[Correspondence] Teriparatide vs risedronate for osteoporosis – Authors' reply
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. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: David L Kendler, Piet Geusens, Cristiano A F Zerbini, Salvatore Minisola, Fernando Marin Tags: Correspondence Source Type: research

[Correspondence] Teriparatide vs risedronate for osteoporosis
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. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Yair Liel Tags: Correspondence Source Type: research

[Correspondence] Drawing conclusions from the VIVA trial – Authors' reply
In their letter, Karsten Juhl J ørgensen 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. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Jes S Lindholt, Rikke S øgaard Tags: Correspondence Source Type: research

[Correspondence] Drawing conclusions from the VIVA trial
The VIVA trial by Jes Lindholt and Rikke S øgaard (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”. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Karsten Juhl J ørgensen, Minna Johansson Tags: Correspondence Source Type: research

[Correspondence] Time to eradicate HTLV-1: an open letter to WHO
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. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Fabiola Martin, Yutaka Tagaya, Robert Gallo Tags: Correspondence Source Type: research

[Obituary] Robert Johns Haggerty
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. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] Not much to say really
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. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Kelvin Corcoran Tags: Perspectives Source Type: research

[Perspectives] The pressures of medical practice
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 o...
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Margaret McCartney Tags: Perspectives Source Type: research

[World Report] Concern over reported number of measles cases in Yemen
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. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Xun Yuan Tags: World Report Source Type: research

[World Report] Cochrane postpones comprehensive free access to reviews
Cochrane postpones implementation of the target to make all Cochrane Reviews open access immediately upon publication. Talha Burki reports. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Talha Burki Tags: World Report Source Type: research

[World Report] EMRO Regional Director to be elected to head office
The election of the Regional Director of the WHO Eastern Mediterranean Regional Office is due to take place on May 19. John Zarocostas reports. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: John Zarocostas Tags: World Report Source Type: research

[Comment] Offline: John E Fogarty and the defeat of Donald J Trump
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 Hea lth (NIH), underlined the importance of Fogarty to the US scientific enterprise. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] Emergency deployment of oral cholera vaccine for the Rohingya in Bangladesh
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. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: Firdausi Qadri, Abul Kalam Azad, Meerjady Sabrina Flora, Ashraful Islam Khan, Md Taufiqul Islam, G Balakrish Nair, Poonam Khetrapal Singh, John D Clemens Tags: Comment Source Type: research

[Editorial] Vitamin A distribution in danger
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. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Cancer drugs in China: affordability and creativity
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 wi th the least affordable prices in the world. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Turning climate change legislation into public health policy
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. (Source: LANCET)
Source: LANCET - May 11, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Department of Error] Department of Error
Global Burden of Disease Health Financing Collaborator Network. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016 –40. Lancet 2018; 391: 1783–98—In table 2 of this Article, a digit was mistakenly omitted from after the decimal point in the value for universal health coverage index in high-income countries in 2030 under the worse scenario. This correction has been made to the online version as of May 3, 20 18, and the printed version is correct. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Department of Error] Department of Error
Stephenson J, Heslehurst N, Hall J, et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet 2018; 391: 1830 –41—In figure 1 of this Series paper (published online first on April 16, 2018), definitions for the use of * and † symbols were added to the legend. This correction has been made to the online version as of May 3, 2018, and the printed Series paper is correct. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Determining the worldwide prevalence of obesity – Authors' reply
Although different measures of adiposity might differentially classify people as overweight or obese, studies that have compared body-mass index (BMI) with other measures of adiposity have found that, at higher BMIs (eg, 30 kg/m2 and above), classification using BMI gives similar results to other approaches, such as dual-energy x-ray absorptiometry.1 More broadly, in selecting risk factor metrics for population health reporting, two other issues should be kept in mind. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Majid Ezzati, Mariachiara Di Cesare, James Bentham Tags: Correspondence Source Type: research

