Comer carne pode trazer algumas vantagens para as mulheres
Eating a lot of meat may promote good conditions for pregnancy
Girls who eat a lot of meat during childhood tend to start their periods earlier than others, a study suggests.
UK researchers compared the diets of more than 3,000 12-year-old girls.
They found high meat consumption at age three (over eight portions a week) and age seven (12 portions) was strongly linked with early periods.
Writing in Public Health Nutrition, the researchers said a meat-rich diet might prepare the body for pregnancy, triggering an earlier puberty.
During the 20th Century, the average age at which girls started their periods fell fairly dramatically, although it now seems to be levelling off.
Continue reading the main story
Meat is a good source of zinc and iron, requirements for which are high during pregnancy
Dr Imogen Rogers
Study leader
This is widely thought to be due to better nutrition and rising levels of obesity, which has an impact on hormones.
In the latest study, the team used data from a group of children followed from birth.
At the age of 12 years eight months, they split the girls into those who had already started their periods and those who had not.
Comparing their diets at the ages of three, seven and 10, they found that meat intake at a young age was strongly linked with earlier periods.
In fact, at age seven there was a 75% increased chance of having a period by age 12 in those eating the most meat compared with those who ate the least.
Although this finding was independent of body weight, the study repeated previous research showing that bigger girls tend to menstruate early.
'Plausible link'
Starting periods at an early age has been linked with an increased risk of breast cancer, possibly because women are exposed to higher levels of oestrogen over their lifetime.
But the researchers stressed there was no need for young girls to cut meat out of their diet as those with the highest meat consumption were eating a lot.
The seven-year-olds in the highest meat category were eating 12 or more portions a week, and the three-year-olds were having more than eight portions.
Eating a lot of meat may promote good conditions for pregnancy
Study leader Dr Imogen Rogers, senior lecturer in human nutrition at the University of Brighton, said weight could not be the only factor in girls having periods earlier as the average age had not gone down further with increasing levels of obesity.
She added: "Meat is a good source of zinc and iron, requirements for which are high during pregnancy.
"A meat-rich diet could be seen as indicating suitable nutritional conditions for a successful pregnancy."
Dr Ken Ong, paediatric endocrinologist at the Medical Research Council, said there had been "vast shifts" in the timing of first periods over the past century.
He added that the link with meat consumption was a "plausible" one.
"This was not related to larger body size, but rather could be due to a more direct effect of dietary protein on the body's hormone levels."
sexta-feira, 11 de junho de 2010
quinta-feira, 10 de junho de 2010
O sapato mais velho do mundo
Arqueologista encontram ainda em bom estado o mais velho sapato feito pelo homem
Boris Gasparian/Institute of Archaeology and Enthography
The perfectly preserved 5,500-year-old shoe that was discovered in a cave in Armenia
Think of it as a kind of prehistoric Prada: Archaeologists have discovered what they say is the world’s oldest known leather shoe.
Related
Times Topics: Shoes and Boots |
Get Science News From The New York Times »
Boris Gasparian/Institute of Archaeology and Enthography
The Areni-1 cave, center, where what is believed to be the world’s oldest leather shoe was found.
Perfectly preserved under layers of sheep dung (who needs cedar closets?), the shoe, made of cowhide and tanned with oil from a plant or vegetable, is about 5,500 years old, older than Stonehenge and the Egyptian pyramids, scientists say. Leather laces crisscross through numerous leather eyelets, and it was worn on the right foot; there is no word on the left shoe.
While the shoe more closely resembles an L. L.Bean-type soft-soled walking shoe than anything by Jimmy Choo, “these were probably quite expensive shoes, made of leather, very high quality,” said one of the lead scientists, Gregory Areshian, of the Cotsen Institute of Archaeology at the University of California, Los Angeles.
It could have fit a small man or a teenager, but was most likely worn by a woman with roughly size 7 feet. (According to the Web site www.celebrityshoesize.com, that would be slightly roomy for Sarah Jessica Parker, whose Manolo Blahniks are size 6 ½, and a tad tight for Sarah Palin, who, during the 2008 campaign, wore red Double Dare pumps by Naughty Monkey, size 7 ½.)
The shoe was discovered by scientists excavating in a huge cave in Armenia, part of a treasure trove of artifacts they found that experts say provide unprecedented information about an important and sparsely documented era: the Chalcolithic period or Copper Age, when humans are believed to have invented the wheel, domesticated horses and produced other innovations.
Along with the shoe, the cave, designated Areni-1, has yielded evidence of an ancient winemaking operation, and caches of what may be the oldest known intentionally dried fruits: apricots, grapes, prunes. The scientists, financed by the National Geographic Society and other institutions, also found skulls of three adolescents (“subadults,” in archaeology-speak) in ceramic vessels, suggesting ritualistic or religious practice; one skull, Dr. Areshian said, even contained desiccated brain tissue older than the shoe, about 6,000 years old.
“It’s sort of a Pompeii moment, except without the burning,” said Mitchell Rothman, an anthropologist and Chalcolithic expert at Widener University who is not involved in the expedition. “The shoe is really cool, and it’s certainly something that highlights the unbelievable kinds of discoveries at this site. The larger importance, though, is where the site itself becomes significant. You have the transition really into the modern world, the precursor to the kings and queens and bureaucrats and pretty much the whole nine yards.”
Previously, the oldest known leather shoe belonged to Ötzi the Iceman, a mummy found 19 years ago in the Alps near the Italian-Austrian border. His shoes, about 300 years younger than the Armenian shoe, had bearskin soles, deerskin panels, tree-bark netting and grass socks. Footwear even older than the leather shoe includes examples found in Missouri and Oregon, made mostly from plant fibers.
The Armenian shoe discovery, published Wednesday in PLoS One, an online journal, was made beneath one of several cave chambers, when an Armenian doctoral student, Diana Zardaryan, noticed a small pit of weeds. Reaching down, she touched two sheep horns, then an upside-down broken bowl. Under that was what felt like “an ear of a cow,” she said. “But when I took it out, I thought, ‘Oh my God, it’s a shoe.’ To find a shoe has always been my dream.”
