more_vertPioneer of UK health services research. He was born in Teplice-Sanov, Czech Republic, on March 5, 1929, and died of prostate cancer in London, UK, on Feb 9, 2017, aged 88 years.
Preference: Statistics, epidemiology and research design
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[Comment] Offline: Owning up on gender equality
There are moments to admit failure. Gender equality is one of those moments. Last week, the first report on gender-responsiveness among the world’s most influential global health organisations—The Global Health 50/50 Report—was launched in London. Led by Sarah Hawkes and Kent Buse, together with a largely voluntary team of researchers, strategists, and communications experts, and housed within the University College London Centre for Gender and Global Health, Global Health 50/50 examines seven domains of gender equality across 140 organisations.
[Correspondence] Clinical benefits of evolocumab appear less than hoped
The strong correlation between on-treatment LDL cholesterol and cardiovascular events observed in the prespecified secondary analysis of the FOURIER trial published in The Lancet (Oct 28, 2017, p 1962)1 is no different from that reported on treatment in several previous clinical trials of statins and on no treatment in epidemiological studies. The on treatment correlation conflates the epidemiology with pharmacological lowering of LDL2 by evolocumab and the co-prescribed statin. In FOURIER,3 the addition of evolocumab to statin therapy lowered LDL by 59%, but the risk of myocardial infarction was only reduced by 27% compared with studies of statin versus placebo, which lowered LDL by 30% and myocardial infarction risk by 38% in the Heart Protection Study4 and 50% and 54%, respectively, in the JUPITER trial.
[Perspectives] The promissory nature of artificial hearts
“The Artificial Heart is Here” announced LIFE magazine in September, 1981. An image of the Utah total artificial heart (TAH), also known as the Jarvik-7 heart, dominated the issue cover against a vivid red background. The inside story, bolstered with large, colourful photographs, predicted a breakthrough decade for this technology. Such anticipation was not entirely off-base, given the promissory nature of the technology as a curative fix for end-stage heart failure that aligned with the view of the body as an entity of replacement parts and the confidence of artificial heart researchers in these devices.
New vaccines for improved coverage against flu in Australia
Two new ground-breaking flu vaccines will be given to more than three million Australians.
The Federal Government recently said it will provide the new vaccines to those Australians aged 65 years and over who want them.
In making the announcement, Health Minister Greg Hunt said: “This is a direct response to last year’s horrific flu season, which had a devastating impact around the world, and aimed squarely at saving lives.”
More than 90 per cent of the 1,100 flu related deaths in 2017 were of people aged over 65 years of age. While less than one to two per cent of people who get influenza will end up with a complication from it, it is the elderly who seem hardest hit.
“The medical advice, both from the vaccine producers, the World Health Organisation and the Chief Medical Officer is that the mutation which occurred last year in many countries will be specifically addressed by these new vaccines,” Mr Hunt said.
The new vaccines – Fluad® and Fluzone High Dose® – were registered in Australia to specifically provide increased protection for people aged 65 years and older.
From April 2018, both vaccines will be available through the National Immunisation Program following a recommendation from the Pharmaceutical Benefits Advisory Committee.
“Annual vaccination is the most important measure for preventing influenza and its complications and we encourage all Australians to get vaccinated. We encourage all Australians aged over six months old to get a flu vaccination this year before the peak season starts in June” Mr Hunt said.
The Chief Medical Officer, Professor Brendan Murphy, believes the new ‘enhanced’ vaccines will be more effective.
However, Professor Murphy said: “No flu vaccine is complete protection, the standard vaccine seems to protect well in younger people, but we are confident this will give better protection for the elderly.”
The Department of Health believes the new trivalent (three strain) vaccines work in over 65s by generating a strong immune response and are more effective for this age group in protecting against influenza.
There is now a mandated requirement for residential aged care providers to provide a seasonal influenza vaccination program to all staff as well as the Aged Care Quality Agency continuing a review of the infection control practices of aged care services across the country.
Under the National Immunisation Program, those eligible for a free flu shot include people aged 65 years and over, pregnant women, most Aboriginal and Torres Strait Islander people, and those who suffer from chronic conditions.
The following four strains will be contained within this year’s Southern Hemisphere vaccines:
- A(H1N1): an A/Michigan/45/2015(H1N1) pdm09 like virus;
- A(H3N2): an A/Singapore/INFIMH-16-0019/2016(H3N2) like virus;
- B: a B/Phuket/3073/2013 like virus; and
- B: a B/Brisbane/60/2008 like virus.
Allen Cheng, Professor in Infectious Diseases Epidemiology at Monash University, has warned: “Despite the common perception that the flu is mild illness, it causes a significant number of deaths worldwide. To make an impact on this, we need better vaccines, better access to vaccines worldwide and new strategies, such as increasing the rate of vaccination in childhood.”
AMA President Dr Michael Gannon welcomed the Government’s announcement because it was targeting vaccine coverage for “a particularly vulnerable group”.
MEREDITH HORNE
Three golden rules for a healthy diet
Which one wins – a healthy low-fat diet or a healthy low-carbohydrate diet?
When it comes to weight change, neither apparently.
The study, published in the Journal of the American Medical Association (JAMA) has found no significant difference between the two diets even after being on them for 12 months. It also found no relationship between weight fluctuation and a participant’s DNA testing.
Importantly however, the study did find that people who cut back on added sugar, refined grains and highly processed foods while concentrating on eating plenty of vegetables and whole foods — without worrying about counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.
Professor Christopher Gardner, the Director of Nutrition Studies at the Stanford Prevention Research Center who led the study, said there is no single diet that fits everyone.
