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[Editorial] Alcohol and cancer  Voir?

The Nov 7 publication of Alcohol and Cancer: a Statement of the American Society of Clinical Oncology (ASCO) emphasises the prominence of alcohol as a proven cause of many cancers. This view is not novel and comes exactly 30 years after a working group of the International Agency for Research on Cancer determined that alcoholic beverages were carcinogenic to humans. It has been echoed by other cancer societies since then but seemingly ignored by the wider medical community and by society. The influential endorsement by ASCO provides a powerful impetus to act on decades of evidence that alcohol harms health.

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[Editorial] Does mobile health matter?  Voir?

Widespread adoption of digital health applications (apps) in five patient populations (diabetes prevention, diabetes, asthma, cardiac rehabilitation, and pulmonary rehabilita-tion) could save the US health system $7 billion a year according to a report published by the IQVIA Institute for Human Data Science (formerly QuintilesIMS) on Nov 7. The report examines the impact of internet-connected mobile devices on human health and describes a doubling of health condition management mobile apps in the past 2 years.

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[Editorial] Food industry must act to safeguard the future of antibiotics  Voir?

WHO has urged farmers and the food industry to stop routine use of antibiotics in healthy animals to promote growth and prevent infectious diseases. WHO guidelines, which were released ahead of World Antibiotic Awareness Week (Nov 13–19), aim to tackle the growing threat of antimicrobial resistance to human health. Use of antibiotics promotes development of drug-resistant bacteria in food-producing animals, which can subsequently be transmitted to humans, and curbing use of antibiotics in animals can reduce the prevalence of resistant bacteria in animals and humans.

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[Comment] Effectiveness trials in asthma: time to SaLSA?  Voir?

In your next clinical consultation, you may well find yourself asking the question “What is the likelihood that this treatment will benefit this patient at this time?” Evidence-based practice answers this question with data collected under ideal conditions from a double-blind, randomised, placebo-controlled trial (RCT). However, what evidence-based practice doesn't tell us is that, when it comes to asthma and many other chronic diseases, only a minority of patients in your clinic would ever meet the eligibility criteria for these RCTs.

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[Comment] Population-based screening for vascular disease  Voir?

In The Lancet, Jes Lindholt and Rikke Søgaard1 report the Viborg Vascular (VIVA) trial in which 50 156 Danish men aged 65–74 years were randomly allocated to combined screening for abdominal aortic aneurysm, peripheral arterial disease, and systemic hypertension or to no screening. After a median follow-up of 4·4 years (IQR 3·9–4·8), screening and subsequent intervention reduced absolute risk of overall mortality by 0·006 (95% CI 0·001–0·011), with a number needed to invite (NNI) to screening to save one life of 169 (89–1811).

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[Comment] Antiangiogenesis to curb urothelial cancer  Voir?

Angiogenesis has been associated with clinicopathological factors and features of biological aggressiveness in urothelial cancer.1,2 Although several agents targeting the vascular endothelial growth factor (VEGF) pathway have been investigated in phase 1 and 2 trials in advanced urothelial cancer and as maintenance,1,3–5 the overall clinical benefit has been small, with occasional disease stabilisation seen in some patients.1,3

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[Comment] Ireland's Public Health Bill: crucial to reduce alcohol harm  Voir?

Ireland has become the fourth heaviest drinking nation in the Organisation for Economic Co-operation and Development in terms of quantity of alcohol consumed,1 and ranked joint third for binge drinking in an analysis of 194 nations by WHO.2 Irish adults consume on average 11·5 L of pure alcohol per person every year, an increase of more than 100% compared with 60 years ago.3 Most alcohol in Ireland is now consumed at home and alcohol retailing off licences have increased by five-fold since 1990.

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[Comment] Improving evidence for health in humanitarian crises  Voir?

Afghanistan, Central African Republic, DR Congo, Iraq, Libya, Nigeria, Somalia, South Sudan, Syria, and Yemen— ten countries identified as having the highest humanitarian needs at the end of 2016 and likely to face worsening situations in 2017.1 Violent conflict and ensuing internal and external population displacement are hallmarks of most of these crises. Worldwide, an estimated 172 million people are affected by armed conflict.2 In addition to these man-made crises, 175 million people are affected by natural disasters each year.

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[Comment] Where is the science in humanitarian health?  Voir?

In 1948, in the aftermath of the partition of India and Pakistan, a journal article on the health situation of refugees and internally displaced persons stated that “this report is based entirely on impressions”.1 Another of the earliest articles about a humanitarian emergency, the East Bengal cyclone in 1970, stated that “relief supplies and volunteers poured in, but no one knew the magnitude or geographic distribution of losses and needs.”2 How did these volunteers know what skills were needed? What supplies and commodities to distribute? How did they know where to go or who to help? Impressions, best intentions, and customary practices were the rule at the time, and health interventions were rarely supported by epidemiological or clinical studies that provided evidence of effectiveness.

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[Comment] Humanitarian medicine is more than a technical exercise  Voir?

