Rheumatic Fever: Neglected Again

Science 3 April 2009: Vol. 324. no. 5923, p. 37 DOI: 10.1126/science.324.5923.37b

Letters

Rheumatic Fever: Neglected Again

We appreciate M. Enserink's News of the Week story ("Some neglected diseases are more neglected than others," 6 February, p. 700) on the Moran et al. study analyzing the current state of research into so-called "neglected diseases" (1). We would like to highlight one neglected disease that was neglected once again: rheumatic fever (RF).

RF and its sequel, rheumatic heart disease (RHD), are almost exclusively restricted to developing countries, with a mortality comparable to that of rotavirus, and about 50% of that of malaria (2). According to the George Institute report, only 0.07% of global funding is directed toward RF, much less the treatment and prevention of RHD. This limited allocation for RF illustrates the misdirection of global health funding. Although the complications of RF/RHD are potentially lethal, they are entirely preventable with antibiotic prophylaxis, which has been shown to be cost-effective in individuals with prior group A streptococcal infection (3). Despite the limited scientific understanding of RF/RHD, some developing countries have been able to control the disease, simply by investing heavily in existing technologies and programs (4). In Enserink's words, global investment in RF/RHD would "pay off quickly."

Although Moran et al. note a consensus on preventative vaccine development for RF/RHD, they fail to document two other critical areas of research--epidemiologic surveillance and disease control. Although several promising initiatives for RF/RHD surveillance and control have been recently published (5), funding opportunities for such programs are still rather scant. We encourage the international donor community to critically examine their funding priorities regarding RF/RHD. We also suggest that future surveys by the George Institute researchers include epidemiological and treatment programs, which are crucial to the eradication of neglected diseases.

David A. Watkins
Department of Medicine
Groote Schuur Hospital and University of Cape Town
Cape Town 7925, South Africa

Liesl J. Zuhlke
Western Cape Paediatric Cardiac Services
Red Cross War Memorial Children's Hospital
Cape Town 7700, South Africa

Mark E. Engel
Department of Medicine
Groote Schuur Hospital and University of Cape Town
Cape Town 7925, South Africa

Bongani M. Mayosi^*
Department of Medicine
Groote Schuur Hospital and University of Cape Town
Cape Town 7925, South Africa

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

References

1. M. Moran et al., PLoS Med. 6, e30 (2009).
2. J. R. Carapetis, A. C. Steer, E. K. Mulholland, M. Weber, Lancet Infect. Dis. 5, 685 (2005).
3. K. A. Robertson, J. A. Volmink, B. M. Mayosi, BMC Cardiovasc. Disord. 5, 11 (2005).
4. P. Nordet, R. Lopez, A. Duenas, L. Sarmiento, Cardiovasc. J. Afr. 19, 135 (2008).
5. B. Mayosi et al., S. Afr. Med. J. 96, 246 (2006).

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The editors suggest the following Related Resources on Science sites:

In Science Magazine

NEWS OF THE WEEK
GLOBAL HEALTH: Some Neglected Diseases Are More Neglected Than Others

Martin Enserink (6 February 2009)
Science 323 (5915), 700. [DOI: 10.1126/science.323.5915.700]
 |  Summary »  |  Full Text »  |  PDF »

World Health Day 2009

Save lives. Make hospitals safe in emergencies

World Health Day 2009 focuses on the safety of health facilities and the readiness of health workers who treat those affected by emergencies. Health centres and staff are critical lifelines for vulnerable people in disasters - treating injuries, preventing illnesses and caring for people's health needs. Often, already fragile health systems are unable to keep functioning through a disaster, with immediate and future public health consequences.

This year, WHO and international partners are underscoring the importance of investing in health infrastructure that can withstand hazards and serve people in immediate need. They are also urging health facilities to implement systems to respond to internal emergencies, such as fires, and ensure the continuity of care.

News

- Event in Beijing: remarks by Dr Margaret Chan, WHO Director-General
- News release: focus on making hospitals safe in emergencies
- Statement by Dr Margaret Chan, WHO Director-General
- News release: Jet Li appointed Goodwill Ambassador

Background

- Emergencies: global and local impact
- How emergencies threaten health facilities and delivery of care
- Why keep health facilities safe?
- How to safeguard health facilities
- What can you do?
- Global efforts to make hospitals safe from disasters
- Making hospitals safe in emergencies: country examples
- More information resources 

World Physical Activity Day

Today, 6 April 2009, is World Physical Activity Day. This year's theme is "Active neighborhoods building health." For more information visit www.agitamundo.com.
From ProCOR:
Every year World Physical Activity Day mobilizes more than one million people in more than 6000 events around the world. The annual campaign is organized by Agita Mundo, a Brazil-based organization that supports research, advocacy, and community education for physical activity and health.

