Archive for ottobre 2012

International HPH Newsletter No. 58 @carlofavaretti @Medici_Manager

Dear reader,

With this Newsletter issue, we invite you to visit the recently launched website of the 21st International HPH conference (Gothenburg, Sweden, May 22-24, 2013), and to participate in the Call for Papers which will be open until January 5, 2013.

In the partners section, we present a new publica- tion by WHO-Euro on governance for health in the 21st century, focusing on new trends, challenges and key messages in the field.

The HPH network section informs you about coop- eration between HPH and Baby-friendly hospitals in Austria; and the colleagues from the Catalan HPH network report about their recent HPH conference.

Finally, in the Events section, we would like to draw your attention to a wealth of upcoming conferences that might be of interest to you.

Any feedback to this Newsletter issue and contribu- tions to Newsletter # 59 are very welcome. Please submit until December 15, 2012.

Sincerely yours,

Jürgen M. Pelikan, Christina Dietscher, Vienna

http://www.hph-hc.cc/fileadmin/user_upload/HPH_Newsletter/hph_newsletter_58.pdf

I 12 errori che possono trasformare la dieta in un fallimento @carlofavaretti @Medici_Manager

Iperproteico, mediterraneo, a punti: chi vuole mettersi a dieta ha a disposizione un’ampia scelta di regimi alimentari che promettono di far perdere i chili di troppo. Spesso, però, i tentativi intrapresi falliscono miseramente, a volte perché l’effetto yo-yo è pronto ad aggredire non appena si smette di far attenzione a ciò che si mette nel piatto, altre volte perché non si riesce nemmeno a dimagrire a causa di piccoli errori commessi proprio durante la dieta.

Esistono, infatti, dei comportamenti che anche se all’apparenza sembrerebbero la scelta ideale per perdere peso in realtà vanificano ogni sforzo messo in atto per dimagrire: dalla riduzione eccessiva delle calorie, all’abitudine sbagliata di saltare i pasti, passando per la scelta di cibi che nascondono più calorie di quanto si creda. Di seguito alcuni degli errori più frequenti evidenziati da Kathleen Zelman, esperta di nutrizione che collabora con il portale dedicato alla salute WebMD.

  1. Scegliere diete troppo “severe”. Regimi alimentari che riducono al minimo le calorie introdotte ogni giorno, facendole scendere al di sotto delle 1.000, rallentano il metabolismo. Di conseguenza l’organismo brucia meno energie e non si riesce a dimagrire.
  2. Saltare la colazione. Quest’abitudine può aumentare l’appetito durante tutta la giornata. Se si vuole agire su questo pasto è meglio farlo scegliendo cibi ricchi di proteine e fibre, che saziano e riducono il senso di fame nelle ore successive.
  3. Esagerare con gli spuntini. A volte capita di contare meticolosamente le calorie dei pasti principali, ma di non tenere in considerazione quelle assunte con gli snack.
  4. Non fare spuntini. Concedersi una merenda a metà mattina e una nel pomeriggio aiuta a controllare la fame e a mantenere attivo il metabolismo. L’importante è non esagerare. Gli spuntini migliori sono quelli a base di proteine. Un esempio? Delle noci, che contengono anche omega 3 http://www.benessereblog.it/tag/omega+3 , i grassi “amici” della salute.
  5. Confidare troppo nei prodotti a basso contenuto di grassi. Anche questi, infatti, contengono calorie. Meglio, quindi, non esagerare e prendere sempre in considerazione non solo la quantità dei grassi introdotti con il cibo, ma anche a quella di zuccheri e degli altri nutrienti energetici.
  6. Consumare bevande caloriche. Anche ciò che si beve apporta calorie, che si tratti di un caffè, di un succo di frutta o di un alcolico.
  7. Non bere abbastanza acqua. L’acqua è essenziale per bruciare le calorie e il metabolismo può risentire a tal punto della disidratazione da vanificare qualsiasi tentativo di perdere peso.
  8. Eliminare i latticini. Alcune ricerche suggeriscono che l’organismo brucia più grassi quando ha a disposizione abbastanza calcio, mentre in caso di carenza di questo minerale, di cui sono ricchi proprio i latticini, ne produce di più. Piuttosto che bandire completamente latte e derivati è meglio optare per quelli a basso contenuto di grassi.
  9. Esagerare con il take away. Spesso quando si ordina un pasto da asporto o a domicilio ci si lascia tentare da piatti poco sani, magari da vero e proprio cibo-spazzatura.
  10. Pesarsi tutti i giorni. Quest’abitudine non fornisce una reale misura del dimagrimento, anzi, può scoraggiare chi si sta impegnando a seguire un regime alimentare ipocalorico. E’ meglio verificare quanti chili si sono persi una volta alla settimana: in questo modo i risultati visibili saranno maggiori e ci si sentirà più motivati a continuare.
  11. Porsi obiettivi irraggiungibili. Non bisogna mettersi in testa di dimagrire troppo rapidamente: la motivazione potrebbe venir meno anche di fronte a una perdita di peso più modesta di quanto sperato.
  12. Non fare esercizio. L’attività fisica è indispensabile per bruciare calorie. Il trucco sta nel trovare uno sport che piaccia, in modo che un attimo che dovrebbe garantire il benessere non si trasformi in una tortura.

