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[Correspondence] Patients' decisions on joint replacement need data on earnings and welfare benefits
The study by Lee Bayliss and colleagues1 (Feb 13, p 1424) provides useful prognostic evidence of the lifetime risks of joint revision. After hip or knee replacement, the revision rate is 5% for men and women older than 70 years, but as high as 35% for men in their early 50s.1 But the risk of revision needs to be weighed against the potential gains from remaining in work and continued earnings. Research is needed to help patients decide and in theory, this research is possible in England. It requires use of the National Health Service (NHS) resource, NHS Digital, to enable linkage between NHS data and data on benefits and e...
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Ruth Gilbert, Paul Wilkinson, Lorraine Dearden Tags: Correspondence Source Type: research

[Correspondence] Response to what WHO can do to support research in LMICs
Jos é M Belizán and Suellen Miller1 (April 29, p 1697) described what the WHO could do to support research in low-income and middle-income countries (LMICs) with an emphasis on better use of evidence in policy development. WHO established the Evidence-Informed Policy Network (EVIPNet)2,3 in 25 LMICs i n Africa, Asia, and Latin America with the main goal of bridging the gap between research and policy. EVIPNet teams, composed of researchers, policy makers, and civil society, facilitate access and synthesis of evidence, develop policy options, and organise discussions between stakeholders—in whic h indivi...
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Tikki Pang Tags: Correspondence Source Type: research

[Correspondence] The dilemmas of the European Union's open access to data policy
European, Arab, and Turkish researchers worked for 2 years on research in six southern and eastern Mediterranean countries, funded by the European Union's (EU's) Seventh Framework Programme for Research and Technological Development. This project allowed researchers from these countries to explore and analyse their peoples' situation in times of turbulent changes. It also created potential collaboration within various research teams and between researchers and their European counterparts in these six countries. (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Blandine Destremau, Rita Giacaman, Mona Harb, Linda Herrera, Maria Mexi, Suzan Mitwalli, Emma C Murphy, Yoke Rabaia, Lynn Welchman, Elena Zambelli Tags: Correspondence Source Type: research

[Correspondence] Unmet challenges for rehabilitation after stroke in China
Stroke is an important public health problem in China, and is one of the leading causes of death and disability. About 2  500 000 people have a stroke in China every year, and 70–80% of patients lose the ability to perform routine activities and require care, resulting in an economic burden for both the country and their family.1 Japan has a similar incidence of stroke because of similar ancestry, but outcomes a fter stroke are better in Japan than in China. In Japan, 64·2% of young patients (age (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Tetsuya Asakawa, Liang Zong, Liang Wang, Ying Xia, Hiroki Namba Tags: Correspondence Source Type: research

[Correspondence] Evaluation of doctors in China: imperative changes are required
An important assessment factor used in the appraisal system for doctors in China is the publication of articles listed in the Science Citation Index, which has put considerable pressure on those in the profession. This aspect of assessment has caused controversy in China for many years.1,2 In April, 2017, the large-scale withdrawal of Chinese articles from Tumor Biology3 sparked debate nationwide. Some members of the scientific community are demanding severe condemnation of the authors, whereas some argue that their decision to entrust manuscript revision and submission to third parties was forgivable. (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Panxi Yu, Xiaonan Yang, Zuoliang Qi Tags: Correspondence Source Type: research

[Obituary] Patrick Gerard Johnston
Cancer researcher and university Vice-Chancellor. Born in Derry, UK, on Sept 14, 1958, he died of a cardiac arrest in Buncrana, Donegal, Ireland, on June 4, 2017, aged 58 years. (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] One woman's journey to equity
My striving to achieve equity for women in medicine was stimulated by many incidents of gender bias that occurred in my life. Early on I realised that I would have to help crack the glass ceiling; my goal was to do so without sustaining a major concussion. By reflecting on my experiences, I hope to encourage others on their journey to equity. (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Catherine DeAngelis Tags: Perspectives Source Type: research