This year Agita Mundo is encouraging "active citizenry" for all people--a commitment to simple lifestyle changes that incorporate physical activity, such as riding a bike to work and walking as a primary mode of transportation whenever possible. The organization recommends at least 150 minutes of physical activity a week, which can be accomplished in 30 minutes a day, five days a week.

Events celebrating World Physical Activity Day are taking place around the world from 1-10 April 2009. More than 20,000 people walked the 3-km Eighth Agita Mundo Walk in São Paulo on Sunday, 5 April 2009.

Information on physical activity from the World Health Organization is available at www.who.int/dietphysicalactivity/pa.

Tips for the general public to become more physically active or to start an exercise program are available from the American College of Sports Medicine at www.acsm.org/physicalactivity.

For more information on Agita Mundo and World Physical Activity Day visit www.agitamundo.orgor send an email to agitamundo@agitamundo.org. Website is available in English, Portuguese, and Spanish; Adobe Flash Player plug-in required to view website.

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Juan Ramos
Program Coordinator, ProCor

Changing history: interview

Changing history: The questions you ask patients keep expanding

The centuries-old interview at the core of medical practice is under pressure to evolve, just as it also becomes more essential.

By Victoria Stagg Elliott, AMNews staff. Posted April 6, 2009.

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[Illustration by Wesley Bedrosian / www.wesleybedrosian.com]

After Martin Duke, MD, retired as director of medical education and chief of cardiology at Connecticut's Manchester Memorial Hospital, he found himself more often the patient than the physician. As a result, he spent more time giving his medical history than taking someone else's, and he noticed significant changes in how the task was accomplished. The time spent on it was shorter. It often was taken by an allied health worker. And, sometimes it didn't even involve a face-to-face conversation. Instead, he simply checked "yes" or "no" boxes on a questionnaire.

In a paper he authored in the November-December 2008 Connecticut Medicine, he bemoaned this shift. "If this trend were to continue, it is conceivable that one day patients and doctors may not even be speaking with each other," he wrote.

"Technology has changed the whole approach, and technology does add something," said Dr. Duke in an interview. "But it cannot stand by itself. It needs the person-to-person interaction for some direction."/.../

ATLAS IDH REGIÃO METROPOLITANA POA

ATLAS DO DESENVOLVIMENTO HUMANO DA REGIÃO METROPOLITANA DE PORTO ALEGRE
O Atlas é uma produção do Observatório da Cidade de Porto Alegre que tem por objetivo disponibilizar um instrumental de análise que possibilite conhecer em profundidade diversos aspectos da realidade socioeconômica em níveis geográficos de município e intramunicípio para a Região Metropolitana de Porto Alegre. O Atlas contém um conjunto de indicadores, para os anos de 1991 e de 2000, obtidos através dos questionários dos censos demográficos do IBGE. São mais de 100 indicadores para os dois anos considerados, agrupados nos seguintes temas: Demografia, Educação, Renda, Habitação, Vulnerabilidade, Trabalho, População e Objetivos de Desenvolvimento do Milênio. O Atlas apresenta também o Índice de Desenvolvimento Humano Municipal - IDHM e os subíndices que o constituem. O IDH sintetiza o nível de sucesso atingido pela sociedade quanto a três necessidades básicas e universais do ser humano: educação, longevidade e renda. /.../

American College of Cardiology Meeting 2009

For the latest news, features, columns, video and audio reports and more,visit our home page at www.medpagetoday.com

HIV in Act of Infection

Videos Capture HIV in Act of Infection

By Michael Smith, North American Correspondent, MedPage Today Published: March 26, 2009 Reviewed by Zalman S. Agus, MD; Emeritus Professor  University of Pennsylvania School of Medicine.

NEW YORK, March 26 -- Remarkable video images show HIV reaching out from an infected T cell to enter an adjacent uninfected cell, researchers here said.  The images, taken using quantitative, high-speed, three-dimensional video microscopy, provide new insight into how HIV propagates from cell to cell, according to Benjamin Chen, M.D., Ph.D., of Mount Sinai School of Medicine here, and colleagues.  In the video images, the virus is seen to reach out through "virological synapses," forming "synaptic buttons" from which genetic material penetrates a target cell, Dr. Chen and colleagues reported in the March 26 issue of Science.

