Life in Dundahera village in the Gurgaon district of Haryana, offers a glimpse of perhaps why economic boom is not translating into better maternal and child health in India. In recent years, Gurgaon has emerged as one of India's hottest outsourcing hubs. Shopping centres, multinational companies, and industrial complexes dot the cityscape. Eager to tap the emerging commercial opportunities, Dunadhera's farmers are selling their land to builders. New houses have been built to accommodate the growing number of migrant families streaming into the area to fuel the economic boom. Many families who have sold their land have suddenly become rich. But within the family and this highly patriarchal society, the status of women has scarcely improved.
segunda-feira, 30 de abril de 2007
Aumenta a desnutrição na India.
Life in Dundahera village in the Gurgaon district of Haryana, offers a glimpse of perhaps why economic boom is not translating into better maternal and child health in India. In recent years, Gurgaon has emerged as one of India's hottest outsourcing hubs. Shopping centres, multinational companies, and industrial complexes dot the cityscape. Eager to tap the emerging commercial opportunities, Dunadhera's farmers are selling their land to builders. New houses have been built to accommodate the growing number of migrant families streaming into the area to fuel the economic boom. Many families who have sold their land have suddenly become rich. But within the family and this highly patriarchal society, the status of women has scarcely improved.
Recuperando a virgindade na França
Sun Apr 29, 2007 9:49pm ET By Alexandra Steigrad
PARIS (Reuters) -- Sitting in a cafe near the Champs Elysees, the 26-year-old French-born woman of Algerian descent looks like any other arisian. But two months ago, she did something none of her friends have done. She had her hymen re-sewn, technically making her a rgin again. "I'm glad I had it done," said the woman, who spoke to Reuters on condition of anonymity. "I wanted to reconstruct part of my life, to reconstruct myself so that I could feel better about myself." This 30-minute outpatient procedure, called "hymenoplasty" and costing etween 1,500 and 3,000 euros ($2,000-$4,000), is increasingly popular among young women of North African descent in France. No exact figures exist to say how many such operations are done, but the woman's surgeon says he gets three to five queries and performs one to three hymenoplasties each week. Demand has been rising for the past three or four years. Doctor Marc Abecassis, whose office is near the chic Champs Elysees, sees the rise in religion among France's five million Muslims fuelling this trend. His patients are between 18 and 45 years old, Muslim, born both in France and in North Africa. "Many of my patients are caught between two worlds," said Abecassis. They have had sex already but are expected to be virgins at marriage according to a custom that he called "cultural and traditional, with enormous family pressure
KFC elimina frituras com ácidos graxos poli-insaturados na forma trans
Abaixo, despacho da Associated Press. Ao que constar, a rede Starbuck´s já tomou posição idêntica. Faltam ainda McDonald´s e Burguer King que possuem filiais no Brasil.KFC Eliminates Trans Fat From Its Chicken
ASSOCIATED PRESSApril 30, 2007; Page B6
KFC's fried-chicken buckets soon will proclaim that its chicken has zero grams of trans fat. The KFC chain, a subsidiary of Yum Brands Inc., Louisville, Ky., is announcing that all 5,500 of its U.S. restaurants have stopped frying chicken in trans fat. The company said in October it was switching to a new soybean oil believed to be less likely to cause heart disease. Sister brand Taco Bell also is expected to announce that its U.S. restaurants have switched to an oil with zero grams of trans fat. All 4,200 single-brand Taco Bells were converted to a canola oil, and all 1,400 multibrand locations switched to a soybean oil, it said. Other companies, including Wendy's International Inc., Starbucks Corp., McDonald's Corp. and Burger King Holdings Inc. have also said they will phase out trans fat from their products
domingo, 29 de abril de 2007
Influenza e Doença Coronariana: uma hipótese
*Perspectives in Biology and Medicine, volume 50, number 2 (spring 2007):228–42
sábado, 28 de abril de 2007
PAC da Saúde: considerações iniciais.
Renúncia fiscal: faça a conta do financiamento não explícito da saúde.
(1) após terminar a declaração, anote o imposto a ser pago e os gastos com saúde;
(2) apague todos os pagamentos para saúde;
(3) verifique o acréscimo no imposto;
(4) calcule a proporção dos seus gastos que foram pagos pela sociedade via renúncia fiscal;
Transplantes: a situação do Brasil
sexta-feira, 27 de abril de 2007
Tráfico de meninas e a aids
Temporão na FMUSP: PAC na Saúde
terça-feira, 24 de abril de 2007
Insuficiência Renal :boa causa, argumentação incompleta, patrocínio desnecessário
Emails: um problema sério; prontuários eletrônicos também.
