Royal Australian College of General Practitioners



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KEY MEDICAL JOURNALS – FEBRUARY 2018

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BMJ British Medical Journal Vol. 360 No. 8135 Jan 6 2018

What are your burning issues for 2018? 360 :k9

CCGs fail to declare pharma funding 360 :j5911

NHS publishes estimates of avoidable deaths in hospitals 359 :j5831

Seven days in medicine: 27 December 2017 to 2 January 2018 360 :j5931

Sixty seconds on . . . Dry January 360 :j5885

UK is a less attractive place to work, GMC warns, as reliance on overseas doctors increases 359 :j5871

London GP clinic sees big jump in patient registrations after Babylon app launch 359 :j5908

Drug shortages cost NHS £38m in November 359 :j5883

Five minutes with . . . David Hinchcliffe 360 :j5843

GMC begins High Court appeal over suspension of paediatrician convicted of manslaughter 359 :j5718

Take-home message: improve naloxone supply 359 :j5874

Earning his stripes: a ward redesigned 360 :k1

What if sugar is worse than just empty calories? An essay by Gary Taubes 360 :j5808

Improving treatment of asthma attacks in children 359 :j5763

Low dose CT screening for lung cancer 359 :j5742

The pharma deals that CCGs fail to declare 360 :j5915

Research Update

Incidence of type 1 diabetes in China, 2010-13: population based study 360 :j5295

Effect of adoption of neoadjuvant chemotherapy for advanced ovarian cancer on all cause mortality: quasi-experimental study 360 :j5463

Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study 360 :j5622

Statistical methods to compare functional outcomes in randomized controlled trials with high mortality

360 :j5748

Comment

Margaret McCartney: If this was cancer there’d be an outcry—but it’s mental health 359 :j5407

Is being a doctor “just a job”? 359 :j5257

Surgical registrar is struck off for refusing to examine three deteriorating patients 359 :j5115

Putting patients in control of data from electronic health records 360 :j5554

Urinary infections are complex and hard to treat 359 :j5766

Views on the Mental Health Act from the frontline 359 :j5767

Online access to GPs can offer benefits to GPs and patients 359 :j5769

Loneliness and tiredness resulting from the European Working Time Regulations 359 :j5775

Daily number of patient contacts as alternative measure of workload in general practice 359 :j5770

Education

Novel therapies for unresectable and metastatic melanoma 359 :j5174

Acute rotator cuff tears 359 :j5366

Letting my daughter go 360 :j5771

An uncommon cause of abdominal pain in a young man 360 :j5182

Blisters in disguise 360 :j5364

Purtscher-like retinopathy as a first manifestation of systemic lupus erythematosus 360 :j5551

Dementia and decline . . . and other stories 360 :j5666

Careers

Anna Batchelor: Twitter trooper, ICU ace 360 :j5710

BMJ British Medical Journal Vol. 360 No. 8136 Jan 13 2018

We need better animal research, better reported k124

GPs forced to turn away patients because of winter pressures k81

“Conflicting” UK asthma guidelines should be streamlined, experts say k99

Seven days in medicine: 3-9 January 2018 k108

Sixty seconds on . . . marijuana smoke k72

Trivalent flu vaccine won’t protect against influenza B strain predominantly circulating k78

GP out-of-hours services struggle to fill shifts amid “intense” winter pressure k97

Winter pressure is putting junior doctors’ training at risk, leaders warn k100

Big tobacco’s new year’s resolution to quit smoking k79

Learning lessons from MVA85A, a failed booster vaccine for BCG k66

Oxford TB vaccine study calls into question selective use of animal data j5845

Improving the conduct, reporting, and appraisal of animal research j4935

Research Update

Polygenic hazard score to guide screening for aggressive prostate cancer: development and validation in large scale cohorts j5757

Improving adherence to healthy dietary patterns, genetic risk, and long term weight gain: gene-diet interaction analysis in two prospective cohort studies j5644

Diet, genes, and obesity k7

Incremental effects of antihypertensive drugs: instrumental variable analysis j5542

Comment

Margaret McCartney: When a crisis is the predictable outcome of poor policy making k90

This emergency department crisis was predictable—and partly preventable k64

David Oliver: Local shouldn’t be a dirty word j5918

Rethinking neoadjuvant chemotherapy for breast cancer j5913

Shifting the focus of shared decision making to human relationships k53

Arguments against prolonged training placements k57

Apples and oranges: comparing residency models in the UK and North America k59

Psychotic symptoms in people with intellectual disability k61

Education

Chronic limb threatening ischaemia j5460

Birth options after a caesarean section j5737

Urgent reversal of vitamin K antagonists j5424

An ulcer on the nipple j5850

Rash on extensor surfaces of a child j5547

Leonine facies as a sign of leukaemia cutis j5605

Pulmonary function and uric acid . . . and other stories k28

Careers

Simon Denegri: Piloting patient involvement j5782

BMJ British Medical Journal Vol. 360 No. 8137 Jan 20 2018

Health and social care, together at last? k227

Smartphone GP consultation app cost CCG £150 000 in first two months k221

NHS weight management programme makes clinical difference in patients with type 2 diabetes k177

Seven days in medicine: 10-16 January 2018 k217

Sixty seconds on . . . the Lansley diaries k199

Football headers and dementia: five minutes with Willie Stewart k190

Spend more on NHS or see services deteriorate further, hospital leaders warn k175

Young women with BRCA mutation can safely postpone radical surgery k180

Under pressure: meeting demand safely means knowing when to shout for help k204

Jeremy Hunt’s new department: major overhaul or window dressing? k208

Mexicans head off spread of zoonotic tuberculosis k220

Conflicting asthma guidelines cause confusion in primary care k29

Health and social care: What’s in a name? k201

Should all patients be asked about their sexual orientation? k52

Commentary: Let’s talk about sex k76

“Everyone thinks it’s someone else’s responsibility”: training for sexual health doctors j5419

