The Lancet RSS Feed: current issue. The Lancet is a weekly medical journal, renowned for the publication of high-quality peer-reviewed research from around the world. It provides context and insight to advancements in medicine and health worldwide.
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[Articles] Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study
High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy.
[Articles] Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys
Achievement of the desired number and healthy timing of births has important benefits for women, families, and societies. To meet the unmet need for modern contraception, countries need to increase resources, improve access to contraceptive services and supplies, and provide high-quality services and large-scale public education interventions to reduce social barriers. Our findings confirm a substantial and unfinished agenda towards meeting of couples' reproductive needs.
[Articles] Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA)
HIV-infected pregnant or post-partum women had around eight times higher mortality than did their HIV-uninfected counterparts. On the basis of this estimate, we predict that roughly 24% of deaths in pregnant or post-partum women are attributable to HIV in sub-Saharan Africa, suggesting that safe motherhood programmes should pay special attention to the needs of HIV-infected pregnant or post-partum women.
[Articles] Reproductive health priorities: evidence from a resource tracking analysis of official development assistance in 2009 and 2010
Donors are prioritising reproductive health, and the slight increase in funding in 2009–10 is welcome, especially in the present economic climate. The large share of such funding for activities related to HIV infection in women of reproductive age affects the amount of ODA received by priority countries. It should thus be distinguished from resources directed to other reproductive health activities, such as family planning, which has been the focus of recent worldwide advocacy efforts. Tracking of donor aid to reproductive health should continue to allow investigation of the allocation of resources across reproductive health activities, and to encourage donor accountability in targeting aid flows to those most in need.
“Gender is probably the most restricting force in American life”Gloria Steinem (American journalist, social activist and feminist), 2008
In June, 2012, a 25-year-old woman presented to our clinic with a 3-month history of excruciating lower back pain radiating to both legs and lower limb weakness. She had been healthy until March, 2012, when she experienced recurrent episodes of right sciatic nerve pain, with increasing frequency and night predominance. These episodes of pain were associated with right ankle instability, leading to an ankle sprain. The patient described intense dysaesthesias in both legs but stated she had no fever, weight loss, headaches, or stiffness.
The US FDA has appealed a court order directing it to make the emergency contraceptive levonorgestrel, known as “Plan B”, available without prescription to women of all ages, but will lower the age limit from 17 years to 15 years. Access to Plan B is a legal and political battleground for reproductive rights groups and social conservatives.
As is the case with many psychiatric diagnoses, bipolar disorder looks simple enough from a distance. Emil Kraepelin's division of mental illness into relapsing and remitting mood disorders, and chronic, deteriorating psychotic conditions, rang true with 19th-century clinicians. This description was followed by an expansion of diagnostic categories, today embodied in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and the mental and behavioural disorders section of WHO's International Classification of Diseases (ICD).
On April 30, the UK's International Development Secretary, Justine Greening, announced that Britain's bilateral development programme in South Africa would end in 2015, on the grounds of South Africa's enormous political and economic progress. The withdrawal decision, however, was regarded as “unilateral” by South Africa's Government, who claimed it would have “far-reaching implications” and would be “tantamount to redefining” the two countries' relationship. In response, the UK Foreign Secretary William Hague said that the UK would clear up any confusion with the South African Government.
A man has suffered a massive stroke. The right side of his body is paralysed, he cannot speak, and needs total assistance with activities of daily living. The man is serving a life sentence in a US prison for cocaine and heroin distribution. In 2006, he appealed for early release, but was denied because his life expectancy could not be determined. This case is one of many highlighted in a new report by the US Department of Justice, which concludes that compassionate release programmes in the USA are poorly managed by the Federal Bureau of Prisons.
Mixed states have long contributed to the concept of manic-depressive illness. Defined broadly as the coexistence of depressive and manic features within the same mood episode, the criteria for mixed states have narrowed in successive editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM) I to IV from manic-depressive reaction mixed type, to mixed episodes. However, in DSM-5, this trend has been reversed and the mixed episode diagnosis replaced by a mixed features specifier (MxFS).
Fast-track surgery or enhanced postoperative recovery programmes have evolved during the past 15 years and have proven effective across a range of procedures in terms of reductions in length of hospital stay, morbidity, and convalescence, without an increase in readmission rates or safety issues. Most data have come from colorectal procedures, including physiological data for preservation of muscle mass and function and cardiopulmonary response to exercise.
The UK has achieved some success in shifting mental health care from institutional to community settings, but with one important and disappointing limitation. Compulsory admissions have risen steadily over the past two decades in the UK and in some other countries undergoing similar deinstitutionalisation processes. increasingly risk-averse clinicians, patients' reluctance to be admitted to crowded and unpleasant wards, and the closure of long-stay wards, resulting in more people with severe illnesses residing in the community.
In The Lancet, Leontine Alkema and colleagues illustrate the usefulness of rigorous modelling to provide convincing estimates of health indicators when empirical data are patchy or non-existent. Their report presents by far the most complete country-specific information about trends between 1990 and 2010, with projections to 2015, in two key family planning indicators for married or cohabiting women: use of any contraceptive method (contraceptive prevalence) and non-use in women who want to avoid childbearing for at least 2 years (unmet need).
[Comment] Annual Report of the Chief Medical Officer: infection and the rise of antimicrobial resistance
The second of the two volumes of the Chief Medical Officer for England's Annual Report on the state of the public's health is released this week. The report includes recommendations aimed specifically at politicians and highlights the need for strong action on antimicrobial resistance, since this issue has the potential to be as important as global warming in terms of its impact on health. The report identifies antimicrobial resistance as a cross-societal and therefore cross-governmental issue that encompasses both a market failure to produce new antibiotics and the need for better antibiotic stewardship.
Returning to my old medical school recently, I crossed paths with the professor who once taught us embryology. I remember him as an excellent lecturer. He took us through the intricacies of human development logically and compellingly. When we met, I recalled his lectures and his enthusiasm. He laughed, saying that, for 32 years, he has taught the same course in the same way to thousands of students. How wonderful, I thought, that, despite enormous changes to the medical school in almost every other way, some things hadn't changed at all.
A 10-year UN plan to make the world safer from natural disasters went into effect in 2005. With 2015 nearing, countries are now assessing how well it has worked. John Maurice reports.
The Irish Government released its long-awaited draft Protection of Life in Pregnancy Bill last week, providing doctors with guidance on legal terminations. Zara Qadir reports.
Nestled inside London's National Portrait Gallery sit three contemporary images that are startling composites of medical imagery, digital photographs, and hand etchings. The portraits, which are literally larger-than-life, are the work of Susan Aldworth, an artist whose work explores the meaning of self. Aldworth's artistic journey has been a deeply personal one. In 1999, a health scare found her in hospital, gazing at a scan of her own brain, contemplating the connection between the image of her brain and her sense of self.
In a 1989 editorial in Science celebrating the impending launch of the Human Genome Project (HGP), Daniel Koshland wrote of its potential to provide solutions for “illnesses such as manic depression, Alzheimer's, schizophrenia, and heart disease”, a potential that was even extended to social problems such as homelessness. To naysayers, he warned against “the failure to apply a great new technology to aid the poor, the infirm, and the underprivileged”.