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[Correspondence] Questions regarding the CONCERN trial – Authors' reply

Sáb, 13/01/2018 - 00:00
We thank Ricky Turgeon for his Correspondence regarding our CONCERN trial1 on the gastrointestinal safety of celecoxib plus esomeprazole versus naproxen and esomeprazole in patients with cardiothrombotic diseases and arthritis after upper gastrointestinal bleeding.

[Correspondence] Translation of the link between cancer and obesity to patients

Sáb, 13/01/2018 - 00:00
The report summarised in The Lancet (Oct 14, 2017, p 1716)1 reinforces findings from previous studies that have noted an association between increased body-mass index and some malignancies.2,3 Obesity is a major public health concern and the way in which the link is communicated to patients is paramount to solving this problem. Patients should be made aware that only an association has been observed—ie, increased body-mass index raises the likelihood of the development of some cancers. Several theories have been proposed to explain this link, implying that adipose tissue directly affects malignancy growth.

[Correspondence] GRECCAR2 trial: details worthy of more attention

Sáb, 13/01/2018 - 00:00
We read with great interest the GRECCAR 2 trial by Eric Rullier and colleagues (July 29, 2017, p 469),1 which reported that local excision showed no superiority over total mesorectal excision in rectal cancer patients with a good response after chemoradiotherapy. However, some aspects of the study warrant closer attention.

[Correspondence] GRECCAR2 trial: details worthy of more attention – Authors' reply

Sáb, 13/01/2018 - 00:00
We thank Ji Zhu and colleagues, who made very appropriate and constructive comments on the French GRECCAR 2 trial.1

[Correspondence] Pitfalls of the healthy vaccinee effect

Sáb, 13/01/2018 - 00:00
We read with interest the Article by Helen Petousis-Harris and colleagues (Sept 30, 2017, p 1603),1 which showed that the vaccine against outer membrane vesicle meningococcal B was 31% effective in reducing gonorrhoea among attendees of 11 clinics in New Zealand for patients with sexually transmitted infections. We disagree, however, with the authors' claims that their “findings provide experimental evidence that these vaccines could offer moderate cross-protection against [gonorrhoea]”.

[Correspondence] Pitfalls of the healthy vaccinee effect – Authors' reply

Sáb, 13/01/2018 - 00:00
In our Article,1 we presented findings from a case-control study that showed a protective effect of a meningococcal vaccine against gonorrhoea infection. In their Correspondence, Salaheddin Mahmud and Christiaan Righolt argue that the correct method to determine vaccine efficacy is a randomised controlled trial (RCT) and that our use of chlamydia as a control is problematic. We would like to clarify the points raised in their letter.

[Editorial] The NHS at 70 and Alma-Ata at 40

Sáb, 06/01/2018 - 00:00
2018 welcomes two important anniversaries for health. In the UK, the National Health Service (NHS) will be 70 years old in July, and the global health community will mark the 40th anniversary of the Alma-Ata Declaration at a conference on Oct 25–26 in Almaty, Kazakhstan. Common to both anniversaries will be recognition of universal health coverage (UHC) as a goal, and the place of primary health care in achieving that goal.

[Editorial] Vision quest: gene therapy for inherited vision loss

Sáb, 06/01/2018 - 00:00
Biomedical research and clinical trials are fundamentally high-stakes endeavours, the results of which are often portrayed in hyperbolic categories. Failed phase 3 trials are called epic disappointments, while successful treatments become game changers or magic bullets. Better still, they receive US Food and Drug Administration (FDA) approval.

[Editorial] Tuberculosis: criteria for global leadership?

Sáb, 06/01/2018 - 00:00
Tereza Kasaeva is to be the new Director of WHO's Global Tuberculosis (TB) Programme. She joins WHO from Russia's Ministry of Health. But instead of a warm welcome, she will arrive in Geneva amid potentially disabling controversy.

[Comment] Renewing the focus on health care for sexually assaulted children and adolescents

Sáb, 06/01/2018 - 00:00
Sexual assault and rape are in the media spotlight in the face of unfolding revelations of abuse of women in the entertainment industry and sports. These disclosures by public figures highlight some aspects of sexual abuse—namely, that it is often pervasive, an expression of power (rather than just about sex) and rooted in ideas of male sexual entitlement, and an experience that victims find shameful and often conceal.1,2 Far from the lights of Hollywood, many children and adolescents in low-income and middle-income countries (LMICs) face sexual abuse and often have little recourse to assistance.

