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Thursday, July 30, 2009

Science Is in the Details

Published: July 26, 2009 NYT

PRESIDENT OBAMA has nominated Francis Collins to be the next director of the National Institutes of Health. It would seem a brilliant choice. Dr. Collins’s credentials are impeccable: he is a physical chemist, a medical geneticist and the former head of the Human Genome Project. He is also, by his own account, living proof that there is no conflict between science and religion. In 2006, he published “The Language of God,” in which he claimed to demonstrate “a consistent and profoundly satisfying harmony” between 21st-century science and evangelical Christianity./.../

Wednesday, July 29, 2009

Assessing the severity of the novel influenza A/H1N1 pandemic

Published 14 July 2009, doi:10.1136/bmj.b2840
Cite this as: BMJ 2009;339:b2840

Research Methods & Reporting

Assessing the severity of the novel influenza A/H1N1 pandemic

Tini Garske, research associate , Judith Legrand, research associate, Christl A Donnelly, professor of statistical epidemiology , Helen Ward, clinical reader in social epidemiology, Simon Cauchemez, RCUK fellow in pathogen population dynamics, Christophe Fraser, reader in theoretical biology, Neil M Ferguson, professor of mathematical biology, Azra C Ghani, professor in infectious disease epidemiology

1 MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG

Correspondence to: T Garske

A major concern about the emergence of the novel strain of influenza A/H1N1 is the severity of illness it causes. Tini Garske and colleagues propose methods to obtain accurate estimates of the case fatality ratio as the pandemic unfolds

The World Health Organization’s declaration of a pandemic of the novel influenza A/H1N1 virus raises questions about the potential morbidity and mortality. By 10 July 2009, nearly 100 000 cases had been reported worldwide; however, most deaths (429 in total) have been reported in the American continents (the US, Mexico, Argentina, and Canada), with smaller numbers in other countries including the United Kingdom.1 At first sight, the data seem to imply that this new virus is relatively mild, with case fatality ratios around 0.5%, similar to the upper range of that seen for seasonal influenza2 and relatively low hospitalisation ratios. However, the case fatality ratio seems to vary substantially between countries, and deaths have occurred in much younger people than is the case for seasonal influenza.3 4

There are many reasons why simple interpretations of these crude figures at the beginning of a pandemic may be misleading both in terms of assessing severity and in making comparisons between countries. Here, we discuss some of the important mechanisms resulting in biases, propose study designs and associated statistical methods to estimate the case fatality ratio given these limitations, and show their strengths using simulated data. The two main sources of bias in estimates of the case fatality ratio we considerstem from shifts in case ascertainment (over time, efforts may become more focused on the most severe cases, leading to an overestimation of the case fatality ratio) and from the inevitable delay between symptom onset and death, which in the early phase of the epidemic can lead to underestimation of the case fatality ratio if it is not adjusted for./.../

Self administered cognitive test (TYM): Alzheimer’s

Published 9 June 2009, doi:10.1136/bmj.b2030
Cite this as: BMJ 2009;338:b2030


Self administered cognitive screening test (TYM) for detection of Alzheimer’s disease: cross sectional study

Jeremy Brown, consultant neurologist, George Pengas, clinical research fellow, Kate Dawson, research nurse, Lucy A Brown, honorary research assistant, Philip Clatworthy, clinical research fellow
1 Department of Neurology, Addenbrooke’s Hospital, Cambridge CB2 2QQ
Correspondence to: J Brown


Objective To evaluate a cognitive test, the TYM ("test your memory"), in the detection of Alzheimer’s disease.

Design Cross sectional study.

Setting Outpatient departments in three hospitals, including a memory clinic.

Participants 540 control participants aged 18-95 and 139 patients attending a memory clinic with dementia/amnestic mild cognitive impairment.

Intervention Cognitive test designed to use minimal operator time and to be suitable for non-specialist use.

Main outcome measures Performance of normal controls on the TYM. Performance of patients with Alzheimer’s disease on the TYM compared with age matched controls. Validation of the TYM with two standard tests (the mini-mental state examination (MMSE) and the Addenbrooke’s cognitive examination-revised (ACE-R)). Sensitivity and specificity of the TYM in the detection of Alzheimer’s disease.

Results Control participants completed the TYM with an average score of 47/50. Patients with Alzheimer’s disease scored an average of 33/50. The TYM score shows excellent correlation with the two standard tests. A score of ≤42/50 had a sensitivity of 93% and specificity of 86% in the diagnosis of Alzheimer’s disease. The TYM was more sensitive in detection of Alzheimer’sdisease than the mini-mental examination, detecting 93% of patientscompared with 52% for the mini-mental state exxamination. The negative and positive predictive values of the TYM with the cut off of ≤42 were 99% and 42% with a prevalence of Alzheimer’s disease of 10%. Thirty one patients with non-Alzheimer dementias scored an average of 39/50.

Conclusions The TYM can be completed quickly and accurately by normal controls. It is a powerful and valid screening test for the detection of Alzheimer’s disease.