Big Tobacco & Big Food

The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?

Kelly D. Brownell and Kenneth E. Warner

Context: In 1954 the tobacco industry paid to publish the “Frank Statement to Cigarette Smokers” in hundreds of U.S. newspapers. It stated that the public’s health was the industry’s concern above all others and promised a variety of good-faith changes. What followed were decades of deceit and actions that cost millions of lives. In the hope that the food history will be written differently, this article both highlights important lessons that can be learned from the tobacco experience and recommends actions for the food industry.

Methods: A review and analysis of empirical and historical evidence pertaining to tobacco and food industry practices, messages, and strategies to influence public opinion, legislation and regulation, litigation, and the conduct of science.

Findings: The tobacco industry had a playbook, a script, that emphasized personal responsibility, paying scientists who delivered research that instilled doubt, criticizing the “junk” science that found harms associated with smoking, making self-regulatory pledges, lobbying with massive resources to stifle government action, introducing “safer” products, and simultaneously manipulating and denying both the addictive nature of their products and their marketing to children. The script of the food industry is both similar to and different from the tobacco industry script.

Conclusions: Food is obviously different from tobacco, and the food industry differs from tobacco companies in important ways, but there also are significant similarities in the actions that these industries have taken in response to concern that their products cause harm. Because obesity is now a major global problem, the world cannot afford a repeat of the tobacco history, in which industry talks about the moral high ground but does not occupy it. 

Inovação em ciência no Brasil?

(Recomendado pela Dra. Maria Inês Reinert Azambuja)

Notícias

Quinta-Feira, 02 de abril de 2009

  JC e-mail 3731, de 30 de Março de 2009.  

10. ''É irreal fazer inovação no Brasil'', diz Antonio Carlos Martins de Camargo
Farmacologista explica porque pediu demissão do cargo do cargo de diretor do Centro de Toxinologia Aplicada (CAT) do Instituto Butantã após ocupá-lo por oito anos Herton Escobar escreve para “O Estado de SP”: O farmacologista Antonio Carlos Martins de Camargo, há oito anos diretor do Centro de Toxinologia Aplicada (CAT) do Instituto Butantã, pediu demissão do cargo. Motivo: "É irreal pensar em fazer inovação no Brasil atualmente. Você pode dar dinheiro para o melhor cientista do mundo que ele vai morrer na praia", justificou, em entrevista exclusiva ao Estado. "Comecei a me sentir mal em mistificar uma coisa que não funciona. Não vou mexer mais com isso", desabafa. Inaugurado em 2000, o CAT é um dos 11 Centros de Pesquisa, Inovação e Difusão (Cepids) da Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp). Foi criado para trabalhar em uma das áreas supostamente mais promissoras da biotecnologia: a busca de novos princípios ativos para drogas em espécies da biodiversidade brasileira. /.../

Functional Foods

Medical News: Diet & Nutrition   See other related items in the same address

No Clear Definition or Regulation for Functional Foods  4/1/2009 LITTLE FALLS, N.J. -- With the growing popularity of so-called "functional foods" and no official government guidance to help consumers sort them out, the American Dietetic Association has developed its own definition: a food that provides a "beneficial effect on health when consumed as part of a varied diet on a regular basis at effective levels." /.../

ECG in College Athletes

ACC: ECG Reveals Cardiac Problems in A Third of College Athletes

By Crystal Phend, Staff Writer, MedPage Today Published: April 01, 2009 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco Earn CME/CE credit for reading medical news

ORLANDO, April 1 -- Cardiac screening for college-level athletes that included an electrocardiogram discovered abnormalities in 21% to 37% of students, according to two studies at major U.S. universities. Action Points   Note that these studies were published as abstracts and presented as posters at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Note that neither study included a control group for comparison of standard history- and physical exam-based preparticipation screening with and without electrocardiograms. But researchers from the two groups reached opposite conclusions about routine EKGs for athletes at the American College of Cardiology (ACC) meeting here this week. Professional athletes in the U.S. commonly get intensive cardiac screening, but its use at lower levels of competition has been debated. The European Cardiology Society supports routine electrocardiograms to reduce risk of sudden cardiac death in competitive collegiate sports. The ACC recommends only a simpler, history- and physical exam-based screening. The leader of one research group, Anthony Magalski, M.D., of St. Luke's Mid America Heart Institute in Kansas City, Mo., spoke to the value of added testing./.../

