Exposure to Airborne Fine Particulate Matter and Cigarette Smoke

Cardiovascular Mortality and Exposure to Airborne Fine Particulate Matter and Cigarette Smoke. Shape of the Exposure-Response Relationship

C. Arden Pope III PhD^*, Richard T. Burnett PhD, Daniel Krewski PhD, Michael Jerrett PhD, Yuanli Shi MD, Eugenia E. Calle PhD, and Michael J. Thun MD

From Brigham Young University, Provo, Utah (C.A.P.); Health Canada, Ottawa, Ontario, Canada (R.T.B.); University of Ottawa, Ottawa, Ontario, Canada (D.K., Y.S.); University of California, Berkeley (M.J.); and American Cancer Society, Atlanta, Ga (E.E.C., M.J.T.).

^* To whom correspondence should be addressed. E-mail: cap3@byu.edu.

Background—Fine particulate matter exposure from both ambient air pollution and secondhand cigarette smoke has beenassociated with larger risks of cardiovascular mortality than would be expected on the basis of linear extrapolations of therelative risks from active smoking. This study directly assessed the shape of the exposure-response relationship between cardiovascular mortality and fine particulates from cigarette smoke and ambient air pollution.

Methods and Results—Prospective cohort data for >1 million adults were collected by the American Cancer Society as part of the Cancer Prevention Study II in1982. Cox proportional hazards regression models that included variables for increments of cigarette smoking and variables to control for education, marital status, body mass, alcohol consumption, occupational exposures, and diet were used to describe the mortality experience of the cohort. Adjusted relative risks of mortality were plotted against estimated average daily dose of fine particulate matter from cigarette smoke along with comparison estimates for secondhand cigarette smoke and air pollution. There were substantially increased cardiovascular mortality risks at very low levels of active cigarette smoking and smaller but significant excess risks even at the much lower exposure levels associated with secondhand cigarette smoke and ambient air pollution.

Conclusions—Relatively low levels of fine particulate exposure from either air pollution or secondhand cigarette smoke are sufficient to induce adverse biologicalresponses increasing the risk of cardiovascular disease mortality. The exposure-response relationship between cardiovascular disease mortality and fine particulate matter is relatively steep at low levels of exposure and flattens out at higher exposures.

2009 World Population Data Sheet

2009 World Population Data Sheet

Download this publication (PDF: 677KB)
View a webcast of the 2009 World Population Data Sheet press briefing (Time: 46min)
Download the PowerPoint presentation from the press briefing (PPT: 401KB)
Download Population Bulletin: World Population Highlights: Key Findings From PRB's 2009 World Population Data Sheet" (PDF: 751KB)

---

ALSO SEE Webcast: 2009 World Population Data Sheet Press Briefing Population Bulletin: World Population Highlights 2009 World Population Clock, 2009

(Aug. 12, 2009) Global population numbers are on track to reach 7 billion in 2011, just 12 years after reaching 6 billion in 1999. Virtually all of the growth is in developing countries. And the growth of the world’s youth population (ages 15 to 24) is shifting into the poorest of those countries.

The Population Reference Bureau's 2009 World Population Data Sheet and its summary report, to be released on Aug. 12, offer detailed information about country, regional, and global population patterns.

"Even with declining fertility rates in many countries, world population is still growing at a rapid rate,” said Bill Butz, PRB's president. "The increase from 6 billion to 7 billion is likely to take 12 years, as did the increase from 5 billion to 6 billion. Both events are unprecedented in world history."/.../

Aspirin does more harm than good in healthy people

ASPIRIN FOR HEART ATTACK PREVENTION SAID TO DO MORE HARM THAN GOOD IN HEALTHY PEOPLE
30 August 2009

Aspirin does more harm than good in healthy people, British researchers
have said.

BY REBECCA SMITH
Medical Editor
The London Telegraph

Healthy people who take aspirin to prevent a heart attack are doing themselves more harm than good, researchers have said.

Millions of people - including a substantial number of the “worried well” - take a daily dose of the drug in the belief it will keep them healthy.

But at a conference for leading doctors, British scientists said they have found that for healthy people taking aspirin does not significantly reduce the risk of a heart attack.

At the same time they found it almost doubles the risk of being admitted to hospital due to internal bleeding.

Electronic Health Records

Electronic Health Records and the 21st Century Health Care System A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology In my role as National Coordinator for Health IT, I have the privilege to be part of a transformative change in health care that will help to extend the benefits of health information technology (HIT) to all Americans. With the passage earlier this year of the Health Information Technology for Economic and Clinical Health (HITECH) Act, we have the tools to begin a major transformation in American health care made possible through the creation of a secure, interoperable nationwide health information network. /.../

50 Best Websites 2009

Sites to Visit

Flickr

By ADAM FISHER

Computers don't handle visual imagery with the same native ease with which they parse text or crunch numbers. Flickr was the first site to solve this problem with something called collaborative tagging. The idea is that if everyone is allowed to tag everyone else's uploaded photos, then a rough-and-ready categorization will naturally emerge from the wisdom of the crowd. It works because it has to — there aren't enough librarians in the world to look after Flickr's archive of 3 billion photos, much less file them away for future reference. But it also works because the many really is smarter than the sum of its parts. The Library of Congress has even started to poll the Flickr hive mind when cataloging its own photos.

See pictures of Barack Obama on Flickr.

View the full list for "50 Best Websites 2009"

Next: California Coastline >>

Rheumatic Fever: Primary Prevention (and more)

On: [procor] Is primary prevention of rheumatic fever the missing link in the control of rheumatic heart disease in Africa?

Dear Catherine and other ProCOR colleagues,

I think this theme of Rheumatic Fever Prevention was very well taken, and perhaps can call attention to all of us for some other critical aspects of prevention not sufficiently considered in a paradigm that just considers the natural history of diseases beginning and finishing in the individual patient, in his personal behavior, reposing quite exclusively in secondary prevention.

