N-Acetylcysteine Does Not Prevent Contrast-Induced Nephropathy: "N-Acetylcysteine Does Not Prevent Contrast-Induced Nephropathy
(Recommended by the AMICOR Paulo Caramori [caramori.p@plugin.com.br])
NEW YORK (Reuters Health) Jun 03 - N-acetylcysteine administration does not reduce the likelihood of contrast-induced nephropathy (CIN) after cardiac catheterization in patients at low to moderate risk of developing the complication, a new study shows.
CIN is a fairly common complication of cardiac procedures, Dr. Paulo Caramori of the Hospital Sao Lucas-PUCRS in Porto Alegre, Brazil, and colleagues note, and while hydration and use of low osmolality contrast media have been shown to help prevent it, the exact mechanisms at work remain unclear.
Based on the hypothesis that such injury is due to renal vasoconstriction and free radical release, the researchers set out to determine whether N-acetylcysteine, which has both vasodilating and antioxidant properties, might help prevent it. Past studies have shown conflicting results.
The researchers randomized 156 patients undergoing coronary procedures and considered to be at risk of developing CIN to 600 mg of N-acetylcysteine orally twice daily for 2 days or placebo, beginning the day before the procedure.
Patients were scheduled for coronary angiography or percutaneous coronary intervention, and all either had serum creatinine of 106.08 micromole/L or greater, creatinine clearance below 50 mL/ min or diabetes mellitus. Ionic low osmolality contrast medium was used in all patients.
CIN, defined as an increase of 44.2 micromoles/L in creatinine over a 48-hour period, occurred in 10.4% of the patients given N-acetylcysteine and 10.1% of those given placebo, which was not a significant difference, the researchers found.
'On the basis of these findings, we believe that the use of N-acetylcysteine in preventing CIN in patients undergoing cardiac catheterization should not be encouraged,' the researchers conclude.
'The recommended measures for preventing CIN continue to be appropriate hydration and the use of a small volume of contrast in patients at low to moderate risk of CIN undergoing cardiac catheterization with a low osmolality contrast medium.'
Heart 2005;91:774-778."
Wednesday, June 15, 2005
The New Cholesterol Targets -- A Nursing Perspective
The New Cholesterol Targets -- A Nursing Perspective: "The New Cholesterol Targets: What Are They and What Are Their Practical Implications? -- A Nursing Perspective
Lynne T. Braun, PhD, RN, CNP
Recommended by Carlos Alberto Machado [carlos.a.machado@uol.com.br]
Even when hypercholesterolemia is identified and treated, many patients fail to meet their cholesterol target levels as defined by national guidelines. Most concerning is that less than 20% of high-risk patients (those with known CHD) meet their LDL-C goal... Ultimately, lowering LDL-C levels to well below currently recommended levels in these high-risk patients [to a target of 75 mg/dL instead of 100 mg/dL, using a high-dose 'second generation' statin] was shown to have clinical benefit with a relative risk reduction for cardiovascular and cerebrovascular events of 20% to 25%."
Lynne T. Braun, PhD, RN, CNP
Recommended by Carlos Alberto Machado [carlos.a.machado@uol.com.br]
Even when hypercholesterolemia is identified and treated, many patients fail to meet their cholesterol target levels as defined by national guidelines. Most concerning is that less than 20% of high-risk patients (those with known CHD) meet their LDL-C goal... Ultimately, lowering LDL-C levels to well below currently recommended levels in these high-risk patients [to a target of 75 mg/dL instead of 100 mg/dL, using a high-dose 'second generation' statin] was shown to have clinical benefit with a relative risk reduction for cardiovascular and cerebrovascular events of 20% to 25%."
IV Congresso de Insuficiência Cardíaca
IV Congresso de Insuficiência Cardíaca:
" MENSAGEM DO PRESIDENTE
O Grupo de Estudos de Insuficiência Cardíaca da Sociedade Brasileira de Cardiologia vem crescendo progressivamente desde a sua criação em 2001.
As atividades promovidas pelo GEIC, incluindo eventos científicos e desenvolvimento de diretrizes, têm proporcionado à comunidade de cardiologistas generalistas e a especialistas em insuficiência cardíaca meios de aprimorar conhecimentos na área, com o objetivo de qualificar a assistência aos pacientes e também estimular a produção intelectual de grupos com vocação científica.
O carro-chefe das nossas atividades é o Congresso Brasileiro de Insuficiência Cardíaca, com sua quarta edição em 2005.
Este evento vem ganhando prestígio pela qualificada e diversificada programação científica e tem contado com apoio da indústria farmacêutica e de produtos na área cardiológica, o que tem contribuído para sua continuada viabilização estreitando parcerias e possibilitando o convívio entre vários profissionais da área.
Contamos com a sua presença em Gramado no Hotel Serrano em 2005, colaborando para mais uma realização de sucesso para todos!
Dra. Nadine Clausell
Presidente do IV Congresso Brasileiro de Insuficiência Cardíaca
" MENSAGEM DO PRESIDENTE
O Grupo de Estudos de Insuficiência Cardíaca da Sociedade Brasileira de Cardiologia vem crescendo progressivamente desde a sua criação em 2001.
As atividades promovidas pelo GEIC, incluindo eventos científicos e desenvolvimento de diretrizes, têm proporcionado à comunidade de cardiologistas generalistas e a especialistas em insuficiência cardíaca meios de aprimorar conhecimentos na área, com o objetivo de qualificar a assistência aos pacientes e também estimular a produção intelectual de grupos com vocação científica.
O carro-chefe das nossas atividades é o Congresso Brasileiro de Insuficiência Cardíaca, com sua quarta edição em 2005.
Este evento vem ganhando prestígio pela qualificada e diversificada programação científica e tem contado com apoio da indústria farmacêutica e de produtos na área cardiológica, o que tem contribuído para sua continuada viabilização estreitando parcerias e possibilitando o convívio entre vários profissionais da área.
Contamos com a sua presença em Gramado no Hotel Serrano em 2005, colaborando para mais uma realização de sucesso para todos!
Dra. Nadine Clausell
Presidente do IV Congresso Brasileiro de Insuficiência Cardíaca
Tuesday, June 14, 2005
6th ICPC: Conferency Commentaries (more...)
De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Barbara Roberts
Enviada em: terça-feira, 14 de junho de 2005 09:19
Assunto: [ProCOR] Conference commentary: 6th ICPC
With as many as nine concurrent sessions on some days, it was impossible toattend all the talks we would have liked. While many presentations weredevoted to cardiovascular disease in women, there was still little mention
of the lack of evidence-based data on which to base treatment decisions inwomen. There was a session devoted to a "polypill" for prevention whichwould contain (among other drugs) a statin and aspirin - this despite the fact that statins have not been shown to lower women's event rates in thetwo primary prevention trials which included them and that aspirin hasrecently been shown not to protect healthy women underage 65 against heart attack.
developing countries and countries in economic transition, from rural populations in Iran to urban populations in Romania. Speaker after speaker discussed the social and economic factors which influence health behaviors and health systems. In this regard, the conference contributed to a change to my way of thinking about cardiovascular disease prevention. Just as the cholera, yellow fever and typhoid fever epidemics of prior centuries were not controlled until governments, from the community to the national level, instituted sewerage systems, safe water supplies and insect control programs, the current cardiovascular disease epidemic will also require governments at all levels to take a more active role. The cardiovascular disease epidemic will not be averted solely by appeals to people to lead healthier lifestyles. Government action will be required to rein in the tobacco and food industries and to provide safe environments so that people can incorporate exercise into their daily lives.
