lunes, 6 de diciembre de 2010

No todo es medicina: El amor en tiempos de facebook & remember John Lennon

No todo es medicina: El amor en tiempos de facebook & remember John Lennon


Las redes sociales, se transforman, y a nadie extrañará que en este momento se esté gestando otra forma de comunicarnos. El marketing reemplaza a la epidemiologia, y el PBI de sólo 5 empresas farmaceuticas internacionales son mayores al PBI de toda America Latina. Del mismo modo que si Facebook fuera un país, sería el tercer país de la tierra.
Fantasias dirán algunos, mundos virtuales para otros, y una vieja terapeuta que tuve, me diria que no hay nada mas real que una fantasia. O quizás hoy no haya nada más real que las propias relaciones virtuales. Tanto asi, que no conozco en persona más que un 8% de mis contactos en Facebook.
Amigos que uno admira, y que hace años no ve, o quizás nunca hemos compartido un café o una cerveza en una mesa. Cómo explicarle a mis hijas, que siempre se rien cuando cuento…que no habia internet cuando yo era niño. Joder, que si a mi mismo me cuesta creerlo. Asi es el mundo Vichi, ciertamente no era para vos mi saludo del dia del médico, ni para muchos que me han escrito alguna vez, y me han contado que van a un pueblo cada 15 dias para leer lo que escribo. A ellos no va mi homenaje, si no las gracias por hacerlo, por estar en un lugar que a mi, si ya este me resulta dificil, no puedo imaginar los otros.
El mundo se ha expandido, con geografias virtuales, hasta el infinito. Mientras el tiempo se ha comprimido hasta el simple momento que dura un twitter.
Pero no era de esto que queria hablar. Las “Coreas”, aunque el mundo lo ignore nos ponen cerca de una guerra nuclear. Como aquella vieja amenaza de Octubre del 62. Los hombres no hemos enloquecido, tan sólo seguimos pensando en lógicas que nada tienen que ver con lás lógicas difusas, profusas y confusas que nos dominan. Es nuestra esencia. Y la lógica aristotelica-tomista, una de las tantas que occidente ha comprado. Quizás por eso los chinos puedan entender mejor a Hegel, aunque no tengan idea quien fue, o que escribió. No, siempre me voy por otros lados……..y regreso.
Regreso para decirles como cada domingo, que no todo es medicina. Y que hubo un hombre, que marcó mi vida, y que un 8 de Diciembre de 1980, lo lloré como muchos en el mundo, porque marco mi infancia, mi adolescencia, y mi temprana juventud. El hablaba de universalismo, no de globalización. Y mis hijas durmieron con esa música, renovada en forma de música clásica, durante su infancia. Para mi Solchi que nunca me lee, para Agus que transita caminos de alegria como siempre, para Vichi que me recordó que el amor existe. Para el mundo, que no olvide que un hombre, un simple hombre, hizo llorar a millones un dia con su ida. Pero no se fue. Porque cada vez que los tiempos son dificiles, nos volvemos a decir, “Hard times are over, over, for a while”, o cantar como cantaron y cantan en su homenaje cada 8 de Diciembre……Give peace a chance…..A John Winston Lennon, mi homenaje. Por haber luchado con una guitarra o un piano, y sus canciones, por la paz. A las mujeres que amo, a los que recorren estas geografias virtuales, difundan el mensaje, la paz siempre es posible…….y todo lo que necesitamos es amor. Y a quien piense que esto es naif, habre de refutar que más naif es creer que un mundo puede sobrevivir sin esto.

domingo, 5 de diciembre de 2010

The Changing Culture War

OP-ED COLUMNIST

The Changing Culture War

For a long time, the contours of America’s culture war seemed relatively straightforward. On one side was the country’s growing educated class, who tended to be secular, permissive and favorably disposed to the sexual revolution. On the other side were the social conservatives of middle America — benighted yahoos or virtuous yeomen, depending on your point of view, but either way a less-educated and more pious demographic, with more traditional attitudes on sexuality and family.
Josh Haner/The New York Times
Ross Douthat

