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Chinese public health officials and international collaborators are responding to an outbreak of a novel strain of influenza that is spreading across the country. Ted Alcorn reports.
Kenya has some dire health indicators and criticisms of government-run health services abound. Can the country's new president turn things around? Andrew Green reports.
On a hot spring afternoon in Dhaka, Bangladesh, an autorickshaw buzzes down the driveway to the hospital at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). A family emerges from the three-wheeled buggy, including a man wrapped in a blanket despite the heat. He is so weak that his relatives must prop him up as he stumbles to the hospital's entrance.
The failure of the international community to address the crisis in Syria threatens health systems in neighbouring nations, warn public health doctors Adam Coutts, Fouad M Fouad, and Rajaie Batniji.
Histories of drug use are often disguised forms of policy advocacy. Their authors use history to subvert current policies by arguing for a return to an earlier golden age when use of the drug in question was legal and seemingly trouble-free. These accounts often fail minimum standards of historical scholarship by making selective and uncritical use of secondary sources to support a preconceived policy position. Much rarer are dispassionate scholarly histories that document the messy process that produces policies by critically analysing primary sources, oral histories, and syntheses of previous scholarly work.
Naomi Wolf's Vagina: A New Biography opens with the author's experiences of a waning intensity of orgasm, and subsequent operation on her pelvic nerve. Wolf then explores how this nerve might affect not just orgasm but a wider sense of wellbeing and creativity. Ranging over scientific research, literary texts, and healing therapies, Wolf argues that sexually intimidating behaviour towards women, as well as bad sex, inhibit the chemicals (she singles out dopamine) that trigger pleasure and relaxation, profoundly affecting the complex neurogenital network that is our sexual apparatus.
China was excluded from the 39 countries with a very high human development index analysed by Hannah Chang and colleagues (Jan 19, p 223) for the potential effect of five preventive interventions for preterm births. China has previously been ranked the second highest country for incidence of preterm births, with 1·5 million annually. To fill in the missing information on China, we selectively analysed birth and intervention data from two maternal and children's hospitals in China. The first, in relatively less developed central China, is a provincial tertiary hospital (P).
Figure 3A in Hannah Chang and colleagues' comprehensive report shows the preterm birth rates (PBR) per 100 livebirths for 39 countries with very high human development index. Greece has been put in 28th place with a PBR of 6·6. According to official data from the Hellenic statistical authority (EL.STAT) for preterm births in Greece (1999–2010), the 2010 PBR in Greece is 11·18 per 100 livebirths: 12 831 livebirths at less than 37 weeks of gestation per 114 766 total livebirths. This rate is almost double Chang and colleagues' estimate and puts Greece in fifth place.
The quantification of factors contributing to the problem of preterm birth reported by Hannah Chang and colleagues finds that half the change in the USA is unexplained, but that non-medically indicated caesarean delivery and assisted reproductive technologies are important drivers.
[Correspondence] Preterm births in countries with a very high human development index – Authors' reply
Our analysis was restricted to the 39 countries with very high human development indices, mainly owing to lack of comparable trend data. We had hoped that this analysis would stimulate improved data and action for prevention and care in countries that could not be included, and are delighted to hear of this in China. Importantly, Zhan Zhang and colleagues highlight the need for implementation of preventive strategies, given the high burden of preterm birth, with an estimated national average of 7·1% and 1·2 million preterm babies every year, and increasingly high incidence of caesarean delivery, yet low use of interventions (eg, cervical cerclage and progesterone).
Improvement of paediatric emergency care is crucial to reduce child mortality. However, we see no need for new international guidelines when existing WHO guidelines meet many of the requirements Mark Ralston and colleagues propose (Jan 19, p 256).
We note your Review calling for the development of advanced paediatric life-support management in resource-poor countries. Many additional lives can be saved by the immediate implementation of some inexpensive treatments, but the provision of a universal effective emergency care system (as developed countries have found) is difficult.
We thank Louisa Pollock and colleagues and David Southall and colleagues for their thoughtful comments, and particularly for highlighting current efforts to improve paediatric emergency and critical care in limited-resource settings.
Tony Kirby and Michelle Thornber-Dunwell (Jan 12, p 101) highlight a “perfect storm” for HIV and hepatitis C transmission in high-risk drug practices in men who have sex with men (MSM). As part of an ongoing investigation of the continuing shigellosis epidemic in MSM in the UK, we did in-depth interviews that explored the lifestyle and sexual behaviour of 12 MSM diagnosed with Shigella flexneri serotype 3a.
In their report on the consequences of high-risk drug practices on the London gay scene, Tony Kirby and Michelle Thornber-Dunwell quote UK Health Protection Agency (HPA) data for incidence of HIV and hepatitis C virus (HCV) co-infection in men who have sex with men (MSM), which show a decrease from 7·38 per 1000 person-years in 2008 to 1·46 per 1000 person-years in 2011. However, as Kirby and Thornber-Dunwell also note, these figures could be a substantial underestimate and might even be increasing.
Your Jan 5 Editorial (p 1) argues for bringing polio eradication back on track in Pakistan through ensuring security for immunisation workers, going beyond the “polio only” agenda, and integration of polio vaccination into routine health and immunisation programmes. This viewpoint and other analyses have rightly highlighted the worsening security conditions and increasing inaccessibility to vaccination in Pakistan as the root cause of failure in polio eradication. Recent efforts by WHO also focused on significantly boosting the number of polio eradication officers at national, provincial, and district levels.
Harms from drugs could greatly increase costs to health-care delivery in countries. Yet pharmacovigilance systems that measure and monitor the harms from drugs remain underdeveloped in developing countries owing to contrasting priorities.
Cross Disorder Group of the Psychiatric Genomics Consortium. Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. Lancet 2013;381: 1371–79—In this Article (published online Feb 28), the Manhattan plot in figure 1 on page 3 has been corrected and replaced. This correction does not change any of the main results of the paper, including those for top signals presented in the text and in table 1. In the third paragraph of the Discussion section, reference 17 was cited in error.