My personal experience started with Rheumatic Fever secondary prevention and Congenital Heart Disease in the 1950s, but since the beginning it remained clear that Benzatine Penicillin given to acute cases of RF and chronic cases of RHD was of benefit just to the detected susceptible individuals, not for control of the disease in the community. It could not prevent the first attacks. The success of this strategy must be contemplated from the individual cases point of view, most in developed countries with better conditions of life and good access to health care services.

Secondary prevention is necessary to the detected susceptible individual cases and is better than nothing, but it was already demonstrated that the downtrend of RF in the world, begun much time before the availability of Penicillin and preceding the specific prevention programs.

In the 1970s we developed in our State a program directed for school-children, with a tentative approach to the diagnosis and treatment of sore throat, including health education of children and families.

Through joint experience with PAHO, WHO, WHF and UNESCO, at the end of the 1980s and into the next decade, we started a new tour de force, including a plan of an extensive and well controlled project in Bangladesh with support of EC, that unhappily could not be realized, even with money availability.

Today we are studying the social-determination of health/disease, and we are convinced that with the approach to the strict classical medical resources, we will not trespass this hardcore resistance where are the causes of the causes (recalling our late master Geoffrey Rose).

The same reasoning must to be applied to all other cardiovascular diseases and to other chronic diseases. We are fascinated by the discovery of the risk factors and description of their distribution through populations, our achievements through medicines for hypertension, cholesterol control, and heart failure; invasive procedures for diagnosis and treatment, surgeries, organs transplantation and so on...

Without human development, culture, education, economical and political stability we will benefit just a few individual cases.

Talking of social determination, we need to consider all interpersonal and inter-group relationships, not just considering rich and poor people. All human beings need respect, identity, a chance of self-expression and personal development inside the community. It may be called a utopia, but who some time ago could imagine what we are contemplating today?

The health gradients in our city among districts follow the socio-economic gradient. The burden of diseases, including CVD, is three or four times higher between extremes, even considering that we are reaching better levels of human development, what may be expressed also by the great level of control of Rheumatic Fever, that was our dream fifty years ago. We need to recognize that amelioration of the indicators and taxes are not direct effect of our original public health programs.

Our contribution probably was more valuable as health promotion, in public education, calling attention to the possibility of conquering better conditions of life, valorizing health and human rights, and demonstrating that not all diseases are a fatality, but can be controlled by collective mobilization and partnership, not just medical.

Pardon this discourse, but I think we are already good doctors and specialists pursuing professional excellence and good health for our clients, but we need also to be better world citizens looking beyond the fence of the traditional medical dominion.

Our ProCOR network is an example of the feasibility of connection of good will people, but we are not exploiting all of our power and responsibility inside our communities throughout the world. We could not just follow the wake of the traditional science, but we are sufficiently strong to be creative and give the necessary jump to reach what is evident (as did the example of Professor Bernard Lown before): Rheumatic Fever was quite completely controlled in several countries; other problems like infant mortality, under-nutrition were also somewhere controlled; the success obtained at the level of some individuals in the control of risk factors could be also achieved collectively, if they were be considered as components of communities with relationships that should be approached.

Sincerely yours

Aloyzio Achutti

Dopamine Long-Term Memory Storage

Comemorando a Prata da Casa!... Science 21 August 2009: Vol. 325. no. 5943, pp. 1017 - 1020 DOI: 10.1126/science.1172545

Reports

Dopamine Controls Persistence of Long-Term Memory Storage

Janine I. Rossato,^1,2 Lia R. M. Bevilaqua,^1,2 Iván Izquierdo,^1,2 Jorge H. Medina,^1,3,4 Martín Cammarota^1,2,3,*

The paradigmatic feature of long-term memory (LTM) is its persistence. However, little is known about the mechanisms that make some LTMs last longer than others. In rats, a long-lasting fear LTM vanished rapidly when the D1 dopamine receptor antagonist SCH23390 was injected into the dorsal hippocampus 12 hours, but not immediately or 9 hours, after the fearful experience. Conversely, intrahippocampal application of the D1 agonist SK38393 at the same critical post-training time converted a rapidly decaying fear LTM into a persistent one. This effect was mediated by brain-derived neurotrophic factor and regulated by the ventral tegmental area (VTA). Thus, the persistence of LTM depends on activation of VTA/hippocampus dopaminergic connections and can be specifically modulated by manipulating this system at definite post-learning time points.

¹ Centro de Memória, Instituto do Cérebro, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
² Instituto Nacional de Neurociência Translacional, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil.
³ Instituto de Biología Celular y Neurociencias "Prof. Dr. Eduardo de Robertis," Universidad de Buenos Aires, Buenos Aires, Argentina.
⁴ Departamento de Fisiologia, Universidad de Buenos Aires, Buenos Aires, Argentina.

^* To whom correspondence should be addressed. E-mail: mcammaro@terra.com.br or martin.cammarota@pucrs.br

Relevant environmental changes trigger transient dopamine-dependent states in the hippocampus that favor memory encoding and synaptic potentiation, perhaps by attaching motivational connotations to experiences (1–4). The ventral tegmental area (VTA) is critical for assessing the significance of punishments and rewards (5), and it has been postulated that a VTA/hippocampus dopaminergic loop controls the entry of information into long-term memory (LTM) (6). Dopamine regulates the expression of proteins essential for the establishment of lasting neuronal plasticity, such as brain-derived neurotrophic factor (BDNF) (7). In rats, we recently demonstrated that in order to persist, fear LTM requires BDNF expression in the hippocampus 12 hours after training (8). We have now investigated the role of hippocampal dopamine and the VTA on LTM persistence./.../

WE ARE AS GODS AND HAVE TO GET GOOD AT IT

Stewart Brand Talks About His Ecopragmatist Manifesto

The shift that has happened in 40 years which mainly has to do with climate change. Forty years ago, I could say in the Whole Earth Catalog, "we are as gods, we might as well get good at it". Photographs of earth from space had that god-like perspective.