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Decades of punditry, pop sociology and prejudice have been premised on this neat division — from the religious right’s Reagan-era claim to be a “Moral Majority” oppressed by a secular elite, to Barack Obama’s unfortunate description of heartland America “clinging” to religion. Like any binary, it oversimplified a complicated picture. But as a beginner’s guide to the culture war, the vision of white-collar social liberals and blue-collar cultural conservatives was, for a substantial period, more accurate than not.
That may no longer be the case. This week, the National Marriage Project is releasing a study charting the decline of the two-parent family among what it calls the “moderately educated middle” — the 58 percent of Americans with high school diplomas and often some college education, but no four-year degree.
This decline is depressing, but it isn’t surprising. We’ve known for a while that America has a marriage gap: college graduates divorce infrequently and bear few children out of wedlock, while in the rest of the country unwed parenthood and family breakdown are becoming a new normal. This gap has been one of the paradoxes of the culture war: highly educated Americans live like Ozzie and Harriet despite being cultural liberals, while middle America hews to traditional values but has trouble living up to them.
But the Marriage Project’s data suggest that this paradox is fading. It’s no longer clear that middle America does hold more conservative views on marriage and family, or that educated Americans are still more likely to be secular and socially liberal.
That division held a generation ago, but now it’s diminishing. In the 1970s, for instance, college-educated Americans overwhelmingly supported liberal divorce laws, while the rest of the country was ambivalent. Likewise, college graduates were much less likely than high school graduates to say that premarital sex was “always wrong.” Flash forward to the 2000s, though, and college graduates have grown more socially conservative on both fronts (50 percent now favor making divorces harder to get, up from 34 percent in the age of key parties), while the least educated Americans have become more permissive.
There has been a similar change in religious practice. In the 1970s, college- educated Americans were slightly less likely to attend church than high school graduates. Today, piety increasingly correlates with education: college graduates are America’s most faithful churchgoers, while religious observance has dropped precipitously among the less-educated.
In part, these shifts may be a testament to the upward mobility of religious believers. America’s college-educated population probably looks more conservative and (relatively speaking) more religious because religious conservatives have become better educated. Evangelical Christians, in particular, are now one of America’s best-educated demographics, as likely to enroll their children in an S.A.T. prep course as they are to ship them off to Bible camp.
This means that a culture war that’s often seen as a clash between liberal elites and a conservative middle America looks more and more like a conflict within the educated class — pitting Wheaton and Baylor against Brown and Bard, Redeemer Presbyterian Church against the 92nd Street Y, C. S. Lewis devotees against the Philip Pullman fan club.
But as religious conservatives have climbed the educational ladder, American churches seem to be having trouble reaching the people left behind. This is bad news for both Christianity and the country. The reinforcing bonds of strong families and strong religious communities have been crucial to working-class prosperity in America. Yet today, no religious body seems equipped to play the kind of stabilizing role in the lives of the “moderately educated middle” (let alone among high school dropouts) that the early-20th-century Catholic Church played among the ethnic working class.
As a result, the long-running culture war arguments about how to structure family life (Should marriage be reserved for heterosexuals? Is abstinence or “safe sex” the most responsible way to navigate the premarital landscape?) look increasingly irrelevant further down the educational ladder, where sex and child-rearing often take place in the absence of any social structures at all.
This, in turn, may be remembered as the great tragedy of the culture war: While college-educated Americans battle over what marriage should mean, much of the country may be abandoning the institution entirely.