Because the cave was also used by later civilizations, most recently by 14th-century Mongols, “my assumption was the shoe would be 600 to 700 years old,” Dr. Areshian said, adding that “a Mongol shoe would have been really great.” When separate laboratories dated the leather to 3653 to 3627 B.C., he said, “we just couldn’t believe that a shoe could be so ancient.”
The shoe was not tossed devil-may-care, but was, for unclear reasons, placed deliberately in the pit, which was carefully lined with yellow clay. While scientists say the shoe was stuffed with grass, acting like a shoe tree to hold its shape, it had been worn.
“You can see the imprints of the big toe,” said another team leader, Ron Pinhasi, an archaeologist at University College Cork in Ireland, who said the shoe resembled old Irish pampooties, rawhide slippers. “As the person was wearing and lacing it, some of the eyelets had been torn and repaired.”
Dr. Pinhasi said the cave, discovered in 1997, appeared to be mainly used by “high-status people, people who had power,” for storing the Chalcolithic community’s harvest and ritual objects. But some people lived up front, probably caretakers providing, Dr. Areshian said, the Chalcolithic equivalent of valet parking.
Many tools found were of obsidian, whose closest source was a 60-mile trek away. (Perhaps why they needed shoes, Dr. Areshian suggested.)
“It’s an embarrassment of riches because the preservation is so remarkable,” said Adam T. Smith, an anthropologist at the University of Chicago who has done separate research in the cave. He said that distinguishing Chalcolithic objects from later civilizations’ artifacts in the cave had been complicated, and that “we’re still not entirely clear what the chronology is” of every discovery.
“The shoe,” he said, “is in a sense just the tip of the iceberg.” (He probably meant to say wingtip.)
Boris Gasparian/Institute of Archaeology and Enthography
The perfectly preserved 5,500-year-old shoe that was discovered in a cave in Armenia
Think of it as a kind of prehistoric Prada: Archaeologists have discovered what they say is the world’s oldest known leather shoe.
Related
Times Topics: Shoes and Boots |
Get Science News From The New York Times »
Boris Gasparian/Institute of Archaeology and Enthography
The Areni-1 cave, center, where what is believed to be the world’s oldest leather shoe was found.
Perfectly preserved under layers of sheep dung (who needs cedar closets?), the shoe, made of cowhide and tanned with oil from a plant or vegetable, is about 5,500 years old, older than Stonehenge and the Egyptian pyramids, scientists say. Leather laces crisscross through numerous leather eyelets, and it was worn on the right foot; there is no word on the left shoe.
While the shoe more closely resembles an L. L.Bean-type soft-soled walking shoe than anything by Jimmy Choo, “these were probably quite expensive shoes, made of leather, very high quality,” said one of the lead scientists, Gregory Areshian, of the Cotsen Institute of Archaeology at the University of California, Los Angeles.
It could have fit a small man or a teenager, but was most likely worn by a woman with roughly size 7 feet. (According to the Web site www.celebrityshoesize.com, that would be slightly roomy for Sarah Jessica Parker, whose Manolo Blahniks are size 6 ½, and a tad tight for Sarah Palin, who, during the 2008 campaign, wore red Double Dare pumps by Naughty Monkey, size 7 ½.)
The shoe was discovered by scientists excavating in a huge cave in Armenia, part of a treasure trove of artifacts they found that experts say provide unprecedented information about an important and sparsely documented era: the Chalcolithic period or Copper Age, when humans are believed to have invented the wheel, domesticated horses and produced other innovations.
Along with the shoe, the cave, designated Areni-1, has yielded evidence of an ancient winemaking operation, and caches of what may be the oldest known intentionally dried fruits: apricots, grapes, prunes. The scientists, financed by the National Geographic Society and other institutions, also found skulls of three adolescents (“subadults,” in archaeology-speak) in ceramic vessels, suggesting ritualistic or religious practice; one skull, Dr. Areshian said, even contained desiccated brain tissue older than the shoe, about 6,000 years old.
“It’s sort of a Pompeii moment, except without the burning,” said Mitchell Rothman, an anthropologist and Chalcolithic expert at Widener University who is not involved in the expedition. “The shoe is really cool, and it’s certainly something that highlights the unbelievable kinds of discoveries at this site. The larger importance, though, is where the site itself becomes significant. You have the transition really into the modern world, the precursor to the kings and queens and bureaucrats and pretty much the whole nine yards.”
Previously, the oldest known leather shoe belonged to Ötzi the Iceman, a mummy found 19 years ago in the Alps near the Italian-Austrian border. His shoes, about 300 years younger than the Armenian shoe, had bearskin soles, deerskin panels, tree-bark netting and grass socks. Footwear even older than the leather shoe includes examples found in Missouri and Oregon, made mostly from plant fibers.
The Armenian shoe discovery, published Wednesday in PLoS One, an online journal, was made beneath one of several cave chambers, when an Armenian doctoral student, Diana Zardaryan, noticed a small pit of weeds. Reaching down, she touched two sheep horns, then an upside-down broken bowl. Under that was what felt like “an ear of a cow,” she said. “But when I took it out, I thought, ‘Oh my God, it’s a shoe.’ To find a shoe has always been my dream.”
Because the cave was also used by later civilizations, most recently by 14th-century Mongols, “my assumption was the shoe would be 600 to 700 years old,” Dr. Areshian said, adding that “a Mongol shoe would have been really great.” When separate laboratories dated the leather to 3653 to 3627 B.C., he said, “we just couldn’t believe that a shoe could be so ancient.”
The shoe was not tossed devil-may-care, but was, for unclear reasons, placed deliberately in the pit, which was carefully lined with yellow clay. While scientists say the shoe was stuffed with grass, acting like a shoe tree to hold its shape, it had been worn.
“You can see the imprints of the big toe,” said another team leader, Ron Pinhasi, an archaeologist at University College Cork in Ireland, who said the shoe resembled old Irish pampooties, rawhide slippers. “As the person was wearing and lacing it, some of the eyelets had been torn and repaired.”
