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[Comment] Using data to improve care: childhood cancer in China

Sa, 24/09/2022 - 00:00
The last decades have seen substantial improvements in childhood cancer treatment, with cure rates of more than 80%.1 Although these statistics represent hope for families, they are only relevant to those treated in high-income countries. Cure rates are far lower in low-income and middle-income countries (LMICs), where more than 80% of children with cancer reside.2 This survival gap is one of the starkest inequalities in global child health. In this context, Xin Ni and colleagues3 established childhood cancer incidence rates across China by leveraging new health services databases that approach population-level coverage, including national hospital-based childhood cancer registries coordinated by the National Center for Pediatric Cancer Surveillance.

[Comment] Global Influenza Surveillance and Response System: 70 years of responding to the expected and preparing for the unexpected

Sa, 24/09/2022 - 00:00
When a cluster of respiratory viral infections occurs, early recognition by clinicians linked to a global network is essential for rapid identification of the causal pathogen and subsequent risk assessment and public health response. Crucial to this process are sentinel physician and hospital networks where samples are collected from patients with febrile respiratory infections; trained laboratory staff to identify the causative pathogen; and epidemiologists and public health staff to collect data and evaluate pathogen spread and disease severity in susceptible populations.

[Comment] Offline: The scramble for science

Sa, 24/09/2022 - 00:00
Almost every day I receive an email from an academic publisher of scientific journals (not The Lancet's publisher, Elsevier, I might add) inviting me to contribute to one of their open access titles. The promises are extravagant. Becoming a guest editor of a special collection of at least ten gold open access papers will advance my career and demonstrate my leadership; make a meaningful impact; give me invaluable editorial and organisational experience; and grow my research networks. All the publisher asks is that I identify potential contributors in advance.

[World Report] Volker Türk appointed top UN human rights chief

Sa, 24/09/2022 - 00:00
The global health and humanitarian communities have high expectations of the new UN High Commissioner for Human Rights. John Zarocostas reports from Geneva.

[World Report] Health organisations call for non-proliferation of fossil fuels

Sa, 24/09/2022 - 00:00
WHO and others have signed a letter urging governments to make a legally binding treaty to end the expansion of fossil fuel production and use. Sharmila Devi reports.

[World Report] War driving cholera in Syria

Sa, 24/09/2022 - 00:00
Conflict has damaged water treatment plants and caused hygiene and sanitation to deteriorate.Sharmila Devi reports.

[World Report] Uncertainty over the future of Sri Lankan health care

Sa, 24/09/2022 - 00:00
An economic crisis is hampering the provision of care for many Sri Lankans. Talha Burki reports.

[Perspectives] Digitising brain age

Sa, 24/09/2022 - 00:00
Chronological age can differ from biological age, particularly in Alzheimer's disease (AD) and related neurodegenerative disorders. By training models with structural and functional brain imaging data obtained serially over time, deep learning artificial intelligence can estimate the brain age gap—the difference between chronological age and predicted age.

[Perspectives] Peter Waiswa: building better health systems in Africa and beyond

Sa, 24/09/2022 - 00:00
Growing up in Iganga, a rural town in Uganda, Peter Waiswa was influenced by his late father, who instilled a love for education in him, and by the newborn deaths he saw in his large family. Waiswa now leads the Makerere University Centre of Excellence for Maternal, Newborn and Child Health in Kampala, Uganda, and the INDEPTH Network's Maternal, Newborn and Child Health Working Group. His work involves paving the way locally, nationally, and globally to develop health systems and health policy in maternal, newborn, and child health, development, and health services.

[Perspectives] Medicine's dark night

Sa, 24/09/2022 - 00:00
In 2016, a British junior doctor, scarcely 6 months out of medical school, left her hospital midway through a shift and then vanished. 25-year-old Rose Polge had not yet completed her first year of medicine when she placed a suicide note in the glove compartment of her car, walked into the sea, and drowned. Hours earlier, she had asked her boyfriend if he would still love her if she left medicine.

[Obituary] Daniel Graymore

Sa, 24/09/2022 - 00:00
Health diplomat who helped guide UK health and development funding strategy. Born on March 10, 1973 in Woking, UK, he died on May 29, 2022 in Geneva, Switzerland, aged 52 years.

[Correspondence] Characterising adults in Scotland who are not vaccinated against COVID-19

Sa, 24/09/2022 - 00:00
By Aug 10, 2022, 3 497 208 of the estimated 4·4 million adults living in Scotland had received three doses of a COVID-19 vaccine. However, a proportion of the adult population remains unvaccinated (defined as no record of any vaccine being administered) and susceptible to severe COVID-19 outcomes. Characterising this population can help to understand gaps in vaccine coverage and determinants of vaccine hesitancy and could support targeted public health messaging. Unlike the vaccinated population, on whom information is gathered at the point of vaccination, current estimates of the unvaccinated population are calculated using general practitioner (GP) records.