A special report on health care and technology

Medicine goes digital

Apr 16th 2009
From The Economist print edition

The convergence of biology and engineering is turning health care into an information industry. That will be disruptive, says Vijay Vaitheeswaran (interviewed here), but also hugely beneficial to patients

Illustration by Otto Steininger

INNOVATION and medicine go together. The ancient Egyptians are thought to have performed surgery back in 2750BC, and the Romans developed medical tools such as forceps and surgical needles. In modern times medicine has been transformed by waves of discovery that have brought marvels like antibiotics, vaccines and heart stents.

Given its history of innovation, the health-care sector has been surprisingly reluctant to embrace information technology (IT). Whereas every other big industry has computerised with gusto since the 1980s, doctors in most parts of the world still work mainly with pen and paper.

Treating Alcohol Addiction: Can a Pill Replace Abstinence?

Man Covering Whiskey Glass With Hand  alcoholic alcoholism drugs
Chris Collins / Corbis
  • They call it "the switch." Alcoholics who take an anticraving medication called baclofen say the drug allows them to resist the most powerful triggers of relapse: former drinking buddies, a favorite bar, the sight of alcohol or even the most potent drinking cue of all, having a single drink.

Bob, 62, a business owner in the Midwest, who asked not to be identified by his real name, experienced his switch at a dinner party two years ago. Bob had battled alcohol dependency for several decades, regularly drinking at least 35 beers a week. Normally he would have downed several glasses of wine before dinner, he says, but that night, after taking baclofen for two weeks, he found himself sipping soda water instead, engrossed in conversation. "I realized I wasn't having that nagging feeling in my head, 'I should really get a drink,'" says Bob. "It never appeared during the dinner either so that was the eureka moment." He continues to take baclofen and now drinks about two or three times per week, no more than a beer or two at a time. (Read about the many faces of addiction.)/.../

Monday, July 27, 2009

Big Tobacco Sets Its Sights on Africa

Three men smoking on a street in Lagos
Three men smoke on a street in Lagos
Photograph for TIME by Sunday Alamba
  • It's easy enough to buy a smoke at Isa Yakubu's grocery store on a busy street in Lagos, Nigeria. Never mind if you don't have much money. Most local merchants are happy to break open a pack and sell cigarettes one at a time — single sticks, as they're known — for about 10 Nigerian naira, or 7 cents. "St. Moritz is the most popular brand," says Yakubu. "But [people] also like Rothmans and Benson & Hedges."

Single sticks go fast at 7 cents each — an especially good price point for kids. And while Yakubu says he doesn't sell to children, other shopkeepers do. About 25% of teens — some as young as 13 — use tobacco in some parts of Nigeria, double the smoking rate of Nigerian men, and many pick up the habit by age 11. That's a demographic powder keg, one that means big trouble if you're a health expert and big promise if you're a tobacco executive. Both sides agree on one thing, though: across all of Africa, cigarettes are set for boom times. (See pictures of vintage pro-smoking propaganda.)/.../

Thursday, July 23, 2009

Em tempos da gripe

Zero Hora 23 de julho de 2009 | N° 16039


Em tempos da gripe, por Aloyzio Achutti*

Perigos e perdas podem ser mais educativos do que tempos de bonança.

Esta epidemia de gripe está nos ensinando hábitos de civilidade e higiene não incorporados em nossa cultura: espirrar e tossir no lenço, evitar ambientes restritos e contato muito íntimo, manter as mãos limpas e lavá-las com frequência, cuidar com as portas de entrada mais frequentes (boca, nariz e olhos), procurar mais precocemente assistência médica...

Pode-se notar também uma evolução favorável, tanto por parte do cidadão comum quanto dos profissionais da saúde, comprometendo-se no que se costuma chamar de vigilância epidemiológica: acompanhar a dinâmica da doença na população, relação de casos comprometidos, mecanismos de propagação e estratégias de prevenção.

Um aspecto particular vale salientar: os afetados, internados e mortos não são mais apenas números: têm sexo, idade, profissão, família, circunstantes, têm endereço e viajam. São pessoas como nós, se relacionam entre si, e conosco. A pandemia nos coloca dentro do mesmo caldeirão e não nos permite fugir, alienando-nos do que se passa em nossa sociedade. O fenômeno não pode mais ser tratado como um objeto na bancada de laboratório, no cavalete da oficina, ou na sala de operação. Está muito próximo de nós, estamos dentro.

É possível que mais adiante se conclua que esta pandemia não seja mais mortal do que outras, e que tenha nos chamado atenção particularmente por ter vindo fora da época esperada e por nos pegar em momento de crise global: ambiental, de costumes, política e econômica. Há quem diga que a mobilização face à epidemia esteja servindo para distrair a atenção de outros problemas.

Parece que os danos desta epidemia não serão maiores do que os provocados pelos surtos das que nos afetam regularmente todos os anos, e certamente serão muito menores do que os relacionados com doenças cardiovasculares, câncer, acidentes, drogas e outros males.

É possível que a epidemia nos sensibilize para a prevenção, inclusive de outras doenças às quais já nos acostumamos. Assim como o vírus entra em nosso organismo, e quase pelas mesmas vias, a poluição atmosférica, e a fumaça do cigarro fumado pela própria pessoa, ou por circunstantes, penetra na intimidade do corpo e não adianta lavar as mãos nem usar máscaras, como as aconselhadas para evitar a gripe. Também a manutenção da saúde global nos torna menos suscetíveis se formos contaminados.

