Thursday, November 10, 2011
As India’s place in the world economy grows, raising the standard of living of its citizens and astounding economists, political leaders, and the public around the globe, its people have as rapidly moved into the crosshairs of two of the most lethal diseases of affluence: diabetes and hypertension.
International Diabetes Federation's estimates are that there are 50.8 million diabetics in India in 2010, rising to 87 million by the year 2030.The epidemic of type 2 diabetes in urban adults has been especially virulent, as the rate has in- creased from less than 3% in 1970 to 12.0% in 2000. But even rural areas are not immune. "Diabetes has risen rapidly in rural areas, with a threefold increase (from 2.4 per- cent to 6.4 percent) in rural southern India over a fourteen-year period," Health Affairs reported.
India 40.9 million
China 38.9 million
U.S. 19.2 million
Russia 9.6 million
Source: World Health Organization
Hypertension too is on the rise. Indians with hypertension are projected to number 214 million in 2025, up nearly 100 million since 2000. Thus, its scourge is even greater than diabetes. With India's fast-growing population projected to overcome China's in the next thirty years, India could achieve another global distinction: "At the current rate of hypertension we will have the largest number of people with hypertension in the world," reported the Journal of Association of Physicians of India.
There was a serious concern that awareness of diabetes and hypertension including their risk factors, symptoms and treatment options, among healthcare providers and patients alike was dangerously low.
About 18 months ago, researchers at Sanofi-Aventis [or Aventis Pharma Limited] began asking questions: Just how serious is hypertension in India? Is India facing a twin epidemic of diabetes and hypertension? How well are these diseases being diagnosed and treated? There was a serious concern that awareness of both diseases, including their risk factors, symptoms, and treatment options, among health care providers and patients alike was dangerously low.
The outcome of these internal discussions, as well as discussions with potential partners (namely, doctors, hospitals, and institutes), was the decision to launch one of India's largest studies of diabetes and hypertension prevalence. On 8th January 2009 sanofi-aventis formally announced the creation of SITE (Screening India's Twin Epidemic), a cross-sectional study to estimate the prevalence of diagnosed and undiagnosed cases of diabetes and hypertension in outpatient settings in major cities across India. Its goals? Increase disease awareness, provide healthy literacy, and that would enable better screening and treatment strategies.
The Global Epidemic
People Worldwide with Diabetes
1985 30 million
1995 135 million
2010 171 million
2030 366 million (projected)
Source: World Health Organization
"Diabetes was already posing an enormous health as well as economic problem for the country, as was hypertension," said Dr. Muruga Vadivale, Senior Director - Medical and Regulatory Affairs, sanofi-aventis India. "A large cross-sectional study could provide doctors and public health officials with valuable insights on both diseases and create awareness among medical professionals and the public about early screening for these diseases."
Today, SITE has enrolled approximately 16,000 patients from 800 centers across 8 states in India. It has partnered with 800 general practitioners and consulting physicians, to conduct the screenings and record and report the results. It is being con- ducted in waves over two years, one state at a time, with 2,000 patients screened from each state over two days per wave. On each of the two days, centers screen 10 patients, who must be over age 18 and not pregnant and have signed data-release consent form. The eight states included in the study are Maharashtra, Delhi, West Bengal, Tamil Nadu, Andhra Pradesh, Karnataka, Gujarat, and Madhya Pradesh.
"Through SITE we hope to identify gaps in treatment needs at the first point of contact for a patient," said Dr. Shashank Joshi, Consultant Endocrinologist, Lilavati Hospital and National Coordinator of SITE study. "SITE will give us important insights on how we screen patients for risk factors and how well we manage them versus current guidelines."
Prevalence of Diagnosed and Undiagnosed Diabetes and Hypertension in India—Results from the Screening India's Twin Epidemic (SITE) Study
Prevalence of Diagnosed and Undiagnosed Diabetes and Hypertension in India—Results from the Screening India's Twin Epidemic (SITE) Study
To cite this article:
Shashank R. Joshi, Banshi Saboo, Muruga Vadivale, Sameer Indravadan Dani, Ambrish Mithal, Upendra Kaul, Mohan Badgandi, Shamanna Seshadri Iyengar, Vijay Viswanathan, Natarajan Sivakadaksham, Partha Sarathi Chattopadhyaya, Arup Das Biswas, Sushil Jindal, Idris Ahmed Khan, Bipin Kumar Sethi, Vala Dayasagar Rao, and Jamshed Jal Dalal on behalf of the SITE Investigators. Diabetes Technology & Therapeutics. -Not available-, ahead of print. doi:10.1089/dia.2011.0243.
Abstract Objective: Despite the rising number of patients with diabetes and hypertension in India, there is a dearth of nationwide, comprehensive prevalence data on these diseases. Our study aimed at collecting data on the prevalence of diabetes and hypertension and the underlying risk factors in various outpatient facilities throughout India. Methods: This cross-sectional study was planned to be conducted in 10 Indian states, one state at a time. It was targeted to enroll about 2,000 patients from 100 centers in each state. Each center enrolled the first 10 patients (≥18 years of age, not pregnant, signed consent) per day on two consecutive days. "Diabetes" and "hypertension" were defined by the 2008 American Diabetes Association and the Joint National Committee's 7(th) Report guidelines, respectively. Patient data (demographics, lifestyle factors, medical history, and laboratory diagnostic results) were collected and analyzed. Results: During 2009-2010, in total, 15,662 eligible patients (54.8% males; mean age, 48.9±13.9 years) from eight states were enrolled. Diabetes was prevalent in 5,427 (34.7%) patients, and 7,212 (46.0%) patients had hypertension. Diabetes and hypertension were coexistent in 3,227 (20.6%) patients. Among those whose disease status was not known at enrollment, 7.2% (793 of 11,028) and 22.2% (2,408 of 10,858) patients were newly diagnosed with diabetes and hypertension, respectively; additionally, 18.4% (2,031 of 11,028) were classified as having prediabetes and 60.1% (6,521 of 10,858) as having prehypertension. A positive association (P<0.05) was observed between diabetes/hypertension and age, familial history of either, a medical history of cardiovascular disorders, alcohol consumption, and diet. Conclusions: Our study demonstrates that the substantial burden of diabetes and hypertension is on the rise in India. Patient awareness and timely diagnosis and intervention hold the key to limiting this twin epidemic.
PMID:22050271[PubMed - as supplied by publisher]
The Screening India's Twin Epidemic: Study design and methodology (SITE-1) Joshi SR, Vadivale M, Dalal JJ, Das AK - Indian J Endocr Metab
Objectives: The recent years have seen a surge in the prevalence of both diabetes and hypertension. Significant demographic variations reported on the prevalence patterns of diabetes and hypertension in India establish a clear need for a nation-wide surveillance study. The Screening India's Twin Epidemic (SITE) study aimed at collecting information on the prevalence of diagnosed and undiagnosed diabetes and hypertension cases in outpatient settings in major Indian states to better understand disease management, as well as to estimate the extent of underlying risk factors. Materials and Methods: During 2009-2010, SITE was conducted in eight states, in waves - one state at a time. It was planned to recruit about 2000 patients from 100 centers per wave. Each center enrolled the first 10 eligible patients (≥18 years of age, not pregnant, signed data release consent form, and ready to undergo screening tests) per day on two consecutive days. Patient demographics, medical history, and laboratory investigation results were collected and statistically interpreted. The protocol defined diabetes and hypertension as per the American Diabetes Association (ADA) and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommendations, respectively. Results: After the first two pilot phases in Maharashtra and Delhi, the protocol was refined and the laboratory investigations were simplified to be further employed for all other states, namely, Tamil Nadu, West Bengal, Karnataka, Andhra Pradesh, Madhya Pradesh, and Gujarat. Conclusion: SITE's nation-wide approach will provide a real-world perspective on diabetes and hypertension and its contributing risk factors. Results from the study will raise awareness on the need for early diagnosis and management of these diseases to reduce complications.