FDA observa problemas con farmacos para el cáncer de próstata

FDA observa problemas con farmacos para el cáncer de próstata


Fda
Image via Wikipedia
WASHINGTON – El personal regulatorio de medicamentos de Estados Unidos mencionó estar preocupado por los datos de dos fármacos de GlaxoSmithKline Plc y Merck & Co Inc y su efecto en la reducción del riesgo de cáncer de próstata en ciertos hombres.
Ambas medicinas ya están aprobadas para tratar los síntomas en hombres con agrandamiento prostático, pero Glaxo está buscando autorización para ampliar el mercado de su fármaco Avodart como una forma de limitar las posibilidades de cáncer de próstata en los varones con mayor riesgo.
Funcionarios de la Administración de Alimentos y Medicamentos de Estados Unidos (FDA) indicaron en documentos publicados de cara a un encuentro público el miércoles que en general los ensayos amplios muestran beneficios, después de cuatro años en el caso de Avodart y de siete en el de Proscar, de Merck.
Esos beneficios se observan fundamentalmente en los varones con ciertos grados de cáncer.
Los expertos manifestaron que “ninguno de los ensayos estaba diseñado adecuadamente y realizado para destacar los resultados de interés primordial”, como la muerte.
“En ambos ensayos hubo además un hallazgo inesperado de un incremento en la incidencia de cánceres de próstata de alto riesgo entre los hombres que estaban recibiendo” los fármacos, añadieron.
En el caso de Avodart de Glaxo, los asesores también mencionaron preocupación por el uso de biopsias y el impacto del medicamento en los hombres negros, entre otras cuestiones.
Por otra parte, los asesores de la agencia estadounidense también considerarán si los nuevos datos deberían incluirse en la etiqueta de Proscar, aunque Merck no está buscando aprobación formal para ampliar su uso.
Proscar es conocido por su nombre genérico finasterida.
“El beneficio de la finasterida sobre la reducción del riesgo en el cáncer de próstata es incierto dado que la disminución del riesgo observada (…) estaba presente sólo en el subgrupo de participantes diagnosticados” con ciertos tumores, escribió el personal de la FDA.
Durante el encuentro del miércoles, un panel de expertos externos a la FDA evaluará los datos de ambas compañías antes de ofrecer su recomendación a la agencia. Luego, la FDA tomará las decisiones finales. Reuters

Protecting Online Privacy

EDITORIAL

Protecting Online Privacy

RelatedThe Federal Trade Commission has come up with timely recommendations to protect privacy online.
For years, data trackers have collected information about people’s activities as they surf the Web, packaging it into profiles to sell to advertisers. The practice itself is not what is at issue, but rather the way it is done. Many trackers don’t disclose it. Others put complex, pro forma disclosures in obscure places on Web sites. Few consumers read them. Most don’t understand how much information they are sharing about their online lives.
Internet companies and advertisers insist that industry self-regulation is enough to protect consumers. But companies’ many lapses — one site that allowed parents to monitor their children online, for example, sold information about the kids’ activities to marketers — suggest it is time for regulators to set minimum standards that every company must follow.
The F.T.C. sets three recommendations to improve the protection of consumer privacy, starting with more transparency, including standard, simple and clear privacy disclosures to let people know who is doing what with the data about their online activities.
It recommends that companies include privacy protection in their operational goals. And most important, the F.T.C. insists that consumers be given a clear, simple option to opt out of online data tracking altogether — along the lines of the do-not-call registry — perhaps through a “do not track” button on Web browsers.
Advertisers argue that allowing surfers to opt out of tracking en masse would hobble the ad revenues that support most Web sites. This argument is overblown.
Giving Americans the choice to opt out of data tracking does not mean everybody will. Moreover, even if regulation limits advertisers’ ability to precisely target their ads according to consumers’ tastes, they will still need to advertise. They will just do it differently. Advertising spending in the United States amounted to 1.8 percent of G.D.P. last year. In 1990, before Yahoo even existed, it amounted to 2.2 percent of G.D.P. It has remained within that range over nearly two decades.
The F.T.C.’s report, which it calls preliminary, is only a first step toward better privacy protection. It is calling for public comment over the next two months, after which it will issue definitive recommendations. Yet while the commission has said it will police privacy abuses more aggressively, its proposal for a “do not track” button will probably require an act of Congress.
Fortunately, privacy protection has bipartisan support. So this is a great opportunity for Congress to prove that it can pass some meaningful legislation.