As Sylvie Stachenko pointed out in her excellent valedictory address, an aging population, technology, urbanization and globalization are powerful forces driving the chronic disease epidemic. To counter these, public health in the 21st century must move the prevention of chronic diseases from a global priority to a global reality. This will require changes in public policy that will no doubt be opposed by sectors in the food and tobacco
industries. She imparted a memorable quote from Bismarck: "Two things you should never watch being made: sausages and public policy." However, averting our gaze from public policy is not an option. Unless the medical
community can influence public policy in meaningful ways, the cardiovascular disease epidemic will overwhelm the scarce health care resources of the developing world and continue to rob their economies of people in their mostproductive years.
I welcome comments from our readers on how we, as medical professionals, can best interact with policy makers to ensure that choosing healthy diets and lifestyles becomes not only possible but easy for people whether they live in Boston or Isfahan.
Contributing Editor, Women's Heart Health, ProCOR
Director, The Women's Cardiac Center at The Miriam Hospital
Monday, June 13, 2005
Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee
Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association--Executive Summary: Endorsed by the Infectious Diseases Society of America -- Baddour et al. 111 (23): 3167 -- Circulation: "Background— Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness.
Methods and Results— This work represents the third iteration of an infective endocarditis 'treatment' document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This executive summary addresses the major points detailed in the larger document that contains more extensive background information and pertinent references. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen.
Conclusions— The recommendations outlined in this summary should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management."
Methods and Results— This work represents the third iteration of an infective endocarditis 'treatment' document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This executive summary addresses the major points detailed in the larger document that contains more extensive background information and pertinent references. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen.
Conclusions— The recommendations outlined in this summary should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management."
Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee
Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: Endorsed by the Infectious Diseases Society of America -- Baddour et al. 111 (23): e394 -- Circulation
Background— Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness.
Methods and Results— This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen.
Conclusions— The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.
Background— Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness.
Methods and Results— This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen.
Conclusions— The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.
Outcomes Research in Cardiovascular Disease -- Krumholz et al. 111 (23): 3158
Report of the National Heart, Lung, and Blood Institute Working Group on Outcomes Research in Cardiovascular Disease -- Krumholz et al. 111 (23): 3158 -- Circulation
The National Heart, Lung, and Blood Institute convened a working group on outcomes research in cardiovascular disease (CVD). The working group sought to provide guidance on research priorities in outcomes research related to CVD. For the purposes of this document, "outcomes research" is defined as investigative endeavors that generate knowledge to improve clinical decision making and healthcare delivery to optimize patient outcomes. The working group identified the following priority areas: (1) national surveillance projects for high-prevalence CV conditions; (2) patient-centered care; (3) translation of the best science into clinical practice; and (4) studies that place the cost of interventions in the context of their real-world effectiveness. Within each of these topics, the working group described examples of initiatives that could serve the Institute and the public. In addition, the group identified the following areas that are important to the field: (1) promotion of the use of existing data; (2) facilitation of collaborations with other federal agencies; (3) investigations into the basic science of outcomes research, with an emphasis on methodological advances; (4) strengthening of appropriate study sections with individuals who have expertise in outcomes research; and (5) expansion of opportunities to train new outcomes research investigators. The working group concluded that a dedicated investment in CV outcomes research could directly improve the care delivered in the United States.
The National Heart, Lung, and Blood Institute convened a working group on outcomes research in cardiovascular disease (CVD). The working group sought to provide guidance on research priorities in outcomes research related to CVD. For the purposes of this document, "outcomes research" is defined as investigative endeavors that generate knowledge to improve clinical decision making and healthcare delivery to optimize patient outcomes. The working group identified the following priority areas: (1) national surveillance projects for high-prevalence CV conditions; (2) patient-centered care; (3) translation of the best science into clinical practice; and (4) studies that place the cost of interventions in the context of their real-world effectiveness. Within each of these topics, the working group described examples of initiatives that could serve the Institute and the public. In addition, the group identified the following areas that are important to the field: (1) promotion of the use of existing data; (2) facilitation of collaborations with other federal agencies; (3) investigations into the basic science of outcomes research, with an emphasis on methodological advances; (4) strengthening of appropriate study sections with individuals who have expertise in outcomes research; and (5) expansion of opportunities to train new outcomes research investigators. The working group concluded that a dedicated investment in CV outcomes research could directly improve the care delivered in the United States.
Heart Drug Intended for One Race
The New York Times > Business > U.S. to Review Heart Drug Intended for One Race
By STEPHANIE SAUL (recommended by Maria Ines Reinert Azambuja)
In 1997, a new heart failure treatment called BiDil appeared dead on arrival. The Food and Drug Administration rejected the drug, saying that studies supporting it were inconclusive.
Then, proponents of BiDil refocused their strategy. This Thursday, eight years after the drug was rejected for use in the general public, an F.D.A. panel will consider whether BiDil should become the first drug intended for one racial group, in this case, African-Americans.
A study of 1,050 African-American heart failure patients showed that BiDil significantly reduced death and hospitalization, prompting the American Heart Association to call BiDil one of the top developments of 2004. BiDil increases levels of nitric oxide, which widens blood vessels.
The drug's maker, NitroMed Inc., says its decision to test and market BiDil as a drug for African-Americans is based on solid science. But BiDil's application has engendered controversy, with many scientists convinced that race is too broad and ill-defined a category to be relevant in determining a drug's approval, especially since geneticists have failed to identify a biological divide separating one race from another.
By STEPHANIE SAUL (recommended by Maria Ines Reinert Azambuja)
In 1997, a new heart failure treatment called BiDil appeared dead on arrival. The Food and Drug Administration rejected the drug, saying that studies supporting it were inconclusive.
Then, proponents of BiDil refocused their strategy. This Thursday, eight years after the drug was rejected for use in the general public, an F.D.A. panel will consider whether BiDil should become the first drug intended for one racial group, in this case, African-Americans.
A study of 1,050 African-American heart failure patients showed that BiDil significantly reduced death and hospitalization, prompting the American Heart Association to call BiDil one of the top developments of 2004. BiDil increases levels of nitric oxide, which widens blood vessels.
The drug's maker, NitroMed Inc., says its decision to test and market BiDil as a drug for African-Americans is based on solid science. But BiDil's application has engendered controversy, with many scientists convinced that race is too broad and ill-defined a category to be relevant in determining a drug's approval, especially since geneticists have failed to identify a biological divide separating one race from another.
Sunday, June 12, 2005
Effect of Treatment of Gestational Diabetes Mellitus
NEJMoa042973v1.pdf (application/pdf Object)
Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy outcomes
Caroline A. Crowther, et al.
