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[Correspondence] The oldest-old in China – Authors' reply
We agree with Fuzhong Li and Peter Harmer that our data1 have limitations, including the unmeasured burden of non-communicable disease. In fact, we acknowledge this in our paper, and conclude that “further studies need to include chronic diseases”. Li and Harmer also point out that we did not assess the magnitude of rural–urban differences, and Tomohiro Morita and colleagues describe our rural–urban dichotomy as “too simplistic”. We agree that an investigation of rural–urban dif ferences is important, which is why we adjusted for rural–urban residence as a covariate in our st...
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Yi Zeng, Qiushi Feng, Therese Hesketh, Kaare Christensen, James W Vaupel Tags: Correspondence Source Type: research

[Correspondence] The oldest-old in China
Yi Zeng and colleagues1 analysed three pairs of oldest-old Chinese cohorts born 10 years apart, and showed coexistence and mixed effects of compression of disability in activities of daily living, and expansion of disability in physical and cognitive functioning with increased longevity. We propose two additional viewpoints to enhance the significance of this research. (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Tomohiro Morita, Kana Yamamoto, Akihiko Ozaki, Kenji Tsuda, Tetsuya Tanimoto Tags: Correspondence Source Type: research

[Correspondence] The oldest-old in China
In The Lancet (April 22, p 1619), Yi Zeng and colleagues1 focus on an important segment of the rapidly ageing population in China. From a public health perspective, their study is valuable because the oldest-old age group represents the most neglected and socially disadvantaged people, who have the greatest burden of non-communicable disease, in Chinese society. (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Fuzhong Li, Peter Harmer Tags: Correspondence Source Type: research

[Correspondence] Time to talk about menstruation: a response
We applaud The Lancet for its Editorial (June 10, p 2264)1 that emphasised the need to talk about menstruation. The Editorial highlighted this neglected issue and supports breaking the silence.2 However, we are concerned that some of the statements made are not substantiated by evidence from rigorous studies. (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Julie Hennegan, Belen Torondel, Penelope A Phillips-Howard, Marni Sommer, Paul Montgomery Tags: Correspondence Source Type: research

[Correspondence] Leonardo's mistake: not evidence-based medicine?
Renowned as one of the most influential figures in many different fields, Leonardo da Vinci (1452 –1519) was also a revolutionary anatomist. In his research on the human body and reproductive system, da Vinci devoted a series of drawings to conception and the fetus, in which the fetal membranes (chorion, amnion, and allantois) are represented for the first time.1 Additionally, when depicting c oitus, da Vinci introduced two errors: a canal in the penis connected to the spinal cord, and a canal linking the uterus to the breasts (figure). (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Nicola Di Stefano, Giampaolo Ghilardi, Sergio Morini Tags: Correspondence Source Type: research

[World Report] Robert Koch Institut: towards digital epidemiology
The Robert Koch Institute (RKI) is setting its sights on a digital future, in which epidemiological intelligence does not rely solely on conventional monitoring through surveys and field data, but links up with machine learning and artificial intelligence. (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Anita Makri Tags: World Report Source Type: research

[Editorial] Minamata Convention on mercury: a contemporary reminder
History provides us with valuable lessons. The tragic Minamata Bay disaster in Japan is a stark reminder that exposure to the element mercury and its compounds can impact human health, causing irreversible neurological damage and other issues such as psychosis. Earth's health is also at risk. In the 2013 Global Mercury Assessment, the UN Environment Programme (UNEP) reported that environmental mercury emissions can reach up to 8900 tonnes annually, of which 90% consist of anthropogenic emissions from processes such as artisanal gold mining, which is often unregulated and involves the forced labour of marginalised communities. (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] The UK's inadequate plan for reducing childhood obesity
“Next stage of world-leading childhood obesity plan announced”, trumpeted the press release from Public Health England (PHE) on Aug 18, to coincide with the 1-year anniversary since the UK Government's child obesity plan was launched. The new focus is calorie reduction, with PHE warning that the UK population is exceeding caloric intake by around 200–300 calories a day. With a third of children being overweight or obese by the time they leave primary school, and the latest data highlighting an increasing prevalence of type 2 diabetes in young people (621 received care from paediatric dia betic clinics in ...
Source: LANCET - August 25, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Charlottesville: symptomatic of a broader pain
The appalling events in Charlottesville, Virginia, this month bring into arresting focus the devastating effects of racism and hatred. On Saturday Aug 12, a group of politically right-wing protestors, which included white supremacists, neo-Nazis, and Ku Klux Klan members, rallied against the removal of a pro-Confederate statue, and clashed with counter protestors. Heather Heyer, a civil rights activist, was run down and killed by a speeding car driven by a Nazi sympathiser; many more were injured in what is being called an act of domestic terrorism. (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[World Report] President of Zambia declares HIV testing mandatory
The President of Zambia has announced HIV testing will now be mandatory in all government health facilities, causing concern among health activists. Andrew Green reports. (Source: LANCET)
Source: LANCET - August 25, 2017 Category: General Medicine Authors: Andrew Green Tags: World Report Source Type: research

