current smokers; 53%, 47%, 38%, and 36% for male never smokers; and 24%, 24%, 19%, and 18% for male current smokers. Analysis by deprivation category gave similar results.

Conclusions Among both women and men, never smokers had much better survival rates than smokers in all social positions. Smoking itself was a greater source of health inequality than social position and nullified women’s survival advantage over men. This suggests the scope for reducing health inequalities related to social position in this and similar populations is limited unless many smokers in lower social positions stop smoking.

© Gruer et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
http://creativecommons.org/licenses/by-nc/2.0/

Relevant Articles

Mortality in relation to smoking: 50 years' observations on male British doctors

Richard Doll, Richard Peto, Jillian Boreham, and Isabelle Sutherland
BMJ 2004 328: 1519. [Abstract] [Full Text] [PDF]

Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies

Richard Peto, Sarah Darby, Harz Deo, Paul Silcocks, Elise Whitley, and Richard Doll
BMJ 2000 321: 323-329. [Abstract] [Full Text] [PDF]

Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study

D J Hole, G C M Watt, G Davey-Smith, C L Hart, C R Gillis, and V M Hawthorne
BMJ 1996 313: 711-715. [Abstract] [Full Text]

Semana Mundial da Atividade Física

Timóteo Leandro de Araújo 

Medical Humanities Blog

On Bioethics (& the Social Determinants of Health)

One of the central aims of MH Blog is to explore the relationship between bioethics and the medical humanities.  The relationship is complex, and in many ways MH Blog itself is on ongoing dialogue on the matter.  On the one hand, there are persistent, vocal, and, to my mind, persuasive criticisms of some of the dominant traditions of bioethics practice and scholarship coming from the medical humanities (and from other places, of course).  On the other hand, if the medical humanist is not at least somewhat interested in ethics related to health, illness, medicine, and health care, it is hard to see the purpose of the medical humanities.  I am using the term "ethics" here in its most expansive sense, a sense that two great questions help explicate:

What is the good?

How shall I live?/.../

Dronedarone in Atrial Fibrillation

Volume 360:668-678 February 12, 2009 Number 7

Effect of Dronedarone on Cardiovascular Events in Atrial Fibrillation

Stefan H. Hohnloser, M.D., Harry J.G.M. Crijns, M.D., Martin van Eickels, M.D., Christophe Gaudin, M.D., Richard L. Page, M.D., Christian Torp-Pedersen, M.D., Stuart J. Connolly, M.D., for the ATHENA Investigators Background Dronedarone is a new antiarrhythmic drug that is bein developed for the treatment of patients with atrial fibrillation.
Methods We conducted a multicenter trial to evaluate the use of dronedarone in 4628 patients with atrial fibrillation who had additional risk factors for death. Patients were randomly assigned to receive dronedarone, 400 mg twice a day, or placebo. The primary outcome was the first hospitalization due to cardiovascular events or death. Secondary outcomes were death from any cause, death from cardiovascular causes, and hospitalization due tocardiovascular events.

Results The mean follow-up period was 21±5 months, with the study drug discontinued prematurely in 696 of the 2301 patients (30.2%) receiving dronedarone and in 716 of the 2327 patients (30.8%) receiving placebo, mostly because of adverse events. The primary outcome occurred in 734 patients (31.9%) in the dronedarone group and in 917 patients (39.4%) in the placebo group, with a hazard ratio for dronedarone of 0.76 (95% confidence interval [CI], 0.69 to 0.84; P<0 .001=""> (5.0%) in the dronedarone group and 139 (6.0%) in the placebo group (hazard ratio, 0.84; 95% CI, 0.66 to 1.08; P=0.18). There were 63 deaths from cardiovascular causes (2.7%) in the dronedarone group and 90 (3.9%) in the placebo group (hazard ratio, 0.71; 95% CI, 0.51 to 0.98; P=0.03), largely due to a reduction in the rate of death from arrhythmia with dronedarone. The dronedaronegroup had higher rates of bradycardia, QT-interval prolongation, nausea, diarrhea, rash, and an increased serum creatinine level than the placebo group. Rates of thyroid- and pulmonary-related adverse events were not significantly different between the two groups.
Conclusions Dronedarone reduced the incidence of hospitalization due to cardiovascular events or death in patients with atrial fibrillation. (ClinicalTrials.gov number, NCT00174785 [ClinicalTrials.gov] .)