The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.0040297&type=printable

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration

Efforts to reduce global cancer disparities begin with an understanding of geographic patterns in cancer incidence, mortality, and prevalence. Using the GLOBOCAN (2002) and Cancer Incidence in Five Continents databases, we describe overall cancer incidence, mortality, and prevalence, age-adjusted temporal trends, and age-specific incidence patterns in selected geographic regions of the world. For the eight most common malignancies-cancers of lung, breast, colon and rectum, stomach, prostate, liver, cervix, and esophagus-the most important risk factors, cancer prevention and control measures are briefly reviewed. In 2002, an estimated 11 million new cancer cases and 7 million cancer deaths were reported worldwide; nearly 25 million persons were living with cancer. Among the eight most common cancers, global disparities in cancer incidence, mortality, and prevalence are evident, likely due to complex interactions of nonmodifiable (ie, genetic susceptibility and aging) and modifiable risk factors (ie, tobacco, infectious agents, diet, and physical activity). Indeed, when risk factors among populations are intertwined with differences in individual behaviors, cultural beliefs and practices, socioeconomic conditions, and health care systems, global cancer disparities are inevitable. For the eight most common cancers, priorities for reducing cancer disparities are discussed.

Patterns of Cancer Incidence, Mortality, and Prevalence Across Five Continents: Defining Priorities to Reduce Cancer Disparities in Different Geographic Regions of the World

Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalizability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies, and cross-sectional studies, and 4 are specific to each of the 3 study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors, and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, 1 or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site (www.strobe-statement.org) should be helpful resources to improve reporting of observational research.

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Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration

1described the presence of cell-free nucleic acid (cfNA) in human blood for the first time. This attracted little attention in the scientific community and it was not until 1994 that the importance of cfNA was recognized as a result of the detection of mutated RAS gene fragments in the blood of cancer patients 2,3 (TIMELINE). In 1996, microsatellite alterations on cell-free DNA (cfDNA) were shown in cancer patients 4

/pdf/cell-free-nucleic-acids-as-biomarkers-in-cancer-patients-3cg84i0sga.pdf

Cell-free nucleic acids as biomarkers in cancer patients

Globalisation and health. Author's reply

In the history of medicine, Rudolph Virchow (1821–1902) stands as “the greatest of all pathologists…in every way an intellectual giant”.1 Mackenbach’s review2 is a well-argued step in going beyond the pathology dimension, illuminating Virchow’s role in epidemiology and public health ( see page 181 ).

When opening courses in epidemiology, I never miss the opportunity to refer to Virchow, stressing the key feature that in my view makes him a permanent model for epidemiologists: his breadth and force of synthesis, expressed both intellectually within his scientific work and behaviourally in joining science with civic engagement.

Throughout his long career, Virchow, the founder of cellular pathology, carried out thousands of necropsies, and his power of analysis, based on meticulous macroscopic and microscopic observations, was matched by the power of integrating, within an essentially physiological framework, notions at different levels of biological complexity, from chemistry to the population.

In Virchow’s words,3:

> When I directed attention to the cell, I wished to coerce research workers to discover exactly the process inside the cell, the happenings inside the smallest elementary organism, and it was self-evident that continued …

https://jech.bmj.com/content/jech/63/3/185.full.pdf

Virchow, a model for epidemiologists

To the Editor.-We thank Dr. Eva Hansen for her comments on the results of our case-control study of lung cancer among man-made vitreous fiber (MMVF) production workers, 1 although we are surprised that she did not choose to criticize our study in the customary way,i.e., in a letter to the editor of the journal in which our results had been published recently.2 In her introductory remarks, Dr Hansen argues that the fact that we did not find an increased risk of lung cancer according to estimated exposure to asbestos invalidates our results on risk according to exposure to MMVFs. She fails to recognize that exposure to asbestos was very limited in the MMVFindustry: most of the occupational asbestos exposure in these workers occurred during employment outside the MMVF industry. We acknowledge that the exposure assessment for jobs outside the MMVF industry, which was based mainly on questionnaire information, was of lower quality than the exposure assessment for jobs within the MMVF industry.

Study of lung cancer in MMVF workers.

Keywords Health inequality Record linkage Venice EpidemiologyIntroductionTourists visiting Venice, nearly thirteen million every year,may regard it as a single multi-facet jewel from the past:they would probably never suspect that when boarding a‘‘vaporetto’’ (the local public transport boat) they wouldstop at different areas where material health inequalitiesaffect today’s resident population.The municipality of Venice (population 271,073,including 66 homeless, in 2001 Census) is composed oftwo rather distinct entities, an inland metropolitan area,next to large industrial facilities, where the majority of thepopulation resides (175,124), and the lagoon area, inhab-ited since the ninth century, where 95,883 islanders livemostly in the historical town and in the larger islands.Since 2001 an integrated epidemiological system (IES)has been activated in Venice with the main goal of moni-toring spatial and time patterns of the health proﬁles in thecommunity. The IES operates through two steps: (a) sum-marisation—deterministic record-linkage is performedbetween the geo-referenced population ﬁle and the elec-tronic health archives available on health events (hospitaldischarge records, mortality records, pathology records,drugs prescriptions, etc.); and (b) consolidation—disease-speciﬁc algorithms have been developed and applied to thedata to identify the subjects affected by a given disease(Simonato et al. 2008).MethodsIndividual information on socio-economic variables, in par-ticular educational level, has been obtained by cross-linkingto the 2001 population census ﬁle. The territory was subdi-vided into 17 units representing the 6 districts of the inlandmetropolitan area plus and the 11 original ancient ‘‘Sestieri’’of the historical town and the islands. From the approxi-mately 11 millions of electronic health records available inthe IES during the study period (2002–2006) a total of 50mortality, incidence and prevalence health outcomes havebeen computed concerning the majority of diseases affectingthe general population resident in the 17 units of the Venicemunicipality. All the outcomes included in the analyses arereported in an online Table (eTable 1). We present here as aselection from the full body of the results the all causesmortality, the prevalence of diabetes type II, a disease ofincreasing importance in public health, and the incidence ofacute myocardial infarction (AMI). Diabetes prevalent caseswereidentiﬁedusing three data sources (hospitals discharges,drug prescription and exemption from copayment of drugs,syringes, and glucose blood level tests) as described in detailpreviously (Gnavi et al. 2008). Acute myocardial infarctionincident cases were identiﬁed through record linkagebetween population ﬁle and hospitalization and causes ofdeath database (Barchielli et al. 2008).

Health inequalities and historically persistent socioeconomic differences in Venice

Two main dates stand out in the more than 40-year life of the International Journal of Epidemiology (IJE): 1972, the year the journal was established by the International Epidemiological Association (IEA) and 2000, the entry into the new century coinciding, as it happened, with the first year in office of the Editors-in-Chief, George Davey Smith and Shah Ebrahim, both of whom will terminate their tenure at the end of 2016. It is convenient to take these dates as signposts for two periods in the IJE history.

Rodolfo Saracci

Papers

Globalisation and health. Author's reply

Virchow, a model for epidemiologists

Study of lung cancer in MMVF workers.

Health inequalities and historically persistent socioeconomic differences in Venice

Epidemiology, the International Epidemiological Association and the International Journal of Epidemiology: a personal chronicle.