[Clinical Picture] Soft tissue plasmacytomas in multiple myeloma
A 50-year-old man was transferred to our hospital with a 3-week history of back pain and a mass on his skull that had been growing slowly for the past 7 months. The mass was smooth, firm, and non-tender. Despite his long hair, it gave him the appearance of having a high domed forehead. Examination was otherwise unremarkable. Laboratory investigations showed renal impairment, hypercalcaemia, anaemia, and immunoparesis. Lambda light chains were detected in the urine and the serum. Magnetic resonance scans of the brain (figure) and spine (appendix) showed soft tissue lesions over the skull and thoracic spine. (Source: LANCET)
Source: LANCET - August 22, 2017 Category: General Medicine Authors: David P Breen, Ciara L Freeman, Rajith N De Silva, Shahram Derakhshani, Jane Stevens Tags: Clinical Picture Source Type: research

[Correspondence] Research misconduct and the INTERGROWTH-21st study
We respectfully take issue with the Comment published in February, 2017, by members of The Lancet's editorial staff stating that WHO's judgment of misconduct regarding the Oxford INTERGROWTH-21st study was unproven.1 –3 We are saddened by the fact that they base their conclusion on limited and biased material and simply dismiss the case as rivalry. As members of the WHO Fetal Growth research group and a former WHO external expert not associated with that trial but with evidence that WHO initially refused to he ar, we wish to note the following. (Source: LANCET)
Source: LANCET - August 22, 2017 Category: General Medicine Authors: Lawrence D Platt, Torvid Kiserud, Marshall Lindheimer Tags: Correspondence Source Type: research

[Series] Update on antithrombotic therapy after percutaneous coronary revascularisation
For relief of coronary obstruction, percutaneous coronary intervention has become a standard-of-care procedure over the past 40 years. Nonetheless, optimal outcomes after coronary stenting require careful attention to antithrombotic therapy. This review aims to summarise the current available evidence and discusses how to integrate scientific knowledge into clinical decisions. In recent years, improvement and modifications of drugs and devices have changed the field tremendously, and substantially benefitted patient outcomes. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Thomas Cuisset, Freek W A Verheugt, Laura Mauri Tags: Series Source Type: research

[Series] Intravascular imaging in coronary artery disease
Although it is the method used by most interventional cardiologists to assess the severity of coronary artery disease and guide treatment, coronary angiography has many known limitations, particularly the fact that it is a lumenogram depicting foreshortened, shadowgraph, planar projections of the contrast-filled lumen rather than imaging the diseased vessel itself. Intravascular imaging —intravascular ultrasound and more recently optical coherence tomography—provide a tomographical or cross-sectional image of the coronary arteries. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Gary S Mintz, Giulio Guagliumi Tags: Series Source Type: research

[Series] Coronary balloon angioplasty, stents, and scaffolds
Since the first coronary angioplasty on Sept 16, 1977, the field of percutaneous coronary intervention has evolved rapidly. Now marking its 40th anniversary, percutaneous coronary intervention has become one of the most common medical procedures worldwide. Much of this progress has been due to the iteration and improvement of angioplasty technologies. Balloon angioplasty was limited by unpredictable procedural outcomes due to vessel dissection and recoil, and a high rate of restenosis. The introduction of stents resulted in more stable early results and lower rates of restenosis, although early stent thrombosis and neointi...
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Robert A Byrne, Gregg W Stone, John Ormiston, Adnan Kastrati Tags: Series Source Type: research

