The Lancet

“Women and Black researchers are less likely to hold multiple NIH grants.” “Female scientists miss out on career advances abroad.” “Time stands still for white male dons of Oxford.” Three recent headlines from Science, Nature, and The Times. Despite The Lancet’s proclamation in 2019 that “Feminism is for everybody”, the truth is that women remain excluded from many of the most senior roles in medicine and global health. An important report published by Women in Global Health last week—The State of Women and Leadership in Health—sets out the gap between words and deeds.

On his election 10 years ago, Pope Francis was hailed as a voice of modernisation. Has his papacy made a difference to health? Sima Barmania and Michael Reiss report.

Two new reports outline how the increasingly indiscriminate use of weapons such as rubber bullets, tear gas, and batons on protestors is harming health and human rights. Talha Burki reports.

The name Elizabeth Blackwell is probably familiar. Born in the UK, she was the first woman in the USA to be awarded a medical degree. In Twice as Hard: The Stories of Black Women Who Fought to Become Physicians, from the Civil War to the 21st Century, Jasmine Brown spans over 150 years to introduce nine less well known names: Black American women who became physicians. These were remarkable women. Rebecca Lee Crumpler (1831–95) was, in 1864, the first Black woman to earn a medical degree in the USA.

Romeo and Juliet, William Shakespeare's story of the two star-crossed lovers written in 1597 and set in Verona, Italy, has fascinated audiences for centuries. The appeal of the tragic fate of two adolescent lovers driven to a dramatic end by the opposition of their families continues to resonate among young generations. There have been many modern adaptations of Romeo and Juliet, including the musical West Side Story and Baz Luhrmann's movie Romeo + Juliet. Welsh playwright Gary Owen has now created his own adaptation, Romeo and Julie, set in modern day Splott, a suburb of Cardiff, in Wales, UK.

Renowned radiologist and pioneer of ultrasound in antenatal diagnosis. She was born in New York, NY, USA, on April 29, 1949 and died of cancer in Cambridge, MA, USA, on Oct 1, 2022 aged 73 years.

We have read with interest Jason Weatherald and colleagues’1 review of novel approaches for achieving more efficient pulmonary arterial hypertension trials. Indeed, the challenge lies in defining meaningful outcomes that are relevant to patients, health-care professionals, and society and also allow for trials that can change clinical practice but require low patient numbers.

We thank F A Klok and B Siegerink for their interest in our article and for their suggestion to consider ordinal outcomes for pulmonary arterial hypertension trials. Indeed, an ordinal outcome not only improves the granularity of patient-relevant outcomes compared with a dichotomous outcome, such as mortality, but it can also allow for smaller trial sample sizes than with a mortality outcome.1

Potential causes of the cases of acute hepatitis in children in the UK over the past year were discussed by Anil Dhawan and Sunitha Vimalesvaran,1 noting the presence of adenovirus subtype 41F in the majority of cases and suggesting the hepatitis was caused by an aberrant immune response to the virus rather than by the virus itself.

We thank Phillip E Morgan and Ragai R Mitry for their letter regarding our Correspondence entitled Hunting down the cause of acute hepatitis in children.1 Our focus in that Comment was to summarise existing data on the increase in the number of cases of acute hepatitis in children and possible pathogenesis of this condition. Morgan and Mitry propose an additional lifestyle component (in particular, foods containing additives such as some colourings) that could have exacerbated hepatocyte damage during the co-infection period.

In modern health care, medical datasets are increasingly being used to improve patient care, including through population health analysis and the development of diagnostic machine learning algorithms. This trend has been a key driver for the development of open-access datasets, giving researchers access to local or national data shared by different institutions. Open-access data can be used to train machine learning algorithms on diverse datasets that have been carefully curated, or to test algorithms that have already been trained by researchers elsewhere to assess their performance when applied to new data.

Although mental health problems are widespread in many African nations, they rarely receive the attention they merit. Stigmatisation is a prevalent factor that makes patients reluctant to seek mental health care in most African countries. As knowledge about mental health increased, some African countries, such as Ghana, Kenya, South Africa, Uganda, and Zambia, began passing legislation and laws to safeguard the rights of individuals who have mental health problems. In 1916, Nigeria, Africa's most populous country, enacted its first mental health legislation, which was called the Lunacy Ordinance.

The earthquakes in Türkiye and Syria on Feb 6, 2023, have left behind a massive burden of injuries, of which a large proportion are likely to be orthopaedic injuries.1 Generally, orthopaedic surgery is a field that is highly dependent on expensive equipment and supplies and, in most low-income and middle-income countries (LMICs), relies heavily on donations. Türkiye, as an upper-middle-income country, faces different challenges than the war-torn, lower-income country of Syria. However, both are set to face barriers in obtaining sufficient materials specific to their context.

The medical education system in China is widely considered one of the most complex and perplexing in the world. Unlike the standardised medical training in Europe and North America, where all medical graduates hold the same degree and possess a uniform level of clinical proficiency,1 China has multiple, distinct medical education pathways that can last from 3 to 8 years. As a result, medical students in China can receive an entry-level medical degree at varying levels of graduation, allowing them to take the Chinese Medical Licensing Examination and become licensed practitioners.

As the COVID-19 pandemic comes to an end in China,1 medical personnel who have worked tirelessly to fight the omicron (B.1.1.529) variant are now facing a new challenge. Despite their heroic efforts, many of them are now struggling to receive the financial compensation they deserve.2

Heyland DK, Patel J, Compher C, et al. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet 2023; 401: 568–76—In this Article, the fifth sentence of the Methods section of the Summary should read “…the secondary outcome was 60-day mortality”, and the table has been updated for style. These corrections have been made to the online version as of March 23, 2023.

Sandborn WJ, Vermeire S, Peyrin-Biroulet L, et al. Etrasimod as induction and maintenance therapy for ulcerative colitis (ELEVATE): two randomised, double-blind, placebo-controlled, phase 3 studies. Lancet 2023; published online March 2. https://doi.org/10.1016/S0140-6736(23)00061-2—The appendix of this Article has been corrected as of March 23, 2023.

A 50-year-old woman attended our clinic reporting a slow-growing mass over the bridge of her nose; she said it had been present for approximately 6 months. She had earlier been prescribed antibiotics for a suspected complicated sinusitis.

Water is fundamental to our existence. Yet mismanagement and complacency over water resources have led to a perilous situation, with access to clean water and sanitation services elusive to many people. The world is hugely off track from achieving Sustainable Development Goal (SDG) 6 by 2030: ensuring availability and sustainable management of water and sanitation for all. In 2015, 70% of people had access to safely managed drinking water; by 2020 this had only progressed to 74%. Over the same period, people accessing safely managed sanitation only increased from 47% to 54%.

In September, 2023, heads of state will reconvene at the 2023 UN General Assembly and report back on progress in keeping the promises made at the first UN High-Level Meeting on Tuberculosis in 2018.1 All three of us were privileged to be a part of this meeting, and still remember the excitement and hope we felt about the pledges made by world leaders to end tuberculosis, and the ambitious targets that were laid out.1