Riviste scientifiche

Legalise online protests to safeguard democracy

New Scientist - %age fa
Internet law needs reform, because criminalising online activism undermines democracy and freedom of speech, says media researcher Molly Sauter






[This Week in Medicine] October 25–31, 2014

The Lancet - %age fa
On Oct 23, Public Health England launched a new national, evidence-based approach, Everybody Active, Every Day, to encourage people to incorporate physical activity into their daily lives. Sport England also announced National Lottery funding for programmes to increase the amount of exercise done in the UK.

[Editorial] National armies for global health?

The Lancet - %age fa
October, 2014, has seen unprecedented deployment of both US and British military personnel to support the efforts in west Africa against the Ebola crisis. Up to 4000 US troops could be deployed in Liberia as part of Operation United Assistance. The British Army commenced Operation Gritrock with the departure of a medical team on Oct 16 to Sierra Leone. “This unit has been the Vanguard medical regiment for the past 20 months which means we are on high readiness to deploy at short notice to anywhere in the world”, said Lieutenant Colonel Alison McCourt from 22 Field Hospital in Aldershot.

[Editorial] Health of the homeless

The Lancet - %age fa
Having a home is a basic human need. However, in any one night in Europe and the USA alone, around 1 million people are classified as homeless. This week The Lancet publishes a new two-paper Series on homelessness and health, led by John Geddes, Seena Fazel, and colleagues. People become homeless through a complex interaction between individual and structural factors (eg, poverty, health, substance misuse, violence, and unemployment). Homelessness can be a long-term state or a temporary transitional period related to circumstances such as domestic violence.

[Editorial] Health inequities in the USA: closing the gaps

The Lancet - %age fa
Increased morbidity and mortality in racial and ethnic minorities, people of low socioeconomic status, sexual minorities, and other marginalised groups, has been well documented in the USA. In 2012, the US National Institutes of Health alone spent more than US$2·7 billion on projects classified as health disparities research. Ironically, however, it seems that disparities exist in research aiming to eliminate health disparities. A new report by the American Academy of Medical Colleges and Academy Health—a non-profit organisation for health services and policy researchers—assessed the state of nation's health equity research and found substantial gaps.

[Comment] Low carbohydrate diets: going against the grain

The Lancet - %age fa
Low carbohydrate high fat (LCHF) diets continue to attract media attention, despite a substantial body of evidence showing that a range of dietary patterns promote health and reduce risk of chronic disease. LCHF diets invariably involve radical restriction of total carbohydrate (typically <12% of energy intake) and largely unrestricted intakes of foods rich in saturated fat. Support for LCHF diets has been partly fuelled by the publication of some papers apparently suggestive of benefit. Recent evidence, however, confirms the established cornerstones of dietary advice—reduce saturated fat, free sugars, and sodium and increase wholegrain cereals and fibre—although changing disease patterns and additional data have necessitated some changes in emphasis.

[Comment] Polio endgame management: focusing on performance with or without inactivated poliovirus vaccine

The Lancet - %age fa
In The Lancet, Jacob John and colleagues report results from a randomised trial of 450 children from Vellore, India, aged 1–4 years that assessed the effects of giving a dose of inactivated poliovirus vaccine (IPV) to children previously immunised with five or more doses of oral poliovirus vaccine (OPV) at least 6 months before the study. The results confirm that an extra dose of IPV in this population increases serum antibodies. The study goes further to show that the IPV dose boosts individual intestinal immunity in OPV-vaccinated children, at least for a short period of time.

[Comment] A new era in medical therapy for retinal degenerative disease?

The Lancet - %age fa
In The Lancet, Robert Koenekoop and coworkers report their open-label study of oral 9-cis-retinyl acetate in 14 patients with Leber congenital amaurosis with either RPE65 or LRAT mutations. These forms of Leber congenital amaurosis have enzymatic defects that usually cause early-onset severe visual loss and nystagmus due to 11-cis-retinal and rhodopsin deficiency in photoreceptors. A synthetic retinoid, 9-cis-retinyl acetate, can provide the chromophore to photoreceptors. The authors report that, after a 7-day course of this compound, ten of 14 patients had improvements of at least 20% in Goldmann visual field (GVF) areas, and six of 14 had improved visual acuity by at least five letters.

[Comment] Pertussis vaccine in pregnancy—first dose for every infant?

