Riviste scientifiche

[Editorial] Changing culture to end FGM

The Lancet - Sa, 03/02/2018 - 01:00
When Ellen Johnson Sirleaf retired last month after 12 years in office in Liberia, she signed an executive order banning female genital mutilation (FGM) in the country for girls younger than 18 years. Her profile as Africa's first female president and a recipient of the Nobel Peace Prize for efforts to advance women's rights and peace ensured her executive order got international media attention, thus shining needed light on a devastating practice. Globally, a staggering 200 million women and girls have undergone FGM, and UNICEF estimates that more than one in three girls between 15 and 19 years of age are currently affected.

[Editorial] Yellow fever: a major threat to public health

The Lancet - Sa, 03/02/2018 - 01:00
The world's largest fractional-dose vaccination campaign for yellow fever started on Jan 25 in Brazil, with the support of WHO. The campaign attempts to avoid the urban transmission cycle, not seen in the country since 1942. 33 people have died due to yellow fever between Jan 14 and 23, while the number of confirmed cases in the country has reached more than 130.

[Editorial] Editing the human genome: balancing safety and regulation

The Lancet - Sa, 03/02/2018 - 01:00
The international race to bring human genome editing into widespread use in clinical medicine is moving fast. On Jan 23, the National Institutes of Health Common Fund launched its Somatic Cell Genome Editing programme, committing approximately US$190 million of funding over the next 6 years to propel development of genome editing into medical practice. A worthy effort, but the USA and Europe still trail behind China. As many as 86 patients in China have already had their genes altered as part of clinical trials to treat a range of diseases, including solid cancers.

[Comment] Should basic science matter to clinicians?

The Lancet - Sa, 03/02/2018 - 01:00
We have observed declining interest in discovery science by our medical colleagues. Across a range of top medical journals, the number of basic science articles decreased by 40–60% from 1994 to 2013,1 while a major North American university recorded a 60% decrease in clinician-investigator trainees pursuing basic science training between 1987 and 2016.2 The decline of basic science research in the medical literature and a disregard for it in continuing education programmes3 are allowing mastery of science to be lost by practising clinicians.

[Comment] The global fight against cancer: challenges and opportunities

The Lancet - Sa, 03/02/2018 - 01:00
By 2030, the number of cancer cases is projected to increase to 24·6 million and the number of cancer deaths to 13 million.1 Worldwide, health systems, especially in low-income and middle-income countries (LMICs), are ill prepared to manage the increasing cancer burden.2 Globally, there is a shortfall in coverage of cancer services for prevention, screening, treatment, and palliative care.3–5 If cost-effective interventions for cancer screening, prevention, and treatment were delivered through strengthened health systems, they could help largely avoid many premature deaths, unnecessary suffering, and unacceptable inequalities.

[Comment] Offline: Adolescent health—vulnerable and under threat

The Lancet - Sa, 03/02/2018 - 01:00
There is no other group in society more emblematic of the Anthropocene than the adolescent—defined as a person between the ages of 10 and 24 years. The irreversible harm we are inflicting on our planet today will hurt the lives of young people most of all. During the past decade, one of the most remarkable achievements in global health has been the emergence of a new movement for adolescent health. When Ban Ki-moon's signature Every Woman Every Child initiative was launched in 2010, the young person was absent.

[World Report] FGM in Sierra Leone

The Lancet - Sa, 03/02/2018 - 01:00
Three years after a 2014 ban against the practice of female genital mutilation in Sierra Leone, Sharmila Devi reports on the progress towards its eradication.

[World Report] Prospects for dementia research

The Lancet - Sa, 03/02/2018 - 01:00
After Pfizer's withdrawal from the market, some predicted a mass exodus of pharmaceutical companies' interests in Alzheimer's disease drug research. Geoff Watts reports.

[World Report] Developing countries in the digital revolution

The Lancet - Sa, 03/02/2018 - 01:00
A multidisciplinary commission was launched to question what role developing countries can and should have in the rapidly changing technological landscape. Talha Burki reports.

[World Report] A new paradigm for the MRC Units in The Gambia and Uganda

The Lancet - Sa, 03/02/2018 - 01:00
Two major medical research institutions in sub-Saharan Africa came under the purview of the London School of Hygiene & Tropical Medicine (LSHTM). The Medical Research Council (MRC) Unit The Gambia and the MRC/Uganda Virus Research Institute (UVRI) Uganda Research Unit transferred to LSHTM from their current positions under the MRC at the beginning of February.

[Perspectives] Virtual care for improved global health

The Lancet - Sa, 03/02/2018 - 01:00
Global access to health care is far from adequate, with health disparities widening; the rise of economic inequities and shortages in the health workforce are contributors. This is especially true for people who live in rural areas in low-income countries without access to essential health services. Yet digital infrastructure and technologies exist that could allow virtual and rapid provision of health care for many health conditions, for almost everyone, at any time, irrespective of their location.