[Correspondence] Determining the worldwide prevalence of obesity
The NCD Risk Factor Collaboration study (Dec 16, 2017, p 2627)1 is a landmark description of the progress of the obesity pandemic, but substantially underestimates the scale of the problem. The study1 defined obesity using body-mass index (BMI) in adults and BMI-for-age in children and adolescents. Systematic reviews2 –4 of a large amount of high-quality and consistent evidence show that the use of BMI to define obesity (the degree of excess body fat) is highly specific, but has low to moderate sensitivity. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: John J Reilly, Asmaa El-Hamdouchi, Adama Diouf, Andries Monyeki, Serge A Somda Tags: Correspondence Source Type: research

[Correspondence] Late effects of childhood cancer – Authors' reply
We thank Amanda Friend and colleagues for their comments. Although our Article1 reflects the most extensive and comprehensive clinical characterisation of long-term morbidities had by adult survivors of childhood cancer to date, we are actively working on additional studies beyond this initial report to expand the list of clinically assessed chronic health conditions. We agree with Friend and colleagues that mental wellbeing is a fundamental component of health. As underscored in their Correspondence, our team has reported on the importance of neurocognitive and psychological outcomes among adult survivors of childhood can...
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Nickhill Bhakta, Melissa M Hudson, Yutaka Yasui, Leslie L Robison Tags: Correspondence Source Type: research

[Correspondence] Late effects of childhood cancer
Nickhill Bhakta and colleagues1 (Dec 9, 2017, p 2569) report a large case-control study (St Jude Lifetime Cohort Study) of survivors of childhood cancer from a single institution in North America.1 The study defines the prevalence of many of the late effects of cancer in children and young people. However, we were disappointed to note the omission of two key areas, mental health and female fertility, limiting the ability to describe the report as a comprehensive description of the late morbidity burden associated with survival from childhood cancer. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Amanda J Friend, Richard G Feltbower, Hannah L Newton, Helen M Picton, Adam W Glaser Tags: Correspondence Source Type: research

[Correspondence] PRIMA, non nocere: a reply from the authors
We thank John Harvin and Lillian Kao for their Comment1 on our Article.2 Harvin and Kao stated, on the basis of the results of the PRIMA trial, that we cannot conclude that there are no increased short-term risks associated with use of prophylactic mesh. The short-term results were published in Annals of Surgery in 2015,3 and it is true that we did not specifically power our study with the short-term outcomes in mind. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: An P Jairam, Lucas Timmermans, Johan F Lange, Johannes Jeekel Tags: Correspondence Source Type: research

[Correspondence] Implementing sexual and reproductive health care in humanitarian crises – Authors' reply
In response to our Series paper1 calling for more rigorous research on health interventions in humanitarian settings, we very much welcome the letter by Sarah Chynoweth and colleagues, which raises the important issue that humanitarian health actors can also fail to apply existing evidence, particularly with regard to sexual and reproductive health. In their letter, the authors note that there are proven examples of effective interventions for family planning, neonatal health, and sexual violence that the humanitarian community still fail to adequately deliver. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Bayard Roberts, Karl Blanchet Tags: Correspondence Source Type: research

[Correspondence] Implementing sexual and reproductive health care in humanitarian crises
We applaud the call made by Karl Blanchet and colleagues (Nov 18, 2017, p 2287)1 for more systematic and rigorous research on health interventions in humanitarian settings. However, we wish to highlight a key concern that the authors did not directly address in their paper: humanitarian health actors' insufficient application of existing evidence, particularly with regard to sexual and reproductive health. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Sarah K Chynoweth, Ribka Amsalu, Sara E Casey, Therese McGinn Tags: Correspondence Source Type: research

[Correspondence] Dengue vaccination: a more ethical approach is needed
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 o...
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Ma íra Aguiar Tags: Correspondence Source Type: research

[Correspondence] Lassa fever in Nigeria: the tale of a reactive health system
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 fatali...
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Victor J Animasahun, Helena J Chapman Tags: Correspondence Source Type: research

[Obituary] David Albert Cooper
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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] Moral injury in time of war
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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Edgar Jones Tags: Perspectives Source Type: research

