The Lancet RSS Feed: current issue. The Lancet is a weekly medical journal, renowned for the publication of high-quality peer-reviewed research from around the world. It provides context and insight to advancements in medicine and health worldwide.
Aggiornato: 11 ore 31 min fa
Peter Kokkinos and colleagues (Feb 2, p 394) describe the interactive effects of fitness and statins on mortality risk in veterans with dyslipidaemia. They report that increasing physical activity and statins independently lowers lipid levels and total mortality, but that the combination of these interventions is superior to either alone. The authors conclude that prescription of physical activity is as important as prescribing statins in groups with increased cardiovascular risk.
Peter Kokkinos and colleagues report that, in dyslipidaemic individuals, combination of statin treatment and fitness lowers mortality risk more than either alone. However, patients not prescribed statins but who were highly fit still had a significantly lower risk of mortality than those taking statins, but who were unfit. These findings might be important in clinical practice in which mounting evidence has established that fatigue and exertional intolerance are frequent adverse effects reported by patients receiving statins.
We read with interest the article by Peter Kokkinos and colleagues. Although cardiorespiratory fitness is developed by physical activity, they are different, and they are linked differently to cardiovascular disease, with cardiorespiratory fitness having a stronger protective association. Being inactive and being unfit are independent risk factors, and inactivity might not be a cause of being unfit. Thus, recommendation of physical activity basis of the cardiorespiratory fitness status might not be entirely appropriate.
We thank Thijs Eijsvoels and colleagues for their thoughtful comments on our study regarding physical activity and statin therapy. As they state, physically active individuals might be more vulnerable to the skeletal muscle side-effects of statins. A lipid-lowering agent that will not adversely affect skeletal muscle will certainly be welcomed.
I agree with Pedro Hallal and I-Min Lee (Feb 2, p 356) that “prescription of physical activity should be placed on a par with drug prescription”. However, this statement implies that doctors know how to prescribe, monitor, and evaluate the effectiveness of the exercise prescribed (eg, adapting exercise type, intensity, frequency, and duration according to individuals' characteristics, such as age and chronic conditions). Scientific reports these instructions do not provide enough information to empower people to exercise, especially if the patient has a comorbid condition, such as osteoarthritis.
Philipe de Souto Barreto raises an important issue in response to our Comment on the need for more prescription of physical activity by physicians. How prepared are doctors to do so? A survey of 31 medical schools in the UK reported that physical activity education in the undergraduate curriculum is virtually non-existent. The situation is not much better in the USA, where only 13% of medical schools feature physical activity education within their curriculum. Although we were unable to find statistics, this situation is likely to be more dire in medical schools in low-income and middle-income countries.
The World Oncology Forum was convened by the European School of Oncology (ESO) for its 30th anniversary in Lugano, Switzerland, with the task of evaluating progress so far in the war against cancer.
Alain Braillon questions why the endnote to the Stop Cancer Now! appeal indicates that the World Oncology Forum was “totally independent of commercial sponsorship”. The reason is that the credibility of the World Oncology Forum and of the Stop Cancer Now! appeal depends on their freedom from influence by commercial interests, so we felt it was important to add this point.
In response to Gregor Pollach's criticism (Jan 19, p 199) that Daniel Bainbridge and colleagues' systematic review of anaesthesia-related mortality did not include evidence from lowest-income countries, Bainbridge and colleagues replied that there are “few published studies on this issue from the lowest-income countries”.
[Correspondence] Mumps outbreak in private schools: public health lessons for the post-Wakefield era
In September 2012, we managed an outbreak of mumps among pupils in a private boarding school in Sedbergh, UK. The school has around 550 pupils aged 4–18 years, but the mumps outbreak was confined to students aged 13–18 years. Many pupils come from overseas, and in particular from east Asia. We believe that the outbreak highlights the risks of mumps and measles following the Andrew Wakefield MMR vaccine controversy, and the subsequent reduction in uptake of the vaccine. Of the 66 clinical cases of mumps, 35 were laboratory confirmed, and vaccination histories were available for 55 cases.
