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[Correspondence] Type 2 diabetes
In the summary of their Seminar,1 Sudesna Chatterjee and colleagues state that the incidence of type 2 diabetes “continues to rise globally”. There is no evidence to support this claim and most recent literature suggests that, in developed countries, incidence peaked sometime in the last decade and then levelled off or slightly decreased.2–5 (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: A Rosemary Tate Tags: Correspondence Source Type: research

[Correspondence] Type 2 diabetes
We read with great interest the Seminar (Feb 9, 2017, p 2239)1 on type 2 diabetes by Sudesna Chatterjee and colleagues. However, we were surprised by the articles selected and believe that detailed selection criteria with the level of evidence of reported studies would have been useful to the reader. According to the research method described, we would expect other papers to be cited, including meta-analyses of randomised controlled trials that could have balanced the authors' outlook.2 –6 For example, intensive glycaemic control probably has some beneficial effect on diabetic complications, such as non-fatal myocard...
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Remy Boussageon, Matthieu Roustit, Francois Gueyffier, Benoit V Tudrej, Michaela B Rehman Tags: Correspondence Source Type: research

[Correspondence] In support of UNRWA appeal for health and dignity of Palestinian refugees
Our research into the UN Relief and Works Agency (UNRWA)'s delivery of health services to Palestinian refugees during the Syria crisis1 puts us in a unique position to anticipate the challenges of the organisation's current funding crisis.2 We have conducted over 90 interviews with health workers and managers, a series of systems modelling sessions, and rigorous analysis of UNRWA health data from 2007 –16, and conclude the following. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Alastair Ager, Mohamad Alameddine, Sophie Witter, Fouad M Fouad, Karin Diaconu, Zeina Jamal, Graham Lough Tags: Correspondence Source Type: research

[Correspondence] Artificial intelligence in health care: enabling informed care
We read with interest the Lancet Editorial on artificial intelligence (AI) in health care (Dec 23, 2017, p 2739).1 Deep learning as a form of AI risks being overhyped. Deep neural networks contain multiple layers of nodes connected by adjustable weights. Learning occurs by adjusting these weights until the desired input-to-output function is achieved.2 With many millions of weights, huge amounts of data are required for learning, a process facilitated by recent increases in computational power. However, the learning algorithm, known as the error back-propagation algorithm, was invented in the 1980s and has been used to tra...
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Lionel Tarassenko, Peter Watkinson Tags: Correspondence Source Type: research

[Correspondence] Did Cro-Magnon 1 have neurofibromatosis type 1?
The Cro-Magnon 1 skeleton corresponds to a 28  000 BCE Homo sapiens male individual that was discovered in 1868 in a rock shelter in Les Eyzies, France.1 Since its discovery, various diagnoses have been proposed with regards to a round polycyclic osteolytic lesion on the right frontal bone, measuring 37 mm x 27 mm (appendix): post-mortem alteration due to the soil,2 rickets,3 actinomycosis,4 and Langerhans cell histiocytosis.5 (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Philippe Charlier, Nadia Benmoussa, Philippe Froesch, Isabelle Huynh-Charlier, Antoine Balzeau Tags: Correspondence Source Type: research

[Correspondence] Liver disease mortality trends: a response to the editor
We read the Offline Comment by Richard Horton (Jan 13, p 106)1 that summarised the evidence and current policy debate in England around minimum unit pricing for alcohol with interest. Unfortunately, the Comment contained an important error, which has already been repeated in UK parliamentary hearings and that we would like to correct to avoid it being repeated elsewhere. This error is the statement that “liver disease is on a trajectory to become the biggest cause of death in England and Wales”. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Colin Angus, Petra Meier, John Holmes Tags: Correspondence Source Type: research

