PLoS medicine
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While many individual genes have been identified that confer protection against malaria, the overall impact of host genetics on malarial risk remains unknown. ⋯ Genetic and unidentified household factors each accounted for around one quarter of the total variability in malaria incidence in our study population. The genetic effect was well beyond that explained by the anticipated effects of the haemoglobinopathies alone, suggesting the existence of many protective genes, each individually resulting in small population effects. While studying these genes may well provide insights into pathogenesis and resistance in human malaria, identifying and tackling the household effects must be the more efficient route to reducing the burden of disease in malaria-endemic areas.
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A 35-year-old woman presented with a neck swelling after a missed abortion. Her thyroid function tests were in the thyrotoxic range. Perros discusses the further investigation and management of this patient.
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Despite the proven benefits of aspirin therapy in the primary and secondary prevention of cardiovascular disease (CVD), utilization rates of aspirin remain suboptimal in relation to recommendations. We studied national trends of aspirin use among intermediate- to high-risk patients in the US ambulatory care settings and compared the priority given to aspirin versus statins for CVD risk reduction. We also examined patient and health care provider contributors to the underuse of aspirin. ⋯ Improvements in use of aspirin in US ambulatory care for reducing risks of CVD were at best modest during the period under study, particularly for secondary prevention, where the strongest evidence and most explicit guidelines exist. Aspirin is more underused than statins despite its more favorable cost-effectiveness. Aggressive and targeted interventions are needed to enhance provider and patient adherence to consensus guidelines for CVD risk reduction.
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The World Health Organization warns that a flu pandemic is inevitable, and possibly imminent. Barnett and colleagues discuss a tool called the Haddon Matrix that could help in pandemic influenza planning.