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[Correspondence] Tocilizumab in COVID-19 therapy: who benefits, and how?

Sab, 24/07/2021 - 00:00
The RECOVERY Collaborative Group reported statistically significant improvement in survival of patients with COVID-19 who were receiving tocilizumab interleukin (IL)-6 inhibitor, albeit with very modest reduction of mortality (31% vs 35% with usual care, p=0·0028).1 This result adds to a number of studies with tocilizumab and other IL-6 antagonists, such as sarilumab, which showed only minor, or no, reduction in mortality.2 Given that IL-6 is associated with COVID-19 severity and mortality,3 the question arises as to why IL-6 antagonist therapy does not substantially improve survival.

[Correspondence] Tocilizumab in COVID-19 therapy: who benefits, and how? – Authors' reply

Sab, 24/07/2021 - 00:00
We thank Chengliang Yang and Hedi Zhao for their interest in the thrombotic event rate in the RECOVERY trial of tocilizumab in patients hospitalised with COVID-19.1 Data on thrombotic events were only collected on follow-up forms from Nov 1, 2020, so these data are only available for about 60% of participants. Nevertheless, we observed no difference in the thrombotic event rate between patients allocated to tocilizumab or usual care alone (appendix).

[Correspondence] The nutrition agenda must include tobacco control

Sab, 24/07/2021 - 00:00
The Lancet's Series on progress in maternal and child undernutrition reminds us that malnutrition and stunting, and the double burden of obesity and malnutrition, remain important priorities for achieving Sustainable Development Goal 3 and other goals for child health. However, although recognising the importance of the environment and commercial determinants of food availability, the nutrition agenda continues to ignore the importance of tobacco control in achieving nutritional goals.

[Correspondence] The nutrition agenda must include tobacco control – Authors' reply

Sab, 24/07/2021 - 00:00
We thank Jonathan Klein for raising the issue of the direct and indirect effects of tobacco smoking on maternal and child undernutrition. Although our Series paper1 did not address the effects of specific risk factors such as tobacco on gestational weight gain and low birthweight, we recognise that smoking is an important determinant of fetal growth. The indirect effects relate to the trade-offs between purchasing nutritious foods and spending the limited family budget on tobacco, alcohol, and non-nutritious foods (eg, sugar-sweetened beverages).

[Correspondence] Heterogeneity of treatment effects in malignant pleural mesothelioma

Sab, 24/07/2021 - 00:00
The results from CheckMate 7431 are a relevant advance for the systemic treatment of patients with malignant pleural mesothelioma. However, we have concerns about the presentation and interpretation of subgroup analyses. Some further clarity would be helpful for the applicability of the study results in clinical practice, beyond the unequivocal clinically relevant effect observed in the whole population.

[Correspondence] Heterogeneity of treatment effects in malignant pleural mesothelioma – Authors' reply

Sab, 24/07/2021 - 00:00
We thank Massimo Di Maio and Marco Tagliamento for their Correspondence regarding CheckMate 743, a global, open-label, randomised, phase 3 study of first-line nivolumab plus ipilimumab versus chemotherapy in unresectable malignant pleural mesothelioma (MPM).1 We appreciate their remarks on the interaction test to investigate heterogeneity across histological subtypes.

[Clinical Picture] Contrast-associated acute kidney injury in a patient with lower respiratory tract infection

Sab, 24/07/2021 - 00:00
An 87-year-old woman presented to our hospital with a 3-day history of dyspnoea on exertion. She had a history of chronic kidney disease, pulmonary embolism, and recent right-sided ischaemic stroke causing aphasia and hemiparesis. She was taking aspirin, clopidogrel, and atorvastatin.

[Comment] Drowning prevention: priorities to accelerate multisectoral action

Ven, 23/07/2021 - 00:30
Most of the 235 000 deaths from drowning each year occur in low-income and middle-income countries (LMICs).1 A quarter of all drowning deaths are reported in children younger than 5 years and drowning is among the ten leading causes of deaths in young people aged 5–14 years.1 The world's highest child drowning rates are in populations who live around river basins in the Bay of Bengal across India and Bangladesh, with nearly 46 children drowning each day.2,3

[Editorial] A sporting chance: physical activity as part of everyday life

Gio, 22/07/2021 - 00:30
Sport is bringing some much needed joy to the world. The Olympics and Paralympics, the Copa América, the European Football Championship, and Wimbledon are bringing excitement to millions after postponement or cancellation in 2020 (safety concerns notwithstanding). Although watching elite sport might be more stimulating than addressing modern day sedentarism, a third Lancet Series published this week, following on from publications in 2012 and 2016, shows the importance of regular physical activity and sport to health and wellbeing.

[Perspectives] Melody Ding: connecting physical activity and public health

Gio, 22/07/2021 - 00:30
As a lead author of the new Lancet Series on physical activity, Melody Ding emphasises the broader context of her work in this field. “My main research area of physical activity is interlinked with many other areas of public health, such as diet and environmental health; this helps me better understand physical activity. I am constantly learning from my mentors, colleagues, and students, one of the most enjoyable aspects of my job”, says Ding, who is Associate Professor in the School of Public Health at the University of Sydney, Australia.

