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[Correspondence] The future of radiology: adding value to clinical care

Sa, 11/08/2018 - 00:00
The practice of radiology needs to change for three reasons: subjective decisions about tests are a major contributor to the overuse of services, images are often inconsistently obtained and analysed, and radiology reports often include vague descriptions.

[Correspondence] Electronic cigarettes: adolescent health and wellbeing

Sa, 11/08/2018 - 00:00
We read with interest John N Newton and colleagues' Comment (Feb 6, p 639),1 in which they incorrectly state that “experimentation with ECs [electronic cigarettes] has had no detectable effect on youth smoking rates and increased availability of ECs has not interrupted declining trends in youth smoking in many countries”. We believe that this statement is incorrect and is not supported by evidence in the literature.

[Correspondence] Electronic cigarettes: adolescent health and wellbeing

Sa, 11/08/2018 - 00:00
The Comment by John N Newton and colleagues1 would have been more credible if it had been consistently based on evidence. The authors claim that the findings of the National Academies of Sciences, Engineering, and Medicine report2 are generally in line with the Public Health England evidence review,3 but differences of emphasis exist.

[Correspondence] Electronic cigarettes: adolescent health and wellbeing – Authors' reply

Sa, 11/08/2018 - 00:00
We thank all correspondents for their interest in our Comment.1

[Correspondence] The increase of suicide rates: the need for a paradigm shift

Sa, 11/08/2018 - 00:00
Suicide was highlighted as a major public health issue in a recent release of data by the US Centers for Disease Control and Prevention (CDC).1 The CDC reported a 30% increase (1999–2016) in suicide across all age groups up to age 75 years (in half of all US states), and in 2016, 54% of people in 27 US states who died by suicide had no mental health diagnosis.1 Yet most papers and reports on suicide stress that up to 90% of people who die by suicide had a psychiatric disorder. Despite innovative approaches in both psychiatric treatments and suicide prevention, some important shortcomings seem to have a role in impairing effective progress in reducing deaths by suicide.

[Correspondence] A century ago: Carlo Forlanini and the first successful treatment of tuberculosis

Sa, 11/08/2018 - 00:00
“They have formed a group, for of course a thing like the pneumothorax brings people together. They call themselves the Half-Lung Club.”1Thomas Mann

[Correspondence] Zero tolerance on claims of harassment at UN agency

Sa, 11/08/2018 - 00:00
I read with interest and concern the Special Report by John Zarocostas (April 21, pp 1561–65).1 It is essential that UN agencies provide a safe and secure working environment for their staff, and that all incidents of sexual harassment or abuse are addressed immediately and dealt with appropriately.

[Correspondence] Reducing child mortality in England

Sa, 11/08/2018 - 00:00
Improving the health of women before and during pregnancy and reducing socioeconomic disadvantages could improve infant outcomes in England.1

[Department of Error] Department of Error

Sa, 11/08/2018 - 00:00
Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet 2018; 391: 939–48—In this Article, percentage symbols have been removed from the mean SYNTAX scores in table 1. Additionally, the data in the last row of the second column in table 2 should have been 11·6% (83/927). These corrections have been made to the online version as of Aug 9, 2018.

[Department of Error] Department of Error

Sa, 11/08/2018 - 00:00
Wallace DJ, Furie RA, Tanaka Y, et al. Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 2 trial. Lancet 2018; 392: 222–31—The appendix of this Article has been corrected as of Aug 9, 2018.

[Department of Error] Department of Error

Sa, 11/08/2018 - 00:00
Watts G. George F Gao: head of China CDC signals a more global outlook. Lancet 2018; 392: 274—In this Profile, the penultimate sentence of the first paragraph should read “….Director General of the Institute of Microbiology of the Chinese Academy of Sciences”, the second paragraph should begin “Most of Gao's time abroad…”, and the second sentence of the second paragraph should say “spent 3 years at Harvard University”. These corrections have been made to the online version as of Aug 9, 2018

[Articles] Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study

Sa, 11/08/2018 - 00:00
Age at onset of type 1 diabetes is an important determinant of survival, as well as all cardiovascular outcomes, with highest excess risk in women. Greater focus on cardioprotection might be warranted in people with early-onset type 1 diabetes.