What a sad indictment of our times that the Turkey Hub of the Health Cluster, a UN-activated humanitarian health coordination body, has begun to calculate the confirmed number of attacks against hospitals in Syria. Mohamed Elamein and colleagues,1 as part of the Lancet Series on health in humanitarian crises,2–5 present evidence on the use of the Monitoring Violence against Health Care tool to detect and verify attacks on health-care services and describe their effect in Syria. The tragic story these statistics tell highlights the need for action to stop attacks against health-care settings and workers in Syria and elsewhere in the world.

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[Comment] Research ethics and evidence for humanitarian health  Voir?

People affected by humanitarian crises deserve responses that promote health, respect dignity, and uphold rights. In this Lancet Series on health in humanitarian crises, Karl Blanchet and colleagues1 highlight substantial deficiencies in the evidence available to guide humanitarian responses. Their call for additional research echoes similar appeals.2 In the second Series paper, Francesco Checchi and colleagues3 argue for improved methods in such research, highlighting the need for better information systems.

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[Comment] Offline: WHO—a roadmap to renewal?  Voir?

The honeymoon for WHO's new Director-General, Dr Tedros, is over. Now the serious work begins. At a special session of the agency's Executive Board next week, his proposed General Programme of Work (GPW) for 2019–23 will be tabled, debated, and judged for the first time. This document represents WHO's promise to the world. In many ways, it conveys urgency and ambition. The agency's mission is to promote health, keep the world safe, and serve the vulnerable. It will do so by achieving a “triple billion” target—1 billion more people with health coverage, 1 billion more people made safer, and 1 billion more people whose lives are improved.

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[World Report] Towards introducing ACOs in the NHS  Voir?

The UK Government is moving towards introducing Accountable Care Organisations to the NHS; some worry that this might happen without public consultation. Talha Burki reports.
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[World Report] 2017 Prince Mahidol Award winners announced  Voir?

Public health prize recognises scientists who advanced the field of Haemophilus influenzae type b vaccination, and medicine award goes to the Human Genome Project. Andrew Green reports.
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[Perspectives] Moses Massaquoi: health leader in humanitarian crises  Voir?

In 1996, Moses Massaquoi and several thousand refugees boarded a Nigerian freight ship to escape the ravages of Liberia's civil war. Within 3 days the ship began to founder in the waters off Cote d'Ivoire, before Massaquoi, acting as the ship's doctor, decided to take charge. “The crew were unable to communicate a SOS radio message. I fixed the radio aerial, and was able to recall from memory the radio signal for MSF in Liberia. Fortunately they got the message out, and we were rescued before the ship sunk”, Massaquoi recalls.

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[Perspectives] Picturing health: Rohingya refugees in Bangladesh  Voir?

Since August, 2017, when violence broke out in Myanmar's northern Rahkine State, it is estimated that more than 600 000 Rohingya people have fled to Bangladesh. To accommodate the steady flow of people, vegetation on steep hillsides and between swathes of paddy fields in Bangladesh has been razed to build spontaneous settlements. Although Bangladesh is planning to build a camp that would house 800 000 people, Rohingya refugees are currently trying to survive in these crowded, haphazard camps. Humanitarian assistance is being provided by the Bangladesh Government, non-governmental organisations (NGOs), UN agencies, WHO, volunteers, and others, but conditions in the refugee camps are difficult.

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[Correspondence] Charlottesville: blatant racism, not grievances, on display  Voir?

We recently published a paper1 on structural racism in a Lancet Series on equity and equality in health in the USA. Structural racism refers to the many ways in which racial subjugation is embedded in US society—not just in one individual, or groups of individuals, or one institution, but in all of our institutions—from culture to housing to employment to law enforcement, and beyond.1,2 Racism is supported by wealthy and working class whites alike.2,3 The ultimate weapon to maintain and reproduce this system is terror.

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[Correspondence] Bisphosphonates in osteoporosis: NICE and easy?  Voir?

The recent National Institute for Health and Care Excellence (NICE) updated multiple technology appraisal on bisphosphonate use in osteoporosis1 demonstrates how, for a common disorder, the strict application of cost-effectiveness thresholds for inexpensive drugs might lead to counterintuitive and potentially harmful guidance. The multiple technology appraisal incorporates the development of fracture risk calculators based on individualised clinical risk factors, such as FRAX and QFracture (recommended by NICE for the assessment of fracture risk in some sections of the population2), and the availability of low-cost generic forms of oral and intravenous bisphosphonates.

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[Correspondence] On evidence-based medicine  Voir?

In their Review1 published in The Lancet (July 22, p 415), Benjamin Djulbegovic and Gordon H Guyatt provide a comprehensive overview of the challenges evidence-based medicine (EBM) will probably face in the next 25 years. Rightly, they conclude that it is a triumph that no critic of EBM has ever suggested that reliable evidence should not be key to medicine. EBM's next challenge will be the continued development of more efficient and rapid ways of disseminating evidence and guidelines.

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[Correspondence] On evidence-based medicine  Voir?

