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[Editorial] Air pollution: a major threat to lung health

Sa, 04/05/2019 - 00:00
The American Lung Association's State of the Air report, released on April 24, highlights that more than 40% of US citizens—more than 141 million people—live in areas with unhealthy levels of ozone and particulate matter. Deteriorating air quality marks an alarming trend for a country that has reduced emissions of common pollutants since the 1980s. Wildfires and heatwaves in parts of the country most affected by climate change have driven record-breaking levels of pollutants in some of the most densely populated cities.

[Comment] Placental growth factor testing for suspected pre-eclampsia

Sa, 04/05/2019 - 00:00
Pre-eclampsia affects between 2% and 8% of pregnancies, and this condition remains a leading cause of maternal and perinatal mortality and morbidity worldwide.1 This syndrome is characterised by new-onset hypertension during pregnancy and it arises from distinct clusters of risk factors.2 Common to each cluster is a specific degree of systemic vascular injury that varies between clusters, which leads to specific end-organ disease. Organ-specific injury via ischaemia and inflammation is the pathway that most commonly leads to fetal growth restriction (FGR) and stillbirth (through placental dysfunction), eclampsia, HELLP syndrome, and renal injury.

[Comment] Delivering on global health priorities: the WHO Task Force on Nursing and Midwifery

Sa, 04/05/2019 - 00:00
WHO is entering a new era in its recognition of the vital domains of nursing and midwifery. After the appointment of WHO's Chief Nursing Officer in 2017, the Director-General has endorsed the establishment of the WHO Task Force on Nursing and Midwifery. The taskforce is engaging the global nursing and midwifery community to accelerate collaboration and progress on the health-related Sustainable Development Goals (SDGs).1

[Comment] Towards eradication of chronic obstructive pulmonary disease: a Lancet Commission

Sa, 04/05/2019 - 00:00
“One must be impressed by the very long road medicine must travel before an understanding of disease is reached, even when its clinical symptomatology is relatively simple.”1 Whether one accepts the Dutch hypothesis advanced by pulmonologists Dick Orie and Henk Sluiter, this idea in the introduction to their 1961 book, Bronchitis,1 still resonates today. Despite many advances in medicine, our understanding of the pathobiological mechanisms that underlie chronic obstructive pulmonary disease (COPD) remains incomplete, the definition of the disease is debated, our diagnostic tests are imprecise, and treatment is inadequate, even as the global burden of the disease continues to increase.

[Comment] Offline: A moral health system demands a moral society

Sa, 04/05/2019 - 00:00
There is nothing like the personal need for high-quality health care to make one appreciate the importance of universal health coverage as a core institution of a just society. Being away from The Lancet for 6 weeks experiencing the benefits of the UK's National Health Service has certainly given me new energy to use the best available health science as a platform to campaign vigorously for expanding the availability of high-quality health care provided free at the point of delivery. There are few indicators of a civilised society more telling than the presence of a strong health system.

[World Report] Health under the spotlight as South Africa takes to the polls

Sa, 04/05/2019 - 00:00
South Africa's leading parties are debating options for health care—but a tendency to reject blame for failures on migration is worrisome. Munyaradzi Makoni reports.

[World Report] Macron's Grand Débat speech falls short for health sector

Sa, 04/05/2019 - 00:00
At an awaited press conference, the French President failed to offer novel solutions for a strained health sector, on a background of a data privacy scandal. Sharmila Devi reports from Bordeaux.

[World Report] Northern Ireland deadlock impedes abortion rights progress

Sa, 04/05/2019 - 00:00
International and local inquiries express concern over the local abortion law's failure to comply with human rights, but devolved government blocks progress. Angel Li reports.

[Perspectives] Dissecting the consultation

Sa, 04/05/2019 - 00:00
As a medical student, I saw medicine as a science. As a surgeon, it was about skills. As a general practitioner (GP), medicine was a performance. As a patient, I recognise all of these, although what I experience most directly is the performance. Underpinning the science of medicine and the skills of surgery is the consultation. This central act brings two people together in a relationship of care based on trust and integrity. Its aim is to make sense of a problem the patient brings.

[Perspectives] Time to breathe

Sa, 04/05/2019 - 00:00
Breathing is essential, universal, and largely unconscious. It is endowed with spiritual significance in many cultures: the words for “spirit” and “breath” in many ancient languages share the same roots. Yet somehow the lungs have not acquired the cultural cachet of the heart. In terms of human and financial resources, respiratory diseases are a poor relation to cardiovascular disease, although hundreds of millions of people worldwide have conditions including tuberculosis, pneumonia, and asthma, and chronic obstructive pulmonary disease (COPD) is the world's third largest cause of premature death.