Uma das maiores lições poderá ser a de que temos capacidade de nos mobilizar, de sermos solidários. Não estamos sós e tem gente do nosso lado que pode nos afetar com o que lhes acontece, e que precisamos respeitar. O que está acontecendo com a gripe é o mesmo que acontece com nosso ambiente, nossos costumes, a política e a economia. Depende de como nos relacionamos.

* Médico

Wednesday, July 22, 2009

World Wonders votes

Tue Jul 21, 2009 7:44pm


By Sam Cage

ZURICH (Reuters) - A contest to choose the seven natural wonders of the world could net a billion online and telephone votes, the head of the group organising the competition told Reuters.

An expert panel on Tuesday nominated 28 sites -- including the Amazon rainforest, the Dead Sea and Grand Canyon - for a short list for the New 7 Wonders of competition, the winners of which will be announced in 2011 after a global vote conducted online and via telephone and sms votes./.../

Tuesday, July 21, 2009

An Aging World: 2008

Appointed by: Coleman, Catherine ProCOR

Within the next 30 years, the number of people worldwide who are over age 65 years will double, according to a new report, "An Aging World: 2008."

Currently there are 506 million people over age 65; by 2040 there will be an estimated 1.3 billion, representing 14% of the world population. Within 10 years, for the first time in human history, the number of people in the world aged 65 years and older will exceed that of children under five. The implications for chronic diseases in developing countries are enormous.

The most rapid increases in the older population are in the developing world, where the current rate of growth of the older population is more than double that in developed countries, and is also double that of the total world population. As of 2008, 62% of people aged 65 and older lived in developing countries; by 2040, 76% of the projected world total of people aged 65 and over will live in developing countries. The oldest old, people aged 80 and older, are the fastest growing portion of the total population in many countries. Globally, the oldest old population is projected to increase 233% between 2008 and 2040, compared with 160% for the population aged 65 and over and 33% for the total population of all ages./.../

Monday, July 20, 2009

Cigarro prejudica o funcionamento e os músculos do coração

Carlos Fioravanti
© Miguel Boyayan
Os efeitos da fumaça de cigarro não se limitam aos mais conhecidos, como a intensificação do risco de infarto e de câncer de pulmão, laringe e boca. Pesquisas recentes em animais de laboratório, realizadas na Universidade Federal de São Paulo (Unifesp) e na Universidade Estadual Paulista (Unesp) em Botucatu, mostraram que essa fumaça pode ser ainda mais deletéria, sobrecarregando e enrijecendo o músculo cardíaco, o miocárdio, a ponto de deformar o coração e alterar seu funcionamento. Outro estudo, na Universidade de São Paulo (USP) em Ribeirão Preto, indicou que a fumaça, agindo sobre as células do nariz, impede a formação dos cílios que filtram as impurezas do ar que entram pelas narinas.

Os experimentos em animais ajudam a avaliar com precisão os riscos à saúde para os 20 milhões de fumantes no Brasil, o equivalente a 16% da população acima de 18 anos, que talvez não possam mais fumar em espaços públicos no estado de São Paulo a partir de agosto, de acordo com uma lei ainda em debate. “Vários estudos têm mostrado que pessoas expostas à fumaça de cigarro apresentam um maior risco de desenvolver sinusite crônica e, ainda, que a exposição à fumaça de cigarro piora a evolução de pacientes operados de sinusite crônica”, comenta Edwin Tamashiro, que detalhou as alterações da fumaça sobre o desenvolvimento dos cílios em um artigo publicado em abril na revista American Journal of Rhinology and Allergy. Outros estudos servem de alerta, como o realizado na Unifesp mostrando que a prática de exercício físico pode intensificar os danos provocados pela exposição à fumaça de cigarro, em vez de os impedir, como era esperado. /.../

Brasiliana Digital

Já dei notícia desta biblioteca Digital, mas sempre vale a pena relembrar.
Está crescendo...
destaques da Brasiliana Digital

Está online o primeiro dicionário da língua portuguesa, escrito por Raphael Bluteau (1638-1734).

A edição da História do Brasil (1627), de Frei Vicente do Salvador, preparada por Capistrano de Abreu, está online.

Está sendo construído um moderno edifício para a Brasiliana USP no coração da Universidade de São Paulo.