[Correspondence] Quantification of the effect of terrorism on the HIV response in Nigeria
The insurgency by the Boko Haram terrorist group in northeast Nigeria has had devastating effects on the region including thousands of deaths, internal displacement, destruction of private and public properties, and considerable economic ruin. The violent conflict perpetuated by the group also has public health implications and has affected the spread and management of HIV, which remains a huge public health issue in Nigeria. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Babayemi O Olakunde, Daniel A Adeyinka, Sabastine S Wakdok, Tolulope T Oladele, Chamberline E Ozigbu Tags: Correspondence Source Type: research

[Obituary] Sir Roger Gilbert Bannister
Neurologist and athletic record-breaker. He was born in Harrow, UK, on March 23, 1929, and died in Oxford, UK, on March 3, 2018, aged 88 years. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Geoff Watts Tags: Obituary Source Type: research

[Perspectives] Newmanopolis
Comedian Robert Newman first came to prominence in the UK during the 1990s and readers of a certain age will remember how classrooms across the UK once abounded with his catchphrases. Newman subsequently largely rejected fame and reinvented himself as iconoclastic stand-up tackling complex subjects with wit and erudition. Whilst one of his early sketches —“History Today”—mocks scholars by having two elderly professors tirelessly trading playground insults, Newman has now graduated to challenging academics directly. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Stephen Ginn Tags: Perspectives Source Type: research

[Perspectives] The girl who died in the fire
A warm light suffuses an empty stage surrounded by nine pianos. A young woman walks to the front and she is caught by a panic attack. Thus the new production of Tennessee Williams' Summer and Smoke, directed by Rebecca Frecknall at London's Almeida Theatre, begins. Written in 1948, just after the success of A Streetcar Named Desire, the play, in its deceptive simplicity, touches some of the key themes of Williams' early works: the marginalisation of women in the southern states of the USA, the dichotomy between spirituality and carnality, and the lability of mental health. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Marco De Ambrogi Tags: Perspectives Source Type: research

[Perspectives] Bridging magic and medicine
12-year-old Tommy lay listlessly in his hospital bed. I noticed, however, that his eyes were becoming a bit brighter since I had bounded into the room a moment earlier with my satchel of magic paraphernalia and made three red foam balls disappear into thin air. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: David J Elkin, Harrison D Pravder Tags: Perspectives Source Type: research

[Perspectives] Moments on the margins
Once upon a time it must have seemed exciting to be photographed, as if you were going to become part of history. Now that everyone with a smartphone can post selfies all day, what does it really mean to make images of someone else? Photographers who are trying to capture marginalised or misunderstood cultures are in an increasingly difficult position if they are not from the same background or culture as their subjects. They risk being accused of objectification in the name of art at best, and exploitation at worst. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Tania Glyde Tags: Perspectives Source Type: research

[Perspectives] Rethinking cures in Jesse Ball's A Cure for Suicide
In January, 2018, UK Prime Minister Theresa May appointed a ministerial lead on loneliness “to address the loneliness endured by the elderly, by carers, by those who have lost loved ones—people who have no one to talk to or share their thoughts and experiences with”. Social psychologist Jean Twenge offers a different perspective on modern loneliness for a generation that has grown u p staring at digital screens. This generation, she argues, is “on the brink of the worst mental-health crisis in decades [and] much of this deterioration can be traced to their phones”. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Daniel Marchalik, Ann Jurecic Tags: Perspectives Source Type: research

[Perspectives] Jan Egeland: humanitarian who gives a voice to the displaced
“The major challenge of our time is to fight social injustice, and to promote human rights and humanitarian principles through action and not just words”, says Jan Egeland. “We must stand up for our values, even in extraordinary times.” As Secretary-General of the Norwegian Refugee Council ( NRC) and Special Adviser to the UN Special Envoy for Syria, he speaks forcefully about the crises in Syria, Yemen, Nigeria, and elsewhere, “where millions of civilians are displaced and attacked, and there is no protection at all”. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: John Zarocostas Tags: Perspectives Source Type: research

[World Report] What does the GDPR mean for the medical community?
The General Data Protection Regulation will start in May across the European Union, but doubts are being cast on how prepared researchers and clinicians are. Becky McCall reports. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Becky McCall Tags: World Report Source Type: research

