Novedades Bibliográficas

Rethinking, reflecting, and reconnecting to medicine

British Medical Journal - Mar, 22/01/2019 - 22:06
The editorial by Marshall and colleagues immediately resonated with me, as I am sure it has with many other medical colleagues.1 We must realise the interconnectedness of things. A public health...

Mother nature: how a hospital garden is nourishing pregnant women in Zimbabwe

British Medical Journal - Mar, 22/01/2019 - 19:35
bmj;364/jan22_15/l301/FAF1faJordi Matas/British Red CrossThe mother to be Nation Mugwadi (in brown dress) examines the vegetables that continue to grow despite the blazing Zimbabwean sunshine. It’s...

People with mental illness are most at risk of losing benefits, study shows

British Medical Journal - Mar, 22/01/2019 - 17:10
People who are mentally ill are more than twice as likely to lose their existing benefits than claimants with a physical condition, a study has shown.1Researchers from the University of York analysed...

Royal college is urged to drop infant formula sponsorship

British Medical Journal - Mar, 22/01/2019 - 17:06
The Royal College of Paediatrics and Child Health has been urged to drop all sponsorship by infant formula manufacturers from its upcoming Middle East and North Africa conference, after an outcry...

Sixty seconds on . . . medical detection dogs

British Medical Journal - Mar, 22/01/2019 - 11:20
What’s this? Canine assisted therapy?In a manner of speaking. As well as being man’s best friend and more than just a Christmas present, there is a growing body of evidence that a dog can be pretty...

Measles Cases Rise Around the Globe

JAMA - Mar, 22/01/2019 - 01:00
Although measles vaccination has saved more than 21 million lives since 2000, reported measles cases increased worldwide by 31% from 2016 to 2017 in large part because of falling vaccination coverage, according to a recent report on the progress of global measles control from 2000 to 2017.

Tracking Progress on Mitigating Health Effects of Climate Change

JAMA - Mar, 22/01/2019 - 01:00
The health effects of climate change aren’t looming off on the horizon; they’re already here. In an international report that describes the impact, researchers called upon health professionals to help the public and policy makers understand the link between climate and human health.

First Oral Sleeping Sickness Drug Is Approved

JAMA - Mar, 22/01/2019 - 01:00
Fexinidazole, the first oral treatment for human African trypanosomiasis—more commonly known as sleeping sickness—has been approved by the European Medicines Agency’s Committee for Medicinal Products for Human Use.


JAMA - Mar, 22/01/2019 - 01:00

Breast Cancer Treatment in 2019

JAMA - Mar, 22/01/2019 - 01:00
This narrative review summarizes current evidence-based approaches to local and systemic treatment of hormone receptor positive/ERBB2 negative (HR+/ERBB2?), ERBB2 positive (ERBB2+), and triple-negative breast cancer.

The Persistence of Metaphor

JAMA - Mar, 22/01/2019 - 01:00

Breast Cancer Treatment

JAMA - Mar, 22/01/2019 - 01:00
This JAMA Patient Page describes the diagnosis and treatment of different types and stages of breast cancer.

Effect of a Low Free Sugar Diet vs Usual Diet on Nonalcoholic Fatty Liver Disease in Adolescent Boys

JAMA - Mar, 22/01/2019 - 01:00
In this randomized clinical trial, a diet low in free sugars reduced hepatic steatosis and liver enzyme levels in Hispanic adolescent boys with nonalcoholic fatty liver disease compared with their usual diet combined with a weekly food stipend.

Association of Aspirin Use for Primary Prevention of CVD With Cardiovascular Events and Bleeding

JAMA - Mar, 22/01/2019 - 01:00
This meta-analysis estimates the association between use of aspirin for primary prevention of cardiovascular disease and the rate of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, and bleeding.

Association Between Matched Sibling HSCT and Transcranial Doppler Velocities in Children With SCA

JAMA - Mar, 22/01/2019 - 01:00
This nonrandomized controlled intervention study compared the effect of matched sibling donor hematopoietic stem cell transplantation (HSCT) vs standard care comprising transfusions and hydroxyurea on transcranial Doppler velocities, a measure of cerebral vasculopathy, at 1 year in children with sickle cell anemia requiring chronic transfusion.