What I'm saying now is we are as gods and have to get good at it. Necessity comes from climate change, potentially disastrous for civilization. The planet will be okay, life will be okay. We will lose vast quantities of species, probably lose the rain forests if the climate keeps heating up. So it's a global issue, a global phenomenon. It doesn't happen in just one area. The planetary perspective now is not just aesthetic. It's not just perspective. It's actually a world-sized problem that will take world sized solutions that involves forms of governance we don't have yet. It involves technologies we are just glimpsing. It involves what ecologists call ecosystem engineering. Beavers do it, earthworms do it. They don't usually do it at a planetary scale. We have to do it at a planetary scale. A lot of sentiments and aesthetics of the environmental movement stand in the way of that./.../

improvements in short-term acute-MI mortality

Significant improvements in short-term acute-MI mortality in US hospitals

August 18, 2009 | Michael O'Riordan

Download slides

New Haven, CT - In the past decade, 30-day mortality rates for patients discharged with acute MI have significantly declined, as has the variation in AMI mortality in hospitals across the US, a new study has shown [1]. Overall, the 30-day mortality rates declined from 18.8% in 1995 to 15.8% in 2006, an approximate one-sixth reduction in short-term mortality over the 12-year study period, report investigators.

"A challenge was really set down about a decade ago, where we really needed to achieve a better system and wanted to shift the entire spectrum of performance toward better care," said lead investigator Dr Harlan Krumholz (Yale University School of Medicine, New Haven, CT). "That meant that we weren't really looking at the outliers but saying that the status quo is not acceptable. This paper is showing the realization of what we hoped to accomplish, which is a shift in the distribution of mortality, and the variation shrinking. We've improved performance and shrunk some of that variation between hospitals."/.../

Smoking : brain hemorrhage risk

Smoking boosts brain hemorrhage risk in those with family history

Last Updated: 2009-01-09 14:00:12 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Smokers with a family history of aneurysmal subarachnoid hemorrhage have six times the risk of suffering the same fate, according to a study funded by the National Institute of Neurological Disorders and Stroke.

Although smoking history and subarachnoid hemorrhage both aggregate within families, the potential for a gene-environment interaction affecting an individual's risk is unknown, Dr. Daniel Woo and co-investigators note in the January 6th issue of Neurology.

"Evidence for a gene-environment interaction," they note, "may have significant implications for screening family members of patients with an aneurysmal subarachnoid hemorrhage, analysis of genetic association studies, and counseling of family members regarding smoking behavior."/.../

AH1N1

Entrevista

Intimidade de alto risco

Os vírus causadores de doenças respiratórias mudam de tempos em tempos e forçam uma convivência prejudicial aos homens, diz virologista Edison Luiz Durigon

Mariluce Moura e Neldson Marcolin

Edição Impressa 162 - Agosto 2009

Pesquisa FAPESP -

© Eduardo César

O vírus, dissílabo que soa muito familiar à maior parte das pessoas e que desde abril, na sua vestimenta A H1N1, tornou-se personagem diária, às vezes de visibilidade escandalosa, na mídia de todo o planeta, ainda é capaz de intrigar, e muito, os cientistas que dedicam a vida a decifrá-lo. Para começar: trata-se de um organismo vivo? Não, ele não é classificado como ser vivo. Quando está fora da célula, é só um elemento químico. Mas, dentro dela, torna-se uma partícula infecciosa com enzimas e sequências de nucleotídeos que fazem com que se replique e se comporte como ser vivo. Quem explica assim o caráter ambíguo e ambivalente do vírus é Edison Luiz Durigon, 53 anos, professor titular e chefe do Laboratório de Virologia do Departamento de Microbiologia do Instituto de Ciências Biomédicas da Universidade de São Paulo (USP). Outra questão: há vírus benéficos para o organismo humano, da mesma forma como há bactérias fundamentais para o metabolismo adequado do corpo do Homo sapiens? Não, ao que se sabe até aqui, nos diz Durigon. Nem todos produzem patologias, há os que permanecem inertes pela vida inteira até, mas não se conhecem benefícios de sua lavra./.../

French cafe culture

French cafe culture struggles to stay alive

August 15, 2009 by Infowars Ireland

www.dw-world.de

Sitting in a cafe in France is part of every tourist cliche. But with locals doing that less and less and the number of cafes dwindling at a rapid pace, is French cafe culture in danger of dying out?

In 1960, there were about 200,000 cafes across France. Fifty years later, there are only around 40,000 left and, according to industry statistics, two cafes go out of business every day.

On a sunny day in Paris, everything still appears normal. At Le Grand Palais, a cafe in Paris’s swanky eighth district, the terraces are full with tourists sipping lemonade, office types having lunch, and people sitting quietly on their own, reading as they take in the warm weather.

Across town at Le Belair in the Belleville neighborhood of Paris, though, there’s a much different scene. Just before lunch, there are only two customers at the bar. It’s the kind of sparsely-decorated one-room cafe with a bar that can be found in working-class neighborhoods all around the country. Owner Zahir Idris says business is extremely slow these days./.../

PROTOCOLOS INFLUENZA A (H1N1)

PROTOCOLOS INFLUENZA A (H1N1)

A Sociedade Brasileira de Cardiologia - SBC ciente do momento que enfrentamos a pandemia de gripe A coloca à disposição de todos os associados, as ferramentas mais atuais disponibilizadas pelo Ministério da Saúde para este tratamento.

