Uma semana fora e, um assassino preso e outro solto.

Estive em várias atividades e compromissos na semana que se encerra. Dois eventos quase ao mesmo tempo em Brasília, mostrando que o Ministério da Saúde assume cada vez mais a direção da pesquisa e da educação na área.

No entanto, o motivo desse post é fazer eco com aqueles que querem punições severas aos crimes de trânsito. Além da lamentável morte de Rodrigo, o episódio provocou suspensão de cirurgias no Hospital, danos materiais a outro motorista etc etc. Um criminoso foi preso, mas outro está à solta à espreita para um novo assasinato...... A grande imprensa paulista não deu a mínima para o ocorrido

Meus cumprimentos às equipes de resgate, da PM e, obviamente a equipe do pronto-socorro do HU.
Jovem é preso por morte de analista durante racha
Plantão Publicada em 31/05/2008 às 10h24mAiuri Rebello, Diário de S. Paulo
SÃO PAULO - O autônomo Thiago da Matta Rossi Faria, de 25 anos, foi preso em flagrante quando estava em observação no pronto-socorro do Hospital Albert Einstein, na zona oeste de São Paulo, na tarde de quarta-feira, após se envolver em um acidente de trânsito que resultou na morte do analista de sistemas Rodrigo Neves de Melo, de 25 anos, naquela manhã. Faria é acusado de ter causado o acidente durante um racha. A defesa do rapaz nega.
Por volta das 6h30 de quarta, Faria guiava um Subaru Impreza prateado em alta velocidade, na contramão da Rua Dr. Luiz Migliano, no Morumbi, na zona sul. De acordo com quatro testemunhas que estavam no local, ele vinha em alta velocidade (acima dos 120 quilômetros por hora) e apostava racha com um Audi preto. A via é estreita e de mão dupla. O limite de velocidade no local é de 30 km/h. Por cerca de 700 metros, os dois carros teriam ficado várias vezes emparelhados, em uma disputa acirrada.
Na altura da esquina com a Rua Dr. José de Andrade Figueira, em um trecho de ladeira, o Audi bateu na traseira no Subaru (que o havia fechado), perdeu o controle e se chocou violentamente de lado em um Palio que subia a rua, guiado por Rodrigo Neves de Melo. Com o impacto, o Palio foi prensado contra um furgão que vinha atrás dele. O Subaru ainda rodopiou e se chocou contra um muro em frente ao local, destruindo-o. O motorista do Audi fugiu. Nenhuma testemunha anotou a placa.
O analista de sistemas foi levado pelo helicóptero Águia, da Polícia Militar, para o Hospital Universitário da USP, na zona oeste. Ele morreu horas depois, por volta das 11h30, de politraumatismo. Melo estava indo para o trabalho.
De acordo com a vigilante Michele dos Santos, de 23 anos, que trabalha próximo ao local do acidente, chamava a atenção o ronco dos motores dos dois carros importados. Ela ficou com medo até que eles perdessem o controle dos veículos e batessem na cabine onde ela estava. Os carros estariam "rachando" de forma evidente.
Faria foi levado pelo Serviço Atendimento Móvel de Urgência (Samu) para o hospital particular Albert Einstein. Baseado nos depoimentos das testemunhas, o delegado Walter Ferrari foi ao hospital e prendeu em flagrante por homicídio doloso (com intenção). Além disso, no veículo do jovem foi encontrada uma pequena quantidade de maconha.
- Quando a pessoa assume riscos, como tirar racha, e coloca a vida dos outros em perigo conscientemente, pode ser presa e acusada de ter praticado o crime de propósito - disse o delegado-assistente do 89º Distrito Policial (Portal do Morumbi), Celso Lahoz Garcia. Faria está preso no Centro de Detenção Provisória de Osasco, em cela comum.
O advogado Maurício Ozi, que defende Faria, diz que seu cliente não participava de racha. Segundo ele, o jovem estaria sendo perseguido pelo Audi preto, daí a alta velocidade. De acordo com o advogado, Faria foi abordado pelo carona do Audi em um semáforo, um quarteirões antes do local do acidente. Esse outro motorista carregaria um revólver na mão e teria anunciado o assalto, de dentro do carro.
- A rua é de mão dupla, estreita e cheia de lombadas. Se fosse um racha, não seria num local tão inadequado - argumenta Ozi.
Sobre a droga, o defensor diz que seu cliente não sabe como o material foi parar no carro, e que alguém deve ter colocado o entorpecente ali. Faria estaria voltando para casa, após passar a noite em seu escritório.

