Riviste scientifiche

[Comment] Renewing the focus on health care for sexually assaulted children and adolescents

The Lancet - Sa, 06/01/2018 - 00:00
Sexual assault and rape are in the media spotlight in the face of unfolding revelations of abuse of women in the entertainment industry and sports. These disclosures by public figures highlight some aspects of sexual abuse—namely, that it is often pervasive, an expression of power (rather than just about sex) and rooted in ideas of male sexual entitlement, and an experience that victims find shameful and often conceal.1,2 Far from the lights of Hollywood, many children and adolescents in low-income and middle-income countries (LMICs) face sexual abuse and often have little recourse to assistance.

[Comment] The polio endgame: securing a world free of all polioviruses

The Lancet - Sa, 06/01/2018 - 00:00
The global effort to eradicate poliomyelitis has reduced the incidence of cases caused by wild poliovirus by more than 99% since its launch in 1988, from 350 000 annual cases in 125 endemic countries to 20 cases in two countries in 2017.1 More than 16 million people who would otherwise have been paralysed by poliovirus infection are today walking, and 80%2 of the world's population lives in regions certified as polio free by WHO. Wild poliovirus now circulates in only a few areas and remains endemic in Nigeria, Pakistan, and Afghanistan.

[Comment] Offline: From 1918 to 2018—the lessons of influenza

The Lancet - Sa, 06/01/2018 - 00:00
Estimates of mortality during the 1918–20 influenza pandemic range from 20 million to 100 million deaths. Mortality between countries varied enormously. A large part of this variation was related to wealth. Resource-poor countries, with weak health systems, pervasive undernutrition, and widespread poverty, had higher death rates. When 1918 mortality rates are modelled for the modern era, an epidemic of influenza with similar virulence and pathogenicity would cause around 62 million deaths, with younger age groups especially vulnerable.

[World Report] Syria: 7 years into a civil war

The Lancet - Sa, 06/01/2018 - 00:00
Years of conflict have killed thousands, but the toll of war on Syria's health systems extends the cost of war beyond the front lines as de-escalation efforts seem to be faltering. Sharmila Devi reports.

[World Report] Zimbabwe post-Mugabe era: reconstructing a health system

The Lancet - Sa, 06/01/2018 - 00:00
A once-functioning health system was weakened by Robert Mugabe's antagonistic policies. Some hope the Mnangagwa administration will bring renewal. Andrew Green reports.

[Perspectives] Using comics to change lives

The Lancet - Sa, 06/01/2018 - 00:00
Comics are a popular source of entertainment, activism, education, and subversion. Within health care the use of comics has been steadily growing for the past 50 years, with comics used to reach all age groups but particularly younger readers. I recall in the early 1980s sending a coupon I had clipped from a comic off to the Health Education Council for a smoking prevention information pack. This followed my reading about the evil Nick O Tine—overpowered by Superman (who never said yes to a cigarette) in a powerful anti-smoking story created by DC Comics.

[Perspectives] In search of a teacher

The Lancet - Sa, 06/01/2018 - 00:00
“Written and Illustrated by…” These words were written on a blackboard in September, 1971, in crisp, authoritative chalk. We first graders at Colton Elementary School sat in awe as a young, energetic teacher took the stage in our lives. Ms Zive (and she was the first person we knew who ever used the term Ms) beguiled us with a dazzling smile, a secret store of Bugle corn snacks, plus the tantalising promise to let us in on the magic that adults possessed: reading.

[Obituary] Geoffrey Christopher Schild

The Lancet - Sa, 06/01/2018 - 00:00
Influenza virologist. He was born in Sheffield, UK, on Nov 28, 1935, and died in Bergen, Norway, on Aug 3, 2017, aged 81 years.

[Correspondence] Another perspective on the Foundation for a Smoke-Free World

The Lancet - Sa, 06/01/2018 - 00:00
Much has, and is, being said about the Foundation for a Smoke-Free World,1 an independent foundation funded by Philip Morris International, but one elemental point has been overlooked. A principal focus of the foundation, as stated on its website, is on treatment of addicted smokers to decrease mortality, including promoting the switch to reduced-risk products, such as e-cigarettes. Geoffrey Rose, in his masterful monograph The Strategy of Preventive Medicine, pointed to the so-called risk paradox, giving the example “whereby it was seen that many people exposed to a small risk may generate more disease than a few exposed to a conspicuous risk.

[Correspondence] WHO washes its hands of older people

The Lancet - Sa, 06/01/2018 - 00:00
Older people (≥60 years) constitute more than 12% of the world's population, which will rise to 16·5% by 2030.1 This age group will represent 10% of the population in less developed regions by 2030. Although older people account for a greater proportion of the global burden of disease and health-care needs than younger people, their positive societal contribution should not be overlooked. This age group often provide unpaid care for children or grandchildren, or other adults with disabilities. Improved health of older people is an essential goal to reduce health-care costs and maintain the societal support older people provide.

[Correspondence] Reducing childhood obesity in the UK

The Lancet - Sa, 06/01/2018 - 00:00
The Lancet's Editorial (Aug 26, 2017, p 882)1 is right about childhood obesity remaining an urgent public health challenge. Unfortunately, there is a certain naivety to The Lancet's view of Public Health England's (PHE) role in policy development.

