The Lancet

Condividi contenuti
The Lancet RSS feed.
Aggiornato: 5 ore 57 min fa

[Comment] Bridging the evidence gap to achieve a healthy, net zero future

Lu, 18/10/2021 - 23:30
The urgent challenge of achieving net zero carbon emissions by 2050 at the latest presents an opportunity to drive transformative changes in all sectors of society. Well designed actions to cut greenhouse gas (GHG) emissions could bring major benefits for health, by both reducing the health risks of climate change and delivering multiple benefits to human health and development (co-benefits).1,2 Modelling studies estimate that many millions of premature deaths could be prevented and GHG emissions greatly reduced by phasing out fossil fuels, thereby reducing air pollution,3 and by encouraging active travel, increasing use of public transport, and shifting to sustainable and healthy diets.

[Comment] Surpassing insulin glargine in type 2 diabetes with tirzepatide

Lu, 18/10/2021 - 23:30
In this centennial year of the isolation and purification of insulin by Banting and colleagues,1 insulin remains a mainstay of treatment for diabetes, being efficacious and cost-effective in controlling glycaemia in people with type 2 diabetes who are poorly controlled on maximal or near-maximal doses of oral hypoglycaemics. The basal analogue insulin glargine is often used as the first-choice injectable for this group, using the algorithm pioneered in the 2003 Treat-to-Target Trial (TTT),2 with progressive titration of insulin doses dependent on measurements of fasting glucose.

[Articles] Tirzepatide versus insulin glargine in type 2 diabetes and increased cardiovascular risk (SURPASS-4): a randomised, open-label, parallel-group, multicentre, phase 3 trial

Lu, 18/10/2021 - 23:30
In people with type 2 diabetes and elevated cardiovascular risk, tirzepatide, compared with glargine, demonstrated greater and clinically meaningful HbA1c reduction with a lower incidence of hypoglycaemia at week 52. Tirzepatide treatment was not associated with excess cardiovascular risk.

[Editorial] Malaria vaccine approval: a step change for global health

Ve, 15/10/2021 - 23:00
On Oct 6, WHO announced that it will be recommending widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine for children in sub-Saharan Africa and in other regions with moderate-to-high Plasmodium falciparum transmission. Malaria has ravaged people's lives for centuries; today the burden falls disproportionately on children in tropical regions. 229 million cases were recorded in 2019, and 409 000 people lost their lives, two-thirds of whom were younger than 5 years and living in sub-Saharan Africa.

[Comment] Developing COVID-19 vaccine policy in increments

Ve, 15/10/2021 - 23:00
Over the past several months, there has been fierce debate in the public domain as to whether booster vaccinations are needed to sustain vaccine-induced immunological protection against SARS-CoV-2 infection.1 Discussions in medical journals, news outlets, social media, and among the wider public have been robust but limited owing to the paucity of data for the breadth and durability of existing vaccines.

[Comment] Offline: The generation of ghosts

Ve, 15/10/2021 - 23:00
What happened to our ambition for a different, better world? One has to go back to World War 2 to find a time when our species faced a catastrophe on the scale of this COVID-19 pandemic. In the early 1940s, there were some observers of the mounting global chaos who recognised a need to create a new world order. In England, two writers stood out, and their far-reaching visions contrast sharply with the surprising lack of aspiration shown by my generation today.

[World Report] An interview with the Nobel Prize 2021 winners

Ve, 15/10/2021 - 23:00
Talha Burki speaks with Ardem Patapoutian and David Julius, winners of the 2021 Nobel Prize in Physiology or Medicine for their discoveries of the receptors for temperature and touch.

[World Report] Cautious optimism for malaria vaccine roll-out

Ve, 15/10/2021 - 23:00
The approval of a vaccine for malaria is a milestone in global health, but challenges remain. Udani Samarasekera reports.

[World Report] Syria and Iraq facing severe drought

Ve, 15/10/2021 - 23:00
Climate change and conflict are driving a humanitarian emergency that threatens 12 million people. Sharmila Devi reports.

[Perspectives] How imperialism, slavery, and war shaped epidemiology

Ve, 15/10/2021 - 23:00
In recent decades, historians have become increasingly attuned to the ways in which empire and imperialism transformed modern conceptions of disease, medicine, and the body. Such scholarship argues that European medical theories were not simply disseminated in imperial territories and that science and medicine should not only be seen as scientific and cultural projects that consolidated imperialism. Instead, the thrust has been to understand how the development of modern ideas of hygiene, sanitation, public health, and disease were themselves produced out of an encounter with empire and subjugated populations.