[Comment] The polio endgame: securing a world free of all polioviruses

Sáb, 06/01/2018 - 00:00
The global effort to eradicate poliomyelitis has reduced the incidence of cases caused by wild poliovirus by more than 99% since its launch in 1988, from 350?000 annual cases in 125 endemic countries to 20 cases in two countries in 2017.1 More than 16 million people who would otherwise have been paralysed by poliovirus infection are today walking, and 80%2 of the world's population lives in regions certified as polio free by WHO. Wild poliovirus now circulates in only a few areas and remains endemic in Nigeria, Pakistan, and Afghanistan.

[Comment] Offline: From 1918 to 2018—the lessons of influenza

Sáb, 06/01/2018 - 00:00
Estimates of mortality during the 1918–20 influenza pandemic range from 20 million to 100 million deaths. Mortality between countries varied enormously. A large part of this variation was related to wealth. Resource-poor countries, with weak health systems, pervasive undernutrition, and widespread poverty, had higher death rates. When 1918 mortality rates are modelled for the modern era, an epidemic of influenza with similar virulence and pathogenicity would cause around 62 million deaths, with younger age groups especially vulnerable.

[World Report] Syria: 7 years into a civil war

Sáb, 06/01/2018 - 00:00
Years of conflict have killed thousands, but the toll of war on Syria's health systems extends the cost of war beyond the front lines as de-escalation efforts seem to be faltering. Sharmila Devi reports.

[World Report] Zimbabwe post-Mugabe era: reconstructing a health system

Sáb, 06/01/2018 - 00:00
A once-functioning health system was weakened by Robert Mugabe's antagonistic policies. Some hope the Mnangagwa administration will bring renewal. Andrew Green reports.

[Perspectives] Using comics to change lives

Sáb, 06/01/2018 - 00:00
Comics are a popular source of entertainment, activism, education, and subversion. Within health care the use of comics has been steadily growing for the past 50 years, with comics used to reach all age groups but particularly younger readers. I recall in the early 1980s sending a coupon I had clipped from a comic off to the Health Education Council for a smoking prevention information pack. This followed my reading about the evil Nick O Tine—overpowered by Superman (who never said yes to a cigarette) in a powerful anti-smoking story created by DC Comics.

[Perspectives] In search of a teacher

Sáb, 06/01/2018 - 00:00
“Written and Illustrated by…” These words were written on a blackboard in September, 1971, in crisp, authoritative chalk. We first graders at Colton Elementary School sat in awe as a young, energetic teacher took the stage in our lives. Ms Zive (and she was the first person we knew who ever used the term Ms) beguiled us with a dazzling smile, a secret store of Bugle corn snacks, plus the tantalising promise to let us in on the magic that adults possessed: reading.

[Obituary] Geoffrey Christopher Schild

Sáb, 06/01/2018 - 00:00
Influenza virologist. He was born in Sheffield, UK, on Nov 28, 1935, and died in Bergen, Norway, on Aug 3, 2017, aged 81 years.

[Correspondence] Another perspective on the Foundation for a Smoke-Free World

Sáb, 06/01/2018 - 00:00
Much has, and is, being said about the Foundation for a Smoke-Free World,1 an independent foundation funded by Philip Morris International, but one elemental point has been overlooked. A principal focus of the foundation, as stated on its website, is on treatment of addicted smokers to decrease mortality, including promoting the switch to reduced-risk products, such as e-cigarettes. Geoffrey Rose, in his masterful monograph The Strategy of Preventive Medicine, pointed to the so-called risk paradox, giving the example “whereby it was seen that many people exposed to a small risk may generate more disease than a few exposed to a conspicuous risk.

[Correspondence] WHO washes its hands of older people

Sáb, 06/01/2018 - 00:00
Older people (?60 years) constitute more than 12% of the world's population, which will rise to 16·5% by 2030.1 This age group will represent 10% of the population in less developed regions by 2030. Although older people account for a greater proportion of the global burden of disease and health-care needs than younger people, their positive societal contribution should not be overlooked. This age group often provide unpaid care for children or grandchildren, or other adults with disabilities. Improved health of older people is an essential goal to reduce health-care costs and maintain the societal support older people provide.

[Correspondence] Reducing childhood obesity in the UK

Sáb, 06/01/2018 - 00:00
The Lancet's Editorial (Aug 26, 2017, p 882)1 is right about childhood obesity remaining an urgent public health challenge. Unfortunately, there is a certain naivety to The Lancet's view of Public Health England's (PHE) role in policy development.

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