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[Perspectives] Mathuros Ruchirawat: leading light in pollution control

By the time she was in high school, Mathuros Ruchirawat had already figured out her professional calling. “I’m a scientist at heart”, says Ruchirawat, now Professor of Pharmacology and Toxicology at Mahidol University in Thailand and Vice President of Research and Academic Affairs at the Chulabhorn Research Institute (CRI) where she oversees nine research laboratories. Somehow she also finds time to direct a major research and educational enterprise at Thailand’s Center of Excellence on Environmental Health and Toxicology (EHT).

[World Report] A new paradigm for the MRC Units in The Gambia and Uganda

Two major medical research institutions in sub-Saharan Africa came under the purview of the London School of Hygiene & Tropical Medicine (LSHTM). The Medical Research Council (MRC) Unit The Gambia and the MRC/Uganda Virus Research Institute (UVRI) Uganda Research Unit transferred to LSHTM from their current positions under the MRC at the beginning of February.

[Comment] Should basic science matter to clinicians?

We have observed declining interest in discovery science by our medical colleagues. Across a range of top medical journals, the number of basic science articles decreased by 40–60% from 1994 to 2013,1 while a major North American university recorded a 60% decrease in clinician-investigator trainees pursuing basic science training between 1987 and 2016.2 The decline of basic science research in the medical literature and a disregard for it in continuing education programmes3 are allowing mastery of science to be lost by practising clinicians.

[Correspondence] Underestimation of the global burden of schistosomiasis

The Global Burden of Disease (GBD) Study aims to determine the cumulative global disability that is attributable to diverse diseases, the knowledge of which is essential in targeting public health responses, prioritising funding, and guiding research. The 2016 GBD study (Sept 16, 2017, p 1211)1 suggested that, of all 328 diseases considered, schistosomiasis showed the most pronounced reduction in age-standardised years lived with disability (YLD) between 2006 and 2016. Schistosomiasis was ranked in the top ten for YLDs in six sub-Saharan countries but was now reported to account for only 1·496 million YLD worldwide (down from the 2·472 million YLD estimated in the 2015 GBD Study);2 we think that the apparent drop is an artifact caused by underestimation of the effects of schistosoma infections and because of several limitations to the methods in the new GBD calculations.

[Perspectives] Andrew Bush: a broad portfolio in paediatric respirology

Although it’s trivial, the first thing I notice on meeting Andrew Bush is his colourful bow tie. All sorts of motives are ascribed to men who favour this form of neckwear, and few are entirely flattering. So the succeeding 40 minutes come as a relief. Far from an attention seeker, Bush is a quietly spoken and thoughtful man: a self-declared work junkie with a commitment to paediatric respirology that’s equally divided between research and clinical work. “For me, they go hand in hand. It’s like someone asking me if I prefer running with my right leg or my left leg.

[Comment] Transformational thinking about asthma

Although asthma has been recognised for thousands of years, the disorder was widely misunderstood until the 20th century.1 The first widely accepted disease definition was released only 30 years ago.2 Although this definition continues to be cited, most clinicians do not actually measure airway inflammation and hyper-responsiveness when they examine a patient with asthma. Yet most patients, clinicians, and researchers claim to recognise “asthma” when they see it—and surveillance programmes continue to document enormous morbidity and costs worldwide.

Intergenerational abortion tendency between mothers and teenage daughters: a population-based cohort study [Research]

BACKGROUND:

A teenage woman’s sexual health practices may be influenced by her mother’s experience. We evaluated whether there is an intergenerational tendency for induced abortion between mothers and their teenage daughters.

METHODS:

We conducted a retrospective population-based cohort study involving daughters born in Ontario between 1992 and 1999. We evaluated the daughters’ data for induced abortions between age 12 years and their 20th birthday. We assessed each mother’s history of induced abortion for the period from 4 years before her daughter’s birth to 12 years after (i.e., when her daughter turned 12 years of age). We used Cox proportional hazard models to estimate a daughter’s risk of having an induced abortion in relation to the mother’s history of the same procedure. We adjusted hazard ratios (HRs) for maternal age and world region of origin, mental or physical health problems in the daughter, mother– daughter cohabitation, neighbourhood-level rate of teen induced abortion, rural or urban residence, and income quintile.

RESULTS:

A total of 431 623 daughters were included in the analysis. The cumulative probability of teen induced abortion was 10.1% (95% confidence interval [CI] 9.8%–10.4%) among daughters whose mother had an induced abortion, and 4.2% (95% CI 4.1%–4.3%) among daughters whose mother had no induced abortion, for an adjusted HR of 1.94 (95% CI 1.86–2.01). The adjusted HR of a teenaged daughter having an induced abortion in relation to number of maternal induced abortions was 1.77 (95% CI 1.69–1.85) with 1 maternal abortion, 2.04 (95% CI 1.91–2.18) with 2 maternal abortions, 2.39 (95% CI 2.19–2.62) with 3 maternal abortions and 2.54 (95% CI 2.33–2.77) with 4 or more maternal abortions, relative to none.

INTERPRETATION:

We found that the risk of teen induced abortion was higher among daughters whose mother had had an induced abortion. Future research should explore the mechanisms for intergenerational induced abortion.

[Editorial] Facial injuries

Patients, surgeons, and other health-care professionals met to discuss life after facial injuries at an event on Jan 22 organised by the Royal Society of Medicine and Saving Faces, the facial surgery research foundation. A large proportion of facial injuries result from interpersonal violence, in which the maxillofacial region is frequently targeted. In domestic violence, damage can be very severe due to extreme violence and protracted uninterrupted attacks. In trauma cases, facial injuries are often a sign of extensive injuries and many patients experience associated head injury.

[Review] What works in inclusion health: overview of effective interventions for marginalised and excluded populations

Inclusion health is a service, research, and policy agenda that aims to prevent and redress health and social inequities among the most vulnerable and excluded populations. We did an evidence synthesis of health and social interventions for inclusion health target populations, including people with experiences of homelessness, drug use, imprisonment, and sex work. These populations often have multiple overlapping risk factors and extreme levels of morbidity and mortality. We identified numerous interventions to improve physical and mental health, and substance use; however, evidence is scarce for structural interventions, including housing, employment, and legal support that can prevent exclusion and promote recovery.