Saturday, April 29, 2006

Supercourse - Epidemiology, the Internet and Global Health

Supercourse - Epidemiology, the Internet and Global Health: "Supercourse is a global repository of lectures on public health and prevention targeting educators across the world. Supercourse has a network of over 32000 scientists in 151 countries who are sharing for free a library of over 2500 lectures. The concept of the Supercourse and its lecture style has been described as the Global Health Network University and the Hypertext Comic Books. "

David Barker Theory

David Barker: "Oregon Health & Science University 10/26/05
Birthweight, Growth Patterns Into Childhood Reveal Risk of Coronary Heart Disease Later in Life

United Press International - New York 10/27/05
Fast Fattening Kids May be Heart Risks

NewScientist.com - London 10/27/05
Fattening Up Skinny Toddlers Risks Heart Health

Boston Globe 10/31/05
Rapid Weight Gain in Young Linked to Later Heart Trouble

Detroit Free Press 11/01/05
Study Says Heart Disease Can Start in Childhood

The Oregonian 11/02/05
Weight Beyond Baby Fat a Worry

The Danone Institute - Paris 11/02/05
PROFESSOR DAVID JP BARKER, WINNER OF THE 2005 DANONE INTERNATIONAL PRIZE FOR NUTRITION

UK top-level scientist rewarded for his pioneering role within the area of diet, nutrition and chronic adult disease."

Trajectories of Growth among Children Who Have Coronary Events as Adults

NEJM -- Trajectories of Growth among Children Who Have Coronary Events as Adults: "Background Low birth weight is a risk factor for coronary heart disease. It is uncertain how postnatal growth affects disease risk.

Methods We studied 8760 people born in Helsinki from 1934 through 1944. Childhood growth had been recorded. A total of 357 men and 87 women had been admitted to the hospital with coronary heart disease or had died from the disease. Coronary risk factors were measured in a subset of 2003 people.

Results The mean body size of children who had coronary events as adults was below average at birth. At two years of age the children were thin; subsequently, their body-mass index (BMI) increased relative to that of other children and had reached average values by 11 years of age. In simultaneous regressions, the hazard ratios associated with a 1 SD increase in BMI were 0.76 (95 percent confidence interval, 0.66 to 0.87; P<0.001) at 2 years and 1.14 (95 percent confidence interval, 1.00 to 1.31; P=0.05) at 11 years among the boys. The corresponding figures for the girls were 0.62 (95 percent confidence interval, 0.46 to 0.82; P=0.001) and 1.35 (95 percent confidence interval, 1.02 to 1.78; P=0.04). Low BMI at 2 years of age and increased BMI from 2 to 11 years of age were also associated with raised fasting insulin concentrations (P<0.001 for both).

Conclusions On average, adults who had a coronary event had been small at birth and thin at two years of age and thereafter put on weight rapidly. This pattern of growth during childhood was associated with insulin resistance in later life. The risk of coronary events was more strongly related to the tempo of childhood gain in BMI than to the BMI attained at any particular age.

Inquérito de Saúde: São Paulo

CAPA
(Enviado por:Carlos Alberto Machado [carlos.a.machado@uol.com.br])

Este site refere-se a Inquéritos de Saúde realizados no Estado de São Paulo, por pesquisadores das Universidades Estaduais Paulistas e da Secretaria de Estado da Saúde. Os participantes, todos com experiências prévias em inquéritos domiciliares, formaram um grupo para aprofundar essa metodologia de investigação e elaboraram projetos com uma base referencial comum e técnicas padronizadas. O primeiro deles, Inquérito Multicêntrico de Saúde no Estado de São Paulo, ISA-SP, foi realizado em quatro áreas do Estado de São Paulo: duas na Região Metropolitana de São Paulo e duas no interior do Estado. Na Região Metropolitana foram estudados o Distrito de Saúde do Butantã e uma área formada pelos municípios de Taboão da Serra, Embu e Itapecerica da Serra, no interior foram estudados os municípios de Botucatu e de Campinas.
O segundo inquérito foi realizado no Município de São Paulo, ISA-Capital. A escolha das áreas baseou-se na sua importância epidemiológica e socioeconômica, na sua vinculação com as Universidades Estaduais, que mantêm, nos locais, unidades experimentais e de extensão de serviços, e na possibilidade de estudo de tendências onde ocorreram inquéritos prévios, representando também, por estas mesmas razões, áreas de estudo que são de interesse da Secretaria de Estado da Saúde.
Participaram da pesquisa pela Universidade de São Paulo – USP: a Faculdade de Saúde Pública e a Faculdade de Medicina; pela Universidade Estadual Paulista – UNESP e Universidade Estadual de Campinas – UNICAMP, as respectivas Faculdades de Medicina e, pela Secretaria de Estado da Saúde, o Instituto de Saúde.