Uma "doença" que se esvai....a síndrome metabólica

In today's Lancet, Naveed Sattar and co-workers put yet another nail in the coffin of the metabolic syndrome. (VER POST ANTERIOR) Their analysis of longitudinal data from two independent population-based cohorts, which document the incidence of cardiovascular events or diabetes in elderly patients, shows that a fasting plasma glucose test is as good as or potentially better than a diagnosis of the metabolic syndrome for predicting diabetes. They also show that a diagnosis of the metabolic syndrome has negligible association with risk of cardiovascular disease; and that the whole is not greater than the sum of the parts. Thus diagnosis of the metabolic syndrome has no apparent clinical value.
In the joint statement from the American Diabetes Association and the European Association for the Study of Diabetes on the metabolic syndrome, eight major concerns were identified. Since then, other commentaries support the concept of the metabolic syndrome or, conversely, provide additional perspectives that concerns raised in the statement were justified.Panel. Summary of concerns about the metabolic syndrome2
• Criteria are ambiguous or incomplete; rationale for thresholds is ill-defined
• Value of including diabetes in definition is questionable
• Insulin resistance as unifying cause is uncertain
• No clear basis for including or excluding other cardiovascular risk factors
• Cardiovascular risk value is variable and dependent on specific risk factors present
• Cardiovascular risk associated with the syndrome seems to be no greater than sum of its parts
• Treatment of syndrome is no different from treatment for each of its components
• Medical value of diagnosing the syndrome is unclear

Importantly, critics of the metabolic syndrome do not question or doubt the evidence that many risk factors of cardiovascular disease are found more often in combination than chance would dictate. Thus identification of one risk factor for cardiovascular disease in a patient should prompt the search for others—even those not in the syndrome's construct. Moreover, there is no argument that results from many studies show that metabolic syndrome factors by themselves, or in any combination, portend cardiovascular disease and many other adverse outcomes. It is well known that elevated blood glucose, obesity, increased blood pressure, or dyslipidaemia are serious.
Substantial evidence also shows that insulin resistance plays an important part in risk-factor clustering, and probably contributes in some way to many of the untoward outcomes attributed to the metabolic syndrome. Indeed, nearly everyone agrees that lifestyle modification is a helpful intervention for those who have one or any combination of the syndrome's components and other risk factors for cardiovascular disease or diabetes (eg, raised LDL cholesterol, smoking).
On the other hand, sceptics of the usefulness of the metabolic syndrome's construct would like evidence that diagnosis of an individual with the syndrome somehow focuses attention on the need for lifestyle therapy that would otherwise be ignored or missed. They would also like evidence that such a diagnosis informs clinicians that cardiovascular disease is a multiple risk-factor model of a form they would otherwise not know, or that the diagnosis conveys the seriousness of obesity in a way not currently appreciated. They would also like evidence that the diagnosis inspires patients to take action and be more adherent to therapy than if they were diagnosed with one or more risk factors, but not the metabolic syndrome. And that the diagnosis results in a treatment that would otherwise not be recommended for modifiable risk factors, and that the construct is a valuable risk-assessment method to identify patients at increased risk of cardiovascular disease or diabetes.
More than a decade since its formal introduction and thousands of papers later, these six propositions—promulgated by the proponents of the syndrome—remain no more than intriguing thoughts. However, the last argument—ie, metabolic syndrome is valuable for risk assessment and therefore its identification will improve patients' outcomes—is often considered as the syndrome's greatest strength.
That people with metabolic syndrome are at increased risk of cardiovascular disease events or diabetes does not mean that the construct is useful for risk prediction in itself or compared with other approaches. First, as reviewed by Pepe and colleagues, odds ratios or relative risks regarded as giving strong associations in observational studies (eg, odds ratios of 1·2–2·5) are inadequate to distinguish between people who do (will) or do not (will not) have the outcome of interest. Much stronger associations are needed (eg, ≥4·0). Second, many reports compare metabolic syndrome with much simpler risk-assessment tests for cardiovascular disease, and those risk-assessment tests are significantly better. and Additionally, a simple fasting plasma glucose measurement is a much better predictor of future diabetes than the expense and inconvenience necessary to diagnose the syndrome.]
What seems to make most sense is for clinicians to focus on global risk assessment that takes into account all the well-established cardiometabolic risk factors (and then to treat each abnormality appropriately. Also, more research is needed to understand the cause of risk-factor clustering and the pathogenesis of insulin resistance. Both actions would better serve the health of those at risk of diabetes and cardiovascular disease than seeking a diagnosis of the metabolic syndrome.

Diabetes e Sindrome Metabólica

Na edição do The Lancet dessa semana, http://www.thelancet.com para quem se inscrever e, com acesso livre para assinantes do Science Direct vários artigos de folego sobre diabetes e a tal da síndrome metabólica.Vale o passeio nesse final de feriado.

Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies
Background: Clinical use of criteria for metabolic syndrome to simultaneously predict risk of cardiovascular disease and diabetes remains uncertain. We investigated to what extent metabolic syndrome and its individual components were related to risk for these two diseases in elderly populations.
Methods We related metabolic syndrome (defined on the basis of criteria from the Third Report of the National Cholesterol Education Program) and its five individual components to the risk of events of incident cardiovascular disease and type 2 diabetes in 4812 non-diabetic individuals aged 70–82 years from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). We corroborated these data in a second prospective study (the British Regional Heart Study [BRHS]) of 2737 non-diabetic men aged 60–79 years.
Findings :In PROSPER, 772 cases of incident cardiovascular disease and 287 of diabetes occurred over 3·2 years. Metabolic syndrome was not associated with increased risk of cardiovascular disease in those without baseline disease (hazard ratio 1·07 [95% CI 0·86–1·32]) but was associated with increased risk of diabetes (4·41 [3·33–5·84]) as was each of its components, particularly fasting glucose (18·4 [13·9–24·5]). Results were similar in participants with existing cardiovascular disease. In BRHS, 440 cases of incident cardiovascular disease and 105 of diabetes occurred over 7 years. Metabolic syndrome was modestly associated with incident cardiovascular disease (relative risk 1·27 [1·04–1·56]) despite strong association with diabetes (7·47 [4·90–11·46]). In both studies, body-mass index or waist circumference, triglyceride, and glucose cutoff points were not associated with risk of cardiovascular disease, but all five components were associated with risk of new-onset diabetes.
Interpretation: Metabolic syndrome and its components are associated with type 2 diabetes but have weak or no association with vascular risk in elderly populations, suggesting that attempts to define criteria that simultaneously predict risk for both cardiovascular disease and diabetes are unhelpful. Clinical focus should remain on establishing optimum risk algorithms for each disease

Doenças negligenciadas: Big Pharma não se dá tão mal quanto seus defensores brasileiros alegam

Em tradução livre: pântano ou mina de ouro? Aquilo que seria custoso e sem sentido para os interesses da Big Pharma pode ser uma fonte rentável: o mercado de países como Brasil, China e Índia, por exemplo, mesmo com quebra de patentes. Pela importância, reproduzo na íntegra o texto do The Economist.

PS: destaco a volta do senhor Yamada, agora na Gates Foundation, já motivo de comentários nesse blogue.

