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[Correspondence] Can #MeToo abolish sexual harassment and discrimination in medicine?

Sa, 03/08/2019 - 00:00
“Discrimination is a disease, we must attack it wherever it appears. This applies to the opportunity to vote, to hold and retain a job, and to secure adequate shelter and medical care no less than to gain an education compatible with the needs and ability of the individual.”Harry S Truman

[Clinical Picture] A quest for Q fever

Sa, 03/08/2019 - 00:00
A 9-year-old girl was admitted to our hospital with status epilepticus. Earlier in the day, she had complained of a headache and started vomiting. She then lost consciousness and began having a fit; the status epilepticus lasted 30 min and was stopped by phenobarbital. She had a congenital heart defect—truncus arteriosus with interventricular communication—which was surgically corrected a few days after birth. The girl was on long-term treatment with low-dose aspirin as the antiaggregant. She had no features of Marfan's or Ehlers–Danlos syndromes.

[Therapeutics] The evolution of the use of faecal microbiota transplantation and emerging therapeutic indications

Sa, 03/08/2019 - 00:00
Developments in high-throughput microbial genomic sequencing and other systems biology techniques have given novel insight into the potential contribution of the gut microbiota to health and disease. As a result, an increasing number of diseases have been characterised by distinctive changes in the composition and functionality of the gut microbiota; however, whether such changes are cause, consequence, or incidental to the disease in question remains largely uncertain. Restoration of the gut microbiota to a premorbid state is a key novel therapeutic approach of interest, and faecal microbiota transplantation—the transfer of prescreened stool from healthy donors into the gastrointestinal tract of patients—is gaining increasing importance in both the clinical and research settings.

[Review] New Zealand health system: universalism struggles with persisting inequities

Sa, 03/08/2019 - 00:00
New Zealand was one of the first countries to establish a universal, tax-funded national health service. Unique features include innovative Māori services, the no-fault accident compensation scheme, and the Pharmaceutical Management Agency, which negotiates with pharmaceutical companies to get the best value for medicines purchased by public money. The so-called universal orientation of the health system, along with a strong commitment to social service provision, have contributed to New Zealand's favourable health statistics.

[Comment] Heat and health: a forthcoming Lancet Series

Gi, 01/08/2019 - 00:30
Planet Earth is heating up, with heatwaves increasing in frequency, intensity, and duration.1 In 2019, so far, all-time high temperature records have been toppled in multiple countries. An early and intense heatwave in Europe made June the hottest month on record for the continent with the average temperature 2°C above normal.2 France reported a new national temperature record of 45·9°C on June 28. On July 24–25, a second major heatwave in a month set new all-time highs on 2 consecutive days in Germany, Belgium, and the Netherlands.

[Correspondence] Bringing closure: towards achieving a better understanding of Israel

Gi, 01/08/2019 - 00:30
We wholeheartedly endorse Richard Horton's timely Comment,1 in which he addresses the global rise of anti-Semitism particularly evident in Europe and the USA. Horton stresses the need to educate medical students and health-care professionals of the evil and disastrous consequences of ignoring the historical reality of the Holocaust. It will remind the world, 75 years on, that the call Never Again remains highly relevant!

[Department of Error] Department of Error

Gi, 01/08/2019 - 00:30
Chiang C-Y, Van Deun A, Trébucq A, et al. Multidrug-resistant tuberculosis. Lancet 2019; 394: 299—The appendix of this Correspondence has been added as of July 31, 2019.

[Department of Error] Department of Error

Me, 31/07/2019 - 00:30
Moazen B, Assari S, Neuhann F, Stöver H. The guidelines on infection control in prisons need revising. Lancet 2019; 394: 301–02—In this Correspondence, the second sentence of the first paragraph should have read “The proportion of prisoners in the world with HIV has been estimated at 3·8%, hepatitis C virus (HCV) at 15·1%, hepatitis B virus (HBV) at 4·8%, and tuberculosis at 2·8%.” This correction has been made to the online version as of July 30, 2019.

[Comment] Progress in beating the tobacco epidemic

Lu, 29/07/2019 - 13:42
Tobacco is a global health emergency.1,2 Tobacco use and second-hand smoke kill 8 million people each year and leave many more in poor health; estimates suggest tobacco could kill up to 1 billion people this century.3

[Editorial] Prioritising primary care in the USA

Sa, 27/07/2019 - 00:00
Although the USA spends more on health care despite having worse outcomes than other high-income nations, one area where it underinvests is primary care. Research has shown that higher levels of spending on primary care lead to improved patient outcomes and lower overall health-care costs. On July 17, 2019, the Patient-Centered Primary Care Collaborative (PCPCC) issued the first report to look at primary care spending by state, including spending from across different types of payers: commercial insurance companies, government-provided insurance (Medicare and Medicaid), as well as the uninsured.