[World Report] Gairdner Awards 2018 honour GBD studies
Creators of the GBD studies look back at almost two decades since the first iteration. Other awards recognised the fields of optogenetics, epigenetics, and lung cancer research. Brian Owens reports. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Brian Owens Tags: World Report Source Type: research

[Comment] Offline: The Palestinian health predicament worsens
The United Nations Relief and Works Agency (UNRWA), which administers health services to 5 ·3 million Palestinian refugees through 143 primary health facilities, is in acute crisis. After President Trump cut almost US$300 million from UNRWA's 2018 budget, services will run out of money by the end of May. Irrespective of one's views about the complex politics of the Middle East, America's decision to threaten the provision of basic health care to millions of dependent people seems utterly cruel. This emergency was a major theme of last week's annual Lancet Palestinian Health Alliance (LPHA) scientific meeting, held i...
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] Transparency of retracting and replacing articles
Journal editors are responsible for the integrity of the published record and must correct it when necessary. They are getting better at this job, as evidenced by journal retraction policies1 and numbers of article retractions.2 Most retractions are due to misconduct, but about 20% are retracted because of an unintentional error or methodological flaw.2 To credit the correction of an honest error and avoid stigmatisation of authors, journals have begun a practice of retraction with republication of a corrected article. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: Tea Marasovi ć, Ana Utrobiĉić, Ana Maruŝić Tags: Comment Source Type: research

[Editorial] Cybersecurity and patient protection
Network-connected devices and data are vulnerable to attack, exploitation, and unintended loss. The alleged harvesting of profiles from 50 million people by Cambridge Analytica through friend networks on Facebook is the most recent and egregious example. In May, 2017, the WannaCry ransomware that infected more than 200  000 computers across 100 countries also infiltrated a third of National Health Service trusts, and brought some services to a standstill. Yet, despite agreement on the need for better cyber hygiene (risk management and online health), there is no consensus on what form it should take. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Good news for the world's newest nation
Despite South Sudan's crippling civil war, the country has interrupted the transmission of Guinea worm disease, announced the Carter Center on March 21. This disease is now on the edge of eradication, with only six countries reporting low rates of infection. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Dementia in the UK: preparing the NHS for new treatments
Dementia is a devastating disease that brings fear, confusion, and loneliness to the lives of patients and their families. Today, around 850  000 people in the UK are living with dementia, costing the National Health Service (NHS) and UK society more than £26 million annually. By 2025, it is estimated that over 1 million people in the UK will be affected, with the prevalence and costs of care for these patients expected to double by 2 050. These are worrisome figures given the absence of any safe, clinically effective, disease-modifying therapy for Alzheimer's disease or other forms of dementia. (Source: LANCET)
Source: LANCET - March 30, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Pyronaridine –artesunate or dihydroartemisinin–piperaquine versus current first-line therapies for repeated treatment of uncomplicated malaria: a randomised, multicentre, open-label, longitudinal, controlled, phase 3b/4 trial
Pyronaridine –artesunate and dihydroartemisinin–piperaquine treatment and retreatment of malaria were well tolerated with efficacy that was non-inferior to first-line ACTs. Greater access to these efficacious treatments in west Africa is justified. (Source: LANCET)
Source: LANCET - March 29, 2018 Category: General Medicine Authors: The West African Network for Clinical Trials of Antimalarial Drugs (WANECAM) Tags: Articles Source Type: research

[Comment] Widening the options for recurrent malaria
The global need for new antimalarial drugs and new combinations is enormous and urgent,1,2 but their successful delivery needs resilience to overcome the barriers imposed by expensive and lengthy clinical development plans. Attention is often directed to areas such as southeast Asia, where some antimalarial combinations are failing but transmission intensities are much lower than in sub-Saharan African countries. Children in Africa have frequent and life-threatening malaria infections as they grow up, and these need to be treated safely. (Source: LANCET)
Source: LANCET - March 29, 2018 Category: General Medicine Authors: Quique Bassat, Sanjeev Krishna Tags: Comment Source Type: research