[Perspectives] Connections and collections
The Enlightenment seems familiar to us in ways that the apocalyptic sectarian fury of the English Civil War, only a generation or two earlier, does not. We recognise its coffee shops and consumerism, its newspapers and networkers, its Eurosceptics and cosmopolitans, and at the heart of it all a grand ambition: to classify and reduce to order the new landscapes, creatures, and peoples revealed by exploration and commerce. All the slave-trading, periwig-powdering ambiguities of 18th-century European life were personified in Hans Sloane —an Ulster parvenu turned society physician and, as James Delbourgo argues in this r...
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Richard Barnett Tags: Perspectives Source Type: research

[World Report] Caring for health in occupied Palestinian territory
50 years after the 1967 Six-Day War, the Palestinian health-care system has fallen behind and struggles to cope with the barriers linked to occupation. Sharmila Devi reports. (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Sharmila Devi Tags: World Report Source Type: research

[Comment] Offline: Not one day more
Economists are the gods of global health. Their dazzling cloak of quantitative authority and their monstrously broad range of inquiry silence the smaller voices of medicine, trapped as we are in the modest discipline of biology. Economists stepped beyond the boundaries of the body long ago. They now bestride the predicaments of our planet with confident insouciance. It is economists we must thank for the modern epidemic of austerity that has engulfed our world. Austerity is the calling card of neoliberalism. (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] Retraction and republication —Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of osteoarthritis pain: a network meta-analysis
On March 17, 2016, The Lancet published online a network meta-analysis of the effectiveness of non-steroidal anti-inflammatory drugs for pain in knee and hip osteoarthritis, and the Article was published in print on May 21, 2016.1 On July 6, 2016, the authors drew our attention to two missed trials2,3 and a duplicate publication.4,5 Lancet editors discussed the corrections that were needed in the paper, and decided, in accordance with the Committee on Publication Ethics' guidelines, that because of the extent of the changes necessary, the previous version of the Article should be retracted and a corrected version republish...
Source: LANCET - July 7, 2017 Category: General Medicine Authors: The Editors of The Lancet Tags: Comment Source Type: research

[Comment] What is the impact of treatment for hepatitis C virus infection?
The introduction of direct-acting antiviral (DAA) medicines in 2013 revolutionised the treatment of chronic hepatitis C virus (HCV) infection. The efficacy of DAA therapy is impressive —in many clinical trials HCV cannot be detected by sensitive laboratory assays in more than 90% of people who complete DAA therapy, and observational studies have documented similar results.1,2 High efficacy combined with low rates of adverse events have led WHO to include DAAs in the WHO Model Li st of Essential Medicines. (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Stefan Z Wiktor, John D Scott Tags: Comment Source Type: research

[Editorial] Where next for UK tobacco control?
July 1, 2017, marked the tenth anniversary of the entire UK becoming smoke free in indoor public places, an opportune moment for Cancer Research UK (CRUK) to provide an update on UK smoking prevalence. Compared with 2007, there are 1 ·9 million fewer smokers, a reduction from 21% to 16%. Smoking prevalence has never been so low, although there remain 8 million smokers in the UK. Importantly, the latest data show that the largest reduction occurred in the 16–24 year age group, although this could reflect a lifestyle switch fro m tobacco to the £1 billion UK e-cigarette industry among younger people. (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] An African-driven health agenda
The first WHO Africa health forum closed on June 28 in Kigali, Rwanda, with commitments from governments to ensure universal health coverage. 700 delegates attended the forum organised by the WHO regional office for Africa to review progress towards the health-related sustainable development goals. The promises of universal health coverage chime well with the instalment of Dr Tedros as WHO's 9th director-general on July 1. He has said “all roads should lead to universal health coverage”. Being the first African director-general, and having transformed Ethiopia's health system, Dr Tedros' leadership bodes well f...
Source: LANCET - July 7, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Addressing the vulnerability of the global food system
This report shows that the global food system is reliant upon highly delicate trade routes, which navigate through 14 so-called chokepoints —such as the Suez Canal, Black Sea ports, and Brazil's road network—where food trade is vulnerable to interruptions or disruptions. (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Correspondence] Open letter to the UN's new health chief from “Alternative Nobel Prize” laureates
We congratulate Tedros Adhanom Ghebreyesus on his election as Director-General of WHO —a job that literally makes the difference between life and death for millions of people around the world. (Source: LANCET)
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Sima Samar, Gino Strada, Monika Hauser, Ran Goldstein, Denis Mukwege Tags: Correspondence Source Type: research