Dr. Pinhasi said the cave, discovered in 1997, appeared to be mainly used by “high-status people, people who had power,” for storing the Chalcolithic community’s harvest and ritual objects. But some people lived up front, probably caretakers providing, Dr. Areshian said, the Chalcolithic equivalent of valet parking.
Many tools found were of obsidian, whose closest source was a 60-mile trek away. (Perhaps why they needed shoes, Dr. Areshian suggested.)
“It’s an embarrassment of riches because the preservation is so remarkable,” said Adam T. Smith, an anthropologist at the University of Chicago who has done separate research in the cave. He said that distinguishing Chalcolithic objects from later civilizations’ artifacts in the cave had been complicated, and that “we’re still not entirely clear what the chronology is” of every discovery.
“The shoe,” he said, “is in a sense just the tip of the iceberg.” (He probably meant to say wingtip.)
quarta-feira, 9 de junho de 2010
Sessão Científica desta quinta 10 de Junho
Nesta quinta feira a sessão cientifica do LASP será sobre lesihmaniose.
Dayana Mendes aluna do curso de Pós Graduação em Biotecnologia e Medicina Investigativa mostrará resultados do seu trabalho de tese de Mestrado.
Figura.
Aspectos clínicos da Leishmaniose Disseminada
Médicos cientistas. Cada vez mais raros
Médicos clínicos e pesquisadores são de fundamental importância para o avanço das pesquisas médicas mas cada vez mais são mais raros. O excesso de trabalho com a prática clínica, a falta de estimulo e as dificuldades em se construir uma carreira de pesquisa podem justificar?. Veja o artigo abaixo
Perspective: The Successful Physician-Scientist of the 21st Century
May 28, 2010
Without a doubt, this is a difficult period to become a physician-scientist. Rather than railing against the system, you should be a constructive, even outspoken, catalyst for change in your home institution.
Physician-scientists have always brought a unique perspective to biomedical research that is inspired by their personal experience in caring for patients. Indeed, throughout history, physicians have played a central role in advancing the science of medicine as the "translators" of medical research. Yet there has been growing concern over the past 3 decades that the workforce of physician-scientists, at least in the form we have come to know them in previous generations, may be vanishing.
We have a problem
(Weill Cornell Medical College)
Andrew I. Schafer, M.D.
There is ample evidence to support this worrisome trend. Although the numbers of National Institutes of Health (NIH) grant applications and applicants over the past 15 years has more than doubled, those numbers have been essentially flat for M.D.-only physician-scientist applicants. During the 5-year period from 1998 to 2003, during which the NIH budget doubled, there was a 43% increase in first-time R01 applicants with Ph.D.s as principal investigators (PIs) and a 104% increase in applications with M.D.-Ph.D. PIs -- a very small percentage of the total pool of applicants. In contrast, applications from those with M.D. degrees declined by 4%.
Perhaps even more disconcerting are data about the recent attrition of NIH-funded physician-scientists. As reported by Theodore Kotchen et al. and Howard Dickler et al. in The Journal of the American Medical Association in 2004 and 2007, respectively, about 40% of M.D.s with K08 (mentored clinical scientist development) awards do not even apply for a subsequent first independent (R01) grant. Furthermore, unsuccessful first-time M.D. applicants for an R01 grant are consistently less persistent than their Ph.D. counterparts in reapplying after an initial failed attempt. And M.D. applicants who do have an R01 grant are less likely than Ph.D. applicants to apply for a subsequent R01 grant. So in recent years, at every point in the early life cycle of NIH funding, physician-scientists have been more likely than Ph.D. scientists to leave the NIH grant-applicant pool.
These numbers suggest that, however serious the problem of insufficient numbers entering the physician-scientist workforce, there's an even more important factor: The pipeline is broken, or at least leaking badly.
How did this problem happen?
What are some of the fundamental causes for the decline in the physician-scientist workforce? At the core of it, I think, is the reality that the arenas of basic biomedical research (on one side) and the clinical practice of medicine (on the other) have progressively and dramatically separated. This widening chasm has created a rapidly increasing language barrier between basic biomedical scientists and practicing clinicians. It is a two-way barrier: Midcareer clinicians today are unable to understand even the basic vocabulary of molecular biology and genetics, and biomedical investigators (even those with M.D. degrees) are increasingly losing track of rapid advances in clinical medicine, which is always increasing in technologic complexity.
In addition to its linguistic aspects, the chasm between basic science and clinical practice is also both scientific and cultural. The scientific chasm was created largely by the reductionism in medical research in the early years of the molecular biology and genetics revolution throughout much of the second half of the 20th century. This reductionist approach to medical science dictated that complex systems can be understood only by first reducing them into the study of their smallest, individual, analyzable parts. Reductionism moved medical research further and further away from the whole patient. More recently, reductionism has been counterbalanced by the emergence of "systems biology," which I expect to reanimate the crucial link between basic science, clinical research, and medical practice.
The cultural chasm between science and clinical practice involves the very distinct mentalities required to practice clinical medicine and to do basic biomedical research. Barry Coller insightfully described this chasm in The Vanishing Physician-Scientist?:
- Clinicians are motivated by the need for immediate action (sometimes to even save a life), whereas scientists are conditioned to avoid rushing to judgment;
- Clinicians are taught to adhere to standards and guidelines of practice, whereas scientists are encouraged to challenge existing paradigms;
- Clinicians traditionally respect hierarchy and expert authority, whereas scientists tend to critique and challenge accepted wisdom;
- For clinicians, errors are potentially mortal threats, whereas for scientists, errors are inevitable manifestations of the creative process;
- Clinicians focus on the unique, whereas scientists look for generalizable principles.
