Aldosterone Antagonists — Last Man Standing?

Paul W. Armstrong, M.D.

November 14, 2010 (10.1056/NEJMe1012547)

Article

References

The transformation of cardiac care over the past half century has been breathtaking to witness. In large part, this transformation is due to the advent of new drugs and devices, improved health care systems, and behavioral modifications such as smoking cessation. Four cardiac medicines developed before 1960 that survived the turn of the millennium are aspirin, digoxin, warfarin, and spironolactone. New competitors threaten the continued longevity of aspirin, the survival of digoxin depends on evidence of its ability to improve exercise tolerance and quality of life in patients with heart failure, and new pretenders for warfarin are here. Remarkably, after over 50 years, the aldosterone antagonism achieved by spironolactone (and more recently eplerenone) has earned an enduring role in the treatment of heart failure.1/.../

deserto em florestas utilizando água reaproveitada

Egito transforma deserto em florestas utilizando água reaproveitada

País já plantou mais de 71 mil quilômetros quadrados de matas por meio do sistema

por Globo Rural Online, com informações da Agência EFE

Eucalipto é uma das espécies que estão sendo plantadas nas florestas que usam água reaproveitada, no Egito

O governo do Egito desafia a natureza ao regar áreas desérticas com água reaproveitada para convertê-las em florestas, cuja superfície já equivale ao território do Panamá. 

Tudo isso foi possível graças à água que utilizam, poluem e desperdiçam todos os dias os 80 milhões de egípcios. Ironicamente, esta é a melhor opção para as chamadas "florestas feitas à mão". 

"A água residual pode transformar o que não é fértil, como o deserto, em algo fértil, já que contém nitrogênio, micronutrientes e substâncias orgânicas ricas para a terra", disse o professor do Instituto de Pesquisa de Solo, Água e Meio Ambiente, Nabil Kandil. 

A opinião é compartilhada pelo professor do Departamento de Pesquisa de Contaminação da Água, Hamdy el Awady, que até ressalta a superioridade das plantas regadas com água reaproveitada. "Esse tipo de água tem muito mais nutrientes do que a água tratada e, por isso, é uma fonte extra de nutrição que pode fazer com que as plantas resistentes aos climas hostis cresçam mais rápido e, inclusive, tenham folhas mais verdes", explica El Awady. 

Can Technology End Poverty?

Kentaro Toyama

http://fsi.stanford.edu/news/the_promise_of_information_and_communications_technology_20100505/
This is the lead article of a forum on the role of information and communication technology in global development.

A ten-year-old boy named Dhyaneshwar looked up for approval after carefully typing the word “Alaska” into a PC.

“Bahut acchaa!” I cheered—“very good.”

It was April, 2004, and I was visiting a “telecenter” in the tiny village of Retawadi, three hours from Mumbai. The small, dirt-floored room, lit only by an open aluminum doorway, was bare except for a desk, a chair, a PC, an inverter, and a large tractor battery, which powered the PC when grid electricity was unavailable. Outside, a humped cow chewed on dry stalks, and a goat bleated feebly.

As I encouraged the boy, I wondered about the tradeoff his parents had made in order to pay for a typing tutor. Their son was learning to write words he’d never use, in a language he didn’t speak. According to the telecenter’s owner, Dhyaneshwar’s parents paid a hundred rupees—about $2.20—a month for a couple hours of lessons each week. That may not sound like much, but in Retawadi, it’s twice as much as full-time tuition in a private school./.../

