Riviste scientifiche

[World Report] GP at hand: a digital revolution for health care provision?

The Lancet - Sa, 10/08/2019 - 00:00
Babylon's health app has certainly changed the way its users consume health care. But a chorus of supporters and detractors struggle to agree on whether it is for better or worse. Talha Burki reports.

[Perspectives] The “nice work” of transforming the health workforce

The Lancet - Sa, 10/08/2019 - 00:00
At a medical conference, a friend apologised for missing my session on inclusion and equity in health care. He had attended a talk on sepsis instead, choosing this “life and death” topic over what seemed to him a more niche issue. “But I really think you're doing such nice work”, he said.

[Perspectives] The remaking of Shakespeare

The Lancet - Sa, 10/08/2019 - 00:00
Does anyone really enjoy Shakespeare? There can be a sense of weary obligation around him: he comes to us as set texts to be studied for exams, or as cultural experiences to be swallowed like medicine, and shrouded in an aura of genius that suggests any lack of delight or understanding must be a failure on your part. But as Emma Smith points out in This is Shakespeare, a collection of essays on 20 of the plays, this hasn't always been the case: “Shakespeare wasn't always ‘Shakespeare’.” In his own time, he was just another playwright; many audience members would not even have known they were watching “Shakespeare”, only the names of the play and the company performing it.

[Obituary] Patricia Bath

The Lancet - Sa, 10/08/2019 - 00:00
Ophthalmologist who invented a new technique for cataract surgery. Born in Harlem, NY, USA, on Nov 4, 1942, she died of complications from cancer in San Francisco, CA, USA, on May 30, 2019, aged 76 years.

[Correspondence] Science and literature: complementary, not contradictory

The Lancet - Sa, 10/08/2019 - 00:00
On introducing myself as an undergraduate biochemist to those without scientific backgrounds, I am almost invariably met by an uncertain look and a change of topic. I find myself far more likely to have a productive conversation about my school A-level qualification in English literature than about the university degree I have spent the last 3 years on. To be what most of general society recognises as cultured is to be well read, historically knowledgable, and politically engaged; a scientific background rarely factors into this concept.

[Correspondence] Preparing the next generation of global public health experts

The Lancet - Sa, 10/08/2019 - 00:00
Students in SciencesPo's Global Health Masters course have extracted health data from the Institute for Health Metrics and Evaluation's Global Burden of Disease database to produce policy papers to address diabetes in Mexico, Alzheimer's disease in France, HIV in South Africa, and traffic accidents in Sudan. The students evaluated the measures taken by governments and ministers of health, and in this issue of The Lancet, they propose ways to strengthen the correction of these burdens of disease, while not omitting the interpectoral aspects of public policies to be put in place.

[Correspondence] Road safety in Sudan

The Lancet - Sa, 10/08/2019 - 00:00
In the field of global health and beyond, a great deal of emphasis is often placed on treating and preventing disease, while the determinants of health often take a back seat. Road safety has become a pillar of healthy populations and a priority for sustainable cities, yet many countries continue to grapple with high numbers of fatalities and injuries from traffic accidents. Developing countries, specifically, must treat road safety as a public health priority and develop policies that can sharply decrease the risk of avoidable deaths on the road.

[Correspondence] Alzheimer's disease and neurodegenerative diseases in France

The Lancet - Sa, 10/08/2019 - 00:00
On May 30, 2018, French Minister of Solidarity and Health Agnès Buzyn unveiled her policy roadmap for the elderly, entitled Great Age and Autonomy.1 In fact, in 2050, one in three individuals in France will be older than 60 years.2 However, to guarantee healthy ageing and long lives to France's elderly people, policy pushes need to be made towards the prevention of Alzheimer's disease and other neurodegenerative diseases.

[Correspondence] HIV in South Africa

The Lancet - Sa, 10/08/2019 - 00:00
South Africa is home to the largest HIV seropositive population in the world, with 7·2 million individuals.1 Since the country's first case of HIV in 1982, South Africa has come a long way to reduce HIV/AIDS-related rates of infection, morbidity, and mortality. Some responses to the epidemic fostered improvement, whereas others exacerbated the crisis. As a dramatic lesson, the denialist line of Thabo Mbeki should be mentioned. Outlawing the use of antiretroviral therapy is estimated to have led to 330 000 AIDS-related deaths.

[Correspondence] Ending diabetes in Mexico

The Lancet - Sa, 10/08/2019 - 00:00
Diabetes leads to thousands of deaths and billion-dollar spending even though it is a predictable lifestyle disease.

[Correspondence] The harsh effects of sanctions on Iranian health

The Lancet - Sa, 10/08/2019 - 00:00
Iran has been under different rounds of economic sanctions since 1980. In July, 2015, the UN Security Council, Germany, and the EU were successful in forming an agreement with Iran, called the Joint Comprehensive Plan of Action (JCPOA), that relieved some of these sanctions. Even though the International Atomic Energy Agency verified that Iran was abiding by the provisions of the deal, US President Donald Trump announced the withdrawal of the USA from the JCPOA in May, 2018. A new round of US-issued sanctions has been imposed on Iran since November, 2018, to stop Iran's oil sales.

[Correspondence] Yellow vests protests: facial injuries from rubber bullets

The Lancet - Sa, 10/08/2019 - 00:00
Since November, 2018, France has been facing violent contestation with the national so-called yellow vests protests, resulting in about 4000 casualties.1 We managed 21 patients who presented with face and eye injuries caused by rubber bullets from non-lethal hand-held weapons (NLHHWs). Because of the steady increase in the overall number and violence of protests worldwide,2 one might expect a rise in injuries caused by NLHHWs.

