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Les derniers abstracts de la revue The Lancet :

    Date de mise en ligne : Samedi 14 janvier 2017
    The Lancet
    [Editorial] Health in India, 2017
    Two randomised controlled trials from Goa, India, in today's Lancet assess brief psychological treatment delivered by lay counsellors in primary care for depression (the Healthy Activity Program; HAP) and for harmful drinking (Counselling for Alcohol Problems; CAP). Although WHO recommends psychological interventions for mental health disorders, evidence comes largely from high-income countries. These trials from the PRogram for Effective Mental health Interventions in Under-resourced health systeMs (PREMIUM), show feasibility, outcomes, and cost in a developing country.

    Date de mise en ligne : Samedi 14 janvier 2017
    The Lancet
    [Editorial] ACA repeal and the AMA
    With inauguration day just a week away, there has been much soul-searching in the USA concerning the future of US health care, as America moves ever closer to at least a partial dismantling of the Affordable Care Act (ACA). The outgoing president set out his views last week, reminding US physicians of the ACA's successes, and being upfront about its shortcomings. The president's core message is clear—any form of ACA repeal until an alternative plan is in place is unthinkable.

    Date de mise en ligne : Samedi 14 janvier 2017
    The Lancet
    [Editorial] Clinical guidance for bronchiolitis
    The UK National Health Service and health-care providers across the northern hemisphere are under unprecedented pressure this month, which coincides with peak season for respiratory infections. Of note is bronchiolitis, a common, and usually mild, viral infection that is caused by respiratory syncytial virus (RSV) in 70% of cases and predominantly affects children under the age of 2 years. Bronchiolitis causes inflammation in the lower respiratory tract and symptom profiles vary from mild to extremely serious, rendering diagnosis of the condition and prognosis challenging.

    Date de mise en ligne : Mardi 29 novembre 2016
    Alberto Papi, Leonardo M Fabbri
    [Comment] Management of patients with early mild asthma and infrequent symptoms
    Persistent asthma leads to fixed airflow limitation,1 albeit through complex trajectories,2 and to decreased survival3 but whether these effects occur in early diagnosed mild asthma (within 3 months before trial entry or first medical access) is not clear. Inhaled glucocorticosteroids (ICS) reduce symptoms and exacerbations in symptomatic mild-to-moderate asthmatics,4 but whether these drugs prevent fixed airflow limitation is unknown.2,5 The reduction of mortality associated with ICS suggested by a population-based study6 was never confirmed in randomised clinical trials (RCTs).

    Date de mise en ligne : Mardi 06 décembre 2016
    Majid Ezzati, Jill C Baumgartner
    [Comment] Household energy and health: where next for research and practice?
    Cooking and home heating with coal and biomass fuels (wood, crop residues, animal dung, and charcoal) are ideal subjects for well intentioned epidemiology. Cooking and heating with such fuels generate large amounts of pollutants that can harm people's health throughout the lifecourse, a risk that largely affects poor communities. In a simple world, epidemiology would investigate the hazardous effects and test the benefits of any interventions, and rational individuals and policy bodies would use this information to initiate positive change.

    Date de mise en ligne : Mercredi 14 décembre 2016
    Roberta Agabio
    [Comment] Non-specialist health workers to treat excessive alcohol consumption and depression
    Excessive alcohol consumption and depression are two of the leading causes of mortality and morbidity worldwide,1,2 impairing quality of life, social functioning, and participation in the workplace. These mental health conditions frequently co-occur in the same individuals, exacerbating the risks and burdens for individuals and their communities.3 Globally, excessive alcohol consumption and depression produce a huge socioeconomic burden and constitute two of the highest risk factors for disability.

    Date de mise en ligne : Samedi 14 janvier 2017
    Michael Wilkes, Mitchell D Feldman
    [Comment] Mentoring clinical trainees: a need for high touch
    Training young doctors in the USA has traditionally relied on the transfer of critical knowledge, skills, and attitudes from experienced senior physicians to new generations. Typically, a trainee engaged in book learning and progressive clinical responsibilities until the senior physician was confident that the trainee was capable of providing patient care independently. This transfer of knowledge and skills was expected to take place through an apprenticeship-like arrangement between the senior clinician and his or her trainee, a relationship we would now recognise as mentoring.