Novel Thyroid Hormone Agent Cuts Lipids Beyond What Statin Can Do Alone

ACC: Novel Thyroid Hormone Agent Cuts Lipids Beyond What Statin Can Do Alone

By Crystal Phend, Staff Writer, MedPage Today Published: April 01, 2009 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

ORLANDO, April 1 -- An experimental agent that targets thyroid receptor hormones in the liver may lower lipids substantially as an add-on to statins, researchers said. Action Points   Explain to interested patients that the liver and thyroid play important roles in cholesterol regulation. Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Investigational eprotirome reduced LDL cholesterol by 25% on average over 12 weeks in patients already on a statin, Bo Angelin, M.D., Ph.D., of the Karolinska University Hospital in Stockholm, and colleagues reported at the American College of Cardiology meeting here. The dose-ranging study showed no signal for thyroid, liver, or cardiac adverse effects, Dr. Angelin said. However, given the history of these agents, some top cardiologists sounded a note of caution about overinterpreting the short-term safety results. "Big pharma has tried for three decades to make this work," commented Steven Nissen, M.D., of the Cleveland Clinic. "It suggests there will be a challenging road ahead./../

Earth Hour 2009

Countdown to Earth Hour 2009… 

 

There's less than 24 hours left before Earth Hour 2009 will begin. While you may hotly debate whether or not turning out your lights for one hour can impact our global climate - it's not about what actually happens to our planet during that hour, but about showing you care. 3,900 cities and towns in 84 countries around the world will be shutting down the lights at 8:30 pm local time in one of the biggest events in history. Even if you don't care, take the time to read just a little bit more… Where will you be when the lights go out? (...) 

Read the rest of Countdown to Earth Hour 2009… (389 words)

world population at over 9 billion by 2050

Revised UN estimates put world population at over 9 billion by 2050

Hania Zlotnik

11 March 2009 – The world’s population will hit 7 billion early in 2012 and top 9 billion in 2050, with the majority of the increase taking place in developing countries, according to revised United Nations estimates released today.

“There have been no big changes for the recent estimates and we have not changed the assumptions for the future,” Hania Zlotnik, Director of the Population Division at the Department of Economic and Social Affairs (DESA), told reporters in New York.

“We’re still projecting that by 2050 the population of the world will be around 9.1 billion,” she said, as she presented the 2008 Revision of the World Population Prospects.

The Revision also says that nine countries are expected to account for half of the world’s projected increase from 2010 to 2050: India, Pakistan, Nigeria, Ethiopia, United States, the Democratic Republic of Congo (DRC), Tanzania, China and Bangladesh./.../

Uma outra forma de se alimentar

Maria Guimarães

Edição Impressa 157 - Março 2009

Pesquisa FAPESP -  

© Lia Chaer/USP

Água do tanque nutre plante e abriga animais

As bromélias Vriesea gigantea vivem no alto de árvores e acumulam água entre suas folhas – por isso são chamadas de epífitas com tanque. Até onde se tem notícia, as plantas desse tipo são as únicas que de preferência extraem nitrogênio diretamente da ureia, abundante na urina das pererecas que usam a água empoçada para se abrigar e depositar seus ovos. O grupo coordenado pela botânica Helenice Mercier, da Universidade de São Paulo (USP), recentemente descobriu que essas bromélias têm duas estratégias para captar a ureia e desvendou mecanismos fisiológicos únicos. /.../

Brazil’s leader blames white people for crisis

Brazil’s leader blames white people for crisis

By Jonathan Wheatley in São Paulo and agencies

Published: March 27 2009 00:27 | Last updated: March 27 2009 00:27

Brazil’s President Luiz Inácio Lula da Silva on Thursday blamed the global economic crisis on “white people with blue eyes” and said it was wrong that black and indigenous people should pay for white people’s mistakes.

Speaking in Brasília at a joint press conference with Gordon Brown, the UK prime minister, Mr Lula da Silva told reporters: “This crisis was caused by the irrational behaviour of white people with blue eyes, who before the crisis appeared to know everything and now demonstrate that they know nothing.”/.../

Karl Pearson

Karl Pearson

Karl Pearson FRS (March 27, 1857 – April 27, 1936) established the discipline of mathematical statistics. [1] A sesquicentenary conference was held in London on 23 March 2007, to celebrate the 150th anniversary of his birth. [2]

In 1911 he founded the world's first university statistics department at University College London. He was a proponent of eugenics, and a protégé and biographer of Sir Francis Galton. He was also a socialist.