A Street of Puzzles

WINDOWS ON THE WORLD

A Street of Puzzles

A series in which writers from around the world describe the view from their windows.
When my writing is not going well, there are two things I do in the hope of luring the words back: I read some pages of books I love or I watch the world. This is my view when I am at home in Nigeria, in the port city of Lagos. An ordinary view, with houses close together, cars crammed in corners, each compound with its own gate, little kiosks dotting the street. But it is a view choked with stories, because it is full of people. I watch them and I imagine their lives and invent their dreams.
The stylish young woman who sells phone cards in a booth next door, the Hausa boys who sell water in plastic containers, stacked in wheelbarrows. The vendor with a pile of newspapers, pressing his horn, his hopeful eyes darting up to the verandas. The bean-hawker who prowls around in the mornings, calling out from time to time, a large pan on her head. The mechanics at the corner who buy from her, often jostling one another, often shirtless, and sometimes falling asleep under a shade in the afternoon.
I strain to listen to their conversations. Once I saw two of the mechanics in a raging but brief fight. Once I saw a couple walk past holding hands, not at all a common sight. Once, a young girl in a blue school uniform, hair neatly plaited, looked up and saw me, a complete stranger, and said, “Good morning, ma,” curtsying in the traditional Yoruba way, and it filled me with gladness. The metal bars on the window — burglary-proof, as we call it — sometimes give the street the air of a puzzle, jagged pieces waiting to be fit together and form a whole.
— Chimamanda Ngozi Adichie
Chimamanda Ngozi Adichie is the author, most recently, of “The Thing Around Your Neck.” Matteo Pericoli, an artist, is the author of “The City Out My Window: 63 Views on New York.”

Site for Teenagers With Literary Leanings

Web Site for Teenagers With Literary Leanings

Enlarge This ImageWhen Jacob Lewis helped create the beta version of the Web siteFigment with Dana Goodyear, a staff writer at The New Yorker, Mr. Lewis envisioned it as a sort of literary Facebook for the teenage set.
Chester Higgins Jr./The New York Times
Jacob Lewis, one of the founders of Figment.com.
“I really went into it and thought, ‘We’ll be the social network for young-adult fiction,’ ” said Mr. Lewis, a former managing editor of The New Yorker. “But it became clear early on that people didn’t want a new Facebook.”
The young people on the site weren’t much interested in “friending” one another. What they did want, he said, “was to read and write and discover new content, but around the content itself.”
Figment.com will be unveiled on Monday as an experiment in online literature, a free platform for young people to read and write fiction, both on their computers and on their cellphones. Users are invited to write novels, short stories and poems, collaborate with other writers and give and receive feedback on the work posted on the site.
The idea for Figment emerged from a very 21st-century invention, the cellphone novel, which arrived in the United States around 2008. That December, Ms. Goodyear wrote a 6,000-word article for The New Yorker about young Japanese women who had been busy composing fiction on their mobile phones. In the article she declared it “the first literary genre to emerge from the cellular age.”
Figment is an attempt to import that idea to the United States and expand on it. Mr. Lewis, who was out of a job after Portfolio, the Condé Nast magazine, was shuttered last year, teamed up with Ms. Goodyear, and the two worked with schools, libraries and literary organizations across the country to recruit several hundred teenagers who were willing to participate in a prototype, which went online in a test version in June.
“We wanted people to be able to write whatever they wanted in whatever form they wanted,” Mr. Lewis said. “We give them a piece of paper and say, ‘Go.’ ” He added that so far contributions had included fantasy, science fiction, biographical work and long serial novels. “There’s a very earnest and exacting quality to what they’re doing.”
Teenagers and their reading habits have been the subject of much fascination in the publishing industry lately. They were a huge driving force behind best-selling books like the “Twilight” series by Stephenie Meyer and the crop of paranormal-romance books that followed. Publishers are eager to learn more about their reading habits and introduce books to them.
Mr. Lewis said he hoped Figment would eventually attract more than a million users and serve as an opportunity for publishers to roam the Web site looking for fresh young talent, or promote their own authors by running book excerpts. “For publishers this is an amazing opportunity to not only reach your consumers but to find out really valuable information about how they are reading,” he said.
Several publishers have already signed on. Running Press Kids, a member of the Perseus Books Group, will provide an excerpt from “Purple Daze,” a historical novel for teenagers written by Sherry Shahan. (Figment charges a small fee to publishers for the privilege.)
David Steinberger, the chief executive of Perseus, said he saw Figment as an opportunity to get the company’s content in front of teenagers.
“The teen culture is a constantly moving target,” Mr. Steinberger said. “We’re looking for partners who are deeply embedded in the way teens interact.”