[Articles] Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: a multicentre, prospective, observational, first-in-man study
This study establishes feasibility of the Edwards PASCAL TMVr system with a high rate of technical success and reduction of mitral regurgitation severity. Further research is needed on procedural and long-term clinical outcomes. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Fabien Praz, Konstantinos Spargias, Michael Chrissoheris, Lutz B üllesfeld, Georg Nickenig, Florian Deuschl, Robert Schueler, Neil P Fam, Robert Moss, Moody Makar, Robert Boone, Jeremy Edwards, Aris Moschovitis, Saibal Kar, John Webb, Ulrich Schäfer, Te Tags: Articles Source Type: research

[Articles] Comparative efficacy and safety of reperfusion therapy with fibrinolytic agents in patients with ST-segment elevation myocardial infarction: a systematic review and network meta-analysis
Significant differences exist among various fibrinolytic regimens as reperfusion therapy in STEMI and alteplase (accelerated infusion), tenecteplase, and reteplase should be considered over streptokinase and non-accelerated infusion of alteplase. The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy should be discouraged. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Peerawat Jinatongthai, Junporn Kongwatcharapong, Chee Yoong Foo, Arintaya Phrommintikul, Surakit Nathisuwan, Ammarin Thakkinstian, Christopher M Reid, Nathorn Chaiyakunapruk Tags: Articles Source Type: research

[Correspondence] Forgotten episodes of euthanasia in the 19th century
Two forgotten episodes of euthanasia occurred in the 19th century. The first was recounted by Giuseppe Bandi,1 an officer of Giuseppe Garibaldi, who was injured during the Battle of Calatafimi in 1860 (Sicily, Italy). Bandi was subsequently admitted to the san Michele Convent (Calatafimi, Italy), where other soldiers who had also been gravely wounded were recovering. Among the soldiers was a young man —the Mantuan—with a broken leg who had gangrene and another—the Maironi from Bergamo—who had been wounded by a bullet to his right arm. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Marta Licata, Federico Nicoli, Giuseppe Armocida Tags: Correspondence Source Type: research

[Correspondence] The BLISTER study: possible overestimation of tetracycline efficacy – Authors' reply
We thank Michael J Sladden and Peter E Hutchinson for their comments, but respectfully disagree that our study design1 favoured doxycycline. BLISTER was not an efficacy study of doxycycline versus prednisolone. We investigated whether a doxycycline-initiated pemphigoid treatment strategy could result in improved safety and acceptable effectiveness, when compared with starting with prednisolone. The doxycycline-initiated strategy was expected to be 25% less effective than prednisolone at 6 weeks. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Hywel C Williams, Joanne R Chalmers, Andrew J Nunn, Gudula Kirtschig, Enno Schmidt Tags: Correspondence Source Type: research

[Correspondence] The BLISTER study: possible overestimation of tetracycline efficacy
The BLISTER study, by Hywell C Williams and colleagues (March 6, p 1630),1 indicated that a 25% decrease in the efficacy of tetracycline in the early control of blisters would be acceptable to most UK dermatologists, if accompanied by a reduction of at least 20% in long-term serious side-effects compared with prednisolone. The efficacy of the tetracycline doxycycline was acceptable according to the study's primary effectiveness measure at 6 weeks (upper limit of 90% CI of adjusted difference between treatments [UB], 26 ·1%, within the 37% predefined acceptable non-inferiority margin [AM]); however, we question the a...
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Michael J Sladden, Peter E Hutchinson Tags: Correspondence Source Type: research

[Correspondence] PubMed should raise the bar for journal inclusion
A survey by Manca and colleagues1,2 found that predatory journals active in neuroscience and neurology outnumber those regularly indexed in the main biomedical databases. Furthermore, this analysis of predatory publishing (as of October, 2016) showed that over 10% of predatory journals in three important subdisciplines are indexed in PubMed (12% for rehabilitation, 11 ·4% for neurosciences, and 20·2% for neurology).1,2 (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Andrea Manca, Lucia Cugusi, Zeevi Dvir, Franca Deriu Tags: Correspondence Source Type: research