In addition to the scientific and cultural chasms, contemporary forces are now contributing to the weakened physician-scientist career pipeline. The number of women graduating from medical school today equals the number of men. The dramatic change in medical student gender demographics has not been accompanied, however, by a proportionate increase of women in senior faculty ranks and leadership positions, even after the expected time lag. It has been noted that women tend to find physician-scientist careers less attractive than men do for a number of reasons: They (1) are concerned that it will be impossible to combine a successful medical research career with childbearing and family life; (2) feel that they have to be better than their male counterparts to be considered equal; (3) receive little encouragement to become physician-scientists; and (4) lack compelling role models.
Entry and retention in physician-scientist careers also appears to be impeded today by a generation gap in expectations. The current generation of medical school graduates, regardless of gender, has very different priorities. They attach much more importance to work-life balance and controllable lifestyles that they believe, perhaps erroneously, to be incompatible with serious research careers. Finally, at least partly as a function of these new forces, there has been serious erosion in the quantity and quality of effective mentoring in its traditional dyadic, "mentor mentee" format.
So, are physician-scientists marked for extinction?
And yet, as I have concluded in The Vanishing Physician-Scientist?, I believe that physician-scientists should be considered "endangered" today only in their current state, not in the sense of permanent extinction. What is vanishing -- if it ever really existed -- is a mass of physician-scientists matching an earlier generation's idealized concept of the "triple threat" who could, as a solitary clinical investigator, move effortlessly between bedside and bench, managing a busy clinical practice and a productive research laboratory while devoting significant time to teaching and mentoring.
How can I make it?
So how can young physician-scientists realistically flourish under these circumstances? First, you must recognize that the current structure of medical schools and universities, with their anachronistic, rigid "up or out" promotion and tenure systems, were designed to accommodate the male physician-scientist of earlier generations whose career ambitions were supported by stay-at-home wives who assumed all household and child-rearing responsibilities. It will take some time for academic systems to catch up to the contemporary realities of being a successful physician-scientist today. During this period of transition, I would offer the following advice.
1. Be proactive in carving out your own physician-scientist career path. In the past, young physicians with a passion and aptitude for research were nourished and incubated in highly supportive environments. They could assume that their paths to independence as investigators would be carefully groomed and personally guided by readily available, experienced, dedicated, and influential mentors who would also create for them the personal connections they need for collaborations. If you are in such an environment now, consider yourself extraordinarily fortunate. The great majority of young physician-scientists today will not have the luxury of being the passive recipients of such spoon-fed career development. So, be proactive, resourceful, and aggressive in searching for and engaging the guidance you will need.
2. Along these lines, seek and cultivate mentors. Of course, above all, you must have strong scientific mentoring. But you must also have role models, confidants, champions, and experienced and influential people who can provide you with connections and show you the ropes (people whom I refer to as academic "godfathers" or "godmothers"). These characteristics are rarely found all rolled into one individual, so assemble your own personal mentoring circle. In many cases, you will find them outside your own department and even outside your institution. Work to recruit them to your mentoring team and then cultivate them by reciprocating as a "good mentee" -- someone who accepts criticism well, keeps an open mind, frequently gives credit to the mentor, and can bring real value to the mentor-mentee relationship.
3. Navigate the diverse missions of academic medicine with self-discipline. You should learn great time-management skills. These are mostly hard-earned, self-taught, acquired skills, not innate abilities, so don't just say, "I don't have good time-management skills" and leave it at that. Try very hard to organize your calendar to enable you to devote large blocks of uninterrupted time to each of your core professional activities -- at least several hours in any given day, preferably whole days or even several consecutive days. This means learning to be able to say "no" -- or "not now" -- in a gracious and disarming way. For example, when asked to give a lecture when you are engaged in writing a grant application, offer a different time when you can do it, after the grant deadline.
4. Learn that medical research today is a team sport. During this generation, the breathtaking pace and scope of progress in both the science and the practice of medicine has vastly outstripped the capacity of any individual physician-scientist to maintain even a semblance of currency in both arenas. The key to success is your ability to thoughtfully surround yourself with partners, particularly Ph.D. scientists, who offer complementary expertise. And for each project, you and your collaborators should try to agree in advance what each scientist's role will be and who will be the "driver." Insisting on being the sole principal investigator on every project, or even most projects, will prove to be counterproductive. Can you be a team player and still be a star? Yes. Remember that the greatest sports stars have been the ones who were able to elevate their teams to win championships.
Without a doubt, this is a difficult period to become a physician-scientist because academic structures and reward systems are lagging well behind the contemporary realities that constrain traditional physician-scientist careers. It is a particularly challenging period for young women physician-scientists. Rather than railing against the system, you should be a constructive, even outspoken, catalyst for change in your home institution. Do not allow systemic adversities to defeat you: The same amazing intellectual rewards that physician-scientists of previous generations enjoyed are most certainly available for the current and future generations.
References
N. C. Andrews, " The other physician-scientist problem: Where have all the young girls gone?" Nature Medicine8, 439 (2002).
H. B. Dickler et al., " New Physician-Investigators Receiving National Institutes of Health Research Project Grants: A Historical Perspective on the 'Endangered Species.' " The Journal of the American Medical Association 297, 2496 (2007).
terça-feira, 8 de junho de 2010
Poiltica de Saude Inglesa
Agora os hospitais não receberão se o paciente voltar ao hospital dentro de 30 dias com o mesmo problema. Essa política reflete um arroxo nas contas publicas!!!
Hospitals to face financial penalties for readmissions
Page last updated at 07:45 GMT, Tuesday, 8 June 2010 08:45 UK
E-mail this to a friendPrintable version
Cannot play media.You do not have the correct version of the flash player. Download the correct version
Health Secretary Andrew Lansley: "This promises to be a much better system"
Hospitals will face financial penalties if patients are readmitted as an emergency within 30 days of being discharged, under government plans.
The scheme will be unveiled on Tuesday by Andrew Lansley, in his first major speech as the new health secretary.
Hospitals in England will be paid for initial treatment but not paid again if a patient is brought back in with a related problem, he will say.
It has been argued that patients are being discharged early to free up beds.
The Conservatives have said cuts to the number of hospital beds under Labour put pressure on NHS staff to discharge people without support.