O Inquérito Multicêntrico, ISA-SP, foi financiado pela Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP, através do programa de Pesquisa em Políticas Públicas, tendo como instituição parceira a Secretaria de Estado da Saúde de São Paulo, que participou também com recursos financeiros. O Inquérito no Município de São Paulo, ISA-Capital, foi financiado pela Secretaria Municipal de Saúde de São Paulo.

Friday, April 28, 2006

The WHO Child Growth Standards

WHO | The WHO Child Growth Standards:
The WHO Child Growth Standards

This web site presents the WHO Child Growth Standards. These standards were developed using data collected in the WHO Multicentre Growth Reference Study. The site presents documentation on how the physical growth curves and motor milestone windows of achievement were developed as well as application tools to support implementation of the standards.

Related links

:: Media page

:: WHO Department of Nutrition for Health and Development

:: WHO Department of Child and Adolescent Health and Development

:: WHO Global Database on Child Growth and Malnutrition

:: Multimedia help

Addressing the Social Causes of Illness: International Development Research Centre

Addressing the Social Causes of Illness: International Development Research Centre:
"By Stephen Dale

Why do some people live long lives, punctuated by only short periods of illness, while others die young after struggling with chronically poor health?

That question was posed to an audience at a recent panel discussion hosted by Canada’s International Development Research Centre (IDRC). International health experts are convinced that they’ve found the answer. In both rich and poor countries, longevity and susceptibility to disease often have less to do with germs and genetics than with the so-called “social determinants of health” — factors such as income, education, occupation, and access to services, good medical treatment, and decent housing. Several exhaustive studies show that scoring well on the checklist of social indicators means one will likely live a long and healthy life, while deprivation is just as sure a predictor of increased illness and fewer years. "/.../

Wednesday, April 26, 2006

Measuring Health Disparities: Home

Measuring Health Disparities: Home: "measuringhealthdisparities.org was created to facilitate the use of the interactive CD-ROM Measuring Health Disparities developed by John Lynch, PhD, and Sam Harper, PhD, of McGill University, and produced by the Michigan Public Health Training Center (MPHTC). Through this gateway, you will be able to:
Register your CD-ROM and access the password
Get Continuing Education credit for nurses, CHES, and physicians
View or post errata on the content of the CD-ROM
View or post comments on the content of the CD-ROM
If the MPHTC can further assist you with this site, the CD-ROM, or other matters, please contact us:
Robyn Nolan
Student Services Coordinator
Michigan Public Health Training Center
University of Michigan School of Public Health
611 Church Street, Room 256
Ann Arbor, MI 48104-3028"

DCPP - Global Burden of Disease and Risk Factors

DCPP - Global Burden of Disease and Risk Factors: "This book emerges from two separate, but intersecting, strands of work that began in the late 1980s, when the World Bank initiated a review of priorities for the control of specific diseases. The review generated findings about the comparative cost-effectiveness of interventions for most diseases important in developing countries. The purpose of the cost-effectiveness analysis (CEA) was to inform decision making within the health sectors of highly resource-constrained countries. This process resulted in the publication of the first edition of Disease Control Priorities in Developing Countries (DCP1).

Also important for informing policy is a consistent, quantitative assessment of the relative magnitudes of diseases, injuries, and their risk factors. DCP1 included an initial assessment of health status for low- and middle-income countries as measured by deaths from specific causes; importantly, the numbers of cause-specific deaths for each age-sex group were constrained by the total number of deaths as estimated by demographers. This consistency constraint led to downward revision of the estimates of deaths from many diseases.