In the Review1 of evidence-based medicine by Benjamin Djulbegovic and Gordon H Guyatt, different or conflicting interpretation of the literature was not mentioned. Although such data selection might not be deliberate, it can be problematic and could result in different interpretations of the evidence by guidelines on the same topic.2

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[Correspondence] On evidence-based medicine  Voir?

In their Review,1 Benjamin Djulbegovic and Gordon H Guyatt do not adequately address the undue emphasis placed on randomisation in clinical research, which is arguably the main criticism of evidence-based medicine (EBM).
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[Correspondence] On evidence-based medicine – Authors' reply  Voir?

We thank Marjolein A van der Marck and colleagues, Feras Ali Mustafa, and Jan Matthys for their interest in our Review.1 We agree with van der Marck and colleagues that tackling multimorbidity is an enormous challenge for evidence-based practice that, so far, has not been met. Authors within the evidence-based medicine (EBM) community have, however, suggested initial strategies for those who write guidelines2 and for the broader scientific community,3 and have emphasised the need for approaches that are minimally disruptive to patients' lives.

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[Correspondence] Practical applications of evolutionary biology in public health  Voir?

Jonathan Wells and colleagues,1 Grazyna Jasienska and colleagues,2 and Graham Rook and colleagues3 are to be congratulated on producing a fascinating and thought-provoking Series on how evolutionary biology could contribute to public health. The key insight that our goal in life might be reproductive success, rather than longevity, provides a means to re-conceptualise public health and could inform some of the major conundrums in global public health.

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[Department of Error] Department of Error  Voir?

Woodcock A, Vestbo J, Bakerly ND, et al. Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial. Lancet 2017; 390: 2247–55—In table 1 of this Article (published Online First on Sept 10, 2017), the number of patients in the fluticasone furoate and vilanterol group who did not have any exacerbations in the previous year before randomisation should be 1378. In figure 3, the data should be as follows: HR=0·96 (95% CI 0·86–1·07); p=0·5041.

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[Articles] Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial  Voir?

In patients with a general practitioner's diagnosis of symptomatic asthma and on maintenance inhaler therapy, initiation of a once-daily treatment regimen of combined fluticasone furoate and vilanterol improved asthma control without increasing the risk of serious adverse events when compared with optimised usual care.

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[Articles] Population screening and intervention for vascular disease in Danish men (VIVA): a randomised controlled trial  Voir?

The observed reduction of mortality risk from abdominal aortic aneurysm, peripheral arterial disease, and hypertension has never been seen before in the population screening literature and can be linked primarily to initiation of pharmacological therapy. Health policy makers should consider implementing combined screening whether no screening or isolated abdominal aortic aneurysm screening is currently offered.

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[Articles] Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): a randomised, double-blind, phase 3 trial  Voir?

To the best of our knowledge, ramucirumab plus docetaxel is the first regimen in a phase 3 study to show superior progression-free survival over chemotherapy in patients with platinum-refractory advanced urothelial carcinoma. These data validate inhibition of VEGFR-2 signalling as a potential new therapeutic treatment option for patients with urothelial carcinoma.

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[Articles] Attacks against health care in Syria, 2015–16: results from a real-time reporting tool  Voir?

The data system used in this study addressed double-counting, reduced the effect of potentially biased self-reports, and produced credible data from anonymous information. The MVH tool could be feasibly deployed in many conflict areas. Reliable data are essential to show how far warring parties have strayed from international law protecting health care in conflict and to effectively harness legal mechanisms to discourage future perpetrators.

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[Series] Evidence on public health interventions in humanitarian crises  Voir?

Recognition of the need for evidence-based interventions to help to improve the effectiveness and efficiency of humanitarian responses has been increasing. However, little is known about the breadth and quality of evidence on health interventions in humanitarian crises. We describe the findings of a systematic review with the aim of examining the quantity and quality of evidence on public health interventions in humanitarian crises to identify key research gaps. We identified 345 studies published between 1980 and 2014 that met our inclusion criteria.

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[Series] Public health information in crisis-affected populations: a review of methods and their use for advocacy and action  Voir?

Valid and timely information about various domains of public health underpins the effectiveness of humanitarian public health interventions in crises. However, obstacles including insecurity, insufficient resources and skills for data collection and analysis, and absence of validated methods combine to hamper the quantity and quality of public health information available to humanitarian responders. This paper, the second in a Series of four papers, reviews available methods to collect public health data pertaining to different domains of health and health services in crisis settings, including population size and composition, exposure to armed attacks, sexual and gender-based violence, food security and feeding practices, nutritional status, physical and mental health outcomes, public health service availability, coverage and effectiveness, and mortality.

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[Series] Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?  Voir?

Humanitarian health workers operate in dangerous and uncertain contexts, in which mistakes and failures are common, often have severe consequences, and are regularly repeated, despite being documented by many reviews. This Series paper aims to discuss the failures of medical humanitarianism. We describe why some of these recurrent failings, which are often not identified until much later, seem intractable: they are so entrenched in humanitarian action that they cannot be addressed by simple technical fixes.

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Dernière mise à jour : 22/11/2017 : 15:22


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