    Date de mise en ligne : Samedi 14 janvier 2017
    Nazaneen Nikpour Hernandez, Soe Myint
    [Comment] Can Myanmar's older people lead the way to universal health coverage?
    The unique prospects in Myanmar, created by its emergence from years of isolation, reflect a country that is in the early stages of capacity building bolstered by renewed governmental commitment. This inspires an exciting potential for new strategies to be adopted for universal health coverage (UHC) by 2030. We suggest the health and social needs of older people should be targeted as an approach to tackle the high burden of non-communicable diseases (NCDs) and create a strong health system. This approach might seem counter-intuitive at first, in terms of achieving the most benefit, but in view of the rapid development in Myanmar it would show admirable foresight.

    Date de mise en ligne : Jeudi 22 décembre 2016
    Raffaella Bosurgi, Richard Horton
    [Comment] The Lancet Planetary Health: a new journal for a new discipline—a call for papers
    Planetary health has been defined as the health of the human civilisation and the state of the natural systems on which it depends.1 To explain this idea in simple terms we need to think of humanity as one of the key driving forces of global environmental change. We live on a planet that is shaped by the activities of human beings. We have benefited from the exploitation of the natural resources of the environment and this has allowed us to develop, flourish, and improve our health.1 But, we have now gone beyond a sustainable limit.

    Date de mise en ligne : Samedi 14 janvier 2017
    Richard Horton
    [Comment] Offline: The possible impossibility of universal health coverage
    Republicans eagerly assembled in the US Congress last week to formulate plans for dismantling President Barack Obama's signature health initiative—the Patient Protection and Affordable Care Act, 2010—which has extended health-care coverage to 20 million citizens. Although “repeal and replace” has now given way to a more pragmatic “repeal and delay”, the new Republican-controlled Congress has the power to torpedo further attempts to deliver universal health coverage for Americans. But if Congress succeeds, the US Government will have struck a deadly blow against the global effort to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all” (Sustainable Development Goal 3.8).

    Date de mise en ligne : Samedi 14 janvier 2017
    Susan Jaffe
    [World Report] Experts confident of Congressional funding for US Cures Act
    The landmark 21st Century Cures Act should receive continued financial support from US Congress, say experts. Susan Jaffe, The Lancet's Washington correspondent, reports.

    Date de mise en ligne : Samedi 14 janvier 2017
    Talha Burki
    [World Report] New research centre focuses on conflict in the Middle East
    A newly launched research centre in Doha aims to improve the international and Arab world response to complex conflict and humanitarian crises in the Middle East. Talha Burki reports.

    Date de mise en ligne : Samedi 14 janvier 2017
    John Maurice
    [World Report] Profile: Swiss School of Public Health, Zurich, Switzerland
    Switzerland is known for its ingenuity in making cheese, chocolate, and watches. 12 years ago, it applied its ingenuity to quite another activity—creating, in 2005, a school of public health designed to bolster public health education and research throughout the country. The school exists in a somewhat virtual state, with only one small office in Zurich. But it exists at the centre of a network of Swiss universities. The network started with six universities, and two more have joined since 2008, when the school became a foundation, acquired an official name, the Swiss School of Public Health, and an acronym (SSPH+), with its plus sign denoting the added value of a network-based school compared with a traditional freestanding school.

    Date de mise en ligne : Samedi 14 janvier 2017
    Osman Sankoh
    [Perspectives] Bridging the theory–practice gap in global health research
    Transnational health research in low-income countries (LICs) has transformed not only our knowledge of the causes and effects of ill health, but also health itself. Malaria mortality, for example, has more than halved since 2000. Research showing the benefits of insecticide-treated bednets, indoor residual spraying, and artemisinin-based combination therapy was fundamental to the progress made. HIV infections in children have fallen by about 60% since 2009. Research into the prevention of mother-to-child transmission of HIV showed how such improvements could be achieved.

    Date de mise en ligne : Samedi 14 janvier 2017
    Fiona Mitchell
    [Perspectives] Fighting for an end to violence against women
    The Speaking Out project is an ongoing effort to record the voices of women who have been involved with Scottish Women's Aid over its 40-year history. Scottish Women's Aid was formed in 1976, bringing together small local groups across Scotland to enable action to prevent violence against women. Rhona Brankin, co-founder of Ross-shire Women's Aid and former Member of the Scottish Parliament, credits her political career to her involvement with Scottish Women's Aid. “It's an organisation that really campaigns for real change”, she says in an oral history recording that forms part of the project.