ACC/AHA Guidelines: Heart Failure in adults

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for theDiagnosis and Management of Heart Failure in Adults. A Report of theAmerican College of Cardiology Foundation/American Heart Association TaskForce on Practice GuidelinesSharon Ann Hunt, William T. Abraham, Marshall H. Chin, Arthur M. Feldman,Gary S. Francis, Theodore G. Ganiats, Mariell Jessup, Marvin A. Konstam,Donna M. Mancini, Keith Michl, John A. Oates, Peter S. Rahko, Marc A.Silver, Lynne Warner Stevenson, and Clyde W. YancyCirculation published 26 March 2009, 10.1161/CIRCULATIONAHA.109.192065
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.109.192065v1?papetoc

Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management ofHeart Failure in Adults. A Report of the American College of CardiologyFoundation/American Heart Association Task Force on Practice GuidelinesMariell Jessup, William T. Abraham, Donald E. Casey, Arthur M. Feldman,Gary S. Francis, Theodore G. Ganiats, Marvin A. Konstam, Donna M. Mancini,Peter S. Rahko, Marc A. Silver, Lynne Warner Stevenson, and Clyde W. YancyCirculation published 26 March 2009, 10.1161/CIRCULATIONAHA.109.192064
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.109.192064v1?papetoc

Health On the Net

Enter depending on your status PATIENT / INDIVIDUAL MEDICAL PROFESSIONAL WEB PUBLISHER

The services offered by HON HONcode HONcode certification: Improving the quality of online health information HONsearch Search only reliable and trustworthy medical websites HONtools Use our free services to enhance and improve your online experience HONtopics Access a varied list of reliable medical/health topics The Health On the Net Foundation (HON) promotes and guides the deployment of useful and reliable online health information, and its appropriate and efficient use. Created in 1995, HON is a non-profit, non-governmental organization, accredited to the Economic and Social Council of the United Nations. For twelve years, HON has focused on the essential question of the provision of health information to citizens, information that respects ethical standards. To cope with the unprecedented volume of healthcare information available on the Net, the HONcode of conduct offers a multi-stakeholder consensus on standards to protect citizens from misleading health information.

State of the World’s Cities 2008/2009

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia@paho.org>
State of the World’s Cities 2008/2009 -
Harmonious Cities Earthscan in the UK and USA in 2008 for and on behalf of the United Nations Human Settlements Programme (UN-HABITAT), 2008
Available online as PDF file [288p.] at:
http://www.unchs.org/pmss/getElectronicVersion.asp?nr=2562&alt=1
“…….Half of humanity now lives in cities, and within two decades, nearly 60 per cent of the world’s people will be urban dwellers. Urban growth is most rapid in the developing world, where cities gain an average of 5 million residents every month. As cities grow in size and population, harmony among the spatial, social and environmental aspects of a city and between their inhabitants becomes of paramount importance. This harmony hinges on two key pillars: equity and sustainability. “
“……Cities embody some of society’s most pressing challenges, from pollution and disease to unemployment and lack of adequate shelter. But cities are also venues where rapid, dramatic change is not just possible but expected. Thus they present real opportunities for increasing energy efficiency, reducing disparities in development and improving living conditions in general. National and local governments can promote harmonious urbanization by supporting pro-poor, inclusive and equitable urban development and by strengthening urban governance structures and processes. History demonstrates that integrated urban policy can be a solid path towards development. Contrary to popular opinion, inequality and the unsustainable use of energy are not inevitable aspects of urban development, nor are they necessary for urbanization and economic growth to occur. Rather, as this report illustrates, cities can advance the prosperity of their inhabitants while achieving equitable social outcomes and fostering the sustainable use of resources. Today, many small, well-managed cities in both the developing and developed worlds are enjoying rapid growth, giving us a chance to stave off entrenched poverty and cultivate healthy environments in which people can thrive. The data and analysis contained in this report are intended to improve our understanding of how cities function and what we, as a global community, can do to increase their liveability and unity. In that spirit, I commend this report to policymakers, mayors, citizens’ groups and all those concerned with the welfare of our urbanizing world………..
”…. Ban Ki-moon, Secretary-General, United Nations