A 22-Year-Old's TiradeMade Trouble for Kaiser;Mr. Deal Got Fired, Famous
By RHONDA L. RUNDLEApril 24, 2007; Page A1
LOS ANGELES -- On a Friday morning last November, Justen Deal, a 22-year-old Kaiser Permanente employee here, blasted an email throughout the giant health maintenance organization. His message charged that HealthConnect -- the company's ambitious $4 billion project to convert paper files into electronic medical records -- was a mess. In a blistering 2,000-word treatise, Mr. Deal wrote: "We're spending recklessly, to the tune of over $1.5 billion in waste every year, primarily on HealthConnect, but also on other inefficient and ineffective information technology projects." He did not stop there. Mr. Deal cited what he called the "misleadership" of Kaiser Chief Executive George Halvorson and other top managers, who he said were jeopardizing the company's ability to provide quality care. "For me, this isn't just an issue of saving money," he wrote. "It could very well become an issue of making sure our physicians and nurses have the tools they need to save lives." Mr. Deal signed the email. Before sending it, he says, he printed out a copy and handed it to his boss. "She gave me a look like, 'I think you're going to be fired,' " he recalls. Soon afterward, his office phone was ringing off the hook. IT staffers later arrived to seize his computers, and Mr. Deal was placed on paid leave from his $56,000-a-year job. Kaiser refutes Mr. Deal's assessment of its custom software system, developed by Epic Systems Corp. The company says HealthConnect is doing fine despite some missteps. Ultimately, the company fired Mr. Deal, who worked on patient-education booklets and provided technical support to his department. But the email episode shows that, in the digital age, flicking away whistle-blowers isn't as easy as it once was.
segunda-feira, 23 de abril de 2007
Dólar em baixa: bom para os hospitais
Tratamento da aids: Abbott se acerta com a Tailândia.
By NICHOLAS ZAMISKA in Hong Kong and JAMES HOOKWAY in BangkokApril 23, 2007
Abbott Laboratories has backed away from a confrontation with the Thai government over patent protection for a popular AIDS treatment, a concession that could embolden other developing countries pushing big drug makers to lower the price of their products.
Abbott is offering to sell the latest version of its AIDS drug Kaletra in Thailand at a discounted rate, according to Miles D. White, Abbott's chief executive. The move reverses Abbott's decision in February to withhold the new form of Kaletra, called Aluvia in some countries, from Thailand following a Thai government announcement it would allow sales of generic versions of the drug and other branded medicines to cut patients' costs. "In this particular case, in the name of access for patients, we offered to resubmit Aluvia at our new price, which is lower than any generic, provided they wouldn't issue a compulsory license," Mr. White said. He said the initial decision was driven by "concern that compulsory licensing would be abused ever-more widely, using HIV as an excuse." Jennifer Smoter, a spokeswoman for Abbott, said Thailand's health ministry has expressed interest in the offer, but a resolution hasn't been reached. Abbott's move doesn't affect its decision to withhold six other drugs from Thailand. Abbott Laboratories in February withheld an AIDS drug from sale in Thailand after the government said it would allow sale of generic versions of drugs. • What's New: Backing down, Abbott is offering to sell the drug in Thailand at a discounted rate. • The Significance: Other developing nations may push for lower drug prices.
• The Background:Abbott's turnabout could crimp growth of global drug makers, which rely on emerging markets to compensate for slowing growth in home markets. Gustav Ando, an analyst for Global Insight, an economic-forecasting firm in Waltham, Mass., said, "If one country does it...any country can do it.... It's not going to stop there." Abbott, of Abbott Park, Ill., in February, refused to sell the country seven of its newest drugs. The move appeared to backfire, prompting consumer boycotts in Thailand, bringing human-rights advocates out in support of Thailand's policy and provoking protests from some Abbott shareholders, who argued Abbott should sell its latest drugs in Thailand. Thailand generated about $30 million a year in sales for Abbott, said a person familiar with the company's sales.