Quagmire to goldmine? May 15th 2008 NEW YORK From The Economist print edition
The rapid growth in developing countries prompts a rethink by drugs companies
Illustration by David Simonds
BRAZIL has long been a thorn in the side of the global drugs companies. The country's vibrant generics industry has often trampled over their patents. As recently as last year, its government threatened to invoke compulsory licensing (a legal mechanism that, in effect, legitimises such trampling) to browbeat a foreign drugs firm into offering huge discounts. And Brazil's state-funded researchers have devised some impressive drugs, including a new therapy for malaria (see article). Small wonder, then, that big drugs firms have remained leery of this market.
Indeed, they have been cautious about developing countries in general, which they have regarded as the source of many headaches and few profits. A decade ago Britain's GlaxoSmithKline (GSK) got a bloody nose in South Africa when it tried too vigorously to defend patents on an HIV drug. More recently Novartis, a Swiss firm, lost a bitter battle in India over patent protection for Gleevec, a profitable cancer drug. In Thailand the government has invoked compulsory licensing for some drugs. And next week the industry can expect another drubbing over patents harming “innovation for the poor” at the World Health Organisation's annual assembly.
But consider the story of Moksha8, a new drugs firm launched last month with money from Texas Pacific Group, a private-equity outfit. It aims to capitalise on Big Pharma's neglect of many emerging economies by striking licensing deals for branded drugs which it, in turn, intends to market to affluent customers in those countries. It already has some two dozen drugs under licence for Brazil from Roche and Pfizer. Fernando Reinach of Votorantim, a Brazilian firm that also invested in Moksha8, expects its annual sales to top $1 billion within a year or two.
All of which suggests that the situation is ripe for change. For much of its history, the industry has focused chiefly on the diseases that afflict people in rich countries, while largely neglecting research into diseases of the poor. But as growth slows in developed markets, and the twin threats of generic drugs and price controls advance even in pharma-friendly America, drugs companies are thinking again.
That is not simply because governments in developing countries are wielding the big stick of busting patents: their expanding middle classes also provide a tantalising carrot. McKinsey, a consultancy, estimates that the value of the Indian drugs market will grow from $6.3 billion in 2005 to $20 billion in 2015. China's market is expected to soar even more spectacularly. Given such prospects for growth, says Mark Feinburg of Merck, an American drugs giant, “you've got to be in these markets—it's a great opportunity.”
G.V. Prasad, vice-chairman of Dr Reddy's, a successful Indian drugs firm that is evolving from copycat to innovator, is convinced that the thinking at Western firms is changing, and cites a recent reorganisation at GSK as evidence. Andrew Witty, who takes over as the firm's chief executive on May 22nd, wants to combine all its little divisions that deal with developing countries into one emerging-markets group, to be run by Abbas Hussain, whom he has just poached from Eli Lilly, a rival American firm.
Serving these markets will mean building up local expertise and research efforts. Where drugs firms have set up shop in developing markets, it has generally been to cut costs, rather than to cater to the needs of locals. But that is changing. Novartis has opened a research centre in Shanghai and has another outpost in Singapore focused on tropical diseases. Merck has struck several deals with firms in emerging markets to do early-stage research. The drugs giants argue that this new approach allows them to tap a global network of innovation, and also provides insights into local markets.
Paul Herrling of Novartis points out that virally induced cancers are rare in Europe but common in China. Terry Hisey of Deloitte, a consultancy, notes that Asians and Europeans can respond differently to anaesthesia. “We see China and India as research-and-development partners, and partnerships can help us learn how to do business there,” says Robert Court of GSK.
New thinking is also needed when deciding how to sell drugs in developing countries. In the past Western firms either ignored such countries or saw them as charity cases. But now, says Tachi Yamada of the Gates Foundation, who was at GSK when the firm faced the South African backlash over HIV drugs, “pharma companies can't possibly survive without recognising their responsibilities to the poor.”
Some firms have adopted “differential pricing” schemes that use formulas, based on average income per head, to set lower prices in poor countries. Merck, for example, recently launched Januvia, a blockbuster diabetes drug, in India for a fraction of the price it charges in America. But in future, says Prashant Yadav of the Massachusetts Institute of Technology, firms must “price differentially not between OECD and developing-country markets, but within each developing-country market.” In other words, middle-class Indian patients will pay more than the rural poor.
Both Novartis and GSK say they are thinking along these lines. But is there not a danger that cheap drugs intended for the poorest will be pilfered and sold at a profit to the urban middle classes, or shipped overseas to rich countries? This has been the standard argument against differential pricing from the drugs companies.
Once again attitudes are shifting. Some diversion will happen, but firms that have tried tiered pricing have found ways to reduce it. Just changing the colour of a pill can help. So too can after-market checks on distributors and pharmacists by drugs companies: those selling looted products may be cut off from future distribution. Nan Wang of Sinovac Biotech, a Chinese vaccine firm, says her company has long sold the same vaccine at lower prices in poor parts of China than in rich cities; the two versions have different packaging.
But not everyone is convinced. “In the absence of competition, differential pricing is a hoax,” scoffs Yusuf Hamied, chairman of Cipla, an Indian generics firm. In his view, only generics-makers like his firm provide genuine competition to Big Pharma, which he insists should have no patent rights in poor countries. Even if the drugs giants really have changed their approach to the developing world, the arguments over their rights and responsibilities will continue to rage.

Há quase 40 anos em uma garagem no Ipiranga

ONGs, o braço ativista da Big Pharma

Esse blogue sempre afirmou que as ONGs que afirmam defender os direitos dos doentes são extensão dos departamentos de marketing da Big Pharma. Nesse domingo, a Folha de S. Paulo traz reportagem mostrando que 11 ONGs brasileiras endossam qualquer tipo de proposta que não quebre patentes da Big Pharma. Quem quiser ver a lista, consulte a Folha de S. Paulo. Uma das ONGs é lobista não somente de medicamentos como também de equipamentos diagnósticos e, possui forte influência no legislativo. Outra tem a mesma assessoria de imprensa da empresa que ela defende o uso de medicamentos. Mais detalhes no site do Essential Action.

Qual a cotação do rim em Karachi ? e, em Manila?

A bolsa de órgãos de Karachi ou de Manila irão regular o mercado de órgãos e haverá também o mercado futuro. O sarcasmo é a única resposta aos fatos relatos nesse post do WSJ.

