A first step forward would be to

A first step forward would be to establish a public-health-oriented commission or agency charged specifically with developing controls over the alcohol market and a strategy for reducing levels of alcohol consumption and problems, drawing on the strategies agreed on in the WHO Global Strategy for Reducing Harmful Use of Alcohol. Additionally, a national monitoring and surveillance system is urgently needed to inform alcohol policy at a time when Chinese alcohol consumption has rapidly grown, with a resulting toll of death and disease.
The summary of the research about rheumatic purchase BX795 disease prevalence by Martina Rothenbühler and colleagues (December, 2014, issue) highlights the substantial burden of disease in endemic regions across the globe. However, the large differences between echocardiography prevalence studies used in the meta-analysis preclude meaningful analysis and comparison (as evident in the heterogeneity scores). In the studies included in the meta-analysis, various echocardiographic diagnostic criteria are used, each with different diagnostic features or disease categorisation. The differences between these criteria can affect the estimation of rheumatic heart disease prevalence (especially of silent or borderline disease), even when applied in the same clinical population. Further, the included studies had varying methods and designs. Some undertook portable echocardiography only, others portable echocardiography followed by hospital echocardiography. There is a risk, identified by Beaton and colleagues, that portable echocardiography alone might result in many false positive diagnoses of rheumatic heart disease and thereby overstate estimates of disease prevalence. Taken together, we consider that it is difficult to compare the prevalence rates from these studies, a concern identified by Roberts and colleagues. We believe that the comparison of these echocardiography studies calls attention to two key areas that necessitate further research. First, the development and then validation of universally accepted and clinically relevant criteria for echocardiographic diagnosis of rheumatic heart disease; and second, the undertaking of diagnostic studies (not cross-sectional prevalence studies) comparing portable with hospital echocardiography. Research into these issues will help us better assess the disease burden of rheumatic heart disease and the suitability of echocardiography for screening.
We acknowledge the large heterogeneity in reported prevalence of rheumatic heart disease documented in our systematic review, and concur with Peter Murray and Caroline Shaw that the statistical combination of heterogeneous studies might have drawbacks. The exploration of potential sources of heterogeneity is therefore important and could provide more insight than the mechanistic calculation of the overall measure of effect. As former US Secretary of State for Defence Donald Rumsfeld said, “There are known knowns. These are the things we know that we know. There are known unknowns. That is to say, there are things that we know we don\'t know. But there are also unknown unknowns. There are things we don\'t know we don\'t know.” The potential sources of heterogeneity addressed by Murray and Shaw fall under the category of known unknowns, for which we tried to account by taking several measures. We assessed the methodological characteristics and summarised the clinical and echocardiographic criteria for case detection of all included studies in the online appendix, did sensitivity analyses, and transparently discussed the limitations of our findings. Additionally, we presented prediction intervals. These intervals represent the true uncertainty of a pooled estimate in the presence of unexplained or only partly explained heterogeneity, as is the case here. Beyond the known unknowns that we tried to address, we are confronted with residual confounders, unknown unknowns that might be uncovered only in subsequent studies.