The apps attempting to transfer NHS 111 online k156

Research Update

Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study j5790

Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study j5745

Concerns about composite reference standards in diagnostic research j5779

Comment

Margaret McCartney: We need another vote j5919

What would a “no deal” Brexit mean—and what does it tell us about those who want it? k189

David Oliver: Will we now see a serious attempt to tackle social care funding? k136

Tackling hearing loss to improve the care of older adults k21

Measuring the prevention of harm due to minimum alcohol pricing k130

Conscientious objection in abortion care k131

Coffee consumption and health: we need randomised controlled trials k132

Differentiating between acute heart failure and acute respiratory distress syndrome k60

Integrated lipid clinics for adults and children with familial hypercholesterolaemia k75

GMC’s push for erasure of paediatrician is questionable k169

Wider effects of the Bawa-Garba case on medical practice and public safety k185

GMC erasure: it could have been me k170

Doctors do not feel protected when things go wrong k171

Criminal and professional sanctions impede honesty and improvement k172

GMC should deal forcefully with repeatedly dishonest doctors k184

Education

Electronic cigarettes for smoking cessation j5543

Management of incidental adrenal tumours j5674

Chronic hip pain j5882

Hyperpigmentation in the skin folds j5729

A dropped lens j5927

Practising larvae removal . . . and other stories k155

Careers

Samiran Nundy: Tackling India’s corruption k105

JAMA Vol. 318 No. 23 December 19 2017

Friedrich MJ.

Preexisting Antibody Titer Associated With Severe Dengue.

p2287. doi:10.1001/jama.2017.19368. PubMed PMID: 29260233.

Friedrich MJ.

Latest Report on Health Effects of Climate Change.

p2287. doi:10.1001/jama.2017.19366. PubMed PMID: 29260232.

Friedrich MJ.

Tuberculosis Update 2017.

p2287. doi:10.1001/jama.2017.18477. PubMed PMID: 29260231.

Gamble C, Krishan A, Stocken D, et al.

Guidelines for the Content of Statistical Analysis Plans in Clinical Trials.

pp2337-2343. doi:10.1001/jama.2017.18556. PubMed PMID: 29260229.

Kirkland KB.

Walking the Shoreline: Erosion, Regrowth, and Professional Formation.

pp2297-2298. doi:10.1001/jama.2017.18040. PubMed PMID: 29260228.

Saccone G, Maruotti GM, Giudicepietro A, et al.

Effect of Cervical Pessary on Spontaneous Preterm Birth in Women With Singleton Pregnancies and Short Cervical Length: A Randomized Clinical Trial.

pp2317-2324. doi:10.1001/jama.2017.18956. PubMed PMID: 29260226.

Stupp R, Taillibert S, Kanner A, et al.

Effect of Tumor-Treating Fields Plus Maintenance Temozolomide vs Maintenance Temozolomide Alone on Survival in Patients With Glioblastoma: A Randomized Clinical Trial.

pp2306-2316. doi:10.1001/jama.2017.18718. PubMed PMID: 29260225.

Gerber JS, Ross RK, Bryan M, et al.

Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality

of Life in Children With Acute Respiratory Tract Infections.

pp2325-2336. doi:10.1001/jama.2017.18715. PubMed PMID: 29260224.

McKee AC, Mez J, Abdolmohammadi B.

Chronic Traumatic Encephalopathy in Football Players-Reply.

p2353. doi:10.1001/jama.2017.16687. PubMed PMID: 29260223.

Cabitza F, Rasoini R, Gensini GF.

Benefits and Risks of Machine Learning Decision Support Systems-Reply.

pp2356-2357. doi:10.1001/jama.2017.16635. PubMed PMID: 29260222.

Yari N.

Chronic Traumatic Encephalopathy in Football Players.

pp2352-2353. doi:10.1001/jama.2017.16675. PubMed PMID: 29260221.

Zuckerman SL, Brett BL, Yengo-Kahn AM.

Chronic Traumatic Encephalopathy in Football Players.

p2352. doi:10.1001/jama.2017.16667. PubMed PMID: 29260220.

Licitra L, Trama A, Hosni H.

Benefits and Risks of Machine Learning Decision Support Systems.

p2354. doi:10.1001/jama.2017.16627. PubMed PMID: 29260219.

Lasko TA, Walsh CG, Malin B.

Benefits and Risks of Machine Learning Decision Support Systems.

p2355. doi:10.1001/jama.2017.16623. PubMed PMID: 29260218.

Berner ES, Ozaydin B.

Benefits and Risks of Machine Learning Decision Support Systems.

pp2353-2354. doi:10.1001/jama.2017.16619. PubMed PMID: 29260217.

Fogel AL, Kvedar JC.

Benefits and Risks of Machine Learning Decision Support Systems.

p2356. doi:10.1001/jama.2017.16615. PubMed PMID: 29260216.

Huesch MD.

Benefits and Risks of Machine Learning Decision Support Systems.

pp2355-2356. doi:10.1001/jama.2017.16611. PubMed PMID: 29260215.

Caputi TL, Smith D, Ayers JW.

Suicide Risk Behaviors Among Sexual Minority Adolescents in the United States, 2015.

pp2349-2351. doi:10.1001/jama.2017.16908. PubMed PMID: 29260214.

The War Surgeon.

p2359. doi:10.1001/jama.2017.10499. PubMed PMID: 29260213.

Rusiecki J, Cifu AS.

Colonoscopy Surveillance After Colorectal Cancer Resection.

pp2346-2347. doi:10.1001/jama.2017.17613. PubMed PMID: 29260211.

Bergmark RW, Pynnonen M.

Diagnosis and First-Line Treatment of Chronic Sinusitis.

pp2344-2345. doi:10.1001/jama.2017.18196. PubMed PMID: 29260210.

Voelker R.

FDA Pursues Unproven Cancer Claims.

p2288. doi:10.1001/jama.2017.19150. PubMed PMID: 29260209.