Keywords: Diabetes mellitus, hypertension, India, management, prevalence, risk factors, screening protocol
How to cite this article:
Joshi SR, Vadivale M, Dalal JJ, Das AK. The Screening India's Twin Epidemic: Study design and methodology (SITE-1). Indian J Endocr Metab 2011;15:389-94
How to cite this URL:
Joshi SR, Vadivale M, Dalal JJ, Das AK. The Screening India's Twin Epidemic: Study design and methodology (SITE-1). Indian J Endocr Metab [serial online] 2011 [cited 2011 Nov 9];15:389-94. Available from: http://www.ijem.in/text.asp?2011/15/8/389/86857
Wednesday, November 09, 2011
Are you a techie looking for work? We recently offered some tips on landing jobs at Google, Apple and Facebook, but there are more companies in the Valley than those three. And you might be wondering what the culture is like at each of these companies, as well as at LinkedIn, Twitter, Eventbrite, Gaia and Tagged.
Back in August, we brought you word of awesome perks at various startups; now, we bring you perks at a number of Silicon Valley’s largest and finest. From yoga to catered lunches, 401(k)s to dry cleaning, sports teams to vacation days, these tech companies seem to understand that quality of life affects productivity — and that having to run fewer errands after work means you’re more likely to stay at the office.
Check out the infographic below from ResumeBear for a breakdown of who offers what perks. Do you work at any of these companies and take advantage of any of these perks? Let us know in the comments below......
Wednesday, October 26, 2011
amednews: Healthy People 2010 misses targets on obesity and health disparities :: Oct. 24, 2011 ... American Medical News
The nation's health improved during the past decade as adult cholesterol levels decreased and fewer people smoked cigarettes, according to the final review of Healthy People 2010. Such improvements led to an increase in life expectancy.
But the country fell short of meeting Healthy People 2010 goals in some of the most critical areas, including reducing obesity and health disparities.
Obesity prevalence increased across all age groups during the last decade. Minorities, people with low incomes and those with limited education experienced widening disparities in areas such as coronary heart disease deaths and exposure to tobacco smoke.
"Overall, we did a fabulous job in terms of moving forward and improving health in the past decade. ... I'm proud we made progress, but we still have so much work to do," said Carter Blakey, acting deputy director of the Office of Disease Prevention and Health Promotion in the Dept. of Health and Human Services.
Blakey said primary care physicians play an integral role in improving public health and are key to helping the nation meet the Healthy People 2020 targets, which were released in December 2010. She encourages doctors to counsel patients on good nutrition, physical activity and smoking cessation.
"Physicians are busy and see a long list of patients every day, but ... if they could really counsel on these issues at the individual level, they can help make a difference," Blakey said.
The Healthy People program has been issued by HHS every decade since 1980. The initiative provides benchmarks to track and monitor progress that can guide action to improve the nation's health.
The final review of Healthy People 2010, released Oct. 6, shows that targets were met for 23% of the 733 objectives. For objectives in which the goal was not achieved, progress was made in nearly half of the cases.
The nation's health got worse for 24% of objectives, and there was no change for 5% of the initiatives.
Among the key findings: Life expectancy for the U.S. population increased from 76.8 years in 2000-01 to 77.8 years in 2006-07. That improvement reflects declining death rates for a variety of conditions, including female breast cancer, coronary heart disease, prostate cancer and stroke, the report shows.
Deaths due to prostate cancer decreased beyond the Healthy People target, falling from 31.1 deaths per 100,000 people in 1999 to 23.5 deaths per 100,000 in 2007. Death rates related to other cancers improved, but did not exceed the goals set for them.
The number of adults and teenagers who smoke also declined. In 2008, 21% of adults 18 and older smoked cigarettes compared with nearly one in four in 1998. In 2009, 19% of students in grades nine through 12 smoked, down from 35% in 1999.
"Despite many areas for optimism, addressing health disparities continues to be our greatest challenge," said Edward Sondik, PhD, director of the National Center for Health Statistics.
Reducing health inequalities
Overall, disparities remained unchanged for about 80% of the objectives, according to the report.
For example, minority and low-income groups continue to be less likely to have a regular source of medical care. Cigarette smoking also remains more common among the poor and those with less education compared with college graduates who have higher incomes.
Health disparities worsened in 13% of the objectives. Deaths due to coronary heart disease is one area where disparities increased for minorities and people with no more than a high school degree.
Also concerning to public health experts is that little progress was made meeting nutrition and weight targets.
The amount of obese adults 20 and older climbed from 23% between 1988 and 1994 to 34% between 2005 and 2008. During that period, obesity among children 6 to 11 increased from 11% to 17%.
To help remedy the problem, physicians should give patients more practical ways to improve their nutrition and physical activity, said Thomas LaVeist, PhD, director of the Hopkins Center for Health Disparities Solutions in the Johns Hopkins Bloomberg School of Public Health in Baltimore.
Rather than instructing patients to eat less salt, sugar and fat, he encourages doctors to give them examples of nutritious alternatives.
"We need to do a better job of providing people with information in a way they can understand," LaVeist said.
Friday, October 14, 2011
DENVER – Diabetes patients with stable symptoms of coronary artery disease appear to have a lower cardiac event risk than previously thought.
The yearly rate of cardiovascular death or nonfatal MI was just 2.4% in a series of 444 consecutive diabetes outpatients with symptoms suggestive of coronary artery disease (CAD) who underwent exercise treadmill or pharmacologic stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging. The cardiovascular death rate of 0.4% per year and the nonfatal MI rate of 2.0% per year were surprisingly low, given that 39% of subjects had known CAD and the rest had symptoms suggestive of CAD, Dr. Jamieson M. Bourque noted at the annual meeting of the American Society of Nuclear Cardiology.
The explanation may be found at least in part in contemporary evidence-based intensive medical management for risk reduction in this traditionally high-risk population, added Dr. Bourque of the University of Virginia, Charlottesville.
Of the 444 symptomatic diabetes patients, 78.5% had no inducible ischemia on stress SPECT myocardial perfusion imaging, 16.5% had 1%-9% left ventricular ischemia, and 5% had left ventricular ischemia of at least 10%. Again, these are lower rates than would be expected based on historical data taken from the era before aggressive risk factor modification in patients with diabetes and CAD symptoms.
During a median 2.4 years of follow-up, the combined rate of cardiovascular death, nonfatal MI, or revascularization more than 4 weeks after myocardial perfusion imaging was 32% in patients with at least 10% left ventricular ischemia on their presenting SPECT study, 14% in those with 1%-9% ischemia, and 8% in those with no ischemia.
Patients who achieved at least 10 METs (metabolic equivalents) on the treadmill during testing had the best prognosis. The sole event that occurred in this subgroup was a late revascularization.
In all, 60% of hard cardiac events occurring in this study were in patients with no perfusion defects. This points to the need for improved patient selection and risk stratification techniques in diabetes patients, according to Dr. Bourque.
He declared having no financial conflicts.
What's in the pipeline?
We've taken a peek at what products the big vaccine producers have up their sleeves. It's a varied bunch – from a vaccine to protect you against bird flu to one that will help you quit smoking
Tuesday, October 04, 2011
Adverse Events is a heath-tech start-up so new, they barely exist. Despite that, they’re getting some major results. This week they announced that they found from their early analysis – of the FDA’s own data – that two epilepsy drugs may be more dangerous in pregnancy than their FDA labeling might suggest. They used the FDA’s adverse event reporting data to compare the adverse events of commonly prescribed epilepsy drugs in pregnancy. What they found was that the FDA’s own labeling wasn’t consistent with their data.
Currently, the FDA classifies drugs used during pregnancy as being anywhere on a scale of safety from class A (“no known risk”), through levels of increasing risk labelled B, C, D, and then one final class X (“danger – do not use”). Specifically, Adverse Events found that two drugs, Lamictal and Keppra, which are Class C, may be “as dangerous to a fetus as drugs currently listed” in a more risky category (D).
In fact, Adverse Events’ analysis showed that an average birth defect rate comparison between the two groups, C and D, revealed no meaningful differences between the two. This scrappy little start-up’s analysis of the FDA’s own data may indicate that the FDA’s current categorization of pregnancy risks for epilepsy drugs may need revision. Or may be subject to bias.