14 de novembro, Dia Mundial do Diabetes

Depois de ficar rosa, por causa da campanha para prevenção do câncer de mama (Outubro Rosa), o mês de novembro comemora o Dia Mundial do Diabetes, dia 14 de novembro. A data foi instituída pela Federação Internacional de Diabetes (IDF) e pela Organização Mundial da Saúde (OMS) desde 1991, e conta com o reconhecimento e apoio da Organização das Nações Unidas (ONU), que em dezembro de 2006 assinou uma Resolução reconhecendo o diabetes como uma doença crônica e de alto custo mundial.   Todos os anos a IDF e OMS estabelecem um tema que é adotado por todas as entidades filiadas e os serviços de saúde de todo o mundo. Desde 2007, a IDF lançou a ideia de iluminar de azul alguns monumentos de diversas cidades em todo mundo, que ficou conhecido como o Dia Azul. No portal da campanha do dia mundial www.worlddiabetesday.org , se encontra disponível vários materiais da campanha deste ano. A organização Pan-Americana da Saúde elaborou um cartaz em português com o tema proposto para 2010, que está disponível para download    Cartaz para o Dia Mundial do Diabetes em alta definição  (versão para impressão)

WW I : IMAGENS AÉREAS NO PÓS GUERRA

IMAGENS AÉREAS NO PÓS GUERRA.

http://tvuol.uol.com.br/permalink/?view/id=filme-inedito-mostra-estragos-da-1-guerra-04029A336CE4B173E6/mediaId=7769635/date=2010-11-09 

Cigarette Product Warning Labels

Proposed Cigarette Product Warning Labels

Overview
The Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) requires that cigarette packages and advertisements have larger and more visible graphic health warnings.

FDA issued a proposed rule, Required Warnings for Cigarette Packages and Advertisements, proposing to modify the required warnings that appear on cigarette packages and in cigarette advertisements.  These new required warnings would consist of nine new textual warning statements accompanied by color graphics depicting the negative health consequences of smoking. 

Timeline for Final Regulations The Tobacco Control Act requires FDA to issue final regulations requiring these color graphics by June 22, 2011.  It also specifies that the requirement for the new health warnings on cigarette packages and advertisements will take effect 15 months after issuance of this final rule. 

Proposed Graphic Health Warnings for Cigarette Packages and Advertisements  

WARNING:  Cigarettes are addictive.
WARNING:  Tobacco smoke can harm your children.
WARNING:  Cigarettes cause fatal lung disease.
WARNING:  Cigarettes cause cancer.
WARNING:  Cigarettes cause strokes and heart disease.
WARNING:  Smoking during pregnancy can harm your baby.
WARNING:  Smoking can kill you.
WARNING:  Tobacco smoke causes fatal lung disease in nonsmokers.
WARNING:  Quitting smoking now greatly reduces serious risks to your health.

High Resolution Image Formats

• PDF format (PDF 13 MB) The PDF contains a composite of all of the proposed images. If you do not already have Adobe Acrobat, you can download Acrobat Reader for free.
• JPEG format (6 MB) The zipped folder contains all of the compressed images. If you do not already have WinZip, you can download WinZip a file compression program.

Brasil é o 13º maior produtor de ciência do mundo

de acordo com Relatório Unesco

Publicada em 10/11/2010 às 15h13m

Catarina Alencastro

• R

BRASÍLIA - Pela primeira vez desde que foi publicado, o Relatório Unesco sobre Ciência dedica ao Brasil um capítulo inteiro. Para o representante da Unesco no Brasil, Vincent Defourny, o país "começa a existir" no mapa mundial da Ciência e Tecnologia. Em 2008, o Brasil investiu US$ 23 bilhões no setor, mais do que a Espanha e a Itália. O país também se tornou o 13º maior produtor de ciência do mundo, com 26.482 artigos científicos publicados, o que corresponde a 2,7% do total mundial.

O Brasil investe 1,1% de seu Produto Interno Bruto (PIB) em ciência e tecnologia. No entanto o relatório destaca a alta concentração desses recursos em São Paulo, onde se encontra 40% dos investimentos nacionais. Além disso, a fonte desses recursos é majoritariamente pública. Parte do governo 55% do dinheiro para o setor, característica comum entre os países em desenvolvimento, segundo a Unesco. O relatório lembra ainda que o presidente Luiz Inácio Lula da Silva deixou de cumprir a promessa feita em 2003, de aumentar os investimentos no setor para 2% do PIB./.../

UNESCO Monitors Worldwide Investment in Science

The UNESCO Science Report 2010 (USR) was launched on World Science Day on 10 November 2010. The report is a global overview of the main developments in scientific research, innovation and higher education since its predecessor was published in 2005. It blends facts and figures with an analysis of the major trends in global expenditure on research and development, scientific personnel and scientific publications.