What We Mean by Social Determinants of Health

From: Ruggiero, Mrs. Ana Lucia (WDC) to EQUIDAD

Vicente Navarro, Department of Health Policy and Management
Johns Hopkins University Bloomberg School of Public Health
keynote address was given at the Eighth IUHPE European Conference on September 9, 2008,
in Turin, Italy, and was originally published in IUHPE – Global Health Promotion, Vol. 16, No. 1, 2009, SAGE Publications
International Journal of Health Services, Volume 39, Number 3, Pages 423–441, 2009 doi: 10.2190/HS.39.3.a
Available online as PDF file [19p.] at:
“……This article analyzes the changes in health conditions and quality of life in the populations of developed and developing countries over the past 30 years, resulting from neoliberal policies developed by many governments and promoted by the World Bank, International Monetary Fund, World Health Organization, and other international agencies. It challenges interpretations by the analysts of “globalization,” including the common assumption that states are disappearing.
The author shows that what has been happening is not a reduction of state interventions but a change in the nature and character of those interventions, resulting from major changes in class (and race and gender) power relations in each country, with establishment of an alliance between the dominant classes of developed and developing countries—a class alliance responsible for the promotion of its ideology, neoliberalism. This is the cause of the enormous health inequalities in the world today.
The article concludes with a critical analysis of the WHO report on social determinants of health, applauding its analysis and many of its recommendations, but faulting it for ignoring the power relations that shape these social determinants. It is not inequalities that kill people, as the report states; it is those who are responsible for these inequalities that kill people…..

Ten Things to Know about Health


Image Thumbnail 10 Things to Know about Health (pdf) E-mail to a friend

A two-page handout that briefly describes ten key messages about health equity, as presented in the PBS series UNNATURAL CAUSES, useful for spurring discussion and raising awareness./.../

Saturday, July 18, 2009

'Master' Switch Governs Antibody Production

'Master' Switch Governs Antibody Production

By Michael Smith, North American Correspondent, MedPage Today
Published: July 16, 2009
Reviewed by
Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

TORONTO, July 16 -- In a study with potential implications for vaccine development and autoimmune diseases, researchers have found what they call the "master regulator" of the antibody response.
Action Points

During a series of animal experiments, scientists found that the protein Bcl6 is the "on" switch that governs the production of so-called T follicular helper cells, according to Shane Crotty, PhD, of the La Jolla Institute for Allergy & Immunology in La Jolla, Calif., and colleagues.

T follicular helper cells -- known as TFH cells for short -- are a subset of CD-positive T cells that help B cells differentiate and produce antibodies, the team reported online in Science.

In the absence of the Bcl6 protein, TFH cells do not arise and a key step in the production of antibodies -- differentiation of germinal centers in the lymph nodes -- does not happen, the researchers showed. /.../

Friday, July 17, 2009

Adam Smith

Scottish philosopher

Adam Smith, paste medallion by James Tassie, 1787; in the Scottish National Portrait Gallery, …[Credits : Courtesy of the Scottish National Portrait Gallery, Edinburgh]

Scottish social philosopher and political economist. After two centuries, Adam Smith remains a towering figure in the history of economic thought. Known primarily for a single work—An Inquiry into the Nature and Causes of the Wealth of Nations (1776), the first comprehensive system of political economy—Smith is more properly regarded as a social philosopher whose economic writings constitute only the capstone to an overarching view of political and social evolution. If his masterwork is viewed in relation to his earlier lectures on moral philosophy and government, as well as to allusions in The Theory of Moral Sentiments (1759) to a work he hoped to write on “the general principles of law and government, and of the different revolutions they have undergone in the different ages and periods of society,” then The Wealth of Nations may be seen not merely as a treatise on economics but also as a partial exposition of a much larger scheme of historical evolution./.../

Darwin 200

    ResourcesThe latest edition of Nature to celebrate Darwin's life and work looks at the human side of evolution. We have features on looking for Darwin in the genome, and on what evolution has done to shape human nature, while our editorial and two commentaries look at some of the problems inherent in applying biology to questions about humanity. We also have an essay on Darwin's pigeons and poetry by his great great grand-daughter Ruth Padel. And in a special insight we bring together reviews by a range of experts on current hot topics in evolution.
    The 200th anniversary of the birth of Charles Robert Darwin felt on 12 February 2009. No single researcher has since matched his collective impact on the natural and social sciences; on politics, religions, and philosophy; on art and cultural relations. In this landmark year, our Nature news special provides continuously updated news, research and analysis on Darwin's life, his science and his legacy./.../

Guide to Biostatistics

From:MedPage Tools
Guide to Biostatistics
Here is a compilation of important epidemiologic concepts and common biostatistical terms used in medical research. You can use it as a reference guide when reading articles published on MedPage Today or download it to keep near the reading stand where you keep your print journals. For more detailed information on these topics, use the reference list at the end of this presentation./.../

Wednesday, July 15, 2009

Emergence of Influenza A (H1N1) Viruses

David M. Morens, M.D., Jeffery K. Taubenberger, M.D., Ph.D., and Anthony S. Fauci, M.D.
It is not generally appreciated that descendents of the H1N1 influenza A virus that caused the catastrophic and historic pandemic of 1918–1919 have persisted in humans for more than 90 years and have continued to contribute their genes to new viruses, causing new pandemics, epidemics, and epizootics (see table). The current international pandemic caused by a novel influenza A (H1N1) virus derived from two unrelated swine viruses, one of them a derivative of the 1918 human virus,3 adds to the complexity surrounding this persistent progenitor virus, its descendants, and its several lineages (see diagram)./.../
Figure 1Figure 1. Emergence of Influenza A (H1N1) Viruses from Birds and Swine into Humans.