The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P<0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women’s mood and quality of
life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group.
conclusions Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman’s health-related quality of life.
Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy outcomes
Caroline A. Crowther, et al.
The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P<0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women’s mood and quality of
life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group.
conclusions Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman’s health-related quality of life.
Gestational Diabetes Mellitus — Time to Treat
NEJMe058100v1.pdf (application/pdf Object)
Gestational Diabetes Mellitus — Time to Treat
Michael F. Greene, M.D., and Caren G. Solomon, M.D., M.P.H.
Gestational diabetes mellitus, broadly defined as carbohydrate intolerance beginning or first recognized during pregnancy, was originally described
decades ago and has since been the subject of extensive research. Yet the most recent guidelines of the U.S. Preventive Services Task Force, noting the absence of data to establish a clear link between screening and improved outcomes of affected pregnancies, concluded that “the evidence is insufficient to recommend for or against routine screening for gestational diabetes.”
The American College of Obstetricians and Gynecologists officially recommends screening for and treatment of gestational diabetes but acknowledges that these recommendations are based on “limited or inconsistent scientific evidence.”
Gestational Diabetes Mellitus — Time to Treat
Michael F. Greene, M.D., and Caren G. Solomon, M.D., M.P.H.
Gestational diabetes mellitus, broadly defined as carbohydrate intolerance beginning or first recognized during pregnancy, was originally described
decades ago and has since been the subject of extensive research. Yet the most recent guidelines of the U.S. Preventive Services Task Force, noting the absence of data to establish a clear link between screening and improved outcomes of affected pregnancies, concluded that “the evidence is insufficient to recommend for or against routine screening for gestational diabetes.”
The American College of Obstetricians and Gynecologists officially recommends screening for and treatment of gestational diabetes but acknowledges that these recommendations are based on “limited or inconsistent scientific evidence.”
Thursday, June 09, 2005
Sociedad Sudamericana de Cardiologia
Sociedad Sudamericana de Cardiologia
Dear coleagues of the South-American Society of Cardiology
It is indeed a great pleasure to see the startup of our SSC home page www.sscardio.org .
I believe it will become an important tool for our better knowledge of our potential and difficulties and , thus, enable us to adjust better to the reality that surround us and in this way , to further enhance our development and opportunities in the field of our professional realms, the practice of Cardiology, to better serve our people, all with our own southamerican stile.
We were built in the midst of a more recent struggle to discover realities of a new world than most part of the remainder world.
These 500 years, nevertheless, are enough for us to have a History that portray us as good honest, progressive, good-natured people, doted with a clear humanitarian notion of the Universe, which leads to understanding, compassion and an in tense energy to achieve our dreams.
This is a reality that makes us proud and clearly full of attributes that are well aligned with those of the profession we are involved with, the Medical profession, and, in this particular regard, as cardiologists.
Therefore lets get it to work!
This homepage has the aim of becoming evermore a place for communication among the distinct Societies that comprise our South-American Society of Cardiology (SSC), and shall be a commonplace for Scientific and Cultural manifestations of all.
For that purpose a window is being prepared for a biweekly publication, under the responsibility of each society, in an alphabetical order, for articles on scientific or societal subjects that they wish to bring to everyone’s attention.
It has been appointed to the Argentinian Society of Cardiology the task of initiating the publications which they did by sending us an interesting article by Drs. Carlos D. Tajer and Hernán C. Doval, on the controversy of Coxibs.
Subsequently we will have themes coming from Bolivia, Brazil, Chile, Colombia, Equator, Paraguay, Peru, Uruguay and Venezuela. According to previous agreements and a calendar already distributed.
In the beginning the homepage will present windows written in Portuguese, but shortly they will be available also in Spanish.
The article can be in Spanish or Portuguese although it would be desirable, considering the current globalization of the scientific world, whenever possible, to have it also translated to the English which will enable us to have in the future a place in the indexation agencies.
Besides this homepage will be make it possible a concection with each Society and thus facilitate communication among the for announcement of their activities.
It would be highly desirable by the same token to have also the homepage of SSC in the homepage of each society.
The SSC homepage will be an editorial responsibility of the President of the Society and will be hosted by his corresponding national society, till the end of his tenure when it will move on to the next president.
A propos I shall thank heartfully to the support that has been provided to this endeavor by the Brazilian Society of Cardiology, under the leadership of Dr. Antonio Felipe Simão and the most efficacious technical support derived from the informatics session of the aforementioned society under the personal supervision of Mr. Orlando Castro, who has been giving invaluable help for this purpose.
Suggestions are quite welcome!
Sincerely yours,
Dr. Gilson S. Feitosa
President of the South-American Society of Cardiology
Dear coleagues of the South-American Society of Cardiology
It is indeed a great pleasure to see the startup of our SSC home page www.sscardio.org .
I believe it will become an important tool for our better knowledge of our potential and difficulties and , thus, enable us to adjust better to the reality that surround us and in this way , to further enhance our development and opportunities in the field of our professional realms, the practice of Cardiology, to better serve our people, all with our own southamerican stile.
We were built in the midst of a more recent struggle to discover realities of a new world than most part of the remainder world.
These 500 years, nevertheless, are enough for us to have a History that portray us as good honest, progressive, good-natured people, doted with a clear humanitarian notion of the Universe, which leads to understanding, compassion and an in tense energy to achieve our dreams.
This is a reality that makes us proud and clearly full of attributes that are well aligned with those of the profession we are involved with, the Medical profession, and, in this particular regard, as cardiologists.
Therefore lets get it to work!
This homepage has the aim of becoming evermore a place for communication among the distinct Societies that comprise our South-American Society of Cardiology (SSC), and shall be a commonplace for Scientific and Cultural manifestations of all.
For that purpose a window is being prepared for a biweekly publication, under the responsibility of each society, in an alphabetical order, for articles on scientific or societal subjects that they wish to bring to everyone’s attention.
It has been appointed to the Argentinian Society of Cardiology the task of initiating the publications which they did by sending us an interesting article by Drs. Carlos D. Tajer and Hernán C. Doval, on the controversy of Coxibs.
Subsequently we will have themes coming from Bolivia, Brazil, Chile, Colombia, Equator, Paraguay, Peru, Uruguay and Venezuela. According to previous agreements and a calendar already distributed.
In the beginning the homepage will present windows written in Portuguese, but shortly they will be available also in Spanish.
The article can be in Spanish or Portuguese although it would be desirable, considering the current globalization of the scientific world, whenever possible, to have it also translated to the English which will enable us to have in the future a place in the indexation agencies.
Besides this homepage will be make it possible a concection with each Society and thus facilitate communication among the for announcement of their activities.
It would be highly desirable by the same token to have also the homepage of SSC in the homepage of each society.
The SSC homepage will be an editorial responsibility of the President of the Society and will be hosted by his corresponding national society, till the end of his tenure when it will move on to the next president.
A propos I shall thank heartfully to the support that has been provided to this endeavor by the Brazilian Society of Cardiology, under the leadership of Dr. Antonio Felipe Simão and the most efficacious technical support derived from the informatics session of the aforementioned society under the personal supervision of Mr. Orlando Castro, who has been giving invaluable help for this purpose.
