Riviste scientifiche

[Editorial] Alcohol and cancer

The Lancet - Sa, 18/11/2017 - 00:00
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.

[Editorial] Does mobile health matter?

The Lancet - Sa, 18/11/2017 - 00:00
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.

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

The Lancet - Sa, 18/11/2017 - 00:00
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.

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

The Lancet - Sa, 18/11/2017 - 00:00
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.

[World Report] Towards introducing ACOs in the NHS

The Lancet - Sa, 18/11/2017 - 00:00
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.

[World Report] 2017 Prince Mahidol Award winners announced

The Lancet - Sa, 18/11/2017 - 00:00
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.

[Perspectives] Picturing health: Rohingya refugees in Bangladesh

The Lancet - Sa, 18/11/2017 - 00:00
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.

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

The Lancet - Sa, 18/11/2017 - 00:00
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.

[Correspondence] Bisphosphonates in osteoporosis: NICE and easy?

The Lancet - Sa, 18/11/2017 - 00:00
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.

[Correspondence] On evidence-based medicine

The Lancet - Sa, 18/11/2017 - 00:00
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.

[Correspondence] On evidence-based medicine

The Lancet - Sa, 18/11/2017 - 00:00
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

[Correspondence] On evidence-based medicine

The Lancet - Sa, 18/11/2017 - 00:00
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).

[Correspondence] On evidence-based medicine – Authors' reply

The Lancet - Sa, 18/11/2017 - 00:00
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.

[Correspondence] Practical applications of evolutionary biology in public health

The Lancet - Sa, 18/11/2017 - 00:00
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.

Postmenopausal hormone therapy and risk of stroke: A pooled analysis of data from population-based cohort studies

PLoS Medicine - Ve, 17/11/2017 - 23:00

by Germán D. Carrasquilla, Paolo Frumento, Anita Berglund, Christer Borgfeldt, Matteo Bottai, Chiara Chiavenna, Mats Eliasson, Gunnar Engström, Göran Hallmans, Jan-Håkan Jansson, Patrik K. Magnusson, Peter M. Nilsson, Nancy L. Pedersen, Alicja Wolk, Karin Leander

Background

Recent research indicates a favourable influence of postmenopausal hormone therapy (HT) if initiated early, but not late, on subclinical atherosclerosis. However, the clinical relevance of timing of HT initiation for hard end points such as stroke remains to be determined. Further, no previous research has considered the timing of initiation of HT in relation to haemorrhagic stroke risk. The importance of the route of administration, type, active ingredient, and duration of HT for stroke risk is also unclear. We aimed to assess the association between HT and risk of stroke, considering the timing of initiation, route of administration, type, active ingredient, and duration of HT.

Methods and findings

Data on HT use reported by the participants in 5 population-based Swedish cohort studies, with baseline investigations performed during the period 1987–2002, were combined in this observational study. In total, 88,914 postmenopausal women who reported data on HT use and had no previous cardiovascular disease diagnosis were included. Incident events of stroke (ischaemic, haemorrhagic, or unspecified) and haemorrhagic stroke were identified from national population registers. Laplace regression was employed to assess crude and multivariable-adjusted associations between HT and stroke risk by estimating percentile differences (PDs) with 95% confidence intervals (CIs). The fifth and first PDs were calculated for stroke and haemorrhagic stroke, respectively. Crude models were adjusted for age at baseline only. The final adjusted models included age at baseline, level of education, smoking status, body mass index, level of physical activity, and age at menopause onset. Additional variables evaluated for potential confounding were type of menopause, parity, use of oral contraceptives, alcohol consumption, hypertension, dyslipidaemia, diabetes, family history of cardiovascular disease, and cohort. During a median follow-up of 14.3 years, 6,371 first-time stroke events were recorded; of these, 1,080 were haemorrhagic. Following multivariable adjustment, early initiation (<5 years since menopause onset) of HT was associated with a longer stroke-free period than never use (fifth PD, 1.00 years; 95% CI 0.42 to 1.57), but there was no significant extension to the time period free of haemorrhagic stroke (first PD, 1.52 years; 95% CI −0.32 to 3.37). When considering timing as a continuous variable, the stroke-free and the haemorrhagic stroke-free periods were maximal if HT was initiated approximately 0–5 years from the onset of menopause. If single conjugated equine oestrogen HT was used, late initiation of HT was associated with a shorter stroke-free (fifth PD, −4.41 years; 95% CI −7.14 to −1.68) and haemorrhagic stroke-free (first PD, −9.51 years; 95% CI −12.77 to −6.24) period than never use. Combined HT when initiated late was significantly associated with a shorter haemorrhagic stroke-free period (first PD, −1.97 years; 95% CI −3.81 to −0.13), but not with a shorter stroke-free period (fifth PD, −1.21 years; 95% CI −3.11 to 0.68) than never use. Given the observational nature of this study, the possibility of uncontrolled confounding cannot be excluded. Further, immortal time bias, also related to the observational design, cannot be ruled out.

Conclusions

When initiated early in relation to menopause onset, HT was not associated with increased risk of incident stroke, regardless of the route of administration, type of HT, active ingredient, and duration. Generally, these findings held also for haemorrhagic stroke. Our results suggest that the initiation of HT 0–5 years after menopause onset, as compared to never use, is associated with a decreased risk of stroke and haemorrhagic stroke. Late initiation was associated with elevated risks of stroke and haemorrhagic stroke when conjugated equine oestrogen was used as single therapy. Late initiation of combined HT was associated with haemorrhagic stroke risk.

Black holes that shred stars burp out cosmic rays and neutrinos

New Scientist - Ve, 17/11/2017 - 22:23
The highest energy cosmic rays and neutrinos that rain down on Earth may come from white dwarf stars being devoured by black holes

The forces that govern matter and light could be united at last

New Scientist - Ve, 17/11/2017 - 18:52
A new grand unified theory seems to unite electromagnetism and the weak and strong nuclear force without resorting to supersymmetry

Rocket-powered Land Rovers can survive deadly roadside bombs

New Scientist - Ve, 17/11/2017 - 18:14
Firing 50 solid rocket fuel motors within 10 milliseconds of an IED blast temporarily makes the vehicle weigh 120 tons, freezing it in place and protecting everyone inside  

We just sent a message to try to talk to aliens on another world

New Scientist - Ve, 17/11/2017 - 17:38
We've just sent a message to a nearby star to see if there's any life there - and we'll only have to wait 25 years for a reply

Biohackers are using CRISPR on their DNA and we can’t stop it

New Scientist - Ve, 17/11/2017 - 16:16
People are starting to alter their own DNA with cheap, easy gene-editing technology. Is it time to regulate CRISPR?
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