I got a chance to talk to Adverse Events’ CEO, Brian Overstreet, at Health 2.0. We touched on some interesting controversies and future directions for this company.
Their provocative premise: Anyone should be able to report a side effect
Adverse Events has taken a new, e-patient approach to adverse events reporting by building in a feature that allows anyone to report their own experiences with side effects from their drugs. That process alone – allowing patients to report problems directly without being filtered through a doctor or drug company – already has some healthcare professionals feeling nervous. Overstreet thinks empowering patients is a huge issue in healthcare, and an important mission for their company. As he put it, “Disease groups have shown that people need a forum and want to share things with other people. Patients are coming to understand that they need to take it into their own hands to manage their conditions. When it comes to side effects, there is both a reluctance to report, and a sense that it will go into a void – if they report it to the FDA, they [the FDA] don’t do anything with it. Even what exists in the FDA’s database is only approximately 10% of what is happening each year. If we can improve that number even a bit – say 30% or 40% – that will be a big benefit to everyone.”
Adverse Events Interactions?
As a doctor, I wanted to know if there is going to be an adverse events “drug interaction” database? I think being able to plug drugs into an app, and find out if their adverse events are compounding each other, would be a great patient care tool. Overstreet explained that such a function “will be version 2.0. It’s a whole new level of math. Just getting and cleaning up the FDA database, we thought would take six months. It took 18 – that kind of adverse events interaction tool is definitely a stage II process.”
A Placebo Side Effects Profile
Every clinical trial ever done against placebo shows the reported placebo side effects. Surprisingly, there is not just a placebo benefit to people, there are also placebo side effects, such as headache and nausea. Sometimes the trials show that the difference between those reported side effects, and the ones for the drug, aren’t that different. I wanted to know if Adverse Events plans to include a placebo tab? Overstreet said no. Since their site is devoted to post-clinical trials experiences (where there is no placebo), they don’t have any plans to include reported placebo side effects for comparison.
Where Do They Go From Here
When it comes to post marketing drug side effect experiences, Overstreet said their first priority is bolstering the patient data beyond the FDA’s reporting, and grabbing the free-form data that is out there in patient chat rooms and groups. That is the most immediate stuff in the pipeline. The second is their approach to areas where the FDA has dropped the ball – as in epilepsy drugs in pregnancy, and statins, where the adverse events for one drug are clearly as common in others, but have prompted no label change. The second big pipeline issue is getting at the number of prescriptions written nationwide. They are currently getting their data from IMS, who get their data from pharmaceutical companies.
Post marketing trials are huge issue that the FDA and pharmaceutical companies are hashing out. Overstreet feels drug companies have to react strongly to any adverse event and the drug companies feel any type of reporting on their part becomes a regulatory issue. But, as he put it, “With our site, they can no longer bury their heads in the sand about this issue. Patients and providers and healthplans are going to now have this data, so they need to start dealing with this data.”
Trolling The Web For Adverse Events
Overstreet explained that one of the innovative approaches they plan to take toward getting adverse events information is by going to patient communities online, and trolling for mentions. He explains that the company is planning on refining this approach, and that, as a task, it is technically very feasible. “There are a lot of resources out there that provide the ability to go out there and look, and give you a dashboard of comments. The question becomes, if you have 1 million records to look at, how do you standardize that process?” Adverse Events plan on tackling that monumental task, and feel it is an important advance in patient safety over the current method, which, as Overstreet explained, “waits for a pharmaceutical company to have received a certain number of completed, full reports, at which point they are required to report it to the FDA. We believe those standards are too high. You don’t need to have the ‘end date’ of someone’s medication [to have a valid report].” According to Overstreet, the primary question they will need to tackle in going out to the web and looking for side effects boils down to “how do you take data that has an unstructured format and turn it into a structured format?”
What They’re Not Planning On Doing
I asked about the touchy issue of vaccines and autism, in terms of where this company stands on the issue of reporting associations that actually may not have any cause at all. In terms of deciphering out the difference between causation versus correlation, Adverse Event’s approach is to deal with this complex issue by a) the sheer scope of the data they have, and b) if a report comes into their database with a higher-than-normal reporting frequency, then it raises a red flag, which they then make public. As Overstreet put it, they don’t want to be arbiters of data, and if they see an issue raised, then they want it investigated.
Similarly, post-marketing trials of open-label drugs is also a scope of work that Adverse Events doesn’t plan on tackling in the immediate future. While there may be some therapeutic potential found for drugs buried in the data that they’ve cleaned and presented, Adverse Events doesn’t, at this time, see pursuing those possibilities as part of their mission.
Overstreet believes that their wealth of data “mutes out some outlier issues.” While they might be willing to work with researchers, and regulatory agencies to investigate issues, they do not plan on going to those groups first and waiting years for it to be sorted out. Like they’re showing with their reporting of pregnancy adverse events rates and anti-epilepsy drug inconsistencies, they instead plan on going straight to the press.
Jan Gurley is an internist physician who practices in a homeless clinic for the San Francisco Department of Public Health. She blogs at Doc Gurley: Posts from an Insane Healthcare System where this post originally appeared.
Nanoparticles make DNA analysis 1,000 times faster
(Nanowerk News) A University of Arkansas researcher has patented a process that reduces the time it takes to perform DNA analysis from hours to minutes. This development could contribute to many areas of health care and law enforcement, including diagnosing and treating disease, developing and testing new vaccines and forensic identification.
Donald K. Roper, associate professor of chemical engineering, explained that the ultimate goal of his research is to develop a credit-card-sized device to be used in a doctor's office or at a crime scene to quickly analyze samples of DNA. "That's the power of being able to do this on a really tiny scale," he said.
To analyze DNA, scientists must often make a tiny sample large enough to work with. To do this, they use a process called polymerase chain reaction, or PCR. Roper, who holds the Charles W. Oxford Endowed Professorship in Emerging Technologies, has invented a way to perform this reaction thousands of times faster than traditional methods.
Roper's process, which he developed while working at the University of Utah, uses gold nanoparticles to increase the efficiency of the chain reaction. During the reaction, strands of DNA are heated and cooled in cycles. When the samples are heated, the two strands of a DNA double helix come apart, and when the temperature is lowered, an enzyme called polymerase zips each strand to other, complementary strands, forming two new DNA helixes.
These copies are then heated and cooled again, doubling each time until the desired amount of DNA has been produced.
Roper's method reduces the time involved in these cycles from minutes to milliseconds, which means that a DNA sample could be analyzed within minutes rather than hours. By associating the DNA and enzyme with a gold nanoparticle and then exciting the nanoparticle with a light source or laser beam, Roper can target temperature changes to the area immediately around the DNA. This allows researchers to raise or lower the temperature more quickly. In addition, the process can be used to analyze the DNA during the reaction.
"We can use the laser light and the gold nanoparticles to do both the amplification and the analysis simultaneously," explained Roper. "The electromagnetic field around the nanoparticle is strong enough that it can sense whether or not the strand that we're interested in is there. The laser induces the field and then a detector assays the difference in the field."
Roper's research has implications for many scientific fields. "Genomics underscores everything of interest to biology: gene sequencing, disease diagnostics, pharmaceutical development and genetic analysis," he explained. "DNA is the basis of inheritance for the cell, and the degree of transcription of the DNA determines how a cell will function. This is a tool that examines these processes."
Source: University of Arkansas, Fayetteville
Friday, September 23, 2011
Puzzling results from Cern, home of the LHC, have confounded physicists - because it appears subatomic particles have exceeded the speed of light.
Neutrinos sent through the ground from Cern toward the Gran Sasso laboratory 732km away seemed to show up a tiny fraction of a second early.
The result - which threatens to upend a century of physics - will be put online for scrutiny by other scientists.
In the meantime, the group says it is being very cautious about its claims.
"We tried to find all possible explanations for this," said report author Antonio Ereditato of the Opera collaboration.
"We wanted to find a mistake - trivial mistakes, more complicated mistakes, or nasty effects - and we didn't," he told BBC News.