The diagram shows the important events and processes in the emergence of influenza A (H1N1) viruses during the past 91 years. Avian, swine, and human populations are represented in the top, middle, and bottom of the diagram, respectively. Epidemic or zoonotic viruses are shown as wide horizontal arrows (white for avian viruses, light blue or pink for swine viruses, and dark blue for human viruses). Cross-species transmissions are shown as vertical dashed lines, with thick lines for transfers that gave rise to sustained transmission in the new host and thin lines for those that were transient and resulted in a self-limited number of cases. Principal dates are shown along the bottom of the diagram. The disappearance of H1N1 in 1957 most likely represents competition by the emerging pandemic H2N2 strain in the face of population immunity to H1N1. The reemergence in 1977 is unexplained and probably represents reintroduction to humans from a laboratory source.

The Persistent Legacy of the 1918 Influenza Virus

David M. Morens, M.D., Jeffery K. Taubenberger, M.D., Ph.D., and Anthony S. Fauci, M.D.

It is not generally appreciated that descendents of the H1N1 influenza A virus that caused the catastrophic and historic pandemic of 1918–1919 have persisted in humans for more than 90 years and have continued to contribute their genes to new viruses, causing new pandemics, epidemics, and epizootics (see table). The current international pandemic caused by a novel influenza A (H1N1) virus derived from two unrelated swine viruses, one of them a derivative of the 1918 human virus,3 adds to the complexity surrounding this persistent progenitor virus, its descendants, and its several lineages (see diagram)./.../

Preventing Sudden Cardiac Death: A Worldwide Approach

Prystowsky, MD
Consulting Professor
Department of Medicine
Duke University School of Medicine
Durham, North Carolina
Director, Clinical Electrophysiology Lab
St. Vincent Indianapolis Hospital
Indianapolis, Indiana
Lau, MD
Institute of Cardiovascular Science & Medicine
University of Hong Kong
Hong Kong, China
Oseroff, MD
University of Buenos Aires
Chief of Electrophysiology and Pacing
Castex Hospital
Buenos Aires, Argentina
Release date: March 10, 2009
Expiration date: March 10, 2010

Sudden cardiac arrest (SCA) accounts for approximately 325,000 deaths per year in the United States, representing an incidence of 0.1% to 0.2% per year in the adult population. The incidence of SCA in other countries though, appear to be lower and may be attributed to inadequate methods for identifying high-risk candidates as well as the prevalence of coronary artery disease prevalence in those populations. Revascularization, pacemaker, and implantation of an implantable cardioverter defibrillator (ICD) have been found to be highest in North America and Western Europe and lowest in South America and Eastern Europe, demonstrating that the incidence, etiology, and management of SCA may vary by region. Ongoing studies and discussions will be needed to address these continental and regional differences, including reimbursement issues and the need for additional education surrounding emerging clinical trial data and clinical guidelines, to ensure clinician awareness and facilitate appropriate patient analysis and management. Join Drs. Prystowsky, Lau, and Oseroff as they provide an international perspective on various prevention strategies of SCA including challenges faced in the Pacific Rim and South America./.../

DIABETES RESEARCH: Trial seeks to head off Type 1

   Dr. David Finegold


The doctor had barely pulled away the needle when a blister appeared on Tracey Berg-Fulton's abdomen: An experimental shot was revving up the 24-year-old's immune system -- part of a bold quest to create a vaccine-like therapy for diabetes.

''If we're right, that is what's going to stop Type 1 diabetes,'' Dr. David Finegold said after administering the last of four shots.

It's a big ``if.''

The research is in its infancy, a first-step experiment to be sure the vaccine approach is safe before researchers at Children's Hospital of Pittsburgh test their real target -- kids newly diagnosed with this deadliest form of diabetes.

It's also part of a big shift: Scientists increasingly hope to control Type 1 diabetes by curbing the rogue immune cells that cause it, before patients become completely dependent on daily insulin injections to survive./.../

Tuesday, July 14, 2009

Cigarette Smoking—United States, 1998-2007

From the Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report

Cigarette Smoking—United States, 1998-2007

JAMA. 2009;302(3):250-252.

MMWR. 2009;58:221-226

Cigarette smoking in the United States results in an estimated 443,000 premature deaths and $193 billion in direct health-care expenditures and productivity losses each year.1 During 2007, an estimated 19.8% of adults in the United States were current smokers.2 To update 2006 state-specific estimates of cigarette smoking, CDC analyzed data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey and examined trends in cigarette smoking from 1998-2007. Results of these analyses indicated substantial variation in current cigarette smoking during 2007 (range: 8.7%-31.1%) among the 50 states, the District of Columbia (DC), Guam, Puerto Rico (PR), and the U.S. Virgin Islands (USVI). Trend analyses of 1998-2007 data indicated that smoking prevalence decreased in 44 states, DC, and PR, and six states had no substantial changes in prevalence after controlling for age, sex, and race/ethnicity. However, only Utah and USVI met the Healthy People 2010 target for reducing adult smoking prevalence to 12% (objective 27-1a).3 The Institute of Medicine (IOM) calls for full implementation of comprehensive, evidence-based tobacco control programs at CDC-recommended funding levels to achieve substantial reductions in tobacco use in all states and areas.4/.../