Between 1998-99 and 2007-08, the number of emergency readmissions in England rose from 359,719 to 546,354.
But there was also a significant rise in the number of procedures performed over the same time period.
Speaking about his vision for the NHS, Mr Lansley will call for patients to be given more control over their healthcare.
He is also expected to give hospitals the responsibility of looking after patients' health and well-being for up to a month after they are discharged.
Continuity of care
Currently primary care trusts and GPs look after patients once they are discharged from hospital.
Under the plan hospitals would receive funding for the first hospital stay plus treatment for the patient's first 30 days after discharge.
Continue reading the main story
What I am saying today is in part about focusing on patient safety and on better care for patients
Andrew Lansley
Health Secretary
Mr Lansley will promise to "empower patients as well as health professionals" and "disempower the hierarchy and the bureaucracy".
"I want the service to listen to patients, to take responsibility, to realise how much patients know about their need, especially for those living with long-term conditions."
Mr Lansley will say that targets focused on processes, data returns and more Department of Health circulars will not achieve these aims.
Neither will "pointless structural upheavals or increasing the number of administrators in primary care trusts, nor even just by supplying more money".
Speaking on BBC Breakfast, Mr Lansley said the Government was "very clear" that it would increase the NHS budget every year in real terms to meet the demands on the service.
"What I am saying today is in part about focusing on patient safety and on better care for patients.
"This safer, better care is also more cost effective and if I can cut, as I will do, the cost of bureaucracy, the cost of administration, cut out waste in the NHS, then we can get those resources to support increasing quality for patients."
He said one of the objectives of cutting waste and working more effectively in the NHS would be in order to find money to fund new drugs, such as those for cancer.
Hospitals to face financial penalties for readmissions
Page last updated at 07:45 GMT, Tuesday, 8 June 2010 08:45 UK
E-mail this to a friendPrintable version
Cannot play media.You do not have the correct version of the flash player. Download the correct version
Health Secretary Andrew Lansley: "This promises to be a much better system"
Hospitals will face financial penalties if patients are readmitted as an emergency within 30 days of being discharged, under government plans.
The scheme will be unveiled on Tuesday by Andrew Lansley, in his first major speech as the new health secretary.
Hospitals in England will be paid for initial treatment but not paid again if a patient is brought back in with a related problem, he will say.
It has been argued that patients are being discharged early to free up beds.
The Conservatives have said cuts to the number of hospital beds under Labour put pressure on NHS staff to discharge people without support.
Between 1998-99 and 2007-08, the number of emergency readmissions in England rose from 359,719 to 546,354.
But there was also a significant rise in the number of procedures performed over the same time period.
Speaking about his vision for the NHS, Mr Lansley will call for patients to be given more control over their healthcare.
He is also expected to give hospitals the responsibility of looking after patients' health and well-being for up to a month after they are discharged.
Continuity of care
Currently primary care trusts and GPs look after patients once they are discharged from hospital.
Under the plan hospitals would receive funding for the first hospital stay plus treatment for the patient's first 30 days after discharge.
Continue reading the main story
What I am saying today is in part about focusing on patient safety and on better care for patients
Andrew Lansley
Health Secretary
Mr Lansley will promise to "empower patients as well as health professionals" and "disempower the hierarchy and the bureaucracy".
"I want the service to listen to patients, to take responsibility, to realise how much patients know about their need, especially for those living with long-term conditions."
Mr Lansley will say that targets focused on processes, data returns and more Department of Health circulars will not achieve these aims.
Neither will "pointless structural upheavals or increasing the number of administrators in primary care trusts, nor even just by supplying more money".
Speaking on BBC Breakfast, Mr Lansley said the Government was "very clear" that it would increase the NHS budget every year in real terms to meet the demands on the service.
"What I am saying today is in part about focusing on patient safety and on better care for patients.
"This safer, better care is also more cost effective and if I can cut, as I will do, the cost of bureaucracy, the cost of administration, cut out waste in the NHS, then we can get those resources to support increasing quality for patients."
He said one of the objectives of cutting waste and working more effectively in the NHS would be in order to find money to fund new drugs, such as those for cancer.
domingo, 6 de junho de 2010
progressos no tratamento dos 2 piores tumores
Figura de Melanoma. Observe as boradas irregulares e cores marron clara e mais engerecida
Mesmo para neoplasias muito malignas e de prognósticos muito ruins tem havido progressos no tratamento. Veja a reportagem do NYT sobre as novidades terapêuticas em melanoma e neoplasia de pulmão
Scientists Cite Advances on Two Kinds of Cancer
By ANDREW POLLACK
Published: June 5, 2010
CHICAGO — Using two opposite strategies, one focused and one broad, scientists say they have made progress in taming two of the most intractable types of cancer. The focused approach shrank tumors significantly in a majority of patients with advanced lung cancer marked by a specific genetic abnormality. Even though the clinical trial was small (just 82 people, with no control group), the results were considered so striking for such sick patients that the study will be featured Sunday at the main session of the annual meeting of the American Society of Clinical Oncology here. “This is a phenomenal example of finding the right patient and the right drug very early on,” said Dr. Pasi A. Janne of the Dana-Farber Cancer Institute in Boston, who was involved in the trial. The broader strategy uses a drug that could potentially become a universal treatment for all types of cancer. It works by releasing a brake on the body’s immune system, letting the immune system attack the cancer more vigorously.