Voelker R.

First Treatment Approved for Rare Blood Cancer.

p2288. doi:10.1001/jama.2017.18871. PubMed PMID: 29260208.

Voelker R.

Blood Test Results-Pronto.

p2288. doi:10.1001/jama.2017.18869. PubMed PMID: 29260207.

Silver RM, Branch DW.

Cervical Pessary to Prevent Preterm Birth.

pp2299-2300. doi:10.1001/jama.2017.18955. PubMed PMID: 29260206.

DeMets DL, Cook TD, Buhr KA.

Guidelines for Statistical Analysis Plans.

pp2301-2303. doi:10.1001/jama.2017.18954. PubMed PMID: 29260205.

Lucey CR.

Is Medical Education a Public or a Private Good?: Insights From the Numbers.

pp2303-2305. doi:10.1001/jama.2017.17552. PubMed PMID: 29260204.

Brotherton SE, Etzel SI.

Graduate Medical Education, 2016-2017.

pp2368-2387. doi:10.1001/jama.2017.16203. PubMed PMID: 29260203.

Barzansky B, Etzel SI.

Medical Schools in the United States, 2016-2017.

pp2360-2367. doi:10.1001/jama.2017.16702. PubMed PMID: 29260202.

Green MJ, Squier SM.

Graphic Medicine: The Best of 2017.

pp2280-2281. doi:10.1001/jama.2017.18637. PubMed PMID: 29260201.

Voelker R.

Finding a Better Way to Assess Presidential Fitness.

pp2285-2286. doi:10.1001/jama.2017.17482. PubMed PMID: 29188273.

Friedrich MJ.

Determining Health Effects of Hazardous Materials Released During Hurricane Harvey.

pp2283-2285. doi:10.1001/jama.2017.15558. PubMed PMID: 29188269.

Curtin LS, Signer MM.

Ensuring the Integrity of the National Resident Matching Program.

pp2289-2290. doi:10.1001/jama.2017.16269. PubMed PMID: 29114782.

Linder KA, Malani PN.

Hepatitis A.

p2393. doi:10.1001/jama.2017.17244. PubMed PMID: 29094153.

Sandel M, Desmond M.

Investing in Housing for Health Improves Both Mission and Margin.

pp2291-2292. doi:10.1001/jama.2017.15771. PubMed PMID: 29090312.

Katz MH.

Homelessness-Challenges and Progress.

pp2293-2294. doi:10.1001/jama.2017.15875. PubMed PMID: 29090310.

Dowell D, Noonan RK, Houry D.

Underlying Factors in Drug Overdose Deaths.

pp2295-2296. doi:10.1001/jama.2017.15971. PubMed PMID: 29049472.

JAMA Vol. 318 No. 24 December 26 2017

Rubin R.

Most Drinking Water-Associated Disease Outbreaks Linked to Legionella.

p2420. doi:10.1001/jama.2017.19202. PubMed PMID: 29279942.

Rubin R.

Lyme Disease Spreading Beyond States With Historically High Incidence.

p2420. doi:10.1001/jama.2017.19129. PubMed PMID: 29279941.

Coulehan J.

Negative Capability and the Art of Medicine.

pp2429-2430. doi:10.1001/jama.2017.19333. PubMed PMID: 29279939.

Hewitt DB, Barnard C, Bilimoria KY.

Insulin Dosing Error in a Patient With Severe Hyperkalemia.

pp2485-2486. doi:10.1001/jama.2017.7964. PubMed PMID: 29279937.

Peiris AN, Jaroudi S, Noor R.

Heat Stroke.

p2503. doi:10.1001/jama.2017.18780. PubMed PMID: 29279936.

Bancks MP, Kershaw K, Carson AP, et al.

Association of Modifiable Risk Factors in Young Adulthood With Racial Disparity in Incident Type 2 Diabetes During Middle Adulthood.

pp2457-2465. doi:10.1001/jama.2017.19546. PubMed PMID: 29279935.

Zhao JG, Zeng XT, Wang J, Liu L.

Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis.

pp2466-2482. doi:10.1001/jama.2017.19344. Review. PubMed PMID: 29279934.

Backes M, Dingemans SA, Dijkgraaf MGW, et al.

Effect of Antibiotic Prophylaxis on Surgical Site Infections Following Removal of Orthopedic Implants Used for Treatment of Foot, Ankle, and Lower Leg Fractures: A Randomized Clinical Trial.

pp2438-2445. doi:10.1001/jama.2017.19343. PubMed PMID: 29279933.

Di Q, Dai L, Wang Y, et al.

Association of Short-term Exposure to Air Pollution With Mortality in Older Adults.

pp2446-2456. doi:10.1001/jama.2017.17923. PubMed PMID: 29279932.

Slomski A.

Surgery Improves Seizures in Children With Drug-Resistant Epilepsy.

pp2419-2420. doi:10.1001/jama.2017.19991. PubMed PMID: 29279931.

Slomski A.

Prochlorperazine Superior to Hydromorphone for Migraine.

p2419. doi:10.1001/jama.2017.19989. PubMed PMID: 29279930.

Slomski A.

Gamification Shows Promise in Motivating Physical Activity.

p2419. doi:10.1001/jama.2017.19987. PubMed PMID: 29279929.

Slomski A.

Recumbent Delivery With Epidural and Spontaneous Vaginal Births.

p2419. doi:10.1001/jama.2017.19985. PubMed PMID: 29279928.

Slomski A.

Stenting Does Not Relieve Stable Angina Symptoms.

p2419. doi:10.1001/jama.2017.19023. PubMed PMID: 29279927.

Guselkumab (Tremfya) for Psoriasis.

pp2487-2488. doi:10.1001/jama.2017.18515. PubMed PMID: 29279926.

Ried-Larsen M, Johansen MY, Pedersen BK.