Cost-Effectiveness of Interventions to Promote Physical Activity: A Modelling Study

Cost-Effectiveness of Interventions to Promote Physical Activity: A Modelling Study

Linda J. Cobiac*, Theo Vos, Jan J. Barendregt

Centre for Burden of Disease and Cost-Effectiveness, School of Population Health, The University of Queensland, Herston, Queensland, Australia


Physical inactivity is a key risk factor for chronic disease, but a growing number of people are not achieving the recommended levels of physical activity necessary for good health. Australians are no exception; despite Australia's image as a sporting nation, with success at the elite level, the majority of Australians do not get enough physical activity. There are many options for intervention, from individually tailored advice, such as counselling from a general practitioner, to population-wide approaches, such as mass media campaigns, but the most cost-effective mix of interventions is unknown. In this study we evaluate the cost-effectiveness of interventions to promote physical activity.

Methods and Findings

From evidence of intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the Australian population. We then determine cost-effectiveness of each intervention against current practice for physical activity intervention in Australia and derive the optimal pathway for implementation. Based on current evidence of intervention effectiveness, the intervention programs that encourage use of pedometers (Dominant) and mass media-based community campaigns (Dominant) are the most cost-effective strategies to implement and are very likely to be cost-saving. The internet-based intervention program (AUS$3,000/DALY), the GP physical activity prescription program (AUS$12,000/DALY), and the program to encourage more active transport (AUS$20,000/DALY), although less likely to be cost-saving, have a high probability of being under a AUS$50,000 per DALY threshold. GP referral to an exercise physiologist (AUS$79,000/DALY) is the least cost-effective option if high time and travel costs for patients in screening and consulting an exercise physiologist are considered.


Intervention to promote physical activity is recommended as a public health measure. Despite substantial variability in the quantity and quality of evidence on intervention effectiveness, and uncertainty about the long-term sustainability of behavioural changes, it is highly likely that as a package, all six interventions could lead to substantial improvement in population health at a cost saving to the health sector.

Recurrence of Congenital Heart Defects in Families

Submitted on February 13, 2009
Accepted on May 8, 2009

Nina Øyen MD, MPH, DrMed*, Gry Poulsen MSc, Heather A. Boyd PhD, Jan Wohlfahrt MSc, DrMed, Peter K.A. Jensen MD, DrMed, and Mads Melbye MD, DrMed

From the Department of Epidemiology Research (N.Ø., G.P., H.A.B., J.W., M.M.), Statens Serum Institut, Copenhagen, Denmark; Department of Public Health and Primary Health Care (N.Ø.), Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway; Center for Medical Genetics and Molecular Medicine (N.Ø.), Haukeland University Hospital, Bergen, Norway; and Department of Clinical Genetics (P.K.A.J.), Århus University Hospital, Århus, Denmark.

* To whom correspondence should be addressed. E-mail: .

Background—Knowledge of the familial contribution to congenital heart diseases (CHD) on an individual and population level is sparse. We estimated an individual's risk of CHD given a family history of CHD, as well as the contribution of CHD family history to the total number of CHD cases in the population.

Methods and Results—In a national cohort study, we linked all Danish residents to the National Patient Register, the Causes of Death Register, the Danish Central Cytogenetic Register, and the Danish Family Relations Database, yielding 1 763 591 persons born in Denmark between 1977 and 2005, of whom 18 708 had CHD. Individuals with CHD were classified by phenotype. We estimated recurrence risk ratios and population-attributable risk. Among first-degree relatives, the recurrence risk ratio was 79.1 (95% confidence interval [CI] 32.9 to 190) for heterotaxia, 11.7 (95% CI, 8.0 to 17.0) for conotruncal defects, 24.3 (95% CI,12.2 to 48.7) for atrioventricular septal defect, 12.9 (95% CI, 7.48 to 22.2) for left ventricular outflow tract obstruction, 48.6 (95% CI, 27.5 to 85.6) for right ventricular outflow tract obstruction, 7.1 (95% CI, 4.5 to 11.1) for isolated atrial septal defect, and 3.4 (95% CI, 2.2 to 5.3) for isolated ventricular septal defect. The overall recurrence risk ratio for the same defect was 8.15 (95% CI, 6.95 to 9.55), whereas it was 2.68 (95% CI, 2.43 to 2.97) for different heart defects. Only 2.2% of heart defect cases in the population (4.2% after the exclusion of chromosomal aberrations) were attributed to CHD family history in first-degree relatives.

Conclusions—Specific CHDs showed highly variable but strong familial clustering in first-degree relatives, ranging from 3-fold to 80-fold compared with the population prevalence, whereas the crossover risks between dissimilar cases of CHD were weaker. Family history of any CHD among first-degree relatives accounted for a small proportion of CHD cases in the population.

