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[Comment] Immunoscore for (colorectal) cancer precision medicine

Ve, 11/05/2018 - 00:30
Immunotherapies targeting immune checkpoints such as CTLA4, PDCD1 (PD-1), and CD274 (PD-L1) have revolutionised oncology.1 High-level microsatellite instability (MSI-high) caused by mismatch repair deficiency is routinely used as a biomarker to predict response to immune-checkpoint blockade.2 MSI-high status in colorectal carcinoma correlates with tumour neoantigen loads, which in turn correlate with immune response.3 Combined analysis of tumoural and immune factors (eg, the so-called Tumour Immunity in the MicroEnvironment [TIME] classification) could be a new cancer classification system.

[Perspectives] Abortion narratives: moving from statistics to stories

Me, 09/05/2018 - 09:00
A Nigerian obstetrician once asked me why I didn't—as he did in his campaigning work—display photographs of haemorrhaging teenage girls, perforated uteri, and prolapsed bowels: the images from the front-line of his daily battle against death from unsafe abortion. In high-income countries with permissive legal regimes and fairly easy access to safe abortion services, people are protected from the bloody consequences of illegal abortion. It has been an easy badge of honour for pro-choice advocates that we draw on research and avoid mirroring the inflammatory language and graphic imagery used by some anti-abortion groups.

[Comment] Contemporary cardiovascular risk prediction

Sa, 05/05/2018 - 00:30
Cardiovascular disease remains an important health problem, accounting for 3·9 million deaths every year in Europe alone.1 To reduce the incidence of cardiovascular disease, risk prediction models are widely used for risk-tailored management, such as antihypertensive and lipid-lowering treatment. More than 350 risk prediction models have been developed for cardiovascular disease in the past decades. These models are mainly based on long-standing cohort data, but only a few models have been validated externally to test their generalisability in present settings.

[Articles] Cardiovascular disease risk prediction equations in 400 000 primary care patients in New Zealand: a derivation and validation study

Sa, 05/05/2018 - 00:30
We constructed a large prospective cohort study representing typical patients in primary care in New Zealand who were recommended for cardiovascular disease risk assessment. Most patients are now at low risk of cardiovascular disease, which explains why the PCEs based mainly on old cohorts substantially overestimate risk. Although the PCEs and many other equations will need to be recalibrated to mitigate overtreatment of the healthy majority, they also need new predictors that include measures of socioeconomic deprivation and multiple ethnicities to identify vulnerable high-risk subpopulations that might otherwise be undertreated.

[Editorial] Campaigning for preconception health

Sa, 05/05/2018 - 00:00
A three-paper Series on preconception health in this week's issue draws special attention to an underappreciated period in the lifecycle with far-reaching consequences across the lifecourse. The Series highlights the importance of good health and nutrition of both women and men before conception, not only for the ability to conceive, pregnancy outcomes, and maternal and child health immediately after birth but also for the long-term health of the next generation and beyond. While it is now widely accepted that alcohol, smoking, certain medications, caffeine, and poor nutritional status during pregnancy have adverse outcomes, the effect of malnutrition in all its forms—overweight and obesity, undernutrition, and nutrient deficiency—before conception is less well understood.

[Editorial] Progress in the USA for autistic spectrum disorder

Sa, 05/05/2018 - 00:00
The prevalence of autistic spectrum disorder is increasing in the USA, the latest figures from the Centers for Disease Control and Prevention suggest. According to the Autism and Developmental Disabilities Monitoring Network (ADDM), the prevalence of autistic spectrum disorder in children was 16·8 per 1000 in 2014—an absolute increase of 2·2% since 2012 and more than double the prevalence in 2000 when monitoring by the ADDM began.

[Editorial] Austerity in Spain: time to loosen the grip

Sa, 05/05/2018 - 00:00
Calculating the health impact of a financial crisis and subsequent austerity measures is an inexact science. A new UN report, published on April 25, 2018, illuminates the repercussions on health care of the 2008 monetary crisis, state retrenchment, and the implementation of a royal decree in Spain, echoing findings of an earlier European Commission 2017 Country Health Profile. The consequences and patient perceptions of Spain's emergency rescue package in the wake of the financial crash were also analysed in an Amnesty International document, published April 24, 2018.

[Comment] Who is responsible for the vaccination of migrants in Europe?

Sa, 05/05/2018 - 00:00
A report from WHO exploring the provision of immunisation services to migrants and refugees in the WHO European Region1 provides a stark reminder that European health services are a long way off adapting to the rapid demographic shift that the region has witnessed in the past two decades, amid unprecedented rises in internal and external migration. Migrants are more likely to be under-immunised—putting them at increased risk of vaccine-preventable diseases circulating in Europe—and may face greater disease, disability, and deaths from vaccine-preventable diseases than the host population.

[Comment] The gendered system of academic publishing

Sa, 05/05/2018 - 00:00
Gender is a sociocultural and economic concept and an institutionalised system of social practices that translates into different experiences and uneven advantages for men and women at the individual, organisational, and societal levels.1 This system manifests as the persistent gender pay gap, endemic sexual harassment,2 and the proverbial glass ceiling limiting women's representation and advancement in social and economic life. Academia, including academic publishing, is not immune to this gendered system of social practices.

