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[Editorial] Zoonoses: beyond the human–animal–environment interface

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World Zoonoses Day on July 6 marks the day, in 1885, when a young boy received the first vaccine against rabies—a zoonosis, a disease caused by a pathogen transmitted from animals to humans. Rarely is a World Zoonoses Day so relevant to consider these diseases and their disruption of societies.

[Comment] Ambulatory management of primary spontaneous pneumothorax: when less is more

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Spontaneous pneumothorax is a pneumothorax that occurs in the absence of trauma or iatrogenic injury, and occurs in about 20 000 people per year in the USA.1 Primary spontaneous pneumothorax is typically defined as a pneumothorax that occurs in patients without evidence of underlying lung disease, and is estimated to affect about 3000 people per year in the UK,2 whereas secondary pneumothorax occurs in patients with known lung disease such as emphysema, lymphangioleiomyomatosis, or Birt-Hogg-Dubé syndrome.

[Comment] Surgery for benign prostatic obstruction

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Almost all men have some form of benign prostatic hyperplasia as they age, often resulting in lower urinary tract symptoms due to benign prostatic obstruction. Most patients with bothersome lower urinary tract symptoms are treated with drugs (eg, α blockers or 5α-reductase inhibitors) and surgery is usually reserved for patients who do not respond to drug treatment. Both the safety issues of medication and surgery-related morbidity must be weighed against the efficacy of these treatments. The main reasons for discontinuation of drug treatment are serious adverse effects, such as postural hypotension, asthenia, dizziness, and impairment of sexual function, or loss of efficacy over time.

[Comment] Investing in surgery: a value proposition for African leaders

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Globally, poor access to high-quality surgical, obstetric, and anaesthesia care remains a main contributor to global disease burden accounting for about a third of deaths worldwide.1 The need for strengthening surgical care systems is especially urgent in sub-Saharan Africa, where access is strikingly limited, leading to the highest mortality and morbidity from surgically preventable and treatable conditions in the world.2,3 Approximately 93% of the population of sub-Saharan Africa lacks access to safe, affordable, and timely surgical care, compared with less than 10% in high-income countries.

[Comment] A Lancet Commission on women and cancer

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Over the past decade, the global health community has begun to acknowledge that cancer is an increasingly important public health and economic challenge in all countries.1 What is not acknowledged is the disproportionate impact of cancer on the lives and livelihoods of women, and the downstream impacts this creates for societies. In 104 countries, breast cancer has the highest age-standardised incidence rate of all cancers in both sexes combined; in 23 countries, it is cervical cancer.2 Of the 938 044 deaths from these two cancers in 2018, most were premature and preventable and occurred in a low-income or middle-income countries (LMICs), where access to high-quality cancer control and care is limited and inequitable.

[Comment] The Wakley–Wu Lien Teh Prize Essay 2020: Chinese health workers' experiences during the COVID-19 pandemic

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“I feel deeply the burden of the honour placed upon me in being chairman of this Medical Conference, which is unique in our history, powerful in its representation, and which gives China a strong position amongst nations seeking the welfare of the people”, wrote Wu Lien Teh in his first publication in The Lancet,1 on his inaugural address delivered at the International Plague Conference in Shenyang, China, in 1911. Wu was elected as the chair of the conference for his work in controlling the pneumonic plague epidemic outbreak in 1910–11 in northeastern China, which ultimately claimed about 60 000 lives.

[Comment] Offline: It's time to convene nations to end this pandemic

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A historic and calamitous milestone was reached this week. WHO reported more than 10 million cases of COVID-19 and over 500 000 COVID-19 deaths. The world's political leaders have been tested and they have been found wanting. It's hard to recall a more lamentable response to a global emergency. Even the climate crisis had its Kyoto and Paris agreements. But despite the urgency of this continuing human catastrophe, despite the immediacy of the economic collapse we are witnessing, there has still been no moment when nations have been convened to reflect on lessons to be learned, to coordinate actions to protect citizens, and to plan for future spikes or waves of infection.

[World Report] Collaborating on kidneys: Haiti's transplantation ambitions

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Haiti lacks health programmes and facilities for kidney disease. Jane Regan reports on an ambitious collaboration between Haitian and US doctors to make kidney transplantation widely available.

[Perspectives] Salome Maswime: dynamic leader in global surgery

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As Associate Professor and Head of Global Surgery at the University of Cape Town (UCT), South Africa, Salome Maswime is aware of the scale of the job in front of her. “For me the big problem is the disconnect between health systems and clinical care in low and middle income countries, especially concerning surgical care. Outcomes are often poor, there being not enough focus on the quality of surgery, and how it relates to integrated health care and overarching health systems performance”, she explains.