Os prontuários de prescrição para o TAMIFLU deverão ser obtidos diretamente com as Secretarias Municipais e Estaduais de Saúde, uma vez que apresenta caracteres específicos. Estes prontuários poderão ser facilmente obtidos através dos sites das secretarias.

Manteremos informados sobre quaisquer modificações.

Dr. Emilio Cesar Zilli	Dr. Antonio Carlos P Chagas
Diretor de Qualidade Assistencial	Presidente

Protocolos sobre a gripe INFLUENZA A (H1N1) à disposição dos cardiologistas:

ATENDIMENTO DE PACIENTE COM SUSPEITA DE INFLUENZA A (H1N1) NA ATENÇÃO
PRIMÁRIA À SAÚDE (FLUXOGRAMA DE ATENDIMENTO)

CONTROLE DE INFECÇÃO EM SERVIÇOS DE SAÚDE

PROTOCOLO DE MANEJO CLÍNICO E VIGILÂNCIA EPIDEMIOLÓGICA DA INFLUENZA

HOSPITAIS

Amino Acid Found in Stardust Comet Sample

August 17th, 2009
Amino Acid Found in Stardust Comet Sample

Written by Nancy Atkinson

Artists concept of the stardust spacecraft flying throug the gas and dust from comet Wild 2. Credit: NASA/JPL

NASA scientists studying the comet samples returned by the Stardust spacecraft have discovered glycine, a fundamental building block of life. Stardust captured the samples from comet Wild 2 in 2004 and returned them to Earth in 2006. "Glycine is an amino acid used by living organisms to make proteins, and this is the first time an amino acid has been found in a comet," said Dr. Jamie Elsila of NASA's Goddard Space Flight Center. "Our discovery supports the theory that some of life's ingredients formed in space and were delivered to Earth long ago by meteorite and comet impacts."

Proteins are a major component of all living cells, and amino acids are the building blocks of protein. Just as the 26 letters of the alphabet are arranged in limitless combinations to make words, life uses 20 different amino acids in a huge variety of arrangements to build millions of different proteins./.../

Albuminuria

Urinary Marker Predicts Prognosis in Heart Failure

By Crystal Phend, Senior Staff Writer, MedPage Today
Published: August 17, 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

Urinary albumin may predict the prognosis for heart failure patients independent of renal dysfunction and other factors including diabetes, researchers found.
Microalbuminuria increased the risk of cardiovascular death or hospitalization for heart failure by 43%, and macroalbuminuria increased risk by 75% compared with normal albumin excretion (both P<0.0001), according to John J.V. McMurray, MD, of the University of Glasgow, Scotland, and colleagues.

Treatment with the angiotensin-receptor blocker candesartan (Atacand) did not reduce albuminuria compared with placebo in their subanalysis of CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and Morbidity) trials, reported in the Aug. 15 issue of The Lancet./.../

The Evolution of Ideology, Fairness and Redistribution

Alberto Alesina, Guido Cozziy, and Noemi Mantovanz
August 8, 2009
Abstract
Ideas about what is "fair" above and beyond the individuals’position in the income ladder determine preferences for redistribution. We study the dynamic evolution of di¤erent economies in which redistributive policies, perception of fairness, inequality and growth are jointly determined.
We show how including fairness explains various observed relationship between inequality, redistribution and growth. We also show how different beliefs about fairness can keep two otherwise identical countries in diferent development paths for a very long time./.../

Device Equals Warfarin for Stroke Prophylaxis in AF

By Crystal Phend, Senior Staff Writer, MedPage Today
Published: August 14, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

The WATCHMAN reduced a composite endpoint of stroke, cardiovascular death, and systemic embolic events by 38% compared with warfarin (3.0 versus 4.9 events per 100 patient-years), David R. Holmes, MD, of the Mayo Clinic in Rochester, Minn., and colleagues reported in the Aug. 15 issue of The Lancet./.../

New safety, durability data for percutaneous mitral-valve repair system

AUGUST 14, 2009 | Shelley Wood

Washington, DC - New safety and durability data for the percutaneous MitraClip system (Evalve), an experimental device being tested for the treatment of mitral regurgitation, suggest that the device yields lasting improvements in mitral regurgitation, with at least two-thirds of patients treated surviving out beyond one year, without needing mitral-valve surgery or developing worsening mitral regurgitation [1]. Of the patients who ended up needing valve repair, there appeared to be no downsides to first having been treated with the device, investigators said.

The MitraClip [Source: Evalve]
"Surgical options were preserved," the authors, led by Dr Ted Feldman (Evanston Hospital, IL), write in the August 18, 2009 issue of the Journal of the American College of Cardiology.

The new data come from 107 patients treated as part of the nonrandomized EVEREST 1 and 2 studies. Results for both studies have previously been reported by heartwire, but the current paper includes larger numbers and additional details and follow-up. The device itself emulates the edge-to-edge repair technique pioneered surgically by Dr Ottavio Alfieri, in which the free edge of the anterior mitral-valve leaflet is joined to the posterior leaflet, creating a point of permanent coaptation and a double orifice./.../

Estimativas populacionais: BR-Municípios

IBGE divulga as estimativas populacionais dos municípios em 2009
O IBGE divulga hoje, 14 de agosto de 2009, as estimativas das populações residentes nos 5.565 municípios brasileiros em 1º de julho de 2009. Esta divulgação anual obedece à lei complementar nº 59, de 22 de dezembro de 1988, e ao artigo 102 da lei nº 8443, de 16 de julho de 1992. As estimativas populacionais são fundamentais para o cálculo de indicadores econômicos e sociodemográficos nos períodos intercensitários, e o parâmetro usado pelo Tribunal de Contas da União na distribuição do Fundo de Participação de Estados e Municípios.
Segundo as estimativas, em 2009 o Brasil tem 191,5 milhões de habitantes espalhados pelas suas 27 unidades da federação e 5.565 municípios. São Paulo se destaca como a unidade da federação mais populosa, com 41,4 milhões de habitantes, seguida por Minas Gerais (20 milhões) e Rio de Janeiro (16 milhões). Nestas três unidades da federação da Região Sudeste concentram-se cerca de 40,4% da população brasileira./.../

Iloprost: Lung Damage Caused by Smoking

By Ed Susman, Contributing Writer, MedPage Today
Published: August 06, 2009 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

SAN FRANCISCO -- Treating asymptomatic ex-smokers with oral iloprost can mitigate the changes that lead to non-small cell lung cancer and other diseases, researchers suggested here.

