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[Comment] Tackling air pollution, climate change, and NCDs: time to pull together

Ve, 26/10/2018 - 23:00
Air pollution, climate change, and non-communicable diseases (NCDs) are three linked threats to planetary health that share common origins and joint solutions. Yet efforts to address these problems have too often moved down separate paths.

[Comment] Offline: In defence of precision public health

Ve, 26/10/2018 - 23:00
Writing in the NEJM recently, Merlin Chowkwanyun, Ronald Bayer, and Sandro Galea questioned and then attacked the emerging concept of precision public health. They labelled the “precision medicine” movement a “bandwagon”. They drew attention to the way organisations, such as the Bill & Melinda Gates Foundation, had extended the idea of “precision” to public health. They suggested that precision public health could represent “an abandonment of our mission of enhancing population wellbeing”. The core of their criticism was that whereas public health starts with populations, the word “precision” implies a concern only with individuals.

[World Report] Funding redirected to pay for immigrant detention centres

Ve, 26/10/2018 - 23:00
A plan to expand immigrant children detention centres requires money from medical research and health programmes. Susan Jaffe, The Lancet's Washington correspondent, reports.

[World Report] Urgent medical attention needed for people on Nauru

Ve, 26/10/2018 - 23:00
Children displaying what has been called by some resignation syndrome have shocked the world and highlighted an urgent need for medical attention in Nauru. Chris McCall reports.

[Perspectives] Bipolar disorder

Ve, 26/10/2018 - 23:00
Riffing on Raymond Carver's most famous title is about as original as paraphrasing Jane Austen's most famous first line, but what do we talk about when we talk about bipolar disorder? Does this deceptively simple term denote a human experience with a very long history or a neuropharmaceutical frame with a comparatively short one? Mania, as the psychiatrist and historian David Healy has observed, is an ancient and enduring concept, with analogous terms in Indian and Chinese medical cosmologies. For Hippocratic physicians, thinking in terms of balance and imbalance, mania was a feverish excitation of the encephalon—the consequence of an excess of hot bile or a deficiency of cooling phlegm—whose opposite was not melancholy but stupor.

[Perspectives] Logical families

Ve, 26/10/2018 - 23:00
Warm, affectionate, and everyday descriptions of gay life have not always been easy to find within literature—or health care. Indeed, diverse sexualities have often been pathologised within health, and legislated against. Against that backdrop it seems unlikely a book series that celebrates sexuality might become an international bestseller. Yet, that is exactly what has happened. Although not without incident. In 1985, the UK's Gay's The Word bookshop in London was eagerly awaiting the delivery of Tales of the City—a novel by Armistead Maupin about the loves and lives of a group of friends in San Francisco.

[Obituary] Lois Gretchen Jovanovic

Ve, 26/10/2018 - 23:00
Leader in diabetic pregnancy care. She was born in Minneapolis, MN, USA, on May 2, 1947, and died in Santa Barbara, CA, USA, on Sept 18, 2018, aged 71 years.

[Correspondence] Cyprus's new National Health Service and future European health

Ve, 26/10/2018 - 23:00
In 2019, Cyprus is expected to introduce its new National Health Insurance System, 13 years after Myria Antoniadou's World Report,1 which identified the Mediterranean island's health-care challenges. With the new National Health Insurance System, Cyprus will become a primary-care-driven country, and it will be the latest European Union (EU) member state to have a universal health-care system.2

[Correspondence] Gender bias in publishing

Ve, 26/10/2018 - 23:00
In their Comment, Jamie Lundine and colleagues (May 5, p 1754)1 asserted that a gendered system of social practices exists that disadvantages women in academic research. We are troubled with the Comment's level of intellectual rigour and exclusion of important facts.

[Correspondence] Gender bias in publishing

Ve, 26/10/2018 - 23:00
We applaud Jamie Lundine and colleagues1 for highlighting the systemic gender bias and structural sexism in academia. We welcome the notion that “the gendered system of academic publishing is both a reflection and a cause” of biases in academia.1 The call to journals and publishers to align their actions with gender equality and broader social justice movements within and outside academia is crucial and timely.