[Correspondence] China, Africa, and US academia join hands to advance global health
In 2016, Chinese President Xi Jinping announced the Healthy China 2030 plan —an ambitious agenda to promote health across China and to strengthen South–South cooperation, including the China–Africa Public Health cooperation plan.1 In 2005, African heads of state championed the Agenda Africa 2063, which had a similar emphasis on population health.2 Ongoing health refor ms across both Africa and China offer immense potential for mutual learning.3,4 China's success in the provision of preventive and primary care has the potential to inform health care in Africa, which faces similar challenges today as China ...
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Liu Peilong, Yemane Berhane, Wafaie Fawzi, China Harvard Africa Network (CHAN) team Tags: Correspondence Source Type: research

[Correspondence] Global health: generation men
The Fearless Girl statue that faces down Wall Street's charging bull grabbed international headlines and triggered a debate about the glass ceiling that continues to obstruct women from reaching the higher echelons of the financial sector. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Nina Schwalbe Tags: Correspondence Source Type: research

[Obituary] Prudence Mabele
South African HIV and gender rights activist. Born in Wattville, South Africa, on July 21, 1971, she died from pneumonia in Johannesburg, South Africa, on July 10, 2017, aged 45 years. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Andrew Green Tags: Obituary Source Type: research

[Perspectives] Fat and heart disease: challenging the dogma
Many readers will be incensed by this book. If you think saturated fats and cholesterol are bad for you, you'll be incensed. If you think the fat story is exaggerated, you'll be incensed. If you trust in the objectivity of science to inform health policy, you'll be incensed. Stories of shocking scientific corruption and culpability by government agencies are all to be found in Nina Teicholz's bestseller The Big Fat Surprise. This is a disquieting book about scientific incompetence, evangelical ambition, and ruthless silencing of dissent that has shaped our lives for decades. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Stuart Spencer Tags: Perspectives Source Type: research

[Perspectives] Jeroen Bax: inspiring the next generation of cardiologists
A conversation with the eminent cardiologist Eugene Braunwald fuelled Jeroen Bax's interest in nurturing aspiring cardiologists. “Braunwald told me that what really matters is developing the next generation of researchers and clinicians”, he recalls. By 2018, Bax will have mentored 60 international PhD students in his cardiac imaging research centre at Leiden University Medical Center (LUMC) in the Netherlands. “Jeroen' s students have achieved prominent positions at medical institutions throughout the world”, says Anthony DeMaria, Professor of Medicine at the University of California, San Diego. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Rachael Davies Tags: Perspectives Source Type: research

[World Report] The cost of complacency —black lung in Australia
Black lung's resurgence in Australia is a wake-up call for the international community. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Chris McCall Tags: World Report Source Type: research

[Comment] Hunting hidden parasites: Trypanosoma cruzi
Pathogens are not aware of international borders, including pathogens that cause emerging and neglected tropical diseases. Although Chagas disease is endemic to Latin America, where it affects around 5 ·7 million people,1,2 it is now a disease of global concern mainly because of the movement of human populations. After the USA, Spain hosts the highest number (more than 50 000) of migrants infected with Trypanosoma cruzi, the parasite that causes this life-threatening disease.3,4 European countr ies should therefore adapt their legislation to control the main non-vector modes of T cruzi transmission (blood transfus...
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Miriam Navarro, Bego ña Monge-Maíllo, María D Flores-Chavez, Rogelio López-Vélez Tags: Comment Source Type: research

[Comment] Expansion of the treatment toolbox for mitral regurgitation
In The Lancet, Fabien Praz and colleagues1 report their preliminary experience with the PASCAL mitral repair device and its success among 23 patients, most of whom were not considered anatomically suitable for conventional percutaneous mitral repair.2 The authors did a multicentre, prospective, observational, first-in-man study, collecting data from seven tertiary care hospitals in five countries. Eligible patients were those with symptomatic, severe functional, degenerative, or mixed mitral regurgitation who were denied other surgical or transcatheter options. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Ottavio Alfieri, Nicola Buzzatti Tags: Comment Source Type: research

