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[Obituary] Jeffrey Lima Hayes O'Riordan

Sa, 03/03/2018 - 01:00
Pioneer researcher in the hormonal control of bone metabolism. Born in Newport, UK, on March 27, 1931, he died in London, UK, of a bowel obstruction on Oct 9, 2017, aged 86 years.

[Correspondence] Putting Ireland's health spending into perspective

Sa, 03/03/2018 - 01:00
The Irish Taoiseach (Prime Minister) Leo Varadkar recently stated that Ireland spends the fifth highest amount on health in the world, therefore citizens should expect the fifth best health system in the world.1 Meanwhile, the European Commission has expressed concerns about the cost-effectiveness and sustainability of the Irish health system.2 However, these observations fail to take into account the fact that the Irish health system is only now recovering from historic long-term underfunding, the effects of which are still being felt.

[Correspondence] Tackling hepatitis C—Pakistan's road to success

Sa, 03/03/2018 - 01:00
In November, 2017, the annual World Hepatitis Summit in São Paulo, Brazil, assessed WHO's global health sector strategy on viral hepatitis 2016–20, and called for prompt, innovative, and coherent interventions, along with evidence-based research.1 The viral hepatitis pandemic caused an estimated 1·4 million deaths in 2015, and yet has received inadequate attention from donors and policy makers until recently, as outlined in an Editorial in The Lancet (Nov 11, 2017, p 2121).2 New data indicate that action has been fragmented and insufficient, with only 82 countries, including Pakistan, adopting strategies to eliminate viral hepatitis by 2030.

[Correspondence] Issues with measuring hepatitis prevalence in resource-limited settings

Sa, 03/03/2018 - 01:00
We read with interest the Correspondence from Noemi García-Tardón and colleagues (Sept 23, 2017, p 1485) 1 describing the prevalence of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among blood donors in Sierra Leone. Considering there are few data on viral hepatitis from the region, the authors should be congratulated for their efforts. However, we fear that some of their results and messages might be misleading.

[Correspondence] Ensuring value in health-related research

Sa, 03/03/2018 - 01:00
Funders of health-related research agree that although considerable research of high value exists, loss of any research because it asks the wrong questions, is poorly designed, is not published, or the reports are unusable is unacceptable.

[Correspondence] Foley catheterisation versus oral misoprostol to induce labour

Sa, 03/03/2018 - 01:00
The INFORM study (Aug 12, 2017, p 669)1 investigated Foley catheterisation versus oral misoprostol in women with hypertension who were scheduled for induction of labour. The authors report a statistically significant lower rate of vaginal delivery within 24 h among women induced via Foley catheterisation, and conclude that oral misoprostol is more effective than Foley catheterisation.

[Correspondence] Foley catheterisation versus oral misoprostol to induce labour – Author's reply

Sa, 03/03/2018 - 01:00
I thank Ben Mol for his thoughtful comments about our research.1 He is concerned that 24 h is too short a cutoff time for vaginal birth, and that we should have continued the induction process with the Foley catheter before resorting to caesarean section. We would usually agree with him, but our study was done in a very different setting to his Dutch study.2 In Europe, outcomes of induced labour are so good that the procedure is often performed for weak indications to prevent adverse outcomes; hence, the proportion of Dutch pregnancies that are induced is around 15%.

[Articles] Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales

Ve, 02/03/2018 - 01:30
Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes.

[Comment] Taking aim at cholera

Ve, 02/03/2018 - 01:30
In 1854, John Snow's work on cholera in London immortalised the power of mapping as a tool for disease prevention and control.1 Over 160 years later, a more ambitious effort to map cholera has been reported in The Lancet.2 Forgoing so-called shoe leather epidemiology in favour of big data, Justin Lessler and colleagues2 used 279 cholera datasets covering 2283 locations in 37 countries, and cluster-level maps of access to improved water and sanitation in 41 countries, to map cholera incidence across sub-Saharan Africa at a 20 km × 20 km grid scale.

[Comment] Nursing Now campaign: raising the status of nurses

Me, 28/02/2018 - 11:44
There have been enormous developments in nursing over the past decades, with extended roles, nurse practitioners, and degree level education spreading globally and with, for example, prescribing by nurses now established in countries as different as Botswana and the UK.1 Nursing and midwifery make up almost half the global health workforce, are at the centre of most health teams, and have a massive impact on health.2 However, nurses and midwives will assume an even more extensive and influential role in the future for at least six powerful reasons.

[Articles] Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial

Me, 28/02/2018 - 01:30
Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care.

[Comment] Hypertension: time for doctors to switch the driver's seat?