[Correspondence] Reducing childhood obesity in the UK and France

The Lancet - Sa, 06/01/2018 - 00:00
The Lancet's Editorial (Aug 26, 2017, p 822)1 suggested that the UK's plan for reducing childhood obesity was inadequate as Public Health England announced it will be “working closely” with the food industry in seeking voluntary calorie reductions in high-energy food sources popular with children and young people.

[Correspondence] Targeted radiotherapy for early breast cancer

The Lancet - Sa, 06/01/2018 - 00:00
We congratulate Charlotte E Coles and colleagues (Sept 9, 2017, p 1048)1 on their randomised trial (IMPORT LOW) ratifying partial-breast irradiation and confirming the original hypothesis2 proposed in The Lancet 20 years ago.3 In 2010, the independent commentary accompanying the first results of the TARGIT-A trial4 of single-dose targeted intraoperative radiotherapy (TARGIT-IORT), published in The Lancet by the authors of this letter, presented partial-breast irradiation as the new standard for suitable patients.

[Correspondence] Targeted radiotherapy for early breast cancer – Authors' reply

The Lancet - Sa, 06/01/2018 - 00:00
We reject the inference of a survival benefit for patients receiving partial-breast irradiation within the IMPORT LOW trial and caution against any such interpretation when the number of events reported is so small.1 There is no suggestion of a difference in disease-free and overall survival across IMPORT LOW treatment groups.1 The TARGIT trialists' claim of survival benefit in their own trial relates to non-breast cancer deaths, and the data they cite are from a selected subset of patients. In IMPORT LOW, there were nine cardiac deaths occurring 6–36 months following randomisation, four after left-sided and five after right-sided breast cancer.

[Correspondence] How does azithromycin improve asthma exacerbations?

The Lancet - Sa, 06/01/2018 - 00:00
We read with interest the Article by Peter G Gibson and colleagues (July 4, 2017, p 659),1 which clearly showed the beneficial effects of macrolide therapy on the incidence of asthma exacerbations. Increasingly, asthma is recognised as a heterogeneous disease with multiple phenotypes and endotypes. By contrast with the effects of anti-inflammatory treatment with inhaled corticosteroids, leukotriene receptor antagonists, and biological therapies—for which therapeutic efficacy depends on the inflammatory profile—Gibson and colleagues showed no differential benefit in terms of eosinophilic inflammation over non-eosinophilic inflammation.

[Correspondence] How does azithromycin improve asthma exacerbations? – Author's reply

The Lancet - Sa, 06/01/2018 - 00:00
Two key findings of the AMAZES trial1 are relevant to asthma management. First, the addition of low-dose azithromycin to a combination of inhaled corticosteroids and long-acting bronchodilators led to a clinically significant reduction in asthma exacerbations in adults with poorly controlled asthma. This finding provides an additional therapeutic option for these patients. Second, the effect occurred equally in both eosinophilic and non-eosinophilic asthma, by an as yet unidentified mechanism, but acting on pathways other than type 2 inflammation.

[Correspondence] Hypothyroidism and hypertension: fact or myth?

The Lancet - Sa, 06/01/2018 - 00:00
We read with interest the thorough Seminar on hypothyroidism (Sept 23, 2017, p 1550),1 in which the authors implicate that hypothyroidism is a cause of hypertension. However, hypertension is not a typical sign of hypothyroidism. This misconception is more than 80 years old with Owen Thompson and colleagues2 reporting a high incidence of hypertension in myxoedema. Since then, many uncontrolled observational studies have shown that elevated blood pressure in patients with hypothyroidism returns to within normal range after thyroid hormone substitution.

[Correspondence] Hypothyroidism and hypertension: fact or myth? – Authors' reply

The Lancet - Sa, 06/01/2018 - 00:00
We thank Louis Hofstetter and Franz H Messerli for their interest in our Seminar on hypothyroidism in The Lancet.1 We agree that hypothyroidism is rarely the sole underlying cause of hypertension in the general population and that hypertension should always be treated in the context of primary cardiovascular disease prevention. However, several observational studies have shown a difference in blood pressure between those with hypothyroidism (clinical or subclinical) and euthyroid individuals, even after adjusting for age.

[Department of Error] Department of Error

The Lancet - Sa, 06/01/2018 - 00:00
Al-Lamee R, Thompson D, Dehbi H-M, et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet 2018; 391: 31–40—In this Article (published online first on Nov 2, 2017) there were data analysis errors, including the erroneous exclusion of the final batch of 24 dobutamine stress echocardiograms. The analyses have been checked and the data corrected in table 3 under headings “SAQ-angina frequency” and “Peak stress wall motion index score”, as well as any text referring to these data in the Results and Discussion.

Tackle UK’s killer toxic air before waging war on ocean plastic

New Scientist - Ve, 05/01/2018 - 17:33
If only environment secretary Michael Gove's enthusiasm to curb plastic pollution extended to more pressing environmental issues, says Olive Heffernan
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