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[Editorial] Abortion bans in the USA harm health equity

Ve, 22/10/2021 - 23:00
On Sept 1, the state of Texas enacted Senate Bill 8S (SB8S), banning all abortions once a fetal heartbeat is detected—at as early as 6 weeks of gestation and before most women know they are pregnant—effectively making abortion illegal in the state. In response, the US Justice Department filed a brief with the US Supreme Court against SB8S, stating that the ban unconstitutionally violates citizens’ rights and wrongly deputises citizens across the USA to notify authorities of anyone aiding or abetting such abortions, thereby rewarding vigilantism (and providing a US$10 000 cash award).

[Comment] Mirtazapine for agitation in dementia: moving forward

Ve, 22/10/2021 - 23:00
Alzheimer's disease is a progressive and fatal neurodegenerative disorder with a worldwide prevalence estimated at 25–37 million.1 Although Alzheimer's disease is clinically characterised by cognitive impairments and functional deficits, agitation is a particularly common symptom2 and associated with excess disability, increased institutionalisation, and diminished quality of life.3 There is an urgent and unmet need for efficacious treatments for agitation. Over the past decade, efforts have included trials using citalopram,4 dextromethorphan,5 brexpiprazole,6 and nabilone.

[Comment] Offline: Lessons from the heart of the storm

Ve, 22/10/2021 - 23:00
“I recall that someone even advanced the hypothesis that the twenty-first century might be 'our last century’.” That someone, cited by the Italian historian Aldo Schiavone in his new book What is Progress, was Martin Rees, a former President of the UK's Royal Society. Schiavone doesn't anticipate apocalypse, but he does foresee dangers, even disasters, ahead. He argues that the course of human history is shaped entirely by scientific and technological progress. The outcomes—discontinuous, contingent, and often fractured—depend on a balance between the power of those scientific and technological forces and our ability to exert reason and control over them.

[World Report] Health at COP26

Ve, 22/10/2021 - 23:00
World leaders will soon gather in Glasgow for the much hyped climate change conference. Talha Burki looks at the health agenda.

[World Report] Vaccine shortages prompt changes to COVAX strategy

Ve, 22/10/2021 - 23:00
COVAX, the global COVID-19 vaccine procurement hub, has changed how it allocates vaccines. Ann Danaiya Usher reports.

[World Report] African Medicines Agency to be established

Ve, 22/10/2021 - 23:00
Experts are hopeful that a new continent-wide agency will strengthen regulation, improve access to medicines, and boost manufacturing. Munyaradzi Makoni reports.

[Perspectives] Making visible medicine's roots in colonialism

Ve, 22/10/2021 - 23:00
Inflammation is a way that the body responds to damage or a threat. It involves various systems working through complex signalling and feedback mechanisms. The inflammatory response can take many forms—acute or chronic, localised or systemic—but its underlying purpose is to repair damage and recover the body's usual state. Yet this system of healing comes with the potential for injury. As physician Rupa Marya and author, film-maker, and academic Raj Patel observe in Inflamed: Deep Medicine and the Anatomy of Injustice, “When the damage keeps coming, the repair cannot fully happen, leaving the inflammatory response running.

[Perspectives] Kofoworola Abeni Pratt: professionalising nursing in Nigeria

Ve, 22/10/2021 - 23:00
Kofoworola Abeni Pratt (known as Rola) was the first qualified Black nurse to practise in the UK's National Health Service (NHS). She then helped to transform nursing standards and training in her home country of Nigeria as it emerged from British colonial rule. Like Florence Nightingale, whom she cited as an inspiration, she devoted herself to nursing even though her family regarded the profession as menial and unsuitable for a woman from her privileged background.

[Perspectives] COVID-19 and the rebiologisation of racial difference

Ve, 22/10/2021 - 23:00
In the first months of the COVID-19 pandemic, early dashboards set up by the US Centers for Disease Control and Prevention and the Johns Hopkins University Center for Systems Science and Engineering tracked overall numbers of cases and deaths but provided no demographic breakdown of these statistics. Current data show wide racial disparities in the burden of COVID-19 in the USA, with Latino, Indigenous, and Black people disproportionately affected. Similar disparities are also evident in other nations with histories of structural racism.

[Correspondence] Antibiotic treatment duration for bacteraemic pneumonia

Ve, 22/10/2021 - 23:00
Aurélien Dinh and colleagues1 suggest that antibiotics can safely be discontinued after 3 days in patients who are admitted to hospital with moderately severe community-acquired pneumonia and meet the clinical stability criteria.