    Date de mise en ligne : Samedi 14 janvier 2017
    Daniel Marchalik, Ann Jurecic
    [Perspectives] Mental illness in Han Kang's The Vegetarian
    The Metamorphosis begins with one transformation already having taken place: Gregor Samsa awakens from a terrible dream to find himself in the shape of a giant insect. His disfigured body, a metaphor for disease or disability, repulses his family. They elect to keep him locked away until he dies in isolation, unrecognisable and useless. In Kafka's short story, the transformations caused by illness do not only affect the sick person, and the real monsters do not always appear monstrous.

    Date de mise en ligne : Samedi 14 janvier 2017
    Roger L Kneebone
    [Perspectives] Performing magic, performing medicine
    Richard comes to your table while you are having a meal at a function with your friends. He's an attractive person and you can't help liking him. Although you've never seen him before he makes you feel completely at ease, as if he's another member of your party who has just dropped in to join you for a few moments. It turns out he's a close-up magician. With no apparent effort he slides into your conversation and for the next few minutes performs astonishing tricks, inches from your face. Cards materialise and vanish, banknotes rotate slowly in mid-air with no visible means of support, coins defy the laws of gravity.

    Date de mise en ligne : Samedi 14 janvier 2017
    Geoff Watts
    [Obituary] Neil Blair Pride
    Influential respiratory physiologist. He was born in Croydon, London, UK, on July 29, 1931, and died of pneumonia in Ealing, London, UK, on Nov 12, 2016, aged 85 years.

    Date de mise en ligne : Samedi 14 janvier 2017
    Manon Vouga, Didier Musso, Bruno Schaub, Alice Panchaud, David Baud
    [Correspondence] Zika virus: are we going too far?
    Because of the risk of sexual transmission and reported persistence of Zika virus RNA in semen, the Centers for Disease Control and Prevention has proposed a 6-month delay before attempts at conception for all men possibly exposed to Zika virus.

    Date de mise en ligne : Samedi 14 janvier 2017
    Patrick Gérardin, Van-Mai Cao-Lormeau, Didier Musso, Philippe Desprès, Marianne Besnard
    [Correspondence] Zika rash and increased risk of congenital brain abnormalities
    In a nationwide investigation of 1501 liveborn infants suspected of congenital Zika virus syndrome in Brazil, Giovanny V A França and colleagues (Aug 27, p 891)1 suggest that microcephaly and rash during pregnancy are sensitive enough to screen for cerebral malformations. In their study, the authors report that the earlier the rash occurred during pregnancy, the smaller the head circumference was at birth. Moreover, “rashes in the third trimester of pregnancy were associated with brain abnormalities despite normal sized heads.” On the basis of the average value of head circumference for third-trimester rashes (Z score −1·5 [SD 0·5]) and post-hoc estimation of sensitivity, specificity, and positive predictive values obtained from the receiver operating characteristic curve, we wish to express our concern that the data linking third-trimester rashes to neuroimaging findings are not shown.

    Date de mise en ligne : Samedi 14 janvier 2017
    Cesar G Victora, Marcia C Castro, Giovanny V A França, Lavinia Schuler-Faccini, Fernando C Barros
    [Correspondence] Zika rash and increased risk of congenital brain abnormalities – Authors' reply
    Patrick Gérardin and colleagues state that “the data linking third-trimester rashes to neuroimaging findings are not shown”. In the Results section1 we mention that for nine cases, the mothers reported a rash in the third trimester. We have reviewed the records for these newborn babies: five presented with typical Zika virus brain malformations (eg, calcifications, ventriculomegaly), and physicians for the remaining four reported malformations without specifying their precise nature. Three other Brazilian studies suggest that late pregnancy infections can lead to brain lesions: in a prospective cohort,2 five of the 12 affected fetuses were born to mothers with a rash on gestational week 25 or later; a case report3 shows that a child infected at 26 weeks' gestation was still shredding the virus at 2 months of age; and a case-control study4 reports that three of 32 confirmed cases had a history of rash in the third trimester.