Cash, Not Goodwill, Can Solve Organ Shortage. Posted by Scott Hensley
Gavin Carney, an Australian nephrologist, has a solution for the perennial shortage of kidneys for transplant: let people sell theirs for $50,000. “We’ve tried everything to drum up support” for organ donation, Carney told the Sydney Morning Herald, but “people just don’t seem willing to give their organs away for free.” Plus, let’s be realistic, the advocates of the new approach argue. There already is a market for organs; it just happens to be a shady one. Some Australians, unable to get kidneys at home, travel to Pakistan and India to buy organs on the black market. Forget about ethics or even good clinical practices in that sort of transaction. Sally Satel, an American psychiatrist and the recipient of a kidney from a friend, thinks Carney’s on the right track, she writes on the opinion pages of the WSJ. She points to World Health Organization estimates that 5% to 10% of transplants performed each year occur in “clinical netherworlds” in China, Colombia, Egypt Pakistan and the Philippines. “The way to stop illicit transactions – and the depredations of underground markets – is to sanction legal exchanges,” she argues.
There are worries, of course, that monetary incentives for organs in Australia or America would simply shift exploitation of the desperately poor onshore from less developed countries. To minimize that risk, Satel and Carney suggest careful screening of donors and longer-term rewards rather than lump sums for donations. Those might include a down payment on a house, money for a retirement fund, or even lifetime health insurance.
How much money would it take? A couple of years ago, economists Gary Becker and Julio Elias of put the “going price” at about $15,000 for kidneys and about $35,000 for livers, though they acknowledged the data for those figures were limited. Even if those guesstimates were too low, payment for organs wouldn’t dramatically affect the total cost of transplants, which run about $100,0000 for kidneys and $175,000 for livers.

A nova pirâmide da dieta saudável

A Harvard School of Public Health lançou nova pirâmide para indicar quais os alimentos mais saudáveis. Quem quiser acesse o programa Healthy Eating Program onde a proposta é apresentada. A pirâmide da Harvard é baseada em um série imensa de estudos que justificam as prioridades apresentadas. No entanto, para quem verificar os cinco steps reproduzidos abaixo, há um ponto bastante controverso, o de número 5. O uso de multivitamínicos tem pouca base, embora a recomendação é para suplementar com vitamina D. Mas, o pior é sugerir a ingestão de bebida alcóolica, apesar da precaução adotada no texto. Eu gosto muito das sugestões apresentadas, mas ficaria com 4 etapas, somente. Uma adaptação ao Brasil da proposta pode ser lido no How Stuff Works, Alimentação saudável no Brasil escrito pela Professora da Faculdade de Medicina, Isabela Bensenor (isabensenor@hu.usp.br) ou no livro "Orientação Nutricional: perda de peso e saúde cardiovascular" da mesma autora.

1. Start with exercise. A healthy diet is built on a base of regular exercise, which keeps calories in balance and weight in check. 2. Focus on food, not grams. The Healthy Eating Pyramid doesn’t worry about specific servings or grams of food, so neither should you. It’s a simple, general guide to how you should eat when you eat. 3. Go with plants. Eating a plant-based diet is healthiest. Choose plenty of vegetables, fruits, whole grains, and healthy fats, like olive and canola oil. 4. Cut way back on American staples. Red meat, refined grains, potatoes, sugary drinks, and salty snacks are part of American culture, but they’re also really unhealthy. Go for a plant-based diet rich in non-starchy vegetables, fruits, and whole grains. And if you eat meat, fish and poultry are the best choices. 5. Take a multivitamin, and maybe have a drink. Taking a multivitamin can be a good nutrition insurance policy. Moderate drinking for many people can have real health benefits, but it's not for everyone. Those who don’t drink shouldn’t feel that they need to start. For more information, read "Alcohol: Balancing Risks and Benefits."

A noite da manipulação no complexo médico-industrial-midiático.

Todo ano é a mesma coisa, a reunião da ASCO provoca asco. Trata-se maior manipulação da informação no complexo médico-industrial-midiático. Há dez anos houve um caso exemplar: um mero abstract alavancou muito as ações de uma empresa farmacêutica devido ao potencial efeito do medicamento envolvido. Quando o paper foi publicado, o resultado era desapontador. Mas, quem já tinha ganho na alta .....Abaixo, post do blogueiro do The Wall Street Journal.

Wall Street Drug Analysts to Pull All-Nighter Tomorrow Posted by Jacob Goldstein
Tomorrow night, at 9 p.m. Eastern, American Society of Clinical Oncology is going to release the results of thousands of cancer studies that will be presented at the group’s big annual meeting. At least a few of those are likely to be market-moving, especially the ones that involve small biotechs whose future rests on a single cancer drug. But the trick is finding the market-moving needles in a haystack of data — and doing it before the markets open Friday morning. Michael King, a biotech analyst at Rodman & Renshaw, figures he’ll stay up all night looking through the data, trying to see what it will mean for companies such as Regeneron and Onyx, Bloomberg reports. And he figures scores of his rival analysts are likely to do the same. In the past, ASCO sent out abstract books to member doctors a few weeks before the conference, but the data were supposed to remain secret until they were presented at the conference. This led to some allegations that people were trading on data that were supposedly still under wraps. So ASCO decided this year to eliminate the embargo problem altogether. King told Bloomberg he prefers the new system. “Although it’s a pain, putting it out on the Web for everyone to see is the best way to do it,” he said. Of course, some analysts aren’t waiting for the abstracts to make bets about what the data will hold. Morgan Stanley analyst Steven Harr on Monday lowered his rating on ImClone, which makes the cancer drug Erbitux. The company’s stock fell more than 7% Monday, before recovering a bit yesterday.