[Articles] Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study
Globally, RSV is a common cause of childhood ALRI and a major cause of hospital admissions in young children, resulting in a substantial burden on health-care services. About 45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months. An effective maternal RSV vaccine or monoclonal antibody could have a substantial effect on disease burden in this age group. (Source: LANCET)
Source: LANCET - July 6, 2017 Category: General Medicine Authors: Ting Shi, David A McAllister, Katherine L O'Brien, Eric A F Simoes, Shabir A Madhi, Bradford D Gessner, Fernando P Polack, Evelyn Balsells, Sozinho Acacio, Claudia Aguayo, Issifou Alassani, Asad Ali, Martin Antonio, Shally Awasthi, Juliet O Awori, Eduardo Tags: Articles Source Type: research

[Comment] Determining the burden of respiratory syncytial virus disease: the known and the unknown
60 years ago, respiratory syncytial virus (RSV) was identified in children admitted to hospital in Baltimore, MD, USA, with bronchiolitis or pneumonia.1 Since that time, RSV has been established as a leading cause of acute lower respiratory illness (ALRI) in infants and children living in all regions of the world.2 –5 As the widespread use of Haemophilus influenzae type b and pneumococcal conjugate vaccines decreases the burden of bacterial pneumonia in children, the proportional contribution of RSV to childhood ALRI will continue to increase. (Source: LANCET)
Source: LANCET - July 6, 2017 Category: General Medicine Authors: Ruth A Karron, Robert E Black Tags: Comment Source Type: research

[Correspondence] New hepatitis C antiviral treatments eliminate the virus
The Cochrane Collaboration has published a topical systematic review1 and meta-analysis on direct-acting antivirals (DAA) for chronic hepatitis C virus (HCV) infection. Jakobsen and colleagues1 compared the results of randomised trials of any HCV DAA regimen versus no intervention or placebo. Their review reported data from 138 trials, which included 25  232 participants and encompassed all drugs on the market or under development. The authors confirm treatment has a significant benefit (relative risk 0·44, 95% CI 0·37–0·52, p (Source: LANCET)
Source: LANCET - July 6, 2017 Category: General Medicine Authors: Joseph S Doyle, Alexander J Thompson, Peter Higgs, Mark Stoove, Paul M Dietze, Margaret E Hellard Tags: Correspondence Source Type: research

[Articles] Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial
Adults with persistent symptomatic asthma experience fewer asthma exacerbations and improved quality of life when treated with oral azithromycin for 48 weeks. Azithromycin might be a useful add-on therapy in persistent asthma. (Source: LANCET)
Source: LANCET - July 4, 2017 Category: General Medicine Authors: Peter G Gibson, Ian A Yang, John W Upham, Paul N Reynolds, Sandra Hodge, Alan L James, Christine Jenkins, Matthew J Peters, Guy B Marks, Melissa Baraket, Heather Powell, Steven L Taylor, Lex E X Leong, Geraint B Rogers, Jodie L Simpson Tags: Articles Source Type: research

[Comment] Azithromycin in uncontrolled asthma
Asthma is a highly prevalent chronic airway disease affecting more than 300 million people worldwide. Despite treatment with inhaled corticosteroids and long-acting bronchodilators, asthma is uncontrolled in a substantial number of patients who remain symptomatic and are at risk of asthma exacerbations. These asthma attacks are often triggered by viral respiratory infections and might lead to emergency room visits, hospitalisations, and rarely, death; they result in a huge personal and societal burden. (Source: LANCET)
Source: LANCET - July 4, 2017 Category: General Medicine Authors: Guy Brusselle, Ian Pavord Tags: Comment Source Type: research

