Friday, December 10, 2010

[EQ] A Report of the US Surgeon General: How Tobacco Smoke Causes Disease

A Report of the Surgeon General: How Tobacco Smoke Causes Disease

The Biology and Behavioral Basis for Smoking-Attributable Disease

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES - 2010
Public Health Service
Office of the Surgeon General
Rockville, MD


Fact Sheet  at: http://bit.ly/dZstjB

FULL REPORT online at: http://bit.ly/eNAP9k

This is the 30th tobacco-related Surgeon General’s report issued since 1964. It describes in detail the specific pathways by which tobacco smoke damages the human body. The scientific evidence supports the following conclusions:

There is no safe level of exposure to tobacco smoke. Any exposure to tobacco smoke – even an occasional cigarette or exposure to secondhand smoke – is harmful.

·         You don’t have to be a heavy smoker or a long-time smoker to get a smoking-related disease or have a heart attack or asthma attack that is triggered by tobacco smoke.

·         Low levels of smoke exposure, including exposures to secondhand tobacco smoke, lead to a rapid and sharp increase in dysfunction and inflammation of the lining of the blood vessels, which are implicated in heart attacks and stroke.

·         Cigarette smoke contains more than 7,000 chemicals and compounds. Hundreds are toxic and more than 70 cause cancer. Tobacco smoke itself is a known human carcinogen.

·         Chemicals in tobacco smoke interfere with the functioning of fallopian tubes, increasing risk for adverse pregnancy outcomes such as ectopic pregnancy, miscarriage, and low birth weight. They also damage the DNA in sperm which might reduce fertility and harm fetal development.

Damage from tobacco smoke is immediate.

·         The chemicals in tobacco smoke reach your lungs quickly every time you inhale. Your blood then carries the toxicants to every organ in your body.

·         The chemicals and toxicants in tobacco smoke damage DNA, which can lead to cancer. Nearly one-third of all cancer deaths every year are directly linked to smoking. Smoking causes about 85% of lung cancers in the U.S.

·         Exposure to tobacco smoke quickly damages blood vessels throughout the body and makes blood more likely to clot. This damage can cause heart attacks, strokes, and even sudden death.

·         The chemicals in tobacco smoke inflame the delicate lining of the lungs and can cause permanent damage that reduces the ability of the lungs to exchange air efficiently and leads to chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis.

Smoking longer means more damage.

·         Both the risk and the severity of many diseases caused by smoking are directly related to how long the smoker has smoked and the number of cigarettes smoked per day.

·         Chemicals in tobacco smoke cause inflammation and cell damage, and can weaken the immune system. The body makes white blood cells to respond to injuries, infections, and cancers. White blood cell counts stay high while smoking continues, meaning the body is constantly fighting against the damage caused by smoking which can lead to disease in almost any part of the body.

·         Smoking can cause cancer and weaken your body’s ability to fight cancer. With any cancer – even those not related to tobacco use – smoking can decrease the benefits of chemotherapy and other cancer treatments. Exposure to tobacco smoke can help tumors grow.

·         The chemicals in tobacco smoke complicate the regulation of blood sugar levels, exacerbating the health issues resulting from diabetes. Smokers with diabetes have a higher risk of heart and kidney disease, amputation, eye disease causing blindness, nerve damage and poor circulation.

Cigarettes are designed for addiction.

·         The design and contents of tobacco products make them more attractive and addictive than ever before. Cigarettes today deliver nicotine more quickly from the lungs to the heart and brain.

·         While nicotine is the key chemical compound that causes and sustains the powerful addicting effects of cigarettes, other ingredients and design features make them even more attractive and more addictive.

·         The powerful addicting elements of tobacco products affect multiple types of nicotine receptors in the brain.

·         Evidence suggests that psychosocial, biologic, and genetic factors may also play a role in nicotine addiction.

·         Adolescents’ bodies are more sensitive to nicotine, and adolescents are more easily addicted than adults. This helps explain why about 1,000 teenagers become daily smokers every day.

There is no safe cigarette.

·         The evidence indicates that changing cigarette designs over the last five decades, including filtered, low-tar, and “light” variations, have NOT reduced overall disease risk among smokers and may have hindered prevention and cessation efforts.

·         The overall health of the public could be harmed if the introduction of novel tobacco products encourages tobacco use among people who would otherwise be unlikely to use a tobacco product or delays cessation among persons who would otherwise quit using tobacco altogether.

The only proven strategy for reducing the risk of tobacco-related disease and death is to never smoke, and if you do smoke to quit.

·         Quitting at any age and at any time is beneficial. It's never too late to quit, but the sooner the better.

·         Quitting gives your body a chance to heal the damage caused by smoking.

·         When smokers quit, the risk for a heart attack drops sharply after just 1 year; stroke risk can fall to about the same as a nonsmoker’s after 2-5 years; risks for cancer of the mouth, throat, esophagus, and bladder are cut in half after 5 years; and the risk for dying of lung cancer drops by half after 10 years.

