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Monday, April 30, 2012

2548 - AMICOR 14 - Julia 15 anos!

JULIA BELLARDINELLI ACHUTTI, nossa única e querida neta
(temos mais três netos) completa 15 anos hoje.
Nasceu na véspera do primeiro Seminário Nacional de dez dias sobre
Epidemiologia e Prevnção das Doenças Cardiovasculares, realizado
em Gramado, sob coordenação do professor Bruce B. Duncan e minha.
De lá saiu a Declaração de Gramado, cuja discussão da versão final deu
origem ao que é hoje o Blog AMICOR.

Sunday, April 29, 2012

Bernard Lown: Avoidable Care

Social Responsibility of Physicians

Bernard Lown, MD
Address presented at
Avoiding avoidable Care Conference 
April 26, 2012
Essay 29
  • Ever since starting clinical practice 62 years ago I have looked forward to this conference. Mercifully, good fortune and good genes enable me to attend.  From my earliest days in medicine I have struggled against the prevailing model of healthcare. My opposition in part was provoked by the growing prevalence of overtreatment. Resort to excessive interventions seemed to be the illegitimate child of technology in the age of market medicine. If more than a half century ago overtreatment was at a trickle pace, it is now at flood tide./.../

DM & Obesity

TODAY — A Stark Glimpse of Tomorrow

David B. Allen, M.D.
April 29, 2012 (10.1056/NEJMe1204710)
Caloric intake that exceeds energy expended and its consequences, particularly development of type 2 diabetes mellitus, is emblematic of a climate change for modern medicine — a phenomenon so complex, embedded in culture and economics, and intertwined with conflicts between individual freedom and societal health that solutions are difficult to envision. Chronic caloric surplus (rather than obesity itself) is a central cause of epidemic type 2 diabetes,1 but differences in response to energy excess,2-4 disproportionately present among disadvantaged youth, increase susceptibility to type 2 diabetes in early life. Indeed, the percentage of type 2 diabetes in cases of new-onset diabetes in adolescence has increased from 3% a few decades ago to approximately 50% today.5Because complications increase with the duration of diabetes, it is critical to improve prevention and treatment strategies for affected youth.
In an impressive effort, the TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study, now reported in the Journal, randomly assigned 699 young people with type 2 diabetes to test how well metformin alone, metformin plus rosiglitazone, and metformin plus an intensive lifestyle-intervention program maintained glycemic control (a glycated hemoglobin level of <8%) for a minimum of 2 years.6 The recruitment and retention of demographically representative participants and the implementation of a lifestyle-intervention program in children and adolescents is laudable. However, the results of the study were discouraging — 52% of participants treated with metformin alone had treatment failure, metformin plus lifestyle intervention did not significantly improve glycemic control and achieved targeted weight loss in only 31% (and this weight loss was apparently transitory in many participants), and the addition of rosiglitazone to metformin improved durable glycemic control, but 39% still had treatment failure. Furthermore, the failure rate with metformin monotherapy appeared higher than that in recently diagnosed adult patients. Thus, these data imply that most youth with type 2 diabetes will require multiple oral agents or insulin therapy within a few years after diagnosis.
Do these results put a nail in the coffin of lifestyle modification and endorse add-on drugs to treat type 2 diabetes in children? Reasons to resist this notion may lie in the study design and analysis. The study's focus on the comparison of metformin alone with metformin plus lifestyle change or metformin plus rosiglitazone, without comparison of the two combination treatments, overshadows the fact that failure rates of the metformin-plus-lifestyle and metformin-plus-rosiglitazone groups did not differ significantly. With regard to secondary outcomes, participants in the metformin-plus-lifestyle group gained less fat mass than those in the metformin-plus-rosiglitazone group, a result that could reduce the risk of other diseases associated with obesity. In addition, possible sex7 and racial differences in the effect of lifestyle change on glycemic control hint that effective strategies to prevent type 2 diabetes and slow its progression may vary.
Critics may conclude that the lack of meaningful weight loss in most participants in the metformin-plus-lifestyle group points to poor adherence, rather than representing an indictment of lifestyle change itself. Because changes in eating and activity habits were calculated to decrease baseline weight by 7 to 10%,8 most participants clearly did not adopt these habits, and the feasibility of lifestyle change was evaluated more than its effect. But this result is still informative, since the assertions that lifestyle change by definition works and that any lack of effect is therefore due to poor adherence constitute a tautology. Indeed, this is the essential, maddening conundrum of the epidemic of type 2 diabetes — collective failure to adhere to a lifestyle healthy enough to prevent the disease. A critical point is that the participants in the TODAY study were not adults, but youth immersed from a young age in a sedentary, calorie-laden environment that may well have induced and now aggravates their type 2 diabetes. Fifty years ago, children did not avoid obesity by making healthy choices; they simply lived in an environment that provided fewer calories and included more physical activity for all. Until a healthier “eat less, move more” environment is created for today's children, lifestyle interventions like that in the TODAY study will fail.
Solace can still be found in the TODAY study, if its larger message transcends its worrisome findings. Illness from childhood overnutrition is a societal and cultural problem that current medicines treat but cannot resolve. For a substantial proportion of those millions of children at risk for largely preventable type 2 diabetes, the findings of the TODAY study reinforce the idea that medications and even procedures9 will not stave off a lifetime of illness. Furthermore, lifestyle changes for youth are undermined by immersion in an obesogenic world, in which personal responsibility appears to be invalidated by the limits of willpower10 with respect to overnutrition. The stark message from the TODAY study is that, tomorrow and beyond, public-policy approaches — sufficient economic incentives to produce and purchase healthy foods11 and to build safe environments that require physical movement — and not simply the prescription of more and better pills will be necessary to stem the epidemic of type 2 diabetes and its associated morbidity.
Disclosure forms provided by the author are available with the full text of this article at
This article (10.1056/NEJMe1204710) was published on April 29, 2012, at