Me, 28/02/2018 - 01:30
In The Lancet, Richard McManus and colleagues1 in the TASMINH4 trial address a timely and clinically relevant question, as to whether self-monitoring of blood pressure, with or without telemonitoring, when used by general practitioners (GPs) to titrate antihypertensive therapy in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings alone.

[Department of Error] Department of Error

Ma, 27/02/2018 - 01:30
Papi A, Vestbo J, Fabbri L, et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet 2018; 391: 1076–84—In figure 3B of this Article (published online first on Feb 8, 2018), the y-axis title and the “Adjusted mean difference between treatments” heading have been corrected. This correction has been made to the online version as of Feb 26, 2018, and the printed Article is correct.

[Comment] Death and suffering in Eastern Ghouta, Syria: a call for action to protect civilians and health care

Lu, 26/02/2018 - 11:44
Since Feb 4, 2018, Syrian forces with Russian support have bombarded Eastern Ghouta, an enclave out of government control near Damascus. This military action has killed hundreds of civilians and injured more than 1550 people as of Feb 21, 2018,1 in an area where about 390 000 people, most of whom are civilians, have lived under siege since October, 2013. The recent escalation is reportedly part of a Syrian Government offensive supported by its Russian and Iranian allies to retake Ghouta. In just 1 day, on Feb 20, 2018, PAX, an international peace movement, documented 110 civilians killed and hundreds injured in 131 air strikes, 44 barrel bombs, 28 surface-to-surface “elephant” missiles, five cluster bombs, and countless other artillery and rocket fire.

[Correspondence] Oxfam: sex scandal or governance failure?

Sa, 24/02/2018 - 01:30
The apparent failure of Oxfam to take appropriate actions against ongoing sexual predation by its aid workers is tragic, infuriating, and concerning. It is also ironic, given that Oxfam is considered a bastion of good governance, ethics, and human rights.1 Indeed, Oxfam's policy and practice arm has no less than 577 publications on promoting good governance and a further 455 on human rights.2 As a health policy and systems researcher who studies the dynamics between international agencies and domestic policy makers in low-income and middle-income countries (LMICs), I believe it is critical to reflect on what the “Oxfam scandal” is not.

[Comment] Challenges in health equity for Indigenous peoples in Canada

Ve, 23/02/2018 - 08:00
Canada's health-care system, like the country itself, is a complex entity. As the two papers in The Lancet's Series on Canada1,2 make clear, the country's health-care landscape is made up of multiple people, places, and policies with often overlapping—and sometimes conflicting—jurisdictions, priorities, paradigms, and practices. These complexities are rooted in Canada's fairly young colonial history that resulted in a nation comprised of a majority of settler and recent immigrants and their descendants, alongside a steady resurgence of Indigenous populations of First Nations, Inuit, and Métis peoples that are growing in numbers, political acumen, and agency.

[Comment] Canada's time to act

Ve, 23/02/2018 - 08:00
Beavers, ice hockey, maple syrup, Mounted Police, peace-keeping. These things conjure Canada in the minds of many. Others will add health to the list, for Canada's public health-care system is one of the oldest and most celebrated in the world and because Canada has ministered to global humanitarian, migration, and medical crises for decades. While Canadian values of solidarity, inclusivity, and diplomacy have found much expression in matters of health, there are clear signs that all of the world now “needs more Canada”.

[Series] Canada's universal health-care system: achieving its potential

Ve, 23/02/2018 - 08:00
Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care.

[Comment] Canada and global health: accelerate leadership now

Ve, 23/02/2018 - 08:00
Canada's celebration in 2017 of 150 years as a nation is a ripe time for reflection on both its own universal health system and the country's global commitments towards universal health coverage (UHC) as articulated in the Sustainable Development Goals (SDGs).1,2 The recognition in the prairie province of Saskatchewan that farmers should not have to sell the farm to pay for their family's health care was the principled pivot point that triggered Canada's march towards UHC in the 1960s. Although it took nearly a century for the Canadian confederation, established in 1867, to achieve UHC, over these past 50 years, from a global perspective, Canada's universal health-care system is viewed as being among the world's best.

[Comment] Canada's efforts to ensure the health and wellbeing of Indigenous peoples

Ve, 23/02/2018 - 08:00
In September, 2017, Prime Minister Justin Trudeau stood before the UN General Assembly and acknowledged that the “failure of successive Canadian governments to respect the rights of Indigenous peoples in Canada is our great shame.”1 For generations, First Nations, Inuit, and Métis peoples in Canada were denied the right to self-determination and subjected to laws, policies, and practices based on domination and assimilation. Indigenous peoples lost control over their own lives.