Intensive Lifestyle Intervention for Type 2 Diabetes-Reply.

pp2494-2495. doi:10.1001/jama.2017.17240. PubMed PMID: 29279925.

Bergeron A, Bondeelle L, Chevret S.

Azithromycin and Survival After Hematopoietic Stem Cell Transplant-Reply.

p2492. doi:10.1001/jama.2017.17236. PubMed PMID: 29279924.

Naci H, Kesselheim AS.

Evidence Required for Drugs Granted Accelerated Approval-Reply.

pp2493-2494. doi:10.1001/jama.2017.17184. PubMed PMID: 29279923.

VanderWeele TJ, Balboni TA, Koh HK.

Spiritual Care in Medicine-Reply.

p2496. doi:10.1001/jama.2017.16571. PubMed PMID: 29279922.

Giugliano D, Maiorino MI, Esposito K.

Intensive Lifestyle Intervention for Type 2 Diabetes.

p2494. doi:10.1001/jama.2017.17232. PubMed PMID: 29279921.

Fuji S.

Azithromycin and Survival After Hematopoietic Stem Cell Transplant.

p2492. doi:10.1001/jama.2017.17228. PubMed PMID: 29279920.

Tanimoto T, Kosugi K, Tsuda K.

Evidence Required for Drugs Granted Accelerated Approval.

pp2492-2493. doi:10.1001/jama.2017.17180. PubMed PMID: 29279919.

Liao L.

Spiritual Care in Medicine.

pp2495-2496. doi:10.1001/jama.2017.16559. PubMed PMID: 29279918.

Young-Wolff KC, Tucker LY, Alexeeff S, et al.

Trends in Self-reported and Biochemically Tested Marijuana Use Among Pregnant Females in California From 2009-2016.

pp2490-2491. doi:10.1001/jama.2017.17225. PubMed PMID: 29279917.

Charcot's Opinion and Criticism of German Medicine.

p2498. doi:10.1001/jama.2017.10500. PubMed PMID: 29279916.

Kuehn B.

CMS Vows to Overhaul Medicaid.

p2418. doi:10.1001/jama.2017.19928. PubMed PMID: 29279914.

Kuehn B.

Crowdsourcing Pregnancy Data.

p2418. doi:10.1001/jama.2017.19923. PubMed PMID: 29279913.

Kuehn B. NIH

Strategy to Combat Opioid Crisis.

p2418. doi:10.1001/jama.2017.19920. PubMed PMID: 29279912.

Kuehn B.

Opioid Emergency Declared.

p2418. doi:10.1001/jama.2017.19014. PubMed PMID: 29279911.

Pieramici DJ.

Sports-Related Eye Injuries.

pp2483-2484. doi:10.1001/jama.2017.17560. PubMed PMID: 29279910.

Fontanarosa P, Bauchner H, Flanagin A.

Authorship and Team Science.

pp2433-2437. doi:10.1001/jama.2017.19341. PubMed PMID: 29279909.

Zhang J.

Low-Level Air Pollution Associated With Death: Policy and Clinical Implications.

pp2431-2432. doi:10.1001/jama.2017.18948. PubMed PMID: 29279908.

Disis MLN.

Movie Review of The Immortal Life of Henrietta Lacks.

pp2410-2412. doi:10.1001/jama.2017.17916. PubMed PMID: 29279906.

Rubin R.

Will the FDA's New Tobacco Strategy Be a Game Changer?

pp2413-2415. doi:10.1001/jama.2017.16396. PubMed PMID: 29214315.

Abbasi J.

Emergency Department Opioid Misuse Diagnoses Increasing in Adolescents and Young Adults.

pp2416-2417. doi:10.1001/jama.2017.16586. PubMed PMID: 29214309.

Sachs RE, Ginsburg PB, Goldman DP.

Encouraging New Uses for Old Drugs.

pp2421-2422. doi:10.1001/jama.2017.17535. PubMed PMID: 29204602.

Nuzzo JB, Cicero AJ, Inglesby TV.

The Importance of Continued US Investment to Sustain Momentum Toward Global Health Security.

pp2423-2424. doi:10.1001/jama.2017.17188. PubMed PMID: 29192316.

Smith DJ, Bono RC, Slinger BJ.

Transforming the Military Health System.

pp2427-2428. doi:10.1001/jama.2017.16718. PubMed PMID: 29121161.

Barsky AJ.

The Iatrogenic Potential of the Physician's Words.

pp2425-2426. doi:10.1001/jama.2017.16216. PubMed PMID: 29090307.

JAMA Vol. 319 No. 1 January 2 2018

Prescott HC, Angus DC.

Enhancing Recovery From Sepsis: A Review.

pp62-75. doi:10.1001/jama.2017.17687. Review. PubMed PMID: 29297082.

Millstein JH.

The Envelope.

p23. doi:10.1001/jama.2017.19273. PubMed PMID: 29297081.

Wohlfeld V.

Love's Muse.

p87. doi:10.1001/jama.2017.10501. PubMed PMID: 29297080.

Prescott HC, Angus DC.

Postsepsis Morbidity.

p91. doi:10.1001/jama.2017.19809. PubMed PMID: 29297079.

Writing Group for the TRIGR Study Group, Knip M, Åkerblom HK, et al.

Effect of Hydrolyzed Infant Formula vs Conventional Formula on Risk of Type 1 Diabetes: The TRIGR Randomized Clinical Trial.

pp38-48. doi:10.1001/jama.2017.19826. PubMed PMID: 29297078.

Purnell TS, Luo X, Cooper LA, et al.

Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014.

pp49-61. doi:10.1001/jama.2017.19152. PubMed PMID: 29297077.

Feldman TE, Reardon MJ, Rajagopal V, et al.

Effect of Mechanically Expanded vs Self-Expanding Transcatheter Aortic Valve Replacement on Mortality and Major Adverse Clinical Events in High-Risk Patients With Aortic Stenosis: The REPRISE III Randomized Clinical Trial.

pp27-37. doi:10.1001/jama.2017.19132. PubMed PMID: 29297076.

