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[Articles] Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK

Sa, 02/07/2022 - 00:00
This trial found equivalence in pain at 3 days in children with a torus fracture of the distal radius assigned to the offer of a bandage group or the rigid immobilisation group, with no between-group differences in pain or function during the 6 weeks of follow-up.

[Articles] Effectiveness of interventions to improve drinking water, sanitation, and handwashing with soap on risk of diarrhoeal disease in children in low-income and middle-income settings: a systematic review and meta-analysis

Sa, 02/07/2022 - 00:00
WASH interventions reduced risk of diarrhoea in children in LMICs. Interventions supplying either water filtered at POU, higher water quality from an improved source on premises, or basic sanitation services with sewer connection were associated with increased reductions. Our results support higher service levels called for under SDG 6. Notably, no studies evaluated interventions that delivered access to safely managed WASH services, the level of service to which universal coverage by 2030 is committed under the SDG.

[Clinical Picture] Not all post-traumatic swellings are haematomas: be alert to a Morel-Lavallée lesion

Sa, 02/07/2022 - 00:00
A 34-year-old man was brought to our Emergency Department after a truck ran over the right side of his body while he was out walking. He had no medical history.

[Seminar] Complex post-traumatic stress disorder

Sa, 02/07/2022 - 00:00
Complex post-traumatic stress disorder (complex PTSD) is a severe mental disorder that emerges in response to traumatic life events. Complex PTSD is characterised by three core post-traumatic symptom clusters, along with chronic and pervasive disturbances in emotion regulation, identity, and relationships. Complex PTSD has been adopted as a new diagnosis in the ICD-11. Individuals with complex PTSD typically have sustained or multiple exposures to trauma, such as childhood abuse and domestic or community violence.

[Correspondence] Clinical severity of omicron lineage BA.2 infection compared with BA.1 infection in South Africa

Ve, 01/07/2022 - 00:30
The omicron SARS-CoV-2 variant of concern (B.1.1.529) was first reported in South Africa in mid-November, 2021. Early data indicated that infection with omicron (around 99% BA.1 lineage during this period) was associated with a lower risk of hospitalisation and lower risk of severe illness, once hospitalised, compared with delta (B.1.617.2) variant infection.1 Recently, the BA.2 lineage has increased in many areas globally, including South Africa, associated with increases in case numbers in some settings.

[Comment] COVID-19 vaccination for children aged 5–11 years

Ve, 01/07/2022 - 00:30
COVID-19 vaccines have already prevented millions of deaths during the current pandemic.1 Given the strong association between increasing age and severe COVID-19 outcomes, adults were prioritised for vaccination when the first COVID-19 vaccines were authorised at the end of 2020.2 For children, BNT162b2 (Pfizer–BioNTech), an mRNA-based vaccine against SARS-CoV-2, was authorised in May, 2021, for adolescents aged 12–15 years and in December, 2021, for those aged 5–11 years. In The Lancet, Chiara Sacco and colleagues3 report the effectiveness of BNT162b2 in children aged 5–11 years after the omicron variant (B.1.1.529) emerged in Italy.

[Articles] Effectiveness of BNT162b2 vaccine against SARS-CoV-2 infection and severe COVID-19 in children aged 5–11 years in Italy: a retrospective analysis of January–April, 2022

Ve, 01/07/2022 - 00:30
Vaccination against COVID-19 in children aged 5–11 years in Italy showed a lower effectiveness in preventing SARS-CoV-2 infection and severe COVID-19 than in individuals aged 12 years and older. Effectiveness against infection appears to decrease after completion of the current primary vaccination cycle.

[Correspondence] The fall of Roe v Wade: a call to action for religious medical providers

Gi, 30/06/2022 - 00:30
On June 24, 2022, the Supreme Court of the USA overturned Roe v Wade, the culmination of a 5 decades-long effort to remove the strongest legal protection of abortion the USA has had thus far. The abortion discourse in the USA has been essentialised to a polarised debate, in which pro-life is equated with a religious–moral injunction to protect the unborn fetus from pro-choice secularists. This rhetoric obfuscates the decades-long activism of faith-based reproductive rights groups for maternal choice and empowers an outlying religious interpretation of prenatal fetal life over the majority of other religious (and non-religious) Americans.

[Series] The political and social contexts of global road safety: challenges for the next decade

Gi, 30/06/2022 - 00:30
The goal of this Series paper is to show how road safety has evolved as a global public health issue over the past two decades and to discuss the political and economic dynamics that led to this change. Specifically, the key stakeholders, influences, networks, issue framing, actor power, and synergistic interactions that have contributed to how road safety has evolved as a global public health issue will be discussed. In doing so, we capture the important chronology of events and discuss a set of challenges that highlight the complexity of road safety.

[Series] Improvement in trauma care for road traffic injuries: an assessment of the effect on mortality in low-income and middle-income countries

Gi, 30/06/2022 - 00:30
Over 90% of the annual 1·35 million worldwide deaths due to road traffic injuries (RTIs) occur in low-income and middle-income countries (LMICs). For this Series paper, our aim was two-fold. Firstly, to review evidence on effective interventions for victims of RTIs; and secondly, to estimate the potential number of lives saved by effective trauma care systems and clinical interventions in LMICs. We reviewed all the literature on trauma-related health systems and clinical interventions published during the past 20 years using MEDLINE, Embase, and Web of Science.