[Comment] Scaling up urban infrastructure for physical activity in the COVID-19 pandemic and beyond

Gio, 22/07/2021 - 00:30
Urban design, planning, and transport play an important role in the promotion of physical activity.1 Since 2010, active transportation systems and active urban design have been recognised as among the best investments for encouraging physical activity at scale.2 Designing and planning activity-promoting cities can help prevent premature mortality,3 reduce the high costs associated with physical inactivity,4,5 and help countries achieve some of the UN Sustainable Development Goals.6 During the COVID-19 pandemic, there have been declines in physical activity worldwide,7 highlighting the need for widespread, accessible, and safe public open spaces for active recreation and infrastructure for active transportation in cities.

[Comment] Moving beyond more: towards a healthy balance of daily behaviours

Gio, 22/07/2021 - 00:30
Increasing physical activity has long been a target of policies and interventions worldwide and requires system-wide multisectoral solutions. The papers in this Lancet Series on physical activity1–3 allude to the need to move from simply aiming for more physical activity towards finding a healthy balance between daily behaviours. To understand physical activity holistically, and to inform interventions and their best timing across the life course, it is important to consider the trade-offs involved in making time for physical activity alongside the type and context of activities.

[Series] Physical activity behaviours in adolescence: current evidence and opportunities for intervention

Gio, 22/07/2021 - 00:30
Young people aged 10–24 years constitute 24% of the world's population; investing in their health could yield a triple benefit—eg, today, into adulthood, and for the next generation. However, in physical activity research, this life stage is poorly understood, with the evidence dominated by research in younger adolescents (aged 10–14 years), school settings, and high-income countries. Globally, 80% of adolescents are insufficiently active, and many adolescents engage in 2 h or more daily recreational screen time.

[Series] An evidence-based assessment of the impact of the Olympic Games on population levels of physical activity

Gio, 22/07/2021 - 00:30
Pre-Olympic Games predictions commonly include an increase in population-based physical activity in the host city, as often stated in the bid, but the post-Olympic Games effects on physical activity have not been summarised. In this Series paper, we aim to do the following: examine mentions of a physical activity legacy in pre-Olympic bid documentation; analyse existing physical activity surveillance data collected before, during, and after the Olympic Games in hosting areas around the world; and evaluate Google Trends data surrounding the London 2012 Olympic Games as a case study of community interest in the topic of exercise during the time of the Olympic Games.

[Series] Participation of people living with disabilities in physical activity: a global perspective

Gio, 22/07/2021 - 00:30
Approximately 1·5 billion people worldwide live with a physical, mental, sensory, or intellectual disability, about 80% of which are in low-income and middle-income countries. This Series paper provides a global overview of the prevalence, benefits, and promotion policies for physical activity for people living with disabilities (PLWD). PLWD are 16–62% less likely to meet physical activity guidelines and are at higher risk of serious health problems related to inactivity than people without disabilities.

[Comment] Answering the call to support youth orphaned by COVID-19

Mer, 21/07/2021 - 00:30
As of July 7, 2021, more than 4 million people have died of COVID-19.1 A large portion of the scientific and media attention has focused on COVID-19-related mortality of adults, with less focus on the bereaved children these deceased adults have left behind. It is vital to draw awareness to the various ways in which children are affected by the pandemic—including the psychosocial burdens of unexpected parental or caregiver loss and the resulting secondary adversities (eg, poverty, abuse, and institutionalisation).

[Comment] Appropriate vascular access for patients with cancer

Mer, 21/07/2021 - 00:30
Questions as to how best to meet vascular access needs and safety requirements when caring for patients with cancer occur daily in clinical practice, yet evidence for which methods are optimal is poor. In cancer, use of vascular devices such as peripherally inserted central catheters (PICCs), Hickman-type tunnelled catheters (eg, Hickman), or totally implanted ports (PORTs) is common. Collectively, these are referred to as central venous access devices (CVADs). Hickman and PICCs are catheters with an external segment, in contrast to PORTs, which are totally implanted under the skin.

[Articles] Global minimum estimates of children affected by COVID-19-associated orphanhood and deaths of caregivers: a modelling study

Mer, 21/07/2021 - 00:30
Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children.

[Articles] Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial

Mer, 21/07/2021 - 00:30
For most patients receiving SACT, PORTs are more effective and safer than both Hickman and PICCs. Our findings suggest that most patients receiving SACT for solid tumours should receive a PORT within the UK National Health Service.

[Comment] Will the COVID-19 crisis catalyse universal health reforms?

Sab, 17/07/2021 - 00:30
The historian Walter Scheidel has argued that reductions in inequality have often emerged after war, revolution, state collapse, and plague.1 On July 12, 2021, there were more than 4 million deaths from COVID-19 globally.2 The disproportionate and unequal impact of COVID-19 on populations has brought renewed attention to deep inequalities. Will the impacts of COVID-19 galvanise efforts to reduce inequality?