In backing down, Abbott is joining Merck & Co. and Sanofi-Aventis SA, which already have cut the prices of their AIDS and heart-disease drugs in the hope of dissuading Thailand from switching to less-expensive alternatives. Thailand still could choose to import generic drugs to replace Abbott's, however, just as it is now using generic versions of Merck's AIDS drug Efavirenz, despite Merck's own move to lower prices. Big drug companies have been pushing sales in emerging markets like Thailand, in part, because of a backlash against expensive brand-name drugs in the U.S. and other Western markets. Merck expects revenue in emerging markets to double by 2010 to more than $2 billion a year. Abbott's international pharmaceutical sales totaled $1.68 billion in the first quarter of this year -- nearly as much as its $1.69 billion in U.S. sales. In 2006, Abbott's total sales in the U.S. dropped 7.5% to $11.5 billion, while the company's international revenue rose nearly 11% to $10.9 billion.
sábado, 21 de abril de 2007
Escândalo no Mississipi: mortalidade infantil aumenta
By ERIK ECKHOLM
Published: April 22, 2007
HOLLANDALE, Miss. — For decades, Mississippi and neighboring states with large black populations and expanses of enduring poverty made steady progress in reducing infant death. But, in what health experts call an ominous portent, progress has stalled and in recent years the death rate has risen in Mississippi and several other states.
The setbacks have raised questions about the impact of cuts in welfare and Medicaid and of poor access to doctors, and, many doctors say, the growing epidemics of obesity, diabetes and hypertension among potential mothers, some of whom tip the scales here at 300 to 400 pounds. “I don’t think the rise is a fluke, and it’s a disturbing trend, not only in Mississippi but throughout the Southeast,” said Dr. Christina Glick, a neonatologist in Jackson, Miss., and past president of the National Perinatal Association. To the shock of Mississippi officials, who in 2004 had seen the infant mortality rate — defined as deaths by the age of 1 year per thousand live births — fall to 9.7, the rate jumped sharply in 2005, to 11.4. The national average in 2003, the last year for which data have been compiled, was 6.9. Smaller rises also occurred in 2005 in Alabama, North Carolina and Tennessee. Louisiana and South Carolina saw rises in 2004 and have not yet reported on 2005. Whether the rises continue or not, federal officials say, rates have stagnated in the Deep South at levels well above the national average. Most striking, here and throughout the country, is the large racial disparity. In Mississippi, infant deaths among blacks rose to 17 per thousand births in 2005 from 14.2 per thousand in 2004, while those among whites rose to 6.6 per thousand from 6.1. (The national average in 2003 was 5.7 for whites and 14.0 for blacks.)
sexta-feira, 20 de abril de 2007
A hora e vez dos estudos de segurança
CHICAGO (Reuters) - U.S. health insurers, whose patient records helped uncover heart risks of the withdrawn arthritis drug Vioxx, called on Thursday for a new body to compare the safety and effectiveness of new drugs versus older treatments. America's Health Insurance Plans, a trade group for big health insurers like Kaiser Permanente and WellPoint Inc., also backed greater authority for U.S. regulators to police the safety of drugs once they hit the market. The recall of Merck & Co.'s Vioxx in 2004 helped ignite a growing controversy over whether drugs are adequately monitored for safety after being approved. "We all tend to assume newest is best, which is not always the case," said Roberta Herman, chief medical officer at Harvard Pilgrim Health Care, a hospital system in Boston which recently won the top spot in a national quality ranking of U.S. hospitals. The health insurers group called for a new entity, funded with public and some private resources, that would be independent of the drug industry to conduct real-world studies of drugs. A representative of the Pharmaceutical Research and Manufacturers of America trade group was not available for comment. Kaiser Permanente, a big health maintenance organization in California with about 8.5 million, supplied some of the data used by the FDA finding Vioxx boosted the risk of stroke and heart attack. Several insurers have contracts with the FDA to supply the large swaths of data needed to detect side effects of drugs on the market. On Wednesday, a U.S. Senate panel approved a bill to bolster the FDA's oversight over prescription drugs, which includes a new power to fine companies for not completing studies and a ban on advertising for new drugs for two years. The Bush Administration has called the bill onerous and some Republicans tried to strike language on the advertising ban. Critics say aggressive consumer advertising boosts overuse of new drugs. Jack Hoadley, a professor at Georgetown University's health policy institute said health plans have vested interest in such reforms because they could trim drug costs, but their support adds clout to the idea. "It's the natural rivalry of the payers versus the manufacturers, but I think any time a major industry group comes out with a particular statement like this it does have some effect," Hoadley said
quinta-feira, 19 de abril de 2007
Abaixo o cretinismo!
O texto acima foi escrito por Antônio Bianco, médico, ex-professor da USP, hoje, radicado em Boston, Estados Unidos. O texto completo está em Pesquisa Fapesp que pode ser acessado clicando o título de post. Os países do planeta com deficiência ou excesso de iodo na dieta pode ser acessado clicando no mapa acima.