http://www.benessereblog.it/post/21817/i-12-errori-che-possono-trasformare-la-dieta-in-un-fallimento

If you smoke like men, you die like men. On Richard Doll’s centenary @carlofavaretti @richardhorton1

The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK
Kirstin Pirie, Richard Peto, Gillian K Reeves, Jane Green, Valerie Beral, for the Million Women Study Collaborators

Summary
Background Women born around 1940 in countries such as the UK and USA were the first generation in which many smoked substantial numbers of cigarettes throughout adult life. Hence, only in the 21st century can we observe directly the full effects of prolonged smoking, and of prolonged cessation, on mortality among women in the UK.

Methods For this prospective study, 1·3 million UK women were recruited in 1996–2001 and resurveyed postally about 3 and 8 years later. All were followed to Jan 1, 2011, through national mortality records (mean 12 woman-years, SD 2). Participants were asked at entry whether they were current or ex-smokers, and how many cigarettes they currently smoked. Those who were ex-smokers at both entry and the 3-year resurvey and had stopped before the age of 55 years were categorised by the age they had stopped smoking. We used Cox regression models to obtain adjusted relative risks that compared categories of smokers or ex-smokers with otherwise similar never-smokers.

Findings After excluding 0·1 million women with previous disease, 1·2 million women remained, with median birth year 1943 (IQR 1938–46) and age 55 years (IQR 52–60). Overall, 6% (66489/1180652) died, at mean age 65 years (SD 6). At baseline, 20% (232 461) were current smokers, 28% (328 417) were ex-smokers, and 52% (619 774) were never-smokers. For 12-year mortality, those smoking at baseline had a mortality rate ratio of 2·76 (95% CI 2·71–2·81) compared with never-smokers, even though 44% (37240/85256) of the baseline smokers who responded to the 8-year resurvey had by then stopped smoking. Mortality was tripled, largely irrespective of age, in those still smoking at the 3-year resurvey (rate ratio 2·97, 2·88–3·07). Even for women smoking fewer than ten cigarettes per day at baseline, 12-year mortality was doubled (rate ratio 1·98, 1·91–2·04). Of the 30 most common causes of death, 23 were increased significantly in smokers; for lung cancer, the rate ratio was 21·4 (19·7–23·2). The excess mortality among smokers (in comparison with never- smokers) was mainly from diseases that, like lung cancer, can be caused by smoking. Among ex-smokers who had stopped permanently at ages 25–34 years or at ages 35–44 years, the respective relative risks were 1·05 (95% CI 1·00–1·11) and 1·20 (1·14–1·26) for all-cause mortality and 1·84 (1·45–2·34) and 3·34 (2·76–4·03) for lung cancer mortality. Thus, although some excess mortality remains among these long-term ex-smokers, it is only 3% and 10% of the excess mortality among continuing smokers. If combined with 2010 UK national death rates, tripled mortality rates among smokers indicate 53% of smokers and 22% of never-smokers dying before age 80 years, and an 11-year lifespan difference.

Interpretation Among UK women, two-thirds of all deaths of smokers in their 50s, 60s, and 70s are caused by smoking; smokers lose at least 10 years of lifespan. Although the hazards of smoking until age 40 years and then stopping are substantial, the hazards of continuing are ten times greater. Stopping before age 40 years (and preferably well before age 40 years) avoids more than 90% of the excess mortality caused by continuing smoking; stopping before age 30 years avoids more than 97% of it.

