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[World Report] West Africa on alert for haemorrhagic fevers

Sab, 21/08/2021 - 00:00
Cases of Ebola virus disease and Marburg virus disease have prompted national and regional emergency responses. Paul Adepoju reports.

[Perspectives] Radiation oncology 2.0

Sab, 21/08/2021 - 00:00
Radiology, pathology, and dermatology are generally considered leading specialties in the medical use of artificial intelligence (AI). But radiation oncology is also increasingly using AI and machine learning (ML) in patient care. In an international survey, about a third of radiation oncologists and medical physicists are now using or preparing to use ML, primarily for image segmentation and treatment planning.

[Perspectives] Ollie Jay: managing heat, improving health

Sab, 21/08/2021 - 00:00
“Our work is all about driving multidisciplinary efforts to help find solutions to complex health problems arising from the impact of heat stress, all within the context of increasing extreme weather events as a result of climate change”, explains Ollie Jay, Professor of Heat and Health in the Faculty of Medicine and Health at the University of Sydney, Australia. Jay is also Director of the Thermal Ergonomics Laboratory within the Sydney Heat and Health Research Centre. “We have a rich research environment with many opportunities to work across broad sections of academia, industry, and in our collaborations with many Australian sports organisations to develop policies and systems that reduce the impact of extreme heat on health outcomes”, he says.

[Obituary] Purnell Whittington Choppin

Sab, 21/08/2021 - 00:00
Virologist, physician–scientist, and administrator. Born in Baton Rouge, LA, USA, on July 4, 1929, he died of prostate cancer in Washington, DC, USA, on July 3, 2021, aged 91 years.

[Correspondence] Revisiting the evidence for physical distancing, face masks, and eye protection

Sab, 21/08/2021 - 00:00
Derek Chu and colleagues’ 2020 meta-analysis1 was epidemiologically flawed. In a comparison of countries where face mask wearing was mandatory (eg, China) with countries where it was not (eg, Italy), they find a lower rate of COVID-19 in countries where masks were mandatory.1 Many variables can explain such a finding, so it is clearly a case of correlation not causation. The only country-wide study included in the meta-analysis that investigated whether face mask wearing protects against COVID-19 was from China.

[Correspondence] Revisiting the evidence for physical distancing, face masks, and eye protection

Sab, 21/08/2021 - 00:00
Derek Chu and colleagues1 concluded, based on an analysis of a subgroup of observational studies, that health-care workers might afford greater protection against SARS-CoV-2 infection from N95 respirators than from surgical masks. They acknowledge substantial limitations and rated certainty of effect as low. We would argue it is lower still, as several studies seem to have been misclassified with regard to mask type.

[Correspondence] Revisiting the evidence for physical distancing, face masks, and eye protection

Sab, 21/08/2021 - 00:00
Derek Chu and colleagues reported that face mask wearing in hospitals and health-care settings reduces risk of respiratory infection.1 Surprisingly, this recommendation was extended to the general population. Summary estimates were calculated using results of three severe acute respiratory syndrome studies, of which only two yielded statistically significant results. The first study was done in households, a situation that is similar to a health-care setting.2 The second was a case-control study in the general population where infected and uninfected individuals were asked via telephone interviews whether they had worn a mask during past interactions.

[Correspondence] Revisiting the evidence for physical distancing, face masks, and eye protection

Sab, 21/08/2021 - 00:00
Derek Chu and colleagues1 examined whether physical distancing, face masks, and eye protection could prevent transmission of SARS-CoV-2. We are concerned that some of the data from the included preprints were out of date, affecting the results of the meta-analysis.

[Correspondence] Revisiting the evidence for physical distancing, face masks, and eye protection

Sab, 21/08/2021 - 00:00
We read with great interest the results of the systematic review1 on the effect of personal protective equipment (PPE) to prevent SARS-CoV-2 infection, predominantly based on evidence from other betacoronaviruses. As this work raised many more questions than it answered, and because its implications are far-reaching, we highlight several salient concerns.

[Correspondence] Revisiting the evidence for physical distancing, face masks, and eye protection

Sab, 21/08/2021 - 00:00
The systematic review and meta-analysis by Derek Chu and colleagues1 has several problems. First, the investigators combine data on SARS-CoV-2, SARS-CoV, and MERS-CoV. The characteristics of the diseases caused by these viruses are different.2,3 The basic reproduction number of MERS-CoV is close to 1,2 mild illness was infrequent for SARS-CoV,3 and relevant presymptomatic, paucisymptomatic, or asymptomatic transmission occurs commonly only with SARS-CoV-2,3,4 which will affect performance of control measures.