Continua, Bianco:
Um novo escândalo: plano especial para jornalistas.
Ministro admite desvio de verbas na Saúde
No Estadão de hoje, o Ministro da Sáude José Gomes Temporão admite aquilo que todos sabem e, poucos têm coragem em explicitar: desvia-se oficialmente recurso da área da saúde. O golpe de prefeitos, governadores e do presidente (na figura do secretário do Planejamento) é de considerar que "alimentação, transporte, etc etc etc" são determinantes do binômio saúde-doença. O casal Garotinho foram os pioneiros e os que melhor executaram essa "cirurgia". Outro aspecto é a não regulamentação da emenda constitucional número 29 de 2000 que aportaria mais R$10 bilhões ao Ministério da Saúde, também obra do secretário do Planejamento.
quarta-feira, 18 de abril de 2007
Declínio do câncer de mama nos Estados Unidos
terça-feira, 17 de abril de 2007
Remédios sem médicos e enfermeiros: um dilema africano
Both the cases of Mozambique and Malawi illustrate the crucial importance of addressing the health workforce crisis. It is easier to remedy the shortage of medicines with external funding than it is to remedy the shortage of health workers with external funding. Medicines can be bought; health workers need to be trained first. This underlines the importance of starting emergency human resources programmes now, before the growing case load—resulting from the fact that most people on ART will stay alive longer, while the number of people in need of ART will grow—undermines either the quality of ART programmes, or the performance of health systems. Without support from the Global Fund, it will be difficult for Mozambique to develop its own emergency human resources programme. Bilateral donors are unable to support human resources programmes that rely on sustained external assistance over decades. The World Bank is unwilling to use foreign assistance for salaries of health workers. The IMF is unwilling to stretch ceilings on wage bills, because commitments from bilateral donors are unreliable. Without flexibility about these ceilings, bilateral donors cannot support salaries of doctors and nurses, even if they want to. It is a vicious circle. The Global Fund is probably the only actor able to break through this vicious circle. It is the only donor mechanism that benefits from an explicit endorsement from the international community to practice a novel approach to sustainability.But donors must give the Global Fund the resources to do so. As one of us argued in a previous article, it is feasible to turn the Global Fund into a world health insurance, funded by rich countries in accordance with their wealth, and creating rights for poor countries to obtain assistance in accordance with their needs. It would allow individual donors to overcome their inability to make commitments beyond the term of their governments, because their contributions would be compulsory. (This is not a heresy. Many bilateral donors consider their contributions to the World Bank as compulsory. This can be achieved for contributions to the Global Fund.) Furthermore, the pooling of resources by many donors would increase continuity: if one donor reduces its contribution, another donor could compensate.And that is exactly what countries like Mozambique need to increase their health workforce: sustained assistance.
Publicidade de medicamentos: será o fim de um suplício?
Pharmaceutical companies could be prohibited from advertising new drugs directly to consumers for the first two years they are on the market under a bill moving through Congress this week. The goal, supporters say, is to ensure medicines are safe before allowing industry to promote them to consumers in the hopes they will request prescriptions from doctors. But a reduction in TV and print advertising, which helped transform medications for heartburn and arthritis into blockbusters, would be a serious financial blow to drug makers. According to one study, every $1 spent on pharmaceuticals advertising often adds more than $2 in sales. While the Food and Drug Administration already screens a small portion of ads voluntarily submitted by drug companies, consumer advocates favor much tougher regulation, arguing that the studies companies use to test the safety of new drugs are not always large enough to spot dangerous side effects. "We don't know, and we won't know, how truly safe a drug is until it's been used in millions of people," said Consumer Reports analyst Bill Vaughan. "The real testing of these drugs takes place after a pill hits the market and that's why the advertising needs to be regulated." For its part, the drug industry says pharmaceutical ads are an important tool for patients, giving them information about diseases and treatment options. "Banning this information even for just a couple of years is not in the best interest of patients and physicians who every day make important health-care decisions," said Ken Johnson, Vice President for the Pharmaceutical Research and Manufacturers of America. Drug makers spent nearly $5 billion on direct-to-consumer advertising last year, according to Nielsen Media Research, and a 2004 study found that American TV viewers watch an average of 30 hours of drug ads per year. The freedom companies have enjoyed over the past decade to employ this marketing tool, however, is now in jeopardy. The Senate committee that oversees the Food and Drug Administration meets Wednesday to put the finishing