Published Online
October 27, 2012 http://dx.doi.org/10.1016/ S0140-6736(12)61720-6

See Online/Comment http://dx.doi.org/10.1016/ S0140-6736(12)61780-2

See also: Women smokers who quit by 30 ‘evade earlier death risks’ http://www.bbc.co.uk/news/health-19946427

Cancer Epidemiology Unit

(K Pirie MSc, Prof V Beral FRS, G K Reeves PhD, J Green DPhil), and Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) (Prof R Peto FRS), University of Oxford, Oxford, UK

Correspondence to:
Kirstin Pirie, Cancer Epidemiology Unit, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK kirstin.pirie@ceu.ox.ac.uk

Girolamo Sirchia

Italo Svevo nella “Coscienza di Zeno” nel 1923 riportava circa il fumo di sigaretta queste due sentenze che inducono a meditare:
… l’origine della sozza abitudine …
… passo da sigaretta a proposito (dismettere) e da proposito a sigaretta …

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Medical checkups fail to reduce death rates @carlofavaretti @Medici_Manager

Clinically motivated testing still important

CBC News

Posted: Oct 16, 2012 7:11 PM ET

It's possible that those getting the checkups were already well cared for by their regular doctor, researchers say.

It’s possible that those getting the checkups were already well cared for by their regular doctor, researchers say. (Jessica Rinaldi/Reuters)

Regular checkups aren’t beneficial in reducing deaths overall or from cancer or heart disease, a large new review concludes.

Checkups are meant to reduce deaths and illness by detecting diseases early and treating them. Historically, checkups included a physical exam, blood work and sometimes heart tests.

In Wednesday’s issue of the Cochrane Library, researchers tested that assumption by pooling the results of nine trials involving 11,940 deaths. In the studies, participants were either randomly invited to general health checks or not.

“We think it’s unlikely that health checks reduce mortality to a degree where it would be beneficial,” said the study’s lead researcher, Dr. Lasse Krogsboll of the Nordic Cochrane Centre in Copenhagen.

The results don’t imply that prevention is worthless, Krogsboll said, just that offering checkups to the general population of adults doesn’t seem to add benefits.

It’s possible that those getting the checkups were already well cared for by their regular doctor, he said.

Those who accept the invitations to screenings may also differ from those who do not, in that they may be sicker or at higher risk for disease.

The authors said the results do not imply that doctors should stop clinically motivated testing and preventive activities.

Dr. Gerry Brosky of the the department of family medicine at Dalhousie University in Halifax said the annual physical has fallen out of favour with most doctors.

“Most often people are checked in the midst of other visits and so they have their blood pressure checked in addition to something else going on, or their cholesterol done when they’re in for something else,” Brosky said.

Potential for harm

Two out of four trials found that health checks made people feel healthier, but the researchers said the result was not reliable.

Most of the trials were old, the reviewers said, which makes the results less applicable today since treatments and risk factors have changed.

The harmful effects of checkups include:

  • Overdiagnosis — diagnosing and treating with no survival benefit.
  • Turning healthy people into patients, which may affect how they view themselves.

Family physician Dr. Maria Patriquin in Halifax said that a regular check-in might work better than broad checkups.

“I really like to be able to check in with patients once a year and make sure that we’ve gone through what are your individual health concerns if you have them, is there anything that we should’ve been doing that we haven’t done?” Patriquin said.

“I think unless you make it somewhat routine it can fall by the wayside.”

The review did not include studies on children or the elderly.

Carlo Favaretti

XLV Congresso Nazionale della Società Italiana di Igiene Medicina Preventiva e Sanità Pubblica
Forte Village Resort – Santa Margherita di Pula (CA), 3-6 ottobre 2012

Inspiring presentation of Professor Walter Ricciardi, President of the European Public Health Association (EUPHA), at the Conference of the Italian Society of Hygiene, Preventive Medicine and Public Health

http://www.slideshare.net/carlofavaretti/ricciardi-cagliari-siti-2012

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Carlo Favaretti

by VIPAN NIKORE, MD on September 10th, 2012in PHYSICIAN

http://www.kevinmd.com/blog/2012/09/primary-care-missing-link-global-health.html

Sitting on a dusty wooden bench in the rural Sacred Valley in Peru with the Andean mountain range serving as a scenic backdrop, it dawned on me that I was the first physician that my 43-year-old Peruvian patient had ever seen.

After treating his acute diarrhea, I was faced with his elevated but asymptomatic 162/89 blood pressure. I knew he needed treatment, but my concern was whether or not to start him on a blood pressure medicine without follow up. Medications often need to be titrated, and side effects need to be monitored.

What if he was exquisitely sensitive to the anti-hypertensive meds thus causing hypotension and light-headedness? What if he couldn’t afford the medicine in the long run and thus abruptly stopped it and developed rebound hypertension? Why give a month supply of medication if he will not have…

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