Mais um argumento para controle da propaganda de cervejas: o dono do bêbado é o bandido

Por pudor, não declamarei o ditado popular sobre o que acontece com bêbados. Mas, pesquisadores canadenses mostraram com um estudo muito elegante que há risco aumentado em ser vítima de assalto ou briga, aquele que consome álcool. Superior, mesmo ao risco de acidente de trânsito. Uma resenha do artigo pode ser lido no Plos Medicine com acesso livre.

Não podemos esquecer a grande contribuição dos nossos legisladores pró-violência do lobby das cervejeiras. , os mesmos que denunciarão nas campanhas eleitorais, a "leniência da justiça" e "ineficiência da polícia" em conter a violência. Ou, então dos publicitários dândis que faturam os tubos com publicidade de cerveja e, depois inventam "movimentos pela paz" para conter a violência. A hipocrisia sobre o uso de drogas e violência muito bem apresentada em "Tropa de Elite" é a mesma dos nossos legisladores e publicitários do lobby cervejeiro.

DST em Vitória, ES e, a prevalência da prostituição.

Um artigo com resultados esperados, outros supreendentes sobre a prevalência de doenças sexualmente transmissíveis em mulheres jovens de Vitória, ES. A autora Angélica Espinosa poderá fornecer o artigo completo em espinosa@ndi.ufes.br. Esses dados merecem ser repetidos em outros locais. Confesso que por ignorância ou por falta de dados, descobri a prevalência da prostituição:1,4%.
Population-based Survey of the Prevalence of HIV, Syphilis, Hepatitis B and Hepatitis C Infections, and Associated Risk Factors Among Young Women in Vitória, Brazil AIDS and Behavior, 05/13/08

Objective To estimate the prevalence of HIV, hepatitis B (HBV) and C (HCV), and syphilis infections and associated risk exposures in a population-based sample of young women in Vitória, Brazil. Methods From March to December 2006, a cross-sectional sample of women aged 18–29 years was recruited into a single stage, population-based study. Serological markers of HIV, HBV, HCV, and syphilis infections and associated risk exposures were assessed. Results Of 1,200 eligible women, 1,029 (85.8%) enrolled. Median age was 23 (interquartile range 20–26) years; 32.2% had ≤8 years of education. The survey weighted prevalence estimates were: HIV, 0.6% [(95% CI), 0.1%, 1.1%]; anti-HBc, 4.2% (3.0%, 5.4%); HBsAg, 0.9% (0.4%, 1.6%); anti-HCV, 0.6% (0.1%, 1.1%), and syphilis 1.2% (0.5%, 1.9%). Overall, 6.1% had at least one positive serological marker for any of the tested infections. A majority (87.9%) was sexually active, of whom 12.1% reported a previously diagnosed sexually transmitted infection (STI) and 1.4% a history of commercial sex work. Variables independently associated with any positive serological test included: older age (≥25 vs. <25>4× minimum wage), previously diagnosed STI, ≥1 sexual partner, and any illicit drug use. Conclusions These are the first population-based estimates of the prevalence of exposure to these infectious diseases and related risks in young women, a population for whom there is a scarcity of data in Brazil.

Mais uma epidemia com mortes na China

Ok, faz de conta que aceitamos as explicações da OMS segundo divulgado hoje na imprensa mundial. Quem quiser saber mais sobre a doença, clique aqui, para ver a síntese do CDC.