Maret-Ouda J, Lagergren J.

Recurrence of Reflux After Laparoscopic Antireflux Surgery-Reply.

p83. doi:10.1001/jama.2017.17728. PubMed PMID: 29297075.

Moreno JD, Schmidt U, Joffe S.

The Nuremberg Code and Informed Consent for Research-Reply.

p86. doi:10.1001/jama.2017.17724. PubMed PMID: 29297074.

Johnson DH.

Self-regulation of the Medical Profession and Maintenance of Certification-Reply.

pp84-85. doi:10.1001/jama.2017.17720. PubMed PMID: 29297073.

Patti MG, Schlottmann F.

Recurrence of Reflux After Laparoscopic Antireflux Surgery.

pp82-83. doi:10.1001/jama.2017.17712. PubMed PMID: 29297072.

Freeman BD.

Self-regulation of the Medical Profession and Maintenance of Certification.

p84. doi:10.1001/jama.2017.17708. PubMed PMID: 29297071.

Merz JF.

The Nuremberg Code and Informed Consent for Research.

pp85-86. doi:10.1001/jama.2017.17704. PubMed PMID: 29297070.

Cardenas CJ.

Self-regulation of the Medical Profession and Maintenance of Certification.

pp83-84. doi:10.1001/jama.2017.17699. PubMed PMID: 29297069.

Xu G, Strathearn L, Liu B, Bao W.

Prevalence of Autism Spectrum Disorder Among US Children and Adolescents, 2014-2016.

pp81-82. doi:10.1001/jama.2017.17812. PubMed PMID: 29297068.

Hamstringing the Army.

p88. doi:10.1001/jama.2017.12182. PubMed PMID: 29297067.

Koh HK, Restuccia R.

Housing as Health.

pp12-13. doi:10.1001/jama.2017.20081. PubMed PMID: 29297066.

Yip L, Carty SE.

Expanding the Options for Patient-Guided Decision Making in Papillary Thyroid Cancer.

pp76-77. doi:10.1001/jama.2017.18608. PubMed PMID: 29297064.

Voelker R.

Treatment for Rare Enzyme Disorder.

p14. doi:10.1001/jama.2017.20058. PubMed PMID: 29297063.

Voelker R.

Opioid Withdrawal Symptoms Subside With Cranial Nerve Stimulation.

p14. doi:10.1001/jama.2017.19313. PubMed PMID: 29297062.

Voelker R.

Digital Pill Gains Approval.

p14. doi:10.1001/jama.2017.19309. PubMed PMID: 29297061.

Jay CL, Cigarroa FG.

Disparities in Live Donor Kidney Transplantation: Related to Poverty, Race, or Ethnicity?

pp24-26. doi:10.1001/jama.2017.19617. PubMed PMID: 29297060.

Vangipuram R, Haley C, Tyring SK.

A Woman With a Large Ulcerated Nodule on the Finger.

pp78-79. doi:10.1001/jama.2017.19282. PubMed PMID: 29297059.

Hampton T.

Smart Artificial Beta Cells May Help Treat Diabetes.

pp11-12. doi:10.1001/jama.2017.12856. PubMed PMID: 29297058.

Verghese A, Shah NH, Harrington RA.

What This Computer Needs Is a Physician: Humanism and Artificial Intelligence.

pp19-20. doi:10.1001/jama.2017.19198. PubMed PMID: 29261830.

Naylor CD.

Canada as Single-Payer Exemplar for Universal Health Care in the United States: A Borderline Option.

pp17-18. doi:10.1001/jama.2017.19668. PubMed PMID: 29255893.

Fuchs VR.

Is Single Payer the Answer for the US Health Care System?

pp15-16. doi:10.1001/jama.2017.18739. PubMed PMID: 29255843.

Lyon J.

New Inroads Against Multiple Sclerosis.

pp9-11. doi:10.1001/jama.2017.14033. PubMed PMID: 29238808.

Kim J, Ross JS, Kapczynski A.

Pediatric Exclusivity and Regulatory Authority: Implications of Amgen v HHS.

pp21-22. doi:10.1001/jama.2017.16477. PubMed PMID: 29117365.

JAMA Vol. 319 No. 2 January 9 2018

Rubin R.

High Cost of Investigating Measles Cases.

p114. doi:10.1001/jama.2017.20423. PubMed PMID: 29318286.

Rubin R.

Nearly 15% of US HIV Infections Undiagnosed in 2015.

p114. doi:10.1001/jama.2017.20149. PubMed PMID: 29318285.

US Preventive Services Task Force, Grossman DC, Curry SJ, et al.

Screening for Adolescent Idiopathic Scoliosis: US Preventive Services Task Force Recommendation

Statement.

pp165-172. doi:10.1001/jama.2017.19342. PubMed PMID: 29318284.

Dunn J, Henrikson NB, Morrison CC, et al.

Screening for Adolescent Idiopathic Scoliosis: Evidence Report and Systematic Review for the US Preventive Services Task Force.

pp173-187. doi:10.1001/jama.2017.11669. PubMed PMID: 29318283.

Gallagher KC.

She Smiled as She Walked Away.

pp121-122. doi:10.1001/jama.2017.19760. PubMed PMID: 29318281.

Jin J.

Screening for Scoliosis in Adolescents.

p202. doi:10.1001/jama.2017.20372. PubMed PMID: 29318279.

Atri A, Frölich L, Ballard C, et al.

Effect of Idalopirdine as Adjunct to Cholinesterase Inhibitors on Change in Cognition in Patients With Alzheimer Disease: Three Randomized Clinical Trials.

pp130-142. doi:10.1001/jama.2017.20373. PubMed PMID: 29318278.

Jones PM, Cherry RA, Allen BN, et al.

Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery.

pp143-153. doi:10.1001/jama.2017.20040. PubMed PMID: 29318277.