Suggestions are quite welcome!
Sincerely yours,
Dr. Gilson S. Feitosa
President of the South-American Society of Cardiology
Tuesday, June 07, 2005
Age, Cohort and Period Effects in the Mortality by Ischemic Heart Diseases and Ill-Defined Causes of Death
art01.pdf (application/pdf Object)
Gláucia Maria Moraes de Oliveira, Carlos Henrique Klein, Nelson Albuquerque de Souza e Silva. Todos os autores são membros da lista AMICOR e Dra. Gláucia é editora da Revista da SOCERJ
Objective: To analyze the mortality due to ischemic heart diseases (IHD) and ill-defined causes (IDC) in the Brazilian states of Rio de Janeiro (RJ), São Paulo (SP), and Rio Grande do Sul (RS) Brazil, according to the age-cohort-period model, in 1980, 1990, and 2000.
Methods: Mortality due to IHD and IDC from 8 birth cohorts, 1901-10, 1911-20, 1921-30, 1931-40, 1941-50, 1951-60, 1961-80 and 1971-80, were estimated for 6 age groups (20- 29; 30-39; 40-49; 50 -59; 60 -69; 70-79 years), in 1980, 1990 and 2000, in RJ, SP, and RS for both sexes.
The annual deaths data were collected from DATASUS, while the population data were collected from IBGE. The HD mortality was balanced for the ill-defined deaths.
Results: Mortality due to IHD was higher in RJ for both sexes in 1980 and 1990 except for the 70-79 women’s age group. In the year of 2000 the IHD
mortality was also higher in RJ for the male 20-29 and 40-49 age groups and in nearly all female age groups. It has decreased in all Brazilian states for the 30-79 age groups in the past few years. The age effect on IHD and IDC mortality was present in all Brazilian states and age groups. The cohort effect on IHD mortality rates was observed in SP and RS for both sexes from the 30-39 age group with lower magnitude in RJ. The period effect occurred in RJ with a decline in mortality due to IHD in 2000, and with an increase due to IDC in 1990 and 2000, and in RS there was a drop in both
mortality rates.
Conclusions: In RJ mortality due to IHD apparently dropped while mortality due to IDC increased sharply in 2000; however, in RS mortality due to IHD and IDC declined in 1990 and 2000. Hypotheses was raised to explain these findings. Efeitos de Idade, Geração e Período na Mortalidade por
Doenças Isquêmicas do Coração e por Causas Mal Definidas nos Estados do Rio de Janeiro, São Paulo e Rio Grande do Sul nos Anos de 1980, 1990 e 2000 - Brasil Age, Cohort and Period Effects in the Mortality by Ischemic Heart Diseases and Ill-Defined Causes of Death in the States of Rio de Janeiro, São Paulo, and Rio Grande do Sul In 1980, 1990, and 2000 - Brazil
Gláucia Maria Moraes de Oliveira, Carlos Henrique Klein, Nelson Albuquerque de Souza e Silva. Todos os autores são membros da lista AMICOR e Dra. Gláucia é editora da Revista da SOCERJ
Objective: To analyze the mortality due to ischemic heart diseases (IHD) and ill-defined causes (IDC) in the Brazilian states of Rio de Janeiro (RJ), São Paulo (SP), and Rio Grande do Sul (RS) Brazil, according to the age-cohort-period model, in 1980, 1990, and 2000.
Methods: Mortality due to IHD and IDC from 8 birth cohorts, 1901-10, 1911-20, 1921-30, 1931-40, 1941-50, 1951-60, 1961-80 and 1971-80, were estimated for 6 age groups (20- 29; 30-39; 40-49; 50 -59; 60 -69; 70-79 years), in 1980, 1990 and 2000, in RJ, SP, and RS for both sexes.
The annual deaths data were collected from DATASUS, while the population data were collected from IBGE. The HD mortality was balanced for the ill-defined deaths.
Results: Mortality due to IHD was higher in RJ for both sexes in 1980 and 1990 except for the 70-79 women’s age group. In the year of 2000 the IHD
mortality was also higher in RJ for the male 20-29 and 40-49 age groups and in nearly all female age groups. It has decreased in all Brazilian states for the 30-79 age groups in the past few years. The age effect on IHD and IDC mortality was present in all Brazilian states and age groups. The cohort effect on IHD mortality rates was observed in SP and RS for both sexes from the 30-39 age group with lower magnitude in RJ. The period effect occurred in RJ with a decline in mortality due to IHD in 2000, and with an increase due to IDC in 1990 and 2000, and in RS there was a drop in both
mortality rates.
Conclusions: In RJ mortality due to IHD apparently dropped while mortality due to IDC increased sharply in 2000; however, in RS mortality due to IHD and IDC declined in 1990 and 2000. Hypotheses was raised to explain these findings. Efeitos de Idade, Geração e Período na Mortalidade por
Doenças Isquêmicas do Coração e por Causas Mal Definidas nos Estados do Rio de Janeiro, São Paulo e Rio Grande do Sul nos Anos de 1980, 1990 e 2000 - Brasil Age, Cohort and Period Effects in the Mortality by Ischemic Heart Diseases and Ill-Defined Causes of Death in the States of Rio de Janeiro, São Paulo, and Rio Grande do Sul In 1980, 1990, and 2000 - Brazil
Ischemic Heart Diseases, Cerebrovascular Diseases and Ill Defined Causes of Death
art01.pdf (application/pdf Object)
Ischemic Heart Diseases, Cerebrovascular Diseases and Ill Defined Causes of Death
in Health Districts of Rio de Janeiro State from 1980 to 2000 - Brazil
Gláucia Maria Moraes de Oliveira, Carlos Henrique Klein, Nelson Albuquerque de Souza e Silva. Todos os autores fazem parte da lista AMICOR e Dra. Gláucia é a editora da Revista da SOCERJ
Objective: To analyze trends in mortality due to Ischemic Heart Diseases (IHD), Cerebrovascular Diseases (CRVD) and Ill Defined Causes (IDC) of death in adults from regions within the State of Rio de Janeiro, RJ, Brazil, between 1980 and 2000.
Methods: Death data were obtained from DATASUS/MS and population data were obtained from IBGE. Ten regions were then defined: Cinturão Metropolitano (Metropolitan area), City of Rio de Janeiro, Niterói, Médio-Paraíba, Serrana (Mountain), Norte (North), Baixada Litorânea (Coastal lowland), Noroeste (Northwest), Centro-Sul (Southeast) e Baía da Ilha Grande (Ilha Grande Bay). Rates of mortality caused by IDC, IHD, and CRVD were adjusted according to gender and age through the direct method. Standards were based on the Rio de Janeiro population aged 20 or over in the 2000 Census. Due to a considerable increase in IDC mortality rates in RJ from 1990 on, a compensation maneuver was effected. Trends were analyzed by linear regression models.
Results: A steady decline in compensated and adjusted CRVD mortality rates was observed in all regions (medium annual decline of 2,9% in Rio de Janeiro) from 1980 on, while the decline of IHD mortality was remarkable from the 1990s on in almost all regions with a simultaneous increase in
IDC mortality in the Metropolitan area.