[Articles] Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome: a case-control study
Rare SCN4A variants that directly alter NaV1.4 function occur in infants who had died from SIDS. These variants are predicted to significantly alter muscle membrane excitability and compromise respiratory and laryngeal function. These findings indicate that dysfunction of muscle sodium channels is a potentially modifiable risk factor in a subset of infant sudden deaths. (Source: LANCET)
Source: LANCET - March 28, 2018 Category: General Medicine Authors: Roope M ännikkö, Leonie Wong, David J Tester, Michael G Thor, Richa Sud, Dimitri M Kullmann, Mary G Sweeney, Costin Leu, Sanjay M Sisodiya, David R FitzPatrick, Margaret J Evans, Iona J M Jeffrey, Jacob Tfelt-Hansen, Marta C Cohen, Peter J Fleming, Amie Tags: Articles Source Type: research

[Comment] Skeletal muscle channelopathy: a new risk for sudden infant death syndrome
Sudden infant death syndrome (SIDS) remains a leading cause of infant mortality, despite a steadily decreasing incidence since the 1990s.1 The reasons for this decline are debated, but it could be due to methodological reasons (eg, changes in reporting or advances in diagnosis of specific diseases) or a reduction of risks, such as an increase in supine sleeping position for infants, as advocated by the Back to Sleep campaign.2 A better understanding of the causes of SIDS is needed to identify infants at high risk and to develop interventions and guidelines that will prevent SIDS for all infants. (Source: LANCET)
Source: LANCET - March 28, 2018 Category: General Medicine Authors: Stephen C Cannon Tags: Comment Source Type: research

[Correspondence] It's time for a change of message, it's time for #GunSafetyNow
Following the high school mass-shooting in Parkland, Florida, the hash-tags #GunControl and #GunControlNow have been trending on social media. Because gun control is such a divisive issue among Americans, we suggest an approach that everyone can support. We call for #GunSafetyNow. (Source: LANCET)
Source: LANCET - March 26, 2018 Category: General Medicine Authors: Adam D M Briggs, Elliott S Fisher Tags: Correspondence Source Type: research

[Department of Error] Department of Error
Harrison SA, Rinella ME, Abdelmalek MF, et al. NGM282 for treatment of non-alcoholic steatohepatitis: a multicentre, randomised, double-blind, placebo-controlled, phase 2 trial. Lancet 2018; 391: 1174 –85 —In this Article (published online first on March 5, 2018), Prof Rohit Loomba's affiliation, the y-axis title of figure 2C, and the version of the appendix available online have been updated. These corrections have been made to the online version as of March 22, 2018, and the printed Article is correct. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Department of Error] Department of Error
Lucey M, Clark J, Glasziou P. Public availability of trial protocols. Lancet 2017; 390: e54 –55. In this Comment, PG should not have been listed as a founding member of SPIRIT in the competing interests statement. This correction has been made to the online version as of March 22, 2018. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Graded exercise self-help for chronic fatigue syndrome in GETSET – Authors' reply
In the graded exercise therapy guided self-help treatment (GETSET) trial,1 we found that addition of guided graded exercise self-help (GES) to specialist medical care (SMC) safely improved fatigue and physical functioning more than did the comparison treatment of SMC alone. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Lucy V Clark, Francesca Pesola, Janice M Thomas, Mario Vergara-Williamson, Michelle Beynon, Peter D White Tags: Correspondence Source Type: research

[Correspondence] Graded exercise self-help for chronic fatigue syndrome in GETSET
The CONSORT statement on harms notes that “it is important to report participants who are non-adherent or lost to follow-up because their actions may reflect their inability to tolerate the intervention.”1 It is thus welcome that Lucy Clark and colleagues2 report physiotherapist-rated data on adherence; they considered that only 42% of participants adhered to guided graded exercise self-help (GES) completely or very well. The protocol notes that to “measure departure from intended treatment, participants will be asked at follow-up whether they adhered to the booklet and guidance, and how much PA [physical...
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Anna Wood Tags: Correspondence Source Type: research