Para quem não estava atento, reproduzo resumo de artigo da Folha de S.Paulo, retirado de "OFiltro" em 04 de maio: Uma epidemia de um vírus intestinal já matou 22 crianças e infectou 4.529 numa província do leste da China. As primeiras 12 vítimas do EV71, que causa a doença de febre aftosa humana – sem relação com a bovina-, morreram entre março e abril, mas o governo chinês só divulgou agora. O vírus causa febre, aftas e bolhas nas mãos e nos pés. Nos casos mais graves, causa paralisia e edema pulmonar. Atinge especialmente crianças com menos de 6 anos. Há 978 crianças internadas, 48 em estado grave. Foram registrados 500 novos casos apenas entre sexta-feira e sábado. A demora na divulgação da epidemia, repete o episódio da gripe aviária, em que o governo chinês foi muito criticado por autoridades de saúde do mundo todo

WHO Backs China's Reporting of Fatal Virus. By Jason Leow
BEIJING -- The World Health Organization's China representative said he doesn't believe China covered up initial cases of the hand, foot and mouth disease that has infected almost 16,000 people and led to 28 deaths. Hans Troedsson, the WHO's China representative, said at a news conference Wednesday that there was a delay in releasing information about the outbreak because initial cases brought to Chinese clinicians' showed atypical symptoms. He said authorities hadn't thought to test the cases for a virus that causes hand, foot and mouth disease and instead focused on testing for severe acute respiratory syndrome and avian flu

Lobby cervejeiro, dos acidentes, da violência, da cirrose...

Na Folha de S. Paulo, hoje.

Levantamento na Câmara aponta que, dos 513 parlamentares, 87 (16,96%) estão ligados a empresas com interesses contrários à regulamentação da publicidade de cerveja, revela reportagem de Angela Pinho e Maria Clara Cabral publicada neste sábado na Folha (íntegra disponível para assinantes do UOL e do jornal).
A pesquisa, realizada pela Folha a partir de dados do TSE (Tribunal Superior Eleitoral), mostra que quase um em cada cinco deputados têm concessões de rádio e televisão e/ou receberam doações de campanha da indústria de bebidas e de comunicação --que em 2006 superou os R$ 2 milhões. Nesta semana, o projeto que restringe a propaganda de bebidas com baixo teor alcoólico, inclusive a cerveja, entre as 6h e as 21h em rádio e televisão, foi retirado da pauta de votações da Câmara, a pedido do governo, após resistência de líderes partidários. Há mais de um mês, representantes da indústria de cerveja e de emissoras de rádio e TV vão ao Congresso quase diariamente para fazer lobby pela derrubada da proposta --bandeira do ministro José Gomes Temporão (Saúde). Outra reportagem publicada na Folha (íntegra disponível para assinantes) revela que representantes das emissoras de televisão admitem ter feito lobby no Congresso para o adiamento da votação do projeto. Os deputados, por sua vez, negam ter sucumbido a interesses econômicos.

A desgraça do pagamento diferenciado para procedimentos médicos

The Wall Street Journal aborda hoje um assunto que é de conhecimento há muito tempo dos médicos brasileiros. Especialidades que realizam procedimentos são desproporcionalmente mais bem remuneradas comparada àquelas onde não há procedimento diagnóstico ou terapêutico.

A reportagem cita redução do número de reumatologistas, pneumologistas, endocrinologistas e neurologistas.

Do excelente "O Filtro", resumindo notícia da Folha de S.Paulo:

Uma epidemia de um vírus intestinal já matou 22 crianças e infectou 4.529 numa província do leste da China. As primeiras 12 vítimas do EV71, que causa a doença de febre aftosa humana – sem relação com a bovina-, morreram entre março e abril, mas o governo chinês só divulgou agora. O vírus causa febre, aftas e bolhas nas mãos e nos pés. Nos casos mais graves, causa paralisia e edema pulmonar. Atinge especialmente crianças com menos de 6 anos. Há 978 crianças internadas, 48 em estado grave. Foram registrados 500 novos casos apenas entre sexta-feira e sábado. A demora na divulgação da epidemia, repete o episódio da gripe aviária, em que o governo chinês foi muito criticado por autoridades de saúde do mundo todo.

A pesquisa Datafolha: crime e violência são diferentes

Resumo do problema apresentando pelo O Filtro:

O Datafolha, para marcar seus 25 anos de existência, repetiu sua primeira pesquisa de opinião pública. Em 1983, o principal medo dos paulistanos era o custo de vida. Hoje, não há nenhuma preocupação de ordem econômica entre os cinco primeiros lugares. O que preocupa é a violência. E, pelos números, não haveria motivo para isso. Em 1983, 12,8 pessoas em cada 100 mil eram assassinadas em São Paulo. No ano passado, foram 11,8. A resposta parece estar no passado mais recente. Esse índice cresceu até 1999, quando se registraram 28,4 homicídios/100 mil. Desde então a taxa de homicídios vem caindo.