[Perspectives] Superhuman, but never enough: Black women in medicine

Ve, 15/10/2021 - 23:00
Historically, Black women have long been disregarded in the USA. The Three-Fifths Compromise of the US Constitution discounted Black women as only “part” of a human being, to be counted for congressional representation and direct taxation but nothing more. Even in prominent social justice movements, Black women have been excluded. Racism and elitism were embedded within the 19th-century and early 20th-century US women's suffrage movement, which prioritised white women over voting rights for all women.

[Obituary] Gino Strada

Ve, 15/10/2021 - 23:00
Surgeon and founder of the non-governmental organisation Emergency. He was born in Sesto San Giovanni, Italy, on April 21, 1948, and died of heart disease in Honfleur, France, on Aug 3, 2021, aged 73 years.

[Correspondence] Telehealth use in antenatal care? Not without women's voices

Ve, 15/10/2021 - 23:00
Kirsten R Palmer and colleagues1 assessed integrated telehealth for antenatal care in Australia during the early COVID-19 pandemic. However, the estimated 50% reduction of in-person consultations does not represent the proportion of telehealth consultations received by women. Women included in the intervention gave birth between March 23 and July 26, 2020, which is equivalent to, at most, 4 months of a telehealth-integrated antenatal care schedule. Although not presented, the average duration of antenatal follow-up was probably 2 weeks (implementation period) and 6 weeks (integrated care period), allowing for a maximum of two telehealth visits with three face-to-face consultations.

[Correspondence] Telehealth use in antenatal care? Not without women's voices – Authors' reply

Ve, 15/10/2021 - 23:00
We thank Anna Galle and colleagues for progressing the conversation about quality and equity in antenatal care. Although our analysis of telehealth integrated care addressed the initial 4 months following widespread telehealth integration and analysed data following birth only,1 this means that women included in the analysis were predominately in the third trimester of pregnancy, a time when most pregnancy complications arise. The fact that women in their final stages of pregnancy received, on average, 40% of consultations via telehealth without an impact on the quality of their pregnancy outcomes remains heartening.

[Clinical Picture] Lumbar sediment sign seen in an unusual presentation of meningitis

Ve, 15/10/2021 - 23:00
A 39-year-old woman was transferred to our neurosurgical service following a fall and development of a progressive quadriparesis over the previous 24 h.

[Review] Management of disease-related malnutrition for patients being treated in hospital

Gi, 14/10/2021 - 23:30
Disease-related malnutrition in adult patients who have been admitted to hospital is a syndrome associated with substantially increased morbidity, disability, short-term and long-term mortality, impaired recovery from illness, and cost of care. There is uncertainty regarding optimal diagnostic criteria, definitions for malnutrition, and how to identify patients who would benefit from nutritional intervention. Malnutrition has become the focus of research aimed at translating current knowledge of its pathophysiology into improved diagnosis and treatment.

[Comment] Forthcoming UK asthma guidelines: an opportunity to improve asthma outcomes

Gi, 14/10/2021 - 23:30
The UK has a strong tradition of providing excellent, evidence-based asthma guidelines,1 and a totally inglorious one of having some of the worst asthma outcomes in the world.2 Addressing these poor outcomes must top the agenda for those taking forward the forthcoming UK National Institute for Health and Care Excellence (NICE), British Thoracic Society (BTS), and Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the diagnosis, monitoring, and management of chronic asthma.3 The challenge for the group developing these guidelines is to think radically, and produce a document that drives real change in outcomes, including mandating sanctions for non-compliance with new clinical practice recommendations.

[Correspondence] An alternative model for health service delivery in Afghanistan

Me, 13/10/2021 - 23:30
Since 2001, Afghanistan has invested two decades and billions of US dollars into reconstructing its health system and bringing the coverage of health service from a meagre 12% to 90% of the population.1 The scope of health services has been defined by the Basic Package of Health Services2 and the Essential Package of Hospital Services,3 the provision of which is highly dependent on donors. By the beginning of 2021, Afghanistan was on its way to expand the content and integrate these two packages in the form of the Integrated Package of Essential Health Services.

[Correspondence] Preventing collapse of the Afghan health service

Lu, 11/10/2021 - 23:30
The public health service for the estimated 39 million Afghan people was, until the Taliban takeover, funded by international donor governments through the Afghanistan Reconstruction Trust Fund. On Aug 26, 2021, the World Bank, which managed the fund, froze its foreign reserves of US$9 billion and the International Monetary Fund and EU have also suspended financing.

[Articles] Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic

Ve, 08/10/2021 - 23:30
This pandemic has created an increased urgency to strengthen mental health systems in most countries. Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option.