"When you don't find anything, then you say 'Well, now I'm forced to go out and ask the community to scrutinise this.'"
The speed of light is the Universe's ultimate speed limit, and much of modern physics - as laid out in part by Albert Einstein in his special theory of relativity - depends on the idea that nothing can exceed it.
Thousands of experiments have been undertaken to measure it ever more precisely, and no result has ever spotted a particle breaking the limit.
But Dr Ereditato and his colleagues have been carrying out an experiment for the last three years that seems to suggest neutrinos have done just that.
Neutrinos come in a number of types, and have recently been seen to switch spontaneously from one type to another.
The team prepares a beam of just one type, muon neutrinos, sending them from Cern to an underground laboratory at Gran Sasso in Italy to see how many show up as a different type, tau neutrinos.
In the course of doing the experiments, the researchers noticed that the particles showed up a few billionths of a second sooner than light would over the same distance.
The team measured the travel times of neutrino bunches some 15,000 times, and have reached a level of statistical significance that in scientific circles would count as a formal discovery.
But the group understands that what are known as "systematic errors" could easily make an erroneous result look like a breaking of the ultimate speed limit, and that has motivated them to publish their measurements.
"My dream would be that another, independent experiment finds the same thing - then I would be relieved," Dr Ereditato said.
But for now, he explained, "we are not claiming things, we want just to be helped by the community in understanding our crazy result - because it is crazy".
"And of course the consequences can be very serious."
Friday, September 02, 2011
Norwegian researchers have developed a new test that checks a person's sweat to monitor blood sugar levels.
The sweat meter can be attached to a smartphone. The phone can then alert patients when their blood sugar is getting low.
It would benefit athletes or patients who don't get the usual warning symptoms, such as palpitations, sweating and intense hunger, the researchers said. Right now, the only way to check blood sugar levels is with a blood test.
The sweat meter works because a diabetic patient's sweat pattern changes when blood sugar levels are too low.
"The advantage of the sweat meter is that the patient doesn't have to prick themselves. All you need to do is paste an electrode on your skin," researcher Orjan Martinsen of the University of Oslo said in the research magazine Apollon.
Christian Tronstad, a medical technology researcher at Oslo University Hospital, said ideally, the electrode would be on the skin constantly to monitor the patient.
The Canadian Diabetes Association says more than nine million Canadians live with diabetes or prediabetes. About 10% of those have Type 1 diabetes is a contributing factor in the deaths of approximately 41,500 Canadians annually
India: The Private Sector Takes Action on NCDsBy: Muruga Vadivale and Aparna Thomas
India is the second most populous nation in the world with nearly 1.2 billion inhabitants. The impact of chronic and infectious diseases on patients, families and society is significant. In addition to the obvious effects on quality of life, morbidity and mortality, the burden of these diseases to the country’s economy is substantial in terms of loss of productivity, loss of employment, and health care expenditures.
The scope and impact of non-communicable diseases (NCDs) such as cardiovascular disease, cancer and diabetes are so complex that all stakeholders, including governments, NGOs, academia and the private sector need to participate in developing solutions. The common challenge – and opportunity – for all stakeholders is to save millions of people from premature death and debilitating health complications, as well as promoting social and economic development.
Health care in India has shown remarkable improvement since independence in 1947. However, in 2004, out of the estimated 10.3 millions deaths, 1.1 million (11 percent) were due to injuries, 4 million (39 percent) to communicable diseases and 5.2 million (50 percent) to NCDs.
In 2005, 9.2 million years of productive life were lost in India due to heart diseases, stroke and diabetes. This translated into US$ 9 billion of lost national income. The projected 2005-2015 cumulative loss of national income for India due to these premature deaths is US$ 237 billion.
India’s total health care spending was 4.2 percent of gross domestic product (GDP) in 2008-09. Public spending on health (0.93 percent of the GDP) was among the lowest in the world, and the reason for private expenditures accounting for 78 percent of total health spending in the country.
Although India’s economy is witnessing remarkable growth, inadequate health care infrastructure continues to be a barrier to access to basic health services. For example, there are only 60 physicians per 100,000 people as compared to 140 per 100,000 globally. Likewise, India has only 130 nurses per 100,000 people whereas the global average is 280 per 100,000.
It is estimated that more than 46 percent of patients travel more than 100kms from small towns to urban facilities to seek proper medical care. Knowing that 71 percent of the population is living in rural areas, accessibility to health care infrastructure is a major issue.
Therefore, in cooperation with other stakeholders (such as doctors, hospitals, institutes and policy makers), Sanofi India is organizing a number of actions to understand the real burden of disease, raise awareness of diabetes and increase access to health care in rural areas.
Estimating the prevalence and risk factors of diabetes and hypertension
The International Diabetes Federation estimates that India has the second highest prevalence of diabetes in the world with 50.8 millions diabetes patients in 2010.
Indians with hypertension are projected to number 214 million in 2025, up nearly 100 million since 2000. Hypertension is an important worldwide public-health challenge because of its high frequency and concomitant risks of cardiovascular and kidney disease.
Reliable information about the prevalence of hypertension and diabetes is essential to the development of health policies for prevention and control of these conditions.
Therefore, in January 2009 Sanofi launched SITE (Screening India’s Twin Epidemic), a cross-sectional study to estimate the prevalence of diagnosed and undiagnosed cases of diabetes and hypertension in outpatient settings in major cities across India.
As of July 2011, SITE has enrolled 15,662 patients from 802 centers across eight states in India (Maharashtra, Delhi, West Bengal, Tamil Nadu, Andhra Pradesh, Karnataka, Gujarat, and Madhya Pradesh) and has partnered with 800 general practitioners and consulting physicians to conduct the screenings, record and report the results. The study was conducted in waves over two years, one state at a time, with 2,000 patients screened from each state over two days per wave.
“Through SITE we hope to identify gaps in treatment needs at the first point of contact for a patient,” said Dr. Shashank Joshi, a consultant endocrinologist at the Lilavati Hospital and the national coordinator of the study. “SITE will give us important insights on how we screen patients for risk factors and how well we manage them versus current guidelines.”
The results obtained in the different cities are progressively communicated at congresses. When the results of the New Delhi screenings were announced, medical researchers, public health officials and physicians were able to compare the prevalence of diabetes and hypertension in Maharashtra and New Delhi. The findings were both alarming and revealing:
■The twin epidemics of diabetes and hypertensions do exist in both states, although more serious in Maharashtra where 29 percent of the patients were both diabetic and hypertensive, as compared to 21 percent in New Delhi.
■Hypertension is more prevalent than diabetes in both states.
■Less expected, were the regional differences: both diabetes and hypertension are more prevalent in Maharashtra (40 percent and 56 percent, respectively) than in New Delhi (33 percent and 48 percent, respectively).
■As troubling were the rates of patients who had been diagnosed and treated, but whose conditions were still uncontrolled.
■In Maharashtra, three-quarters of known diabetics had uncontrolled blood sugars (Hba1c levels), as compared to two-thirds in New Delhi.
■Uncontrolled hypertension was also a serious problem in both states and occurred at about the same rate: 79 percent in Maharashtra and 77 percent in New Delhi.
Through partnerships with doctors, hospitals and other organizations in these eight States, SITE has already started to raise disease awareness of the risk factors, symptoms and treatment of diabetes, hypertension and other related conditions, such as cardiovascular diseases.
Celebrating Diabetes Control
According to Dr. Shailesh Ayyangar, general manager of Sanofi in India and vice president of Sanofi in South Asia, “The diabetes epidemic makes it essential to create awareness about diabetes control. The ‘I Am A Champ’ program will help patients who are in control to reach out to others with their inspiring testimonials. Treatment regimens must be complemented by a more comprehensive approach to diabetes management for the health and well-being of a patient.”
Through the program patients and caregivers are learning that a positive attitude and few lifestyle changes to support their treatment regime can empower them to improve their health and well-being.