[Perspectives] Roger Glass: celebrating the Fogarty at 50
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 scient ists, 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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Marianne Guenot Tags: Perspectives Source Type: research

[Perspectives] Illuminating the body
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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Fiona Mitchell Tags: Perspectives Source Type: research

[Perspectives] Plastic perfection
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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Charles Fernyhough Tags: Perspectives Source Type: research

[World Report] Pimavanserin evaluated by the FDA
The US Food and Drug Administration is conducting an evaluation of available evidence about pimavanserin. Paul Webster reports. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Paul Webster Tags: World Report Source Type: research

[World Report] Managing MDR tuberculosis in Nepal
The burden of multidrug and extensively drug resistant tuberculosis might be underevaluated among Nepalis, threatening bordering countries. Sophie Cousins reports from Kathmandu. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Sophie Cousins Tags: World Report Source Type: research

[World Report] El Salvador's total ban on abortion risks women's health
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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Amanda Sperber Tags: World Report Source Type: research

[Comment] Offline: A Caribbean consciousness
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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] The gendered system of academic publishing
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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Jamie Lundine, Ivy Lynn Bourgeault, Jocalyn Clark, Shirin Heidari, Dina Balabanova Tags: Comment Source Type: research

[Comment] Who is responsible for the vaccination of migrants in Europe?
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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Sally Hargreaves, Laura B Nellums, Mary Ramsay, Vanessa Saliba, Azeem Majeed, Sandra Mounier-Jack, Jon S Friedland Tags: Comment Source Type: research

[Editorial] Austerity in Spain: time to loosen the grip
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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Progress in the USA for autistic spectrum disorder
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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Campaigning for preconception health
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 outcome...
Source: LANCET - May 4, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Cardiovascular disease risk prediction equations in 400  000 primary care patients in New Zealand: a derivation and validation study
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 under...
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Romana Pylypchuk, Sue Wells, Andrew Kerr, Katrina Poppe, Tania Riddell, Matire Harwood, Dan Exeter, Suneela Mehta, Corina Grey, Billy P Wu, Patricia Metcalf, Jim Warren, Jeff Harrison, Roger Marshall, Rod Jackson Tags: Articles Source Type: research

[Comment] Contemporary cardiovascular risk prediction
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 d isease 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. (Source: LANCET)
Source: LANCET - May 4, 2018 Category: General Medicine Authors: Johanna A A G Damen, Lotty Hooft, Karel G M Moons Tags: Comment Source Type: research

[Comment] New leadership for the WHO Regional Office for the Eastern Mediterranean: exceptional election in an exceptional time
On May 19, 2018, during the 71st World Health Assembly, the 21 health ministers, or their representatives, from the Eastern Mediterranean region are due to elect a new Regional Director for the WHO Regional Office for the Eastern Mediterranean (EMRO) in a special session of its regional committee. The exceptional election follows the unexpected death of Mahmoud Fikri who was WHO EMRO Regional Director for only 8 months during 2017. WHO has accelerated the normally lengthy election process to fill the vacuum in WHO EMRO leadership. (Source: LANCET)
Source: LANCET - May 2, 2018 Category: General Medicine Authors: Samer Jabbour, Sameen Siddiqi, Rita Giacaman, Hani Serag, Jawad Al-Lawati, Amirhossein Takian, Habiba Ben Romdhane, Elsheikh Badr, Laith J Abu-Raddad, Aida Seif El-Dawla, Salwa Najjab, Driss Moussaoui, Mustafa Khogali, Yousef Khader, Bothaina Attal, Iman Tags: Comment Source Type: research

[Articles] Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis
In acutely ill adults, high-quality evidence shows that liberal oxygen therapy increases mortality without improving other patient-important outcomes. Supplemental oxygen might become unfavourable above an SpO2 range of 94 –96%. These results support the conservative administration of oxygen therapy. (Source: LANCET)
Source: LANCET - April 27, 2018 Category: General Medicine Authors: Derek K Chu, Lisa H-Y Kim, Paul J Young, Nima Zamiri, Saleh A Almenawer, Roman Jaeschke, Wojciech Szczeklik, Holger J Sch ünemann, John D Neary, Waleed Alhazzani Tags: Articles Source Type: research