[Series] Germany's expanding role in global health
Germany has become a visible actor in global health in the past 10 years. In this Series paper, we describe how this development complements a broad change in perspective in German foreign policy. Catalysts for this shift have been strong governmental leadership, opportunities through G7 and G20 presidencies, and Germany's involvement in managing the Ebola virus disease outbreak. German global health engagement has four main characteristics that are congruent with the health agenda of the Sustainable Development Goals; it is rooted in human rights, multilateralism, the Bismarck model of social protection, and a link betwee...
Source: LANCET - July 3, 2017 Category: General Medicine Authors: Ilona Kickbusch, Christian Franz, Anna Holzscheiter, Iris Hunger, Albrecht Jahn, Carsten K öhler, Oliver Razum, Jean-Olivier Schmidt Tags: Series Source Type: research

[Series] Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition
Bismarck's Health Insurance Act of 1883 established the first social health insurance system in the world. The German statutory health insurance system was built on the defining principles of solidarity and self-governance, and these principles have remained at the core of its continuous development for 135 years. A gradual expansion of population and benefits coverage has led to what is, in 2017, universal health coverage with a generous benefits package. Self-governance was initially applied mainly to the payers (the sickness funds) but was extended in 1913 to cover relations between sickness funds and doctors, which in ...
Source: LANCET - July 3, 2017 Category: General Medicine Authors: Reinhard Busse, Miriam Bl ümel, Franz Knieps, Till Bärnighausen Tags: Series Source Type: research

[Perspectives] Picturing the past and present of health care in Germany
The Lancet Series on Germany highlights the resilience of the German health system, which is characterised by principles of solidarity and self-governance, over its turbulent history —a history marked by revolutions, wars, separation and re-unification of the country. These photographs capture images that highlight aspects of this history, from the late 19th century to the realities of 2017, from the discoveries of Robert Koch to memorials to the dark days of war. The moments captured in these photographs also celebrate current, state-of-the-art, scientific achievements and Germany's welcoming attitude to refugees in...
Source: LANCET - July 3, 2017 Category: General Medicine Authors: Matthieu Zellweger Tags: Perspectives Source Type: research

[Perspectives] Reinhard Busse: leader in Germany's health-system development
As head of the Department for Health Care Management at the Technical University of Berlin, Germany, Reinhard Busse enjoys a varied, interdisciplinary academic life. “I run a department of around 20 researchers, crossing disciplines including medicine, public health, business engineering, political science, and economics, a vast array of talent that is needed in the projects we run in the field of health systems performance”, he says. Busse's analysis of Ger many's health-system characteristics and performance is detailed in the first paper of the Lancet Germany country Series. (Source: LANCET)
Source: LANCET - July 3, 2017 Category: General Medicine Authors: Richard Lane Tags: Perspectives Source Type: research

[Perspectives] Ilona Kickbusch: global health reformer
Nowadays global health has high visibility. But it wasn't always so. It took champions to put global health on the agenda, among them Ilona Kickbusch. Currently Director of the global health programme at the Graduate Institute of International and Development Studies in Geneva, she has had a distinguished career in WHO, government, and academia that has shaped global health. She's also seen major social and political change in her life. Kickbusch grew up in post-war Germany and has vivid memories of living in both a divided Germany and a new democracy. (Source: LANCET)
Source: LANCET - July 3, 2017 Category: General Medicine Authors: Jocalyn Clark Tags: Perspectives Source Type: research

[Comment] Together today for a healthy tomorrow —Germany's role in global health
More than 2 years ago, in west Africa, almost 30  000 people contracted the Ebola virus, and over 11 000 people died. Alongside concern for the health of the affected people in Africa, fear swept across Europe and North America that this disease could spread to other parts of the globe. (Source: LANCET)
Source: LANCET - July 3, 2017 Category: General Medicine Authors: Hermann Gr öhe Tags: Comment Source Type: research

[Comment] My Germany in 2017: a resilient country that is taking responsibility
2017 is a good year to put a spotlight on Germany and health. Germany is leading the forthcoming G20 meeting and has a general election on Sept 24. The political landscape is shifting palpably given President Donald Trump in the White House, the UK's decision to leave the European Union, and a newly hopeful and energised France under President Emmanuel Macron. After a frustrating G7 meeting in Taormina, Italy, on May 26 and 27, Germany's Federal Chancellor Angela Merkel stated in an unusually blunt speech that as Europeans “we should really take our fate into our own hands…the times in which we could rely full...
Source: LANCET - July 3, 2017 Category: General Medicine Authors: Sabine Kleinert Tags: Comment Source Type: research

