Riviste scientifiche

[Editorial] The lung: a magnificent organ that needs lifelong attention

The Lancet - Sa, 30/04/2016 - 00:00
When more than 15 000 pulmonologists and other health workers interested in respiratory medicine meet in San Francisco, USA, at the annual American Thoracic Society (ATS) meeting from May 13–18, 2016, the lung will be at the centre of attention. To coincide with the meeting, this issue of The Lancet dedicates content to the lung—a wondrous and neglected organ that provides every cell in the body with vital oxygen and stands at the interface between the environment and the circulation.

[Editorial] The next Director-General of WHO

The Lancet - Sa, 30/04/2016 - 00:00
WHO last week fired a starting pistol to launch the election for its next Director-General. The final vote does not take place until May, 2017. Procedures have been substantially revised since 2012, when Margaret Chan was elected to serve a second term. It is likely that this lengthy process will therefore be more transparent, accountable, and disputatious (and considerably less corrupt) than past elections.

[Editorial] Transforming primary care

The Lancet - Sa, 30/04/2016 - 00:00
Last week saw two important publications on primary care in the UK. The General Practice Forward View, published by NHS England and developed in partnership with the Royal College of General Practitioners and Health Education England, sets out a plan to transform general practice over the next 5 years. Backed by an extra £2·4 billion a year, the plan outlines steps to increase the number of general practitioners (GPs) and co-workers, as well as measures to reduce workload stresses, develop infrastructure, and support care redesign to enable increased access to GPs.

[Comment] Vilanterol fluticasone and mortality in comorbid COPD GOLD B

The Lancet - Sa, 30/04/2016 - 00:00
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Due to common risk factors such as smoking and ageing, COPD often coexists with cardiovascular diseases, which have a major effect on prognosis. Cardiovascular death is the most important cause of death in patients with symptomatic moderate COPD (ie, COPD GOLD B).1,2 However, as highlighted by the GOLD guidelines, none of the current treatments of COPD, except smoking cessation, has been shown to significantly decrease all-cause mortality.

[Comment] Expanding the benefits of HPV vaccination to boys and men

The Lancet - Sa, 30/04/2016 - 00:00
Human papillomavirus (HPV) is the most common sexually transmitted infection. It affects 80% of the population, with the initial infection usually occurring between 15 and 24 years of age. Persistent infection with high-risk oncogenic HPV genotypes, primarily types 16 and 18, is the cause of almost all cervical cancers.1 HPV is also thought to cause about 95% of anal cancers, 75% of oropharyngeal cancers, 75% of vaginal cancers, 70% of vulvar cancers, and 60% of penile cancers.2 Low-risk or non-oncogenic genotypes (eg, types 6 and 11) cause anogenital warts, low-grade cervical disease, and recurrent respiratory papillomatosis.

[Comment] Offline: The King and his courtiers

The Lancet - Sa, 30/04/2016 - 00:00
“Why are you telling us to report on hospitals and disease rates when the real problems in this country are political…You are keeping us away from the issues that matter in our lives by making us write these insignificant reports.” This young journalist was pleading with Anjan Sundaram, the author of Bad News (Doubleday, 2016), an urgent account of repression, violence, and torture in a country the global health community has come to celebrate as an extraordinary example of African success. But behind the facade, the mirage, another story apparently lies untold.

[World Report] US responds to increase in Zika cases

The Lancet - Sa, 30/04/2016 - 00:00
Health officials pursue Zika research and prepare to combat a formidable foe—the mosquito—despite uncertain funding. Susan Jaffe, The Lancet's Washington correspondent, reports.

[World Report] The age of drones: what might it mean for health?

The Lancet - Sa, 30/04/2016 - 00:00
Drones can destroy lives in conflict settings where they are used for surveillance and bombings. But can they save them too? Dinsa Sachan reports on the use of drones in the health sector.

[Perspectives] The ship of hope

The Lancet - Sa, 30/04/2016 - 00:00
As the African Mercy docks at the port, a long queue is already forming. The people who will wait in line all day are ill, some severely so. For the African Mercy is a surgery ship, run by the charity Mercy Ships, providing free operations for some of the world's poorest people. The Surgery Ship (video) follows a team of Australian volunteers on board during the ship's 2012–13 visit to Guinea.

[Perspectives] Designs upon death in ancient Egypt

The Lancet - Sa, 30/04/2016 - 00:00
Much is known about ancient Egyptian medicine from papyri in various museums, which describe treatments consisting of a combination of magical spells, rituals, and practical prescriptions. But although physicians were clearly important members of a pharaoh's entourage, very few of their names survive. One exception is that of Wepwawetemhat. His name and function is written in coloured hieroglyphs alongside painted natural creatures on a fragment of his coffin made of sycamore fig wood dating from about 1975–1790 BC, kept at the Fitzwilliam Museum in Cambridge, UK.

