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[Perspectives] Talking about bereavement and grief

Lu, 14/05/2018 - 12:00
“Grief is just the messiest process…you could ever wade yourself through, without a doubt”, says Kim Garrison, a bereaved parent, in A Love That Never Dies (video), a documentary by Jane Harris and Jimmy Edmonds, whose son Josh died in 2011.

[Comment] Stents in saphenous vein grafts

Sa, 12/05/2018 - 00:30
Drug-eluting stents (DES) have been effective in the treatment of coronary artery disease. Active agents such as paclitaxel and sirolimus, and their derivatives, have shown good efficacy and safety in the prevention of intimal hyperplasia and clinical events after stent implantation.1 Accordingly, the benefit of DES entered current clinical guideline recommendations for many clinical scenarios.2 In saphenous venous grafts (SVG), evidence for efficacy of DES is scarce since just four randomised trials with various sizes and limitations have been done (ie, RRISC,3 SOS,4 ISAR-CABG,5 and BASKET-SAVAGE6), though all four studies showed a benefit of DES versus bare-metal stents (BMS) with respect to their primary endpoints (ie, late lumen loss after 6 months3 or a composite of clinical events after 12 months).

[Articles] Drug-eluting stents versus bare-metal stents in saphenous vein grafts: a double-blind, randomised trial

Sa, 12/05/2018 - 00:30
In patients undergoing stenting of de-novo SVG lesions, no significant differences in outcomes between those receiving DES and BMS during 12 months of follow-up were found. The study results have important economic implications in countries with high DES prices such as the USA, because they suggest that the lower-cost BMS can be used in SVG lesions without compromising either safety or efficacy.

[Editorial] Turning climate change legislation into public health policy

Sa, 12/05/2018 - 00:00
The effects of climate change are inextricably entwined with health: ranging from the WHO estimate of 7 million deaths from breathing polluted air indoors and outdoors; through the impact of weather-related natural disasters; negative effects on crop yields and food security; and changing patterns of vector-borne diseases; to the shaping of social and environmental determinants of health. 2018 marks 10 years of the UK's 2008 Climate Change Act, which mandated reduction of UK carbon dioxide emissions by 80% by 2050 to 1990 levels, and legislated an independent Committee on Climate Change.

[Editorial] Cancer drugs in China: affordability and creativity

Sa, 12/05/2018 - 00:00
Cancer is a major public health concern in China. According to the National Central Cancer Registry of China, there were around 4·3 million new cancer cases and 2·8 million cancer deaths in China in 2015. Improving the accessibility and availability of effective treatments is key to tackling the huge burden of cancer in China. However, in terms of local affordability of cancer drugs, China emerges as one of the countries with the least affordable prices in the world.

[Editorial] Vitamin A distribution in danger

Sa, 12/05/2018 - 00:00
Vitamin A deficiency affects almost half of children under 5 years in south Asia and sub-Saharan Africa. A new UNICEF report, released on May 2, highlights the current problems facing vitamin A supplementation programmes around the world. Coverage at a crossroads: new directions for vitamin A supplementation programmes claims that vitamin A distribution has reached a 6-year low, with 62 million children in high-mortality countries not receiving the supplement.

[Comment] Emergency deployment of oral cholera vaccine for the Rohingya in Bangladesh

Sa, 12/05/2018 - 00:00
Cholera is a threat to vulnerable populations caught in humanitarian emergencies.1 WHO has recommended that inactivated oral cholera vaccines (OCVs), in conjunction with provision of appropriate rehydration therapy, clean water, and sanitation, be considered for use in humanitarian and emergency settings at high risk for cholera.2 Since 2013, inactivated vibrio whole cell OCVs have been made available for deployment from a global OCV stockpile, funded by Gavi, the Vaccine Alliance, which is intended for cholera control in outbreaks, humanitarian crises, and settings with endemic cholera.

[Comment] Offline: John E Fogarty and the defeat of Donald J Trump

Sa, 12/05/2018 - 00:00
If President Trump had had his way, the Fogarty International Center would now be a footnote in history. Targeted for elimination in 2017, the Trump administration viewed the Fogarty mission—to support and facilitate global health research—as contrary to the spirit of America First. Yet last week, the Fogarty Center celebrated its 50th birthday in a stronger and more stable position than at any time in its short existence. Francis Collins, Director of the National Institutes of Health (NIH), underlined the importance of Fogarty to the US scientific enterprise.

[World Report] EMRO Regional Director to be elected to head office

Sa, 12/05/2018 - 00:00
The election of the Regional Director of the WHO Eastern Mediterranean Regional Office is due to take place on May 19. John Zarocostas reports.

[World Report] Cochrane postpones comprehensive free access to reviews

Sa, 12/05/2018 - 00:00
Cochrane postpones implementation of the target to make all Cochrane Reviews open access immediately upon publication. Talha Burki reports.

