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[Comment] Reducing maternal mortality: can elabela help in this fight?

Sa, 06/07/2019 - 00:00
Maternal mortality is an international health-care crisis. A staggering 830 women die daily from pregnancy-related complications1 globally—over 300 000 per year. Pre-eclampsia affects approximately 2–8% of pregnancies worldwide and is a leading cause of maternal morbidity and mortality.2 The Global Strategy for Women's, Children's and Adolescents’ Health aims to reduce global maternal mortality to less than 70 per 100 000 livebirths by 2030.1 In order to accomplish this goal, new treatments to prevent hypertensive disorders of pregnancy are urgently needed.

[Comment] The Wakley–Wu Lien Teh Prize Essay 2019: telling the stories of Chinese doctors

Sa, 06/07/2019 - 00:00
Wu Lien Teh (1879–1960), a Malayan-born Chinese physician, made many firsts in China's medical history. He was one of the first students of Chinese descent to graduate in medicine from the UK's University of Cambridge. Wu published papers in The Lancet and was nominated for the Nobel Prize in Physiology or Medicine. One of the most outstanding of Wu's many contributions to medicine in China and global health was his success in leading the fight against plague in 1910, and his appointment as the chair of the International Plague Conference in 1911.

[Comment] Offline: Who should lead UNAIDS?

Sa, 06/07/2019 - 00:00
Who is best qualified to lead an organisation—UNAIDS— that has not only suffered severe reputational loss, but also faces threats to its continuing existence? UNAIDS is a jointly sponsored UN programme that has, in its own words, “led and inspired global, regional, national, and local leadership, innovation, and partnership to ultimately consign HIV to history”. But some observers believe this glorious history is just that—history. Rob Yates was recently appointed head of Chatham House's Centre on Global Health Security.

[World Report] Kazakhstan: health after the Nazarbayev era

Sa, 06/07/2019 - 00:00
Health improved under now-former President Nursultan Nazarbayev's 30 year rule, but discontent suggests more progress is needed to fight inequalities. Sharmila Devi and Aliya Uteuova report.

[World Report] Apply to trial Ebola vaccines in DR Congo, says ministry

Sa, 06/07/2019 - 00:00
A WHO expert panel said that vaccines against Ebola virus infection could be used in clinical trials, DR Congo ministry say they are open to this option. Esther Nakkazi reports.

[Perspectives] The rise of the virtualist

Sa, 06/07/2019 - 00:00
From time immemorial, an invariable feature of doctor–patient interaction has been that it takes place in person. But the status quo is changing. A large portion of patient care might eventually be delivered via telemedicine by virtualists, physicians who treat patients they may never meet.

[Perspectives] How to grow a human

Sa, 06/07/2019 - 00:00
Over the history of science and medicine, and across cultures—carried in the myths and traditions of populations around the world—attributions of how life is created and how humans could ourselves create life have been fed both by rich imaginings and colourful scientific hypotheses. Take, for example, the early 16th-century German–Swiss physician Theophrastus Philippus Aureolus Bombastus von Hohenheim (better known as Paracelsus), who spent much of his life formulating a method for the creation of human life.

[Perspectives] Takeshi Kasai: the health security thinker from Japan

Sa, 06/07/2019 - 00:00
“We cannot stand still, because our region is extremely dynamic: it is rapidly changing—economically, socially, and environmentally. This means that to stay relevant and valuable, we must also stay ahead of the curve”, says Takeshi Kasai, who has been Regional Director of the WHO Regional Office for the Western Pacific (WPRO) since February, 2019. This is essential, he says, “to be more effective” in meeting the needs of the region's nearly 1·9 billion people. Kasai's strong track record in dealing with health security threats such as severe acute respiratory syndrome (SARS) and avian influenza and his key role in developing and implementing the Asia-Pacific Strategy for Emerging Infectious Diseases (APSED) are viewed as a plus for the region.

[Perspectives] Physician narratives of illness

Sa, 06/07/2019 - 00:00
In psychiatrist Linda Gask's memoir The Other Side of Silence, she describes an exhaustive experience of depression during medical school. “There came a point when I couldn't go on. My head was splitting open and I struggled to hold the pieces of my brain together”, Gask writes. Her candid memoir is part of a changing trajectory of physician narratives of illness that have moved from often anonymised accounts in the early 20th century to deeply personal, owned contemporary works. We've examined a selection of physician narratives of illness from the UK and USA and discovered how illness can conflict with doctors’ professional identities and how difficult it can be for health professionals to be open about illness, especially mental health problems.

[Obituary] Henry T Lynch

Sa, 06/07/2019 - 00:00
Leading early figure in cancer genetics. Born on Jan 4, 1928, in Lawrence, MA, USA, he died of congestive heart failure on June 2, 2019, in Omaha, NE, USA, aged 91 years.

[Correspondence] Global epidemiology of use of and disparities in caesarean sections

Sa, 06/07/2019 - 00:00
In their Series on optimising caesarean section (CS) use, Ties Boerma and colleagues1 report on 98·4% of the world's births in 2015 from 169 countries. They found that CS use in some low-income and middle-income countries was more frequent in private health-care facilities than in public health-care facilities.1 In this respect, the Series paper singles out Brazil as a country where CS is the predominant delivery mode in private facilities.1 Gilberto Magalhães Occhi and colleagues2 contrasted the rates of CS in Brazil in private facilities (83% of all deliveries) versus public facilities (41%; with public facilities being those hospitals registered in the Unified Health System) for the year 2016.