Launch of UNESCO Science Report 2010

Metabolic Syndrome Linked to Calcium Deposits

By Ed Susman, Contributing Writer, MedPage Today Published: November 09, 2010 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 Action Points   Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Explain that a small study found that meeting criteria for the metabolic syndrome was independently associated with high coronary artery calcium scores. Note that coronary calcium scores are believed to predict subclinical atherosclerosis. LOS ANGELES -- People diagnosed with metabolic syndrome may be well on their way to heart disease, as reflected by a new study showing that these patients are apt to have significant subclinical coronary artery calcium deposits. After adjusting for diabetes, fasting blood sugar, systolic blood pressure, and use of cholesterol-lowering medications, people who fit the criteria for metabolic syndrome had an odds ratio of 2.13 (CI 1.02 to 4.43) (P<0.001) of falling in the highest quartile for coronary artery calcium scores. "We found that having the metabolic syndrome independently predicts subclinical atherosclerosis," Muddassir Mehmood, MD, chief resident for research at Wright State University, Dayton, Ohio, toldMedPage Today at his poster presentation during the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease here./.../

Brief Test May Aid Dementia Diagnosis

By Charles Bankhead, Staff Writer, MedPage Today Published: November 08, 2010 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco. Action Points   Explain to interested patients that a 16-item cognitive assessment tool demonstrated 99% sensitivity for diagnosing cognitive impairment in a 700-patient cohort with known cognitive status. Note that the test studied, known as the "Sweet 16," had a high correlation with the Mini-Mental State Examination and performed as well or better than the MMSE in several comparisons. A 16-item cognitive assessment tool demonstrated 99% sensitivity for diagnosing cognitive impairment in a 700-patient cohort with known cognitive status, investigators reported. The "Sweet 16" test had a high correlation with the Mini-Mental State Examination (MMSE) and performed as well or better than the MMSE in several comparisons. Developers plan to make the test freely available via the Internet. "We have successfully developed and validated a cognitive assessment instrument that is efficient and simple; requires no pen, paper, or other props to administer; and will be available open access," Tamara G. Fong, MD, PhD, of Harvard and Beth Israel Deaconess Medical Center in Boston, and co-authors wrote in an article published online in Archives of Internal Medicine./.../

What men should know before getting tested for prostate cancer

Let sleeping dogs lie? What men should know before getting tested for prostate cancer Simon Chapman, Alexandra Barratt and Martin Stockler Sydney University Press ISBN: 9781920899684 Few issues have been as divisive as prostate cancer screening. While some prominent Australian urologists are very active in talking up the importance of prostate cancer screening, few Australians would be aware that no government anywhere in the world has a formal policy supporting prostate cancer screening. Nor would they be aware that aside from some professional urological societies, no reputable cancer control or expert prevention agency anywhere in the world currently recommends screening for the disease. Despite this international expert consensus, de facto screening of populations is well under way, being driven by well-meaning advice about the importance of men becoming more informed about their health. Medical science is today unable to predict with any precision which early discovered prostate cancers will turn out to be those that kill, and particularly which will kill men in middle age. The frontline diagnostic tool in efforts to screen for prostate cancer - the PSA test - is a tool which has very poor ability to find problematic cancers. It finds many benign cancers which could have been left alone./.../

Acute Heart Failure Syndromes:

(Circulation. 2010;122:1975-1996.)
© 2010 American Heart Association, Inc. 