[Comment] Intravenous fibrinolytics in STEMI: a 25-year perspective
Heart disease remains the number one cause of mortality and morbidity across most of the world.1 Although rates of acute myocardial infarction have fallen in high-income countries, mostly as a consequence of improved lifestyle modifications and continued evolution of risk factor modification,2 acute myocardial infarction remains the most important driver of cardiac mortality. The cornerstones of therapy for acute myocardial infarction have been based on the open-artery hypothesis.3 Previous experimental animal models have shown the initiation of myocardial cell death early after ligation of an epicardial coronary artery. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: Saurav Chatterjee, Jay Giri Tags: Comment Source Type: research

[Editorial] Nicotine addiction, reduction, and smoking cessation
Last week, the US Food and Drug Administration (FDA) announced a multiyear roadmap to begin regulating the amount of nicotine allowed in tobacco products. Researchers, including tobacco control advocates, have proposed nicotine reduction as a way of decreasing levels of tobacco use, and the USA may be the first country to seriously discuss using this form of regulation to produce a potentially less addictive form of tobacco. In the wake of the FDA announcement, it was widely reported that other countries, including the UK, Canada, New Zealand, and Finland, have suggested that they would consider nicotine reduction policies...
Source: LANCET - August 18, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] The rising north –south divide in health in the UK
The north –south divide in the UK, and in England in particular, is made up of economic and health-related disparities, among other socioeconomic factors. An article by Iain Buchan and colleagues, published on Aug 7 in the Journal of Epidemiology and Community Health, reported that in the past 20 years, age - and sex-adjusted excess mortality has increased by as much as 46 percentage points in people aged 35–44 years in the north of England compared with the south, and by 27 percentage points in people aged 25–34 years. (Source: LANCET)
Source: LANCET - August 18, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] 40 years of percutaneous coronary intervention: where next?
When cardiologists gather in Barcelona, Spain, from Aug 26 –31 for the annual European Society of Cardiology meeting, they will celebrate Andreas Grüntzig in a special tribute session. Grüntzig performed the first percutaneous coronary angioplasty on Sept 16, 1977, at the University Hospital Zurich, Switzerland, on a 38-year-old patient with a high-grad e discrete stenosis of the proximal left anterior descending coronary artery. He reported the first five patients in The Lancet in 1978. To mark this breakthrough and the birth of interventional cardiology, this year's conference spotlight is on 40 years of ...
Source: LANCET - August 18, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up
Penile transplantation restored normal physiological functions in this transplant recipient without major complications in the first 24 months. (Source: LANCET)
Source: LANCET - August 17, 2017 Category: General Medicine Authors: Andr é van der Merwe, Frank Graewe, Alexander Zühlke, Nicola W Barsdorf, Amir D Zarrabi, Jeremy T Viljoen, Hilgard Ackermann, Pieter V Spies, Dedan Opondo, Talal Al-Qaoud, Karla Bezuidenhout, Johan D Nel, Bertha Bailey, M Rafique Moosa Tags: Articles Source Type: research

[Comment] Penile transplantation is here
Despite high initial mortality, the development of immunosuppressants has allowed solid organ transplantation to become a mainstay of modern medicine, providing a near cure for otherwise fatal conditions. Life-enhancing vascularised composite allotransplantation (VCA), such as face or hand transplantation, has increasingly been used to successfully treat devastating tissue loss. Results from a recent survey suggest that public attitudes in the USA are favourable overall towards the use of VCA, although concerns remain about seeing familiar body parts on the donor recipient, psychological discomfort, identity loss, and the ...
Source: LANCET - August 17, 2017 Category: General Medicine Authors: Nikolai A Sopko, Arthur L Burnett Tags: Comment Source Type: research