From the Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison.

2547 - AMICOR 14


Turning City Green

Aloyzio AchuttiemAMICOR - 1 hora atrás
*Se NY pode nos também podemos...*Turning Unused Acres Green Chester Higgins Jr./The New York Times *PEACEFUL TAKEOVER *In Gowanus, a group from Feedback Farms works on planters to grow vegetables. By JOHN LELANDPublished: April 27, 2012 - - THE city of New York owns thousands of slivers of unused land, and about a year ago, a group of Brooklyn gardeners had an idea: identify all the vacant lots in the borough, then help neighborhood residents take them over. They built an online map, then a mobile app, with information about the plots, including the names and phone numbe... mais »

Health Spending is Flattening Out

Aloyzio AchuttiemAMICOR - 1 hora atrás
Multimedia Graphic Explaining a Slowdown in Health Care Spending In Hopeful Sign, Health Spending Is Flattening OutMuch of the slowdown is because of the recession, and thus not unexpected, health experts say. But some of it seems to be attributable to changing behavior by consumers and providers of health care — meaning that the lower rates of growth might persist even as the economy picks up. Because Medicare and Medicaid are two of the largest contributors to the country’s long-term debts, slower growth in health costs could reduce the pressure for enormous spending cuts or tax in... mais »

Vitamin and Mineral Supplements

Aloyzio AchuttiemAMICOR - 23 horas atrás
Sugested by the AMICOR Jorge OssanaiVitamin and Mineral Supplements: Do You Really Need Them? Do you take a dietary supplement? If so, you're in good company: More than half of all U.S. adults take at least one daily or occasionally. But a group of researchers are now saying that vitamin and mineral supplements may be doing some people more harm than good. Two recent studies are questioning the long-term safety of multivitamins for older women and vitamin E supplements for men, and show the need for more research on this important subject. *More...* - *Over age 50.* You may need... mais »

Prevent Alzheimer’s?

Aloyzio AchuttiemAMICOR - 1 dia atrás
Can Household Chores Help Prevent Alzheimer’s? By AMANDA GARDNER/HEALTH.COM | April 19, 2012 | [image: Getty Images] In recent years, several studies have found that older people are less likely to develop Alzheimer’s disease and other forms of dementia if they engage in vigorous exercise, such as jogging, swimming or brisk walking. People who are too frail or out of shape to hit the pool or treadmill shouldn’t despair, however. According to a new study, even mundane, low-key tasks like gardening, cooking and washing dishes can lower the risk of Alzheimer’s if they’re performed often...mais »

defeat aging entirely

Aloyzio AchuttiemAMICOR - 1 dia atrás
‘This house wants to defeat aging entirely’: de Grey vs. BlakemoreApril 24, 2012 *[+]*[image: Aubrey de Grey] Aubrey de Grey (credit: SENS Foundation) Oxford University Scientific Society is hosting a debate on Wednesday, April, 25, 2012, addressing whether aging should be a target of decisive medical intervention — raising the possibility of substantial extension of human lifespan. Dr. Aubrey de Grey will propose the motion, “This house wants to defeat aging entirely“ and Professor Colin Blakemore will be opposing. The debate will be chaired and moderated by Professor Sir Richard Pe... mais »