[Correspondence] Antibiotic treatment duration for bacteraemic pneumonia

Ve, 22/10/2021 - 23:00
Aurélien Dinh and colleagues1 have shown that among the patients admitted to hospital with community-acquired pneumonia who met the clinical stability criteria, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of therapy. However, we want to draw attention to notable diagnostic considerations before these findings are more broadly applied.

[Correspondence] Antibiotic treatment duration for bacteraemic pneumonia – Author's reply

Ve, 22/10/2021 - 23:00
On behalf of the Pneumonia Short Treatment investigators, I thank Guillaume Butler-Laporte and colleagues for their interest in the Pneumonia Short Treatment trial.1 The subgroup analysis of patients with microbiological diagnosis showed no significant difference in outcome at day 15 in the intention-to-treat and per-protocol analyses (table). Moreover, two of three patients with streptococcal bacteraemia given treatment for 3 days recovered without additional antibiotic treatment. That outcome supports the fact that bacteraemia is not a prognostic factor, and that the treatment duration should be based solely on the source of infection and clinical response.

[Department of Error] Department of Error

Ve, 22/10/2021 - 23:00
Lowres N, Freedman B. Population screening for atrial fibrillation to prevent stroke. Lancet 2021; 398: 1463–65—In this Comment, owing to an editorial error, the name of the STROKESTOP study was incorrect throughout. This correction has been made to the online version as of Oct 21, 2021, and the printed version is correct.

[Department of Error] Department of Error

Ve, 22/10/2021 - 23:00
Svendsen JH, Diederichsen SZ, H⊘jberg S, et al. Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial. Lancet 2021; 398: 1507–16—In this Article, in the eighth paragraph of the Results, the second sentence should have said “The second sensitivity analysis, further censoring participants at premature discontinuation of ILR monitoring without outcome, atrial fibrillation, or death, identified 307 instances of the primary outcome with an HR of 0·75 (0·56–1·00; p=0·047)”.

[Articles] Study of mirtazapine for agitated behaviours in dementia (SYMBAD): a randomised, double-blind, placebo-controlled trial

Ve, 22/10/2021 - 23:00
This trial found no benefit of mirtazapine compared with placebo, and we observed a potentially higher mortality with use of mirtazapine. The data from this study do not support using mirtazapine as a treatment for agitation in dementia.

[Clinical Picture] Conservative treatment of perforated diverticulitis: following the latest guidelines pays dividends

Ve, 22/10/2021 - 23:00
A 58-year-old woman presented to our hospital with a 10-h history of acute lower abdominal pain, nausea, and vomiting. The patient was otherwise healthy with no significant medical history.

[Seminar] Borderline personality disorder

Ve, 22/10/2021 - 23:00
Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded by or co-develops with symptoms of internalising disorders (depression and anxiety), externalising disorders (conduct problems, hyperactivity, and substance use), or both.

[Correspondence] Fertility rates and birth outcomes after ChAdOx1 nCoV-19 (AZD1222) vaccination

Gi, 21/10/2021 - 23:30
Fears of adverse effects of COVID-19 vaccination on fertility have affected vaccine uptake in some communities. Despite the absence of supporting evidence for such a risk, low biological plausibility, and preliminary data supporting the safety of mRNA vaccines in pregnancy,1–3 this claim has become widespread, and it has been challenged by WHO.4 Vaccine hesitancy during pregnancy, or among women of childbearing age, could have substantial public health consequences because infection with SARS-CoV-2 during pregnancy is a risk factor for severe maternal illness and complications.

[Editorial] The climate emergency: a last chance to act?

Me, 20/10/2021 - 23:30
The annual Lancet Countdown on health and climate change, published today, precedes the global convening of political leaders at the UN Framework Convention on Climate Change 26th Conference of the Parties (COP26) in Glasgow, UK, from Oct 31 to Nov 12. The world is watching COP26—widely perceived as the last and best opportunity to reset the path to global net zero carbon emissions by 2050—and public interest in climate change is higher than ever, in part due to global youth activism and engagement.

[Review] The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future

Me, 20/10/2021 - 23:30
The Lancet Countdown is an international collaboration that independently monitors the health consequences of a changing climate. Publishing updated, new, and improved indicators each year, the Lancet Countdown represents the consensus of leading researchers from 43 academic institutions and UN agencies. The 44 indicators of this report expose an unabated rise in the health impacts of climate change and the current health consequences of the delayed and inconsistent response of countries around the globe—providing a clear imperative for accelerated action that puts the health of people and planet above all else.