·         Smokers often make several attempts before they are able to quit, but new strategies for cessation, including nicotine replacement and non-nicotine medications, can make it easier.

·         Talk to your doctor or call 1-800-QUIT-NOW and get started on a quit plan today.


 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
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[EQ] Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis

Burden of endemic health-care-associated infection in developing countries:
systematic review and meta-analysis

Benedetta Allegranzi a, Sepideh Bagheri Nejad a, Christophe Combescure b, Wilco Graafmans a, Homa Attar a, Liam Donaldson a d, Prof Didier Pittet a c
a  First Global Patient Safety Challenge, WHO Patient Safety, Geneva, Switzerland

b  Division of Clinical Epidemiology, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

c  Infection Control Programme, and WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), University of Geneva Hospitals & Faculty of Medicine Switzerland

d National Patient Safety Agency, London, UK

The Lancet, Early Online Publication, 10 December 2010doi:10.1016/S0140-6736(10)61458-4

Website: http://bit.ly/ggXdOJ

 

Health-care-associated infection is the most frequent result of unsafe patient care worldwide, but few data are available from the developing world. We aimed to assess the epidemiology of endemic health-care-associated infection in developing countries.


Methods

We searched electronic databases and reference lists of relevant papers for articles published 1995—2008. Studies containing full or partial data from developing countries related to infection prevalence or incidence—including overall health-care-associated infection and major infection sites, and their microbiological
cause—were selected. We classified studies as low-quality or high-quality according to predefined criteria. Data were pooled for analysis.


Findings

Of 271 selected articles, 220 were included in the final analysis. Limited data were retrieved from some regions and many countries were not represented. 118 (54%) studies were low quality. In general, infection frequencies reported in high-quality studies were greater than those from low-quality studies. Prevalence of health-care-associated infection (pooled prevalence in high-quality studies, 15·5 per 100 patients [95% CI 12·6—18·9]) was much higher than proportions reported from Europe and the USA. Pooled overall health-care-associated infection density in adult intensive-care units was 47·9 per 1000 patient-days (95% CI 36·7—59·1), at least three times as high as densities reported from the USA. Surgical-site infection was the leading infection in hospitals (pooled cumulative incidence 5·6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative bacilli represented the most common nosocomial isolates. Apart from meticillin resistance, noted in 158 of 290 (54%) Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance.


Interpretation

The burden of health-care-associated infection in developing countries is high. Our findings indicate a need to improve surveillance and infection-control practices

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
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[EQ] The Origin of the Haitian Cholera Outbreak Strain

The Origin of the Haitian Cholera Outbreak Strain

Chen-Shan Chin, Jon Sorenson, Jason B. Harris, William P. Robins, Richelle C. Charles, Roger R. Jean-Charles, James Bullard, Dale R. Webster, Andrew Kasarskis, Paul Peluso, Ellen E. Paxinos, Yoshiharu Yamaichi, Stephen B. Calderwood, John J. Mekalanos, Eric E. Schadt, and Matthew K. Waldor

December 9, 2010 (10.1056/NEJMoa1012928) - The New England Journal of Medicine


Available online at: http://bit.ly/eLpxFp

 

“….Although cholera has been present in Latin America since 1991, it had not been epidemic in Haiti for at least 100 years. Recently, however, there has been a severe outbreak of cholera in Haiti.

 

“…..A comparison of the genomes of two “outbreak” Vibrio cholerae isolates from Haiti with those of other isolates indicate that this outbreak strain is distinct from circulating Latin American isolates and bears striking similarity to recent isolates from South Asia. The epidemic is probably due to the introduction, through human activity, of V. cholerae from a distant geographic source.

Methods

We used third-generation single-molecule real-time DNA sequencing to determine the genome sequences of 2 clinical Vibrio cholerae isolates from the current outbreak in Haiti, 1 strain that caused cholera in Latin America in 1991, and 2 strains isolated in South Asia in 2002 and 2008. Using primary sequence data, we compared the genomes of these 5 strains and a set of previously obtained partial genomic sequences of 23 diverse strains of V. cholerae to assess the likely origin of the cholera outbreak in Haiti.

Results

Both single-nucleotide variations and the presence and structure of hypervariable chromosomal elements indicate that there is a close relationship between the Haitian isolates and variant V. cholerae El Tor O1 strains isolated in Bangladesh in 2002 and 2008. In contrast, analysis of genomic variation of the Haitian isolates reveals a more distant relationship with circulating South American isolates.