[World Report] Concern over reported number of measles cases in Yemen

Sa, 12/05/2018 - 00:00
Over 3000 suspected measles cases have been reported in 2018 across Yemen, where conflict has plunged the country into the world's largest humanitarian crisis. Xun Yuan reports.

[Perspectives] The pressures of medical practice

Sa, 12/05/2018 - 00:00
Caroline Elton is a chartered psychologist who has had an unusual career. She worked to challenge outdated models of medical education by observing doctors at work, and then went on to become Head of the Careers Unit for trainee doctors at the London Deanery. She now works for a private counselling company specialising in medical and dental careers. Also Human: the Inner Lives of Doctors draws on her more than two decades of work with physicians. Elton's book is a frequently angry and shocked response to the tools used for selection for medical school, the induction into and nature of medical training, and the management of doctors who find themselves, for whatever reason, in some kind of difficulty.

[Perspectives] Not much to say really

Sa, 12/05/2018 - 00:00
When I was collecting autobiographical stories for a project called Showing Your Age, 86-year-old Joan began our conversation by saying, “there's not much to say really”. She then talked about her life for several hours. Other people's responses followed the same pattern: hesitation, then a pouring out of intriguing, humorous, and heart-breaking recollections of individuals weighing up their lives. The book that came out of this project, Not Much To Say Really, was a poetic and artistic account of my extended conversations with these patients.

[Obituary] Robert Johns Haggerty

Sa, 12/05/2018 - 00:00
Paediatrician who reinvented his specialty. He was born in Saranac Lake, NY, USA, on Oct 20, 1925, and died of cancer in Canandaigua, NY, USA, on Jan 23, 2018, aged 92 years.

[Correspondence] Time to eradicate HTLV-1: an open letter to WHO

Sa, 12/05/2018 - 00:00
Human T-cell leukaemia virus 1 (HTLV-1) is the most potent carcinogenic oncovirus and potentially the most oncogenic risk factor including chemical carcinogens.1 A unique and aggressive T-cell leukaemia (adult T-cell leukemia) was discovered in Japan,2,3 from which a new retrovirus, HTLV-1, was identified in the USA4 and then in Japan,5 independently. In addition to adult T-cell leukaemia, HTLV-1 causes progressive and disabling inflammatory conditions, such as HTLV-1-associated myelopathy/tropical spastic paraparesis6,7 (HAM/TSP), associated with high morbidity and mortality.

[Correspondence] Drawing conclusions from the VIVA trial

Sa, 12/05/2018 - 00:00
The VIVA trial by Jes Lindholt and Rikke Søgaard (Nov 18, 2017, p 2256)1 assessed the effects of screening for abdominal aortic aneurysm, peripheral arterial disease, and hypertension, showing a small but statistically significant reduction in total mortality in the screening group versus the non-screening group. The authors concluded that “the observed reduction of mortality risk from abdominal aortic aneurysm, peripheral arterial disease, and hypertension” should lead policy makers to “consider implementing combined screening”.

[Correspondence] Drawing conclusions from the VIVA trial – Authors' reply

Sa, 12/05/2018 - 00:00
In their letter, Karsten Juhl Jørgensen and Minna Johansson highlighted the fact that the VIVA trial1 showed a reduction in overall mortality that could not be attributed to individual causes of death. They further made the case that this overall effect on mortality is inconsistent with current evidence on the effects of general health checks.

[Correspondence] Teriparatide vs risedronate for osteoporosis

Sa, 12/05/2018 - 00:00
David L Kendler and colleagues (Jan 20, p 230)1 compared the anti-fracture efficacy of subcutaneous teriparatide injections with that of oral risedronate in patients with severe osteoporosis, and indicated that the risk of new vertebral and clinical fractures is significantly lower in patients receiving teriparatide than in those receiving risedronate. Nevertheless, it seems to me that a comparison between a parenteral and an oral anti-osteoporosis drug might be of relatively minor clinical significance.

[Correspondence] Teriparatide vs risedronate for osteoporosis – Authors' reply

Sa, 12/05/2018 - 00:00
Yair Liel stated that the VERO clinical trial1 results were of relatively minor clinical significance because of the nature of the active comparator used (risedronate) and because bone turnover markers were not measured, suggesting that the inferior anti-fracture efficacy in the risedronate group was not evaluated properly. He suggested that a clinically relevant comparison could be made between teriparatide and zoledronate, or between teriparatide and denosumab, given their superior effects on bone mineral density observed when compared with oral bisphosphonates.

[Articles] International validation of the consensus Immunoscore for the classification of colon cancer: a prognostic and accuracy study

Ve, 11/05/2018 - 00:30
The Immunoscore provides a reliable estimate of the risk of recurrence in patients with colon cancer. These results support the implementation of the consensus Immunoscore as a new component of a TNM-Immune classification of cancer.