Plevritis SK, Munoz D, Kurian AW, et al.

Association of Screening and Treatment With Breast Cancer Mortality by Molecular Subtype in US Women, 2000-2012.

pp154-164. doi:10.1001/jama.2017.19130. PubMed PMID: 29318276.

Abbasi J.

Why Are American Indians Dying Young?

pp109-111. doi:10.1001/jama.2017.10122. PubMed PMID: 29318275.

Lesinurad/Allopurinol (Duzallo) for Gout-Associated Hyperuricemia.

pp188-189. doi:10.1001/jama.2017.20189. PubMed PMID: 29318274.

Liu W, Liu JW, Ma DL.

Dermoscopic Patterns of Spitz Nevi-Reply.

p194. doi:10.1001/jama.2017.18999. PubMed PMID: 29318273.

Manson JE, Aragaki AK, Rossouw JE.

Menopausal Estrogen Therapy and Breast Cancer Mortality-Reply.

pp193-194. doi:10.1001/jama.2017.18316. PubMed PMID: 29318272.

Cifu AS.

Improving Diagnostic Decisions-Reply.

p195. doi:10.1001/jama.2017.17732. PubMed PMID: 29318271.

Pollock JL.

Dermoscopic Patterns of Spitz Nevi.

p194. doi:10.1001/jama.2017.18991. PubMed PMID: 29318270.

Hickey M, McNamara HC, Mishra GD.

Menopausal Estrogen Therapy and Breast Cancer Mortality.

p193. doi:10.1001/jama.2017.18308. PubMed PMID: 29318269.

Patel JJ, Bergl P.

Improving Diagnostic Decisions.

p195. doi:10.1001/jama.2017.17716. PubMed PMID: 29318268.

Joynt Maddox KE, Orav EJ, Zheng J, et al.

Participation and Dropout in the Bundled Payments for Care Improvement Initiative.

pp191-193. doi:10.1001/jama.2017.14771. PubMed PMID: 29318267.

Sancar F, Abbasi J, Bucher K.

Mortality Among American Indians and Alaska Natives.

p112. doi:10.1001/jama.2017.20760. PubMed PMID: 29318264.

Bagian JP, Paull DE.

Handovers During Anesthesia Care: Patient Safety Risk or Opportunity for Improvement?

pp125-127. doi:10.1001/jama.2017.20602. PubMed PMID: 29318263.

Sarwark JF, Davis MM.

Evolving Recommendations for Scoliosis Screening: A Compelling Need for Further Research.

pp127-129. doi:10.1001/jama.2017.20190. PubMed PMID: 29318262.

Bennett DA.

Lack of Benefit With Idalopirdine for Alzheimer Disease: Another Therapeutic Failure in a Complex Disease Process.

pp123-125. doi:10.1001/jama.2017.19700. PubMed PMID: 29318261.

Abbasi J.

Clinical Advances in Human Gene Therapies.

p113. doi:10.1001/jama.2017.20692. PubMed PMID: 29318258.

Abbasi J.

iPhone-Based Device Helps Treat River Blindness.

p113. doi:10.1001/jama.2017.20077. PubMed PMID: 29318257.

Bindman AB, Pronovost PJ, Asch DA.

Funding Innovation in a Learning Health Care System.

pp119-120. doi:10.1001/jama.2017.18205. PubMed PMID: 29270611.

Greenland P.

Cardiovascular Guideline Skepticism vs Lifestyle Realism?

pp117-118. doi:10.1001/jama.2017.19675. PubMed PMID: 29242938.

Ioannidis JPA.

Diagnosis and Treatment of Hypertension in the 2017 ACC/AHA Guidelines and in the Real World.

pp115-116. doi:10.1001/jama.2017.19672. PubMed PMID: 29242891.

JAMA Vol. 319 No. 3 January 16 2018

Friedrich MJ.

Combination Strategy Associated With Reduced HIV Incidence in Uganda.

p219. doi:10.1001/jama.2017.21296. PubMed PMID: 29340692.

Friedrich MJ.

Dangers of Substandard or Falsified Medicines.

p219. doi:10.1001/jama.2017.21291. PubMed PMID: 29340691.

Friedrich MJ.

Possible Biomarkers of Deadly Ebola.

p219. doi:10.1001/jama.2017.20420. PubMed PMID: 29340690.

Kennedy AB, Lavie CJ, Blair SN.

Fitness or Fatness: Which Is More Important?

pp231-232. doi:10.1001/jama.2017.21649. PubMed PMID: 29340689.

Guth E.

Counting Calories as an Approach to Achieve Weight Control.

pp225-226. doi:10.1001/jama.2017.21355. PubMed PMID: 29340688.

Yanovski SZ, Yanovski JA.

Toward Precision Approaches for the Prevention and Treatment of Obesity.

pp223-224. doi:10.1001/jama.2017.20051. PubMed PMID: 29340687.

Powell LM, Maciejewski ML.

Taxes and Sugar-Sweetened Beverages.

pp229-230. doi:10.1001/jama.2017.19522. PubMed PMID: 29340686.

Pomeranz JL, Mozaffarian D, Micha R.

Can the Government Require Health Warnings on Sugar-Sweetened Beverage Advertisements?

pp227-228. doi:10.1001/jama.2017.19209. PubMed PMID: 29340685.

Burke MA, Heiland FW.

Evolving Societal Norms of Obesity: What Is the Appropriate Response?

pp221-222. doi:10.1001/jama.2017.18947. PubMed PMID: 29340684.

Puzziferri N, Almandoz JP.

Sleeve Gastrectomy for Weight Loss.

p316. doi:10.1001/jama.2017.18519. PubMed PMID: 29340681.

Jakobsen GS, Småstuen MC, Sandbu R, et al.

Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities.

pp291-301. doi:10.1001/jama.2017.21055. PubMed PMID: 29340680.

Peterli R, Wölnerhanssen BK, Peters T, et al.

Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in

Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial.

pp255-265. doi:10.1001/jama.2017.20897. PubMed PMID: 29340679.

Ikramuddin S, Korner J, Lee WJ, et al.

Lifestyle Intervention and Medical Management With vs Without Roux-en-Y Gastric Bypass and Control of Hemoglobin A1c, LDL Cholesterol, and Systolic Blood Pressure at 5 Years in the Diabetes Surgery Study. pp266-278. doi:10.1001/jama.2017.20813. PubMed PMID: 29340678.

Reges O, Greenland P, Dicker D, et al.

Association of Bariatric Surgery Using Laparoscopic Banding, Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care Obesity Management With All-Cause Mortality.

pp279-290. doi:10.1001/jama.2017.20513. PubMed PMID: 29340677.

Salminen P, Helmiö M, Ovaska J, et al.

Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial.

pp241-254. doi:10.1001/jama.2017.20313. PubMed PMID:29340676.

Abbasi J.

Interest in the Ketogenic Diet Grows for Weight Loss and Type 2 Diabetes.

pp215-217. doi:10.1001/jama.2017.20639. PubMed PMID: 29340675.

Lichtman JH, Howard G, Brott TG.

Trends in Carotid Revascularization Procedures-Reply.

pp308-309. doi:10.1001/jama.2017.19781. PubMed PMID: 29340674.

Krumholz HM.

Risks of Statins for Lower-Risk Individuals-Reply.

p310. doi:10.1001/jama.2017.19174. PubMed PMID: 29340673.

Ballman KV, McCall LM, Giuliano AE.

Axillary vs Sentinel Lymph Node Dissection in Women With Invasive Breast Cancer-Reply.

pp306-307. doi:10.1001/jama.2017.18318. PubMed PMID: 29340672.

Hussain MA, Bhatt DL, Al-Omran M.

Trends in Carotid Revascularization Procedures.

pp307-308. doi:10.1001/jama.2017.19773. PubMed PMID: 29340671.

Paraskevas KI.

Trends in Carotid Revascularization Procedures.

p308. doi:10.1001/jama.2017.19769. PubMed PMID: 29340670.

Regenold WT.

Risks of Statins for Lower-Risk Individuals.

pp309-310. doi:10.1001/jama.2017.19170. PubMed PMID: 29340669.

Uno H, Hassett MJ, Wei LJ.

Axillary vs Sentinel Lymph Node Dissection in Women With Invasive Breast Cancer.

p306. doi:10.1001/jama.2017.18312. PubMed PMID: 29340668.

Appropriations for City Health Departments.

p312. doi:10.1001/jama.2017.12204. PubMed PMID: 29340667.

Biener AI, Decker SL; Agency for Healthcare Research and Quality.

Medical Care Use and Expenditures Associated With Adult Obesity in the United States.

p218. doi:10.1001/jama.2017.21063. PubMed PMID: 29340665.

Shubeck S, Dimick JB, Telem DA.

Long-term Outcomes Following Bariatric Surgery.

pp302-303. doi:10.1001/jama.2017.20521. PubMed PMID: 29340664.

Voelker R.

Monthly Buprenorphine Injection Approved for Opioid Use Disorder.

p220. doi:10.1001/jama.2017.20647. PubMed PMID: 29340663.

Voelker R.

Regulatory Pathway for 3D Printing.

p220. doi:10.1001/jama.2017.20643. PubMed PMID: 29340662.

Voelker R.

Second Cancer Biosimilar Approved.

p220. doi:10.1001/jama.2017.20642. PubMed PMID: 29340661.

Livingston EH.

Reimagining Obesity in 2018: A JAMA Theme Issue on Obesity.

pp238-240. doi:10.1001/jama.2017.21779. PubMed PMID: 29340660.

Arterburn D, Gupta A.

Comparing the Outcomes of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for Severe Obesity.

pp235-237. doi:10.1001/jama.2017.20449. PubMed PMID: 29340659.

Avorn J.

Engaging With Patients on Health Policy Changes: An Urgent Issue.

pp233-234. doi:10.1001/jama.2017.20257. PubMed PMID: 29222542.

Cawley J, Willage B, Frisvold D.

Pass-Through of a Tax on Sugar-Sweetened Beverages at the Philadelphia International Airport.

pp305-306. doi:10.1001/jama.2017.16903. PubMed PMID: 29071342.

Lancet Vol. 390 No. 10113 December 16 2017

Lucey M, Clark J, Glasziou P.

Public availability of trial protocols.

e54-e55. doi:10.1016/S0140-6736(17)33255-5. PubMed PMID: 29256405.

Olusanya BO, Sirimanna T, McPherson B.

Timely sensory stimulation and early childhood development.

p2626. doi:10.1016/S0140-6736(17)32410-8. PubMed PMID: 29256404.

Tsuda K, Tanimoto T, Mori J, et al.

Targeted-release budesonide therapy for IgA nephropathy.

p2625. doi:10.1016/S0140-6736(17)32145-1. PubMed PMID: 29256403.

Fellström B, Barratt J, Flöge J, et al.

Targeted-release budesonide therapy for IgA nephropathy - Authors' reply.

pp2625-2626. doi:10.1016/S0140-6736(17)32138-4. PubMed PMID: 29256402.

Ali SI, Khan A, Fatima H, et al.

A call to reinstate Pakistan's death penalty moratorium.

p2623. doi:10.1016/S0140-6736(17)33110-0. PubMed PMID: 29256401.

Pang T, Fathalla M, Whitworth J, et al.

Time for WHO to renew its commitment to health research.

pp2623-2624. doi:10.1016/S0140-6736(17)33111-2. PubMed PMID: 29256400.

Zarocostas J.

The cost of mass-casualty attacks.

pp2617-2618. doi:10.1016/S0140-6736(17)33306-8. PubMed PMID: 29256399.

Horton R.