    Date de mise en ligne : Samedi 14 janvier 2017
    Tomohiro Morita, Asaka Higuchi, Akihiko Ozaki, Yuki Shimada, Tetsuya Tanimoto
    [Correspondence] The possibility of vascular care for prevention of dementia
    The study by Eric P Moll van Charante and colleagues (Aug 20, p 797)1 showed that vascular care intervention offered no apparent advantages on the prevention of dementia, although it has some useful implications for future studies.

    Date de mise en ligne : Samedi 14 janvier 2017
    Franz H Messerli, Urs Fischer, Stefano F Rimoldi, Sripal Bangalore
    [Correspondence] Hypertension control and cardiovascular disease
    On the basis of Omran's theory of epidemiological transition, Jacques Blacher and colleagues (July 30, p 530)1 provocatively propose six strategies to reduce the burden of hypertensive cardiovascular disease. Notably, missing from their list are strategies to minimise blood pressure variability. In several large randomised trials, such as ALLHAT2 and ASCOT,3 blood pressure variability has been identified as a powerful independent risk factor for stroke and cardiovascular events.4–6 Of note, not all antihypertensive drugs are equally effective in reducing blood pressure variability.

    Date de mise en ligne : Samedi 14 janvier 2017
    Jack E James
    [Correspondence] Hypertension control and cardiovascular disease
    In the Viewpoint by Jacques Blacher and colleagues (July 30, p 530),1 decreased population prevalence of cardiovascular disease and associated increased life expectancy in some high-income countries in recent decades were attributed to improvements in screening and treatment. Focusing on elevated blood pressure as a risk factor, Blacher and colleagues proposed new strategies for managing hypertension, emphasising pharmacological interventions involving antihypertensive drugs and drug combinations directed at ambitious blood pressure targets in the initial stages of diagnosis and thereafter throughout life.

    Date de mise en ligne : Samedi 14 janvier 2017
    Jacques Blacher, Bernard I Levy, Jean-Jacques Mourad, Michel E Safar, George Bakris
    [Correspondence] Hypertension control and cardiovascular disease – Authors' reply
    As pointed out by Franz Messerli and colleagues, we did not include blood pressure variability among our therapeutic objectives for optimisation of the management of hypertension and prevention of its complications in our Viewpoint.1 Numerous epidemiological studies2 have shown blood pressure variability to be correlated with prognosis in hypertension. However, many risk factors, including age, mean blood pressure, and diabetes, are significantly associated with blood pressure variability. The questions are whether this blood pressure variability is an independent cardiovascular risk factor, and whether the attributable risk could potentially be reversed.

    Date de mise en ligne : Samedi 14 janvier 2017
    Zeshan Qureshi
    [Correspondence] Effect of staffing on improving newborn health
    As one of the authors of the Lancet Series on stillbirth, it fills me with an immense sense of hope to see the ambitious targets that the Government is taking to provide world class newborn care in the UK.

    Date de mise en ligne : Vendredi 09 décembre 2016
    Kim Brøsen, Christian Funck-Brentano, Heyo K. Kroemer, Munir Pirmohamed, Matthias Schwab
    [Correspondence] Open letter on access to the BIA 10-2474 clinical trial data
    To the French judicial authorities and to the Executive Director of the European Medicines Agency,

    Date de mise en ligne : Samedi 14 janvier 2017
    [Department of Error] Department of error
    Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet 2016; 389: 197–210—In this Seminar on figure 1, the low risk GRACE of “<140” has been changed to “<109”. This correction has been made to the online version as of Jan 12, 2016, and the printed Seminar is correct.

    Date de mise en ligne : Mardi 29 novembre 2016
    Helen K Reddel, William W Busse, Søren Pedersen, Wan C Tan, Yu-Zhi Chen, Carin Jorup, Dan Lythgoe, Paul M O'Byrne
    [Articles] Should recommendations about starting inhaled corticosteroid treatment for mild asthma be based on symptom frequency: a post-hoc efficacy analysis of the START study
    In mild recent-onset asthma, once daily, low-dose budesonide decreases SARE risk, reduces lung function decline, and improves symptom control similarly across all symptom subgroups. The results do not support restriction of inhaled corticosteroids to patients with symptoms on more than 2 days per week and suggest that treatment recommendations for mild asthma should consider both risk reduction and symptoms.