[Seminar] Chagas disease
Chagas disease is an anthropozoonosis from the American continent that has spread from its original boundaries through migration. It is caused by the protozoan Trypanosoma cruzi, which was identified in the first decade of the 20th century. Once acute infection resolves, patients can develop chronic disease, which in up to 30 –40% of cases is characterised by cardiomyopathy, arrhythmias, megaviscera, and, more rarely, polyneuropathy and stroke. Even after more than a century, many challenges remain unresolved, since epidemiological control and diagnostic, therapeutic, and prognostic methods must be improved. (Source: LANCET)
Source: LANCET - June 30, 2017 Category: General Medicine Authors: Jos é A Pérez-Molina, Israel Molina Tags: Seminar Source Type: research

[Seminar] Measles
Measles is a highly contagious disease that results from infection with measles virus and is still responsible for more than 100  000 deaths every year, down from more than 2 million deaths annually before the introduction and widespread use of measles vaccine. Measles virus is transmitted by the respiratory route and illness begins with fever, cough, coryza, and conjunctivitis followed by a characteristic rash. Complicatio ns of measles affect most organ systems, with pneumonia accounting for most measles-associated morbidity and mortality. (Source: LANCET)
Source: LANCET - June 30, 2017 Category: General Medicine Authors: William J Moss Tags: Seminar Source Type: research

[Seminar] Human African trypanosomiasis
Human African trypanosomiasis (sleeping sickness) is a parasitic infection that almost invariably progresses to death unless treated. Human African trypanosomiasis caused devastating epidemics during the 20th century. Thanks to sustained and coordinated efforts over the past 15 years, the number of reported cases has fallen to an historically low level. Fewer than 3000 cases were reported in 2015, and the disease is targeted for elimination by WHO. Despite these recent successes, the disease is still endemic in parts of sub-Saharan Africa, where it is a considerable burden on rural communities, most notably in central Africa. (Source: LANCET)
Source: LANCET - June 30, 2017 Category: General Medicine Authors: Philippe B üscher, Giuliano Cecchi, Vincent Jamonneau, Gerardo Priotto Tags: Seminar Source Type: research

[Department of Error] Department of Error
Jairam AP, Timmermans L, Eker HH, et al, for the PRIMA Trialist Group. Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet 2017; 390: 567 –76—In this Article, the author line should begin “An P Jairam*, Lucas Timmermans*, Hasan H Eker, …” to indicate the equal contribution of An Jairam and Lucas Timmermans to the study. This correction has been made to the online version as of June 30, 2017, and the printed Article i...
Source: LANCET - June 30, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] The INFANT trial
Robert Keith1 (April 28, p 1697) suggests that the INFANT trial2 is flawed by design. Previous reports3,4 suggested that a key element in substandard intrapartum care is the failure of clinicians to recognise an abnormal fetal heart-rate pattern, so the trial was set up to investigate whether decision support that detects and highlights abnormality of the fetal heart rate could improve outcomes. We compared decision support with no decision support. All other aspects of care were kept constant, including the use of the Guardian platform, which is the electronic data collection system in which the decision-support software ...
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Peter Brocklehurst, David J Field, Ed Juszczak, Sara Kenyon, Louise Linsell, Mary Newburn, Rachel Plachcinski, Maria Quigley, Liz Schroeder, Philip Steer Tags: Correspondence Source Type: research

[Correspondence] A personalised or procrustean approach to treating hypertension? – Authors' reply
We agree with the comments of Genevieve M Gabb and colleagues about our study1 with regard to the goals of therapy, but differ in our views on evidence interpretation and strategy in several areas. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Anthony Rodgers, Clara K Chow, Jay Thakkar, Alexander Bennett Tags: Correspondence Source Type: research

