Cefaléia em idosos: dados brasileiros.

The prevalence of headache among elderly in a low-income area of São Paulo, Brazil.

Autoria de Isabela M. Benseñor, Paulo A. Lotufo, Alessandra C. Goulart, Paulo R. Menezes e Márcia Scazufca. O texto completo - publicado "on line first" em Cephalalgia - pode ser solicitado à primeira autora em isabensenor@hu.usp.br. Abstract There are scarce data about headache prevalence and its characteristics among elderly people. The aim was to carry out a cross-sectional study to determine the 1-year prevalence of tension-type and migraine headaches in people >65 years old in the city of São Paulo, Brazil. All 1615 people living in the study catchment area who agreed to participate in the study answered a questionnaire based in the International Headache Society criteria. Prevalence (mean and 95% confidence interval) of any type of headache in the last year was 45.6% (43.2, 48.0). Prevalence of tension-type headache in the last year was 33.1% (30.8, 35.4): 28.1% (24.6, 31.6) for men and 36.4% (33.4, 39.4) for women; for migraine headaches, prevalence in the last year was 10.6% (9.1, 12.1): 5.1% (3.4, 6.8) for men and 14.1% (11.9, 16.3) for women. One-year prevalence rates of headaches, and especially of migraine headaches, are very high among the elderly in Brazil.

Big Pharma quer abrir o processo de revisão por pares

A Pfizer por meio de seus advogados pede que The New England Journal of Medicine "abra" o seu processo de revisão. Nada contra a revista, autores ou revisores, somente para ajudar na defesa da empresa. Nobre, não?

Acho que trata-se mais de manobra dos "tubarões" (advogados) do que política institucional da Pfizer. Afinal, qualquer empresa sabe que há momentos nos quais o sigilo é a base do negócio. A revisão por pares na editoria científica é um desses momentos, quando o negócio é a ciência. Abaixo, reproduzo o post do blog to The Wall Street Journal. Porém, o debate aberto nesse post é prá lá de ácido e, repleto de acusações e ressentimentos. Prova que a revisão confidencial por pares tem sua razão de ser e existir.

Pfizer wants the New England Journal of Medicine to turn over confidential peer reviews of certain studies published in the journal — and the company’s filed a motion in federal court to compel the journal to produce the documents. The journal Science writes in an editorial that it’s “a fishing expedition” that could have a chilling effect on scientific publishing. The company says it needs the documents to defend itself in court cases involving its painkillers Celebrex and Bextra, in which plaintiffs lawyers have cited studies published in the NEJM. But the author of the editorial, Donald Kennedy, a former FDA commissioner and the current editor of Science, argues that if Pfizer succeeds it could make scientists wary of reviewing papers submitted to research journals. The peer review process is used to vet papers before publication and is a cornerstone of the research world. Pfizer says the “public has no interest in protecting the editorial process of a scientific journal,” according to a legal filing cited by Kennedy. “Say what?” he responds. “Doesn’t the public want access to credible biomedical science? … Do medical advocacy groups really have no use for knowledge that might help their members?” Kennedy concludes that “if efforts of this kind were to succeed, the sad day might come when Science would have to add a firm caveat emptor to its instructions for peer reviewers.” Pfizer didn’t immediately respond to a request for comment this morning. Update: Pfizer just emailed us a statement. “Subpoenas are a routine part of fact gathering in any litigation by both plaintiffs and defendants,” the statement says. “Indeed, in this litigation, both parties served subpoenas on a number of authors and/or medical and scientific journals.”

Aids e sífilis na China: aumento de casos relatados pode ser um bom sinal

Abaixo, o despacho da Reuters. Não se assustem com aumento de 45% dos casos de aids e 24% nos casos de sífilies. Com grande chance, esses números refletem melhoria substancial no serviço de vigilância epidemiológica ou então na hipótese mais provável, o fim da censura estatal às estatísticas de saúde. Defendo que estatísticas de saúde somente podem ser comparadas entre países democráticos, com imprensa livre, autonomia universitária e ministério público atuante.

China: Rise in AIDS and Syphilis By REUTERS Published: February 23, 2008 China disclosed a large percentage rise for 2007 in diseases transmitted sexually or via blood, including AIDS and syphilis, without reporting exact figures. The number of new AIDS cases rose 45 percent in 2007 from the year before and new syphilis cases rose 24 percent, the Health Ministry said on its Web site. It did not elaborate. China has been battling an acknowledged rise in cases of AIDS and H.I.V., the virus that causes AIDS, now mainly sexually transmitted, though it had said before that the overall rate was slowing. In the past, most cases were caused by intravenous drug use. The government said last year that it estimated that about 700,000 people had H.I.V. or AIDS.

Carros, carros e mais carros

A Folha de S.Paulo noticiou ontem que na cidade de São Paulo há 6 milhões de veículos. Um recorde e tanto. As conseqüências da motorização da vida estão analisadas em Cars, corporations, and commodities: consequences for the social determinants of health com acesso direto. O impacto nas taxas de mortalidade, principalmente atropelamentos em São Paulo foram analisados por mim em outro momento no texto Mortalidade por acidentes de trânsito no Brasil.

A incrível situação da mão de obra na África

leia no The Lancet o artigo completo(precisa de registro, mas é grátis) sobre a situação da mão de obra na área da saúde na África. Parte do texto segue abaixo e, se quiser clique na tabela para verificar os números impressionantes da diferença entre aqueles países e Reino Unido, Austrália, Canadá e Estados Unidos.

