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[Correspondence] Clinical disease activity in the CALM study

Sáb, 14/04/2018 - 00:00
Jean-Frederic Colombel and colleagues' CALM study (Dec 23, 2017, p 2779),1 which investigated the effect of tight control management on Crohn's disease, reported significantly better outcomes with tight control than with clinical medical management. Tight control consisted of prespecified therapy escalation if a patient's Crohn's disease activity index (CDAI) was at least 150, or if they had elevated C-reactive protein or calprotectin, and resulted in significantly better mucosal healing (and clinical remission) than did therapy escalation based on clinical symptoms alone.

[Correspondence] Clinical disease activity in the CALM study – Authors' reply

Sáb, 14/04/2018 - 00:00
The Correspondence from Hans Herfarth and colleagues raised clinically relevant questions about our study1 of patients with Crohn's disease, whose treatment was adjusted based on stringent criteria for clinical symptoms and biomarkers (tight control) or less stringent clinical criteria alone.

[Articles] Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599?912 current drinkers in 83 prospective studies

Sáb, 14/04/2018 - 00:00
In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.

[Comment] Public Health Science Conference: a call for abstracts

Mar, 10/04/2018 - 00:30
We are delighted to invite abstract submissions for Public Health Science: A National Conference Dedicated to New Research in UK Public Health, to be held in Belfast, UK, on Nov 23, 2018. This is our seventh annual conference to showcase the creativity of the public health research community in the UK and Ireland. The conference provides a forum for academics, practitioners, and policy makers to discuss important public health issues, and learn about the latest public health science and its role in advancing and supporting public health practice, policy, and health services.

[Editorial] The collapse of the Venezuelan health system

Sáb, 07/04/2018 - 00:00
When Hugo Chavez became Venezuela's new president in 1998, he promised to provide free health care to all and enshrined this right within Venezuela's new constitution, rewritten in 1999. Progress was rapid and initial results were promising: according to the World Bank, life expectancy at birth rose from 71·8 to 74·1 years for both genders and infant mortality fell from 26·7 to 14·6 deaths per 1000 live births between 1998 and 2013, the period of Chavez's rule. Success was recognised on the international stage and Venezuela achieved most of the UN's Millennium Development Goals set for 2010.

[Editorial] Privatising versus prioritising veterans' health

Sáb, 07/04/2018 - 00:00
On March 28, President Donald Trump relayed on Twitter that Ronny L Jackson, personal physician to the president and a rear admiral in the US Navy, but with no prior experience in administration, would replace Veterans Affairs (VA) Secretary David Shulkin. The announcement was met with shock and dismay as Shulkin, who had been at the VA since 2015 and who was the sole holdover from the Obama years, was well regarded by Republicans and Democrats alike. Trump himself had even referred to Shulkin as “our David”, an unusual term of endearment for anyone from the previous administration.

[Editorial] Health-care system transition in China

Sáb, 07/04/2018 - 00:00
On March 27, the National Health Commission replaced China's National Health and Family Planning Commission (NHFPC) as the ministry responsible for health. The new commission is now headed by Ma Xiaowei, who was the former deputy head of the dismantled NHFPC. Chinese media have described Xiaowei as the person who understands China's health and hospital situation best, owing to his strong background in medicine. Since his graduation from the medical treatment department of China Medical University in 1982, Xiaowei has served many key roles in various health sectors such as the president of the First Affiliated Hospital of China Medical University and director of Liaoning Provincial Health Department.

[Comment] Clinical Pictures in The Lancet: a good eye for detail

Sáb, 07/04/2018 - 00:00
A key part of medical training is developing the ability to recognise physical signs of illness in a patient and associate them with the causative pathology. The acquisition of this skill, through training and experience, marks the transition of student to clinician. In recent years, the required repertoire has changed, expanding to include recognition of pathological and radiological signs. But the passing of this diagnostic expertise from one generation to the next remains remarkably unchanged across the globe.

[Comment] Measuring Humanity: hip-hop as evidence for health inequalities

Sáb, 07/04/2018 - 00:00
Dear Human (video), a hip-hop video was developed as part of the project Measuring Humanity.1 Working with marginalised groups, the participant-led research programme uses bottom-up creative community engagement to challenge policy makers and academics to reassess what counts as evidence when developing policies, practices, and recommendations. The video features rapping written using co-produced data from marginalised community members, health and voluntary sector practitioners, and researchers.