Brain: ‘use it or lose it’

Aloyzio AchuttiemAMICOR - 1 dia atrás
Protecting your brain: ‘use it or lose it’April 25, 2012 Effects on neurons of an active cognitive lifestyle in Brodmann area 9 (mid-prefrontal lobe, involved in memory). A high cognitive lifestyle score was associated with increased neuronal density (A, B) and greater neocortical thickness (C, D). (Credit: M. J. Valenzuela et al./Biol Psychiatry) Cultivation of an active cognitive lifestyle through lifespan engagement in a rich array of mentally stimulating activities may help reduce dementia risk, according to a major study of more than 13,000 individuals aged over 65 years and fo... mais »

Polythiophenes inhibit prion propagation

Aloyzio AchuttiemAMICOR - 1 dia atrás
Polythiophenes inhibit prion propagation by stabilizing PrP aggregates 1. Ilan Margalith1, et al. 2. * 1. *Background:* Luminescent conjugated polymers (LCPs) are highly specific to amyloid conformations and may represent potential antiprion compounds. *Results:* LCPs significantly reduce prion titers, while rendering PrPSc more stable to proteolytic digestion. *Conclusion:* LCPs possess pronounced antiprion potential and appear to act by compaction of frangible fibers. *Significance:* LCPs may represent novel pharmacophores for the prevention and treatment of prion disea... mais »

student-produced educational video

Aloyzio AchuttiemAMICOR - 1 dia atrás
MIT launches student-produced educational video initiative Original short videos, in collaboration with Khan Academy, aim to fuel K-12 students’ interest in engineering and science. David L. Chandler, MIT News Office; Chad Galts, School of Engineering MIT has launched an initiative encouraging its students to produce short videos teaching basic concepts in science and engineering. The videos — aimed at younger students, in grades from kindergarten through high school — will be accessible through a dedicated MIT website and YouTube channel. A subset of the videos will also be available... mais »

images of the Milky Way Galaxy

Aloyzio AchuttiemAMICOR - 1 dia atrás
Picture captures a billion starsBy Jonathan AmosScience correspondent, BBC News, Manchester [image: Milky Way over the desert] [image: Milky Way graphic]Scientists have produced a colossal picture of our Milky Way Galaxy, to reveal the detail of a billion stars. It is built from thousands of individual images acquired by two UK-developed telescopes operating in Hawaii and in Chile. Archived data from the project, known as the Vista Data Flow System, will be mined by astronomers to make new discoveries about the local cosmos. But more simply, it represents a fabulous portrait of the nig... mais »

10 toxic chemicals suspected to cause autism and learning disabilities

Aloyzio AchuttiemAMICOR - 1 dia atrás
The top 10 toxic chemicals suspected to cause autism and learning disabilities April 27, 2012 [image: Autism-stacking-cans_edit]* *The current issue of Environmental Health Perspectives calls for increased research to identify possible environmental causes of autism and other neurodevelopmental disorders in America’s children and presents a list of the top ten target chemicals in consumer products likely to contribute to these conditions: 1. Lead 2. Methylmercury 3. PCBs 4. Organophosphate pesticides 5. Organochlorine … more… To begin formulation of a systematic strategy for discover... mais »

PET Scan & Alzheimer's D.

Aloyzio AchuttiemAMICOR - 3 dias atrás
PET Scan Readings Lead to Alzheimer's Misdiagnosis Pauline Anderson April 25, 2012 (New Orleans, Louisiana) — Misdiagnosis of Alzheimer's disease (AD) based on positron emission tomography (PET) scan readings appears to be a troubling problem that could get worse as more amyloid-specific tracers become available. A new study found that almost two thirds of patients were misdiagnosed or had inconclusive data on the basis of interpretation of their PET scan in a community setting. "We concluded that since this is such a large percentage of people who are misdiagnosed based upon their P... mais »

200 Years of the New England Journal of Medicine

Aloyzio AchuttiemAMICOR - 3 dias atrás
A Reader's Guide to 200 Years of the *New England Journal of Medicine* Allan M. Brandt, Ph.D. N Engl J Med 2012; 366:1-7January 5, 2012 Comments open through December 31, 2012 ArticleReferencesCiting Articles (1)Comments (5) Audio Interview [image: Interview with Allan Brandt on the first 200 years of the Journal as a window into the history of medicine, science, and society.] Interview with Allan Brandt on the first 200 years of the*Journal* as a window into the history of medicine, science, and society. (22:26) - Listen - Download With this issue, the *New England Journal of M... mais »