Conclusions: CRVD trends prevailed in all regions except in Niterói and in the City of Rio de Janeiro. Annual CRVD trends were higher than IHD trends in all regions.
Ischemic Heart Diseases, Cerebrovascular Diseases and Ill Defined Causes of Death
in Health Districts of Rio de Janeiro State from 1980 to 2000 - Brazil
Gláucia Maria Moraes de Oliveira, Carlos Henrique Klein, Nelson Albuquerque de Souza e Silva. Todos os autores fazem parte da lista AMICOR e Dra. Gláucia é a editora da Revista da SOCERJ
Objective: To analyze trends in mortality due to Ischemic Heart Diseases (IHD), Cerebrovascular Diseases (CRVD) and Ill Defined Causes (IDC) of death in adults from regions within the State of Rio de Janeiro, RJ, Brazil, between 1980 and 2000.
Methods: Death data were obtained from DATASUS/MS and population data were obtained from IBGE. Ten regions were then defined: Cinturão Metropolitano (Metropolitan area), City of Rio de Janeiro, Niterói, Médio-Paraíba, Serrana (Mountain), Norte (North), Baixada Litorânea (Coastal lowland), Noroeste (Northwest), Centro-Sul (Southeast) e Baía da Ilha Grande (Ilha Grande Bay). Rates of mortality caused by IDC, IHD, and CRVD were adjusted according to gender and age through the direct method. Standards were based on the Rio de Janeiro population aged 20 or over in the 2000 Census. Due to a considerable increase in IDC mortality rates in RJ from 1990 on, a compensation maneuver was effected. Trends were analyzed by linear regression models.
Results: A steady decline in compensated and adjusted CRVD mortality rates was observed in all regions (medium annual decline of 2,9% in Rio de Janeiro) from 1980 on, while the decline of IHD mortality was remarkable from the 1990s on in almost all regions with a simultaneous increase in
IDC mortality in the Metropolitan area.
Conclusions: CRVD trends prevailed in all regions except in Niterói and in the City of Rio de Janeiro. Annual CRVD trends were higher than IHD trends in all regions.
Monday, June 06, 2005
Recommendations of the National Heart, Lung, and Blood Institute Working Group on Future Direction in Cardiac Surgery -- Baumgartner et al. 111 (22):
Recommendations of the National Heart, Lung, and Blood Institute Working Group on Future Direction in Cardiac Surgery -- Baumgartner et al. 111 (22): 3007 -- Circulation: "Recommendations of the National Heart, Lung, and Blood Institute Working Group on Future Direction in Cardiac Surgery
William A. Baumgartner, MD; Stephanie Burrows, PhD; Pedro J. del Nido, MD; Timothy J. Gardner, MD; Suzanne Goldberg, RN, MSN; Robert C. Gorman, MD; George V. Letsou, MD; Alice Mascette, MD; Robert E. Michler, MD; John D. Puskas, MD; Eric A. Rose, MD; Todd K. Rosengart, MD; Frank W. Sellke, MD; Sara J. Shumway, MD; Norbert Wilke, MD
From the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
Correspondence to William A. Baumgartner, MD, Vincent L. Gott Professor of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe St, Blalock 618, Baltimore, MD 21287-4618. E-mail wbaumgar@csurg.jhmi.jhu.edu
Received December 16, 2004; revision received February 15, 2005; accepted March 2, 2005.
New surgical procedures, imaging modalities, and medical devices have improved therapy for many patients and made treatment possible for others who have had few options in the past. In February 2004, the National Heart, Lung, and Blood Institute’s (NHLBI) Advisory Council proposed that the institute evaluate the status and future directions in cardiac surgery. In response to this recommendation, the NHLBI convened a working group of cardiac surgeons on May 7 and 8, 2004, to assess the state of cardiac surgery research, identify critical gaps in current knowledge, determine areas of opportunity, and obtain specific recommendations for future research activities. The working group discussed surgical revascularization, novel surgical approaches, valvular research directions, biotechnology and cell-based therapy, heart failure, imaging modalities, and barriers to clinical research and presents its recommendations here.
"
William A. Baumgartner, MD; Stephanie Burrows, PhD; Pedro J. del Nido, MD; Timothy J. Gardner, MD; Suzanne Goldberg, RN, MSN; Robert C. Gorman, MD; George V. Letsou, MD; Alice Mascette, MD; Robert E. Michler, MD; John D. Puskas, MD; Eric A. Rose, MD; Todd K. Rosengart, MD; Frank W. Sellke, MD; Sara J. Shumway, MD; Norbert Wilke, MD
From the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
Correspondence to William A. Baumgartner, MD, Vincent L. Gott Professor of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe St, Blalock 618, Baltimore, MD 21287-4618. E-mail wbaumgar@csurg.jhmi.jhu.edu
Received December 16, 2004; revision received February 15, 2005; accepted March 2, 2005.
New surgical procedures, imaging modalities, and medical devices have improved therapy for many patients and made treatment possible for others who have had few options in the past. In February 2004, the National Heart, Lung, and Blood Institute’s (NHLBI) Advisory Council proposed that the institute evaluate the status and future directions in cardiac surgery. In response to this recommendation, the NHLBI convened a working group of cardiac surgeons on May 7 and 8, 2004, to assess the state of cardiac surgery research, identify critical gaps in current knowledge, determine areas of opportunity, and obtain specific recommendations for future research activities. The working group discussed surgical revascularization, novel surgical approaches, valvular research directions, biotechnology and cell-based therapy, heart failure, imaging modalities, and barriers to clinical research and presents its recommendations here.
"
Saturday, June 04, 2005
Epidemiological modelling of routine use of low dose aspirin for the primary prevention of coronary heart disease and stroke in those aged >=70
Epidemiological modelling of routine use of low dose aspirin for the primary prevention of coronary heart disease and stroke in those aged >=70 -- Nelson et al. 330 (7503): 1306 -- BMJ:
"Results The proportional benefit gained from the use of low dose aspirin by the prevention of myocardial infarctions (-389 in men, -321 in women) and ischaemic stroke (-19 in men and -35 in women) is offset by excess gastrointestinal (499 in men, 572 in women) and intracranial (76 in men, 54 in women) bleeding. The results in health adjusted years of life lived (which take into account length and quality of life) are equivocal for aspirin causing net harm or net benefit.
Conclusion Epidemiological modelling suggests that any benefits of low dose aspirin on risk of cardiovascular disease in people aged ≥ 70 are offset by adverse events. These findings are tempered by wide confidence intervals, indicating that the overall outcome could be beneficial or adverse."
"Results The proportional benefit gained from the use of low dose aspirin by the prevention of myocardial infarctions (-389 in men, -321 in women) and ischaemic stroke (-19 in men and -35 in women) is offset by excess gastrointestinal (499 in men, 572 in women) and intracranial (76 in men, 54 in women) bleeding. The results in health adjusted years of life lived (which take into account length and quality of life) are equivocal for aspirin causing net harm or net benefit.