[Articles] Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial
In patients with treatment-resistant depression, iTBS was non-inferior to 10 Hz rTMS for the treatment of depression. Both treatments had low numbers of dropouts and similar side-effects, safety, and tolerability profiles. By use of iTBS, the number of patients treated per day with current rTMS devices can be increased several times without compromising clinical effectiveness. (Source: LANCET)
Source: LANCET - April 27, 2018 Category: General Medicine Authors: Daniel M Blumberger, Fidel Vila-Rodriguez, Kevin E Thorpe, Kfir Feffer, Yoshihiro Noda, Peter Giacobbe, Yuliya Knyahnytska, Sidney H Kennedy, Raymond W Lam, Zafiris J Daskalakis, Jonathan Downar Tags: Articles Source Type: research

[Correspondence] Port-of-Spain Declaration for global NCD prevention
As global health researchers who work on non-communicable diseases (NCDs) and global health diplomacy, we were delighted to see the prioritisation of and emphasis on a global commitment to tackle the epidemic of NCDs in the Comment1 by Sania Nishtar (Oct 21, p 1820). Nishtar suggests excellent strategies, such as a multi stakeholder structure to serve as a holistic platform, to enable transparency and accountability to negotiate policy space for NCDs. Nishtar also highlights that none of the more than 80 disease-specific partnerships that have been created holistically address NCDs, and that this requires a multisectoral, ...
Source: LANCET - April 27, 2018 Category: General Medicine Authors: Vijay Kumar Chattu, Sateesh Sakhamuri Tags: Correspondence Source Type: research

[Correspondence] Associations of fats and carbohydrates with cardiovascular disease and mortality —PURE and simple? – Authors' reply
We concur with Jim Mann and colleagues that dietary recommendations should be informed with all available evidence, and that ideally large randomised trials on clinical outcomes should be used. In the absence of randomised trials, large, well designed observational studies on clinical outcomes provide the next best type of evidence. Our results are consistent with previous observational studies1 that showed no harm with high fat intake —even when mean fat intake was higher than in the Prospective Urban Rural Epidemiological (PURE) study. (Source: LANCET)
Source: LANCET - April 27, 2018 Category: General Medicine Authors: Mahshid Dehghan, Andrew Mente, Salim Yusuf Tags: Correspondence Source Type: research

[Correspondence] Associations of fats and carbohydrates with cardiovascular disease and mortality —PURE and simple?
The Prospective Urban Rural Epidemiological (PURE) study,1 which included 18 cohorts from low-income, middle-income, and high-income countries worldwide, reported that high carbohydrate intake was associated with an increased risk of total mortality, whereas high intake of total fat and individual types of fat were associated with reduced total mortality. These results contribute valuable evidence to the field of nutrition, but using questionnaires to infer the amount, quality, and composition of intake of fats is error prone because of the complexity of foods and the possibility of implausible questionnaire entries. (Source: LANCET)
Source: LANCET - April 27, 2018 Category: General Medicine Authors: Marcus E Kleber, Graciela E Delgado, Christine Dawczynski, Stefan Lorkowski, Winfried M ärz Tags: Correspondence Source Type: research

[Correspondence] Associations of fats and carbohydrates with cardiovascular disease and mortality —PURE and simple?
In The Lancet, Mahshid Dehghan and colleagues1 reported a positive association between carbohydrate intake and non-cardiovascular mortality, and an unexpected inverse association between non-cardiovascular mortality and saturated fat intake. The authors recommended changes in dietary guidelines on the basis of assumed causality. (Source: LANCET)
Source: LANCET - April 27, 2018 Category: General Medicine Authors: Boris Hansel, Ronan Roussel, Philippe Giral Tags: Correspondence Source Type: research