[Perspectives] Superbugs and us

The Lancet - Sa, 03/02/2018 - 01:00
These days you would have to be peculiarly immune to public health messaging not to know that the world is on the brink of an antibiotic apocalypse. From the back of pill packets to the panels on the back of buses, prompts urging us to “keep antibiotics working” are almost as ubiquitous as the drug-resistant microbes themselves. Although medical experts have been warning about the indiscriminate use of antibiotics since the 1940s, their consumption continues to grow. This is not only a problem in countries like South Africa and India where antibiotics are widely available over the counter.

[Perspectives] The medical suffragettes

The Lancet - Sa, 03/02/2018 - 01:00
In January, 1918, the women staff of Endell Street Military Hospital in central London, UK, forgot their ward duties for a few hours as they sang and danced in celebration. That evening the women doctors, nurses, and orderlies donned costumes for a fancy dress party, had a sumptuous dinner, and toasted the Queen before marching through the hospital in a grand procession. It was 10 months before the end of World War 1—and victory for the Allies still hung in the balance—yet the women were intent on celebrating.

[Perspectives] The burning light

The Lancet - Sa, 03/02/2018 - 01:00
“In our life there is a single colour, as on an artist's palette, which provides the meaning of life and art. It is the colour of love”, artist Marc Chagall wrote. While these words encapsulate the strong emotional undercurrent that characterises the work of the Belorussian artist, they also perfectly describe the profound love between Chagall and his first wife Bella, whom he portrayed in many of his canvasses, often flying with him above the roofs of their hometown.

[Obituary] Fotis Kafatos

The Lancet - Sa, 03/02/2018 - 01:00
Biologist, science administrator, and founding President of the European Research Council. He was born in Heraklion, Crete, Greece, on April 16, 1940, and died there on Nov 18, 2017, aged 77 years.

[Correspondence] Can the scientific world positively influence decision makers on planetary health?

The Lancet - Sa, 03/02/2018 - 01:00
The 2017 G7 Health Ministerial Meeting was on Nov 5–6, in Milan, Italy, and for the first time the effect of climate and environmental factors on health was addressed in the agenda of the meeting. As reported in the final Health Ministers communiquè after the meeting (signed by all seven countries),1 the delegation agreed to identify and promote some fundamental adaptation actions. In addition to the novelty of these subjects being in the agenda and in the final meeting documents, we believe the process that led to these outcomes is innovative and interesting.

[Correspondence] The growing problem of loneliness

The Lancet - Sa, 03/02/2018 - 01:00
Imagine a condition that makes a person irritable, depressed, and self-centred, and is associated with a 26% increase in the risk of premature mortality. Imagine too that in industrialised countries around a third of people are affected by this condition, with one person in 12 affected severely, and that these proportions are increasing. Income, education, sex, and ethnicity are not protective, and the condition is contagious. The effects of the condition are not attributable to some peculiarity of the character of a subset of individuals, they are a result of the condition affecting ordinary people.

[Correspondence] Influenza vaccination and prevention of cardiovascular disease mortality

The Lancet - Sa, 03/02/2018 - 01:00
Catharine Paules and Kanta Subbarao presented in their Seminar (Aug 12, 2017, p 697) the clinical features, therapeutic options, and controversies regarding treatment and prevention of seasonal influenza infection.1 Although they acknowledged that influenza can impair different organ systems, little attention was given to cardiovascular consequences. Ischaemic heart disease is the leading cause of death worldwide and influenza vaccination could reduce cardiovascular mortality, particularly in patients with coronary heart disease for whom cardiovascular mortality risk has been reported to be halved by influenza vaccination.

[Correspondence] Influenza vaccination and prevention of cardiovascular disease mortality – Authors' reply

The Lancet - Sa, 03/02/2018 - 01:00
We thank Daniel Caldeira, Joaquim J Ferreira, and João Costa for highlighting the effect of influenza infection on underlying cardiovascular disease and the role of influenza vaccination in potentially mitigating this risk. Although we briefly mentioned that influenza infection could exacerbate underlying cardiovascular disease in our Seminar,1 we were unable to fully expand on this point because of word-count restrictions. In this regard, an epidemiological link between influenza and excess deaths associated with cardiovascular disease was suggested as early as in the 1930s.

[Correspondence] Challenges of measuring the Healthcare Access and Quality Index

The Lancet - Sa, 03/02/2018 - 01:00
We read with interest the GBD 2015 Healthcare Access and Quality study (July 15, 2017, p 231),1 which constructed the Healthcare Access and Quality (HAQ) Index on the basis of risk-standardised cause-specific death rates to facilitate comparisons of personal health-care access and quality for 195 countries and territories from 1990 to 2015. However, we would like to contest some of the findings on the HAQ Index related to chronic kidney disease (CKD).
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