[Editorial] Hopes for health from new European Commission leader

Sa, 27/07/2019 - 00:00
Ursula von der Leyen, the former German minister of defence, looks set to become President of the European Commission at a vital time for the European project. The rise of the populist right was unexpectedly matched by a rise in votes for liberal and green parties in the recent EU elections, making it less likely that von der Leyen will have to satisfy empowered populists during her presidency. Similarly, as it has become obvious across Europe that leaving the EU entirely is undesirable, the voices demanding a Brexit of their own have gone silent.

[Editorial] The slowdown in eradicating hunger

Sa, 27/07/2019 - 00:00
In 2015, the UN set the goal to eradicate hunger and malnutrition and to ensure nutritious food for all (Sustainable Development Goal 2) by 2030. On July 18, the Food and Agriculture Organization (FAO) and UN partners published their annual report The State of Food Security and Nutrition in the World. Following the trend from the two previous reports, the results point to the unlikelihood of achieving this goal.

[Comment] Rethinking management of neonates at risk of sepsis

Sa, 27/07/2019 - 00:00
Clinicians involved in the care of young infants are aware of the consequences of not administering or of delaying antibiotics in cases of bacterial sepsis. Those who have seen such cases might be quicker to prescribe antibiotics in the future, even if sepsis is a remote possibility. However, this practice is not without risks. Exposure to broad-spectrum antibiotics alters the body's microbiota, increases opportunistic infections, and promotes antimicrobial resistance (AMR), which may restrict future treatment options for the child.

[Comment] Surrogate endpoints in randomised controlled trials: a reality check

Sa, 27/07/2019 - 00:00
At the 24th Congress of the European Hematology Association in June, 2019, the results of the BELLINI trial, a double-blind, randomised, placebo-controlled trial of venetoclax, bortezomib, and dexamethasone versus placebo, bortezomib, and dexamethasone in patients with relapsed, refractory multiple myeloma, were presented, on which one of us (SK) is an investigator.1 Earlier, in March, 2019, the US Food and Drug Administration (FDA) had placed a hold on clinical trials of venetoclax in multiple myeloma.

[Comment] Offline: Global health's indifference to poverty must end

Sa, 27/07/2019 - 00:00
Global health thrives on fashion. During the era of the Millennium Development Goals (MDGs, 2000–15), that fashion was poverty. The manifesto for the MDGs was the Commission on Macroeconomics and Health, chaired by Jeff Sachs and published in 2001. The Commission concluded that “The linkages of health to poverty reduction and to long-term economic growth are powerful, much stronger than is generally understood.” Sachs argued that the poor were more susceptible to disease and less likely to seek medical care, even when that care was urgently needed.

[World Report] Ebola outbreak declared a PHEIC, world waits for next steps

Sa, 27/07/2019 - 00:00
After the fourth meeting of the Emergency Committee, WHO declared the Ebola outbreak in DR Congo a Public Health Emergency of International Concern. John Zarocostas reports.

[World Report] US Planned Parenthood leadership shake-up

Sa, 27/07/2019 - 00:00
The announcement came as a surprise: Leana Wen will no longer be the head of Planned Parenthood on the request of the board of directors. Susan Jaffe reports.

[World Report] Northern Ireland likely to legalise abortion

Sa, 27/07/2019 - 00:00
Only an unlikely turn of events could prevent this bill from coming into law; activists celebrate the move towards overturning some of the world's strictest abortion laws. Talha Burki reports.

[Perspectives] The public health and industry partnership conundrum

Sa, 27/07/2019 - 00:00
Although we hesitate to admit it, those of us who make a living in public health, be it in the academic world or in practice, have a near reflexive suspicion of working with the private sector. We come by that suspicion honestly. There is abundant research, evidence, and experience of how some industry practices have harmed the health of the public.

[Perspectives] Eleanor Crook: master of morbid sculpture

Sa, 27/07/2019 - 00:00
Guy the Gaunt, very likely the first Transi, or cadaver tomb, to be sculpted in over 400 years, is slowly, eerily emerging from a long block of limewood, carved chip by chip by Eleanor Crook since 2014. Guy's anatomically accurate, skeletal body is in the tradition of English cadaver memorials, carved out of stone or wood, dating between around 1425–1558. Christina Welch, Senior Fellow in Theology and Religious Studies at the UK's University of Winchester, led a crowd-funding campaign for the project.