“I continually see three factors that come up again and again: get rid of added sugar; get rid of refined grain; and eat as many vegetables as you can,” Professor Gardner said.
He argues that the study has shown the diet argument is often focused on the wrong things, like which type of diet.
“We are battling points on the fringe of this whole debate without getting to the core,” he said.
The large clinical trial included 609 adults aged 18 to 50 years without diabetes, with a body mass index between 28 and 40, where participants were randomised to the 12-month healthy low-fat diet or a healthy low-carbohydrate diet.
“We really stressed to both groups again and again that we wanted them to eat high-quality foods,” Professor Gardner said.
The low-fat group was told to avoid refined carbohydrates like soft drinks, fruit juice, muffins, white rice and white bread – even though they are low fat. Instead they were advised to eat more nutritionally beneficial foods like brown rice, barley, steel-cut oats, lentils, lean meats, low-fat dairy products, quinoa, fresh fruit and legumes.
The low-carb group was trained to choose nutritious foods like olive oil, salmon, avocados, hard cheeses, vegetables, nut butters, nuts and seeds, and grass-fed and pasture-raised animal foods.
Australia is ranked the fifth highest in the Organisation for Economic Co-operation and Development’s (OECD) latest obesity rankings. Projections show a steady increase in obesity rates until at least 2030. Currently more than one in two adults and nearly one in six children are overweight or obese in OECD countries. OECD adult obesity rates are highest in the United States, Mexico, New Zealand and Hungary, while they are lowest in Japan and Korea.
Speaking on radio recently, AMA President Dr Michael Gannon said the AMA would continue to call for a tax on sugar-sweetened beverages because it is designed to change behaviour.
“We have a situation now where it’s often cheaper to purchase one of these drinks than it is to purchase water,” Dr Gannon said.
Further information about the study can be found https://jamanetwork.com/journals/jama/article-abstract/2673150?redirect=true
AMA’s Position Statement on nutrition was launched earlier this year and is available here: position-statement/nutrition-2018
MEREDITH HORNE
Ground-breaking research leads to better autism test
A world first test, developed through an international cooperative effort, could lead to earlier diagnosis of autism spectrum disorders.
British scientists have developed a blood and urine test that can detect autism in children, and they say it is the first of its kind.
The University of Warwick researchers said their test will allow earlier diagnoses and therefore earlier and more effective treatments.
They worked in collaboration with the University of Bologna in Italy, as well as with the University of Birmingham in the UK.
Children of varying age groups were tested from these locations.
Because there are so many symptoms of autism spectrum disorders (ASD), diagnosis can be difficult in the early stages of its development.
But the scientists discovered a link between ASD and damage to proteins in blood plasma. By examining protein in blood plasma, they found children with ASD had higher levels dityrosine – and oxidisation marker – and advanced glycation end-products – sugar modified compounds.
“Our discovery could lead to earlier diagnosis and interventions,” said lead researcher Naila Rabbani from the University of Warwick.
“We hope the tests will also reveal new causative factors.
“With further testing we may reveal specific plasma and urinary profiles, or ‘fingerprints’, of compounds with damaging modifications.
“This may help us improve the diagnosis of ASD and point the way to new causes of it.”
Findings of the research have been published in the journal Molecular Autism.
The next step of the program is to repeat the study with further groups of children.
CHRIS JOHNSON
Risk of stroke in patients with dengue fever: a population-based cohort study [Research]
BACKGROUND:
Stroke is a severe neurologic complication of dengue fever, described in only a few case reports. The incidence and risk factors for stroke in patients with dengue remain unclear. We conducted a population-based retrospective cohort study to investigate the risk of stroke in patients with dengue.
METHODS:
Using data from the Taiwan National Health Insurance Research Database, we included a total of 13 787 patients with dengue newly diagnosed between 2000 and 2012. The control cohort consisted of patients who did not have dengue, matched 1:1 by demographic characteristics and stroke-related comorbidities. We calculated the cumulative incidences and hazard ratios (HRs) of stroke in both cohorts using Kaplan–Meier curves and Cox proportional hazards regression.
RESULTS:
The overall incidence rate of stroke was 5.33 per 1000 person-years in the dengue cohort and 3.72 per 1000 person-years in the control cohort, with an adjusted HR of 1.16 (95% confidence interval [CI] 1.01–1.32). The risk of stroke among patients with dengue was highest in the first 2 months after diagnosis (25.53 per 1000 person-years, adjusted HR 2.49, 95% CI 1.48–4.18).
INTERPRETATION:
Dengue fever was associated with an increased risk of stroke in the first few months after diagnosis. The effect of dengue on stroke may be acute rather than chronic.
[The Lancet Commissions] Lancet Commission: Stem cells and regenerative medicine
In this Commission, we argue that a combination of poor quality science, unclear funding models, unrealistic hopes, and unscrupulous private clinics threatens regenerative medicine’s social licence to operate. If regenerative medicine is to shift from mostly small-scale bespoke experimental interventions into routine clinical practice, substantial rethinking of the social contract that supports such research and clinical practice in the public arena will be required.
[Correspondence] Foley catheterisation versus oral misoprostol to induce labour – Author’s reply
I thank Ben Mol for his thoughtful comments about our research.1 He is concerned that 24 h is too short a cutoff time for vaginal birth, and that we should have continued the induction process with the Foley catheter before resorting to caesarean section. We would usually agree with him, but our study was done in a very different setting to his Dutch study.2 In Europe, outcomes of induced labour are so good that the procedure is often performed for weak indications to prevent adverse outcomes; hence, the proportion of Dutch pregnancies that are induced is around 15%.