[Comment] Offline: A Caribbean consciousness

Sa, 05/05/2018 - 00:00
The word Windrush now defines the shame of a nation, a nation that once courted, welcomed, and put to work Caribbean migrants to fill shortages in Britain's labour market after World War 2. The cold expediency of modern British politics, the racist nationalism of today's England, and the angry isolationism of Brexiteers have combined to foster a bitterly hostile environment for anyone with a skin colour or accent deemed outside populist boundaries of acceptability. The British colonialist state expropriated riches from those it occupied to build an inglorious Empire.

[World Report] El Salvador's total ban on abortion risks women's health

Sa, 05/05/2018 - 00:00
The total and enforceable ban on abortion creates a climate of fear among medical professionals and threatens women's health. Amanda Sperber reports from San Salvador.

[World Report] Managing MDR tuberculosis in Nepal

Sa, 05/05/2018 - 00:00
The burden of multidrug and extensively drug resistant tuberculosis might be underevaluated among Nepalis, threatening bordering countries. Sophie Cousins reports from Kathmandu.

[World Report] Pimavanserin evaluated by the FDA

Sa, 05/05/2018 - 00:00
The US Food and Drug Administration is conducting an evaluation of available evidence about pimavanserin. Paul Webster reports.

[Perspectives] Plastic perfection

Sa, 05/05/2018 - 00:00
At a time of increasing dissatisfaction with the natural body, people are ever more likely to call for the sculptor with the scalpel. Two-thirds of young people and adults in the UK are unhappy about how they look, and cosmetic surgery is big business. British artist Jonathan Yeo's new exhibition shows his long-held interest in ideas of bodily perfection and their shaping by new technologies. Self-taught as a portraitist while recovering from Hodgkin's lymphoma as a young man, Yeo achieved fame with paintings of celebrities such as Damien Hirst, Nicole Kidman, and Dennis Hopper.

[Perspectives] Illuminating the body

Sa, 05/05/2018 - 00:00
This instalment of the Scottish National Gallery of Modern Art's NOW series brings together the work of artists who explore ideas related to the human body, performance, process, and materials. The highlight of the show is a selection of works by Jenny Saville.

[Perspectives] Roger Glass: celebrating the Fogarty at 50

Sa, 05/05/2018 - 00:00
At the Fogarty International Center, “we're small, but we're catalytic”, says Roger Glass, the centre's Director and Associate Director for International Research at the US National Institutes of Health (NIH). The Fogarty celebrates its 50th anniversary this month and has been under Glass's leadership since 2006. By training scientists, supporting research, and building partnerships, the Fogarty serves a bridge between the NIH and the global health community. Since its creation in 1968, about 6000 scientists have received research training through its programmes and the centre funds about 500 projects.

[Perspectives] Moral injury in time of war

Sa, 05/05/2018 - 00:00
The word injury derives from the Latin injuria meaning a wrong. Applied to both physical and psychological wounds, it is now used as a label for the impact that a moral and ethical dilemma might have on an individual's wellbeing. Although the term moral injury is relatively recent, examples can readily be found in the aftermath of past conflicts. As the 100th anniversary of the end of World War 1 approaches, it is opportune to explore how its survivors attempted to come to terms with so much death—doctors at war like Arthur Osburn.

[Obituary] David Albert Cooper

Sa, 05/05/2018 - 00:00
HIV researcher and global champion of patients' rights. Born in Sydney, NSW, Australia, on April 19, 1949, he died there with a haemophagocytic syndrome on March 18, 2018, aged 68 years.

[Correspondence] Lassa fever in Nigeria: the tale of a reactive health system

Sa, 05/05/2018 - 00:00
The World Report by Talha Burki (Feb 24, p 728)1 described an unprecedented astronomical rise in Lassa fever cases in Nigeria, for which the first case was reported in 1969 and the epidemiology and endemicity are well understood. Failure of the Nigerian health system to prioritise preparedness activities has been detrimental for prompt control of Lassa fever, which requires robust laboratory facilities, trained health personnel, and coordinated epidemiological surveillance.2 Therefore, we propose a four-pronged plan to ensure consistent and proactive preventive activities that could ameliorate the high proportion of fatalities and long-term debilitation observed in outbreaks of Lassa fever.

[Correspondence] Dengue vaccination: a more ethical approach is needed

Sa, 05/05/2018 - 00:00
Since 2016, we have discussed the risks behind the recommendation and use in mass vaccination programmes of Dengvaxia—a dengue vaccine produced by Sanofi Pasteur (Lyon, France)—without immunological pretesting.1,2 By using differential equation models and statistical methods, my colleagues and I reassessed publicly available data from vaccine trials, and found a substantial reduction in the number of hospital admissions when Dengvaxia was given only to seropositive individuals (ie, those with a history of a previous infection from dengue virus), and a substantial increase in the number of hospital admissions over 5 years when administered without a previous population screening.