[Correspondence] Maintenance antipsychotic trials and the effect of withdrawal

Sa, 24/09/2022 - 00:00
Johannes Schneider-Thoma and colleagues1 report the results of a systematic review and network meta-analysis of antipsychotics for the maintenance treatment of adults with schizophrenia, but did not consider the effect of withdrawal-related effects when interpreting their results. They included 49 trials with a placebo group, of which we were able to access information on participants and design for 47 trials (appendix). Of those 47 trials, all used a discontinuation design, most involving people who had been taking antipsychotics for many years, and 43 trials described or implied abrupt cessation of antipsychotic treatment upon assignment to placebo, although the trial with the longest taper period stopped antipsychotics over 4–6 weeks.

[Correspondence] Maintenance antipsychotic trials and the effect of withdrawal – Authors' reply

Sa, 24/09/2022 - 00:00
We thank Klaus Munkholm and colleagues for their valuable Correspondence. First, we would like to mention that this Correspondence does not call into question the main results of our network meta-analysis1 about differences between antipsychotics, for which placebo primarily served as a reference intervention and for which sensitivity and meta-regression analyses on tapering did not yield different results.

[Articles] Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study

Sa, 24/09/2022 - 00:00
Our study showed that the burden of cancer in children and adolescents in China is much higher than previously nationally reported from 2000 to 2015. The distribution of the accessibility of health services, as a social determinant of health, might have a notable role in the socioeconomic inequalities in cancer incidence among Chinese children and adolescents. With regards to achieving the Sustainable Development Goals, policy approaches should prioritise increasing the accessibility of health services for early diagnosis to improve outcomes and subsequently reduce disease burdens, as well as narrowing the socioeconomic inequalities of childhood and adolescent cancer.

[Clinical Picture] Chilling to the marrow: finding extramedullary haematopoiesis in an unusual location behind the xiphoid

Sa, 24/09/2022 - 00:00
An 80-year-old man with a 1-week history of a red, swollen, and painful right leg presented to our emergency department. Additionally, he had reported long-term fatigue. A deep vein thrombosis was excluded after an ultrasound of his leg and he was found to have an infected ulcer caused by chronic venous insufficiency and an iron deficiency anaemia. The patient was referred to our clinic for further exploration of his anaemia and painful leg.

[Comment] Point-of-care HIV diagnosis for infants: the outcomes we need to achieve

Sa, 17/09/2022 - 00:00
Caring for infants and young children living with HIV remains a reality for many families. Despite decades of work leading to a substantial reduction in vertical transmission rates, the stark reality of poor and often late access to HIV diagnosis and subsequent antiretroviral therapy (ART) remains an issue. This is especially true in the African region, where 90% of all HIV-exposed infants reside.1 150 000 children aged 0–9 years acquire HIV globally each year, but less than two-thirds access early infant testing services.

[Comment] Linzagolix: an oral gonadotropin-releasing hormone receptor antagonist treatment for uterine fibroid-associated heavy menstrual bleeding

Sa, 17/09/2022 - 00:00
Gonadotropin-releasing hormone receptor antagonists, as selective gonadotropin-releasing hormone receptor blockers, reduce the release of follicle-stimulating hormone and luteinising hormone from the pituitary, resulting in anovulation and amenorrhea in a dose-dependent manner.1 The suppression of gonadotropin-releasing hormone receptor presents several potential therapeutic options for hormone-dependent disorders, such as endometriosis, uterine fibroids, prostatic hyperplasia, or prostate cancer.

[Comment] Biological therapy for young children with atopic dermatitis

Sa, 17/09/2022 - 00:00
Atopic dermatitis is a common inflammatory skin disease that might lead to severe and persistent disease during infancy. Atopic dermatitis is associated with poor school performance, psychiatric disease, and allergic comorbidities.1–3 If atopic dermatitis is inadequately controlled with emollient use and topical anti-inflammatory therapies, systemic medications including ciclosporin, azathioprine, and methotrexate can be used to treat children with moderate-to-severe disease. However, systemic therapies are rarely used in children because the natural disease course often leads to spontaneous improvement, and because their use requires continuous blood monitoring and is associated with tolerance issues and modest efficacy.

[Comment] The impact of war on the environment and health: implications for readiness, response, and recovery in Ukraine

Sa, 17/09/2022 - 00:00
Since the Russian invasion began on Feb 24, 2022, Ukraine has suffered a dramatic escalation of a humanitarian, health, and environmental emergency, spurring the most rapid forced population movement within Europe since World War 2.1–3 By Aug 10, 2022, there had been 12 867 civilian casualties in Ukraine, including 5401 deaths; more than 6 million people had registered as refugees in Europe alone; and an estimated 6·6 million people had been internally displaced.4 The war has devastated much of Ukraine's infrastructure, disrupting essential services in many parts of the country.