In a study of patients who had advanced melanoma, those who got an experimental drug lived a median of about 10 months, compared with 6.4 months for those in a control group. After two years, about 23 percent of those who got the drug were alive, compared with 14 percent in the control group. Lung cancer and melanoma are among the hardest cancers to treat. So the studies are being viewed as significant advances, though far from cures. Dr. Steven J. O’Day of the Angeles Clinic and Research Institute in Santa Monica, Calif., a lead investigator in the melanoma trial, called the result “historic,” and added, “This is the first randomized placebo-controlled trial ever to show a survival benefit in Stage 4 melanoma.” Bristol-Myers Squibb, which sponsored the trial, is planning to apply for regulatory approval to sell the drug, ipilimumab. The lung cancer drug, by contrast, blocks an aberrant protein called ALK that is found in only about 5 percent of non-small-cell lung tumors. But in patients whose tumors have this aberration, the drug seems to work wonders. The tumors shrank significantly in 57 percent of the 82 patients, and they remained stable in 30 percent more. Beverly Sotir, 71, of Belmont, Mass., who has been taking the pills as part of the trial since July, said her tumors had shrunk without debilitating side effects. “For someone who’s been on chemo before, this is like a miracle drug,” she said. “You feel yourself. You look yourself.” Pfizer, which sponsored the study, has started a more definitive trial aimed at winning approval of the drug, crizotinib. There are caveats. The effects of crizotinib can wear off, though 72 percent of the patients in the trial were free of cancer progression for six months. As for the melanoma drug, because it removes checks on the immune system, 10 percent to 15 percent of patients who took it in the study suffered severe side effects because their immune systems attacked their own organs. Seven patients out of 540 who got ipilimumab died from these immune effects, according to a report of the study published online Saturday by The New England Journal of Medicine.
Efforts to harness the immune system to fight cancer have suffered setback after setback. Because tumor cells are mutated forms of the body’s own cells, not an invading pathogen, they do not usually elicit a strong immune response.
But the Food and Drug Administration this year approved a “cancer vaccine” for prostate cancer called Provenge, so-called because it trains the immune system to attack the patient’s tumors. Most such vaccines focus on a single type of cancer, or are even tailored to individual patients. Ipilimumab, by contrast, is a more general immune booster. It blocks a protein called CTLA-4 that acts as a brake on T cells, the soldiers of the immune system. It is already also being tested against lung and prostate cancer. Still, if a tumor does not elicit a strong immune response to begin with, then just keeping the response going longer would not help much, just as lifting one’s foot from the brake usually will not make a car go faster if the accelerator is not pressed.
In at least one other melanoma trial, conventional chemotherapy drugs achieved median survival of about 10 months, the same as ipilimumab. Dr. Charles M. Balch, a melanoma expert at Johns Hopkins who was not involved in the trial, called the results “a single, not a home run,” though he added that for this disease even a single was important.
About 68,000 Americans are expected to get melanoma this year, with 8,700 deaths, according to the American Cancer Society. The numbers have been increasing, probably because of sun exposure decades ago. The trial involved 676 patients in the United States and 12 other countries with previously treated metastatic melanoma. They received either ipilimumab or an experimental cancer vaccine or both. Those who got ipilimumab alone did as well as those who got both, suggesting the vaccine had little effect. Dr. Petra Rietschel of the Montefiore-Einstein Center for Cancer Care in the Bronx said melanoma experts were equally or even more excited about a drug being developed by Plexxikon and Roche that blocks a particular protein called B-RAF that is aberrant in more than half of all cases of the disease. That is similar to the approach of crizotinib, Pfizer’s lung cancer drug. They are part of a trend to genetically analyze a patient’s tumor and find drugs that block the particular genetic anomaly that drive that tumor’s growth. Pfizer developed crizotinib to block another protein called MET. The fact that the drug also blocked ALK was considered unimportant. But in 2007, after the clinical trial had started, Dr. Hiroyuki Mano and colleagues at Jichi Medical University in Japan reported that in a small number of lung cancers, there was a chromosome translocation that brought the gene for ALK together with the gene for another protein called EML4. That created a fusion protein that spurred tumor growth. Dr. Mano had discovered this by systematically testing all the active genes in a tumor removed from a lung cancer patient. Pfizer turned on a dime and began enrolling lung cancer patients with this fusion protein in the trial. Japanese patients began flying to South Korea, the nearest place with trial sites. Dr. Mano said the first Japanese patient who went was so sick — heavily dependent on oxygen tanks and unable to swallow — that he had to be taken to the airport by medical helicopter and met by an ambulance at the airport in Seoul. Two weeks later, Dr. Mano said, he went to Seoul to check on the patient. The man no longer needed oxygen and was walking in the neighborhood each day looking for good restaurants. The patient returned to Japan and lived for several more months.
Scientists said the ALK gene aberration tends to be more frequent in younger patients and nonsmokers. Experts say that even though the drug might be useful for only 5 percent of non-small-cell lung cancer patients, that would still be about 10,000 people a year in the United States and 40,000 worldwide.Finding drugs for each subset of tumors will take years. And cancers can mutate and become resistant to drugs blocking particular abnormalities.Dr. James Allison, who paved the way for ipilimumab with work he did at the University of California, Berkeley, said the immune therapies might be helped by such mutations. So the targeted drugs and the immune boosting ones might work best together. “It’s the ultimate personalized treatment for cancer,” said Dr. Allison, who is now chairman of immunology at the Memorial Sloan-Kettering Cancer Center.
By ANDREW POLLACK
Published: June 5, 2010
CHICAGO — Using two opposite strategies, one focused and one broad, scientists say they have made progress in taming two of the most intractable types of cancer. The focused approach shrank tumors significantly in a majority of patients with advanced lung cancer marked by a specific genetic abnormality. Even though the clinical trial was small (just 82 people, with no control group), the results were considered so striking for such sick patients that the study will be featured Sunday at the main session of the annual meeting of the American Society of Clinical Oncology here. “This is a phenomenal example of finding the right patient and the right drug very early on,” said Dr. Pasi A. Janne of the Dana-Farber Cancer Institute in Boston, who was involved in the trial. The broader strategy uses a drug that could potentially become a universal treatment for all types of cancer. It works by releasing a brake on the body’s immune system, letting the immune system attack the cancer more vigorously.
