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[Correspondence] Septoplasty for nasal obstruction

Sa, 15/02/2020 - 01:00
We read with interest the Article by Machteld van Egmond and colleagues1 on the effects of surgery versus non-surgical management of nasal obstruction. The Nasal Obstruction Symptom Evaluation (NOSE) scale2 and its validated Dutch version,3 as well as the Sino-Nasal Outcome Test-22 (SNOT-22), were used to assess subjective symptoms. In the Article's appendix,1 the NOSE and SNOT-22 scales are defined as ranging “from 0 to 100, with higher scores representing worse outcomes”. We think that further clarity is required here.

[Correspondence] Septoplasty for nasal obstruction

Sa, 15/02/2020 - 01:00
We congratulate Machteld van Egmond and colleagues for improving our understanding of the role of surgery in the treatment of nasal obstruction.1 Septoplasty is the most frequently performed ear, nose, and throat procedure in many countries. The value of septoplasty is undisputed for treating symptomatic nasal obstruction caused by significant anterior septal deformity with ipsilateral mechanical obstruction. In most patients, however, a combination of mucosal dysregulation, septal pathology, inspiratory collapse of the ala, psychological factors, and potentially altered trigeminal airflow perception have an influence on nasal obstruction.

[Correspondence] Septoplasty for nasal obstruction – Authors' reply

Sa, 15/02/2020 - 01:00
We thank Alfonso Pendolino and colleagues, Neil Tan and Samuel Leong, and Basile Landis and Abel-Jan Tasman for the interest in our study, and welcome the opportunity to reply.

[Correspondence] Portugal needs to revolutionise end-of-life care

Sa, 15/02/2020 - 01:00
End-of-life care is one of the most neglected areas in Portugal's health system.1 In adults and children, deaths caused by conditions requiring palliative care are rising,2,3 and this aligns with global projections.4 Portugal has the fourth highest aged population in the world, and is predicted to have the third by 2050.5 There is a continuing trend towards dying in hospital,2,3 which is often against people's preferences.6 Falling investment in end-of-life care will diminish the chances of reversing this trend and affect the conditions in which people die in hospitals.

[Correspondence] Anti-Semitism and critiquing the actions of Israel

Sa, 15/02/2020 - 01:00
As members of the health-care community, all of us Jewish, we disagree with the comments made by Julio Rosenstock and colleagues1 about the Correspondence by Paola Manduca and colleagues2 representing “a clear manifestation of anti-Semitism”.1 This accusation is commonly wielded as a means of foreclosing critical discussion of the behaviour of the state of Israel, conflating such criticism with anti-Semitism, meaning anti-Jewish.

[Department of Error] Department of Error

Sa, 15/02/2020 - 01:00
Cuzick J, Sestak I, Forbes JF, et al. Use of anastrozole for breast cancer prevention (IBIS-II): long-term results of a randomised controlled trial. Lancet 2020; 395: 117–22—The Acknowledgments of this Article have been updated as of Feb 13, 2020.

[Correspondence] Smoking cessation programmes in China

Sa, 15/02/2020 - 01:00
The Editors1 discuss China's commitment to improving the occupational health of its 776 million workers and outline a range of important health risks faced by this population (eg, dust, chemicals, and poison); however, they forget to mention one of the most critical hazards that they endure: smoking in the workplace.

[Correspondence] Exclusion criterion: learning disability

Sa, 15/02/2020 - 01:00
In 2013 the UK Department of Health commissioned an independent Confidential Inquiry into the premature deaths of people with learning disabilities.1 In response, the Learning Disabilities Mortality Review (LeDeR) programme, the first of its kind globally, was carried out by the Healthcare Quality Improvement Partnership on behalf of the UK National Health Service. The LeDeR programme had two aims: to improve the quality of health and social care, and to reduce premature mortality and health inequalities for people with learning disabilities.

[Clinical Picture] Breathlessness, pleural effusions, fibromas, and Meigs syndrome: look beyond the chest and don't delay!