touches on a bill that would give the agency new powers, including a provision that would allow the agency to bar advertisements for two years after a drug is approved -- a restriction the industry says is tantamount to a prohibition on free speech. Sens. Ted Kennedy (D., Mass.) and Michael Enzi (R., Wyo.) began crafting the bill several years ago, following public outcry over FDA's handling of the Merck pain reliever Vioxx, which was pulled from the market in 2004 after showing links to heart attack and stroke. In an effort to show they can better regulate themselves, drug companies including Pfizer Inc. and Bristol-Myers Squibb Co. have voluntarily stopped advertising their prescription drugs for the first 6 and 12 months they are on the market. And the trade group Pharmaceutical Research and Manufacturers of America recently issued voluntary guidelines for members to follow when promoting drugs to patients. The guidelines recommend companies submit all television advertisements to FDA for review before they are broadcast. Under an agreement reached last year, companies are expected to start paying the agency more than $80,000 for each ad reviewed in 2008. The agency said it will use the money to hire 27 new employees. Figures from FDA suggest companies are indeed changing how they promote their medicines. The agency has only cited four companies for consumer-directed ad violations since January 2006. FDA made 17 citations in 2005. Still, lawyers working for the drug industry are attacking proposals that would mandate even tighter restrictions. "In our system of jurisprudence we have a very high threshold that protects the right to free speech, whether it's political or commercial," said Jim Davidson, attorney for the Advertising Coalition, which is funded by advertising firms and drug companies. "What they're saying with this ban is "we don't know where the harm is, but we know there's a statistical likelihood that some adverse event will occur, therefore you can't promote your product.'" Mr. Davidson has urged Senate staffers to eliminate the provision on advertising, arguing that the Supreme Court has already struck down similar attempts to regulate commercial speech. Consumer advocates who support the measure stress that it would merely give FDA the option of barring advertising, and would probably only be used on first-of-a-kind drugs. But that hasn't assuaged drug companies that increasingly invest in consumer-directed marketing. Most of the blockbuster drugs of the last decade have been supported by heavy TV advertising, beginning with AstraZeneca's heart-burn medication Prilosec in 1998 and continuing to the current campaign for Bristol Myers and Sanofi-Aventis' blood thinner Plavix
segunda-feira, 16 de abril de 2007
Prontuário eletrônico para pobres em Nova Iorque
Big Medical Step, Starting With the City’s Poor
By RICHARD PÉREZ-PEÑA Published: April 16, 2007
For years, policymakers have said that the next big step in American health care should be electronic records systems that remind doctors and patients about needed care, and make it easier for doctors to share information with one another.
New York City officials today are to announce what they hope is a leap in that direction, far beyond what any other part of the country has attempted, by providing free software to doctors who treat hundreds of thousands of people. And defying the usual pattern of wealthy patients benefiting first from technological advances, the city is starting with the poor.
“We will cover half of all the high-volume Medicaid providers in the city, those where over 30 percent of their patient encounters are Medicaid or the uninsured,” said Farzad Mostashari, an assistant city health commissioner overseeing the project.
Over the next two years, the city’s Department of Health and Mental Hygiene will distribute the software to about 1,500 medical practices, from small neighborhood doctors’ offices to large clinics, including the medical offices at the Rikers Island jail. City officials, and makers of patient records software, said they do not believe any state or large local government has tried such a thing.
The department spent months shopping for an electronic records system before awarding a $19.8 million contract to eClinicalWorks, a Massachusetts company that is a sales leader in the field. The medical practices will have to supply the computers. Some already have the equipment. Others that do not might qualify for a state program that awards grants to upgrade medical technology.
Many doctors’ offices have computer systems for billing and scheduling, but most do not have software for patient care. The software the city is buying combines all those functions, Dr. Mostashari said.
The project is intended to address one of the biggest flaws in modern medicine, that even people who have regular doctors often do not get preventive care. For instance, every year, tens of millions of Americans fail to get recommended flu and pneumonia vaccines, and surveys have shown that many doctors fail to ask patients who smoke whether they want help quitting. “As a doctor, I’m likely to pay attention to the patient’s acute complaint, and not to notice, ‘Oh, my goodness, she hasn’t had a mammogram,’ ” Dr. Mostashari said. “The computer never forgets, and it will remind me.” The system can alert doctors when patients are due for preventive care and then the doctor can advise the patient.