Animal studies have indicated that prostacyclin supplementation prevented development of lung cancer. With those studies as background, Keith and his colleagues enrolled patients in a multicenter, double-blind, placebo- controlled, phase II trial of iloprost in patients at increased risk for lung cancer./.../

Healthy Living Is the Best Revenge

Healthy Living Is the Best Revenge Findings From the European Prospective Investigation Into Cancer and Nutrition–Potsdam Study
Earl S. Ford, MD, MPH; Manuela M. Bergmann, PhD; Janine Kröger; Anja Schienkiewitz, PhD, MPH; Cornelia Weikert, MD, MPH; Heiner Boeing, PhD, MSPH
Background: Our objective was to describe the reduction in relative risk of developing major chronic diseases such as cardiovascular disease, diabetes, and cancer associated with 4 healthy lifestyle factors among German adults.
Methods: We used data from 23 153 German participants aged 35 to 65 years from the European Prospective Investigation Into Cancer and Nutrition–Potsdam study. End points included confirmed incident type 2 diabetes mellitus, myocardial infarction, stroke, and cancer. The 4 factors were never smoking, having a body mass index lower than 30 (calculated as weight in kilograms divided by height in meters squared), performing 3.5 h/wk or more of physical activity, and adhering to healthy dietary principles (high intake of fruits, vegetables, and whole-grain bread and low meat consumption). The 4 factors (healthy, 1 point; unhealthy, 0 points) were summed to form an index that ranged from 0 to 4.
Results: During a mean follow-up of 7.8 years, 2006 participants developed new-onset diabetes (3.7%), myocardial infarction (0.9%), stroke (0.8%), or cancer (3.8%).
Fewer than 4% of participants had zero healthy factors, most had 1 to 3 healthy factors, and approximately 9% had 4 factors. After adjusting for age, sex, educational status, and occupational status, the hazard ratio for developing a chronic disease decreased progressively as the number of healthy factors increased. Participants with all 4 factors at baseline had a 78% (95% confidence interval [CI], 72% to 83%) lower risk of developing a chronic disease (diabetes, 93% [95% CI, 88% to 95%]; myocardial infarction, 81% [95% CI, 47% to 93%]; stroke, 50% [95% CI, −18% to 79%]; and cancer, 36% [95% CI, 5% to 57%]) than participants without a healthy factor.
Conclusion: Adhering to 4 simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases.
Arch Intern Med. 2009;169(15):1355-1362

Global Health Caucus Panel Briefing on "Chronic Disease in Emerging Countries"

[procor] US Congressional Global Health Caucus Panel Briefing on "Chronic Disease in Emerging Countries"

---

ProCor	Tue, Aug 11, 2009 at 6:18 PM
Reply-To: Global Dialogue To: Global Dialogue
On behalf of ProCor, I visited Washington DC on July 13, 2009 to participate in a legislative briefing for the US Congressional Global Health Caucus. The briefing convened representatives from the Senate and House of Representatives dozens of NGOs, key US government offices, corporations, and international organizations like the World Bank and WHO. The purpose of the briefing was to increase awareness of chronic diseases in low- and middle-income countries. The panel of experts included: - Dr. Rachel Nugent, Deputy Director for Global Health, Center for Global Development - Dr. Gerard Anderson, Professor of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University - Dr. K.S. Reddy, President, Public Health Foundation of Indian - Dr. Thomas Gaziano, Assistant Professor, Harvard Medical School. Sir George Alleyne, Chancellor of the University of the West Indies, was the distinguished and eloquent moderator of the discussion. In opening the briefing, he noted that "Nowhere in the Millennium Development Goals are noncommunicable diseases mentioned. This is not 'my' disease or 'your' disease. It has been neglected and we must pay attention to it." Thank you to Trevor Gunn, Director of International Relations, Medtronic and Adjunct Professor, School of Foreign Service, Georgetown University, who organized the briefing, for providing the following summary of the discussion. Catherine Coleman, Editor in Chief, ProCor Summary of key points: - Chronic and non-communicable diseases are a worldwide problem, impacting men, women and children of varying ages, races, and income categories. - Many myths surround chronic and non-communicable diseases, from the nature of the disease to the characteristics of people who develop symptoms. In most cases, successful, cost-effective interventions have been identified and tested. A lack of political will and funding are preventing the execution of these programs. - There is some overlap in the treatment and prevention of communicable and non-communicable disease. Treating both is important--one should not come at the cost of the other. Building health systems could directly combat the "double burden of disease" imposed by overlaying non-communicable disease burden on an already severe infectious disease burden. Programs or public health goals, previously only measured by communicable disease variables (as HIV/AIDS, TB, and malaria) should expand the range of measurements to include non-communicable diseases. - To raise awareness and direct funding toward intervention, the issues of non-communicable and chronic diseases need to be framed in a manner that is accessible to the general public and to governments. A new Millennium Development Goal for NCDs is not necessary. We can simply add "and other diseases" to existing, disease-restrictive (HIV/AIDS, etc.) MDGs related to child and maternal health. -US involvement, starting with public recognition of the need for addressing non-communicable and chronic disease from the Centers for Disease Control and Prevention, the National Institutes of Health, or the US State Department will have a significant impact on donor willingness to participate in efforts to reduce these diseases. - In addition to health consequences, chronic and non-communicable disease have a significant impact on the productivity and earning potential of individuals and consequently on a country's GDP. - Medical device, diagnostic, and pharmaceutical companies can contribute by further advancing lower-cost and easier-use equipment and medications. Moderator Closing Remarks Sir George Alleyne, MD (Director Emeritus, PAHO/WHO): - Non-communicable and chronic disease is not just a problem in the US but is a rapidly growing global problem. - Non-communicable disease has a significant impact on the economic 'bottom line' at both a macro and micro level, impacting the earning capacity of countries and individuals. - Aid organizations and governments have identified the interventions needed to prevent disease and reduce their impacts. But they need to be implemented. - The United States should take initiative and demonstrate leadership in bringing the issue of chronic and non-communicable disease to the forefront. No- or low-cost ways such as speaking at the UN General Assembly will carry tremendous impact. For more information, contact: Trevor Gunn, Director, International Relations Medtronic (Washington, DC) Telephone: +1 202 442 3655 or email: Trevor.Gunn@medtronic.com & Adjunct Professor, School of Foreign Service, Georgetown University/ GunnT@georgetown.edu We welcome your comments. Catherine Coleman Editor in Chief. ProCor