[Department of Error] Department of Error
Loewenberg S. Treating and preventing cholera in Bangladesh. Lancet 2017; 390: 637 –38—This World Report benefited from external funding from the European Journalism Centre via its Innovation in Development Reporting Grant Programme, which should have been declared. This information was added to the online version as of Aug 17, 2017. (Source: LANCET)
Source: LANCET - August 17, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Articles] Pembrolizumab versus ipilimumab for advanced melanoma: final overall survival results of a multicentre, randomised, open-label phase 3 study (KEYNOTE-006)
Substantiating the results of the interim analyses of KEYNOTE-006, pembrolizumab continued to provide superior overall survival versus ipilimumab, with no difference between pembrolizumab dosing schedules. These conclusions further support the use of pembrolizumab as a standard of care for advanced melanoma. (Source: LANCET)
Source: LANCET - August 16, 2017 Category: General Medicine Authors: Jacob Schachter, Antoni Ribas, Georgina V Long, Ana Arance, Jean-Jacques Grob, Laurent Mortier, Adil Daud, Matteo S Carlino, Catriona McNeil, Michal Lotem, James Larkin, Paul Lorigan, Bart Neyns, Christian Blank, Teresa M Petrella, Omid Hamid, Honghong Zh Tags: Articles Source Type: research

[Comment] KEYNOTE-006: a success in melanoma, but a long way to go
A breakthrough in cancer therapy was achieved by the introduction of immune checkpoint inhibition, starting with the US Food and Drug Administration approval of the cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4)-specific antibody ipilimumab in 2011.1,2 Since then, clinical experience indicates that only around 20% of patients with late-stage melanoma experience durable responses with ipilimumab, but can pay a high price in terms of adverse events, because ipilimumab has been associated with autoimmune reactions like colitis that can require treatment discontinuation. (Source: LANCET)
Source: LANCET - August 16, 2017 Category: General Medicine Authors: Kilian Wistuba-Hamprecht, Graham Pawelec Tags: Comment Source Type: research

[Articles] Is late-life dependency increasing or not? A comparison of the Cognitive Function and Ageing Studies (CFAS)
On average older men now spend 2 ·4 years and women 3·0 years with substantial care needs, and most will live in the community. These findings have considerable implications for families of older people who provide the majority of unpaid care, but the findings also provide valuable new information for governments and care provide rs planning the resources and funding required for the care of their future ageing populations. (Source: LANCET)
Source: LANCET - August 15, 2017 Category: General Medicine Authors: Andrew Kingston, Pia Wohland, Raphael Wittenberg, Louise Robinson, Carol Brayne, Fiona E Matthews, Carol Jagger, Cognitive Function and Ageing Studies collaboration Tags: Articles Source Type: research

[Comment] The burden of triumph: meeting health and social care needs
Life is getting longer. Death is not defeated, but it takes longer to win than it used to. The increases seen for most people in life expectancy are surely a matter for great rejoicing. References to the burden of ageing seem to have missed the crucial point that living is something that most people at most times want to prolong, and on average people are able to do that for longer than ever before1,2 This increased life expectancy is a triumph of a century or more of improved incomes, lifestyles, and medical technology and intervention. (Source: LANCET)
Source: LANCET - August 15, 2017 Category: General Medicine Authors: Andrew Dilnot Tags: Comment Source Type: research

[Correspondence] False and real, but avoidable, dichotomies – Authors' reply
We agree with Gorik Ooms and colleagues that the dichotomies we discussed in our Viewpoint1 are artificial and avoidable. We call these dichotomies false not because they do not exist, but because they are not genuine or true, which is another meaning of this adjective. They are real and have had very negative consequences. The divide between the proponents of the vertical and the horizontal approaches to dealing with the HIV/AIDS challenge, which Ooms and colleagues refer to, was indeed gruelling. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Julio Frenk, Octavio G ómez-Dantés Tags: Correspondence Source Type: research

[Correspondence] False and real, but avoidable, dichotomies
Although we join Julio Frenk and Octavio G ómez-Dantés (Feb 11, p 667) in calling for integrative thinking in global health,1 we believe it is important to distinguish between avoidable and false dichotomies. Some of the dichotomies mentioned as false are indeed artificial and avoidable, but nonetheless real; they require conscious effort to be resolved. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Gorik Ooms, Walter Flores, Moses Mulumba, Malabika Sarker, Remco Van de Pas, Albrecht Jahn Tags: Correspondence Source Type: research