Profilaxis de la úlcera de estrés: revisión sistemática y metaanálisis


REMI envía todos sus contenidos gratuitamente por correo electrónico a más de 8.600 suscriptores. [Suscripción]
Artículo nº 1579. Vol 12, diciembre 2010.
Autor: Belén Quesada Bellver

Profilaxis de la úlcera de estrés: revisión sistemática y metaanálisis

Artículo original: Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis. Marik PE, Vasu T, Hirani A, Pachinburavan M. Crit Care Med 2010; 38(11): 2222-2228. [Resumen] [Artículos relacionados]

Introducción: La profilaxis de la úlcera de estrés es una práctica universalmente extendida [1] y forma parte de los paquetes de medidas en el paciente crítico. Sin embargo, actualmente esta patología es un evento relativamente infrecuente en nuestras Unidades y el riesgo de sangrado clínicamente significativo es bajo [2]. Dicho tratamiento no está exento de riesgos, tales como la modificación del pH gástrico (favoreciendo la colonización y crecimiento de microorganismos), mayor riesgo de neumonía nosocomial [3] e interacciones medicamentosas, además de tener sus efectos secundarios específicos. Por otro lado, distintos estudios han sugerido que la nutrición enteral (NE) precoz reduce el riesgo de úlcera de estrés. Los autores realizaron esta revisión pensando que la profilaxis del ulcus podría no aportar ningún beneficio en los pacientes con NE, e incluso ser perjudicial en términos de morbimortalidad.

Resumen: Se incluyeron 17 estudios controlados y aleatorizados (1.836 pacientes) en que se comparaban inhibidores de receptores H2 de histamina contra placebo. En general, la profilaxis redujo el riesgo de sangrado gastrointestinal, aunque este efecto sólo se vio en el subgrupo de pacientes sin NE. En los pacientes con NE la profilaxis no disminuyó el riesgo de sangrado. La incidencia de neumonía nosocomial no fue mayor en pacientes con profilaxis, aunque esta complicación sí se observó con más frecuencia en los pacientes con NE. Aunque la profilaxis de úlcera de estrés no tuvo efecto sobre la mortalidad, los pacientes con nutrición enteral y que recibieron profilaxis presentaron mayor mortalidad hospitalaria.

Comentario: Salvando los inconvenientes de toda revisión o metanálisis, los datos sugieren que en pacientes que toleran adecuadamente la NE, la profilaxis de úlcera de estrés podría no ser necesaria e incluso favorecería el riesgo de neumonía y muerte; la combinación de profilaxis de úlcera y nutrición enteral eleva el pH gástrico y el riesgo de colonización gástrica más que cualquiera de las dos intervenciones por separado. Dado que la profilaxis de la úlcera de estrés está considerada como indicador de calidad, es necesario reevaluar la eficacia y seguridad de esta medida en pacientes con y sin nutrición enteral.
Belén Quesada Bellver
Hospital Fundación Jiménez Díaz, Madrid
©REMI, http://remi.uninet.edu. Diciembre 2010.

Enlaces:
  1. Prevention of stress ulceration: current trends in critical care. Daley RJ, Rebuck JA, Welage LS, Rogers FB. Crit Care Med 2004; 32(10): 2008-2013. [PubMed]
  2. Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis. Faisy C, Guerot E, Diehl JL, Iftimovici E, Fagon JY. Intensive Care Med 2003; 29(8): 1306-1313. [PubMed]
  3. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. JAMA 2009; 301: 2120-2128. [PubMed]
Búsqueda en PubMed:
  • Enunciado: Profilaxis de la úlcera de estrés, nutrición enteral, inhibidores de la bomba de protones y antagonistas de los receptores H2 de la histamina
  • Sintaxis: stress ulcer prophylaxis AND (histamine receptor blocker OR proton pump inhibitor) AND enteral nutrition
  • [Resultados]
Palabras clave: Profilaxis de la úlcera de estrés, Antagonistas de los receptores H2 de la histamina, Inhibidores de la bomba de protones, Nutrición enteral, Neumonía nosocomial, Cuidados Intensivos.