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[Comment] Financing sustainable health systems for the next decade

Ve, 05/11/2021 - 00:30
In The Lancet, Gloria Ikilezi and colleagues1 estimated annual spending on immunisation by governments, households, and donors for 135 low-income and middle-income countries (LMICs) between 2000 and 2017. To do so, the authors collated financial data from a variety of sources, including National Health Accounts, vaccine-specific financial reporting and budgeting, and donor records, and used financial modelling to reconcile inconsistencies and gaps in the data, reporting outcomes in standardised cost categories.

[Articles] Estimating total spending by source of funding on routine and supplementary immunisation activities in low-income and middle-income countries, 2000–17: a financial modelling study

Ve, 05/11/2021 - 00:30
These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030.

[Comment] Cervical cancers avoided by HPV immunisation

Gi, 04/11/2021 - 00:30
In 2020, WHO launched a global strategy to accelerate the elimination of cervical cancer as a public health problem,1 one of the most common causes of cancer deaths in women globally. While recognising that the burden of disease is carried by low-income countries, WHO did not avoid setting challenging targets. Where there are no existing cancer control measures, WHO believes the priority should be human papillomavirus (HPV) immunisation of girls to prevent future cervical cancers and other HPV-related malignancies.

[Articles] The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study

Gi, 04/11/2021 - 00:30
We observed a substantial reduction in cervical cancer and incidence of CIN3 in young women after the introduction of the HPV immunisation programme in England, especially in individuals who were offered the vaccine at age 12–13 years. The HPV immunisation programme has successfully almost eliminated cervical cancer in women born since Sept 1, 1995.

[Comment] Geriatric assessment in older patients with cancer: a new standard of care

Gi, 04/11/2021 - 00:30
Advanced cancer mostly affects older adults, and the dilemma of how to best treat older patients with cancer led to the emergence of geriatric oncology over 25 years ago. Early studies showed the heterogeneity in the older population and highlighted that frailty is insufficiently captured in a standard oncological work-up.1 Adopting geriatric assessment—a multidimensional assessment of health status across somatic, functional, and psychosocial domains, which is routinely used in geriatric medicine—led to studies consistently showing an association between geriatric impairments, frailty, and various adverse outcomes, including complications, toxic effects, and mortality across various cancer and treatment types.

[Articles] Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study

Gi, 04/11/2021 - 00:30
A geriatric assessment intervention for older patients with advanced cancer reduced serious toxic effects from cancer treatment. Geriatric assessment with management should be integrated into the clinical care of older patients with advanced cancer and ageing-related conditions.

[Correspondence] Restoring biodiversity and slowing climate change are crucial to protect health

Gi, 04/11/2021 - 00:30
Lukoye Atwoli and colleagues1 deliver a compelling call to address interacting global crises and to improve equity. Crucially, they link biodiversity loss with health and clearly warn that the Earth system is now too close to multiple tipping points, beyond which lie “catastrophic, runaway environmental change”.2 However, we think there is risk that the part of Atwoli and colleagues’ Comment concerned with future food security could give rise to pessimism.

[Comment] Reconsidering upstream approaches to improving population health

Ma, 02/11/2021 - 00:30
Racial and socioeconomic disparities in health outcomes have been well documented.1,2 Although overall global rates of poor birth outcomes have decreased, decades of research and interventions have not eliminated disparities. However, much intervention research has focused on individual-level risk factors and groups at high risk. In The Lancet, Jennifer Jardine and colleagues3 report on population attributable fractions, which indicate the proportion of a particular outcome that would be removed if a risk factor did not exist or was more similar to a reference population.

[Articles] Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study

Ma, 02/11/2021 - 00:30
Our results indicate that socioeconomic and ethnic inequalities were responsible for a substantial proportion of stillbirths, preterm births, and births with FGR in England. The largest inequalities were seen in Black and South Asian women in the most socioeconomically deprived quintile. Prevention should target the entire population as well as specific minority ethnic groups at high risk of adverse pregnancy outcomes, to address risk factors and wider determinants of health.

[Comment] Boosters appear effective, but are they always needed?

Ve, 29/10/2021 - 23:30
High efficacy rates of the mRNA vaccines against symptomatic COVID-19, reported from clinical trials, kindled hope that they would prevent all infections caused by SARS-CoV-2. Currently approved vaccines provide high levels of protection against serious illness, but do not confer mucosal immunity to resist entry of the virus into the respiratory tract. When mostly mild breakthrough infections were reported from different countries,1–3 concern arose that individuals with a fast fading immune response to the standard vaccination schedule might experience serious illness if infected.