These two strands of work—CEA and burden of disease—were further developed during preparation of the World Development Report 1993: Investing in Health. This report drew on both the CEA work in DCP1 and on a growing academic literature on CEA. /...."

Saturday, April 22, 2006

Health Promotion - Home - Victorian Government Health Information, Australia

Health Promotion - Home - Victorian Government Health Information, Australia: "Welcome to the Health Promotion web site
This web site provides a gateway to health promotion activities within the Department of Human Services and other key health promotion resources.
It provides a comprehensive, starting point for exploring health promotion on the internet, and aims to facilitate and improve communication about quality health promotion practice in the following areas."

Health Promotion - Home - Victorian Government Health Information, Australia

Health Promotion - Home - Victorian Government Health Information, Australia: "Welcome to the Health Promotion web site
This web site provides a gateway to health promotion activities within the Department of Human Services and other key health promotion resources.
It provides a comprehensive, starting point for exploring health promotion on the internet, and aims to facilitate and improve communication about quality health promotion practice in the following areas."

Wednesday, April 12, 2006

Indicadores sociais 2005 - IBGE

IBGE - Instituto Brasileiro de Geografia e Estatística
Síntese de Indicadores Sociais 2005

Reúne indicadores sobre a realidade social brasileira, abrangendo informações sobre aspectos demográficos, educação, trabalho e rendimento, domicílios, famílias e grupos populacionais específicos - crianças, adolescentes e jovens, mulheres e idosos - entre outros aspectos, acompanhados de breves comentários sobre as características observadas nos diferentes estratos geográficos e populacionais do País relativamente aos temas selecionados.

Os indicadores estão apresentados em tabelas e gráficos, para o Brasil, grandes regiões e unidades da federação e, para alguns aspectos, também para regiões metropolitanas. Estes são elaborados, principalmente, a partir dos resultados da Pesquisa Nacional por Amostra de Domicílios realizada em 2004, que, neste ano, ampliou sua cobertura para todo o Território Nacional e agrega, pela primeira vez, as informações das áreas rurais de Rondônia, Acre, Amazonas, Roraima, Pará e Amapá.

A publicação apresenta, ainda, um glossário com os termos e conceitos considerados relevantes para a compreensão dos resultados.

O conjunto dessas informações está disponível no CD-ROM.

A elaboração e sistematização desses indicadores atende às recomendações internacionais e contribui para a compreensão das modificações no perfil demográfico, social e econômico da população, possibilitando, assim, o monitoramento de políticas sociais e a disseminação de informações relevantes para toda sociedade brasileira.

Monday, April 10, 2006

É certo uma doméstica ganhar mais que um professor?

(Recomendado por Maria Inês Reinert Azambuja [miazambuja@terra.com.br])