Tobacco sales fall by -19.3%

Tobacco sales fall by -19.3%
By Generation Research, 11 August 2009

In the first quarter of 2009, global duty free and travel retail tobacco sales slumped by -19.3% compared with the same quarter in 2008 – according to the TREND Tobacco Index which is based on actual audits of retail sales among a panel of locations worldwide.

"This is probably the worst quarter ever recorded for the tobacco business which has been battered in travel retail and elsewhere", says Yngve Bia, President Generation Research. "Sales were especially poor onboard airlines with a sales decline of -26.5%. Also airport sales were down steeply by -24.0%"./.../

Health-care reform

Dr. Ezekiel Emanuel, the medical ethicist and oncologist who advises President Obama, does not own a television, and if you catch him in a typically energized moment, when his mind speeds even faster than his mouth, he is likely to blurt out something like, "I hate the Internet." So it took him several days in late July to discover he had been singled out by opponents of health-care reform as a "deadly doctor," who, according to an opinion column in the New York Post, wanted to limit medical care for "a grandmother with Parkinson's or a child with cerebral palsy." /.../

Four golden rules reduce chronic disease by 78%

Four golden rules can help reduce your chances of chronic disease by 78%
Four simple lifestyle measures - not taking up smoking, keeping slim, eating a healthy diet and regular exercise - together reduce the risk of deadly chronic diseases by up to 78%, a study has shown.

Researchers based the finding on results from a major public health investigation involving more than 23,500 adults aged 35 to 65./.../

Primary Prevention of Rheumatic Fever: Control of Rheumatic Heart Disease in Africa?

Is Primary Prevention of Rheumatic Fever the Missing Link in the Control of Rheumatic Heart Disease in Africa?
Ganesan Karthikeyan MBBS, MD, DM and Bongani M. Mayosi MBChB, DPhil*
From the Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (G.K.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India (G.K.); and Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (B.M.M.).


* To whom correspondence should be addressed. E-mail: bongani.mayosi@uct.ac.za.


Abstract—Rheumatic fever and rheumatic heart disease continue to be major public health problems in the developing world, particularly in the countries of sub-Saharan Africa. Because of its cost effectiveness, secondary prophylaxis is advocated as the principal means of disease prevention and control. However, in developing countries, valvular damage, due to earlier, unrecognized episodes of rheumatic fever, has already occurred by the time secondary prophylaxis is instituted. Secondary prophylaxis cannot reduce the incidence of new cases of rheumatic fever and has not been shown to alter the natural history of rheumatic valvular disease. Experience from several regions of the world suggests that incorporation of a strategy of primary antibiotic prophylaxis into a comprehensive program for disease control can reduce the incidence of rheumatic fever and rheumatic heart disease. In this article, we argue that a strategy of primary antibiotic prophylaxis, with appropriate modifications, can be successfully implemented in resource-poor settings across the world and should be a key component of any rheumatic heart disease control program. This, we believe, is essential for reducing the global burden of rheumatic heart disease.

Rheumatic Heart Disease Screening by Echocardiography

Rheumatic Heart Disease Screening by Echocardiography. The Inadequacy of World Health Organization Criteria for Optimizing the Diagnosis of Subclinical Disease
Eloi Marijon MD*, David S. Celermajer PhD, FRACP, Muriel Tafflet PhD, Saïd El-Haou PhD, Dinesh N. Jani MD, Beatriz Ferreira MD, PhD, Ana-Olga Mocumbi MD, PhD, Christophe Paquet MD, MPH, Daniel Sidi MD, PhD, and Xavier Jouven MD, PhD
From Université Paris Descartes, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (E.M., X.J.); Paris Cardiovascular Research Center, INSERM 970, Université Paris Descartes, AP-HP, Hôpital Européen Georges Pompidou, Paris, France (E.M., M.T., X.J.); Department of Medicine, Sydney University, Sydney, Australia (D.S.C.); INSERM UMRS-956, Université Pierre et Marie Curie, Paris, France (S.E.H.); Instituto do Coração, Maputo, Mozambique (D.N.J., B.F., A.O.M., D.S.); Institut de Veille Sanitaire, Saint Maurice, France (C.P.); and Université Paris Descartes, AP-HP, Hôpital Necker-Enfants Malades, Paris, France (D.S.).


