Trisha Greenhalgh and colleagues argue that, although evidence based medicine has had many benefits, it has also had some negative unintended consequences. They offer a preliminary agenda for the movement’s renaissance, refocusing on providing useable evidence that can be combined with context and professional expertise so that individual patients get optimal treatment

https://www.bmj.com/content/bmj/348/bmj.g3725.full.pdf

Evidence based medicine: a movement in crisis?

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00837-5.pdf

Stillbirths: rates, risk factors, and acceleration towards 2030

The extent to which member states transpose EU directives in a timely fashion is often argued to be strongly associated with the general effectiveness of national bureaucracies. But what kind of institutional solutions ensure better performance? This paper examines the patterns and effects of departmental oversight across 28 ministries in Estonia, Hungary, Poland and Slovenia. In mapping the strength of oversight, it relies on around 90 structured interviews regarding the rules-in-use on transposition planning, legal review and monitoring of deadlines. The analysis of the impact of departmental oversight is based on an original dataset of over 300 directives with transposition deadlines between January 2005 and December 2008.

On the european union

Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown. We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning. We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm. Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved.

/pdf/the-global-distribution-of-fatal-pesticide-self-poisoning-ulsr1od2bw.pdf

The global distribution of fatal pesticide self-poisoning: systematic review

This book is a guide for planners and programme managers in the health and education sectors who are responsible for implementing community-based programmes for control of soil-transmitted helminth (STH) and schistosome infections in school-age populations. The book describes a common and cost-effective approach whereby periodic parasitological surveys in a sample of the school population are used to select the appropriate control strategy for the whole community. An alternative approach which relies on individual diagnosis and treatment has been used with success in the rapidly evolving economies of Japan and the Republic of Korea but is not discussed here. Key elements of guidelines previously published by WHO—Guidelines for the evaluation of soil-transmitted helminthiasis and schistosomiasis at community level and Monitoring helminth control programmes are brought together in this book with a third component on planning and budgeting. The book is intended to help managers to plan implement and monitor worm control programmes using methods based on the best current experience. It covers the following topics: programme design; delivery of drugs to schools and treatment of children; collection of data for programme evaluation; obtaining the needed materials. (excerpt)

/pdf/helminth-control-in-school-age-children-a-guide-for-managers-1t67tpw4hg.pdf

Helminth Control in School-age Children: A Guide for Managers of Control Programmes

The excretion of hydrogen cyanide in breath and blood concentrations of cyanide were measured in eight normal subjects. There was no correlation between breath and blood levels of cyanide. Furthermore, breath cyanide concentrations calculated from blood values were much lower than measured values, which suggested a local production of hydrogen cyanide in the oropharynx. When saliva was incubated at 37° C hydrogen cyanide was formed in the presence of air but not in a nitrogen atmosphere. No hydrogen cyanide was formed with boiled saliva and the production of hydrogen cyanide by native saliva was inhibited by catalase and by 6-n-propyl-thiouracil. Centrifugation of saliva resulted in a supernatant and a sediment, which were both required for the formation of hydrogen cyanide. Dialysis of the supernatant abolished its cyanide forming ability, which could be restored by addition of thiocyanate. We conclude that most of the hydrogen cyanide found in breath from normal human beings originates from oxidation of thiocyanate by salivary peroxidase in the oropharynx. As a consequence measurements of breath hydrogen cyanide can only be used to detect heavy exposure to cyanide.

The origin of hydrogen cyanide in breath.

The severe epidemic of Ebola virus disease in Liberia started in March 2014. On May 9, 2015, the World Health Organization declared Liberia free of Ebola, 42 days after safe burial of the last known case-patient. However, another 6 cases occurred during June-July; on September 3, 2015, the country was again declared free of Ebola. Liberia had by then reported 10,672 cases of Ebola and 4,808 deaths, 37.0% and 42.6%, respectively, of the 28,103 cases and 11,290 deaths reported from the 3 countries that were heavily affected at that time. Essential components of the response included government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves. Priorities after the epidemic include surveillance in case of resurgence, restoration of health services, infection control in healthcare settings, and strengthening of basic public health systems.

Ebola and Its Control in Liberia, 2014-2015.

Metabolic fates in humans of linamarin in cassava flour ingested as stiff porridge

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The origin of hydrogen cyanide in breath.

Ebola and Its Control in Liberia, 2014-2015.

Metabolic fates in humans of linamarin in cassava flour ingested as stiff porridge