[Correspondence] A personalised or procrustean approach to treating hypertension?
Clara Chow and colleagues (Feb 9, p 1035)1 advocate initiating hypertension treatment with combination therapy, using four drugs rather than two, which is currently suggested by some authorities.2 This approach contradicts deprescribing efforts to reduce polypharmacy. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Genevieve M Gabb, Peter G M Mol, Leonard F Arnolda Tags: Correspondence Source Type: research

[Correspondence] Are ACE inhibitors acceptable ingredients in polypills?
The Lancet suggested in their Editorial (March 11, p 984)1 that an affordable polypill would be welcomed in the more than 30 million people worldwide who do not have access to appropriate secondary prevention. When considering such numbers, balance between benefits and harms becomes exceedingly important. As can be estimated by the number needed to treat, most people taking a polypill for years or decades will never be benefited by it. They nevertheless have to put up with adverse events, which are up to 16% higher (risk ratio 1 ·16, 95% CI 1·09–1·25) in participants randomly assigned polypills t...
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Franz H Messerli, Sripal Bangalore, Stefano F Rimoldi, Jerzy G ąsowski, Juerg Nussberger Tags: Correspondence Source Type: research

[Correspondence] Sepsis outcomes in the correctional system: more potential disparity
In their Series paper, Christopher Wildeman and Emily Wang (April 8, p 1464)1 reported the myriad of health disparities resulting from mass incarceration in the USA. We applaud the authors' meticulous effort in providing a comprehensive review of this underreported problem, and would like to highlight a crucial disparity that was not mentioned. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Jason Chertoff, Paul Stevenson, Hassan Alnuaimat Tags: Correspondence Source Type: research

[Correspondence] Mass incarceration and severe mental illness in the USA
In their Series paper, Christopher Wildeman and Emily Wang (April 8, p 1464)1 described the harms associated with mass incarceration in the USA. The authors noted that deinstitutionalisation of mental health had “undoubtedly helped to both launch mass incarceration and keep it going”. The problem of reduced psychiatric bed availability is not just historical. US states continue to close the only publicly funded beds available to the poorest Americans with serious mental illnesses, such as schizophrenia or bipolar disorder. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Stephen Allison, Tarun Bastiampillai, Doris A Fuller Tags: Correspondence Source Type: research

[Obituary] Babatunde Osotimehin
Nigerian physician and Executive Director of UNFPA. He was born in Ogun State, Nigeria, on Feb 6, 1949, and died in West Harrison, NY, USA, on June 4, 2017, aged 68 years. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] Borderlands
Cristina comes into the tiny clinic in the migrant shelter in Tapachula, Mexico, where I am doing psychological consultations. She is a young woman. She sits down and starts crying, speaking in rushed sentences between sobs. “I am very scared of being found…that's why we are here. They want to kill us, me and my mother. They found us at home. They told my mum they will cut off her head and they will kill me by dropping me in a river…I have nightmares every night, I cannot sleep. I am terrified all the time…And t he lady says we must leave in 5 days because we have been here 5 days already and the...
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Lynne Jones Tags: Perspectives Source Type: research

[Perspectives] Fiona Loud: the kidney patients' champion
Fiona Loud was plagued by health problems for years, but it was only after the birth of her daughter in the early 1990s that signs of kidney damage were first identified. “It took a further 7 years before routine screening for another medical problem indicated that there might be something seriously wrong”, she recalls. Loud was eventually diagnosed with kidney cancer and a rare genetic condition called tuberous sclerosis. “I was told that my kidneys were likel y to fail in 10 to 15 years. In the end, it only took 3 years”, she says. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Rachael Davies Tags: Perspectives Source Type: research

[Perspectives] I have stayed for as long as I possibly can
There is a terrible sense of abandonment and rejection when a parent dies by suicide, especially when it happens at a young age. The loss of a parent may have deep repercussions on a person's self-esteem, identity, and outlook for the future. People who endure such a tragic experience as children or adolescents often describe a persistent sense of insecurity and guilt, difficulty in establishing trusting relationships, fear of being abandoned, and self-destructive behaviours, such as use of drugs and binge drinking. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Marco De Ambrogi Tags: Perspectives Source Type: research