Sunday, July 12, 2009

Princípios da Política Nacional de Atenção Integral à Saúde do Homem

Princípios da Política Nacional de Atenção Integral à Saúde do Homem

1. Orientar as ações e serviços de saúde para a população masculina, com integralidade e equidade, primando pela humanização da atenção;
2. Mudar paradigmas no que concerne à percepção da população masculina em relação ao cuidado com a sua saúde e a saúde de sua família;
3. Capacitar tecnicamente os profissionais de saúde para o atendimento ao homem.
4. Além da ênfase nos aspectos educacionais, os serviços devem ser organizados de modo a acolher e fazer com que o homem sinta-se parte integrante deles;
5. Implementar a Política do Homem de forma integrada às demais políticas existentes, priorizando a atenção primária como porta de entrada de um sistema de saúde universal, integral e equânime.
1.Elaboração do Plano de Ação subordinado a esta Política e pautado pelos princípios da integralidade, factibilidade, coerência e viabilidade;
2. Entender a Saúde do Homem como um conjunto de ações de promoção e prevenção, assistência e recuperação, executadas com humanização e qualidade, nos diferentes níveis de atenção;
3. Priorizar a Atenção Básica com foco na Estratégia de Saúde da Família, porta de entrada do sistema de Saúde integral, hierarquizado e regionalizado./.../

Saturday, July 11, 2009

Managing the Health effects of Climate Change

From: Ruggiero, Mrs. Ana Lucia (WDC) to EQUIDAD

London, UK, May, 2009
A collaboration between The Lancet and University College London, UK
“…… setting out how climate change over the coming decades could have a disastrous effect on health across the globe. The report examines practical measures that can be taken now and in the short and medium term to control its effects. …”
“…….Climate change could be the biggest global health threat of the 21st century. Effects on health of climate change will be felt by most populations in the next decades and put the lives and wellbeing of billions of people at increased risk. During this century, the earth’s average surface temperature rises are likely to exceed the safe threshold of 2°C above pre-industrial average temperature.

This report outlines the major threats—both direct and indirect—to global health from climate change through changing patterns of disease, water and food insecurity, vulnerable shelter and human settlements, extreme climatic events, and population migration. Although vector-borne diseases will expand their reach and death tolls, the indirect effects of climate change on water, food security, and extreme climatic events are likely to have the biggest effect on global health.

A new advocacy and public health movement is needed urgently to bring together governments, international agencies, non-governmental organisations, communities, and academics from all disciplines to adapt to the effects of climate change on health.

Friday, July 10, 2009

Entrevista com José Manoel Bertolote

ABEAD (10/07/2009)

Graduado em Medicina pela Faculdade de Ciências Médicas e Biológicas de Botucatu (Unesp) e com Mestrado em Psiquiatra Social e Transcultural pela McGill University de Montreal, no Canadá, José Manuel Bertolote é o entrevistado da semana. Durante 20 anos foi coordenador da equipe de transtornos mentais e neurológicos na sede da Organização Mundial da Saúde, em Genebra. Membro do Conselho Consultivo da Abead, atualmente é professor colaborador do Departamento de Neurologia, Psicologia e Psiquiatria, da Faculdade de Medicina de Botucatu (Unesp). Confira a entrevista!

1. No recente relatório mundial sobre drogas divulgado pela ONU, o Brasil foi apontado como o maior mercado consumidor de cocaína da América do Sul e está entre os líderes no uso de drogas injetáveis. Por que chegamos a este ponto?

Primeiramente devemos considerar como são levantados esses dados. Normalmente esses dados são decorrentes de informações obtidas com a repressão, ou seja, com a polícia. Portanto se supõe que quanto mais drogas são apreendidas, maior é o consumo. /.../

WHO approves cervical cancer vaccine Cervarix

LONDON (AP) — The World Health Organization has approved a second cervical cancer vaccine, this one made by GlaxoSmithKline, meaning U.N. agencies and partners can now officially buy millions of doses of the vaccine for poor countries worldwide.

GlaxoSmithKline PLC said in a statement Thursday the approval would help speed access to Cervarix globally.

WHO had previously approved Gardasil, a competing cervical cancer vaccine made by Merck & Co. With two cervical cancer vaccines now ready to be bought by donor agencies, officials estimate that tens of thousands of lives might be saved.

More than 80 percent of the estimated 280,000 cervical cancer deaths a year occur in developing countries. In the West, early diagnosis and treatment has slashed the disease's incidence.

Enfermedades crónicas: Prevención y control en las Américas

Enfermedades crónicas: Prevención y control en las Américas

Enfermedades crónicas: Prevención y control en las AméricasFinalidad de las Noticias: Promover la Estrategia Regional y Plan de Acción para un enfoque integrado sobre la prevención y el control de las enfermedades crónicas, incluyendo el régimen alimentario, la actividad física y la salud; y compartir logros relacionados con la Estrategia en todos sus aspectos así como sus cuatro líneas de acción (vigilancia y respuesta, abogacía y política, promoción de salud y prevención y manejo integrado de las enfermedades crónicas y sus factores de riesgo) y noticias sobre la implementación de programas.