[Series] Saving lives through road safety risk factor interventions: global and national estimates

Gi, 30/06/2022 - 00:30
Global road mortality is a leading cause of death in many low-income and middle-income countries. Data to support priority setting under current resource constraints are urgently needed to achieve Sustainable Development Goal (SDG) 3.6. This Series paper estimates the potential number of lives saved if each country implemented interventions to address risk factors for road injuries. We did a systematic review of all available evidence-based, preventive interventions for mortality reduction that targeted the four main risk factors for road injuries (ie, speeding, drink driving, helmet use, and use of seatbelt or child restraint).

[Editorial] Road safety: more than reducing injuries

Gi, 30/06/2022 - 00:30
The UN High-Level Meeting on global road safety (June 30–July 1) aims to put the issue on the highest political agenda. The need is huge. The global burden of road traffic injuries is estimated at an annual 1·35 million deaths, and 50 million injuries and disabilities. Road traffic injuries are not limited to drivers, but also affect pedestrians, cyclists, and motorcyclists. They are also the global leading cause of death for children and young people aged 5–29 years. There have been international commitments on road safety: Sustainable Development Goal (SDG) target 3.6 calls for a 50% reduction of road traffic injuries by 2030 (they are the only type of injury with an explicit SDG target); SDG target 11.2 demands safe and sustainable transport for all; the UN's decade of road traffic injury action from 2010 to 2020; and a biennial UN Global Road Safety Week.

[Comment] Tenecteplase for acute ischaemic stroke

Me, 29/06/2022 - 16:00
The introduction of intravenous thrombolysis for acute ischaemic stroke has changed the outlook of stroke neurology, altering the field from a rehabilitation focus to emergency medicine. Because the treatment effect of intravenous thrombolysis in acute stroke is time dependent, stroke services globally are constantly striving to reduce the time from symptom onset to treatment by promoting stroke awareness campaigns, implementing prehospital delivery of thrombolysis in mobile stroke units, and restructuring in-hospital protocols to reduce door-to-needle time.

[Articles] Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial

Me, 29/06/2022 - 16:00
Intravenous tenecteplase (0·25 mg/kg) is a reasonable alternative to alteplase for all patients presenting with acute ischaemic stroke who meet standard criteria for thrombolysis.

[Comment] A new paradigm is needed for financing the pandemic fund

Me, 29/06/2022 - 12:00
At the second meeting of the G20 finance ministers and central bank governors on April 20, 2022, the G20, under the presidency of Indonesia, agreed to establish a new financial mechanism: a Financial Intermediary Fund (FIF) for pandemic prevention, preparedness, and response (PPR) to be hosted by the World Bank.1,2 The proposed FIF will be discussed at the World Bank board meeting on June 30, 2022, and is expected to be launched in the third quarter of 2022.

[Comment] Istanbul Protocol 2022 empowers health professionals to end torture

Me, 29/06/2022 - 11:00
Torture, one of the most heinous crimes known to humanity, inflicts profound harms on individuals and threatens the health, dignity, and wellbeing of families and communities. Health professionals have a duty both to document torture and to protect human rights as a foundation for human health and wellbeing.1 Effective clinical investigation and documentation are essential to corroborate allegations of torture and other forms of ill-treatment and to achieve prevention, accountability, and redress for such crimes.

[Comment] Reducing the threat of epidemic-prone infections at mass gathering religious events

Ma, 28/06/2022 - 00:30
Mass gathering sporting, religious, festival, and celebratory events attract people from across the world and create optimal conditions for the transmission of a range of infectious diseases with epidemic potential.1 Countries hosting recurrent annual religious pilgrimages that cater for millions of overseas and local pilgrims have the arduous task of reducing risk for the importation, amplification, and transmission of infectious diseases between pilgrims and indigenous populations, and exportation overseas after the event.

[Editorial] Cancer care: widening the scope of innovation

Sa, 25/06/2022 - 00:00
The keynote address at the 2022 American Society of Clinical Oncology (ASCO) meeting earlier in June was met with great enthusiasm. André Ilbawi, WHO's Cancer Control Officer, announced the first partnership between ASCO and WHO that, he says, “catalyses meaningful innovation to address persistent inequities—locally and globally—in cancer care”. The principle of the collaboration is to incentivise “social and organisational innovations” rather than the development of new drugs or diagnostics, particularly in low-income and middle-income countries.

[Comment] Early introduction of allergenic food for all infants

Sa, 25/06/2022 - 00:00
The 2015 Learning Early About Peanut Allergy (LEAP) study triggered a paradigm shift in the field of food allergy prevention from an understanding that, in infants at high risk of developing a peanut allergy, prevention was best achieved by peanut avoidance to active early peanut consumption.1 LEAP showed that in infants at high risk of peanut allergy aged 4–10 months with either severe eczema or egg allergy, or both, peanut consumption three times a week achieved an 81% reduction in the prevalence of peanut allergy at 5 years of age.

[Comment] The 2022 Wakley Prize: compassion and connection

Sa, 25/06/2022 - 00:00
During the COVID-19 pandemic health professionals have found themselves working in a landscape that has been utterly transformed, for good and ill. There have been remarkable advances, such as accelerated research to produce effective treatments and vaccines, and increased use of digital health care. There are also ongoing challenges in many health-care settings, such as staff shortages, the pressures of long waiting lists for routine care, and an exhausted health workforce. Yet whatever the innovations and adversities, compassion and connection remain fundamental to establishing a positive, healing relationship between health-care workers and patients.