India’s first ever Diabetes Awards Ceremony was the first step to kick start the ‘I Am A Champ’ program which is based on the model of peer-to-peer counselling. Champions from various regions in the country were assessed on various parameters such as their understanding of diabetes, awareness about diabetes complications, their fitness and diet regime, and the ‘champ’ factor. In their role as ‘Champions of Diabetes’, they will be the face and voice of this awareness program in their respective cities.
Sanofi provides the 42 (seven national and 35 regional) ‘champs’ with platforms to share their testimonials, create awareness amongst other diabetes patients in their respective cities and address their concerns on managing the disease. These individuals symbolize triumph over diabetes and are a beacon of hope for countless other diabetics who often believe that ‘life is over’ once they are diagnosed with diabetes.
Empowering Doctors in Rural India
Prayas, meaning endeavour in Sanskrit, focuses on empowering doctors in rural India with the latest developments and updates in medicine.
The government is doing extensive work through the National Rural Health Mission (NHRM) to provide effective health care to India’s rural population. Considering the magnitude of the task, NHRM has incorporated public-private partnerships in its strategic roadmap for achieving its public health goals. This was echoed by Shomita Biswas, joint secretary, Public Health, Government of Maharashtra, citing,“Two major problems that government is facing at the grass root level is lack of infrastructure and adequately trained human resources. There is also an acute need of training institutes for developing nursing and paramedic professionals at the rural level. These are some of the areas where government will look forward to getting support from the private organizations.”
Launched in 2009,Prayas is aimed at bridging the diagnosis-treatment gap through a structured continuing education program for rural doctors across India. In Prayas, specialists from semi-urban areas share latest medical knowledge, clinical experience and practical insights through structured workshops for general practitioners- from smaller towns and villages in the interiors of India - through a ‘mentor-mentee’ model.
As of July 2011, 4,700 workshops have been conducted across 14 states for more than 11,500 rural doctors. Forty-eight expert doctors and 574 mentors have so far lent their support to Prayas. The workshops cover major acute-care therapy areas like respiratory diseases, infections, allergies, gastrointestinal disorders, etc. Each course is validated and certified by reputable international medical associations such as the American College of Physicians and the American Gastroenterology Association, amongst others.
Progressively disease awareness camps were organized to improve awareness and treatment seeking behaviour of patients in these regions. These camps focus on topics like child health, anaemia and malnutrition, and diarrhea which are in line with the needs of the patients.
With plans to cover new doctors under the program on a continual basis, there should be 100,000 mentees by 2015.
To complement this knowledge-based program, the Hoechst Business Unit, a Sanofi Unit has also launched a new range of quality medicines at affordable prices in these geographical areas. The product range helps address the challenges of accessibility, affordability and availability of quality medicines to patients in remote villages. In addition, a new distribution model with emphasis on availability of drugs to the most rural interiors is being established. The next step is to adapt this model to the fight against diabetes which is also developing in rural areas.
1. World Health Organization, Global Health Observatory. Accessed July 17, 2011
2. World Health Organization, Global Infobase. Accessed July 17, 2011
3. World Health Organization, Chronic Disease Report, 2005. Accessed July 17, 2011
4. World Health Organization, Global Health Expenditure Database. Accessed July 26, 2011
5. World Health Organization, World Health Statistics 2010. Accessed July 17, 2011
6. Accessible Healthcare - Joining the Dots Now. White paper, TECHNOPAK Leadership Forum on Healthcare, Oct. 20, 2011, New Delhi.
7. International Diabetes Federation. 4th Atlas - 2009. Accessed July 17, 2011
8. Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365: 217-23.
9. Joshi S.R. et al. SITE 1st wave results (Maharashtra). ADA June 2010. Mithal A. et al. results from Delhi (abstract 2496-PO) and Jindal S. et al. Results from Madhya Pradesh (abstract 2497-PO). ADA June 2011.
10. Marketing Whitebook (2011-12) report.
Dr. Muruga Vadivale is senior director, Medical and Regulatory Affairs, Sanofi India. Aparna Thomas is senior director, Communications and Public Affairs, Sanofi India.
Thursday, August 18, 2011
In a major technological breakthrough that could prevent amputation of legs in diabetics, a city doctor has successfully patented a medical device that helps doctors to monitor and treat nerve damage or neuropathy in patients.
At present there’s no perfect medical device that could tell doctors the quantum of nerve damage (diabetic neuropathy) in the feet of diabetics.
Though glucometers tell the sugar levels in the blood, they do not inform physicians about the damage diabetes has caused to nerves. It is this damage that causes diabetic sores, gangrene, or diabetic foot, which may ultimately result in amputation.
Senior chronobiologist Dr C. Jairaj Kumar, who is currently a visiting faculty in Ludwig-Maximilians University, Germany, developed the device based on “chaos science”. Dr Jairaj’s technology was one of the seven indigenous technologies selected by the Centre for presentation before the US Secretary of State, Ms Hillary Clinton, in New Delhi earlier this week.
“High glucose levels in blood damage the blood vessels. The first to be affected are small blood vessels. Medium and large blood vessels are affected gradually. Our device helps in knowing the extent of damage caused to such nerves. The problem can be treated at initial stages, preventing amputation in case of diabetic foot, and death in case of heart muscle damage,” Dr Jairaj said.
The device works on the concept of chaos science and neuropathy. It measures the progression of diabetic neuropathy and predicts foot ulcer development. “It is a novel concept based on the theory of chaotic movement of the foci in the sole of the foot,” he added.
A diabetes patient has to stand on the device for a few minutes and the report is generated in five minutes. The equipment studies the feet in detail and identify areas prone to ulcers.
Wednesday, August 17, 2011
Can a fat body be a healthy body? Using a new grading tool that takes health issues into account in addition to body mass index, it may be possible for healthy obese people to have the same lifespan as normal-weight people.
The findings were released Monday in a study in the journal Applied Physiology, Nutrition, and Metabolism. Researchers looked at data on 6,224 obese men and women who were followed on average for about 16 years. The participants were part of the Aerobics Center Longitudinal Study who attended the Cooper Aerobics Center in Dallas. Their mortality risk was compared with that of a group of 23,309 normal-weight people.
In addition to completing surveys on health history, dietary habits, weight and weight loss, the participants also underwent a standard medical exam, had their blood pressure taken and fasting blood work done, and completed a treadmill exercise test.
Researchers used the Edmonton Obesity Staging System, a five-stage grading tool for determining who should lose weight, based on health risks from other diseases and conditions such as cancer and heart disease. Using this system, those in stages 0 or 1 may be so healthy they may not need to lose weight since their health issues are minimal.
In the study, those in stages 0 or 1 on the EOSS scale were not at a higher risk of death compared with their normal-weight counterparts. Being in stages 2 and 3 was linked with a higher risk of death from all causes, as well as death from cardiovascular disease and chronic heart disease compared with those who were normal weight.
This group also weighed more as young adults, were OK with being overweight, hadn't dieted that much during their lives and were more apt to be physically active and eat healthfully.
In the study, the authors argue that this system improves upon measures that calculate risk such as metabolic syndrome or insulin sensitivity, since those don't seem to distinguish mortality risk in obese people.
"Our findings challenge the idea that all obese individuals need to lose weight," says lead author Jennifer Kuk of York University in Toronto, Canada, in a news release.
Wednesday, August 10, 2011
A clinical warning system that uses wireless sensors to track the vital signs of at-risk patients is undergoing a feasibility study at Barnes-Jewish Hospital in St. Louis.
When the full system is operational, sensors will take blood oxygenation and heart-rate readings from at-risk patients once or twice a minute. The data will be transmitted to a base station and combined with other data, such as lab test results, in the patient's electronic medical record.
The incoming vital signs and data in the medical record will be continually scrutinized by a machine-learning algorithm looking for signs of clinical deterioration. If any such signs are found, the system will call a nurse on a cell phone, alerting the nurse to check on the patient.
The idea is to create a virtual ICU where the patients are not wired to beeping machines and instead are free to move about as they please, said Chenyang Lu, PhD, a computer scientist and professor at Washington University in St. Louis, who was the principal investigator for the prototype-network trial.