[Correspondence] Revisiting the evidence for physical distancing, face masks, and eye protection – Authors' reply

Sab, 21/08/2021 - 00:00
We appreciate the comments we received on our urgent evidence synthesis addressing use of masks, eye protection, and distancing early on in the COVID-19 pandemic.1 Although we appreciate Willem Lijfering's concerns, he appears to have misunderstood the intent of our analysis to be a comparison of rates between countries, which would be an ecological analysis. As clearly reflected in our stated objective and eligibility criteria, we included only comparative studies and focused on relative effects for all intervention effects.

[Articles] Estimating the cause-specific relative risks of non-optimal temperature on daily mortality: a two-part modelling approach applied to the Global Burden of Disease Study

Sab, 21/08/2021 - 00:00
Acute heat and cold exposure can increase or decrease the risk of mortality for a diverse set of causes of death. Although in most regions cold effects dominate, locations with high prevailing temperatures can exhibit substantial heat effects far exceeding cold-attributable burden. Particularly, a high burden of external causes of death contributed to strong heat impacts, but cardiorespiratory diseases and metabolic diseases could also be substantial contributors. Changes in both exposures and the composition of causes of death drove changes in risk over time.

[Series] Hot weather and heat extremes: health risks

Sab, 21/08/2021 - 00:00
Hot ambient conditions and associated heat stress can increase mortality and morbidity, as well as increase adverse pregnancy outcomes and negatively affect mental health. High heat stress can also reduce physical work capacity and motor-cognitive performances, with consequences for productivity, and increase the risk of occupational health problems. Almost half of the global population and more than 1 billion workers are exposed to high heat episodes and about a third of all exposed workers have negative health effects.

[Series] Reducing the health effects of hot weather and heat extremes: from personal cooling strategies to green cities

Sab, 21/08/2021 - 00:00
Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat.

[Department of Error] Department of Error

Gio, 19/08/2021 - 00:30
Yu L-M, Bafadhel M, Dorward J, et al. Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet 2021; 398: 843–55—In this Article, in figure 1, “primary analysis” was corrected to “secondary analysis” in reference to the all participants population. In figure 2, the key was incorrect and has now been amended. In figure 3B, a typing error has been corrected in the p value for duration of illness.

[Comment] More than honour, humanitarian health-care workers need life-saving protection

Gio, 19/08/2021 - 00:30
Honouring all humanitarian workers, including health-care professionals, Aug 19, 2021, marks the second World Humanitarian Day since the start of the COVID-19 pandemic. Many humanitarian workers have given their lives to support and protect the communities they serve, including millions of the world's most vulnerable women, children, and adolescents.

[Articles] Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Mer, 18/08/2021 - 00:30
Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR.

[Comment] In-country data will illuminate under-5 mortality disparities

Mer, 18/08/2021 - 00:30
In The Lancet, Nicholas Kassebaum and colleagues present all-cause and cause-specific mortality findings from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to illustrate global, regional, and national progress toward Sustainable Development Goal 3.2 for neonatal and child health.1 Their analysis provides a comprehensive assessment of under-5 and neonatal mortality across 203 countries, including a focus on preventable mortality and projections to 2030. The authors' meta-level look at death rates and cause-specific mortality, grouped by country level and sociodemographic indices, also looks at the effect of COVID-19 on future projections.

[Editorial] The NHS: the many challenges for leadership

Sab, 14/08/2021 - 00:00
Amanda Pritchard has her work cut out. The new Chief Executive of NHS England has taken charge of an organisation reeling from the pressures of the past 18 months, with huge backlogs in care, an exhausted workforce, and the COVID-19 pandemic not yet over. Reforms to the health service are making their way through parliament in the teeth of opposition from union leaders who say the timing is wrong. Pritchard is respected and seemingly well liked. “I am realistic. I am also optimistic”, she said on taking up her new role on Aug 1.

[World Report] Haiti's health woes intensify

Sab, 14/08/2021 - 00:00
Assassination, after months of violence, fuel shortages, and protests, has led to instability in Haiti, causing interruptions to normal care and the COVID-19 response. Joe Parkin Daniels reports.