[Perspectives] Shitaye Alemu Balcha: committed to rural health care in Ethiopia

Sa, 04/05/2019 - 00:00
To work on non-communicable diseases (NCDs) in Africa is to work in a branch of medicine that some have not viewed as a priority for the continent. Shitaye Alemu Balcha, Associate Professor in Internal Medicine in the College of Medicine and Health Sciences of the University of Gondar, Ethiopia, would be happy to enlighten them. Shitaye is a specialist in NCDs, diabetes in particular. “My concern over diabetes…came about because of the difficulties facing poor patients who have to walk long distances to the hospital to collect insulin.

[Perspectives] After the golden age: what is medicine for?

Sa, 04/05/2019 - 00:00
In the pilot episode of The Sopranos, the central character, capo Tony Soprano mused of the mafia: “Lately, I'm getting the feeling that I came in at the end. The best is over.” I feel a similar regret over the timing of my career in medicine. I qualified in 1983, towards the end of medicine's golden age, which I have, somewhat arbitrarily, defined as lasting from the mid-1930s to the mid-1980s.

[Obituary] John Mendelsohn

Sa, 04/05/2019 - 00:00
Renowned cancer researcher who led the University of Texas MD Anderson Cancer Center. Born on Aug 31, 1936, in Cincinnati, OH, USA, he died on Jan 7, 2019, in Houston, TX, USA, of glioblastoma, aged 82 years.

[Correspondence] Precision public health: pitfalls and promises

Sa, 04/05/2019 - 00:00
We were delighted that Richard Horton (Oct 27, 2018, p 1504)1 continued the conversation we2 aimed to start about precision public health. However, Horton incompletely characterises our assessment2 of precision public health. He argues that precision public health does not sideline political and social influences on health. In fact, he argues, it does exactly the opposite. Horton cites two studies3,4 to conclude that precision public health “is about using the power of data to improve health and achieve social justice”.

[Correspondence] Social network theory and rising suicide rates in the USA

Sa, 04/05/2019 - 00:00
Maurizio Pompili (Aug 11, 2018, p 474)1 identified the importance of understanding the emotional experience of suicidal individuals as integral to effective suicide prevention methods. Supporting and extending this concept, we suggest that it is also important for clinicians to assess whether such empathetic understanding exists in an individual's social network. Positive and negative emotions can be transmitted through social connections. For example, Rosenquist and colleagues2 described how depression spread person-to-person across Framingham (MA, USA), from one person to their contacts and to people with up to three degrees of separation (friends' friends' friends).

[Correspondence] Social network theory and rising suicide rates in the USA – Author's reply

Sa, 04/05/2019 - 00:00
Tarun Bastiampillai and colleagues stress that proper understanding of an individual's social network could be important for suicide prevention. In support of this statement are several seminal works that highlight the fact that social integration in society, as well as events in the societal environment, such as economic crises and the business cycle, might influence suicide rates, with differences according to gender, age, ethnicity, or other similar factors.1,2

[Correspondence] The MATRIX trial

Sa, 04/05/2019 - 00:00
Marco Valgimigli and colleagues (Aug 25, 2018, p 835)1 did the largest randomised trial comparing radial versus femoral access for coronary angiography and concluded that radial access could become the default approach in patients with acute coronary syndrome undergoing invasive management. As nephrologists, we would to like add a word of caution.

[Correspondence] The MATRIX trial

Sa, 04/05/2019 - 00:00
Marco Valgimigli and colleagues1 addressed the two most debated issues (anticoagulation and vascular access) in percutaneous coronary intervention and concluded that in patients with acute coronary syndrome, radial access should be the default approach because it decreases net adverse clinical events compared with femoral access.1

[Correspondence] The MATRIX trial – Author's reply

Sa, 04/05/2019 - 00:00
I thank Torsten M Meyer and colleagues for discussing the hypothetical trade-off for radial access between reduced kidney injury1 after coronary catheterisation and the concerns of lower patency rates of the previously instrumented vessel if used as dialysis shunt. Yet, although the early benefits of radial access, including lower mortality, have been shown in large randomised trials and meta-analyses,2 that the radial artery, if used as an access site, might be associated with higher access failure of the dialysis shunt, remains unproven.

[Correspondence] Decriminalisation of recreational cannabis in South Africa

Sa, 04/05/2019 - 00:00
A South African Constitutional Court (ConCourt) ruling in September, 2018, upheld and extended the Western Cape High Court judgment, which found the criminalisation of home use and cultivation of cannabis by adults, as specified in the Drugs Act of 1992 and the Medicines Act of 1965, unconstitutional.1 Deputy Chief Justice Zondo stated that it will not be a criminal offence for an adult to use or be in possession of cannabis in a private place, although the amount a person can be in possession of will need to be decided by parliament.