Dara Mohammadi, in his piece “US-led economic sanctions strangle Iran's drug supply” (Jan 26, p 279), correctly explains some of the consequences of economic sanctions on Iran, but some clarifications are needed.
Maercker A, Brewin CR, Bryant RA, et al. Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet 2013; 381:1683–85—In this Viewpoint (published online May 11), the ninth author's name should have been Ashraf Kagee. This correction has been made to the online version as of May 10, 2013, and to the printed Viewpoint.
Wang LW, Kotlyar E, Bester L, Feneley MP, Omari A, Subbiah RN. Pulmonary arteriovenous malformation: an unusual cause of exertional dyspnoea. Lancet 2013; 381: 1430—The supplementary video caption 1 for this Case Report (April 20) should have read: “Taken from the apical 4-chamber transducer position during peripheral agitated saline contrast injection. Bubbles appear in the left atrium and ventricle five beats later, which is consistent with a fast pulmonary transit time.” Supplementary video caption 2 should have read: “Selective pulmonary angiography of the left inferior pulmonary artery demonstrating the presence of a pulmonary arteriovenous malformation.
[Articles] Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial
In well coordinated mental health services the imposition of compulsory supervision does not reduce the rate of readmission of psychotic patients. We found no support in terms of any reduction in overall hospital admission to justify the significant curtailment of patients' personal liberty.
[Articles] Clinical outcomes of Joint Crisis Plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial
Our findings are inconsistent with two earlier JCP studies, and show that the JCP is not significantly more effective than treatment as usual. There is evidence to suggest the JCPs were not fully implemented in all study sites, and were combined with routine clinical review meetings which did not actively incorporate patients' preferences. The study therefore raises important questions about implementing new interventions in routine clinical practice.
[Articles] National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis
Trends in contraceptive prevalence and unmet need for family planning, and the projected growth in the number of potential contraceptive users indicate that increased investment is necessary to meet demand for contraceptive methods and improve reproductive health worldwide.
A 71-year-old, obese woman presented to our clinic with multiple seborrheic keratoses over her entire body (). She reported the rapid appearance of the tumours several weeks before an initial diagnosis of breast cancer. Histopathological examination confirmed seborrhoeic keratoses, and we diagnosed Leser-Trélat sign. More than 500 tumours were ablated by curettage because of recurring superinfections ().
Studies of families and twins show the importance of genetic factors affecting susceptibility to bipolar disorder and suggest substantial genetic and phenotypic complexity. Robust and replicable genome-wide significant associations have recently been reported in genome-wide association studies at several common polymorphisms, including variants within the genes CACNA1C, ODZ4, and NCAN. Strong evidence exists for a polygenic contribution to risk (ie, many risk alleles of small effect). A notable finding is the overlap of susceptibility between bipolar disorder and schizophrenia for several individual risk alleles and for the polygenic risk.
Bipolar disorder refers to a group of affective disorders, which together are characterised by depressive and manic or hypomanic episodes. These disorders include: bipolar disorder type I (depressive and manic episodes: this disorder can be diagnosed on the basis of one manic episode); bipolar disorder type II (depressive and hypomanic episodes); cyclothymic disorder (hypomanic and depressive symptoms that do not meet criteria for depressive episodes); and bipolar disorder not otherwise specified (depressive and hypomanic-like symptoms that do not meet the diagnostic criteria for any of the aforementioned disorders).
We review recent developments in the acute and long-term treatment of bipolar disorder and identify promising future routes to therapeutic innovation. Overall, advances in drug treatment remain quite modest. Antipsychotic drugs are effective in the acute treatment of mania; their efficacy in the treatment of depression is variable with the clearest evidence for quetiapine. Despite their widespread use, considerable uncertainty and controversy remains about the use of antidepressant drugs in the management of depressive episodes.