* To whom correspondence should be addressed. E-mail: eloi_marijon@yahoo.fr.


Background—Early case detection is vital in rheumatic heart disease (RHD) in children to minimize the risk of advanced valvular heart disease by preventive measures. The currently utilized World Health Organization (WHO) criteria for echocardiographic diagnosis of subclinical RHD emphasize the presence of pathological valve regurgitation but do not include valves with morphological features of RHD without pathological regurgitation. We hypothesized that adding morphological features to diagnostic criteria might have significant consequences in terms of case detection rates./.../

BRAZIL

Brazil
Table of Contents
1 Background
2 Geography
3 Biodiversity and Ecology
3.1 Ecoregions
3.2 Protected Areas
3.3 International Environmental Agreements
4 Government
5 People and Society
6 Water
7 Energy
8 Conflict
9 Economy
10 Further Reading
Content Partners: World Wildlife Fund (other articles) and Conservation International (other articles)
Content Sources: Central Intelligence Agency (other articles), Food and Agriculture Organization (other articles) and Energy Information Administration (other articles)
Article Topic: Geography
This article has been reviewed and approved by the following Topic Editors: Sidney Draggan (other articles) and Juan Pablo Arce (other articles)
Last Updated: May 21, 2009

(Gripe) Uma visão do front

ZH: 09 de agosto de 2009 | N° 16057

por Luís Beck da Silva Neto*

A epidemia de influenza H1N1 está longe de ser uma epidemia de “gripe como as outras” como veiculado por autoridades da Saúde.

Embora formado há 15 anos e trabalhando em UTI, ainda não havia visto uma UTI com 11 pessoas com o mesmo diagnóstico. Temos gripes todos os invernos, mas em nenhum ano as gripes tiveram esta repercussão. Em hospitais do interior do Estado, sabe-se que a situação não é diferente.

As orientações do Ministério da Saúde têm sido no mínimo contraditórias. Recomendaram, até dias atrás, tratar apenas os casos graves com o Oseltamivir (antiviral anti-Influenza – Tamiflu), enquanto a recomendação é usar a droga nas primeiras 48 horas da doença. Assim, torna-se uma loteria a determinação de quem receberá o remédio, e os que o recebem o fazem tardiamente. No Rio Grande do Sul, dentre os óbitos registrados pela doença, não consta que esses pacientes tiveram a oportunidade de receber Tamiflu.

A profilaxia dos contatos, no Brasil, não tem sido realizada. Nossos colegas médicos, e outros profissionais de saúde, estão na linha de frente, atendendo em emergências e UTIs, utilizando as medidas de proteção disponível (máscaras), mas sem profilaxia medicamentosa. O Center for Disease Control (CDC) dos Estados Unidos recomenda a profilaxia com Oseltamivir para os profissionais de saúde que examinam pacientes infectados ou com suspeita de infecção, sem a proteção adequada. Um profissional que permanece por 12 horas atendendo em uma sala de emergência contaminada tem alta chance de contágio e deveria incluir-se no critério recomendado pelo CDC.

No Brasil, o governo recolheu o medicamento das farmácias, possui milhões de cartelas do remédio em sua posse e não tem a destreza necessária para distribuí-lo aos doentes. Os remédios estão disponíveis nos hospitais, mas a recomendação do ministério é de que os pacientes não procurem os hospitais, que busquem informações nos postos de saúde. Está correto descentralizar a assistência, pois a aglomeração não é recomendada. Mas como a população vai ser tratada se o remédio está centralizado! Este é um paradoxo que merece ser explicado.

O argumento de recolhê-lo para evitar a resistência do vírus ao Oseltamivir é pífio, se não irônico. É possível comprar qualquer antibiótico livremente nas farmácias, inclusive antibióticos de amplo espectro sem qualquer exigência de receita médica. Por que agora tamanho rigor “científico” em meio a uma epidemia de proporções ainda desconhecidas? Bastaria implantar um efetivo sistema de controle de venda através da prescrição médica. Além disso, não há setor do Ministério da Saúde que funcione à noite. Isto obriga a população a ser tratada apenas em horário comercial.

O ministro da Saúde, senhor José Gomes Temporão, reafirma que este vírus “tem uma taxa de letalidade semelhante ao vírus da gripe comum”. Ora, a letalidade é simplesmente desconhecida, num contexto de franco subdiagnóstico (por falta de laboratórios capacitados), de subnotificação e subtratamento, devido à definição de tratar apenas os pacientes em estado grave.

Portanto:

1. A população está pouco informada da gravidade e, por conseguinte, pouco vigilante;

2. Os serviços públicos de saúde, normalmente já saturados, nesta situação tornam-se críticos e, certamente, insuficientes;

3. O remédio está indisponível, por determinação “superior”;

4. As características da doença são desconhecidas e indicam possibilidades de quadros graves e fatais, inclusive em pessoas jovens e saudáveis;

5. Os médicos estão expostos e sem a prevenção farmacológica recomendada internacionalmente;

Na minha opinião:

1. A prevenção é a maior arma. E para isso as pessoas devem estar informadas e seguir medidas de prevenção;

2. Deve-se evitar lugares com muitas pessoas;

3. Usar máscara liberalmente;

4. Lavar as mãos frequentemente;

5. Usar álcool gel liberalmente;

6. Se estiver febril ou com sinais de gripe, não sair de casa. Aguardar determinações para o uso de Oseltamivir (Tamiflu), que, creio, deverá ter seu uso afrouxado em breve. Espera-se.

*Internista e cardiologista, doutor em Medicina pela UFRGS, professor do Programa de Pós-Graduação em Cardiologia da UFRGS

Prostate Cancer Mortality Lower in Statin Users

By Charles Bankhead, Staff Writer, MedPage Today
Published: February 27, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

ORLANDO, Feb. 27 -- Prostate cancer mortality risk declined by 50% in men taking statins for reasons unrelated to cancer, data from a case-control study showed.

