Riviste scientifiche

[Correspondence] Scientific leadership: the Italian Government's perspective

The Lancet - Sa, 17/08/2019 - 00:00
A number of articles in high impact medical journals in the past few months1–3 report on the alleged anti-scientific attitude of the present Italian Government.

[Correspondence] Enhancing the National Family Health Survey-5 for policy making

The Lancet - Sa, 17/08/2019 - 00:00
India contributes substantially to the global burden of neonatal deaths and stillbirths.1 It will soon embark on round five of the National Family Health Survey (NFHS), the major household survey used to guide policy making and programme planning for maternal and child health. We highlight two issues that are important for the NFHS to address to effectively contribute to the India National Action Plan (INAP), which aims to reduce the proportion of neonatal deaths and preventable stillbirths to single digits (<10 neonatal deaths per 1000 livebirths and <10 stillbirths per 1000 births) in India by 2030.

[Correspondence] Coroners' investigations of stillbirths

The Lancet - Sa, 17/08/2019 - 00:00
As a practising senior coroner and a physician, we were surprised by the immediate positive stance taken in by the Editors1 on the topic of progress in investigating stillbirths. The UK Government's proposal for coroners to have the power to investigate full-term stillbirths2 was subject to consultation until June 18, 2019, and we hope all those with an interest in this field to responded accordingly. Feedback is expected in September, 2019.

[Correspondence] Prepregnancy calcium supplementation and pre-eclampsia

The Lancet - Sa, 17/08/2019 - 00:00
G Justus Hofmeyr and colleagues1 report a very high risk of pre-eclampsia among pregnant women in their double-blind study in South Africa, Zimbabwe, and Argentina. The risk was not reduced by prepregnancy calcium supplementation. They disregarded an important determinant of pre-eclampsia, infection by strains of Helicobacter pylori expressing CagA, an immunodominant determinant endowed with an increased inflammatory potential.2 In Turin, Italy, the association of pre-eclampsia with infection by pathogenic H pylori is strong, especially for pre-eclamptic women who gave birth to small-for-gestational-age babies.

[Correspondence] Prepregnancy calcium supplementation and pre-eclampsia

The Lancet - Sa, 17/08/2019 - 00:00
In their multicentre, randomised controlled trial, G Justsus Hofmeyr and colleagues1 showed that prepregnancy or early pregnancy calcium supplementation led to a significant reduction in recurrent pre-eclampsia among participants with more than 80% compliance and in recurrent pre-eclampsia or pregnancy loss at any gestation. However, we are concerned about the external validity of the study.

[Correspondence] Prepregnancy calcium supplementation and pre-eclampsia – Author's reply

The Lancet - Sa, 17/08/2019 - 00:00
I thank the correspondents for their comments on our Article.1 In response to Antonio Ponzetto and colleagues, we did not test for Helicobacter pylori infection and, therefore, are not able to comment on its prevalence in our population. However, because of the randomised, double-blind, placebo-controlled study design that was used in the Calcium and Pre-eclampsia (CAP) trial, the occurrence of H pylori infection and the many other possible causative factors for pre-eclampsia would be expected to have been equally distributed between the study groups.

[Clinical Picture] Getting to the heart of the matter in a multisystem disorder: Erdheim–Chester disease

The Lancet - Sa, 17/08/2019 - 00:00
A 59-year-old woman was admitted to our emergency department for asthenia and swollen ankles. 1 week earlier she began to feel tired while walking. On clinical examination, we found peripheral oedema but no other signs suggestive of heart failure. Her blood pressure was 150/70 mm Hg. An electrocardiogram showed junctional bradycardia (35 beats per min): P waves were absent and the QRS complexes were regular and narrow. In her medical history, it was noted that she had recently been treated with ibuprofen and colchicine for acute idiopathic pericarditis: the patient had chest pain and paroxysmal atrial flutter.

Early occupational intervention for people with low back pain in physically demanding jobs: A randomized clinical trial

PLoS Medicine - Ve, 16/08/2019 - 23:00

by Bjarke Brandt Hansen, Lilli Kirkeskov, Luise Moelenberg Begtrup, Mikael Boesen, Henning Bliddal, Robin Christensen, Ditte Lundsgaard Andreasen, Lars Erik Kristensen, Esben Meulengracht Flachs, Ann Isabel Kryger

Background

Occupational medicine seeks to reduce sick leave; however, evidence for an add-on effect to usual care is sparse. The objective of the GOBACK trial was to test whether people with low back pain (LBP) in physically demanding jobs and at risk of sick leave gain additional benefit from a 3-month complex intervention that involves occupational medicine consultations, a work-related evaluation and workplace intervention plan, an optional workplace visit, and a physical activity program, over a single hospital consultation and an MRI.

