Riviste scientifiche

[World Report] Fighting Ebola in conflict in the DR Congo

The Lancet - Sa, 13/10/2018 - 00:00
Armed conflict and mistrust risk spreading the “long tail” of the Ebola virus outbreak in the DR Congo. Benedict Moran reports from North Kivu.

[World Report] Nobel Prizes: cancer, phages, and fighting sexual violence

The Lancet - Sa, 13/10/2018 - 00:00
This year's Nobel Prizes rewarded work done towards developing new treatments, to combat the use of sexual violence as a weapon of war, and in medical research. Talha Burki reports.

[World Report] 2018 World Food Prize recognises advances in nutrition

The Lancet - Sa, 13/10/2018 - 00:00
Lawrence Haddad and David Nabarro will be presented with the World Food Prize for work significantly improving nutrition. Talha Burki reports.

[Perspectives] Yvonne Sylvain: women's health pioneer in Haiti

The Lancet - Sa, 13/10/2018 - 00:00
In the mid-20th century, a remarkable woman used her medical prowess and social prestige to address inequalities in Haitian society and raise the profile of public health. Born in Port-au-Prince in 1907, Yvonne Sylvain was the sixth of seven children of the poet, diplomat, and lawyer Georges Sylvain and his wife Eugénie. Both parents were part of a progressive intellectual elite that campaigned against the US occupation of Haiti, which lasted from 1915 to 1934. With a staunch feminist for a mother, the four Sylvain sisters all pursued either PhDs or medical training and furthered the cause of women's rights.

[Perspectives] Gothic revival

The Lancet - Sa, 13/10/2018 - 00:00
When Sarah Perry introduces the main character of her new novel Melmoth, walking through the streets of modern-day Prague, it is as an avatar of ordinariness: “Helen Franklin, forty-two, neither short nor tall… What might commend so drab a creature to your sight, when overhead the low clouds split and the upturned bowl of a silver moon pours milk out on the river?” But there is something about Helen that compels our attention, something that has driven her from an English home to isolation overseas.

[Perspectives] Ana Pilar Betrán: seeking the optimum use of caesarean section

The Lancet - Sa, 13/10/2018 - 00:00
What is the “correct” rate of deliveries in which birth should be by caesarean section? There is no clear-cut answer to the question, and the success of recommendations intended to raise or lower an existing caesarean section rate is not easily judged by reference to a predetermined numerical goal. As one of the key contributors to this issue's Lancet Series on optimising the use of caesarean section, Ana Pilar Betrán of WHO's Department of Reproductive Health and Research finds herself in territory characterised by uncertainty.

[Perspectives] Feminist science: who needs it?

The Lancet - Sa, 13/10/2018 - 00:00
Feminism may be on the brink of being acceptable, but it's still regarded with suspicion in science. Common thinking is that while feminism is all very well for Gender Studies, it should be kept away from science, lest political preferences of how women, men, and the world should be lead to distortion of scientific evidence as to how they actually are.

[Obituary] Alfred Alberts

The Lancet - Sa, 13/10/2018 - 00:00
Discoverer of the drug lovastatin. Born on May 16, 1931, in New York City, NY, USA, he died from complications of a myocardial infarction on June 16, 2018, in Fort Collins, CO, USA, aged 87 years.

[Correspondence] World Restart a Heart initiative: all citizens of the world can save a life

The Lancet - Sa, 13/10/2018 - 00:00
Sudden cardiac arrest is the third leading cause of death in industrialised nations, resulting in more than 700 000 deaths in Europe and the USA annually.1 After cardiac arrest, the brain can survive for 3–5 min, which could be the minimum time that emergency medical services take to arrive. Consequently, the most important way to improve survival is the instigation of early bystander cardiopulmonary resuscitation (CPR).2 Bystander CPR increases survival by two to four times, which is much better than with any other intervention by emergency medical services or hospital staff.

[Correspondence] Prevalence and control of hypertension

The Lancet - Sa, 13/10/2018 - 00:00
Jiapeng Lu and colleagues (Dec 9, 2017, p 2549)1 elegantly showed that uncontrolled blood pressure was highly prevalent in China, although resources to control hypertension were limited.1 As in other studies assessing the prevalence of hypertension,2 controlled hypertension was defined as a blood pressure of 140/90 mm Hg or more, irrespective of age and cardiovascular risk. However, several guidelines, including those from WHO, recommend prescribing a blood pressure-lowering treatment only if cardiovascular risk is high (eg, 10-year risk of fatal or non-fatal cardiovascular event ≥20%) or blood pressure is very high (eg, ≥160/100 mm Hg).

[Correspondence] Prevalence and control of hypertension – Authors' reply

The Lancet - Sa, 13/10/2018 - 00:00
We appreciate the Correspondence by Pascal Bovet and Arnaud Chiolero about our study of the prevalence, awareness, treatment, and control of hypertension in China.1 They suggest that for all studies reporting the prevalence of uncontrolled hypertension, and the resources needed to address the burden, authors should explicitly state whether referring to a risk factor approach, a cardiovascular risk approach, or a mix of both so as to help interpret the results and guide policy.As stated in the Methods section of our Article, we clearly defined controlled and treated hypertension.

