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 [Editorial] Orban not delivering health for Hungary  |
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| Viktor Orban's re-election to a third consecutive term in Hungary offers a preview for western countries of what the health consequences could be for governments that value populism and economic strength over the health of their people. The controversial populist was swept back into power by a wave of support, with a manifesto that included a crackdown on liberal non-governmental organisations. Orban said before the election that his opponents will face ?moral, political, and legal revenge?, in the aftermath. |
| [Editorial] Sexual harassment and abuse?the sinister underbelly |
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| This week, The Lancet, publishes a Special Report on allegations of sexual harassment and abuse at UNAIDS. The report suggests that UNAIDS has at best marginalised and at worst buried allegations of sexual harassment. Its responses have been unduly weak and unacceptable, and the announcements of remediation are too little too late. Furthermore, internal loyalty to the existing leadership seems to trump integrity in the organisation, and has contributed to a culture devoid of transparency and accountability. |
| [Editorial] UK COPD treatment: failing to progress |
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| Chronic obstructive pulmonary disease (COPD) is a major cause of mortality in the world today. More than a million British people lived with diagnosed COPD in the UK in 2014?15, or just under 2% of the population. COPD admissions to emergency services in the UK are on the rise, but, access to treatments shown to reduce patients' time spent in hospital is still woefully inadequate. |
| [Comment] Insecticide-resistant malaria vectors must be tackled |
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| Vector control with long-lasting insecticidal nets and indoor residual spraying accounts for most of the 1·3 billion fewer malaria cases and 6·8 million fewer malaria-related deaths attributable to declining transmission between 2000 and 2015.1?3 However, because resistance to pyrethroid insecticides has spread through African malaria vector populations, concerns over maintaining these gains have been widely voiced?but these are frequently disputed.4 The findings presented by Natacha Protopopoff and colleagues5 in The Lancet provide rigorous, long overdue, new evidence for those working in the field of malaria vector control. |
| [Comment] A snapshot of surgical outcomes and needs in Africa |
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| It is estimated that two-thirds of the world's population do not have access to safe, affordable, and timely surgical care.1 Around 16·9 million people die from conditions that require surgical care each year, most of them in low-income and middle-income countries (LMICs).2 In 2014, Jim Kim, President of the World Bank, challenged the global community to address this injustice, and to develop targets to measure progress on effective coverage of surgical interventions.3 In response, the global surgery community developed a set of core surgical indicators that measure timely access, provider density, operative volume, surgical safety, and financial effects. |
| [Comment] Macrolide resistance in yaws |
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| The study by Oriol Mitjā and colleagues in The Lancet1 shows that a single round of mass administration of azithromycin is insufficient to achieve yaws eradication. It also represents the first report of a mutation in both 23S rRNA genes of the yaws-causing spirochaete, Treponema pallidum subspecies pertenue (T p pertenue), causing macrolide resistance in five epidemiologically linked patients. The mutation, A2059G, was previously reported in a patient with syphilis (caused by T p pallidum) with spiramycin treatment failure;2 it is one of two macrolide-resistant mutations previously detected in T p pallidum (the other is A2058G). |
| [Comment] The Lancet Commission on malaria eradication |
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| 20 years ago, infectious diseases dominated the global health agenda. Policy makers, researchers, implementers, and donors united in the fight against infectious diseases, creating the Millennium Development Goals, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Gavi, the Vaccine Alliance, the US President's Emergency Plan For AIDS Relief (PEPFAR), the Roll Back Malaria Partnership, the Multilateral Initiative on Malaria (MIM),1 and more. Tremendous progress was made. Malaria benefited spectacularly and there has been a 47% reduction in global deaths from the disease since 2000. |
| [Comment] Social lobbying: a call to arms for public health |
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| The term lobbying derives from the public lobbies of the UK Houses of Parliament in London, where concerned citizens have gathered since at least the 16th century to speak with elected officials on the sidelines of legislative debates. In today's parlance, lobbying has evolved to represent a more pernicious and systematic approach to influencing lawmakers, occurring much deeper within the corridors of power. |
| [Comment] Offline: The legacy and lessons of May '68 |
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| Doctors have only cared for the world, in various ways; the point, however, is to change it. Imagine you are a distinguished Professor of Medicine, the Rector of one of your country's most garlanded universities. Your students are angry. They have seen fellow students at a nearby university rebel against atrociously poor conditions?overcrowding, incompetent curriculum reforms, and feelings of utter alienation. Tensions are palpable. The air is chilled by the threat of violence. What would you do? Let us not judge. |
| [Perspectives] Winnie Mpanju-Shumbusho: leader in the fight against malaria |
