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Preference: Statistics, epidemiology and research design

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[Comment] REACTing: the French response to infectious disease crises

In the past decade, scientific and health systems have been challenged by an increase in the emergence of infectious diseases such as Middle East respiratory syndrome coronavirus, chikungunya, Ebola virus disease, and Zika virus.1–4 An effective and global public health response to these crises depends on our ability to anticipate these events and our level of preparedness. However, the development of research programmes in response to a rapidly emerging infectious disease in an emergency context is a challenge.

[Comment] Microcephaly and Zika virus infection

Rarely have scientists engaged with a new research agenda with such a sense of urgency and from such a small knowledge base as in the current epidemic of microcephaly (6000 notified suspected cases in Brazil1 and the first case detected in Colombia in March, 20162) associated with the Zika virus outbreak across the Americas. Indeed, in 2015, in a review of infections that have neurological consequences, Zika virus was not even mentioned.3 In only 5 months since the detection of the first excess cases of microcephaly in Brazil,4 WHO has declared the clusters of microcephaly and other neurological disorders to be a Public Health Emergency of International Concern.

[Comment] Respiratory medicine: a call for papers

The Lancet and The Lancet Respiratory Medicine would like to hear from authors of research papers in any area of clinical research related to respiratory medicine and critical care as the two journals are once again planning special issues timed to coincide with the 2016 European Respiratory Society (ERS) International Congress, in London, UK, on Sept 3–7. We welcome high-quality submissions from this thriving research community, particularly clinical trials and research that will change clinical practice or current thinking.

Health a vote winner

The Federal Government’s decision to inject almost $3 billion into public hospitals was the most popular measure in the Budget, underlining the high value voters put on health care.

A survey of voters by polling company JWS Research and reported by the Australian Financial Review has found that 75 per cent approved the allocation in the Budget of $2.9 billion over four years to support public hospitals, overshadowing the 72 per cent who welcomed an extra $50 billion for road, rail and water infrastructure and the 65 per cent who approved an extra $840 million for youth employment programs.

The result suggests that Labor is playing to the concerns of a majority of voters with its push to make health a key election battleground, including through its commitment to unfreeze the Medicare patient rebate from January next year.

Highlighting the Government’s failure to get much of a pre-election bounce out of Treasurer Scott Morrison’s first Budget, the survey found that only 17 per cent thought it would be good for them personally, and just 21 per cent said it would be good for the country. Thirty-seven percent thought it would be bad for them, and for the nation.

Pollster John Scales, who oversaw the survey, told the AFR the results showed that the Government’s attempt to sell the Budget as an economic plan, encapsulated in its “jobs and growth” mantra, had failed to resonate with voters.

The Government made company tax cuts the centrepiece of the Budget, arguing that they would boost the economy by encouraging investment and employment.

But Mr Scales told the AFR that although the message had been understood at the “micro level, that’s been missed by the general population. They’re asking what is in it for them, they’re saying, ‘there’s nothing in it for me’.”

Adrian Rollins

 

[Comment] Progestogens and preterm birth—not the hoped for panacea?

Preterm birth is the most common cause of neonatal morbidity and mortality globally, affecting about 15 million children every year.1 Of children born preterm, an estimated 2·4 million (15·6%) are born extremely preterm (before 28 weeks gestation) or very preterm (before 32 weeks gestation).1 Furthermore, some 1 million children every year die as a consequence of preterm birth or its complications.1 In 2014, the Preterm Birth Priority Setting Partnership in the UK identified prediction and prevention of preterm birth as the top research priority in this area.

[Correspondence] Outcomes in the EXAMINATION trial – Authors’ reply

The rationale and design of the EXAMINATION trial,1 reported the primary and the secondary endpoints to be assessed at 1 year2 and every year up to 5 year follow-up.3 These endpoints were selected following Academic Research Consortium (ARC) guidelines, which specifically recommend that trials of drug-eluting stent select and concomitantly report both patient-oriented and stent-oriented (or device-oriented) endpoints.4 Individual components of these two endpoints were also prespecified and reported in the design paper.

Comparative effectiveness of angiotensin-converting-enzyme inhibitors and angiotensin II receptor blockers in patients with type 2 diabetes and retinopathy [Research]

Background:

Angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are effective treatments for diabetic retinopathy, but randomized trials and meta-analyses comparing their effects on macrovascular complications have yielded conflicting results. We compared the effectiveness of these drugs in patients with pre-existing diabetic retinopathy in a large population-based cohort.

Methods:

We conducted a propensity score–matched cohort study using Taiwan’s National Health Insurance Research Database. We included adult patients prescribed an ACE inhibitor or ARB within 90 days after diagnosis of diabetic retinopathy between 2000 and 2010. Primary outcomes were all-cause death and major adverse cardiovascular events (myocardial infarction, ischemic stroke or cardiovascular death). Secondary outcomes were hospital admissions with acute kidney injury or hyperkalemia.

Results:

We identified 11 246 patients receiving ACE inhibitors and 15 173 receiving ARBs, of whom 9769 patients in each group were matched successfully by propensity scores. In the intention-to-treat analyses, ARBs were similar to ACE inhibitors in risk of all-cause death (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.87–1.01) and major adverse cardiovascular events (HR 0.95, 95% CI 0.87–1.04), including myocardial infarction (HR 1.03, 95% CI 0.88–1.20), ischemic stroke (HR 0.94, 95% CI 0.85–1.04) and cardiovascular death (HR 1.01, 95% CI 0.88–1.16). They also did not differ from ACE inhibitors in risk of hospital admission with acute kidney injury (HR 1.01, 95% CI 0.91–1.13) and hospital admission with hyperkalemia (HR 1.01, 95% CI 0.86–1.18). Results were similar in as-treated analyses.

Interpretation:

Our study showed that ACE inhibitors were similar to ARBs in risk of all-cause death, major adverse cardiovascular events and adverse effects among patients with pre-existing diabetic retinopathy.

[Seminar] Chronic pancreatitis

Chronic pancreatitis describes a wide spectrum of fibro-inflammatory disorders of the exocrine pancreas that includes calcifying, obstructive, and steroid-responsive forms. Use of the term chronic pancreatitis without qualification generally refers to calcifying chronic pancreatitis. Epidemiology is poorly defined, but incidence worldwide seems to be on the rise. Smoking, drinking alcohol, and genetic predisposition are the major risk factors for chronic calcifying pancreatitis. In this Seminar, we discuss the clinical features, diagnosis, and management of chronic calcifying pancreatitis, focusing on pain management, the role of endoscopic and surgical intervention, and the use of pancreatic enzyme-replacement therapy.