[Correspondence] VLCD for weight loss and remission of type 2 diabetes?

The Lancet - Sa, 13/10/2018 - 00:00
In the DiRECT trial, Michael Lean and colleagues (Feb 10, p 541)1 report diabetes remission after very low calorie diets (VLCDs). Numerous studies of VLCDs have shown diabetes improvement and remission, but much of the effect, as this trial confirms, is correlated to weight loss.2 Unfortunately, weight loss from VLCD with behavioural therapy has proven to be unsustainable in 1-year to 5-year follow-up studies.3 Metabolic adaptation driving regain in response to caloric restriction is well documented, supporting the paradigm that weight regain after VLCD is more related to energy regulatory mechanisms than willpower.

[Correspondence] VLCD for weight loss and remission of type 2 diabetes? – Authors' reply

The Lancet - Sa, 13/10/2018 - 00:00
We thank Nadia Ahmad and Nasreen Alfaris for their Correspondence.

[Correspondence] Improve access to quality primary care for patients with anxiety or depression

The Lancet - Sa, 13/10/2018 - 00:00
Graham Thornicroft (Feb 17, 2017, p 636)1 suggests that teams working on the Improving Access to Psychological Therapies (IAPT) programmes have helped increase treatment rates for adults with anxiety or depression (from 24% in 2007, to 37% in 2014).2 However, from a primary care perspective, the proportion of people with these disorders who receive psychological therapy is still small.

[Correspondence] Improve access to quality primary care for patients with anxiety or depression – Authors' reply

The Lancet - Sa, 13/10/2018 - 00:00
We thank Tony Kendrick for raising the important issue of how few people with anxiety or depression in the UK actually receive any treatment. In high-income countries like the UK, psychological treatment services, such as the Improving Access to Psychological Therapies (IAPT) programme, have an important role in increasing choice and access to evidence-based treatments, alongside strengthening primary care.

[Correspondence] Essential need for quality in surgical health-care systems

The Lancet - Sa, 13/10/2018 - 00:00
We congratulate Donald Berwick and colleagues (July 21, p 194)1 for highlighting the need for health systems to achieve safe, effective, universal health-care coverage in the Era of Sustainable Development. The need is most apparent in surgery, obstetrics, and anaesthesia, in which adverse health-care events can have devastating consequences. Surgery can be deemed a reliable stress test for health-care facilities and indicative of overall quality as it requires the successful integration of multiple systems.

[Correspondence] Madagascar should introduce typhoid conjugate vaccines now

The Lancet - Sa, 13/10/2018 - 00:00
In December, 2017, WHO prequalified a typhoid conjugate vaccine, recommending its use in people aged 6 months to 45 years residing in typhoid fever-endemic areas.1 Typhoid conjugate vaccines have also been included in the portfolio of subsidised vaccines managed by Gavi, The Vaccine Alliance.2 Typhoid fever surveillance has been done in Madagascar since 2011 as part of the Typhoid Fever Surveillance in Africa Program (TSAP) and the Febrile Illnesses Surveillance in Africa Program. TSAP identified an incidence of 171 per 100 000 individuals aged 5–14 years in a rural setting,3 corresponding to five typhoid cases in a study population of 13 188 individuals.

[Correspondence] The proposed health bill in South Africa

The Lancet - Sa, 13/10/2018 - 00:00
I read with interest the World Report by Andrew Green (July 7, p 18)1 about the proposed health bill in South Africa. Green avoids discussion of some important factors. For example, South Africa already has a comprehensive public health system. This system delivers all kinds of treatment based on that deemed necessary by the doctor, rather than working off a tightly prescribed list. Those people who are least able to pay for their treatment get it for free, the wealthy people pay as much as they would in the private sector, and a sliding scale operates for those who are in between.

[Department of Error] Department of Error

The Lancet - Sa, 13/10/2018 - 00:00
Head SJ, Papageorgiou G, Milojevic M, Stone GW, Kappetein AP. Interpretation of results of pooled analysis of individual patient data – Authors' reply. Lancet 2018; 392: 818—In this Correspondence, the linked appendix should contain the results of the authors' further analyses. This correction has been made to the online version as of Oct 11, 2018.

[Department of Error] Department of Error

The Lancet - Sa, 13/10/2018 - 00:00
Tauschmann M, Thabit H, Bally L, et al. Closed-loop insulin delivery in suboptimally controlled type 1 diabetes: a multicentre, 12-week randomised trial. Lancet 2018; 392: 1321–29—In table 1 of this Article (published online Oct 3), the data presented for the total insulin dose, U/kg per day, should have been 0·76 (0·25) for the closed-loop group and 0·69 (0·18) for the control group. These corrections have been made to the online version as of Oct 11, 2018, and the printed Article is correct.
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