[Correspondence] Unexplained infertility

Ve, 26/10/2018 - 23:00
We read with interest the findings by Cynthia Farquhar and colleagues (Feb 3, p 441),1 and the accompanying Comment,2 relating to the use of intrauterine inseminations (IUIs) in the treatment of so-called unexplained infertility. Although we applaud the basic hypothesis behind the study, we object to the design and, in particular, the interpretation of the study. We also decry the uncritical acceptance of the reported findings and interpretation in the accompanying editorial.

[Correspondence] Unexplained infertility – Authors' reply

Ve, 26/10/2018 - 23:00
We thank Norbert Gleicher and colleagues for their correspondence related to The Uterine Insemination (TUI) trial, a randomised trial comparing intrauterine insemination with expectant management in couples with unexplained infertility and a low chance of conception.1

[Department of Error] Department of Error

Ve, 26/10/2018 - 23:00
Kraut JA, Madias NE. Sodium bicarbonate for severe metabolic acidaemia. Lancet 2018; 392: 3–4—In the third paragraph of the first column on page 3, the sentence in parentheses, which describes the patient population and analysis, should read “…(patients were included in the intention-to-treat analysis)…”. This correction has been made to the online version as of Oct 25, 2018.

[Department of Error] Department of Error

Ve, 26/10/2018 - 23:00
Walker KF, Thornton JG. Encouraging awareness of fetal movements is harmful. Lancet 2018; published online Sept 27. http://dx.doi.org/10.1016/S0140-6736(18)31720-3—In this Comment, the reference to the linked Article was incorrect. This correction has been made to the online version as of Oct 25, 2018.

[Department of Error] Department of Error

Ve, 26/10/2018 - 23:00
Patel V, Saxena S, Lund C, et al. The Lancet Commission on global mental health and sustainable development. Lancet 2018, 392: 1553–98—In this Commission, grant numbers have been added to the details of funding for Ilina Singh in the Acknowledgments section. This correction has been made to the online version as of Oct 25, 2018

[Clinical Picture] Persistent red and swollen eyelids

Ve, 26/10/2018 - 23:00
A 44-year-old woman presented with a 3-year history of having swollen and red eyelids. The problem was not associated with pruritus or pain. She had been previously treated with topical steroids and antibiotics but with little effect. Her past medical history was unremarkable. During physical examination, she was found to have scaly, atrophic, erythematous plaques—with the loss of eyelashes on the lateral aspects—on both lower eyelids (figure). Additionally, the scaly erythema was accompanied by hyperpigmentation on the left lateral canthus (figure).

[Comment] Disentangling the burden of disease in the UK: what now?

Me, 24/10/2018 - 23:30
“I wouldn't be here today if it were not for the NHS” was Professor Steven Hawking's response1 to an American newspaper that used him as an example to highlight the deficiencies of the UK National Health Service (NHS) by writing, “People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless”.2

[Comment] Long-acting technologies for infectious diseases in LMICs

Me, 24/10/2018 - 23:30
Imagine a child in the Sahel protected from malaria for an entire season after just one injection of chemoprophylaxis. Or a woman at risk of HIV in Zambia taking a single capsule every 2 weeks that slowly releases an antiretroviral drug to protect her from infection. Could the risk of resistance to medications for infectious diseases be reduced through the use of long-acting (LA) patches, implants, or injectable drugs?

[Articles] Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Me, 24/10/2018 - 23:30
These estimates at local, regional, and national level will allow policy makers to match resources and priorities to levels of burden and risk factors. Improvement in YLLs and life expectancy slowed notably after 2010, particularly in cardiovascular disease and cancer, and targeted actions are needed if the rate of improvement is to recover. A targeted policy response is also required to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression.

[Editorial] The Astana Declaration: the future of primary health care?

Ve, 19/10/2018 - 23:00
Primary health care is in crisis. It is underdeveloped in many countries, underfunded in others, and facing a severe workforce recruitment and retention challenge. Half the world's population has no access to the most essential health services. Yet 80–90% of people's health needs across their lifetime can be provided within a primary health-care framework—from maternity care and disease prevention through vaccination, to management of chronic conditions and palliative care. As populations age, and multimorbidity becomes the norm, the role of primary health-care workers becomes ever more important.