With an electronic records system, a doctor or nurse would, ideally, have a computer at hand when seeing a patient, and would record findings with a keyboard, not a pen. (There are even blood pressure cuffs and thermometers that automatically send their readings to computers, but the city will not pay for those.) The Department of Health and Mental Hygiene plans to compile the information in the systems, and tell each practice how it is doing at making sure its patients are receiving routine care. One of the biggest problems with electronic records has been that different software systems cannot communicate with one another — so that, for example, an emergency room doctor might not be able to instantly call up records kept by a patient’s cardiologist. Dr. Mostashari said that no program available commercially is trouble-free on that score, but that creating a network of so many doctors using the same system is a start
domingo, 15 de abril de 2007
O almoço grátis novamente: agora a avaliação de projetos de pesquisa.
This penetration of commerce into the province of science isn't limited to continuing medical education. Since 1992, the United States has relied heavily on the pharmaceutical industry to pay the salaries of Food and Drug Administration (FDA) scientists who review new drug applications. The Prescription Drug User Fee Act (PDUFA) is now up for its periodic 5-year renewal, and Congress seems ready to reauthorize it with the same short-sightedness that afflicted that naive hospital administrator.
sábado, 14 de abril de 2007
Destruir ou não as últimas cepas do vírus da varíola?
Edward Hammond, director Sunshine Project, PO Box 41987, Austin, TX 78704, USA
hammond@sunshine-project.org Smallpox was eradicated in 1980, but the virus still exists in WHO controlled depositories. Edward Hammond maintains that stocks should be destroyed to prevent the disease re-emerging, but John Agwunobi insists further research is essential for global security
The World Health Organization is justly proud of the global effort that led to the eradication of smallpox; but the truth is that the job remains unfinished. Although it is almost 30 years since the last natural transmission of smallpox virus (Variola), laboratories in the United States and Russia retain virus stocks.
The destruction of remaining Variola stocks is an overdue step forward for global public health and security that will greatly reduce the possibility that this scourge will kill again, by accident or design. Although deploying modern scientific techniques such as genetic engineering on smallpox virus may be intellectually intriguing, the risks far outweigh the potential benefits. In 1990, the US secretary of health and human services, Louis Sullivan, made a pledge on behalf of the US government. "There is no scientific reason not to destroy the remaining stocks of wild virus," he declared, "So I . . . [Full text of this article]
sexta-feira, 13 de abril de 2007
Aumento do custo da assistência médica na França: um pouco além do envelhecimento
“…….The ageing of population is often referred to as a major determinant of the future evolution of health care expenditures. Indeed, at the individual level, health care expenditures is an increasing function of age. As life expectancy keeps improving in developed countries, the likely growing proportion of elderly people should lead mechanically to an accelerated growth of total health care expenditures….”
“…..The increase in total health care expenditures in France can be explained by three distinct factors:(i) the purely demographic effect (namely, the increase in the proportion of elderly people, given that health expenditure is an increasing function of age(ii) the changes in morbidity at a given age (iii) the changes in practices, for a given age and morbidity level (e.g. technological progress). The aim of this paper is basically to disentangle, evaluate and interpret the respective effects of these three factors. If the technological progress hypothesis were to explain most of the rise in health care costs, it would reflect a collective choice towards allocating more health care to the elderly, coupled with improved technical feasibility…..”
quinta-feira, 12 de abril de 2007
Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral no Brasil: The Lancet Neurology
Improving WHO STEPS Stroke in Brazil
Paulo A Lotufo and Isabela M Bensenor Further to your editorial and the article by Truelsen and colleagues, which emphasise the importance of WHO STEPS Stroke methodology for cerebrovascular disease surveillance, we would like to comment on our experience with regard to the use of this surveillance tool.
The rationale for studying cerebrovascular epidemiology in a country like Brazil is obvious, but paradoxically, there are few researchers focusing on clinical and epidemiological research about stroke. Death rates from cerebrovascular and coronary heart diseases surpassed those for infectious diseases in the 1960s and stroke mortality rates in Brazil are the highest in Latin America. However, most vascular research in Brazil is focused on coronary heart disease rather than stroke. There is a simple reason for this discrepancy: mortality due to stroke is twice as common among people living in neighbourhoods with low socioeconomic indicators than in those in more affluent ones. In the past 40 years, coronary care units have spread across the country; by contrast, there are no public stroke units. Patients with stroke are treated in emergency wards, and hospitalisation in a critical care unit is not considered a priority. Thrombolysis is common for patients with acute coronary syndromes but is unavailable for people with ischaemic stroke.