Offline: The unspoken dangers facing UK medical science.

p2616. doi:10.1016/S0140-6736(17)33299-3. PubMed PMID: 29256398.

Dementia burden coming into focus.

p2606. doi:10.1016/S0140-6736(17)33304-4. PubMed PMID: 29256397.

The balancing act of orphan drug pricing.

p2606. doi:10.1016/S0140-6736(17)33305-6. PubMed PMID: 29256396.

Achieving sustainable solidarity development goals.

p2605. doi:10.1016/S0140-6736(17)33303-2. PubMed PMID: 29256395.

Watts G.

Osman Sankoh: better data for better health.

e56. doi:10.1016/S0140-6736(17)33252-X. PubMed PMID: 29229174.

Sams K, Desclaux A, Anoko J, et al.

Mobilising experience from Ebola to address plague in Madagascar and future epidemics.

pp2624-2625. doi:10.1016/S0140-6736(17)33088-X. PubMed PMID: 29195687.

Pigott DM, Deshpande A, Letourneau I, et al.

Local, national, and regional viral haemorrhagic fever pandemic potential in Africa: a multistage analysis. pp2662-2672. doi:10.1016/S0140-6736(17)32092-5. PubMed PMID: 29031848; PubMed Central PMCID: PMC5735217.

BACKGROUND: Predicting when and where pathogens will emerge is difficult, yet, as shown by the recent Ebola and Zika epidemics, effective and timely responses are key. It is therefore crucial to transition from reactive to proactive responses for these pathogens. To better identify priorities for outbreak mitigation and prevention, we developed a cohesive framework combining disparate methods and data sources, and assessed subnational pandemic potential for four viral haemorrhagic fevers in Africa, Crimean-Congo haemorrhagic fever, Ebola virus

disease, Lassa fever, and Marburg virus disease.

METHODS: In this multistage analysis, we quantified three stages underlying the potential of widespread viral haemorrhagic fever epidemics. Environmental suitability maps were used to define stage 1, index-case potential, which assesses populations at risk of infection due to spillover from zoonotic hosts or vectors, identifying where index cases could present. Stage 2, outbreak potential, iterates upon an existing framework, the Index for Risk Management, to measure potential for secondary spread in people within specific communities. For stage 3, epidemic potential, we combined local and international scale connectivity assessments with stage 2 to evaluate possible spread of local outbreaks nationally, regionally, and internationally.

FINDINGS: We found epidemic potential to vary within Africa, with regions where viral haemorrhagic fever outbreaks have previously occurred (eg, western Africa) and areas currently considered non-endemic (eg, Cameroon and Ethiopia) both ranking highly. Tracking transitions between stages showed how an index case can

escalate into a widespread epidemic in the absence of intervention (eg, Nigeria and Guinea). Our analysis showed Chad, Somalia, and South Sudan to be highly susceptible to any outbreak at subnational levels.

INTERPRETATION: Our analysis provides a unified assessment of potential epidemic trajectories, with the aim of allowing national and international agencies to pre-emptively evaluate needs and target resources. Within each country, our framework identifies at-risk subnational locations in which to improve surveillance, diagnostic capabilities, and health systems in parallel with the design of policies for optimal responses at each stage. In conjunction with pandemic preparedness activities, assessments such as ours can identify regions where needs and provisions do not align, and thus should be targeted for future strengthening and support.

Ihekweazu C, Abubakar I.

Tackling viral haemorrhagic fever in Africa.

pp2612-2614. doi:10.1016/S0140-6736(17)32475-3. PubMed PMID: 29031845.

NCD Risk Factor Collaboration (NCD-RisC).

Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.

pp2627-2642. doi:10.1016/S0140-6736(17)32129-3. PubMed PMID: 29029897; PubMed Central PMCID: PMC5735219.

BACKGROUND: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults.

METHODS: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity).

FINDINGS: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m2 per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese.

INTERPRETATION: The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.

Dietz WH.

Double-duty solutions for the double burden of malnutrition.

pp2607-2608. doi:10.1016/S0140-6736(17)32479-0. PubMed PMID: 29029895.

Lear SA, Hu W, Rangarajan S, et al.

The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study.

pp2643-2654. doi:10.1016/S0140-6736(17)31634-3. PubMed PMID: 28943267.

BACKGROUND: Physical activity has a protective effect against cardiovascular disease (CVD) in high-income countries, where physical activity is mainly recreational, but it is not known if this is also observed in lower-income countries, where physical activity is mainly non-recreational. We examined whether different amounts and types of physical activity are associated with lower mortality and CVD in countries at different economic levels.

METHODS: In this prospective cohort study, we recruited participants from 17 countries (Canada, Sweden, United Arab Emirates, Argentina, Brazil, Chile, Poland, Turkey, Malaysia, South Africa, China, Colombia, Iran, Bangladesh, India, Pakistan, and Zimbabwe). Within each country, urban and rural areas in and around selected cities and towns were identified to reflect the geographical diversity. Within these communities, we invited individuals aged between 35 and 70 years who intended to live at their current address for at least another 4 years. Total physical activity was assessed using the International Physical Activity Questionnaire (IPQA). Participants with pre-existing CVD were excluded from the analyses. Mortality and CVD were recorded during a mean of 6·9 years of follow-up. Primary clinical outcomes during follow-up were mortality plus major CVD (CVD mortality, incident myocardial infarction, stroke, or heart failure), either as a composite or separately. The effects of physical activity on mortality and CVD were adjusted for sociodemographic factors and other risk factors taking into account household, community, and country clustering.

FINDINGS: Between Jan 1, 2003, and Dec 31, 2010, 168 916 participants were enrolled, of whom 141 945 completed the IPAQ. Analyses were limited to the 130 843 participants without pre-existing CVD. Compared with low physical activity (750 minutes per week) were associated with graded reduction in mortality (hazard ratio 0·80, 95% CI 0·74-0·87 and 0·65, 0·60-0·71; p ................
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