Conclusions

The Haitian epidemic is probably the result of the introduction, through human activity, of a V. cholerae strain from a distant geographic source. (Funded by the National Institute of Allergy and Infectious Diseases and the Howard Hughes Medical Institute.)



perspective

Responding to Cholera in Post-Earthquake Haiti

December 9, 2010 | D.A. Walton and L.C. Ivers
DOI: 10.1056/NEJMp1012997 http://www.nejm.org/doi/full/10.1056/NEJMp1012997


Antibiotics for Both Moderate and Severe Cholera

December 9, 2010 | E.J. Nelson and Others
DOI: 10.1056/NEJMp1013771 http://www.nejm.org/doi/full/10.1056/NEJMp1013771


 
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[EQ] Productive Management Methodology for Health Services - Introduction

Productive Management Methodology for Health Services
Introduction


The Pan American Health Organization PAHO/WHO, 2010
English Version: PDF [43p.] available online at: http://bit.ly/eH25YW

Metodología de Gestión Productiva de los Servicios de Salud – Introducción
Spanish version PDF [44p.] URL: http://bit.ly/hYKtsD


.

“………As a contribution to the task of building and strengthening managerial capacity in health systems and services, improving the use of information and evidence for decision-making and action, PAHO provides the Productive Management Methodology for Health Services (PMMHS) and its support tools as an option for health services managers. The PMMHS is presented as an alternative that provides information for analyzing the relevance, efficiency and quality of healthcare provision, negotiation of management agreements (contracts) and costing and financing of health care services.

“…………health systems face two major challenges that affect progress toward health systems based on PHC, namely segmentation of health systems and the resulting fragmentation of the services. Segmentation is defined as the coexistence of independently operating subsystems with varying financing mechanisms that cover various segments of the population usually in accordance with ability to pay (3).

Fragmentation is defined as the “coexistence of several units or facilities with no integration within the healthcare network” (4).

 

The predominant health system model in the Region Americas segments populations based on employment status and ability to pay. In organisational terms, segmented models are characterized by the existence of multiple financing and insurance schemes in which one or more public subsystems (central or local government financing and social security systems represented by one or more entities) coexist with private financing/insurance entities, all competing within the health sector. These various financing mechanisms in turn, create fragmented healthcare delivery services that operate without coordination, and provide health services to the segmented populations as defined by the financing entities.

 

Fragmentation is a major cause of low performance levels by health systems and services and it has been identified as one of the main obstacles to the achievement of health goals, including the Millennium Development Goals. This fragmentation can have myriad causes and effects on both the population and health systems……..

 

Content

CONCEPTUAL FRAMEWORK AND PAHO’s STRATEGIC MANDATES

 

What is the Productive Management Methodology for Health Services  PMMHS?

STRUCTURAL ELEMENTS OF PMMHS

FUNCTIONS OF THE PMMHS AND PRODUCTS OF THE PERC TOOL

PMMHS: BASIC CONCEPTS

KEY CONCEPTS IN PMMHS

1. FUNDAMENTAL ELEMENTS OF THE PMMHS

2. PRODUCT

3. PRODUCTION

4. EFFICIENCY

5. RESOURCES

6. COSTS

METHODOLOGICAL CHARACTERISTICS OF THE PMMHS

PMMHS AND PAHO’S TECHNICAL COOPERATION

REFERENCES

Dr. Reynaldo Holder Regional Advisor – Health Services

Health Systems and Services Area OPS/OMS – PAHO/WHO


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Friday, December 3, 2010

[EQ] Estimates of global health indicators - PLoS series

Global Health Estimates

PLoS Medicine - Published 30 November 2010

Available online at: http://bit.ly/goci45

“……Estimates of global health indicators—which give insight into death and disease rates, document advances in development, and help policymakers monitor progress—are absolutely essential for improving global health.
Estimates, however, are always imperfect and are sometimes fiercely debated. Recently, new players from academia have entered the game of global health estimation, once the chief domain of United Nations agencies such as WHO.


This has created some controversy but also an opportunity to reflect. In November 2010, PLoS Medicine published a cluster of six articles from a series of experts that provide insights and opinion on what estimates mean for global health and how to move forward with better data, measurement, coordination, and leadership.

The cluster includes the perspectives of WHO, the Institute for Health Metrics and Evaluation (IHME), and stakeholders from low- and middle-income countries, as well as the PLoS Medicine Editors…..”

Can We Count on Global Health Estimates?

Published 30 Nov 2010 | info:doi/10.1371/journal.pmed.1001002

The Imperfect World of Global Health Estimates

Peter Byass: Published 30 Nov 2010 | info:doi/10.1371/journal.pmed.1001006

WHO and Global Health Monitoring: The Way Forward

J. Ties Boerma, Colin Mathers, Carla Abou-Zahr: Published 30 Nov 2010 | info:doi/10.1371/journal.pmed.1000373

Production and Analysis of Health Indicators: The Role of Academia

Christopher J. L. Murray, Alan D. Lopez
Published 30 Nov 2010 | info:doi/10.1371/journal.pmed.1001004

Global Health Estimates: Stronger Collaboration Needed with Low- and Middle-Income Countries

Osman Sankoh Published 30 Nov 2010 | info:doi/10.1371/journal.pmed.1001005

A Call for Responsible Estimation of Global Health

Wendy J. Graham, Sam Adjei Published 30 Nov 2010 | info:doi/10.1371/journal.pmed.1001003

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