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vrijdag 23 juni 2017

The Lancet: [Comment] Risk of Zika-related microcephaly: stable or variable?

[Comment] Risk of Zika-related microcephaly: stable or variable?
As unexpected as the epidemic of microcephaly was, the Brazilian Government immediately set up a special notification system. By December, 2015, 3174 suspected cases of microcephaly were reported (more than 1000 in one state in northeast Brazil1). Zika spread rapidly in Latin America. We braced ourselves for a vast international epidemic of Zika-related microcephaly; but when it did not happen we asked ourselves why. Were the numbers an artifact of over reporting?2 Were they real, did cofactors modify the risk given Zika virus in pregnancy,3 or was it due to something else?
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[Articles] Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial
GES is a safe intervention that might reduce fatigue and, to a lesser extent, physical disability for patients with chronic fatigue syndrome. These findings need confirmation and extension to other health-care settings.
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[Comment] Guided graded exercise self-help as a treatment of fatigue in chronic fatigue syndrome
In The Lancet, Lucy Clark and colleagues1 show that, in the GETSET trial (n=211), patients with chronic fatigue syndrome who were treated with a 12 week guided graded exercise self-help programme in addition to ongoing specialist medical care had significantly lower mean fatigue score (reduction by 4·2 points [95% CI 2·3–6·1], p<0·0001; effect size 0·53) and higher self-reported physical function score (increase by 6·3 points [1·8–10·8], p=0·006; effect size 0·20) than did patients managed with specialist medical care alone.
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[Seminar] Oesophageal cancer
Oesophageal cancer is a clinically challenging disease that requires a multidisciplinary approach. Extensive treatment might be associated with a considerable decline in health-related quality of life and yet still a poor prognosis. In recent decades, prognosis has gradually improved in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer.
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[Comment] How to harness the private sector for universal health coverage
Universal health coverage (UHC) is a global goal that enjoys near universal support and is underpinned by a strong body of evidence.1,2 That battle has been won. What UHC means in reality is, however, less clear. Many countries have health systems that are fragmented and short of funds. If we are to realise the goal of delivering safe, high-quality care to as many people as possible, every available resource must be used. That includes private providers.
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