[Correspondence] Global epidemiology of use of and disparities in caesarean sections

Sa, 06/07/2019 - 00:00
Ties Boerma and colleagues1 give an excellent review of the global increase in caesarean section (CS) use, and identify two key factors driving increases in CS use that relate poorly to medical need: a shift to more births occurring in health facilities, and increasing provision of CS in such facilities. In a related paper in the same Series, Ana Betrán and colleagues2 identify several additional predictors of unnecessary CS use, encompassing behavioural, psychosocial, health system, and financial factors.

[Correspondence] Global epidemiology of use of and disparities in caesarean sections – Authors’ reply

Sa, 06/07/2019 - 00:00
We are grateful to Suzanne Delport and Jonathan Wells and colleagues for their comments on our analysis of the global epidemiology of caesarean section (CS).1 We agree with Delport that South Africa has an extremely high prevalence of CS deliveries in private facilities. Data from the South Africa Demographic and Health Survey 2016,2 which only became available after the publication of our Lancet Series paper, suggest a CS prevalence of 61·3 per 100 livebirths in private health facilities, compared with 21·7 per 100 livebirths in public facilities.

[Correspondence] Is high use of caesarean section sometimes justified?

Sa, 06/07/2019 - 00:00
We read with great interest the recent Lancet Series on optimising caesarean section (CS) use and, being situated at a tertiary referral centre in Greece—a country with a high prevalence of CS1 and with shrinking health-care funding due to a prolonged period of austerity—we would like to add our perspective on the topic.

[Correspondence] How should the health-care community respond to human rights violations?

Sa, 06/07/2019 - 00:00
The Editors1 drew on Human Rights Watch's World Report 20192 to warn about a range of human rights violations and their effect on health and also highlight a new-found momentum for resistance to these violations. I thank The Lancet for highlighting these issues and for the call to action, namely that resistance to such abuses should continue throughout 2019. Although many will agree that the health-care community have a part to play in fighting human rights violations, how we can be most effective in putting up such resistance and in pursuing social and political change are far more difficult questions.

[Correspondence] Another blow to credibility in published data sources

Sa, 06/07/2019 - 00:00
In the period since submission of our previous Correspondence,1 a new event has occurred that further questions the utility of some published data—the Institute for Health Metrics and Evaluation (IHME) has updated its Global Burden of Disease (GBD) data, which includes revision of historic facts. Our example based on that source quoted mortality data for children aged 10–14 years in 2015; these data have now been changed, and moreover, the previous data are no longer displayed. The new data were published too late to be used in the Models of Child Health Appraised project, funded by the EU Horizon 2020 programme, which has now concluded.

[Correspondence] Another blow to credibility in published data sources – Author's reply

Sa, 06/07/2019 - 00:00
Michael Rigby and colleagues have pointed out the changes in the Global Burden of Disease (GBD) estimates over the previous iterations of GBD 2016 and GBD 2017. They argue that estimates should not change, and we beg to differ. Sound, evidence-based decision making should be based on the best available evidence estimated using up-to-date methods and the most recent empirical data. More recently available data and improved methods surely will change our estimates, and such change should be encouraged; one should certainly not prefer a false sense of assurance based on unchanged estimates.

[Department of Error] Department of Error

Sa, 06/07/2019 - 00:00
Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet 2019; 393: 1505–16—In this Article, the data for the laser trabeculoplasty group and the eye drops group were incorrectly switched in several places. The third paragraph of the Results section should have begun: “At 36 months, the selective laser trabeculoplasty group had an average EQ-5D score of 0·90 (SD 0·16), compared with 0·89 (SD 0·18) in the eye drops group…”.

[Department of Error] Department of Error

Sa, 06/07/2019 - 00:00
Pratley R, Amod A, Hoff ST, et al. Oral semaglutide versus subcutaneous liraglutide and placebo in type 2 diabetes (PIONEER 4): a randomised, double-blind, phase 3a trial. Lancet 2019; 394: 39–50—In this Article, in panel C of figure 2, the p value for the proportion of patients achieving the HbA1c target of less than 7·0% for oral semaglutide versus liraglutide by use of the trial product estimand should have been “p=0·0620”; in table 2, the p value for the estimated odds ratio for HbA1c ≤·5% at 26 weeks for the liraglutide group by use of the trial product estimand should have been “p=0·1503”, the 95% CI range for the estimated odds ratio for bodyweight loss ≥10% at 26 weeks in the liraglutide group by use of the trial product estimand should have been “(1·52 to 5·05)”, and the estimated odds ratio for bodyweight loss ≥10% at 52 weeks in the placebo group by use of the trial product estimand should have been “8·39 (2·79 to 25·26); p=0·0002”.

[Clinical Picture] Gallstone causing gastric outlet obstruction 50 years after cholecystectomy

Sa, 06/07/2019 - 00:00
A 90-year-old woman was transferred to our hospital with a 7-day history of pain in the right upper quadrant of her abdomen, decreased appetite, and post-prandial vomiting. On examination, she was afebrile, mildly tachycardic, at 95 beats per min, and in atrial fibrillation. Her blood pressure was 125/75 mm Hg. Clinically, she looked dehydrated and had a scar over the right hypochondrium, which was slightly tender, with a palpable mass, but she had no peritonism. In her medical history, she had a cholecystectomy approximately 50 years ago.