[Perspectives] Patterns to grow bone
On walking into the small room in the Hunterian Museum in Glasgow, a viewer's first thought might be of the Giant's Causeway —the monumental, hexagonal columns of basalt in County Antrim, Northern Ireland. Without an idea of scale, the collection of sketches, etchings, and photographs could represent these colossal structures; but instead they reveal information about a material many orders of magnitude smaller. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Fiona Mitchell Tags: Perspectives Source Type: research

[World Report] IPK —Cuban–US collaboration targets arboviruses
Common concern about mosquito-borne diseases is spurring collaborative research between Cuban and US scientists in an effort the researchers say is also helping to build bridges between the countries after half a century of tensions. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Barbara Fraser Tags: World Report Source Type: research

[World Report] Drug shops as primary point of care —the case of Nigeria
Unlicensed medicine vendors, known as drug shops, are common practice in Nigeria, where primary health providers are scarce. Paul Webster reports. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Paul Webster Tags: World Report Source Type: research

[Comment] Offline: Racism —the pathology we choose to ignore
London (July 7, 2005; 52 dead). Woolwich (May 22, 2013; one dead). Westminster (March 22, 2017; five dead). Manchester (May 22, 2017; 23 dead). London Bridge (June 3, 2017; eight dead). Finsbury Park (June 19, 2017; one dead). Grenfell Tower (June 14, 2017; 79+ dead). These tragedies are connected. Hate is a health issue. Racism is a health issue. Xenophobia is a health issue. And terror is a health issue too. Our societies are struggling to find solutions to these threats —threats that are causing deaths with increased frequency. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] Health in focus: 2017 Highlights photography competition is open for submissions
Photographs are an immediate and compelling way to communicate —they can entertain, educate, inspire, outrage, or move us. They can be a powerful way to focus on important health stories and capture and make permanent those fleeting moments that matter in medicine. The Lancet's annual photography competition, Highlights, is now open for entries. We are lookin g for striking, original pictures on any health topic, from clinical medicine to global health, from the individual person to populations. Some of the winning photographs in last year's competition highlighted the need for clean water and surgery in Africa and t...
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Joanna Palmer Tags: Comment Source Type: research

[Comment] 2017 Wakley Prize Essay competition: clinical truths
“It seemed to illustrate the theory of medicine, yet it made no improvement in the practice”.1,2 This 17th-century criticism of William Harvey's theory of the circulation of the blood now seems somewhat premature—nevertheless, it contains an important point that has endured through the 360 yea rs since Harvey's death. While The Lancet publishes new advances in medical science every week, how does this affect the practice of medicine? We're not referring here to implementation science, the tricky business of getting new methods or protocols incorporated into clinical routine. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Niall Boyce, Rhiannon Howe, Joanna Palmer Tags: Comment Source Type: research

[Comment] Cerebral amyloid angiopathy and implications for atrial fibrillation management
Atrial fibrillation, the most common arrhythmia in adults, will increase in prevalence as the population ages.1 The risk of embolic stroke in atrial fibrillation also increases with age. Treatments for the prevention of embolic stroke include warfarin, direct oral anticoagulant agents, and non-anticoagulation strategies such as left atrial appendage occlusion.1 Current scores to estimate the risk of ischaemic stroke (CHA2DS2-VaSc score) or haemorrhage (HAS-BLED score) help guide intervention, but do not account for cerebral amyloid angiopathy (CAA), a prevalent, but overlooked condition. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: Christopher V DeSimone, Jonathan Graff-Radford, Majd A El-Harasis, Alejandro A Rabinstein, Samuel J Asirvatham, David R Holmes Tags: Comment Source Type: research

[Editorial] Cosmetic procedures: a cause for concern
The Nuffield Council on Bioethics has called for stricter controls over the provision of non-reconstructive cosmetic procedures, citing ethical concerns about their promotion and regulation in the UK and suggesting that they be made available only to people aged 18 years or older. Social media, advertising, and apps are being used to convey the message that these procedures are not only accessible but desirable, meaning that people could feel pressured to conform to a society's ideal of beauty at susceptible points in their development. (Source: LANCET)
Source: LANCET - June 29, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research