[Articles] Effectiveness of a third dose of the BNT162b2 mRNA COVID-19 vaccine for preventing severe outcomes in Israel: an observational study

Ve, 29/10/2021 - 23:30
Our findings suggest that a third dose of the BNT162b2 mRNA vaccine is effective in protecting individuals against severe COVID-19-related outcomes, compared with receiving only two doses at least 5 months ago.

[Comment] Rising and falling prevalence of asthma symptoms

Ve, 29/10/2021 - 23:00
Asthma is the leading chronic disease in children, affecting 5·1 million children in the USA.1 However, worldwide important variations have been reported in asthma prevalence. In The Lancet, Innes Asher and colleagues report findings from the Global Asthma Network (GAN), assessing global changes in asthma prevalence over the past three decades, with use of similar, standardised methods as the International Study of Asthma and Allergies in Childhood (ISAAC).2 Using centres that completed GAN Phase I and ISAAC Phase I (1993–95), ISAAC Phase III (2001–03), or both, the authors assessed the global prevalence and the 10-yearly change in prevalence of current wheeze, severe asthma symptoms, asthma ever, exercise wheeze, and night cough (defined by four core questions in a questionnaire).

[Comment] Apical sodium-dependent bile acid transporter inhibition in children with Alagille syndrome

Ve, 29/10/2021 - 23:00
In The Lancet, Emmanuel Gonzales and colleagues1 present the findings of the phase 2 placebo-controlled, randomised withdrawal period, open-label, extension ICONIC study of the apical sodium-dependent bile acid transporter (ASBT) inhibitor, maralixibat, in paediatric patients with Alagille syndrome. Alagille syndrome is a cholestatic liver disease that leads to pruritus, xanthomas, and impaired quality of life. Surgical interventions to interrupt the enterohepatic bile acid circulation or liver transplantation are often pursued2,3 because there are no approved medical therapies.

[Comment] Inequities in adolescent and young adult deaths

Ve, 29/10/2021 - 23:00
On the heels of hard-won gains in infant and child survival in most parts of the world, we now have the largest generation of adolescents in human history. This shows the importance of realising the potential for young people to participate in shaping the future and contribute to communities they are part of. This potential, however, will not be fulfilled by merely being alive. We must consider the opportunities and threats that influence the wellbeing and agency of young people at this crucial stage of human development.

[Comment] Offline: Living in an Age of Indecency

Ve, 29/10/2021 - 23:00
Political leaders will declare COP26 a success—an important staging post, although not UK Prime Minister Boris Johnson's promised “turning point for humanity”, on the way to decarbonising the planet's energy use. Historians will most likely look back and judge COP26 in Glasgow, UK, as a graveyard of opportunities. To be fair, the target set for COP26 was narrowly drawn—to keep alive the 2015 Paris Agreement. That landmark agreement committed nations to “holding the increase in the global average temperature to well below 2°C above pre-industrial levels and pursuing efforts to limit the temperature increase to 1·5°C above pre-industrial levels”.

[World Report] Nicaraguan health-care workers under attack

Ve, 29/10/2021 - 23:00
Doctors report being targeted by the Government of Daniel Ortega. Joe Parkin Daniels reports.

[World Report] Pleas for health funding for Yemen

Ve, 29/10/2021 - 23:00
10 000 children have been killed or maimed in the Yemen War, and health needs are not being met. John Zarocostas reports.

[World Report] Further setbacks for Ethiopia humanitarian missions

Ve, 29/10/2021 - 23:00
5·2 million people need assistance in Tigray, but the national Government is hampering the response. Sharmila Devi reports.

[Perspectives] Stephani Hatch: rethinking power in health-care research

Ve, 29/10/2021 - 23:00
Stephani Hatch was raised in Atlanta, GA, by parents who had lived through racial segregation in the US public school system. Her parents, Hatch says, “sacrificed quite a lot for us to get a quality education. Like many during the 1980s, I was bussed to majority white schools for most of my education, to make sure I went to schools with resources because US school resources are often linked to a neighbourhood's wealth. It wasn’t lost on us as children the challenges we faced as a family. I am Black American, raised in the south in Atlanta and I think particularly in terms of exposure to racism and discrimination, there is a life course narrative very much entrenched in social context.

[Perspectives] A story of sisterhood

Ve, 29/10/2021 - 23:00
“It was now clear to us that my sister, at the age of forty-five, had died in a prominent London hospital from an unknown illness”. Consumed: A Sister's Story is a poignant memoir by Arifa Akbar, journalist and theatre critic, written to try and understand the circumstances that led to the death of her elder sister Fauzia from tuberculosis, a treatable disease, in 2016. The diagnosis had eluded her medical team until after Fauzia had suffered a catastrophic intracerebral bleed. As Akbar writes, “she had been as unlucky in death as in life”.