[Correspondence] Graded exercise self-help for chronic fatigue syndrome in GETSET
The results of the guided graded exercise self-help trial (GETSET) by Lucy Clark and colleagues1 reaffirm that graded exercise therapy (GET) is not a rehabilitative treatment for chronic fatigue syndrome.2 Although fatigue (measured by Chalder Fatigue Questionnaire [CFQ]) and physical functioning (assessed using the Short Form-36 physical function [SF-36 PF] subscale) improved in the guided graded exercise self-help (GES) group (and the non-intervention group), these effects were by far insufficient to come close to the normal levels defined previously3 by one of the GETSET authors (CFQ ≤6 and SF-36 PF ≥85). (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Frank Twisk Tags: Correspondence Source Type: research

[Correspondence] Graded exercise self-help for chronic fatigue syndrome in GETSET
I was surprised to read that the GETSET trial by Lucy Clark and colleagues1 excluded participants who had physical contraindications to exercise, as such a criterion would appear to exclude anyone suffering from post-exertional malaise (PEM). In its 2015 report,2 the US Institute of Medicine concluded: “There is sufficient evidence that PEM is a primary feature that helps distinguish ME/CFS [myalgic encephalomyelitis/chronic fatigue syndrome] from other conditions”. Indeed, post-exertional neuroimmune exhaustion is a compulsory requirement for a diagnosis of myalgic encephalomyelitis under the International Con...
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Robert H Saunders Tags: Correspondence Source Type: research

[Correspondence] Graded exercise self-help for chronic fatigue syndrome in GETSET
The mean score for physical functioning (measured by the Short Form-36 [SF-36] subscale)1 for people aged 35 –44 years is 93·3 (SD 13·4).2 Participants in the GETSET trial by Lucy Clark and colleagues3 had a mean age of 38·1 years in the active treatment arm (guided graded exercise self-help [GES] group) and 38·7 years in the control group. After the short 12-week intervention, participants' mean sel f-reported physical functioning score using the SF-36 scale was 55·7 (23·3) in the GES group, an increase from 47·3 (22·2) before the intervention, compared with a ...
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Joan S Crawford Tags: Correspondence Source Type: research

[Correspondence] Graded exercise self-help for chronic fatigue syndrome in GETSET
Lucy Clark and colleagues1 (July 22, 2017, p 363) reported that guided graded exercise self-help (GES) for chronic fatigue syndrome was “more useful in those with worse physical functioning”, defined as a Short Form-36 physical function (SF-36 PF) score of 40 or less. As follow-up GES sessions were done by Skype and telephone, this result might suggest to some clinicians the possibility of modifying and extending this interventi on to patients with severe and very severe chronic fatigue syndrome, all of whom are housebound and some of whom are bedbound. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Karen D Kirke Tags: Correspondence Source Type: research

[Correspondence] Systems modelling tools to support policy and planning
In their Viewpoint, Harry Rutter and colleagues (Dec 9, 2017, p 2602)1 make another welcomed call for increased uptake and investment in systems modelling tools to provide evidence better suited to addressing complex public health problems. We note the authors' assessment that systems modelling tools and approaches are “rarely operationalised in ways that generate relevant evidence” to support public health policy and practice. We disagree with this assessment and provide a broader perspective to show the efforts and progress in using systems modelling tools to support complex public health problems. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Jo-An Atkinson, Andrew Page, Ante Prodan, Geoff McDonnell, Nathaniel Osgood Tags: Correspondence Source Type: research