The performance of the prototype network, which was installed at Barnes-Jewish Hospital from June 4, 2009, until Jan. 31, 2010, was described at the SenSys '10 conference in Zurich, Switzerland. The feasibility study of the clinical warning system now under way at the hospital will be presented at the American Medical Informatics Association Annual Symposium this October.
The clinical warning system is part of a burgeoning new field called body sensor networks or wireless health that, Lu said, will change the future of medicine.
Once they worked out the kinks, the computer scientists installed a prototype network in a cardiac step-down unit at Barnes-Jewish Hospital. Lu said he was pleased to find physicians and hospital administrators at the hospital who were technology savvy and willing to let him install the prototype network.
Clinical deterioration is a major concern in every hospital unit, said Thomas C. Bailey, MD, professor of medicine (infectious diseases) in the Washington University School of Medicine, who is collaborating with Lu on the system. Of hospitalized patients, between 4% and 17% suffer an adverse event such as myocardial infarction or respiratory arrest.
Most patients exhibit changes in their vital signs hours before an adverse event, sometimes as much as six hours before. In ICUs, vital signs continuously are monitored by wired devices, but in the step-down units, they often are measured intermittently by the unit's clinical staff. A wireless sensor network could monitor vital signs tens or hundreds of times more frequently.
According to Lu, it will not be long before any patient with a serious medical condition, such as diabetes or asthma, will wear a wireless medical device that will allow him or her to monitor his or her own vital signs on a smartphone that also will call relatives or doctors if serious problems arise.
The device for an asthma sufferer, for example, might keep track of respiration rate, air quality and pollen counts, among other features. A frail patient might wear a wireless sensor with built-in accelerometers or gyroscopes that would monitor for falls.
The possibilities are endless, Liu said, and they all promise better, more consistent care at lower cost — the primary objective of healthcare.
Thursday, August 04, 2011
Background: Previous studies of predictors of end-stage renal disease (ESRD) have limitations: (1) some focused on patients with clinically recognized chronic kidney disease (CKD); (2) others identified population-based patients who developed ESRD, but lacked earlier baseline clinical measures to predict ESRD. Our study was designed to address these limitations and to identify the strength and precision of characteristics that might predict ESRD pragmatically for decision-makers--as measured by the onset of renal replacement therapy (RRT).
Methods: We conducted a population-based, retrospective case-control study of patients who developed ESRD and started RRT. We conducted the study in a health maintenance organization, Kaiser Permanente Northwest (KPNW). The case-control study was nested within the adult population of KPNW members who were enrolled during 1999, the baseline period. Cases and their matched controls were identified from January 2000 through December 2004. We evaluated baseline clinical characteristics measured during routine care by calculating the adjusted odds ratios and their 95% confidence intervals after controlling for matching characteristics: age, sex, and year.
Results: The rate of RRT in the cohort from which we sampled was 58 per 100,000 person-years (95% CI, 53 to 64). After excluding patients with missing data, we analyzed 350 cases and 2,114 controls. We identified the following characteristics that predicted ESRD with odds ratios ≥ 2.0: eGFR<60 mL/min/1.73 m2 (OR = 20.5; 95% CI, 11.2 to 37.3), positive test for proteinuria (OR = 5.0; 95% CI, 3.5 to 7.1), hypertension (OR = 4.5; 95% CI, 2.5 to 8.0), gout/positive test for uric acid (OR = 2.5; 95% CI, 1.8 to 3.5), peripheral vascular disease (OR = 2.2; 95% CI, 1.4 to 3.6), congestive heart failure (OR = 2.1; 95% CI, 1.4 to 3.3), and diabetes (OR = 2.1; 95% CI, 1.5 to 2.9).
Conclusions: The clinical characteristics needed to predict ESRD--for example, to develop a population-based, prognostic risk score--were often documented during routine care years before patients developed ESRD and required RRT.
Death certificates now list diabetes as the underlying cause of death more often than in previous years, data from the Translating Research into Action for Diabetes trial suggest.
Of 2,261 participants enrolled in the study who died from 2000 to 2007, 41% had diabetes listed on their death certificates and 13% cited the disease as the underlying cause of death. These findings indicated increased reporting of diabetes as the underlying cause of death over time, the researchers said, although the frequency of the disease’s appearance on death certificates in general remained unchanged.
In contrast, the listing of cardiovascular disease as an underlying cause of death declined significantly throughout the study period, a factor that may have played a role in the increased reporting of diabetes as an underlying cause of death, the researchers said. They attributed this trend to a decrease in the reporting of cardiac causes of death for men and cerebrovascular causes of death for women. Diabetes was more likely to be recorded anywhere on the death certificate in decedents with CVD cited as the underlying cause of death.
“Although diabetes listed as any cause of death was stable over time, we have observed a statistically significant increase in reporting of diabetes as the underlying cause of death on death certificates between 2001 and 2008 independent of age at death and duration of diabetes at death,” the researchers wrote. “If this trend is indeed occurring on a national level, it may complicate the interpretation of mortality rates ascertained from death certificates.”
Disclosure: The researchers report no relevant financial disclosures
Wednesday, August 03, 2011
Diabetic patients using Web and mobile computing tools lowered their blood glucose levels more during a one-year study
Diabetic patients using Web and mobile computing tools lowered their blood glucose levels more during a one-year study than patients in a control group receiving usual care.
The test at the University of Maryland School of Medicine tested the effectiveness of combining regular patient checking and documentation of their glucose levels with coaching via computing devices. The test included use of the Diabetes Manager System from Baltimore-based WellDoc Inc., which received Food and Drug Administration approval in July 2010 and will be commercially available this fall.
The application enables Type 2 diabetic patients to enter their blood sugar readings into a secure Web site via a computer or their mobile phone and receive real-time feedback on what they should eat and other ways they can help stabilize their blood sugar. The software also can alert patients when they need to test their levels.
The Diabetes Manager System also enables analysis of the data and access by a patient's physicians and disease management case workers. It supports glucose meters that can send data via Bluetooth wireless technology.
In the test, the mean decline in glucose was 1.9 percent in the group using the Web and mobile technology and 0.7 percent in the control group. A one percent drop in glucose levels can reduce risk factors by 37 percent, according to research previously published in the British Medical Journal.
The new study, "Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control," is published in the August issue of Diabetes Care.
Tuesday, August 02, 2011
Mammography screening should be offered annually to women beginning at age 40 years, according to new breast cancer screening guidelines issued by ACOG. The new Practice Bulletin, entitled "Breast Cancer Screening," is published in the August 2011 issue of Obstetrics & Gynecology. These guidelines replace the 2003 ACOG recommendations, which were that women should have mammograms every 1 to 2 years beginning at age 40 years, and every year beginning at age 50 years.....
Monday, August 01, 2011
Sunday, July 31, 2011
iPhone add-on could mean end of finger pricking for diabetics - FierceMobileHealthcare#.Ti9a7U6iLSo.facebook#.Ti9a7U6iLSo.facebook
Sunday, July 24, 2011
Friday, July 22, 2011
Saturday, July 09, 2011
By that measure, Mississippi is the fattest state in the union with an adult obesity rate of 34.4 percent. Colorado is the least obese -- with a rate of 19.8 percent -- and the only state with an adult obesity rate below 20 percent, according to 'F as in Fat,' an annual report from the Trust for America's Health and the Robert Wood Johnson Foundation."...........
Friday, July 08, 2011
Joint Statement by Global BERSIH 2.0 on 8 July 2011,
with updated list of BERSIH hotspots around the world
The BERSIH 2.0 Global Solidarity Network strongly supports the BERSIH 2.0 rally for Clean and Fair Elections in Malaysia on the 9th of July 2011.
We urge all Malaysians abroad to unite in solidarity with our Malaysian brothers and sisters at home by joining BERSIH 2.0 walks and other events in cities across the world (see below for complete list). Malaysians have the constitutional right to peaceful assembly and freedom of speech in keeping with international human rights norms.
As citizens, we demand free and fair elections, which provide the foundation a better, more democratic Malaysia. We support BERSIH 2.0’s eight points of electoral reform and call in addition for a ninth: suffrage for Malaysians residing abroad.