Comento: além das sequelas da epidemia de homicídios há outro aspecto importante a ser considerado. Homicídio é parte da violência, mas a sua manifestação mais rara e, restrita a grupos sociais, como homens jovens pobres. Há inúmeros exemplos de sociedades com baixa taxa de homicídio e, altas taxas de roubos, assaltos e violência sexual. Esse fato lembra livro de impacto relativamente grande publicado há onze anos nos Estados Unidos onde os fatos eram muito semelhantes a São Paulo de 2008. O livro de Franklin Zimring e Gordon Hawkins, Crime Is Not The Problem, Lethal Violence in America (Oxford University Press, 1997) merece ser relido e, analisado com os dados brasileiros atuais.

Chamou-me a atenção de fatos interessantes como a comparação entre Nova Iorque e Londres. Apesar das taxas menores de homicídio em Londres em 1990, a capital britânica registrava 66% a mais de roubos e 57% a mais de furtos do que Nova Iorque. Há outra comparação também entre Los Angeles e Sidnei com resultados semelhantes.

Desrespeito ao médico brasileiro: ezitimiba

Duas vezes citei a grande fanfarronice da Big Pharma no estudo Enhance e, na comercialização da Ezitimiba. Hoje, estive no Congresso da Sociedade de Cardiologia do Estado de São Paulo, o maior evento da especialidade abaixo do Rio Grande e, tal como vários colegas, fiquei surpreso com a cara de pau dos marqueteiros locais da Big Pharma. Estão divulgando o ezitimiba como se os resultados do Enhance não tivessem sido publicados e divulgados.

Caramba, carambola...

Divulgou-se (veja aqui) que na cidade de Jaú o suco de carambola foi proibido pela Câmara Municipal. Faz sentido considerando o conhecimento adquirido e publicado pela equipe da Faculdade de Medicina da USP em Ribeirão Preto cujo artigo completo pode lido clicando aqui. Destaquei esse fato para mostrar como a cadeia: (1) observação clínica;(2) estudo epidemiológico; (3) proposta de saúde pública. Com o aumento da vida média da população, a função renal média também se reduzirá e, os riscos aumentarão.

Um belo trabalho de "los hermanos": IECS

Abaixo, trabalho original publicado no The New England Journal of Medicine realizado pelos "hermanos porteños". O conteúdo é muito bom, mas o destaque aqui no blogue vai pela trabalho do Instituto de Efectividad Clínica y Sanitaria da Argentina. Infelzmennte, não temos nada ainda definido nessa área no país.

Behavioral Intervention to Improve Obstetrical Care
Fernando Althabe, M.D., Pierre Buekens, M.D., Eduardo Bergel, Ph.D., José M. Belizán, M.D., Marci K. Campbell, Ph.D., Nancy Moss, Ph.D., Tyler Hartwell, Ph.D., Linda L. Wright, M.D., for the Guidelines Trial Group ABSTRACT Background Implementation of evidence-based obstetrical practices remains a significant challenge. Effective strategies to disseminate and implement such practices are needed.
Methods We randomly assigned 19 hospitals in Argentina and Uruguay to receive a multifaceted behavioral intervention (including selection of opinion leaders, interactive workshops, training of manual skills, one-on-one academic detailing visits with hospital birth attendants, reminders, and feedback) to develop and implement guidelines for the use of episiotomy and management of the third stage of labor or to receive no intervention. The primary outcomes were the rates of prophylactic use of oxytocin during the third stage of labor and of episiotomy. The main secondary outcomes were postpartum hemorrhage and birth attendants' readiness to change their behavior with regard to episiotomies and management of the third stage of labor. The outcomes were measured at baseline, at the end of the 18-month intervention, and 12 months after the end of the intervention.
Results The rate of use of prophylactic oxytocin increased from 2.1% at baseline to 83.6% after the end of the intervention at hospitals that received the intervention and from 2.6% to 12.3% at control hospitals (P=0.01 for the difference in changes). The rate of use of episiotomy decreased from 41.1% to 29.9% at hospitals receiving the intervention but remained stable at control hospitals, with preintervention and postintervention values of 43.5% and 44.5%, respectively (P<0.001 for the difference in changes). The intervention was also associated with reductions in the rate of postpartum hemorrhage of 500 ml or more (relative rate reduction, 45%; 95% confidence interval [CI], 9 to 71) and of 1000 ml or more (relative rate reduction, 70%; 95% CI, 16 to 78). Birth attendants' readiness to change also increased in the hospitals receiving the intervention. The effects on the use of episiotomy and prophylactic oxytocin were sustained 12 months after the end of the intervention.
Conclusions A multifaceted behavioral intervention increased the prophylactic use of oxytocin during the third stage of labor and reduced the use of episiotomy. (ClinicalTrials.gov number, NCT00070720 [ClinicalTrials.gov] ; Current Controlled Trials number, ISRCTN82417627 [controlled-trials.com] .