In a study of patients who had advanced melanoma, those who got an experimental drug lived a median of about 10 months, compared with 6.4 months for those in a control group. After two years, about 23 percent of those who got the drug were alive, compared with 14 percent in the control group. Lung cancer and melanoma are among the hardest cancers to treat. So the studies are being viewed as significant advances, though far from cures. Dr. Steven J. O’Day of the Angeles Clinic and Research Institute in Santa Monica, Calif., a lead investigator in the melanoma trial, called the result “historic,” and added, “This is the first randomized placebo-controlled trial ever to show a survival benefit in Stage 4 melanoma.” Bristol-Myers Squibb, which sponsored the trial, is planning to apply for regulatory approval to sell the drug, ipilimumab. The lung cancer drug, by contrast, blocks an aberrant protein called ALK that is found in only about 5 percent of non-small-cell lung tumors. But in patients whose tumors have this aberration, the drug seems to work wonders. The tumors shrank significantly in 57 percent of the 82 patients, and they remained stable in 30 percent more. Beverly Sotir, 71, of Belmont, Mass., who has been taking the pills as part of the trial since July, said her tumors had shrunk without debilitating side effects. “For someone who’s been on chemo before, this is like a miracle drug,” she said. “You feel yourself. You look yourself.” Pfizer, which sponsored the study, has started a more definitive trial aimed at winning approval of the drug, crizotinib. There are caveats. The effects of crizotinib can wear off, though 72 percent of the patients in the trial were free of cancer progression for six months. As for the melanoma drug, because it removes checks on the immune system, 10 percent to 15 percent of patients who took it in the study suffered severe side effects because their immune systems attacked their own organs. Seven patients out of 540 who got ipilimumab died from these immune effects, according to a report of the study published online Saturday by The New England Journal of Medicine.
Efforts to harness the immune system to fight cancer have suffered setback after setback. Because tumor cells are mutated forms of the body’s own cells, not an invading pathogen, they do not usually elicit a strong immune response.
But the Food and Drug Administration this year approved a “cancer vaccine” for prostate cancer called Provenge, so-called because it trains the immune system to attack the patient’s tumors. Most such vaccines focus on a single type of cancer, or are even tailored to individual patients. Ipilimumab, by contrast, is a more general immune booster. It blocks a protein called CTLA-4 that acts as a brake on T cells, the soldiers of the immune system. It is already also being tested against lung and prostate cancer. Still, if a tumor does not elicit a strong immune response to begin with, then just keeping the response going longer would not help much, just as lifting one’s foot from the brake usually will not make a car go faster if the accelerator is not pressed.
In at least one other melanoma trial, conventional chemotherapy drugs achieved median survival of about 10 months, the same as ipilimumab. Dr. Charles M. Balch, a melanoma expert at Johns Hopkins who was not involved in the trial, called the results “a single, not a home run,” though he added that for this disease even a single was important.
About 68,000 Americans are expected to get melanoma this year, with 8,700 deaths, according to the American Cancer Society. The numbers have been increasing, probably because of sun exposure decades ago. The trial involved 676 patients in the United States and 12 other countries with previously treated metastatic melanoma. They received either ipilimumab or an experimental cancer vaccine or both. Those who got ipilimumab alone did as well as those who got both, suggesting the vaccine had little effect. Dr. Petra Rietschel of the Montefiore-Einstein Center for Cancer Care in the Bronx said melanoma experts were equally or even more excited about a drug being developed by Plexxikon and Roche that blocks a particular protein called B-RAF that is aberrant in more than half of all cases of the disease. That is similar to the approach of crizotinib, Pfizer’s lung cancer drug. They are part of a trend to genetically analyze a patient’s tumor and find drugs that block the particular genetic anomaly that drive that tumor’s growth. Pfizer developed crizotinib to block another protein called MET. The fact that the drug also blocked ALK was considered unimportant. But in 2007, after the clinical trial had started, Dr. Hiroyuki Mano and colleagues at Jichi Medical University in Japan reported that in a small number of lung cancers, there was a chromosome translocation that brought the gene for ALK together with the gene for another protein called EML4. That created a fusion protein that spurred tumor growth. Dr. Mano had discovered this by systematically testing all the active genes in a tumor removed from a lung cancer patient. Pfizer turned on a dime and began enrolling lung cancer patients with this fusion protein in the trial. Japanese patients began flying to South Korea, the nearest place with trial sites. Dr. Mano said the first Japanese patient who went was so sick — heavily dependent on oxygen tanks and unable to swallow — that he had to be taken to the airport by medical helicopter and met by an ambulance at the airport in Seoul. Two weeks later, Dr. Mano said, he went to Seoul to check on the patient. The man no longer needed oxygen and was walking in the neighborhood each day looking for good restaurants. The patient returned to Japan and lived for several more months.
Scientists said the ALK gene aberration tends to be more frequent in younger patients and nonsmokers. Experts say that even though the drug might be useful for only 5 percent of non-small-cell lung cancer patients, that would still be about 10,000 people a year in the United States and 40,000 worldwide.Finding drugs for each subset of tumors will take years. And cancers can mutate and become resistant to drugs blocking particular abnormalities.Dr. James Allison, who paved the way for ipilimumab with work he did at the University of California, Berkeley, said the immune therapies might be helped by such mutations. So the targeted drugs and the immune boosting ones might work best together. “It’s the ultimate personalized treatment for cancer,” said Dr. Allison, who is now chairman of immunology at the Memorial Sloan-Kettering Cancer Center.
terça-feira, 1 de junho de 2010
Nunca é tarde para ser feliz- Será
Leia o artigo publicado no PNAS e comentado no New York Times
http://www.pnas.org/content/early/2010/05/04/1003744107.full.pdf+html?sid=632b590e-ca75-43de-ade2-59ef6f391015
Happiness May Come With Age, Study Says
It is inevitable. The muscles weaken. Hearing and vision fade. We get wrinkled and stooped. We can’t run, or even walk, as fast as we used to. We have aches and pains in parts of our bodies we never even noticed before. We get old.
It sounds miserable, but apparently it is not. A large Gallup poll has found that by almost any measure, people get happier as they get older, and researchers are not sure why.
“It could be that there are environmental changes,” said Arthur A. Stone, the lead author of a new study based on the survey, “or it could be psychological changes about the way we view the world, or it could even be biological — for example brain chemistry or endocrine changes.”
