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[Obituary] Gwynifer Clare Wenger

Ve, 29/10/2021 - 23:00
Social gerontologist who led longitudinal studies of ageing. She was born in London, UK, on Oct 17, 1936, and died of pancreatic cancer in Rhyl, Wales, UK, on July 20, 2021, aged 84 years.

[Correspondence] Optimising epilepsy care throughout the Afghan refugee crisis

Ve, 29/10/2021 - 23:00
The takeover of Afghanistan by the Taliban in August, 2021, and the associated collapse of governmental institutions has led to innumerable security and humanitarian concerns, particularly for women and girls.1 Even before this event, more than 550 000 Afghans had been internally displaced during 2021.2 At the end of 2020, 3 million Afghans were internally displaced, and 2·6 million Afghan people were recognised as refugees or asylum seekers; most of them hosted in neighbouring Pakistan and Iran.

[Correspondence] Reinforcing security through prohibition of nuclear weapons

Ve, 29/10/2021 - 23:00
The Nuclear Weapons Group of Medact, the UK affiliate of the International Physicians for the Prevention of Nuclear War, commends the Editors1 for drawing attention to the first meeting of states parties to the Treaty on the Prohibition of Nuclear Weapons, which will be held in January, 2022. Publications in The Lancet have previously referred to the controversial but important public health issue of nuclear war.2,3

[Correspondence] When suspicion replaces evidence in public health

Ve, 29/10/2021 - 23:00
The UK Government's decision not to recognise people as vaccinated if they received COVID-19 vaccines in most of Latin America, Africa, and south Asia received widespread condemnation.1 Many commentators have rightly called out this discriminatory policy, which unfairly targets people from low-income countries. However, as a group of scholars from the medical humanities and social sciences, we are particularly concerned that the way in which the government makes decisions about which countries are exempt from quarantine once fully vaccinated dispenses with evidence-based policy making.

[Correspondence] Unclear conclusions on SARS-CoV-2 elimination versus mitigation

Ve, 29/10/2021 - 23:00
I read with great interest Miquel Oliu-Barton and colleagues’ Comment1 on the health outcomes of elimination versus mitigation strategies against SARS-CoV-2. I would be interested to know more about the categorisation of countries into these two strategies. Five countries (all of which were islands or peninsulas) were categorised as opting for elimination, whereas 32 countries (most of which bordered other countries) were categorised as opting for mitigation. Where do these categories come from? Were they explicitly stated in the policy documents of these countries? The other data sources are explicit, but this source is unclear despite being central to the analyses.

[Correspondence] Unclear conclusions on SARS-CoV-2 elimination versus mitigation – Authors' reply

Ve, 29/10/2021 - 23:00
We thank Christian Gold for his interest and thoughtful Correspondence. Country strategies to control SARS-CoV-2 vary across many parameters but can be crudely grouped into countries that aim for elimination (ie, maximum action to control SARS-CoV-2 and stop community transmission as quickly as possible) or mitigation (ie, action increased in a stepwise, targeted way to reduce cases so as not to overwhelm health-care systems).1 Our classification is based on a qualitative analysis of policy documents, communication by government officials and advisers (eg, through press releases or other public communication), and lockdown dates and their severity with respect to case and mortality reports.

[Correspondence] The World Health Network: a global citizens' initiative

Ve, 29/10/2021 - 23:00
The COVID-19 pandemic has cost more than 4 million lives, left millions of people with persistent symptoms (ie, long COVID), and has devastated societies, with already disadvantaged communities being hit hardest. The tragedy is that much of this harm was preventable, as shown early on by many Asia-Pacific countries that pursued elimination of COVID-19 and protected both their public health and economies.1–3 The rest of the world can still work towards elimination. The World Health Network (WHN) is a coalition of citizens and experts who are committed to global action to protect public health through progressive elimination of COVID-19.

[Articles] Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study

Ve, 29/10/2021 - 23:00
Trends in prevalence and severity of asthma symptoms over the past three decades varied by age group, country income, region, and centre. The high worldwide burden of severe asthma symptoms would be mitigated by enabling access to effective therapies for asthma.

[Articles] Efficacy and safety of maralixibat treatment in patients with Alagille syndrome and cholestatic pruritus (ICONIC): a randomised phase 2 study

Ve, 29/10/2021 - 23:00
In children with Alagille syndrome, maralixibat is, to our knowledge, the first agent to show durable and clinically meaningful improvements in cholestasis. Maralixibat might represent a new treatment paradigm for chronic cholestasis in Alagille syndrome.

[Articles] Global, regional, and national mortality among young people aged 10–24 years, 1950–2019: a systematic analysis for the Global Burden of Disease Study 2019

Ve, 29/10/2021 - 23:00
Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10–24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group.