[Articles] Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study

Sa, 11/08/2018 - 00:00
Sodium intake was associated with cardiovascular disease and strokes only in communities where mean intake was greater than 5 g/day. A strategy of sodium reduction in these communities and countries but not in others might be appropriate.

[Clinical Picture] Re-expansion pulmonary oedema

Sa, 11/08/2018 - 00:00
A 46-year-old man presented to the emergency department with moderate dyspnoea and a 4-day history of cough. His medical history also included alcoholic cirrhosis with portal hypertension and ascites. On admission, a chest x-ray showed complete white-out of the right hemithorax with contralateral mediastinal deviation compatible with a large pleural effusion—presumed to be hepatic hydrothorax (figure). A chest drain was inserted into the right pleural cavity under ultrasound guidance and 2 L of clear fluid were rapidly drained over approximately 2 min.

[Editorial] Heatwaves and health

Sa, 04/08/2018 - 00:00
22 000 people, half of them elderly, were reportedly taken to hospital with symptoms of heat stroke during the past month's heatwave in Japan, where record temperatures exceeded 41°C. Exceptionally high and persistent July temperatures also baked north America and Europe, and set the stage for catastrophic forest fires not only in Greece, but also above the Arctic circle in Alaska and Lapland. Climate change makes heatwaves more frequent and severe. Yet, unlike other natural disasters—with which, based on impact, they should be rightly grouped—heatwaves do not elicit an immediate cross-sectoral response to protect life.

[Editorial] Vaccine scandal and confidence crisis in China

Sa, 04/08/2018 - 00:00
In July, China experienced its “worst public health crisis in years” as stated by South China Morning Post. Chinese vaccine maker Changsheng Biotechnology was found to have fabricated production and inspection records and to have arbitrarily changed process parameters and equipment during its production of freeze-dried human rabies vaccines. Furthermore, substandard diphtheria, pertussis, and tetanus (DPT) vaccines produced by Changsheng Biotechnology were administered to 215 184 Chinese children; and 400 520 substandard DPT vaccines produced by Wuhan Institute of Biological Products were sold in Hebei and Chongqing.

[Editorial] Half measures on children's mental health

Sa, 04/08/2018 - 00:00
In December, 2017, the UK Department of Health and Social Care and the Department for Education released Transforming Children and Young People's Mental Health Provision, a green paper proposing changes to the way that mental health services are provided to children. The proposal calls for an additional 8000 staff in Child and Adolescent Mental Health Services (CAMHS), which account for 0·7% of the National Health Service's (NHS's) £125 billion budget, to create new Mental Health Support Teams in schools.

[Comment] Peer-delivered self-management programmes in mental health

Sa, 04/08/2018 - 00:00
Facilitating recovery and full lives among people with serious mental illness is a priority for mental health services.1,2 Reducing the use of acute care services is also important, for economic reasons and to maximise personal freedom, by treating people in the least restrictive setting possible. Peer support and self-management programmes are increasingly popular recovery-oriented services that have the potential to improve patient wellbeing, reduce relapse, and decrease burden on formal acute mental health services.

[Comment] Reimagining population health as convergence science

Sa, 04/08/2018 - 00:00
Convergence science is a transdisciplinary approach for framing research questions. A 2016 report from the Massachusetts Institute of Technology (MIT) described convergence science as “an approach to problem solving that integrates expertise from life sciences with physical, mathematical, and computational sciences as well as engineering to form comprehensive frameworks that merge areas of knowledge from multiple fields to address specific challenges”.1 The report examined four priority areas in which convergence strategies, applied systematically, can impact biomedicine: cancer; infection and immunity; brain disorders and injuries; and heart disease, diabetes, and inherited genetic disease.

[Comment] Sexual harassment and abuse: when the patient is the perpetrator

Sa, 04/08/2018 - 00:00
A young female physician receiving unwelcomed sexual attention from a patient and feeling unsafe is not a new problem. However, these encounters destabilise patient–physician relationships and can have negative consequences for the physician's future. The patient–physician relationship is founded on trust and entered into by mutual consent.1 Now that more than 50% of medical students in the UK and the USA are women, systematic approaches are needed to ensure that female clinicians can safely treat patients in populations where sexism is common.