GILBERTO DIMENSTEIN
É certo uma doméstica ganhar mais do que um professor?
O salário médio de uma empregada doméstica na cidade de São Paulo é de R$ 800, informa a Federação Nacional das Trabalhadoras Domésticas. É mais do que os R$ 615 pagos a uma professora iniciante da rede municipal, com uma carga horária de 20 horas. Se comparássemos com uma doméstica diarista, a diferença seria muito maior: sua média de rendimentos é de R$ 1.600 mensais.
O professor iniciante paulistano não pode, aliás, nem mesmo contar vantagem diante dos pedintes dos semáforos. Segundo estimativa da Secretaria Municipal do Desenvolvimento Social, esse trabalhador tira, em média, R$ 25 por dia.
Com o rendimento inferior ao de uma empregada doméstica e quase empatado com o de um pedinte, entende-se por que os professores entraram em greve em São Paulo. O problema não é só dinheiro: eles vivem sob intenso estresse, devido às salas superlotadas, alunos indisciplinados e agressivos, além de serem vítimas das mais diversas formas de violência.
Nessa questão salarial se revelam, na verdade, os valores de uma nação. Na prática, essas comparações significam, por mais absurdo que pareçam, que a sociedade dá mais valor à posição social de uma empregada do que a de um professor público -é assim que se medem, e não no palavrório, as verdadeiras prioridades do país.
Poderíamos medir a prioridade não só pelo salário mas pela baixa repercussão que essa greve tem na opinião pública. Imaginem o barulho que haveria se a paralisação fosse em escolas de elite, e os filhos das famílias mais ricas tivessem de ficar em casa por duas semanas. No caso da rede pública, as mães muitas vezes não têm nem com quem deixar seus filhos.
Se achamos que, sem boa educação pública, uma nação não consegue se desenvolver com um mínimo de igualdade e que a produtividade econômica estará ameaçada, o lógico seria que existissem esforços continuados e obsessivos para estimular a carreira do professor. Como podemos atrair pessoas mais talentosas e preparadas sem estímulo salarial?
Evidentemente o que vemos hoje não é culpa desse ou daquele governo, mas de uma falta de reverência a compartilhar de conhecimento entre todos.
Como as famílias mais ricas têm seus filhos em escolas privadas, uma greve como a que está ocorrendo provavelmente só entra na conversa -isso se
entrar- se a empregada lamentar com a patroa que não tem com quem deixar o filho.
Há traduções óbvias e repetidas para essa fragilidade: repetência, evasão e baixíssimo aprendizado. Uma das traduções não tão óbvias foi apontada, na semana passada, pelo presidente Lula, ao dar uma estocada, sem citar o nome, em Geraldo Alckmin, seu principal adversário e cada vez mais ameaçador, como mostra hoje o Datafolha.
No esforço de ir minando a imagem do ex-governador, o PT se prepara para mostrar as imagens de selvageria da Febem, que, na semana passada, voltou a exibir mais uma rebelião. Essas imagens apenas reforçam o que todos
sabemos: o desempenho do governo estadual está muito abaixo, nessa área, do que o esperado. Pelo volume de dinheiro que se despeja na prisão de crianças e adolescentes e pelo que já conhecemos sobre a inutilidade de grandes instalações como a do Tatuapé, melhores resultados poderiam ter sido apresentados.
Lula lembrou que se construíssem mais escolas haveria menos prisões.
Colocada nesses termos simplistas, a frase tem efeito apenas eleitoral. Mas, em essência, é isso mesmo.
O problema da Febem não é, a rigor, apenas a Febem. Antes fosse. O problema é nossa incapacidade de prevenir a delinqüência juvenil, e, aí, a discussão se torna extremamente complexa.
Se houvesse mais e melhores escolas, provavelmente haveria menos unidades da Febem, menos assaltos e menos assassinatos. Como ter boas escolas se, na cidade mais rica do país, um professor ganha tanto quanto um pedinte e menos do que uma empregada doméstica? Será que esse indivíduo terá recursos para comprar livros ou ir ao teatro? Pode alguém ser, de fato, um bom professor sem uma vivência cultural?
Evidentemente que não. Isso significa que a escola vira mais um espaço de exclusão, especialmente para aqueles em situação de risco, do que de inclusão, servindo de incubadora para candidatos a internos da Febem.
Se os ataques sobre a Febem, de Alckmin, servirem para esse tipo de reflexão, ruim para o ex-governador, bom para o país. Se forem apenas para ficar nos chavões, será perda de tempo.
P.S- Para melhorar o desempenho dos professores, gosto de uma idéia que, em geral, os professores detestam. Em vez de aumentos salariais indiscriminados, os educadores poderiam ganhar um bônus a partir do desempenho de seus alunos. Nos lugares em que tal idéia foi testada e, ao mesmo tempo, se ajudou na qualificação do educadores, os resultados foram estimulantes. O professor passa a ser sócio do sucesso do aluno, e não do fracasso.

Sunday, April 09, 2006

Some questions that are seldom asked...

Human Rights Reader 131
SOME QUESTIONS WITH HUMAN RIGHTS IMPLICATIONS THAT ARE SELDOM ASKED.
1. To start with, on matters of our time:
1.1. Does the war against terror not really divert the world’s attention from the underlying causes of growing global insecurity (and the underlying human rights situation…?)
1.2. Should we not transcend old adversarial models and processes of seeking solutions (defining ourselves by what we stand against) and bring more light to these processes by encouraging the development of a more positive way of relating to the problems as they exists today (defining ourselves rather by what we stand for)? (J. Buderer)

2. On Health:
2.1. With Health For All by the Year 2000 having failed, should we be content with Health For Half by 2015?
2.2. Why is it that decentralization of health services has often led to privatization and fragmentation along socio-economic lines, exacerbating the class divide?