Conclusion Epidemiological modelling suggests that any benefits of low dose aspirin on risk of cardiovascular disease in people aged ≥ 70 are offset by adverse events. These findings are tempered by wide confidence intervals, indicating that the overall outcome could be beneficial or adverse."
Epidemiological transition and the study of burden of disease in Brazil
Destaque102.pdf (application/pdf Object)
(Sent by Maria Inês Reinart Azambuja)
Joyce Mendes de Andrade Schramm, Andreia Ferreira de Oliveira, Iúri da Costa Leite, Joaquim Gonçalves Valente, Ângela Maria Jourdan Gadelha,
Margareth Crisóstomo Portela, Mônica Rodrigues Campos.
Abstract In Brazil, the epidemiological transition has not followed the model experienced by most developed countries. There is coexistence of old and new health problems, where despite the predominance of the chronical and degenerative diseases, the communicable ones still play an important role. In this study the differentials in relation to the epidemiological pattern are described not only for the country as a whole, but also for its major regions, using the Disability Adjusted Life Years (DALY), the health indicator of the studies of burden of disease. Amongst the main results found we stand out that the group of chronical and degenerative diseases is responsible for 66,3% of the national burden of disease; 23,5% are responded by the communicable diseases, perinatal and maternal conditions and nutritional deficiencies; and 10,2% is due to the injuries. The use of DALY permits the identification of health priorities based on the epidemiological profile, making easier the process of decision make and the use of resources by the managers.
Key words Epidemiological transition, Burden of disease, DALY, Non-communicable diseases Resumo No Brasil, a transição epidemiológica não tem ocorrido de acordo com o modelo experimentado pela maioria dos países desenvolvidos. Velhos e novos problemas em saúde coexistem, com predominância das doenças crônico-degenerativas, embora as doenças transmissíveis ainda desempenhem um papel importante. Neste estudo,
os diferenciais, em relação ao padrão epidemiológico, são descritos para o Brasil e grandes regiões, para o indicador de saúde dos estudos da carga de doença, o DALY. Entre os principais resultados encontrados, para o Brasil, destaca-se que o grupo das doenças não-transmissíveis, Infecciosas/parasitárias/maternas/perinatais/ nutricionais, e das causas externas representaram, respectivamente, 66,3%, 23,5% e 10,2% da carga total de doença estimada. A utilização do indicador DALY propicia a identificação de prioridades em função do perfil epidemiológico, facilitando a tomada de decisões e destinação adequada de recursos por parte dos gestores. Palavras-chave Transição epidemiológica, Carga de doença, DALY, Doenças não-transmissíveis
(Sent by Maria Inês Reinart Azambuja)
Joyce Mendes de Andrade Schramm, Andreia Ferreira de Oliveira, Iúri da Costa Leite, Joaquim Gonçalves Valente, Ângela Maria Jourdan Gadelha,
Margareth Crisóstomo Portela, Mônica Rodrigues Campos.
Abstract In Brazil, the epidemiological transition has not followed the model experienced by most developed countries. There is coexistence of old and new health problems, where despite the predominance of the chronical and degenerative diseases, the communicable ones still play an important role. In this study the differentials in relation to the epidemiological pattern are described not only for the country as a whole, but also for its major regions, using the Disability Adjusted Life Years (DALY), the health indicator of the studies of burden of disease. Amongst the main results found we stand out that the group of chronical and degenerative diseases is responsible for 66,3% of the national burden of disease; 23,5% are responded by the communicable diseases, perinatal and maternal conditions and nutritional deficiencies; and 10,2% is due to the injuries. The use of DALY permits the identification of health priorities based on the epidemiological profile, making easier the process of decision make and the use of resources by the managers.
Key words Epidemiological transition, Burden of disease, DALY, Non-communicable diseases Resumo No Brasil, a transição epidemiológica não tem ocorrido de acordo com o modelo experimentado pela maioria dos países desenvolvidos. Velhos e novos problemas em saúde coexistem, com predominância das doenças crônico-degenerativas, embora as doenças transmissíveis ainda desempenhem um papel importante. Neste estudo,
os diferenciais, em relação ao padrão epidemiológico, são descritos para o Brasil e grandes regiões, para o indicador de saúde dos estudos da carga de doença, o DALY. Entre os principais resultados encontrados, para o Brasil, destaca-se que o grupo das doenças não-transmissíveis, Infecciosas/parasitárias/maternas/perinatais/ nutricionais, e das causas externas representaram, respectivamente, 66,3%, 23,5% e 10,2% da carga total de doença estimada. A utilização do indicador DALY propicia a identificação de prioridades em função do perfil epidemiológico, facilitando a tomada de decisões e destinação adequada de recursos por parte dos gestores. Palavras-chave Transição epidemiológica, Carga de doença, DALY, Doenças não-transmissíveis
[ProCOR] Case for Prevention: Porto Alegre, Brazil
De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: quarta-feira, 1 de junho de 2005 09:38
Para: procor@healthnet.org
Assunto: [ProCOR] Case for Prevention: Porto Alegre, Brazil
________________
Nurses and nutritionists, epidemiologists and neurologists, cardiologists and communicators, primary care physicians and public health professionals, government officials and staff of NGOs, recently convened in Porto Alegre, Brazil, to discuss the city's model of CVD prevention and control. The participants represented a microcosm of the sectors of society that contribute to health. In Porto Alegre, multi-sectoral partnerships bring together diverse groups to promote health in multidisciplinary ways and on multiple levels.
National policy, community interventions, and medical care-family medicine, primary care, specialists, and emergency-are working together to develop a range of innovative programs that serve the poorest pockets of Porto Alegre and the richest.
* On an outlying island, programs to provide water treatment, sewage disposal, and electricity accompany a family medicine clinic's services, which include home visits to each resident by a trained member of the clinic staff.
* The hospital is building its new laundry facility in a poor area of the city. Although the facility is several miles away from the hospital, the location was chosen because it will create more than 300 jobs for nearby residents and the hospital realizes that health benefits will follow when more employment is available.
* A 24-hour emergency clinic recently was established in an empty building in an area of Porto Alegre that experiences a high incidence of violence and injuries. The Institute of Education and Prevention has developed a one-year program for individuals planning to enter medical school which includes an orientation to community health and a patient-focused approach to their future profession.
* Primary care, dental care, and a wellness clinic are available in a hospital branch located in an upscale shopping, increasing ease of access to preventive services by including health care among residents' everyday errands.
I was struck by the balance I saw at Hospital Moinhos de Vento between their successful strategy of creating a "hotel" atmosphere in their private hospital facility and their success in providing the same level of care at the public hospital. Many cardiologists with whom I spoke emphasized the importance of balancing an emphasis on the use of clinical skills and multi-disciplinary medical management of cardiovascular disease while incorporating the latest technology in appropriate ways. The "rush to refer" that is overtaking much of American medicine did not seem to dominate the model of care described at Hospital Moinhos de Vento. One physician asked, "Why should we prescribe the latest, more effective, most marketed drug when older medications work better, are cheaper, and have a longer track record." Another physician said, "We need to recognize the important role of non-physicians. And we need to learn in new areas that were not part of our training, like how to counsel a patient on physician activity or nutrition." While the philosophy and vision at this hospital is not representative of all medical institutions in the region or the country, I was told that it is not the only Brazilian example of successful
integration of clinical care and community, of technology and the "art of healing."