[Clinical Picture] Pituitary apoplexy, but not as we thought: a xanthogranuloma rather than an adenoma

Ve, 29/10/2021 - 23:00
A 37-year-old man presented to our emergency room with a sudden onset of partial loss of vision and diplopia while driving home 2 h earlier. The patient was previously fit and well and had no medical history.

[Correspondence] Characteristics and risk of COVID-19-related death in fully vaccinated people in Scotland

Gi, 28/10/2021 - 23:30
Vaccines are highly effective in preventing COVID-19 hospitalisations and deaths.1,2 COVID-19-related deaths in fully vaccinated individuals have, however, been reported. To inform public health strategy and vaccination policy, it is vital to characterise these post-vaccination COVID-19 fatalities.

[Comment] Nowcasting towards sustainable SARS-CoV-2 endemicity

Me, 27/10/2021 - 23:30
Unlike vetting pharmaceuticals, for which there are well defined requirements of laboratory investigations and animal studies followed by clinical trials, public health policies are much less routinely pretested by table-top simulations or pilot runs. This divergence in evidentiary burden between drugs and policies is particularly jarring because policies almost always affect entire populations, whereas the target patients for pharmaceuticals are usually a small subset of the population. The gravity of this paradox is especially acute during the exigency of a pandemic.

[Articles] Non-pharmaceutical interventions, vaccination, and the SARS-CoV-2 delta variant in England: a mathematical modelling study

Me, 27/10/2021 - 23:30
Our findings show that the risk of a large wave of COVID-19 hospital admissions resulting from lifting NPIs can be substantially mitigated if the timing of NPI relaxation is carefully balanced against vaccination coverage. However, with the delta variant, it might not be possible to fully lift NPIs without a third wave of hospital admissions and deaths, even if vaccination coverage is high. Variants of concern, their transmissibility, vaccine uptake, and vaccine effectiveness must be carefully monitored as countries relax pandemic control measures.

[Articles] Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial

Lu, 25/10/2021 - 23:30
This trial did not show benefit from 2% alcoholic chlorhexidine skin preparation compared with povidone–iodine, or with triclosan-coated sutures compared with non-coated sutures, in preventing SSI in clean-contaminated or contaminated or dirty surgical wounds. Both interventions are more expensive than alternatives, and these findings do not support recommendations for routine use.

[Comment] Prevention of surgical site infection in low-resource settings

Lu, 25/10/2021 - 23:30
WHO defines universal health coverage (UHC) as “access to needed essential health services, without financial hardship”.1 UHC requires about US$100 per head for an essential package of 218 interventions, and approximately $50 per head for a basic package of 108 of the highest priority interventions.2 Yet, estimates in 2016 suggested that only nine of the 49 low-income and middle-income countries (LMICs) could afford the essential package, and that 16 countries could afford the 108 highest priority interventions of the basic package.

[Editorial] Can digital technologies improve health?

Do, 24/10/2021 - 23:30
If you have followed the news on digital technology and health in recent months, you will have read of a blockbuster fraud trial centred on a dubious blood-testing device, a controversial partnership between a telehealth company and a data analytics company, a social media company promising action to curb the spread of vaccine misinformation, and another addressing its role in the deteriorating mental health of young women. For proponents and critics alike, these stories encapsulate the health impact of many digital technologies, and the uncertain and often unsubstantiated position of digital technologies for health.

[Comment] The future of health governance needs youth voices at the forefront

Do, 24/10/2021 - 23:30
Today's children and young people are growing up in a time of radical digital transformation, rapidly changing information ecosystems, widespread integration of digital technologies, and other social, political, and environmental shifts. By 2030, almost 40% (3·3 billion) of the world's population will be younger than 25 years.1 As the most active users of digital technology and digital media, this generation stands to gain—or lose—the most from the digital transformations in all domains, including health.

[Perspectives] Anurag Agrawal: harnessing digital technologies for better health

Do, 24/10/2021 - 23:30
Growing up in a family of scientists, Anurag Agrawal recalls that research was a frequent topic of conversation in his youth. But it was the launch of the first IBM computer in 1981, when he was 9 years old, that “left a lasting impression and instilled a personal lifelong interest in computation”, he says. Now a physician, researcher, and the Director of the CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB) in New Delhi, India, he has brought these passions together in his role as a Co-Chair of the Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world.

[The Lancet Commissions] The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world

Do, 24/10/2021 - 23:30
From the short-term and long-term effects of the COVID-19 pandemic to the health insecurities brought about by climate change, health futures are unfolding in an era of accelerating economic, societal, technological, and environmental changes. Digital transformations, which we define as the multifaceted processes of integration of digital technologies and platforms into all areas of life, including health, are central to understanding—and shaping—many of these disruptive dynamics. Because large gaps remain in the current evidence base on the interface of digital technologies and health, taking a precautionary, mission-oriented, and value-based approach to its governance is crucial.