    Date de mise en ligne : Mardi 06 décembre 2016
    Kevin Mortimer, Chifundo B Ndamala, Andrew W Naunje, Jullita Malava, Cynthia Katundu, William Weston, Deborah Havens, Daniel Pope, Nigel G Bruce, Moffat Nyirenda, Duolao Wang, Amelia Crampin, Jonathan Grigg, John Balmes, Stephen B Gordon
    [Articles] A cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5 years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled trial
    We found no evidence that an intervention comprising cleaner burning biomass-fuelled cookstoves reduced the risk of pneumonia in young children in rural Malawi. Effective strategies to reduce the adverse health effects of household air pollution are needed.

    Date de mise en ligne : Mercredi 14 décembre 2016
    Vikram Patel, Benedict Weobong, Helen A Weiss, Arpita Anand, Bhargav Bhat, Basavraj Katti, Sona Dimidjian, Ricardo Araya, Steve D Hollon, Michael King, Lakshmi Vijayakumar, A-La Park, David McDaid, Terry Wilson, Richard Velleman, Betty R Kirkwood, Christopher G Fairburn
    [Articles] The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial
    HAP delivered by lay counsellors plus EUC was better than EUC alone was for patients with moderately severe to severe depression in routine primary care in Goa, India. HAP was readily accepted by this previously untreated population and was cost-effective in this setting. HAP could be a key strategy to reduce the treatment gap for depressive disorders, the leading mental health disorder worldwide.

    Date de mise en ligne : Mercredi 14 décembre 2016
    Abhijit Nadkarni, Benedict Weobong, Helen A Weiss, Jim McCambridge, Bhargav Bhat, Basavaraj Katti, Pratima Murthy, Michael King, David McDaid, A-La Park, G Terence Wilson, Betty Kirkwood, Christopher G Fairburn, Richard Velleman, Vikram Patel
    [Articles] Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial
    CAP delivered by lay counsellors plus EUC was better than EUC alone was for harmful drinkers in routine primary health-care settings, and might be cost-effective. CAP could be a key strategy to reduce the treatment gap for alcohol use disorders, one of the leading causes of the global burden among men worldwide.

    Date de mise en ligne : Jeudi 14 juillet 2016
    Layla A Nasr, Ali A Haydar
    [Clinical Picture] Plain film signs of sickle β-thalassaemia
    A 28-year-old woman of Jewish descent with a history of sickle β-thalassaemia disorder and uterine fibroids presented to the emergency department with a 2-week history of frank haematuria. She had been taking paracetamol daily for persistent headaches. On examination she was pale and tachycardic and had a palpable spleen. Full blood count showed haemoglobin 60 g/L. Creatinine was 97 μmol/L. Intravenous urogram showed pyelotubular reflux, splenomegaly, gallstones, uterine fibroids, and coarsening of the pelvic bones and spine.

    Date de mise en ligne : Vendredi 05 août 2016
    Grant W Reed, Jeffrey E Rossi, Christopher P Cannon
    [Seminar] Acute myocardial infarction
    Acute myocardial infarction has traditionally been divided into ST elevation or non-ST elevation myocardial infarction; however, therapies are similar between the two, and the overall management of acute myocardial infarction can be reviewed for simplicity. Acute myocardial infarction remains a leading cause of morbidity and mortality worldwide, despite substantial improvements in prognosis over the past decade. The progress is a result of several major trends, including improvements in risk stratification, more widespread use of an invasive strategy, implementation of care delivery systems prioritising immediate revascularisation through percutaneous coronary intervention (or fibrinolysis), advances in antiplatelet agents and anticoagulants, and greater use of secondary prevention strategies such as statins.

    Date de mise en ligne : Vendredi 19 août 2016
    Todd A Florin, Amy C Plint, Joseph J Zorc
    [Seminar] Viral bronchiolitis
    Viral bronchiolitis is a common clinical syndrome affecting infants and young children. Concern about its associated morbidity and cost has led to a large body of research that has been summarised in systematic reviews and integrated into clinical practice guidelines in several countries. The evidence and guideline recommendations consistently support a clinical diagnosis with the limited role for diagnostic testing for children presenting with the typical clinical syndrome of viral upper respiratory infection progressing to the lower respiratory tract.