AHA Scientific Statement

Acute Heart Failure Syndromes: Emergency Department Presentation, Treatment, and Disposition: Current Approaches and Future Aims

A Scientific Statement From the American Heart Association

Neal L. Weintraub, MD, Chair; Sean P. Collins, MD, MSc, Co-Chair; Peter S. Pang, MD; Phillip D. Levy, MD, MPH;Allen S. Anderson, MD; Cynthia Arslanian-Engoren, PhD, RN, FAHA; W. Brian Gibler, MD, FAHA;James K. McCord, MD; Mark B. Parshall, PhD, RN; Gary S. Francis, MD, FAHA; Mihai Gheorghiade, MD;on behalf of the American Heart Association Council on Clinical Cardiology and Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation

Key Words: AHA Scientific Statements • acute care • diagnosis • emergency medicine • heart failure • outcomes • prognosis • treatment

	Introduction

With a prevalence of 5 800 000 (2% of the entire populace) in 2009 and an estimated yearly incidence of 550 000, the burden of heart failure (HF) in the United States is tremendous.¹ Although HF is largely a condition defined by chronic debility, virtually all patients experience, at some point, acute symptoms that trigger a visit to the emergency department (ED). These symptoms may vary in severity but, for the most part, they necessitate early intervention, often with intravenous medication and, less frequently, respiratory support. As shown by combined data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), this is a common occurrence; there are nearly 658 000 annual ED encounters primarily for acute HF in the United States—a figure that represents almost 20% of the total HF-specific ambulatory care delivered each year.^2/.../

Making community health information as useful as weather data

Making community health information as useful as weather data

Open health data from Health and Human Services is driving more than 20 new apps.

by Alex Howard | @digiphile | Comment |  2 June 2010

The chief technology office of Health and Human Services, Todd Park, is fond of using the National Ocean and Oceanographic Association (NOAA) as a metaphor for the innovation that may be unlocked through releasing public data. NOAA data underpins Weather.com and nearly every commercial meteorological service in the United States. Park has been working closely with other government officials and the technology community to put community healthcare data into a parallel role as a catalyst for innovation. In other words, HHS is creating a framework for government to act as a platform through the Community Health Data Initiative./.../

What the Bible Has to Say About Sex

By ALEXANDRA SILVER Sunday, Oct. 31, 2010

Editor of The New Oxford  Annotated Bible Michael Coogan recently applied his thorough knowledge of Scripture to a universal and eternally relevant topic: sex. In God and Sex: What the Bible Really Says, he discusses Advertising from marriage and prostitution to "fire" in God's own loins (yeah, you may want to reread the Book of Ezekiel). Coogan puts the Bible, which is often inconsistent on such hot topics, in perspective, and you may find yourself surprised by what the ancient texts have to say. 
(See 10 surprising facts about the world's oldest Bible.)/.../

Hospitals' new specialist: Social media manager

As Facebook, Twitter and other technologies become more pervasive, more hospitals are hiring staff members dedicated solely to social media -- and getting physicians to use these tools.

By BOB COOK, amednews staff. Posted Nov. 8, 2010.

• 
  

Dana Lewis, the interactive marketing specialist for Seattle's Swedish Medical Center, trains physicians in all aspects of social media.[Photo by Rick Dahms /www.rickdahms.com]

For otolaryngologist Douglas Backous, MD, Twitter and blogging were "like speaking a foreign language." So he went to his hospital and got himself a translator: Dana Lewis, hired by Seattle's Swedish Medical Center to handle all things social media.

Lewis is part of a trend in a new and growing type of hospital employment: the social media manager.

Technically, she's called the interactive marketing specialist. But she, and others like her, are being charged by their hospitals to handle such duties as overseeing their social media presence, communicating with patients through social media -- and, in many cases, teaching affiliated or employed physicians how to use social media. The idea is that by having a person dedicated to social media, the hospital can use the technology to strengthen its connections with all of what organizations like to call their stakeholders, which include the physicians who refer patients through their doors.

A Physician's Guide to Personal Health Program

This program provides background information and tools to help physicians support their personal efforts to live a healthier lifestyle and to change four key health behaviors: diet, physical activity, alcohol consumption and tobacco use. The toolkit describes the importance physicians play in fostering lifestyle change as role models to their patients, and explains how physicians can implement strategies to assess their own readiness to change and how to implement those changes. This brief toolkit is written for physicians by physicians, and yet the tools can apply to any busy professional. The toolkit provides a screening milestone document, action plans and progress tracking calendars.