By contrast with classic surveys located in small towns, our aim is to assess stroke distribution in São Paulo, a large metropolitan area with more than 10 million inhabitants. We chose the neighbourhoods located in the western area of the city, in which a teaching hospital with a 260-bed facility offers the only support for emergencies and is responsible for 80% of the hospitalisations of people living in the area. Here, we launched Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral (EMMA) study, funded by the Brazilian National Research Council. EMMA enrolled its first participant on May 10, 2006, applying the form proposed for step one of STEPS Stroke. In this phase, objectives are to characterise the delay in hospitalisation since the start of symptoms, to determine the frequency of stroke by hour of the day, day of the week, and month of the year, and to calculate the 28 day, 180 day, and 1 year case-fatality rates.
For step two—which began in November, 2006—we included the assessment of housing conditions, with a detailed assessment of the place in which each stroke survivor lives. Step three, due to start this year, will offer strong support from primary care physicians in the area, mainly community health agents who are working together in the Family Primary Care Program.
In addition to STEPS Stroke, we are implementing other tools to verify motor, speech, and alimentary tract disabilities with specific questionnaires and a clinical consultation with physiotherapists and speech disorder specialists
Entrevista em Pesquisa Médica
quarta-feira, 11 de abril de 2007
A catástrofe chinesa: tabagismo
terça-feira, 10 de abril de 2007
Novamente a omissão da redução dos homicídios
segunda-feira, 9 de abril de 2007
China proibe venda de órgãos e doação de menores de idade
China Takes Steps to Deter Human Organ Profiteering
Contributed by Tom Harrison 07 April, 2007 20:16 GMT
New rules adopted by the Chinese government prohibit the sale of human organs for profit and make it illegal for persons under the age of 18 to make organ donations. The regulations, which are published in the People's Daily, take effect on May 1. China has been criticized for its organ transplant policies, particularly for the practice of selling organs harvested from executed prisoners, which is not addressed in the new rules. owever, they do limit the number of hospitals allowed to perform transplants, and they standardize the procedures. Most organs used for transplants come from voluntary donations, said the country's official news agency Xinhua.
However, human rights groups argue that is not the case, contending that 90 percent or more of the organs used for transplants come from executed prisoners. Even if those individuals signed consent forms, they argue, the circumstances make it unlikely that it could be considered informed and voluntary. There is an extreme shortage of human organs available for transplant in China, partly due to a cultural taboo on removing organs prior to burial. About 10,000 transplant procedures take place annually, but an estimated 1.5 million people require them, according to Chinese health officials. The demand has spawned rampant abuses, leading Chinese legislators to push for reform
Corte na saúde pode ir a R$8,4 bilhões
Pena de morte e aborto: a maioria incoerente domina a cena.
(4) a favor da pena de morte e contra o aborto: posição da maioria da população, encampada pela direita tradicional (ainda existe??), posição que venceria um plebiscito hoje ou nos próximos anos. Posicionamento em relação à vida: incoerente.
domingo, 8 de abril de 2007
Arquivos Brasileiros de Cardiologia com indexação no Current Contents
sábado, 7 de abril de 2007
"O intelectual brasileiro tem obsessão pelo fracasso".
The New York Times inicia série sobre as 6 principais doenças.
Ginecologistas brasileiros e a Reposição Hormonal
OBJECTIVE: The objective of this study was to evaluate gynecologists' knowledge of the WHI study, and its repercussions on their attitudes and practice 3 years after publication. DESIGN: A self-administered, anonymous questionnaire containing 19 questions was sent to 6000 gynecologists, members of the Sao Paulo Society of Obstetrics and Gynecology. RESULTS: The response rate was 24.2% (1453 completed questionnaires) with a sample error of 2.23% and confidence level of 95%. Although 95.9% of the respondents were aware of the WHI study, only 24.4% knew of all the other studies mentioned (HERS I, HERS II and Million Women Study). Although 84.6% stated that the results of the WHI study could not be extrapolated to other forms of HT, 23.1% and 25.2%, respectively, stopped prescribing CEE or MPA, 63.7% decreased the dose, 55.2% opted for drugs such as bisphosphonates, tibolone and SERMS, and 46.3% began to prescribe tranquilizers, isoflavone and other natural medications. Moreover, 59.2% agreed that HT should be used for only 4-5 years. Prescriptions decreased significantly for all indications (p<0.0001).> A high percentage of gynecologists in this study knew of the WHI study and followed its recommendations concerning cardiovascular prevention; consequently they changed their management of the treatment of postmenopausal women by restricting indications for HT and decreasing its duration of use and dose.
sexta-feira, 6 de abril de 2007
Rio Grande do Sul: as maiores taxas de câncer de pulmão.
quinta-feira, 5 de abril de 2007
Um caso de corrupção na China: exceção ou regra na aprovação de medicamentos?
quarta-feira, 4 de abril de 2007
A reposição hormonal: nada de novo no front.