[Comment] Offline: UHC—one promise and two misunderstandings

Sáb, 07/04/2018 - 00:00
On April 7, 2018, World Health Day, WHO launches a new campaign—Universal Health Coverage: Everyone, Everywhere. This is a noble cause. As the agency notes: half the world's population is unable to access essential health services; 100 million people are pushed into extreme poverty each year because of out-of-pocket expenditures on health; and catastrophic spending on illness and disease is a truly global problem. Therefore, “our next historic achievement is right in front of us: health for all humankind…Together, we can make universal health coverage happen in our lifetime.” The campaign will run throughout 2018.

[World Report] Violence rife in Mexico, affecting medical community

Sáb, 07/04/2018 - 00:00
The medical community is caught in the middle of omnipresent violence in Mexico, where homicide rates reached record levels in 2017. David Agren reports from Villahermosa.

[World Report] Progress in influenza surveillance in Africa

Sáb, 07/04/2018 - 00:00
Influenza could be an overlooked cause of death in Africa. Although rapid progress has been made, there is still limited surveillance capacity to assess the risk of epidemic. Andrew Green reports.

[Perspectives] A neurologist's detective stories

Sáb, 07/04/2018 - 00:00
Western medicine is organised into silos. Faced with a patient requiring specialist advice, a general practitioner or emergency doctor has to make a call about where to direct them. Sometimes, the right clinical destination is obvious: a compound thigh fracture will always need an orthopaedic surgeon. But many patients fall foul of this rigid system. An individual complaining of dizziness might get bounced from ENT, to cardiology, to neurology, to psychiatry before achieving a diagnosis.

[Perspectives] Getting back in touch

Sáb, 07/04/2018 - 00:00
Clinicians and patients are getting out of touch with one another. When I was a medical student, I spent hours with patients, examining them on the ward, taking blood, and assisting at operations. At first I felt clumsy, inept, and embarrassed at the prospect of physical contact, for touch is surrounded by social conventions and taboos that are difficult to break through. But gradually, through practice, I became more confident. Touching people stopped feeling strange. Ostensibly, the purpose of these examinations was to gather diagnostic information that I would relay to senior clinicians.

[Perspectives] WHOse health agenda? 70 years of struggle over WHO's mandate

Sáb, 07/04/2018 - 00:00
Like any milestone, WHO's 70th anniversary offers an opportunity to reflect on its past trajectory and chart the challenges ahead. WHO's promising mandate for health cooperation, forged amid a short-lived post-war optimism, mapped out a world of possibilities. Yet its realisation has been limited across distinct eras by complex geopolitical, economic, and institutional pressures, ranging from the Cold War rivalry between US and Soviet blocs to contemporary assaults on WHO's independence by powerful private actors.

[Obituary] John Sulston

Sáb, 07/04/2018 - 00:00
Nobel Prize winner for work on Caenorhabditis elegans and a leader in human genome research. Born in Fulmer, UK, on March 27, 1942, he died on March 6, 2018, from complications of stomach cancer, aged 75 years.

[Correspondence] Polio transition: overlooked challenges

Sáb, 07/04/2018 - 00:00
The reduction in the number of poliomyelitis cases by more than 99% is an extraordinary success of the global community. In their Comment, Michel Zaffran and colleagues (Jan 6, p 11)1 assume that eradication will be achieved soon and focus on strategies to ensure that poliovirus will not be reintroduced into a polio-free world.2

[Correspondence] On the misuses of medical history

Sáb, 07/04/2018 - 00:00
A surprising amount of bad history passes peer review in the sciences and medicine. What do we mean by bad history? One example would be the misuse of historical images. Many images of so-called plague used in scientific publications depict patients suffering from leprosy.1 Another example is when commonly repeated claims about historical people or events are lifted from earlier scientific or medical writings, without checking whether professional historical scholarship has revised earlier interpretations.

[Correspondence] C1 esterase inhibitor concentrates and attenuated androgens

Sáb, 07/04/2018 - 00:00
Marc A Riedl and colleagues (July 25, 2017, p 1595)1 conducted a phase 2, multicentre, randomised, double-blind, placebo-controlled crossover trial in 32 patients to test the prophylactic efficacy of recombinant human C1 esterase inhibitor for hereditary angio-oedema. Once or twice weekly administration of recombinant human C1 esterase inhibitor (50 IU/kg) reached the primary endpoint (reduced number of attacks) in an intention-to-treat analysis.

[Correspondence] C1 esterase inhibitor concentrates and attenuated androgens – Authors' reply

Sáb, 07/04/2018 - 00:00
We thank Yannick D Muller and colleagues for their interest in our Article1 describing results from a randomised, double-blind, placebo-controlled study with the use of recombinant human C1 esterase inhibitor for prophylaxis of hereditary angio-oedema.

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