To order, or for other questions or comments, please contactHealthier.LifeSteps@ama-assn.org.

The AMA Healthier Life Steps™ - A Physician's Guide to Personal Health materials can be reproduced or duplicated and distributed without charge for noncommercial purposes.  All copies must include the American Medical Association's copyright notice and contain no change in the content or format of the publication.  Any other uses require AMA's prior written consent.

Toolkit:

Action Plans & Health Screening Milestones

View Physician's Guide to Personal Health Toolkit introduction

Maintain wellness through the health screening milestones timeline

To begin your plan to make healthier lifestyle changes, choose from the following action plans:

• Healthy eating
• Increasing physical activity
• Reducing risky drinking
• Quitting smoking

Ethnicity: Insulin Resistance Risk

Ethnicity Related to Insulin Resistance Risk

By Ed Susman, Contributing Writer, MedPage Today Published: November 06, 2010 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco. Action Points   Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Explain to interested patients that although individuals of African-Caribbean and South Asian ethnicity are both more likely to exhibit insulin resistance than white Europeans, the African-Caribbeans appear to have a more protective lipid profile than the South Asians. LOS ANGELES -- Although individuals of African-Caribbean and South Asian ethnicity are both more likely to exhibit insulin resistance than white Europeans, the African-Caribbeans appear to have a more protective lipid profile than the South Asians, a researcher said here. The African-Caribbeans had fasting insulin levels of 84.1 pmol/L (11.7 μU/mL) higher than the white control population (65.3 pmol/L, 9.1 μU/mL) (P=0.02), reported Louise Goff, MD, of King's College London in a poster presentation here at the World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease. African-Caribbean individuals also had lower total cholesterol (4.7 mmol/L, 180.1 mg/dL) than whites (5.3 mmol/L, 203.8 mg/dL) (P=0.001) and decreased low density lipoprotein cholesterol (2.92 mmol/L, 113.0 mg/dL) than whites (3.15 mmol/L, 121.9 mg/dL) and decreased triglycerides (0.80 mmol/L, 70.7 mg/dL) compared with whites (1.30 mmol/L, 114.9 mg/dL) (P<0.001).

Cosmos: Carl Sagan

"The surface of the Earth is the shore of the cosmic ocean. On this shore, we've learned most of what we know. Recently, we've waded a little way out, maybe ankle-deep, and the water seems inviting. Some part of our being knows this is where we came from. We long to return, and we can, because the cosmos is also within us. We're made of star stuff. We are a way for the cosmos to know itself." – Excerpted from The Shores of the Cosmic Ocean, Carl Sagan, Cosmos, 1980

In honor of Carl Sagan's birthday on November 9th, NASA’s Kepler Mission and the SETI Institute invited the public to submit writings inspired by the imagery that he created for us in his allegory of The Shores of the Cosmic Ocean. Essays have been submitted; it is now time to enjoy them. Finalists will be published on this site up until Sagan Day. Winning essay will be announced November 9,

What will change everything?

Streaming Video-Click Here

"John Brockman has thrown the stone in the pond of the debate using the prophetic words of Danny Hillis, uttered in 1996: "Many people think that the Net is the Internet, but doing so will lose something. Because the Internet is a new breeding ground where they can grow many things, and the Net is only the first of these, potentially endless. The Network is an old media embedded in a new environment. " This new environment is not merely change the context of our lives but has re-created ourselves. A powerful and subtle revolution. The Internet has not only changed our daily lives and our habits: it has entered into our minds, changing our way of thinking. No one has voted for or against the introduction of printing, electricity, radio, telephone, the airplane. Nobody has ever expressed about the penicillin antibiotic, to space travel and even less on the personal computer. Nor about the Internet, mobile phones and sequencing the human genome. Yet today, in the environment of absolute interactivity, this may seem a paradox. Here, then, the question: what will happen in the near future? Will future decisions concerning technology be treated as if they will vitally important?John Brockman, Stewart Brand, and Clay Shirky will try to give an answer and move beyond the limits of our current horizon. Technology. But not only."