Prior to the conference, on May 17, I celebrated the 8th anniversary of AMICOR with Dr. Achutti and his wife, Dr. Valderes Robinson, also a cardiologist. Dr.Achutti founded AMICOR in 1997 to establish a network of cardiologists, physicians, and health workers from Brazil, Latin America, and other countries.
Daily he links them to locally relevant information from Latin American and international sources. Information is presented in Portuguese, Spanish, or English. Dr. Achutti is currently exploring the potential of blogs to transfer
information among networks and he maintains an extensive email distribution list. ProCOR and AMICOR are part of an increasingly linked "network of networks" around the globe, in which interpersonal, institutional, regional, national, and global networks intersect with each other at common points of interest to proliferate the sharing of knowledge and connections among people.
Thank you to the many Brazilian colleagues who made me feel welcome, patiently explained what was unfamiliar and enthusiastically explored what was possible. I especially thank Dr. Achutti for his faith in all kinds of connections and his ability to make them happen.
_____________________________________________________________________
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Thursday, June 02, 2005
Cholesterol-lowering effects of rosuvastatin compared with atorvastatin in patients with type 2 diabetes - CORALL study
Cholesterol-lowering effects of rosuvastatin compared with atorvastatin in patients with type 2 diabetes - CORALL study
Wolffenbuttel BH, Franken AA, Vincent HH; THE DUTCH CORALL STUDY GROUP.
University Medical Centre, Groningen, the Netherlands.
Abstract. Wolffenbuttel BHR, Franken AAM, Vincent HH on behalf of the Dutch CORALL Study Group (University Medical Centre, Groningen; Isala Clinics, Zwolle; and Antonius Hospital, Nieuwegein, the Netherlands). Cholesterol-lowering effects of rosuvastatin compared with atorvastatin in patients with type 2 diabetes - CORALL study. J Intern Med 2005; 257: 531-539.Objectives. To compare the efficacy of the newest cholesterol-lowering drug, rosuvastatin (RSV) with atorvastatin (ATV) in subjects with type 2 diabetes. Design. A 24-week, open-label, randomized, parallel-group, phase IIIb, multicentre study. Setting. Diabetes outpatient clinics of 26 hospitals in the Netherlands. Subjects. A total of 263 patients with type 2 diabetes treated with oral agents or insulin, age (mean +/- SD) 60 +/- 10 years, body mass index (BMI) 31.4 +/- 6.1 kg m(-2), 46% males. Intervention. After a 6-week dietary lead-in period, patients were randomized to RSV (n = 131) or ATV (n = 132) treatment in a dose escalation scheme (RSV: 10, 20 and 40 mg or ATV: 20, 40 and 80 mg for 6 weeks each sequentially). Main outcome measures. Primary outcome was the change in apolipoprotein B (apoB) and apoB/apolipoprotein A1 (apoA1) ratio, which has been suggested a better predictor for cardiovascular events than total (TC) or low-density lipoprotein cholesterol (LDL-C). Secondary outcomes were the changes in other lipid parameters. Results. Baseline LDL-C in the RSV and ATV groups was 4.23 +/- 0.98 mmol L(-1) and 4.43 +/-0.99 mmol L(-1), whilst apoB/apoA1 was 0.86 +/-0.22 and 0.92 +/- 0.35, respectively. A greater reduction in apoB/apoA1 was seen with RSV (-34.9%, -39.2% and -40.5%) than with ATV (-32.4%, -34.7% and -35.8%, P < 0.05 at weeks 12 and 18). Significantly greater reductions in LDL-C were also seen with RSV (-45.9%, -50.6% and -53.6%) than with ATV (-41.3%, -45.6% and -47.8%, all P < 0.05). The American Diabetes Association (ADA) LDL-C goal of <2.6 mmol L(-1) was reached by 82%, 84% and 92% of patients with RSV and 74%, 79% and 81% with ATV. Triglyceride reductions ranged from 16 to 24% and were not different between treatments. Both treatments were well-tolerated: nine patients in the RSV and 11 in the ATV group withdrew from treatment because of adverse events after randomization. Conclusion. In subjects with type 2 diabetes, greater improvements of apoB/apoA1 and across the lipid profile were observed with RSV compared with ATV.
PMID: 15910557 [PubMed - in process]
Wolffenbuttel BH, Franken AA, Vincent HH; THE DUTCH CORALL STUDY GROUP.
University Medical Centre, Groningen, the Netherlands.
Abstract. Wolffenbuttel BHR, Franken AAM, Vincent HH on behalf of the Dutch CORALL Study Group (University Medical Centre, Groningen; Isala Clinics, Zwolle; and Antonius Hospital, Nieuwegein, the Netherlands). Cholesterol-lowering effects of rosuvastatin compared with atorvastatin in patients with type 2 diabetes - CORALL study. J Intern Med 2005; 257: 531-539.Objectives. To compare the efficacy of the newest cholesterol-lowering drug, rosuvastatin (RSV) with atorvastatin (ATV) in subjects with type 2 diabetes. Design. A 24-week, open-label, randomized, parallel-group, phase IIIb, multicentre study. Setting. Diabetes outpatient clinics of 26 hospitals in the Netherlands. Subjects. A total of 263 patients with type 2 diabetes treated with oral agents or insulin, age (mean +/- SD) 60 +/- 10 years, body mass index (BMI) 31.4 +/- 6.1 kg m(-2), 46% males. Intervention. After a 6-week dietary lead-in period, patients were randomized to RSV (n = 131) or ATV (n = 132) treatment in a dose escalation scheme (RSV: 10, 20 and 40 mg or ATV: 20, 40 and 80 mg for 6 weeks each sequentially). Main outcome measures. Primary outcome was the change in apolipoprotein B (apoB) and apoB/apolipoprotein A1 (apoA1) ratio, which has been suggested a better predictor for cardiovascular events than total (TC) or low-density lipoprotein cholesterol (LDL-C). Secondary outcomes were the changes in other lipid parameters. Results. Baseline LDL-C in the RSV and ATV groups was 4.23 +/- 0.98 mmol L(-1) and 4.43 +/-0.99 mmol L(-1), whilst apoB/apoA1 was 0.86 +/-0.22 and 0.92 +/- 0.35, respectively. A greater reduction in apoB/apoA1 was seen with RSV (-34.9%, -39.2% and -40.5%) than with ATV (-32.4%, -34.7% and -35.8%, P < 0.05 at weeks 12 and 18). Significantly greater reductions in LDL-C were also seen with RSV (-45.9%, -50.6% and -53.6%) than with ATV (-41.3%, -45.6% and -47.8%, all P < 0.05). The American Diabetes Association (ADA) LDL-C goal of <2.6 mmol L(-1) was reached by 82%, 84% and 92% of patients with RSV and 74%, 79% and 81% with ATV. Triglyceride reductions ranged from 16 to 24% and were not different between treatments. Both treatments were well-tolerated: nine patients in the RSV and 11 in the ATV group withdrew from treatment because of adverse events after randomization. Conclusion. In subjects with type 2 diabetes, greater improvements of apoB/apoA1 and across the lipid profile were observed with RSV compared with ATV.