The Lancet - %age fa
The potential for whole-cell pertussis vaccination in pregnancy to reduce high-mortality early infant disease was first shown almost 75 years ago. Although interest was rekindled by the advent of acellular pertussis vaccines in the 1980s, the first recommendation for routine pertussis vaccination in pregnancy was not given until 2011. Uptake of this recommendation in the USA has been slow, and empirical evidence that pertussis vaccination in pregnancy prevents early infant disease is lacking.

[Comment] Ombudsman's report on the letter by Manduca and others

The Lancet - %age fa
On July 22, 2014, “An open letter for the people of Gaza”, by Paola Manduca and coauthors, was published online by The Lancet, subsequently appearing in the journal's issue of Aug 2. Accompanying the print version and in two subsequent print issues were further letters, 20 in total, in equal proportions supporting Manduca and colleagues' perspective, or opposing it. A further letter from Manduca and colleagues was published on Aug 21, responding in conciliatory language to some criticism of the original piece and including details of relevant competing interests which had not been included in the authors' first letter.

[Comment] Offline: What might a university achieve, and how?

The Lancet - %age fa
I never expected to discover a university so happy not to have a medical school. Princeton rejoices in avoiding the grip of a faculty that, through its sheer size and force, can sometimes crush its scholarly neighbours. With the highest density of academic stars per undergraduate of any higher education institution in the world, Princeton could afford to enjoy this unmatched reputation amid its beautiful 500-acre estate in the rich heartland of New Jersey. But if you visit Princeton (and I owe a debt of thanks to Adel Mahmoud for warmly opening its doors to me last week), you will find a university not at all relaxed about its present or its future.

[World Report] US federal health agencies questioned over Ebola response

The Lancet - %age fa
A congressional inquiry into the handling of Ebola in the USA has sparked new guidance to protect health-care workers. Susan Jaffe, The Lancet's Washington correspondent, reports.

[World Report] East Timor striving for universal access to health care

The Lancet - %age fa
More than a decade on from gaining independence, East Timor has made gains in health but still faces an uphill battle to achieve universal health coverage and access. Chris McCall reports.

[Perspectives] Managing mortality

The Lancet - %age fa
Ignoring W C Fields' famous advice never to work with children or animals, Dr Bill Thomas introduced both to the Chase Memorial Nursing Home in New York during the 1980s: two dogs, four cats, 100 parakeets, a colony of rabbits, a flock of chickens, and an on-site childcare facility for staff, to be precise. The initial effect was chaos (especially since the birds arrived uncaged), but over the next 2 years the number of prescriptions per resident dropped in half and even the mortality rate declined.

[Perspectives] Dorothy Hodgkin: on proteins and patterns

The Lancet - %age fa
Just before Easter in 1928, 18-year-old Dorothy Crowfoot heard that she had been accepted to read chemistry at Somerville College, the University of Oxford. As a schoolgirl she had read Sir William Bragg's book Concerning the Nature of Things, which explained in accessible style how everything was made of atoms, and how atoms combined to form crystals. The chapter on crystals had arrested Dorothy's attention, because it contained something she hadn't come across in her school chemistry textbooks.

[Correspondence] Ebola control: effect of asymptomatic infection and acquired immunity

The Lancet - %age fa
Evidence suggests that many Ebola infections are asymptomatic, Particularly, results from one post-Ebola outbreak serosurvey showed that 71% of seropositive individuals did not have the disease; another study reported that 46% of asymptomatic close contacts of patients with Ebola were seropositive. Although asymptomatic infections are unlikely to be infectious, they might confer protective immunity and thus have important epidemiological consequences.

[Correspondence] Conflict and drug-resistant tuberculosis in Ukraine

The Lancet - %age fa
The UN released a report on Aug 29 about the worsening situation for human rights in the conflict region of Ukraine. An average of 36 people are killed every day and at least 260 000 people have been displaced from this region. Ed Holt in The Lancet (Aug 30, p 735) reported about the threat to medical staff, equipment, and essential drugs, including for tuberculosis. Ukraine is one of the 27 countries in the world with a high burden of multidrug-resistant (MDR) tuberculosis and in 2012, there were an estimated 6800 new cases in the country.

[Correspondence] Making primary care people-centred

The Lancet - %age fa
The Lancet Editorial (July 26, p 281) commented on the recently released report by an independent expert panel of the European Commission on how a primary care system should operate in the 21st century. While the Editorial agreed with the report's diagnosis of what is wrong with primary care in most high-income countries and what needs to be fixed, your suggested solution did not. By placing the blame on primary care leadership to explain why primary care remains fragmented, ineffective, and plagued with accessibility problems, the Editorial perpetuates the myth that most resistance to change comes from within the primary care community itself.
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