[Correspondence] Planetary health: a new sociopolitical framework is urgently needed
We welcome the Lecture by Samuel S Myers (Dec 23, 2017, p 2860)1 on planetary health. Paul J Crutzen assigned the term Anthropocene to “the present, in many ways human-dominated, geological epoch”.2 The capacity of mankind to shape its own habitat is a major environmental force. More than 15 000 scientists proclaimed that urgent changes are needed to avoid the consequences of humanity's impact on the environment and reverse t he trend of collapsing the delicate planetary health.3 (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Ivan Landires, Virginia Nu ñez-Samudio, Giovanni Apraez-Ippolito, Guillermo Castro Tags: Correspondence Source Type: research

[Correspondence] Action on minimum unit pricing of alcohol: a broader need
The impending minimum unit pricing (MUP) of alcohol in Scotland, commented on by Richard Horton in The Lancet (Jan 13, p 106),1 focuses attention on this public health strategy again. However, this strategy is a live issue well beyond the UK. An MUP has existed in Canadian provinces since the 1990s and in several eastern European countries since 2008.2 Nevertheless, the Scottish MUP of £0·50 per unit of alcohol is likely to have only a moderate effect because the amount was based on 2010 prices. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Heng Jiang, Robin Room Tags: Correspondence Source Type: research

[Perspectives] The vanishing act
One of the most poignant representations of the devastating impact of morphine addiction on a family comes from Eugene O'Neill's play Long Day's Journey Into Night, written in 1941 –42 but published only in 1956. In this work, rightly considered one of the best American plays of the 20th century, O'Neill drew inspiration for the characters from his own family who had to face his mother's morphine addiction. Time has not dented the intensity of this seminal work now on stage in a superb production directed by Richard Eyre at the Wyndham's Theatre in London, UK. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Marco De Ambrogi Tags: Perspectives Source Type: research

[World Report] Commitments to an end to tuberculosis renewed in India
At a summit in Delhi on March 13, Prime Minister Narendra Modi launched a campaign to end tuberculosis by 2025. Dinesh C Sharma reports. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Dinesh Sharma Tags: World Report Source Type: research

[World Report] New York Challenge sets high bar for HPV vaccination
A joint campaign from the CUGH, Perlmutter Cancer Center, and the Department of Population Health at NYU Langone Health sets new targets for HPV vaccination rate. Geoff Watts reports. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Geoff Watts Tags: World Report Source Type: research

[World Report] Trump Administration's new direction for Medicaid
Medicaid work requirements would make the health insurance programme a pathway out of poverty, say top US health officials. Susan Jaffe, The Lancet's Washington correspondent, reports. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Susan Jaffe Tags: World Report Source Type: research

[Comment] Offline: Liberty vs equity in global health
Is equity the defining objective of global health in the 21st century? Equity is hardwired into every definition of global health. It would be insane to argue otherwise. But global health is too important to allow this assumption to go unchallenged. Global health is about who we are, who we want to be, and how we want to live together on this wounded world of ours. Global health is about everything we hold dear in life. So if we ask what is wrong with our societies today, is the answer really that we have too little equity? (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] The Lancet Commission on tuberculosis: building a tuberculosis-free world
The Sustainable Development Goals have prioritised ending the epidemic of tuberculosis by 2030. We are therefore at a critical juncture in implementing efforts to control and eliminate tuberculosis. Current efforts have averted 56 million deaths since 2000.1 We also have better diagnostic tools and the promise of a few new, potent agents in the pipeline.2 Yet tuberculosis remains the leading source of infectious disease deaths globally, responsible for 1 ·7 million deaths in 2016.1 The UN's High-Level Meeting on Tuberculosis, due to take place in New York, USA, later in 2018, represents a unique opportunity to secur...
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Eric Goosby, Dean Jamison, Soumya Swaminathan, Michael Reid, Elizabeth Zuccala Tags: Comment Source Type: research