3. On Science:
3.1. Does the use of statistics by any science make it beyond dispute or are statistics merely just one method of measurement? [Somebody said that, if you torture the data long enough, they will create the evidence you want; they call this ‘evidence making’].
3.2. And, have you ever heard of ‘stadigraphy’? [It actually is a new, but minor science; a novel way to tell lies…]. (C. Fuentes)
3.3. Do you feel that science, more often than you want, keeps off the path of ethics and politics? If so, is that right? Would you agree that the teaching and practice of values and of an ideology is what gives our lives and words their full meaning?
3.4. Ergo, do we have (or have not) the responsibility to profess political principles to govern our respective professions? (G. Cannon)

5. On the Media:
5.1. Why do many of the media we are exposed to no longer inform us, but only create the illusion of doing so?
5.2. As general public, are we being manipulated?
5.4. Have you noticed that wars are a bit trivialized and that Western victims are more important than others?
5.5. Why is the focus of news more on drama than on the big picture?
5.6. Why if there are no images, increasingly, there is no news report?
5.7. Would you agree that rural audiences stay out altogether of the public debate? --are they the ‘deliberately unheard’? (A. Roy)
5.8. Is the press thus, with few exceptions, ‘partisan’ and often even unethical in a subtle way?
5.9. If the purpose is ‘to minimize the noise and maximize the signal’, are internet mailing lists and websites a powerful means of establishing a common alternative space in restricted and often repressive media environments?
5.10. Can this medium become a space for open public debate for the expression of dissenting political opinion, for constructive criticism and a space for social and political mobilization --a space to act ‘glocally’? (D+C 32:5 May 2005, F&D 42:1 March 2005).

6. On poverty:
6.1. What is more appropriate to speak of: ‘the feminization of poverty or the ‘povertization’ of women?
6.2. Should development objectives be specifically stated in distributional terms and as poverty-redressing objectives?
6.4. Why have we, both in the North and in the South, not been able to deprive tyrants of their ability to finance themselves against-the-interest-of-their-own-people who always end up poorer?
6.5. Should international debt not having been used in the public interest be legally enforceable? [Many think no, and they call this type of debt ‘odious debt’]. (F+D, 42:2, June 2005)

7. On human rights:
7.1. It has been said that basic needs are about ‘having’ while human rights (HR) are about ‘being’. Think about it. Would you agree? (U. Jonsson)
7.2. To state the obvious, those who have the power are not those who have the problems: What is the best response: weakening the strong or strengthening the weak? [Note that HR work is about both --and that is the right approach!] (G. Kent)
7.3. Should we not get the street protesters (e.g., at WTO or WB/IMF meetings) from the barricades and have them join us in an organized, common, creative and constructive HR cause? Is there untapped young energy there?
7.4. Should a rights-based approach now be used to frame public policy?
7.5. If yes, does this call for a social contract that would then have to be given political expression in both legislation and in public policy?
7.6. How do you interpret the following?: ‘HR are not just something that society or governments simply achieve: they are an imperative which citizens have to actively demand for’.
7.7. What are and how can we seek viable ways of strengthening citizens’ claims to such rights in highly inequitable and poor societies?
7.8. How can we build a social consensus regarding those rights and set up/strengthen institutions that will act upon that consensus? [Economic, social and cultural rights have to be internalized first by all the various actors so that day-to-day practice and policy decisions are all geared towards a rights-based society].
7.9. Have you noticed that the results of the ballot have virtually no impact on the actual conduct of state economic, social and HR policies?

8. On the semantics of human rights:
8.1. Are we witnessing a process of ‘neutering’ and denigration of basic HR language by those who are still for a status-quo? (G. Cannon)
8.2. Should we not talk about ending rather than reversing HR violations?
8.3. Should we not talk about ‘neoliberal global restructuring’ or ‘global marketization’ instead of just ‘globalization’ --as one of the important causes of HR violations?
8.4. Does not charity --e.g., giving out handouts-- allow the giver to maintain control, i.e., on what to give, to whom, how and when? Is charity thus not disempowering to recipients and antithetical to HR? Is that why some have called for not talking about aid, but rather about ‘restitution’?