The mortality benefit increased to almost two-thirds after adjustment for potential confounding factors, according to Stephen Marcella, M.D., of the University of Medicine and Dentistry of New Jersey School of Public Health in Piscataway. He reported his findings at the Genitourinary Cancers Symposium here./.../

Cinema e Cigarro

Veja: Comportamento

6 de agosto de 2009

Fumar era, em meados do século XX, um símbolo de glamour. No cinema, ele se tornou acessório indispensável de personagens charmosos. Veja, nesta galeria, atores e atrizes que fumaram em cena e na vida real - alguns morreram por isso. (Imagens: Reprodução)

Navegue clicando nas fotos menores, nas setas ou pelo teclado ( ).

Foto 7/13

Montana, Terra Proibida, de 1950. O ator era um grande adepto do alcool e do cigarro e morreu em 1959 vítima de um ataque do coração" src="http://veja.abril.com.br/galeria-de-imagens/cinema-cigarro/flynn-gde.jpg">

rrol Flynn em Montana, Terra Proibida, de 1950. O ator era um grande adepto do alcool e do cigarro e morreu em 1959 vítima de um ataque do coração

O cerco ao cigarro se fecha

Exclusivo VEJA.com O cerco ao cigarro se fecha Entenda novas restrições em SP e os males do vício.

•

Nutrição:

Como parar de fumar e não engordar?

Mitos e verdades sobre o café

Cientistas afirmam: café não faz mal à saúde

Primeiros resultados de uma pesquisa feita pelo Instituto do Coração, em São Paulo, indicam que bebida não aumenta o risco de infarto./.../

Eça de Querioz

Um amigo me enviou esta preciosidade:

"Os políticos e as fraldas devem ser mudados

frequentemente e pela mesma razão"

Há mais de um século disse Eça de Queroz.

Brazil enforces smoking ban in São Paulo

Financial Times - By Jonathan Wheatley in São Paulo

Published: August 6 2009 21:14 | Last updated: August 6 2009 21:14

A smoking ban comes into force in the Brazilian state of São Paulo on Friday, adding to what has become one of the world’s toughest anti-smoking campaigns.

Brazil was among the first countries in the world to print disturbing images on cigarette packs in an effort to persuade smokers not to light up. The images, in use since 2001, have coincided with a steady fall in the number of smokers in the country, from 34 per cent of the adult population in 1989 to 15 per cent last year, although the part played by the images is hard to gauge/.../

Warning Signs: A New Test to Predict Alzheimer's

Time.com By Alice Park Wednesday,
May. 13, 2009
Images.com / Corbis

Researchers at the University of California, San Francisco (UCSF), and the University of Pittsburgh have developed the first screening tool that can help predict whether elderly patients are at low, moderate or high risk of developing dementia. The new test takes into account characteristic risk factors for dementia, including advanced age and the presence of genes associated with Alzheimer's, but also relies on lesser-known contributors such as patients' body weight and alcohol-drinking habits./.../

Red Yeast Rice: Lowering LDL Cholesterol

Red Yeast Rice: A New Possibility for Lowering LDL Cholesterol By Kevin Self Reviewed by Elizabeth Klodas, MD, FACC The use of red yeast rice, a dietary supplement, may help lower cholesterol levels in patients who are unable to comfortably take conventional cholesterol-lowering medications./.../

pitavastatin

FDA approves cholesterol drug, pitavastatin

August 4, 2009 | Michael O'Riordan

Rockville, MD - The US Food and Drug Administration has approved pitavastatin (Livalo, Kowa Pharmaceuticals America Inc), a new cholesterol-lowering drug for the primary treatment of hypercholesterolemia and combined dyslipidemia.

Pitavastatin is the newest addition to the drug class, joining atorvastatin, rosuvastatin, simvastatin, pravastatin, lovastatin, and fluvastatin on the crowded statin market. The drug is expected to launch in the US in early 2010 and will be available in three low dosages: 1 mg, 2 mg, and 4 mg. It is has been available in Japan since 2003, and is also available in South Korea, Thailand, and China.

According to the FDA, the drug was approved on the basis of results from five clinical trials showing that pitavastatin was as safe and effective as other statins on the market [1]. A press release issued by the company notes that the studies showed the drug to be particularly effective in special populations, including the elderly, patients with diabetes, and those at higher cardiovascular risk [2].

Reynolds Risk Score

If you are a healthy woman or man without diabetes, the Reynolds Risk Score is designed to predict your risk of having a future heart attack, stroke, or other major heart disease in the next 10 years. In addition to your age, blood pressure, cholesterol levels and whether you currently smoke, the Reynolds Risk Score uses information from two other risk factors, a blood test called hsCRP (a measure of inflammation) and whether or not either of your parents had a heart attack before they reached age 60 (a measure of genetic risk).

Top 200 and Top 500 by Country and Regions

Top 200 and Top 500 by Country and Regions

The following graphics shows the distribution by country of the universities that ranks under the 200th and 500th position respectively according to our Web Ranking.

Top Latin America

Universities 1 to 100 of 100 CONTINENT RANK UNIVERSITY COUNTRY WORLD RANK 1 Universidade de São Paulo 38 2 Universidad Nacional Autónoma de México ** 44 3 Universidade Estadual de Campinas 115 4 Universidade Federal de Santa Catarina Brasil 134 5 Universidade Federal do Rio Grande do Sul 152 6 Universidade Federal do Rio de Janeiro 196 7 Universidade de Brasília 204 8 Universidad de Chile 227 9 Universidade Federal de Minas Gerais 241 10 Universidade Estadual Paulista 269