The telephone survey, carried out in 2008, covered more than 340,000 people nationwide, ages 18 to 85, asking various questions about age and sex, current events, personal finances, health and other matters.
The survey also asked about “global well-being” by having each person rank overall life satisfaction on a 10-point scale, an assessment many people may make from time to time, if not in a strictly formalized way.
Finally, there were six yes-or-no questions: Did you experience the following feelings during a large part of the day yesterday: enjoyment, happiness, stress, worry, anger, sadness. The answers, the researchers say, reveal “hedonic well-being,” a person’s immediate experience of those psychological states, unencumbered by revised memories or subjective judgments that the query about general life satisfaction might have evoked.
The results, published online May 17 in the Proceedings of the National Academy of Sciences, were good news for old people, and for those who are getting old. On the global measure, people start out at age 18 feeling pretty good about themselves, and then, apparently, life begins to throw curve balls. They feel worse and worse until they hit 50. At that point, there is a sharp reversal, and people keep getting happier as they age. By the time they are 85, they are even more satisfied with themselves than they were at 18.
In measuring immediate well-being — yesterday’s emotional state — the researchers found that stress declines from age 22 onward, reaching its lowest point at 85. Worry stays fairly steady until 50, then sharply drops off. Anger decreases steadily from 18 on, and sadness rises to a peak at 50, declines to 73, then rises slightly again to 85. Enjoyment and happiness have similar curves: they both decrease gradually until we hit 50, rise steadily for the next 25 years, and then decline very slightly at the end, but they never again reach the low point of our early 50s.
Other experts were impressed with the work. Andrew J. Oswald, a professor of psychology at Warwick Business School in England, who has published several studies on human happiness, called the findings important and, in some ways, heartening. “It’s a very encouraging fact that we can expect to be happier in our early 80s than we were in our 20s,” he said. “And it’s not being driven predominantly by things that happen in life. It’s something very deep and quite human that seems to be driving this.”
Dr. Stone, who is a professor of psychology at the State University of New York at Stony Brook, said that the findings raised questions that needed more study. “These results say there are distinctive patterns here,” he said, “and it’s worth some research effort to try to figure out what’s going on. Why at age 50 does something seem to start to change?”
The study was not designed to figure out which factors make people happy, and the poll’s health questions were not specific enough to draw any conclusions about the effect of disease or disability on happiness in old age. But the researchers did look at four possibilities: the sex of the interviewee, whether the person had a partner, whether there were children at home and employment status. “These are four reasonable candidates,” Dr. Stone said, “but they don’t make much difference.”
For people under 50 who may sometimes feel gloomy, there may be consolation here. The view seems a bit bleak right now, but look at the bright side: you are getting old
http://www.pnas.org/content/early/2010/05/04/1003744107.full.pdf+html?sid=632b590e-ca75-43de-ade2-59ef6f391015
Happiness May Come With Age, Study Says
It is inevitable. The muscles weaken. Hearing and vision fade. We get wrinkled and stooped. We can’t run, or even walk, as fast as we used to. We have aches and pains in parts of our bodies we never even noticed before. We get old.
It sounds miserable, but apparently it is not. A large Gallup poll has found that by almost any measure, people get happier as they get older, and researchers are not sure why.
“It could be that there are environmental changes,” said Arthur A. Stone, the lead author of a new study based on the survey, “or it could be psychological changes about the way we view the world, or it could even be biological — for example brain chemistry or endocrine changes.”
The telephone survey, carried out in 2008, covered more than 340,000 people nationwide, ages 18 to 85, asking various questions about age and sex, current events, personal finances, health and other matters.
The survey also asked about “global well-being” by having each person rank overall life satisfaction on a 10-point scale, an assessment many people may make from time to time, if not in a strictly formalized way.
Finally, there were six yes-or-no questions: Did you experience the following feelings during a large part of the day yesterday: enjoyment, happiness, stress, worry, anger, sadness. The answers, the researchers say, reveal “hedonic well-being,” a person’s immediate experience of those psychological states, unencumbered by revised memories or subjective judgments that the query about general life satisfaction might have evoked.
The results, published online May 17 in the Proceedings of the National Academy of Sciences, were good news for old people, and for those who are getting old. On the global measure, people start out at age 18 feeling pretty good about themselves, and then, apparently, life begins to throw curve balls. They feel worse and worse until they hit 50. At that point, there is a sharp reversal, and people keep getting happier as they age. By the time they are 85, they are even more satisfied with themselves than they were at 18.
In measuring immediate well-being — yesterday’s emotional state — the researchers found that stress declines from age 22 onward, reaching its lowest point at 85. Worry stays fairly steady until 50, then sharply drops off. Anger decreases steadily from 18 on, and sadness rises to a peak at 50, declines to 73, then rises slightly again to 85. Enjoyment and happiness have similar curves: they both decrease gradually until we hit 50, rise steadily for the next 25 years, and then decline very slightly at the end, but they never again reach the low point of our early 50s.
Other experts were impressed with the work. Andrew J. Oswald, a professor of psychology at Warwick Business School in England, who has published several studies on human happiness, called the findings important and, in some ways, heartening. “It’s a very encouraging fact that we can expect to be happier in our early 80s than we were in our 20s,” he said. “And it’s not being driven predominantly by things that happen in life. It’s something very deep and quite human that seems to be driving this.”
Dr. Stone, who is a professor of psychology at the State University of New York at Stony Brook, said that the findings raised questions that needed more study. “These results say there are distinctive patterns here,” he said, “and it’s worth some research effort to try to figure out what’s going on. Why at age 50 does something seem to start to change?”
The study was not designed to figure out which factors make people happy, and the poll’s health questions were not specific enough to draw any conclusions about the effect of disease or disability on happiness in old age. But the researchers did look at four possibilities: the sex of the interviewee, whether the person had a partner, whether there were children at home and employment status. “These are four reasonable candidates,” Dr. Stone said, “but they don’t make much difference.”
For people under 50 who may sometimes feel gloomy, there may be consolation here. The view seems a bit bleak right now, but look at the bright side: you are getting old
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