[Correspondence] Fiscal policies and global public health

The Lancet - Sa, 10/08/2019 - 00:00
In his Correspondence on fiscal policies and the gilets jaunes, Franco Sassi1 argued that policy makers should consider using hypothecation (earmarking) to increase public acceptance of taxes levied on unhealthy products such as tobacco, alcohol, and sugar-sweetened beverages.

[Department of Error] Department of Error

The Lancet - Sa, 10/08/2019 - 00:00
Huang SS, Septimus E, Kleinman K, et al. Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial. Lancet 2019; 393: 1205–15—The appendix of this Article has been corrected as of August 8, 2019.

[Clinical Picture] Dyspnoea, clubbing, cirrhosis, and bubbles in both sides of the heart suggests hepatopulmonary syndrome

The Lancet - Sa, 10/08/2019 - 00:00
A 48-year-old Chinese man with a 12-month history of increasing shortness of breath on exertion was admitted to our hospital. He was a heavy smoker and had been diagnosed with Child-Pugh class C alcoholic cirrhosis 5 years earlier, which was complicated by oesophageal varices that haemorrhaged 1 month before this admission; he had an urgent gastroscopy and the varices were banded.

Variation of all-cause and cause-specific mortality with body mass index in one million Swedish parent-son pairs: An instrumental variable analysis

PLoS Medicine - Ve, 09/08/2019 - 23:00

by Kaitlin H. Wade, David Carslake, Per Tynelius, George Davey Smith, Richard M. Martin

Background

High body mass index (BMI) is associated with mortality, but the pervasive problem of confounding and reverse causality in observational studies limits inference about the direction and magnitude of causal effects. We aimed to obtain estimates of the causal association of BMI with all-cause and cause-specific mortality.

Methods and findings

In a record-linked, intergenerational prospective study from the general population of Sweden, we used two-sample instrumental variable (IV) analysis with data from 996,898 fathers (282,407 deaths) and 1,013,083 mothers (153,043 deaths) and their sons followed up from January 1, 1961, until December 31, 2004. Sons’ BMI was used as the instrument for parents’ BMI to compute hazard ratios (HRs) for risk of mortality per standard deviation (SD) higher parents’ BMI. Using offspring exposure as an instrument for parents’ exposure is unlikely to be affected by reverse causality (an important source of bias in this context) and reduces confounding. IV analyses supported causal associations between higher BMI and greater risk of all-cause mortality (HR [95% confidence interval (CI)] per SD higher fathers’ BMI: 1.29 [1.26–1.31] and mothers’ BMI: 1.39 [1.35–1.42]) and overall cancer mortality (HR per SD higher fathers’ BMI: 1.20 [1.16–1.24] and mothers’ BMI: 1.29 [1.24–1.34]), including 9 site-specific cancers in men (bladder, colorectum, gallbladder, kidney, liver, lung, lymphatic system, pancreas, and stomach) and 11 site-specific cancers in women (gallbladder, kidney, liver, lung, lymphatic system, ovaries, pancreas, stomach, uterus, cervix, and endometrium). There was evidence supporting causal associations between higher BMI in mothers and greater risk of mortality from kidney disease (HR: 2.17 [1.68–2.81]) and lower risk of mortality from suicide (HR: 0.77 [0.65–0.90]). In both sexes, there was evidence supporting causal associations between higher BMI and mortality from cardiovascular diseases (CVDs), stroke, diabetes, and respiratory diseases. We were unable to test the association between sons’ and mothers’ BMIs (as mothers’ data were unavailable) or whether the instrument was independent of unmeasured or residual confounding; however, the associations between parents’ mortality and sons’ BMI were negligibly influenced by adjustment for available confounders.

Conclusions

Consistent with previous large-scale meta-analyses and reviews, results supported the causal role of higher BMI in increasing the risk of several common causes of death, including cancers with increasing global incidence. We also found positive effects of BMI on mortality from respiratory disease, prostate cancer, and lung cancer, which has been inconsistently reported in the literature, suggesting that the causal role of higher BMI in mortality from these diseases may be underestimated. Furthermore, we expect different patterns of bias in the current observational and IV analyses; therefore, the similarities between our findings from both methods increases confidence in the results. These findings support efforts to understand the mechanisms underpinning these effects to inform targeted interventions and develop population-based strategies to reduce rising obesity levels for disease prevention.

Milky Way's black hole has got 75 times brighter and we don't know why

New Scientist - Ve, 09/08/2019 - 17:32
Astronomers were shocked to find the area around the supermassive black hole at the centre of the Milky Way growing 75 times brighter in just two hours

Deep-sea microbe could answer one of evolution's biggest mysteries

New Scientist - Ve, 09/08/2019 - 16:38
At last, scientists have managed to grow, study and photograph a mysterious deep-sea microbe that could explain the evolutionary origin of our complex cells

World’s largest frog builds its own ponds using heavy rocks

New Scientist - Ve, 09/08/2019 - 01:01
To build nests, goliath frogs move heavy rocks to create little ponds in the middle of streams, which may explain how these frogs have evolved to be so enormous

Mysterious signals from space could teach us how dark energy works

New Scientist - Gi, 08/08/2019 - 17:43
Weird bursts of radio waves from space could be used to measure cosmic distances, which would help us learn about dark energy and the universe’s expansion
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