Periodontal Disease and Vascular Disease

Aloyzio AchuttiemAMICOR - 5 dias atrás
*Periodontal Disease and Atherosclerotic Vascular Disease:* /.../Evidence for PD as a Risk Factor for ASVD The potential associations between PD and ASVD can be considered in light of published standards for levels of evidence that include Level of Evidence A, for which supportive data are derived from multiple randomized clinical trials or meta-analyses, and Level of Evidence B, for which data derive from a single randomized trial or nonrandomized studies. An association between PD and ASVD is supported by evidence that meets standards for Level of Evidence A. A benefit of periodo... mais »


Aloyzio AchuttiemAMICOR - 6 dias atrás
[image: See Explanation. Clicking on the picture will download the highest resolution version available.] *Antares and Clouds * Image Credit & Copyright: Ivan Eder*Explanation: *Antares is a huge star. In a class called red supergiant, Antares is about 850 times the diameter of our own Sun, 15 times more massive, and 10,000 times brighter. Antares is the brightest star in the constellation of Scorpius and one of the brighter stars in all the night sky. Located about 550 light years away,Antares is seen on the left surrounded by a yellowish nebula of gas which it has itself expelled.... mais »

Os Limites da Ciência

Aloyzio AchuttiemAMICOR - 6 dias atrás
*Os Limites da Ciência* O conhecimento científico é o resultado de uma construção progressiva. São formas de entendimento que se sucedem no tempo e que se aperfeiçoam, realizada principalmente a partir dos esforços da cultura do século XVI. Nomes como Lavoisier, Galileu, Descartes, Newton, Darwin, entre outros, despontam como pilares históricos desta construção, culminada no que denominamos paradigma científico dominante, um sistema de conhecimentos que se autodefine como objetivo, universal e determinista.

Air Pollution

Aloyzio AchuttiemAMICOR - 6 dias atrás
Air Pollution Sickens Seniors By Nancy Walsh, Staff Writer, MedPage Today Published: April 21, 2012 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. Action Points - A model using satellite data to predict short- and long-term exposure to small particulate matter in the atmosphere found increased hospitalizations for respiratory causes, cardiovascular disease, stroke, and diabetes among exposed Medicare participants in New England. - Note that the increases in hospitalizations for each of the conditions were ... mais »

Super Duper Secret Mega Weapons

Aloyzio AchuttiemAMICOR - 6 dias atrás
*Is Moscow Developing Super Duper Secret Mega Weapons?* By SIMON SHUSTER / MOSCOW Thursday, Apr. 19, 2012 Russian self-propelled howitizer MSTA are seen during a rehearsal for the May 9 Victory Day parade at Ababino military polygon on April, 4, 2012 near Moscow. Sasha Mordovets / Getty Images The first mention of these mega-weapons came in February, when Vladimir Putin, Russia's perennial leader, published an article as part of what would be a successful campaign to win a third term as President. In the near future, he wrote, military strength will rely on a country's pr... mais »

tobacco's harm to CV health

Aloyzio AchuttiemAMICOR - 6 dias atrás
*Global ignorance of tobacco's harm to cardiovascular health costing lives - EurekAlert! April 23, 2012* *New study presented at the World Congress of Cardiology organized by the World Heart Federation* A report released today at the World Heart Federation World Congress of Cardiology in Dubai reveals significant gaps in public awareness regarding the cardiovascular risks of tobacco use and secondhand smoke. The report, entitled "Cardiovascular harms from tobacco use and secondhand smoke", was commissioned by the World Heart Federation and written by the International Tobacco Contr... mais »


Aloyzio AchuttiemAMICOR - 1 semana atrás
Memória de internet Publicado em 16/04/2012 Permalink Tags: História da Ciência, Web 2.0, Internet Cada vez mais numerosa, lista de acervos digitalizados de cientistas e personalidades conta agora com coleção de Nelson Mandela. A tendência, que pode ajudar a preservar a história da ciência e das lutas sociais, ainda tem poucas e isoladas iniciativas brasileiras. [image: Memória de internet] Diários, bilhetes, cadernos, cartas, fotos: acervos ‘on-line’ reúnem enorme quantidade de documentos de grandes cientistas e personalidades e permitem conhecer o passado e pensar o futuro da ciênci... mais »

Evento: 28 Maio próximo

Aloyzio AchuttiemAMICOR - 1 semana atrás