[Correspondence] Aggregate health spending
The Article on disaggregated data on health spending by the Global Burden of Disease Health Financing Collaborator Network (May 20, p 1981)1 offers great insight into the patterns of spending by countries. Spending is presented per capita in the Article; however, global totals present a more vivid picture of global health finances. By multiplying per capita spending by estimates of population in each country,2 we were able to calculate that total global spending on health was US$8982 billion in 2014. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: David Bishai, Carolina Cardona Tags: Correspondence Source Type: research

[Correspondence] Can post-mortem CT and angiography provide all the answers?
We commend Guy Rutty and colleagues on their Article (July 8, p 145)1 recommending the use of post-mortem imaging at autopsy. A fundamental role of the pathologist is to assist the coroner in fulfilling their statutory duty in establishing the cause and circumstances of death. How precise that cause of death needs to be depends on the requirements of the relevant legislation. To what extent pathology and radiology can satisfactorily provide the information to inform this advice depends on the circumstances of the case and, most importantly, on the questions being asked by interested parties, including families. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Chris O'Donnell, Matthew Lynch, Noel Woodford Tags: Correspondence Source Type: research

[Correspondence] George Gershwin's death and Duret haemorrhage
George Gershwin (born Sept 26, 1898) was one of the greatest American composers in history. He died, aged 38 years on July 11, 1937, after surgery for his brain tumour. His olfactory hallucinations, a sign of temporal lobe epilepsy, had begun in early 1934,1 –3 but he continued active musical works despite the gradual deterioration of his health status until several months before his premature death. His headaches, spells of blurred consciousness and abnormal behaviours, and other symptoms were ascribed to mental health problems. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Takahiro Mezaki Tags: Correspondence Source Type: research

[Correspondence] Preventing stolen childhood
We read with interest The Lancet Editorial (June 10, p 2264)1 on the End of Childhood Report 2017 by Save the Children,2 which assesses major risks threatening children's wellbeing. In the report, Greece, which is experiencing an unprecedented socioeconomic crisis with profound detrimental effects on all aspects of everyday life,3 was ranked 18th among 172 countries assessed, while Denmark was 21st, the UK 23rd, and Latvia 30th. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Helen Lazaratou, Konstantina Magklara Tags: Correspondence Source Type: research

[Obituary] Angela Mary Hartley Brodie
Pioneer of aromatase inhibition in breast cancer. Born in Oldham, UK, on Sept 28, 1934, she died of the complications of Parkinson's disease in Fulton, MD, USA, on June 7, 2017, aged 82 years. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] Arts-based learning for a Circle of Care
Over the past 3 years, staff at Guy's and St Thomas' NHS Foundation Trust have been offered courses that draw on ideas from theatre, dance, and the visual arts as part of a collaboration between the Simulation and Interactive Learning Centre (SaIL) and the Performing Medicine programme. The stories we have heard during this time leave no doubt that a career in health care is intensely demanding: a nurse sitting in a mortuary with a grieving mother, wondering “was it ok that I cried too?”; an anaesthetist attempting to save the life of a pregnant woman with her terrified husband looking on; team reactions after ...
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Suzy Willson, Peter Jaye Tags: Perspectives Source Type: research

[Perspectives] Reflex hammer
Medical students were traditionally taught that, in their initial encounter with their patients, gastroenterologists relied mostly on the patient's history and neurologists on the physical examination. The neurologist needed skill, knowledge, careful powers of observation, and two simple pieces of equipment: a safety pin and a reflex hammer. Sometimes the hammer came with an integral pin, and a brush for further testing of sensation. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Bill Bynum, Helen Bynum Tags: Perspectives Source Type: research

[Perspectives] Insight into autism: a view from inside
In June this year, soon after the UK general election, WikiLeaks founder Julian Assange levelled an insult at Prime Minister Theresa May on Twitter. This wasn't particularly newsworthy; a great many people were doing the same. But the words he chose were striking: “It's OK for Theresa May to be awkward, unfeeling or even autistic…The problem is that her policies match”. Sadly, the use of the term “autistic” to mean cold, emotionless, and unempathic is not a rare occurrence. Naoki Higashida's latest book Fall Down 7 Times Get Up 8: A Young Man's Voic e From the Silence of Autism is, however, a...
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Anna Remington Tags: Perspectives Source Type: research