[Perspectives] Maria Neira: no limits to public health

The Lancet - Sa, 30/04/2016 - 00:00
In the league table of all-embracing job titles, Maria Neira's at WHO in Geneva is hard to beat: Director of the Department of Public Health and the Environmental and Social Determinants of Health. As if to underline the extent of this role she also adopts a broad working definition of the term environment: “all that is not me”. But does she not feel overwhelmed by the literally global scope of this brief? She laughs. “Yes, a little bit. But it's all so connected. If you love public health there are no limits.”

[Perspectives] The medicine of Alex Higgins

The Lancet - Sa, 30/04/2016 - 00:00
Alex Higgins died aged 61 years. He had not expected to live so long. The greatest snooker player of his generation, he drank and smoked too much, and rested too little; broke too many hearts, including his own; and lived on the brink of ecstasy or disaster. He gambled with his money, his relationships, and his life. Having survived overdoses, a fall from a second-storey window, and knife and axe attacks, Alex Higgins had the last rites read over him after cancer surgery in 1998. Defying medical opinion, as was his custom, he lived another 12 years.

[Obituary] Holbrook Kohrt

The Lancet - Sa, 30/04/2016 - 00:00
Oncologist who specialised in cancer immunotherapy. Born on Dec 14, 1977, in Scranton, PA, USA, he died from an intracranial haemorrhage related to haemophilia on Feb 22, 2016, in Miami, FL, USA, aged 38 years.

[Correspondence] No universal health coverage without primary health care

The Lancet - Sa, 30/04/2016 - 00:00
Universal health coverage is currently the aspiration of many countries worldwide. We commend Michael Reich and colleagues1 for analysing lessons learned from different country experiences, but we believe there is a crucial element neglected within the ongoing universal health coverage debate.

[Correspondence] Uncommon presentation of Zika fever or co-infection?

The Lancet - Sa, 30/04/2016 - 00:00
We read with great interest Ouafae Karimi and colleagues' Correspondence (March 5, p 940)1 on severe thrombocytopenia and subcutaneous bleeding in a patient with Zika virus infection. High fever, haematomas, and severe thrombocytopenia are very uncommon in Zika virus infections. Fever over 39°C has been reported in seven Indonesian patients in 1977–78, in one Chilean traveller returning from Colombia in 2015, and in a Colombian and two Brazilian patients in 2015.2 Blood count abnormalities have been reported only sporadically in Zika fever and include mild thrombocytopenia (100 × 109 to 150 × 109 platelets per L), mild leucopenia (1·0 × 109 to 1·5 × 109 leucocytes per L), and the presence of activated lymphocytes.

[Correspondence] Uncommon presentation of Zika fever or co-infection? – Authors' reply

The Lancet - Sa, 30/04/2016 - 00:00
We thank Didier Musso and colleagues for their interest in our Correspondence1 and their thoughtful comments. In our patient, diagnosis at disease onset was confined to Zika virus PCR in Suriname, at which point in time the likelihood of a malaria co-infection was limited because all signs and symptoms were satisfactorily explicable by a Zika virus infection. The diagnosis was beyond doubt confirmed by PCR analysis of blood (in Suriname) and then later of urine (in Europe). 2 weeks after disease onset, the patient was afebrile and otherwise paucisymptomatic as described.

[Correspondence] Suicide in adolescent girls

The Lancet - Sa, 30/04/2016 - 00:00
Suzanne Petroni, Vikram Patel, and George Patton1 ask why suicide is the leading killer of older adolescent girls. The simple answer is that among girls aged 15–19 years, maternal causes of death have decreased significantly since 2000, whereas deaths due to suicide remained stable in this sex and age group during the same period.2

[Correspondence] Suicide in adolescent girls – Authors' reply

The Lancet - Sa, 30/04/2016 - 00:00
Thomas Verberne correctly notes that suicide has become the top ranked cause of death among 15–19–year–old girls, because of very welcome declines in maternal mortality in this age group. But we disagree that by shining a light on what have long been neglected issues, such as adolescent mental health, harmful gender norms, and adolescent mortality, we are somehow being misleading.1

[Correspondence] The urgency of a sociocultural approach to adolescent men's health risk behaviours

The Lancet - Sa, 30/04/2016 - 00:00
Adolescent men's health is a global concern.1 Most reports and consensus focus on individuals' health risk behaviours—eg, tobacco consumption, binge drinking, and drug consumption, among others.2 In addition to this approach, we need to incorporate a sociocultural dimension into adolescent men's health.

[Correspondence] Do generic correction algorithms produce reliable estimates?

The Lancet - Sa, 30/04/2016 - 00:00
In 2010, Margaret Hogan and colleagues1 credited Italy with the lowest maternal mortality ratio (MMR) in the world. Despite reporting a 63% underestimation of MMR,2 the figure of four maternal deaths per 100 000 livebirths was again published in 2014 in an Article by Kassebaum and colleagues,3 to which we replied,4 as well as by recent WHO estimates published by Leontine Alkema and colleagues in The Lancet.5
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