Reforming Nutritional Epidemiologic Research—Reply

JAMA - Mar, 22/01/2019 - 01:00
In Reply The calculation of 12 years of life gained with the consumption of 12 hazelnuts daily (and similar calculations with other foods) was an argumentum ad absurdum. The estimation combined several prevalent assumptions and common practices to demonstrate how absurd inferences can arise. These assumptions are that nutritional epidemiology–derived hazard ratios estimate causal effects; and these causal estimates can be extrapolated across the life span. These assumptions may be false, but nevertheless they are held by several scientists and widely disseminated by media. Moreover, a common practice in multiple fields is to report almost exclusively RRs without providing absolute risks. Almost all nutritional epidemiology studies, and even the best meta-analyses such as the one done by Schwingshackl et al, report RRs, not the far more informative absolute risks. It is not uncommon to read in scientific articles (and in the media) that some factor reduced all-cause mortality by 15% or improved survival by 15%. A naive calculation by a nonexpert, based on a baseline life expectancy of 80 years, might produce an estimate of (80 × 15%) 12 years of life gained. False assumptions combined with poor reporting and misleading dissemination propagate absurdity.

Cell-Free DNA Screening During Pregnancy—Reply

JAMA - Mar, 22/01/2019 - 01:00
In Reply In response to our JAMA Insights article on noninvasive prenatal genetic screening, Drs Cohen and Westover advocate for universal public and private reimbursement for cfDNA tests, arguing that it will reduce disparities in access to prenatal screening. Approximately 40% of US pregnancies are supported by Medicaid. This population is, by definition, confined to the lowest end of the income scale and to women who cannot access other forms of health care coverage. These women are predominantly younger and less likely to present for care during the first trimester, which is why many Medicaid programs may not consider a more expensive aneuploidy screen to be a priority. The most prominent conditions adversely affecting pregnancies in this population are preeclampsia, risk of preterm birth, and preventable maternal-fetal morbidities due to complications, possibly linked to the rate of untreated chronic disease such as obesity and diabetes. None of these are detectable by commercial cfDNA panels but are significantly more likely to be detected and treated when women have consistent prenatal care. In declining immediate expanded reimbursement for cfDNA, many Medicaid programs are simply making rational decisions about scarce resources and the real needs of their patients.

Reforming Nutritional Epidemiologic Research

JAMA - Mar, 22/01/2019 - 01:00
To the Editor The Viewpoint by Dr Ioannidis discussed the need for reform of nutritional epidemiologic research. We were surprised by the “nonexpert” calculations of gain or loss in life expectancy using data from our meta-analysis. We presented the findings in our meta-analysis as relative risks (RRs). Ioannidis calculated from those RRs the number of years of life gained or lost by consumption of a number of foods. Such calculations are not in line with statistical methodology and should not be used in a scientific debate about diet-disease associations and potential implications. An RR of 2 does not mean a shorter life expectancy of 40 years or an RR of 4 a shorter life expectancy of 60 years. An RR of 0.5 does not generate a life expectancy of 120 years or an RR of 0.85 a life expectancy of 92 years, a 12-year increase in life expectancy for 1 serving of nuts daily as calculated by Ioannidis. In the article, more misleading calculations of this type were done using other examples from our publication, but we would like to point out that heavy smoking, with an RR of 2.38 to 2.66, would result in a life expectancy of only about 35 years (assuming a life expectancy of 80 years), or a loss of life-years of 45 years according to the calculations of Ioannidis.

Cell-Free DNA Screening During Pregnancy

JAMA - Mar, 22/01/2019 - 01:00
To the Editor In the JAMA Insights Clinical Update on noninvasive prenatal screening using cfDNA, the authors discussed test failures that occur when the fraction of fetal DNA is too low, leading to a diagnostic test. The cited fetal fraction threshold of 4% is historical and modeled and follows empirical reasoning. However, a standard method for its calculation has not been set, and higher levels of detection for common aneuploidies at fetal fractions between 2% and 4% can be obtained using proprietary algorithms.

Cell-Free DNA Screening During Pregnancy

JAMA - Mar, 22/01/2019 - 01:00
To the Editor Drs Allyse and Wick reviewed noninvasive prenatal genetic screening using cell-free DNA (cfDNA). We have concerns about some of their statements about the use of cfDNA screening and are disappointed that disparities in access were not discussed in greater detail.
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