We, ordinary Malaysian citizens around the world, are supporting BERSIH 2.0 because we can and because we should. We believe that the future of Malaysia belongs to all our children and that together we can ensure that the legacy we leave them is a beautiful and just one. We are speaking out because we live in open democracies where the freedoms of speech and of peaceful assembly and the right to demonstrate are the norm rather than the exception.
As is the case with the rally in Kuala Lumpur, we intend to gather peacefully and with dignity, and we shall do so without fear of water cannon, tear gas, police intimidation and brutality, or arbitrary arrest for dressing in yellow. Wherever we may be, we shall be wearing yellow T-shirts and carrying yellow banners, balloons and placards with peaceful slogans in support of clean and fair elections in Malaysia. We shall be bringing our family members both young and old.
Together with Malaysians all over the world, we urge the Najib government to support electoral reform. Clean and fair elections are essential to developing a mature and open democracy, and to safeguard the integrity of our nation for future generations.
We call on the Prime Minister to respect DYMM Seri Paduka Baginda Yang Di-Pertuan Agong’s advice to His Majesty’s government to ‘show prudence and fairness in carrying out the duties entrusted to it by the Malaysian people’. We also urge the federal government and the Inspector-General of Police to follow this advice by releasing all those detained in connection with BERSIH 2.0, and stop the ongoing, systematic harassment of BERSIH 2.0 supporters.
It is not too late for the Prime Minister to fulfil his duties and responsibilities in a manner that becomes his office and to allow this gathering to proceed peacefully in recognition of the will of the people. With the proper cooperation of all government agencies, we are confident the gathering will be nothing more and nothing less than a peaceful expression of a just and legitimate cause.
The eyes of the world are now on the Prime Minister and his government, in this pivotal moment that will surely define his legacy in the eyes of Malaysians as well as citizens and governments the world over. We urge him to rise to the occasion.
Temme Lee, email@example.com, +6016 489 8224
Ginie Lim, firstname.lastname@example.org, +44 586 083 488
Malaysians from all walks of life have travelled a very long road to reach this defining point in our nation’s history. With less than 24 hours to our intended peaceful gathering, our resolve to walk the last, most difficult mile as one united people in pursuit of clean and fair elections and a better Malaysia for all is firmer than ever.
Our reason for gathering is pure and simple – to demand the electoral roll be cleaned, that the postal voting system be reformed, that indelible ink be used, a minimum 21 day campaign period be instated, free and fair access to media for all be provided, public institutions be strengthened, and for corruption as well as dirty politics to be stopped.
The authorities have put obstacle after obstacle where they only needed to provide sincere cooperation to win the trust and confidence of the people. Having faced half hearted offers of stadiums, arrogance regarding meetings as well as denials of permits, arrests, detentions and so much more, we feel that we have done all that is humanly possible to demonstrate sincerity and good faith in dealing with the government – but we have only been met with reversed decisions and stone walls.
There are no walls however, that will arrest the advance of the cause of peace and justice. Come the 9th of July, we will uphold our constitutional right to converge peacefully on Stadium Merdeka in Kuala Lumpur.
No government agency has any right whatsoever to prevent Malaysians from exercising their freedom of movement and access to our capital city. No threat or intimidation can overturn this fundamental truth.
Malaysians have now seen for themselves the degree of paranoia and lack of principled leadership that seems to have gripped the government. It is thus all the more imperative that patriotic Malaysians rise now and take this stand together to save Malaysia from slipping further into this insane darkness.
Since the beginning of Bersih 2.0, we have witnessed nothing but the utmost bravery and commitment to peace and justice demonstrated by ordinary Malaysians from every walk of life. Inspired by this example, the Bersih 2.0 leadership reiterates our own unyielding commitment to our shared cause, and to being at Stadium Merdeka at 2pm tomorrow. We will meet at the carpark, and trust that the doors will be opened for us.
This is Malaysia’s single most important defining moment in recent history, and we are fully confident that the rakyat will heed the call to safeguard the principles Malaysia was founded on and together ensure that we pass down to our children a nation that is just, democratic and united in love for one another.
Coalition for Clean and Fair Elections (BERSIH 2.0)
The Steering Committee of BERSIH 2.0 comprises:
Dato’ Ambiga Sreenevasan (Chairperson), Andrew Khoo, Arul Prakkash, Arumugam K., Dr Farouk Musa, Haris Ibrahim, Liau Kok Fah, Maria Chin Abdullah, Richard Y W Yeoh, Dr Subramaniam Pillay, Dato’ Dr Toh Kin Woon, Dr Wong Chin Huat, Dato’ Yeo Yang Poh dan Zaid Kamaruddin."
July 7th, 2011
By: Anna Bratulic
Tags: BayerBenlystaBMSFDAGSKHGSJ&JMerck & Co.United StatesVertexVioxxXareltoYervoy
PrintJanet Woodcock, director of the FDA's Center for Drug Evaluation and Research, testified Thursday before the US House Energy and Commerce's health subcommittee that first-cycle drug approvals are at a 20-year high and that more than two-thirds of new treatments are being cleared within the time frames given to new drug applications. The director also noted the agency approved 20 compounds so far this year, one less than the total for all of 2010, and that the FDA meets more than 90 percent of drug-review deadlines.
At the hearing, Woodcock fielded questions regarding the regulatory process at the FDA, which some lawmakers suggested 'has become less transparent and [has] increased the time it takes for products to reach those who need them.' However, she proposed that challenges being faced by the biotechnology and pharmaceutical industries are related to high failure rates of drugs in development rather than the FDA's regulations.
OncoMed Pharmaceuticals CEO Paul Hastings, who also testified at the hearing, said 'regulatory uncertainty, longer drug development timelines, and an increasing regulatory and Congressional focus on risk instead of reward in pharmaceutical innovation, deters limited partners from investing in biotech venture capital firms and subsequently deters venture capitalists from investing in biotechnology discovery companies.'"
FDA restricts use of simvastatin 80 mg
June 8, 2011
Silver Spring, MD - The Food and Drug Administration is recommending that physicians restrict prescribing high-dose simvastatin (Zocor, Merck) to patients, given an increased risk of muscle damage . The new FDA drug safety communication, issued today, states that physicians should limit using the 80-mg dose unless the patient has already been taking the drug for 12 months and there is no evidence of myopathy.
"Simvastatin 80 mg should not be started in new patients, including patients already taking lower doses of the drug," the agency states.
In addition, the FDA is requesting that additional changes be made to the drug's label. The label will be changed to include the new dosing recommendations, as well as warnings not to use the drug with various medications, including itraconazole (Sporanox, Jannsen Pharmaceutica), ketoconazole (Nizoral by Ortho-McNeil Pharmaceutical), posaconazole (Noxafil, Merck), erythromycin, clarithromycin, telithromycin (Ketek, Sanofi-Aventis), HIV protease inhibitors, nefazodone, gemfibrozil, cyclosporine, and danazol.
In addition, the 10-mg dose should not be exceeded in patients taking amiodarone, verapamil, and diltiazem, and the 20-mg dose should not be exceeded with amlodipine (Norvasc, Pfizer) and ranolazine (Ranexa, Gilead).
The changes to the label are based on the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH), a study reported by heartwire. In that trial, 52 patients taking the 80-mg dose developed myopathy compared with one patient treated with the 20-mg dose. In addition, 22 patients treated with the high dose of simvastatin developed rhabdomyolysis compared with none treated with the 20-mg dose.
The FDA notes that the risks of myopathy and rhabdomyolysis were highest in the first year and that older age and female sex increased the risks.
In statement released today following the FDA alert , Merck notes that it has launched a new information website and is encouraging patients who think the prescribing changes might affect them to speak with their doctors.
Dr Steven Nissen (Cleveland Clinic, OH), who wrote an editorial accompanying the 2004 publication of the A to Z trial, a study that tested high-dose simvastatin in acute coronary syndrome patients, who was critical of the high rate of myopathy in that study, called the FDA decision "appropriate" but said it comes late.