Número actual: junio de 2009

Hospital Performance in Acute Myocardial Infarction

Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission

Harlan M. Krumholz, MD, SM; Angela R. Merrill, PhD; Eric M. Schone, PhD; Geoffrey C. Schreiner, BS;Jersey Chen, MD, MPH; Elizabeth H. Bradley, PhD; Yun Wang, PhD; Yongfei Wang, MS; Zhenqiu Lin, PhD;Barry M. Straube, MD; Michael T. Rapp, MD, JD; Sharon-Lise T. Normand, PhD and Elizabeth E. Drye, MD, SM

From the Section of Cardiovascular Medicine (H.M.K., G.C.S., J.C., Y.W., Y.-F.W., E.E.D.) and the Robert Wood Johnson Clinical Scholars Program (H.M.K.), Department of Internal Medicine; Section of Health Policy and Administration (H.M.K., E.H.B.), School of Public Health, Yale University School of Medicine; and the Center for Outcomes Research and Evaluation (H.M.K., Y.W., Z.L.), Yale-New Haven Hospital, New Haven, Conn; Mathematica Policy Research, Inc (A.R.M., E.M.S.), Cambridge, Mass; Centers for Medicare & Medicaid Services (B.M.S., M.T.R.), Baltimore, Md; and the Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health (S.-L.T.N.), Boston, Mass.

Correspondence to Harlan Krumholz, MD, Yale University School of Medicine, 1 Church St, Suite 200, New Haven, CT 06510.

Background: In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures.

Methods and Results: We calculated the 30-day mortality and readmission rates for all Medicare fee-for-service beneficiaries ages 65 years or older with a primary diagnosis of AMI or HF, discharged between July 2005 and June 2008. We compared weighted risk-standardized mortality and readmission rates across Hospital Referral Regions and hospital structural characteristics. The median 30-day mortality rate was 16.6% for AMI (range, 10.9% to 24.9%; 25th to 75th percentile, 15.8% to 17.4%; 10th to 90th percentile, 14.7% to 18.4%) and 11.1% for HF (range, 6.6% to 19.8%; 25th to 75th percentile, 10.3% to 12.0%; 10th to 90th percentile, 9.4% to 13.1%). The median 30-day readmission rate was 19.9% for AMI (range, 15.3% to 29.4%; 25th to 75th percentile, 19.5% to 20.4%; 10th to 90th percentile, 18.8% to 21.1%) and 24.4% for HF (range, 15.9% to 34.4%; 25th to 75th percentile, 23.4% to 25.6%; 10th to 90th percentile, 22.3% to 27.0%). We observed geographic differences in performance across the country. Although there were some differences in average performance by hospital characteristics,there were high and low hospital performers among all types of hospitals.

Conclusions: In a recent 3-year period, 30-day risk-standardized mortality rates for AMI and HF varied among hospitals and across the country. The readmission rates were particularly high.

Thursday, July 09, 2009

public health effect of economic crises

The public health effect of economic crises and alternative policy responses in Europe:
an empirical analysis

David Stuckler PhD a b, Sanjay Basu PhD c d, Marc Suhrcke PhD e f, Adam CouttsPhD g, Martin McKee MD b h

a Department of Sociology, Oxford University, Oxford, UK

b Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

c Department of Medicine, University of California San Francisco, CA, USA

d Division of General Internal Medicine, San Francisco General Hospital, CA, USA

e School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK

f Centre for Diet and Activity Research (CEDAR), Cambridge, UK

g Oxford Department of Politics and International Relations, Oxford, UK

h European Observatory on Health Systems and Policies, Brussels, Belgium

The Lancet, Early Online Publication, 8 July 2009



There is widespread concern that the present economic crisis, particularly its effect on unemployment, will adversely affect population health. We investigated how economic changes have affected mortality rates over the past three decades and identified how governments might reduce adverse effects.


We used multivariate regression, correcting for population ageing, past mortality and employment trends, and country-specific differences in health-care infrastructure, to examine associations between changes in employment and mortality, and how associations were modified by different types of government expenditure for 26 European Union (EU) countries between 1970 and 2007.

We noted that every 1% increase in unemployment was associated with a 0·79% rise in suicides at ages younger than 65 years (95% CI 0·16—1·42; 60—550 potential excess deaths [mean 310] EU-wide), although the effect size was non-significant at all ages (0·49%, −0·04 to 1·02), and with a 0·79% rise in homicides (95% CI 0·06—1·52; 3—80 potential excess deaths [mean 40] EU-wide). By contrast, road-traffic deaths decreased by 1·39% (0·64—2·14; 290—980 potential fewer deaths [mean 630] EU-wide). A more than 3% increase in unemployment had a greater effect on suicides at ages younger than 65 years (4·45%, 95% CI 0·65—8·24; 250—3220 potential excess deaths [mean 1740] EU-wide) and deaths from alcohol abuse (28·0%, 12·30—43·70; 1550—5490 potential excess deaths [mean 3500] EU-wide). We noted no consistent evidence across the EU that all-cause mortality rates increased when unemployment rose, although populations varied substantially in how sensitive mortality was to economic crises, depending partly on differences in social protection. Every US$10 per person increased investment in active labour market programmes reduced the effect of unemployment on suicides by 0·038% (95% CI −0·004 to −0·071).

Rises in unemployment are associated with significant short-term increases in premature deaths from intentional violence, while reducing traffic fatalities. Active labour market programmes that keep and reintegrate workers in jobs could mitigate some adverse health effects of economic downturns.