Did some of these questions make you feel uncomfortable? Or confused as to the better answer?
There is no pass-or-fail in this quiz; but remember:
It is OK and important to have your own opinion on the importance of HR; Why not proactively share it then!?

Claudio Schuftan,Ho Chi Minh City
claudio@hcmc.netnam.vn

Wednesday, April 05, 2006

Global Burden of Disease

Global Burden of Disease and Risk Factors

A copublication of Oxford University Press and The World Bank, April 2006
ISBN: 0-8213-6262-3

EDITORS: Alan D. Lopez, Colin D. Mathers, Majid Ezzati. Dean T. Jamison, Christopher J. L. Murray
The Disease Control Priorities Project (DCPP) is a joint enterprise of The World Bank, the Fogarty International Center (FIC) of the National Institutes of Health (NIH), the World Health Organization (WHO), and the Population Reference Bureau. The NIH National Library of Medicine (NLM) is also a partner. DCPP is funded principally through a grant from the Bill & Melinda Gates Foundation.
Website: http://www.dcp2.org/pubs/GBD
PDF version [506p.] at: http://files.dcp2.org/pdf/GBD/GBD.pdf
“…..Over the past six years, the World Health Organization has undertaken a new assessment of the global burden of disease for 2000-2. The World Health Organization has also invested in improving the conceptual, methodological, and empirical basis of burden of disease assessments and the assessment of the disease and injury burden from major risk factors. During 1999-2004, the authors of this volume and many collaborators from around the world worked intensively to assemble an updated, comprehensive assessment of the global burden of disease and its causes.
The Global Burden of Disease and Risk Factors is the definitive, scientific account of these efforts and of the health conditions of the world's population at the beginning of the 21st century. This book includes a full account of methods, the complete results of recent work, and an assessment of trends for total mortality and for major causes of death among children under five. In addition, two chapters cover sensitivity and uncertainty analyses in relation to a broad range of potentially important parameters….”

Priorities in Health

Available online at: http://www.dcp2.org/pubs/PIH
PDF version [236p.] at: http://files.dcp2.org/pdf/PIH/PIH.pdf
Delivering efficacious and inexpensive health interventions leads to dramatic reductions in mortality and disability at modest cost. Globalization has been diffusing the knowledge about what these interventions are and how to deliver them. The pace of this diffusion into a country–more than its level of income–determines the tempo of health improvement in that country.
Two overarching themes emerge from the extensive research and analyses:
· Current resources can yield substantial health gains if knowledge of cost-effective interventions were applied more fully.
· Additional resources are needed in low-income countries to minimize the glaring inequities in health care. Increased resources would provide highly-effective interventions, expand research, and extend basic health coverage to more people.
Translations For DownloadFrench (PDF 4.1MB) Portuguese (PDF 4.2MB) Russian (PDF 4.1MB) Spanish (PDF 3.7MB)

Monday, April 03, 2006

WHO | Tackling social factors to improve health

WHO Tackling social factors to improve health
Professor Sir Michael Marmot was born in London. He earned his MD in 1968 at the University of Sydney, Australia, and a PhD in epidemiology from the University of California, Berkeley, United States. He started his career as a doctor at the Royal Prince Alfred Hospital, University of Sydney in 1969. Marmot has been at the forefront of research in health inequalities for the past 20 years, most famously as Principal Investigator of the Whitehall studies of British civil servants. He is Professor of Epidemiology and Public Health at University College London (UCL) and Director of the UCL International Institute for Society and Health, which he set up in 2005. Marmot was appointed Chair of WHO’s Commission on the Social Determinants of Health in 2005.
Many governments recognize that factors such as status, education and employment have an impact on people’s health, but few have tackled these social determinants head on. WHO established a commission in March 2005 to come up with recommendations on how countries can address these. One year later, the Commission’s chair Professor Sir Michael Marmot tells the Bulletin how WHO’s Commission on the Social Determinants of Health is helping governments tackle underlying factors to improve the health and well-being particularly of disadvantaged populations.