Ontem, JAMA publicou mais uma análise do ensaio clínico Women´s Health Initiative. Essa pesquisa foi aplicada em dois tipos diferentes de mulheres: com e sem útero para testa a combinação estrógeno-progestágeno ou somente estrógeno, respectivamente. Os resultados iniciais publicados em 2002 encerraram a carreira da reposição hormonal como prevenção de doença cardiovascular e, ao contrário do que se pensa não contra-indicaram o uso restrito por pouco tempo no início do climatério. O estudo publicado ontem faz uma "mistura" das duas populações para verificar se o uso precoce, próximo à menopausa, não seria protetor, principalmente em mulheres mais jovens. O resultado foi que não há risco para mulheres que começam o uso próximo da menopausa para doença coronariana. Porém, há risco maior de doença cerebrovascular. Porém, os press release somente enfatizam o fato que não há risco de doença coronariana mas, simplesmente não noticiam o aumento de risco da doença cerebrovascular. Como se sofrer um acidente cerebral fosse uma questão menor em relação a ter um infarto do miocárdio. Abaixo, o resumo publicado em JAMA, com destaque para a permanência de risco de doença, não interessa se na coronária ou na carótida.
Postmenopausal Hormone Therapy and Risk of Cardiovascular Disease by Age and Years Since Menopause
Jacques E. Rossouw, MD; Ross L. Prentice, PhD; JoAnn E. Manson, MD, DrPH; LieLing Wu, MSc; David Barad, MD; Vanessa M. Barnabei, MD, PhD; Marcia Ko, MD; Andrea Z. LaCroix, PhD; Karen L. Margolis, MD; Marcia L. Stefanick, PhD JAMA. 2007;297:1465-1477.
Context The timing of initiation of hormone therapy may influence its effect on cardiovascular disease. Objective To explore whether the effects of hormone therapy on risk of cardiovascular disease vary by age or years since menopause began.
Design, Setting, and Participants Secondary analysis of the Women's Health Initiative (WHI) randomized controlled trials of hormone therapy in which 10 739 postmenopausal women who had undergone a hysterectomy were randomized to conjugated equine estrogens (CEE) or placebo and 16 608 postmenopausal women who had not had a hysterectomy were randomized to CEE plus medroxyprogesterone acetate (CEE + MPA) or placebo. Women aged 50 to 79 years were recruited to the study from 40 US clinical centers between September 1993 and October 1998. Main Outcome Measures Statistical test for trend of the effect of hormone therapy on coronary heart disease (CHD) and stroke across categories of age and years since menopause in the combined trials. Results In the combined trials, there were 396 cases of CHD and 327 cases of stroke in the hormone therapy group vs 379 cases of CHD and 239 cases of stroke in the placebo group. For women with less than 10 years since menopause began, the hazard ratio (HR) for CHD was 0.76 (95% confidence interval [CI], 0.50-1.16); 10 to 19 years, 1.10 (95% CI, 0.84-1.45); and 20 or more years, 1.28 (95% CI, 1.03-1.58) (P for trend = .02). The estimated absolute excess risk for CHD for women within 10 years of menopause was –6 per 10 000 person-years; for women 10 to 19 years since menopause began, 4 per 10 000 person-years; and for women 20 or more years from menopause onset, 17 per 10 000 person-years. For the age group of 50 to 59 years, the HR for CHD was 0.93 (95% CI, 0.65-1.33) and the absolute excess risk was –2 per 10 000 person-years; 60 to 69 years, 0.98 (95% CI, 0.79-1.21) and –1 per 10 000 person-years; and 70 to 79 years, 1.26 (95% CI, 1.00-1.59) and 19 per 10 000 person-years (P for trend = .16). Hormone therapy increased the risk of stroke (HR, 1.32; 95% CI, 1.12-1.56). Risk did not vary significantly by age or time since menopause. There was a nonsignificant tendency for the effects of hormone therapy on total mortality to be more favorable in younger than older women (HR of 0.70 for 50-59 years; 1.05 for 60-69 years, and 1.14 for 70-79 years; P for trend = .06).
Conclusions Women who initiated hormone therapy closer to menopause tended to have reduced CHD risk compared with the increase in CHD risk among women more distant from menopause, but this trend test did not meet our criterion for statistical significance. A similar nonsignificant trend was observed for total mortality but the risk of stroke was elevated regardless of years since menopause. These data should be considered in regard to the short-term treatment of menopausal symptoms.