PMID: 15910557 [PubMed - in process]
Wednesday, June 01, 2005
Noninvasive Coronary Angiography
Noninvasive Coronary Angiography
(Full text available on request)
Hype or New Paradigm?
Mario J. Garcia, MD
When Sones Inadvertentely performed the first coronary angiogram in 1958, he could not anticipate the profound future implications of that event. Four years later, when he reported his experience with more than 1000 procedures, the technique was still considered experimental and was dismissed by many leading authorities in cardiovascular medicine.
Yet, the introduction of coronary angiography started a new era, leading to the rapid development of coronary artery bypass graft surgery and percutaneous revascularization for the routine management of ischemic heart disease.
Four decades later, more than 2 million angiographic procedures are performed annually in the United States alone. Although invasive coronary angiography clearly has led to improved outcomes, it also has contributed to greater expenses in health care cost, limiting its potential to become more widely available. This has led to a growing interest in the scientific community in the development of less expensive, noninvasive alternative methods for evaluating coronary anatomy.
(Full text available on request)
Hype or New Paradigm?
Mario J. Garcia, MD
When Sones Inadvertentely performed the first coronary angiogram in 1958, he could not anticipate the profound future implications of that event. Four years later, when he reported his experience with more than 1000 procedures, the technique was still considered experimental and was dismissed by many leading authorities in cardiovascular medicine.
Yet, the introduction of coronary angiography started a new era, leading to the rapid development of coronary artery bypass graft surgery and percutaneous revascularization for the routine management of ischemic heart disease.
Four decades later, more than 2 million angiographic procedures are performed annually in the United States alone. Although invasive coronary angiography clearly has led to improved outcomes, it also has contributed to greater expenses in health care cost, limiting its potential to become more widely available. This has led to a growing interest in the scientific community in the development of less expensive, noninvasive alternative methods for evaluating coronary anatomy.
[ProCOR] Conference report: 6th ICPC "Protecting the heart ofglobal development"
-----Mensagem original-----
De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: quarta-feira, 1 de junho de 2005 09:37
[ProCOR] Conference report: 6th ICPC "Protecting the heart ofglobal development"
The 6th International Conference on Preventive Cardiology convened more than 700 international participants to discuss how clinical practice, community intervention, and policy development can promote global heart health. At those who attended head home, we must ask ourselves:
What did we learn? What next steps will we take? What concrete actions will result? What will have changed in four years, at the next conference? We invite all of our global colleagues to utilize ProCOR as a forum in which to continue and expand the conference, and to discuss these important questions.
________
Only half of the world's countries have surveillance systems. "We can't guide the development of policy, and we can't make wise decisions about the allocation of scarce health resources, unless we track trends in health status," said Ruth Bonita, WHO. "Using this information, we can develop appropriate and effective interventions and evaluate them." WHO's STEPwise approach assists countries in collecting information about NCD risk factors in their unique settings (www.who.int/chp/steps> or email rileyl@who.int)
Surveillance data paves the way for policy development. Less than 50% of countries have a national NCD policy; less than 30% have a CVD plan, and less than 40% have a tobacco plan. Surveillance data can be incorporated into successful strategies that place heart health on the political agenda. Sylvie Stachenko, Canada, reminded attendees that "we need to communicate with policy makers in plain language that helps them understand the urgency. Tell them the stories. Use reports and important documents. Engage the media in publicizing the problem. Link the heart health agenda to other policy agendas. Make the economic case--show how policies will translate to reduced burden on health care.But always insist that economics are not more important than health." Dr. Stachenko emphasized the roles of government, the private sector, industry, NGOs, and civil society advocates. "By educating the public, we can build consumer demand, which in turn can drive policy development. Health ministries need to take a stewardship role in rallying other players, but a heart-healthy society is a shared effort."
While policy creates environmental change, successful population approaches are delivered in partnership with communities. Working with communities requires knowing and valuing their cultures, contexts, and dynamics. Multi-factoral approaches work better than single approaches; a program addressing physical activity and nutrition will produce more benefit than a physical activity program alone. Engaging a range of sites--home, workplace, schools--further increases change.
Brian O'Connor, Canada, outlined strategies for population-based programs, including community mobilization and education, social marketing and media, health promotion programs, alliances and partnerships, and involvement of the community in policy making. Examples of interventions from the world can be reviewed online at www.internationalhearthealth.org. The social determinants of health--risk conditions in which people live--are an important component of community health programming. Dr. O'Connor pointed out that "many of the tools we develop are sophisticated and can't reach people living on the margin.
Approaches should be tailored to take this into consideration.
Partnerships with communities produce benefits beyond improved health status.Communities that participate in planning develop a sense of ownership that increases the likelihood of success and sustainability. Leadership and other community capacity such as advocacy and planning skills can be transferred to
other areas and contribute to a healthier environment. But building an infrastructure requires a sustained and committed effort and willingness to share control of the agenda. "The community is not a laboratory," Dr. O'Connor warned. "Don't take the data and depart. Don't patronize them. Engage them in the process."
Darwin Labarthe, USA, examined the role of physicians and the choices that they face: "Rescue the individual, report accumulated cases, or respond to community needs. All are essential." Physicians can influence health on many levels--by promoting health for all, encouraging healthy lifestyles for their patients, identifying and treating underlying conditions, diagnosing and treating CVD, preventing occurrences, and enhancing quality of life for those with CVD."
This shift in the physician's role calls for a redefinition of primary care, noted David MacLean, Canada. "Primary care is multidisciplinary and assumes an active role in chronic disease prevention. Physicians can enhance preventive practice by utilizing multiple approaches." Noting that for many physicians "their idea of preventive medicine is vaccination," Dr. MacLean described a Russian polyclinic where doctors with minimal resources nevertheless were able to successfully manage their patients' CVD risk.
It is encouraging that this international conference on preventive cardiology addressed issues that extended far beyond the physician's examination room or the hospital's catheterization lab.
But questions remain. What have we learned during these days of discussions?What next steps will each of us take to translate what we learned into action? In four years, at the next conference, what will have changed?
Aloyzio Achutti, Brazil, reminded participants that "Our scientific meetings must be permanent. It is important for us to stay connected through a virtual community. The technical resources are already available and accessible.
Regional networks can be connected into a global network. Sharing information creates a connection that leads to mutual support and empowerment, for example the development of multi-centric research opportunities. There are many potential friends hidden by traditional communication barriers and institutional, economic, social, cultural and political restraints."
It is our hope that those who attended the conference and those who did not will use ProCOR, AMICOR, and other electronic networks as a way to continue and expand the conversation, introduce new topics, challenge one another, stay connected, and continue the global dialogue until we have achieved our goals.
Editor in Chief, ProCOR
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ProCOR (www.procor.org) is a program of the Lown Cardiovascular Research Foundation. ProCOR's email discussion is hosted by SATELLIFE (www.healthnet.org), The Global Health Information Network.
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