Methods and findings

We enrolled people from the capital region of Denmark to an open-label, parallel-group randomized controlled trial with a superiority design from March 2014 through December 2015. In a hospital setting 305 participants (99 women) with LBP and in physically demanding jobs were randomized to occupational intervention (n = 153) or no additional intervention (control group; n = 152) added to a single hospital consultation giving a thorough explanation of the pain (i.e., clinical examination and MRI) and instructions to stay active and continue working. Primary outcome was accumulated sick leave days due to LBP during 6 months. Secondary outcomes were changes in neuropathic pain (painDETECT questionnaire [PDQ]), pain 0–10 numerical rating scale (NRS), Fear-Avoidance Beliefs Questionnaire (FABQ), Roland–Morris Disability Questionnaire (RMDQ), Short Form Health Survey (SF-36) for physical and mental health-related quality of life (HRQoL), and self-assessed ability to continue working (range 0–10). An intention-to-treat analysis of sick leave at 6 months showed no significant difference between groups (mean difference in days suggestively in favor of no additional intervention: 3.50 [95% CI –5.08 to 12.07], P = 0.42). Both groups showed significant improvements in average pain score (NRS), disability (RMDQ), fear-avoidance beliefs about physical activities and work (FABQ), and physical HRQoL (SF-36 physical component summary); there were no significant differences between the groups in any secondary outcome. There was no statistically significant improvement in neuropathic pain (PDQ score), mental HRQoL (SF-36 mental component summary), and self-assessed ability to stay in job. Four participants could not complete the MRI or the intervention due to a claustrophobic attack or accentuated back pain. Workplace visits may be an important element in the occupational intervention, although not always needed. A per-protocol analysis that included the 40 participants in the intervention arm who received a workplace visit as part of the additional occupational intervention did not show an add-on benefit in terms of sick leave (available cases after 6 months, mean difference: –0.43 days [95% CI –12.8 to 11.94], P = 0.945). The main limitations were the small number of sick leave days taken and that the comprehensive use of MRI may limit generalization of the findings to other settings, for example, general practice.

Conclusions

When given a single hospital consultation and MRI, people in physically demanding jobs at risk of sick leave due to LBP did not benefit from a complex additional occupational intervention. Occupational interventions aimed at limiting biopsychological obstacles (e.g., fear-avoidance beliefs and behaviors), barriers in the workplace, and system barriers seem essential to reduce sick leave in patients with LBP. This study indicates that these obstacles and barriers may be addressed by thorough usual care.

Trial registration

Clinical Trials.gov: NCT02015572

15 studies retracted due to fears they used Chinese prisoners' organs

New Scientist - Ve, 16/08/2019 - 12:16
15 organ transplantation studies by researchers in China have been retracted due to concerns the work may have used organs from executed prisoners

Tiny magnets could help rid the ocean of harmful microplastics

New Scientist - Ve, 16/08/2019 - 11:00
Tiny magnetic coils can turn microplastics into carbon dioxide and water. The reaction could catch plastic in wastewater streams and stop it entering the ocean

Wildlife summit to consider global ban on saiga antelope trade

New Scientist - Ve, 16/08/2019 - 08:00
Protections for saiga antelope, mako sharks and even woolly mammoths will be considered at a conference of the Convention on International Trade in Endangered Species

Inclusion of key populations in clinical trials of new antituberculosis treatments: Current barriers and recommendations for pregnant and lactating women, children, and HIV-infected persons

PLoS Medicine - Gi, 15/08/2019 - 23:00

by Amita Gupta, Michael D. Hughes, Anthony J. Garcia-Prats, Katherine McIntire, Anneke C. Hesseling

Amita Gupta and colleagues discuss priorities in clinical research aimed at improving tuberculosis prevention and treatment in pregnant women, children, and people with HIV.

Super-deep diamonds contain traces of a pristine chunk of early Earth

New Scientist - Gi, 15/08/2019 - 20:00
Diamonds that formed twice as deep as normal contain evidence of a pristine hunk of original Earth rock hiding deep underground

Robotic shorts could help you run and walk more efficiently

New Scientist - Gi, 15/08/2019 - 20:00
A robotic exosuit cuts the energy required to walk and run, and could be used by firefighters or others who spend long periods of time on their feet

Sticky nets of DNA from immune cells may be to blame for gallstones

New Scientist - Gi, 15/08/2019 - 17:00
Immune cells may help painful gallstones grow by ejecting sticky nets of DNA around the crystals that form in bile – a finding that could lead to new treatments

Europe’s extinct cave bears went into decline just as humans arrived

New Scientist - Gi, 15/08/2019 - 15:00
The population of cave bears in Europe held steady for tens of thousands of years, then crashed after humans showed up – suggesting we helped wipe them out

Louisa Aldrich-Blake: a trailblazer for female surgeons and a war hero

New Scientist - Gi, 15/08/2019 - 13:33
The first woman to qualify as a surgeon in the UK, Louisa Aldrich-Blake also helped to establish hospitals for soldiers in the First World War

Lyme disease in England and Wales is most common in older, white women

New Scientist - Gi, 15/08/2019 - 02:00
An analysis of hospital records has found that people with Lyme disease in hospitals in England and Wales tend to be white, female and relatively affluent

Ketogenic diet may stop migraines by changing the brain’s fuel

New Scientist - Me, 14/08/2019 - 21:20
A low-carb diet cut the number of days people had migraines in half, possibly by forcing the brain to run on ketones instead of glucose

Plant growth has declined drastically around the world due to dry air

New Scientist - Me, 14/08/2019 - 20:00
A lack of water in the air has resulted in a decline in growth rates in 59 per cent of global vegetated areas over the past twenty years
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