[Perspectives] Maps and guides

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Like many people, I use satnav when I'm driving to an unfamiliar address. I know that if I follow the instructions as they come up, I'll almost certainly get to my destination. But there are times when you need a broader sense of the territory you'll be passing through. If you're plotting a route from one part of the country to another in the car, a small-scale road atlas works well. If you're planning a cross-country hike, however, you'll need a map that shows the landscape in detail—contours, footpaths, points of reference.

[Correspondence] Time for WHO to declare climate breakdown a PHEIC?

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At the opening plenary of the World Health Assembly in May, 2019, Richard Horton urged member states and the Secretariat of WHO to recognise climate change as a planetary emergency. A few days later, during a side event on air pollution, climate change, oceans, and health sponsored by the Government of Sweden, the Minister of Health for the Seychelles Jean Paul Adam argued that climate change has to be recognised as a public health emergency at the international level. Johan Giesecke1 once stressed that as public health emergencies of international concern (PHEICs) evolve into more complex forms, it becomes necessary to identify gaps in the alarm and response mechanism of the International Health Regulations (IHRs).

[Correspondence] US Global Gag Rule increases unsafe abortion

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The Trump administration issued the Protecting Life in Global Health Assistance policy in 2017. This policy is an expansion of the Global Gag Rule that blocks US global health assistance to foreign non-governmental organisations that provide, counsel on, refer to, or advocate for abortion services; even if they do so with their own funding and in countries where abortion is legal. Following an additional policy expansion in 2019, foreign organisations that comply with the policy must now attach it to all subgrants that they give to other foreign organisations, including those that do not involve US global health assistance.

[Correspondence] Methodology in the GBD study of China

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We found the Article by Maigeng Zhou and colleagues1 intriguing. However, we have some concerns. Our major concern arises from mixing data from mainland China and Taiwan. These two regions have distinct health-care and social welfare systems; they also have different time trends of how socioeconomic conditions evolved during the past half century. Therefore, mixing the data from these two regions might lead to biased estimates, especially for the health outcomes shaped by health policies (eg, vaccination programmes as a prevention strategy).

[Correspondence] Methodology in the GBD study of China

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Maigeng Zhou and colleagues1 claimed that they had implemented the same hierarchical model setup as Christopher Murray and colleagues had in their Global Burden of Disease Study (GBD),2 in which Taiwan and China were treated at the same level in the hierarchical model. However, according to figures 3 and 4 in the Article,1 Taiwan was placed at the level under the umbrella of China. The inconsistency between the methodology and results in these figures requires clarification.

[Correspondence] Methodology in the GBD study of China – Author's reply

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The Global Burden of Disease Study (GBD) 2017 provides comprehensive assessment of population health for 195 countries and territories and subnational units for selected countries, including all province-level administrative units in China. It is important to point out that, as the GBD uses a hierarchical analytical framework, data input from all GBD 2017 analytical units, national or subnational, are integrated into a single modelling process to provide a set of estimates for all locations that are internally consistent and comparable across locations and over time.

[Department of Error] Department of Error

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Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2019; 394: 1145–58—The appendix of this Article has been corrected as of July 2, 2020.

[Articles] Ambulatory management of primary spontaneous pneumothorax: an open-label, randomised controlled trial

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Ambulatory management of primary spontaneous pneumothorax significantly reduced the duration of hospitalisation including re-admissions in the first 30 days, but at the expense of increased adverse events. This data suggests that primary spontaneous pneumothorax can be managed for outpatients, using ambulatory devices in those who require intervention.

[Articles] Thulium laser transurethral vaporesection of the prostate versus transurethral resection of the prostate for men with lower urinary tract symptoms or urinary retention (UNBLOCS): a randomised controlled trial

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TURP and ThuVARP were equivalent for urinary symptom improvement (IPSS) 12-months post-surgery, and TURP was superior for Qmax. Anticipated laser benefits for ThuVARP of reduced hospital stay and complications were not observed.

[Clinical Picture] Coarctation of the aorta: a rare cause of severe hypertension in pregnancy

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A 24-week pregnant 18-year-old woman was seen at her local health-care centre where she was found to have a respiratory rate of 38 breaths per min, a blood pressure of 250/90 mm Hg, and a heart rate of 39 beats per min. She collapsed and required intubation and ventilation. A chest x-ray showed bilateral infiltrates—pulmonary oedema—and she was treated with furosemide and nitroglycerin and transferred to our intensive care unit.

[Editorial] Generation coronavirus?

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The catastrophic elements that have perpetuated the COVID-19 pandemic—global interconnectedness, climate change due to human activity, vast economic inequality, and deep veins of antiscience—have resulted in more than 9 million infections and almost 500 000 deaths worldwide. Although children might be less susceptible to infection by severe acute respiratory syndrome coronavirus 2 and generally have better outcomes than adults, COVID-19 as a phenomenon weighs heavily on their health and wellbeing.