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| ?The malaria fight is at a crossroads. If we don't seize the moment now, our hard-won gains against the disease will be lost,? says Winnie Mpanju-Shumbusho. ?After a decade of progress, malaria cases have increased for the first time, and funding for malaria treatments and prevention has plateaued?especially in Africa which carries more than 90% of the disease burden and progress has stalled over the past few years. We need a new movement to mobilise the political will and resources, as well as citizen action, towards effective malaria control and elimination.? As Board Chair of the RBM Partnership to End Malaria, she is in the forefront of global efforts to mobilise the necessary political will and resources to ensure the fight against malaria is renewed with vigour. |
| [Perspectives] Water and our planet |
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| From worryingly low precipitation in California to acute water shortages in Cape Town, climate change is exacerbating natural variations in weather patterns. Problems of water use and security are apparent worldwide and underpin Edward Burtynsky: Water Matters, an exhibition at Arup's offices in London's Fitzrovia. Canadian photographer and film maker Burtynsky has been photographing our environment for over 30 years, documenting the industrially ravaged earth in the process. He turned his attention to water in 2009, releasing the critically acclaimed film Watermark with Jennifer Baichwal in 2013. |
| [Perspectives] Stories of shame |
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| The American physician and writer, Danielle Ofri, tells the story of a near fatal mistake that she made at the beginning of the second year of her residency. A patient was brought to the emergency room in a diabetic coma, and although her initial management was fine, Ofri then made an error and ?proceeded to nearly kill?[the] patient?. Recognising her predicament, she called for senior assistance. When an explanation was demanded of her performance, Ofri's words dried up. Humiliation set in as she was questioned in front of her intern: ?I could almost feel myself dying away on the spot. |
| [Obituary] Dame Beulah Rosemary Bewley |
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| Public health physician and champion of women in medicine. She was born in Derry, UK, on Sept 2, 1929, and died with heart disease and dementia in London, UK, on Jan 20, 2018, aged 88 years. |
| [Correspondence] Surgical surveillance in resource-poor settings |
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| We congratulate the African Surgical Outcomes Study team, led by investigators from low-income and middle-income countries, for quantifying the scale of global inequality in surgical care, and for providing measurable goals for future improvement efforts (April 21, p 1589).1 This work also highlights the poor availability of the detailed information necessary to translate these inequalities into potential solutions.2,3 Continuous surveillance systems or registries could provide such information but are notoriously challenging; disparate paper-based systems, inadequate resources, and overburdened staff are seemingly insurmountable problems. |
| [Correspondence] Healthier lives for all Africans |
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| In their Commission, Irene Agyepong and colleagues (Dec 23, 2017, p 2803)1 provide a comprehensive report on the pathway to healthier lives for all Africans by 2030. As highlighted in the Commission, we have been involved in training family physicians in Africa for the past 20 years within the framework of the Primary Care and Family Medicine Education (Primafamed) network, a South?South cooperation that brings together family medicine, primary care, and public health in more than 20 African countries. |
| [Correspondence] The hepatitis B epidemic in China should receive more attention |
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| China's childhood hepatitis B virus (HBV) vaccination programme is a great public health success, resulting in a prevalence of HBsAg of only 1% in children under 5 years. However, the burden of HBV infection in China is still the highest in the world, with one third of the world's 240 million people with chronic HBV living in China.1 Nevertheless, most people with HBV infection in China are unaware that they carry the disease, making HBV infection a truly silent epidemic.2 |
| [Correspondence] Mesh augmentation for midline abdominal closure |
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| In the 2-year follow-up of the PRIMA (PRImary Mesh closure of Abdominal midline wounds) trial (Aug 5, 2017, p 567),1 prophylactic onlay mesh augmentation for midline abdominal closure significantly reduced the risk of incisional hernia, with similar risks of surgical site infection compared with primary closure. Consequently, An Jairam and colleagues1 conclude that onlay mesh augmentation has the potential to become the standard treatment for patients at high risk of incisional hernia. |
| [Correspondence] Prophylactic repair to prevent midline incisional hernia |
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| The PRIMA (PRImary Mesh closure of Abdominal midline wounds) trial by An Jairam and colleagues (Aug 5, 2017, p 567),1 provides relevant information on the outcomes of prophylactic repair of midline laparotomies for the prevention of incisional hernia. The trial shows significant reduction in the incidence of incisional hernia with onlay and sublay mesh reinforcement compared with primary suture only repair in patients with abdominal aortic aneurysm, but not in patients with a body mass index (BMI) greater than 27 kg/m2, contrary to the claim made by the authors of the PRIMA trial (ie, superior outcome of onlay mesh repair in patients with BMI greater than 27 kg/m2). |
| [Correspondence] Prophylactic mesh augmentation in midline laparotomy |