[Comment] Addressing social determinants to end tuberculosis
Leave no one behind. This is the overarching pledge of the Sustainable Development Goals; a pledge that is far from being realised. In 2016, more than 4 million people with tuberculosis were estimated to be undiagnosed or their care and treatment were unknown.1 In the same year, nearly a fifth of the people who were diagnosed and known to be treated for tuberculosis had adverse outcomes, including 1 ·3 million deaths.1 One reason that millions of people affected by tuberculosis are left behind is an absence of coordinated, international action to combat poverty and inequality. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Tom Wingfield, Marco A Tovar, Sumona Datta, Matthew J Saunders, Carlton A Evans Tags: Comment Source Type: research

[Editorial] Diagnosis of heavy menstrual bleeding: a change in direction
Menorrhagia is a debilitating condition that negatively affects quality of life, with accompanying symptoms sometimes including severe abdominal pain and persistent and irregular bleeding outside the menstrual cycle. The UK's National Institute for Health and Care Excellence (NICE) estimates that menorrhagia affects up to 25% of women of reproductive age, accounting for 12% of all UK gynaecological specialist referrals. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Brexit and the NHS
On March 14, the Office for National Statistics released the latest data on child mortality in England and Wales. After decades of progress, both infant and neonatal mortality rates rose for the second consecutive year. Furthermore, in an analysis of 15 similar countries done by the Nuffield Trust and the Royal College of Paediatrics and Child Health, the UK compares badly in seven of 16 indicators of child health. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Abortion: access and safety worldwide
44% of the world's annual 227 million pregnancies are unintended, of which 56% end in abortion, 32% in an unplanned birth, and 12% in miscarriage. These estimates —from a modelling study authored by the Guttmacher Institute and the University of Massachusetts and published by The Lancet Global Health—form the basis of a Guttmacher report on global abortion published on March 20. This analysis was last performed in 2009, since when the rate of unintended p regnancy and abortion in high-income countries has fallen significantly, concurrent with both an increase in the rate of modern contraception usage and a decr...
Source: LANCET - March 23, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Seminar] Multiple sclerosis
Multiple sclerosis continues to be a challenging and disabling condition but there is now greater understanding of the underlying genetic and environmental factors that drive the condition, including low vitamin D levels, cigarette smoking, and obesity. Early and accurate diagnosis is crucial and is supported by diagnostic criteria, incorporating imaging and spinal fluid abnormalities for those presenting with a clinically isolated syndrome. Importantly, there is an extensive therapeutic armamentarium, both oral and by infusion, for those with the relapsing remitting form of the disease. (Source: LANCET)
Source: LANCET - March 22, 2018 Category: General Medicine Authors: Alan J Thompson, Sergio E Baranzini, Jeroen Geurts, Bernhard Hemmer, Olga Ciccarelli Tags: Seminar Source Type: research

[Articles] Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study
Siponimod reduced the risk of disability progression with a safety profile similar to that of other S1P modulators and is likely to be a useful treatment for SPMS. (Source: LANCET)
Source: LANCET - March 22, 2018 Category: General Medicine Authors: Ludwig Kappos, Amit Bar-Or, Bruce A C Cree, Robert J Fox, Gavin Giovannoni, Ralf Gold, Patrick Vermersch, Douglas L Arnold, Sophie Arnould, Tatiana Scherz, Christian Wolf, Erik Wallstr öm, Frank Dahlke, EXPAND Clinical Investigators Tags: Articles Source Type: research

[Comment] Effective treatment of progressive MS remains elusive
Relapsing-remitting multiple sclerosis (RRMS) has been treatable for over 20 years and increasingly effective therapies continue to be developed.1 Unfortunately, therapies that convincingly affect the progressive phase of MS have yet to be identified. The International Progressive MS Alliance was formed to combat this multifaceted problem.2 This alliance of several MS societies, scientists, foundations, pharmaceutical sponsors, and individuals has been working together since 2012 to accelerate the understanding of, develop therapies for, and undertake clinical trials in progressive MS. (Source: LANCET)
Source: LANCET - March 22, 2018 Category: General Medicine Authors: Luanne M Metz, Wei-Qiao Liu Tags: Comment Source Type: research