"Most knowledgeable lipid experts stopped administering the 80-mg dosage of simvastatin years ago," he said in an email to heartwire. "Unfortunately, once again the FDA has been too slow to react to a serious drug safety problem. We currently have more than two million Americans taking an unsafe dosage of simvastatin when there are safer alternatives. I'm glad the FDA acted but wish they hadn't taken so long."
The study, carried out at the University of Alberta, investigated the properties of aspirin in its use as a preventative measure for cardiovascular disease, as well as the reoccurrence in patients with type 2 diabetes. It involved analysing information from clinical trials, to assess if taking aspirin as a course of treatment would be able to prevent a first or recurrent heart attack or stroke .
It was shown that patients who had previously experienced a cardiac episode and who also took a low dose of aspirin every day received very little benefit with regards to preventing a second heart attack or a lowering the risk of mortality. For those people who took a higher dose of aspirin every day, on the other hand, the chances of a repeat heart attack and/or death was seen to be much reduced.
Researcher Scot Simpson commented "We took all of the data from 21 studies and focused specifically on diabetic patients who had suffered a previous heart attack or stroke to measure the ability of aspirin to prevent a second event."
He added "We found that, if those patients took up to 325 milligrams of aspirin per day, they had a 23 percent lower risk of death."
ATLANTA, Ga. - People who are struggling to lose weight even while watching what they eat may need to look carefully at what they drink. One doctor blames difficulty losing weight on a habit he calls “eating under the influence”.
Studies have shown that alcohol can make you feel hungry, even when you’re not. Experts also say that drinking alcohol can make people crave carbohydrates.
Weight loss expert Dr. Howard Shapiro says, "Eating under the influence means you have a couple of drinks and you have too many and all of a sudden your blood sugar is down, you get hungry and you grab the first thing you can find. It’s usually fast food, high calorie food.
In addition to that effect, alcohol is high in calories. Two glasses of wine adds up to about 300 calories. Drinking that much six nights a week can add up to two pounds of weight gain in a month.
Finally, drinking alcohol can make it more difficult to burn up the calories you take in. Alcohol slows the body’s process for metabolizing fat and carbohydrates. It also can prevent the body from taking in vitamins and nutrients.
Dr. Shapiro advises people who are trying to lose weight to give up alcohol for a week or two. He says they may find that doing so makes it easier for them to shed the pounds.
Thursday, July 07, 2011
I would like to thank all Bersih supporters for your kind outpouring of support thus far. Bersih 2.0 has come a long way in carrying the aspirations of the rakyat for clean and fair elections, and it is the rakyat themselves above all who have made this possible.
We have faced massive obstacles, vilification and oppression, but inspired by the bravery of the Malaysian people, managed to overcome them all thus far.
Like many other Steering Committee members, it has been challenging personally to face threats of murder, gang rape and various other violence directed against myself and others. Nonetheless, we understand our responsibility in holding the line on behalf of all of you who want nothing more than a clean electoral system and a better Malaysia.
Malaysians both at home and abroad have already been called to make so many sacrifices, so while we do not aspire to add to your burdens, we are writing this in the hopes that you can spare some support.
The cost of our campaign increases every day, complicated by constant harassment by the authorities. In addition to our operational expenses listed below that are necessary to organising our gathering successfully in a peaceful and secure environment, we find ourselves having to raise money to bail staff at the secretariat of Bersih 2.0 that have been unjustly arrested and are now facing charges that make no sense whatsoever. Having key staff detained will cripple our operations in devastating ways.
|10 ‘road shows’ around the country||RM2000 x 10 road shows||20,000|
|Brochures of Bersih 2.0 Demands (100,000 copies in 3 languages)||100000 brochures x RM0.25||25,000|
|Banners for publicity and ‘road shows’ (3 languages)||200,000 banners x RM0.03||6,000|
|Pickets||100 pickets x RM60||6,000|
|Purchase of communications devices for use during rally||100 items x RM200||20,000|
|Safety/security allowance||3000 volunteers x RM10||30,000|
|T-shirts (5000 pieces)||5000 T-shirts x RM9.00||45,000|
|10 ‘road shows’ di merata negeri||RM2000 x 10 road shows||20,000|
|Risalah Tuntutan Bersih 2.0 (100,000 naskhah dalam 3 bahasa)||100000 risalah x RM0.25||25,000|
|Selebaran untuk publisiti dan ‘road shows’ (3 bahasa)||200,000 selebaran x RM0.03||6,000|
|Sepanduk||100 sepanduk x RM60||6,000|
|Pembelian peralatan komunikasi untuk kegunaan dalam perarakan||100 buah x RM200||20,000|
|Elauan keselamatan||3000 orang x RM10||30,000|
|Baju kemeja T (5000 helai)||5000 kemeja T x RM9.00||45,000|
In light of these challenges, whatever you can spare to aid our efforts will lift our spirits in ways you cannot imagine.
Thank you for your kind consideration, and we look forward to feeling your presence on July 9th one way or another.
Dato’ Ambiga Sreenevasan
Chair, BERSIH 2.0 Steering Committee
HOW TO DONATE TO BERSIH 2.0
Account No: 507 246 118 995
Account Name: Aliran
Bank: Malayan Banking Berhad
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Bersih 2.0 urges the Federal Government not to suspend multiple public services this weekend in a futile attempt to stop the BERSIH 2.0 Rally at Merdeka Stadium.
BERSIH 2.0 is alarmed by intelligence that there might be a full or partial clampdown on the internet as we approach this weekend.
BERSIH 2.0 warns the Federal Government that should access to the mobile phone networks, the internet, mobile 3G services, specific websites or social media be compromised in any way whatsoever, then the authorities will look absolutely no different from the Middle Eastern dictators who have used the same measures with no success whatsoever.
BERSIH 2.0 urges members of the public who want to join the historical July 9 rally to enter the city centre by today or tomorrow morning as intelligence suggests that public transport will be shut down, either partially or fully on Friday and/or Saturday. Observing the shocking fact that bus permits to Kuala Lumpur have already been frozen, plans seem to be well in place to make entering Kuala Lumpur on the 9th of July to as difficult as humanly possible.
Bersih 2.0 reiterates in on no uncertain terms that any repression, intimidation and obstacles will not for an instant dilute our resolve to gather peacefully at Stadium Merdeka at 2pm on the 9th of July 2011, after which we will disperse just as peacefully.
Should any of the above repressive measures come into effect, Malaysians and the international community will witness for themselves the desperate and unwarranted extremes to which the government is willing to go to prevent clean and fair elections.
The government will also be unequivocally and fully responsible for the loss of business, the loss of confidence within the investment community, and the complete loss of goodwill towards Malaysia’s political and commercial standing.
Coalition for Clean and Fair Elections (BERSIH 2.0)
The members of the BERSIH 2.0 Steering Committee are:
Dato’ Ambiga Sreenevasan (Chair), Andrew Khoo, Arul Prakkash, Arumugam K., Dr Farouk Musa, Haris Ibrahim, Liau Kok Fah, Maria Chin Abdullah, Richard Y W Yeoh, Dr Subramaniam Pillay, Dato’ Dr Toh Kin Woon, Dr Wong Chin Huat, Dato’ Yeo Yang Poh dan Zaid Kamaruddin."
Saturday, May 14, 2011
Looking for ways to cut back on what you eat? Try cutting everything into smaller pieces--you may eat less.A study found that slicing candies in half caused people to eat less of the snacks, ultimately consuming fewer calories. The research, published in the May issue of the Journal of the American Dietetic Assn., put 54 college students through two scenarios: in one, 20 pieces of candy were served whole. In another, the 20 candies were cut in half. In both scenarios the test subjects busied themselves with a computer task that acted as a distraction, since snacking is often done while preoccupied. Don't pretend you don't do that......
Sunday, May 08, 2011
New Mechanism Identified That May Provide Potential Cure for Diabetes
Researchers from UCLA's Larry L. Hillblom Islet Research Center have discovered the underlying mechanism that could convert other cells in the body into insulin-making cells, which could provide a potential cure for diabetes....