High-income countries, such as Australia, Canada, Saudi Arabia, the USA, the United Arab Emirates, and the UK have sustained their relatively high physician-to-population ratio by recruiting medical graduates from developing regions, including countries in sub-Saharan Africa. In contrast, over half of the countries in sub-Saharan Africa do not meet the minimum acceptable physician to population ratio of one per 5000—WHO's Health for All standard. Nurses, pharmacists, and other health workers are systematically recruited from a region struggling with the greatest burden of infectious and chronic illness and the specific challenge of HIV/AIDS. Several recent reviews of health workers employed in Australia, Canada, the UK, and the USA have shown the extent of the brain drain. An estimated 13 272 physicians trained in sub-Saharan Africa are practising in Australia, Canada, the UK, and the USA. Around a third of medical graduates from Nigerian state medical schools migrate within 10 years of graduation to Canada, the UK, and the USA.

A exportação da Doença de Chagas

Transmissão silenciosa, entrevista de Pedro Albajar Viñas à Agência Fapesp 21/02/2008 Por Washington Castilhos, do Rio de Janeiro Agência FAPESP – Casos de doença de Chagas têm sido registrados na Europa e na América do Norte, o que estimulou a OMS a criar a Rede Global pela Eliminação da Doença de Chagas. Essa criação se deu porque a doença deixou de afetar somente os países pobres? Viñas – Sim, mas podemos dizer que isso é positivo. Quando algo se torna de interesse de um país rico e desenvolvido, as indústrias farmacêuticas começam a se interessar e a investir, o que acaba beneficiando a todos, ricos ou pobres. Como faz parte das Américas, os Estados Unidos têm, em seu território, espécies de barbeiros. A grande questão é que muitos imigrantes das Américas do Sul e Central têm ido morar lá. Quando foram detectados no país sete casos autóctones da doença, de cidadãos norte-americanos, e 117 casos de doadores positivos em bancos de sangue, descobriu-se que o problema não era somente da América Latina. Em Barcelona, onde a população latino-americana, proveniente especialmente do Equador, Colômbia, Brasil e Argentina, representa cerca de 5% do total, foram registrados cem infectados. Se existem lá 324 mil imigrantes e aplicamos uma taxa de prevalência de infecção de 2,5% – vigente nos países de origem desses imigrantes –, teremos cerca de 8,1 mil infectados. Levando em conta que desses 30% a 40% desenvolvem doenças do coração ou do intestino, então são cerca 2,4 mil pessoas doentes só nessa região da Espanha. Se existem 147 mil mulheres latino-americanas vivendo na região e aplicamos a mesma taxa de prevalência da infecção, teremos 3,6 mil infectadas, com risco de transmissão vertical para os filhos. No caso dos Estados Unidos, se aplicarmos a taxa de prevalência de Barcelona e fizermos o mesmo cálculo, veremos que a situação é ainda pior, além de ser um país sem sistema gratuito de saúde. Atualmente, vivem nos Estados Unidos 40 milhões de latino-americanos, o que representa 14% da população total. A Austrália, por sua vez, abriga 65 mil latino-americanos, portanto deve ter mais de 100 infectados. O Canadá tem 130 mil imigrantes, por isso estimamos 1,2 mil infectados. Os resultados são diferentes porque o cálculo é sempre feito tendo em vista a taxa de prevalência da infecção nos países de origem dos imigrantes. Com isso, percebemos que há uma bomba prestes a explodir.

Trasylol: cada vez mais evidências

Leia clicando aqui, os resumos de dois artigos e editorial do The New England Journal of Medicine sobre o Trasylol. Antes, re-leia os posts antigos sobre o tema.

El Jefe, El Cid: do sempre bem humorado blog do WSJ

February 19, 2008, 10:44 am Fidel Castro and the Health Secrets of World Leaders Posted by Jacob Goldstein Fidel Castro said today that he’s stepping down, but the beginning of the end came nearly two years ago, when he had emergency surgery to treat intestinal bleeding. The official word at the time was that the bleeding was brought on by “stress,” though outside observers speculated that Castro was sick with something much more serious than that. Cuba-watchers in the U.S. government told Time magazine Castro had terminal cancer. Others said diverticulitis was a possibility. Bottom line, we still don’t know. The health of El Jefe is officially regarded as a state secret in Cuba — no surprise, perhaps, for a charismatic leader whose myth of invulnerability has only grown as generations of world leaders have come and gone. (Castro’s 81 years old; the U.S. has had nine different presidents during his rule.) But keeping the leader’s health woes from the public is a long tradition in liberal democracies as well. In 1893, President Grover Cleveland, had his upper jaw removed in a secret cancer surgery performed on a yacht. Cleveland’s cancer wasn’t revealed until after his death many years later. (Cleveland shared Castro’s fondness for cigars, though Castro reportedly renounced his signature smokes in 1985.) A century later, in the days after Ronald Reagan was shot, “the moments recorded by television were carefully chosen and showed brief and unrepresentative intervals of lucidity and vigor in an otherwise disabled president,” Jerrold Post, a psychiatrist who studies politics, wrote in his book When Illness Strikes the Leader. Still, those shadings and omissions pale in comparison to old-school cover-ups. In a story last year on the recurring rumors of Castro’s death, the Economist reported that Tibetan leaders hid the death of the fifth Dalai Lama for 15 years. And, according to legend, the Spanish warrior El Cid returned to battle after his death, his body “strapped to his horse” to terrify opponents with the mere presence of the hero.