Sa, 15/02/2020 - 01:00
A 51-year-old woman attended our hospital with a 3-week history of worsening shortness of breath. She had no other physical complaints. She had a history of rheumatoid arthritis, which was in remission. On physical examination she was breathless and had an increased respiratory rate. We found no signs of joint disease, sclerodactyly, skin eruption, or pretibial oedema. Arterial blood gas gave an oxygen saturation of 92% on room air. A chest x-ray showed large bilateral pleural effusions (figure).

[Health Policy] Improving the prognosis of health care in the USA

Sa, 15/02/2020 - 01:00
Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017).

[Comment] The global burden of chronic kidney disease

Ve, 14/02/2020 - 01:30
Chronic kidney disease (CKD) is a non-communicable disease usually caused by diabetes and hypertension.1 Cardiovascular disease is the major cause of the early morbidity and mortality sustained by patients with CKD. The severity of CKD can be quantified by a low serum creatinine-based estimated glomerular filtration rate (eGFR), which indicates excretory kidney function, and raised urinary albumin measured by the urinary albumin-to-creatinine ratio (ACR), which is a marker of kidney damage.2 The Kidney Disease: Improving Global Outcomes classification system for staging CKD is based on eGFR and ACR and is widely used in clinical practice.

[Comment] Do not violate the International Health Regulations during the COVID-19 outbreak

Ve, 14/02/2020 - 01:30
The International Health Regulations (2005) (IHR)1 govern how 196 countries and WHO collectively address the global spread of disease and avoid unnecessary interference with international traffic and trade. Article 43 of this legally binding instrument restricts the measures countries can implement when addressing public health risks to those measures that are supported by science, commensurate with the risks involved, and anchored in human rights.1 The intention of the IHR is that countries should not take needless measures that harm people or that disincentivise countries from reporting new risks to international public health authorities.

[Articles] Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Ve, 14/02/2020 - 01:30
Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI.

[Clinical Picture] First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia

Ve, 14/02/2020 - 01:30
A 56-year-old man presented to our Emergency Department in Toronto, ON, Canada, with fever and non-productive cough, 1 day after returning from a 3-month visit to Wuhan, China. Given this travel history, the transferring ambulance and receiving hospital personnel used appropriate personal protective equipment. He had a medical history of well controlled hypertension. On examination, his maximum temperature was 38·6°C, oxygen saturation was 97% on room air, and respiratory rate was 22 breaths per min—without any signs of respiratory distress.

[Comment] COVID-19: what is next for public health?

Gi, 13/02/2020 - 10:40
The WHO Scientific and Technical Advisory Group for Infectious Hazards (STAG-IH), working with the WHO secretariat, reviewed available information about the outbreaks of 2019 novel coronavirus disease (COVID-19) on Feb 7, 2020, in Geneva, Switzerland, and concluded that the continuing strategy of containment for elimination should continue, and that the coming 2–3 weeks through to the end of February, 2020, will be crucial to monitor the situation of community transmission to update WHO public health recommendations if required.

[Comment] European Green Deal: a major opportunity for health improvement

Gi, 13/02/2020 - 01:30
The European Green Deal1 aims to respond to the escalating climate crisis by achieving net zero greenhouse gas (GHG) emissions from the EU by 2050. Current policies will achieve only 60% reductions by 2050 from 1990 levels, indicating the need for increased ambition. Additionally, the deal aspires to “protect the health and well-being of citizens from environment-related risks and impacts” and establish a toxic-free environment, deliver healthy and sustainable diets, and protect biodiversity.1 This ambitious agenda would support planetary health.

[Correspondence] Anti-Chinese sentiment during the 2019-nCoV outbreak

Gi, 13/02/2020 - 01:30
The rampant spread of the 2019 novel coronavirus (2019-nCoV), first identified in Wuhan, Hubei, China, has stirred panic and an unwelcoming sentiment towards Chinese people across the world.1 Hong Kong, where a social movement triggered by an extradition bill to China has been ongoing since June, 2019, is at the forefront of this crisis. One example is Kwong Wing Catering, a pro-movement restaurant chain, which in a Facebook announcement on Jan 28, 2020, said it would only serve English or Cantonese-speaking but not Mandarin-speaking customers as a public health measure.