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| The conclusions of the PRIMA (PRImary Mesh closure of Abdominal midline wounds) trial1 (Aug 5, 2017, p 567) need to be taken with caution for several reasons. The rate of 18% of incisional hernia in patients receiving prophylactic sublay mesh implantation is very high compared with frequencies below 5% in many other reports.2,3 Furthermore, most series report a lower recurrence rate after sublay than onlay mesh implantation in the repair of incisional hernia.4,5 Therefore, the technical problems or insufficient training with the sublay group does not allow the conclusion that onlay mesh reinforcement has the potential to become the standard treatment for high-risk patients having elective midline laparotomy. |
| [Correspondence] Prevention of dementia by targeting risk factors |
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| The report by Gill Livingston and colleagues (Dec 16, 2017 p 2673)1 is a valuable collation of a large body of medical research evidence that aims to combat the dementia epidemic, the greatest global challenge for health and social care in the 21st century. One of the key messages of the Commission is the need to be ambitious in terms of prevention. Using population attributable fractions (PAF), the authors estimate that as much as 35% of dementia cases could be prevented by targeting nine modifiable risk factors. |
| [Correspondence] Prevention of dementia by targeting risk factors |
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| The Lancet Commission (Dec 16, 2017, p 2673)1 on prevention and management of dementia reviews the mounting evidence that hearing loss is a major risk factor for cognitive decline. Crucial information is still absent about the nature of this linkage and what factors might modify the cognitive effect of peripheral hearing loss. Particularly, the potential relevance of central hearing impairment should not be underestimated. As Gill Livingston and colleagues1 acknowledge, on pathophysiological and neuroanatomical grounds, central auditory processing is likely to be susceptible early in the course of Alzheimer's disease and other dementias. |
| [Department of Error] Department of Error |
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| Das P, Horton R. Pollution, health, and the planet: time for decisive action. Lancet 2018; 391: 407?08?In the acknowledgments section of this Comment (published online first on Oct 19, 2017), the Governments of Germany, Norway, and Sweden should have been thanked for their ?funding of the report, input, or both?. This correction has been made to the online version as of April 10, 2018. |
| [Department of Error] Department of Error |
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| The Lancet. Dementia in the UK: preparing the NHS for new treatments. Lancet 2018; 391: 1237? In the second sentence of this Editorial, the cost of dementia to the National Health Service in the UK should have been Ģ26 billion. This correction has been made to the online version as of April 5, 2018. |
| [Department of Error] Department of Error |
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| Cohen AJ, Brauer M, Burnett R, et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet 2017; 389: 1907?18?In this Article (published online first on April 10, 2017), the mathematical form for the IER has been corrected. This correction has been made to the online version as of April 19, 2018. |
| [Department of Error] Department of Error |
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| Chen I, Cooney R, Feachem RGA, Lal A, Mpanju-Shumbusho W. The Lancet Commission on malaria eradication. Lancet 2018; 391: 1556?58?In this Comment (published online first on April 16, 2018), the affiliation for Winnie Mpanju-Shumbusho should be RBM Partnership to End Malaria, and the weblink should be RBM Partnership to End Malaria. These corrections have been made to the online version as of April 19, 2018, and the printed Comment is correct. |
| [Articles] Re-emergence of yaws after single mass azithromycin treatment followed by targeted treatment: a longitudinal study |
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| The implementation of the WHO strategy did not, in the long-term, achieve elimination in a high-endemic community mainly due to the individuals who were absent at the time of mass treatment in whom yaws reactivated; repeated mass treatment might be necessary to eliminate yaws. To our knowledge, this is the first report of the emergence of azithromycin-resistant T p pertenue and spread within one village. Communities' surveillance should be strengthened to detect any possible treatment failure and biological markers of resistance. |
| [Seminar] Malaria |
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| Following unsuccessful eradication attempts there was a resurgence of malaria towards the end of the 20th century. Renewed control efforts using a range of improved tools, such as long-lasting insecticide-treated bednets and artemisinin-based combination therapies, have more than halved the global burden of disease, but it remains high with 445?000 deaths and more than 200 million cases in 2016. Pitfalls in individual patient management are delayed diagnosis and overzealous fluid resuscitation in severe malaria. |
| [Seminar] Multiple sclerosis |
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| Multiple sclerosis continues to be a challenging and disabling condition but there is now greater understanding of the underlying genetic and environmental factors that drive the condition, including low vitamin D levels, cigarette smoking, and obesity. Early and accurate diagnosis is crucial and is supported by diagnostic criteria, incorporating imaging and spinal fluid abnormalities for those presenting with a clinically isolated syndrome. Importantly, there is an extensive therapeutic armamentarium, both oral and by infusion, for those with the relapsing remitting form of the disease. |
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The Lancet 