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[Editorial] Closing the gender pay gap: when and how?

Sáb, 14/04/2018 - 00:00
The most recent estimates by the World Economic Forum indicate that the global economic gender gap will take 217 years to close, and that this gap widened in 2017. That pay inequality is pervasive in the UK is therefore unsurprising. The UK median gender pay gap—the difference in average hourly earnings between men and women—is 18%. To address this disparity, the UK became the first country to mandate individual employers to release their gender pay gap data. All public and private sector employers with at least 250 employees had to report by April 4, 2018.

[Editorial] The General Medical Council has lost its way

Sáb, 14/04/2018 - 00:00
On March 28, the tragic case of Jack Adcock—a 6-year-old boy with Down's syndrome who died of sepsis in Leicester Royal Infirmary in 2011—and Dr Hadiza Bawa-Garba took another turn. Bawa-Garba, the paediatric trainee convicted of gross negligence manslaughter by a jury in 2015, was given permission to appeal a January High Court ruling to permanently strike her off the medical register. The General Medical Council (GMC), the UK's licensing body for doctors, had successfully appealed its own but independent Medical Practitioners Tribunal Service's decision from last July to suspend the doctor for 12 months but not revoke her licence.

[Editorial] South Africa sliding backwards

Sáb, 14/04/2018 - 00:00
After nearly two decades of progress following the abolishment of apartheid, South Africa's societal gains are now deteriorating. These are the conclusions of a report published on March 28 by The World Bank that analysed the country's progress in reducing poverty and inequality from 1994 to 2015. While overall the country's poverty levels have fallen since 1994, at least 2·5 million more South Africans since then have become poor. Over half the population lives under the poverty line, many of whom are black or South Africans of mixed race.

[Comment] Thresholds for safer alcohol use might need lowering

Sáb, 14/04/2018 - 00:00
Guidelines for levels of alcohol use that pose a low risk to drinkers' health are provided by many countries, usually based on meta-analyses of epidemiological studies.1–3 However, to devise such guidelines is challenging because alcohol is linked to poor health in various and complex ways. Injury, suicide, and assault, for example, are associated with drinking to intoxication, whereas regular alcohol consumption increases the risks of liver cirrhosis, gastrointestinal diseases, cardiovascular disease, dementia, and some types of cancer.

[Comment] The social sciences, humanities, and health

Sáb, 14/04/2018 - 00:00
Humanities and social sciences have had many positive influences on health experiences, care, and expenditure. These include on self-management for diabetes, provision of psychological therapy, handwashing, hospital checklists, the Scottish Government's stroke guidelines, England's tobacco control strategy, the response to the Ebola outbreak in west Africa and Zika virus in Brazil, and many more.1 Researchers have shown time and time again the political, practical, economic, and civic value of education and research in disciplines like anthropology, history, and philosophy.

[Comment] Offline: “A sea of suffering”

Sáb, 14/04/2018 - 00:00
How did it happen that palliative care lost the dignity debate? Palliative care is a discipline dedicated to improving quality of life by preventing and alleviating suffering. There can be few higher callings in medicine. Yet those who advocate “dignity in dying” have successfully claimed that the idea of dignity lies not in palliative care but in assisted dying for the terminally ill. A large majority of the public seems to agree. Those in favour of assisted dying have portrayed palliative care as somehow antithetical to patient autonomy.

[World Report] Ireland to vote on a referendum to repeal the Eighth

Sáb, 14/04/2018 - 00:00
Ireland has set a date for a referendum that could be decisive in women's access to abortion. Anita Makri reports on the arguments on both sides of the debate.

[World Report] Mediators help migrants access health services in Italy

Sáb, 14/04/2018 - 00:00
Cultural mediators can help migrants, asylum seekers, and refugees to face what can seem an insurmountable wall of cultural difference. Amanda Sperber reports from Polistena.

[World Report] Charles Perkins Centre

Sáb, 14/04/2018 - 00:00
Obesity and the diseases that are related to it are at the core field of Sydney's Charles Perkins Centre, led by a man whose first area of research was locust behaviour. Stephen Simpson says his own varied background shows why this research body is different.

[Perspectives] Syphilis

Sáb, 14/04/2018 - 00:00
For early modern physicians syphilis was “the great imitator”, a disease that mystified with the sheer range of its symptoms and the length of time it might take to show itself. Syphilis was first recorded in Europe in the mid-1490s, and the coincidence with Christopher Columbus' first voyage to the New World led contemporary physicians (along with more recent archaeologists and historians) to conclude that his sailors had brought the disease back with them.

[Perspectives] The teenage brain: under construction

Sáb, 14/04/2018 - 00:00
There have been times when I've said that if I ended up meeting my teenage self, due to some bizarre time-travel mishap, I'd probably end up trying to strangle the arrogant, bungling, self-absorbed waste of space that he was. I've heard other people echo similar sentiments. It's weird how so many think so little of their adolescent selves, from their older, more mature perspective. How can we change so much and yet remain the same person? And why were we like that, consumed with all the neuroses and priorities that as adolescents were so vital but now just seem ridiculous, or baffling, or even a little sad?

[Perspectives] Guo-Qiang Chen: haematologist who risked all for research success

Sáb, 14/04/2018 - 00:00
If determination is a predictor of future achievements in medical research, the likelihood that Professor Guo-Qiang Chen would have a flourishing career should have become apparent when he was still a very junior doctor. To leave the provincial medical school to which he was then contracted and relocate himself to a distant and more research-oriented institution, he had to find the money to take on a major debt. It was, as he himself admits, “a gamble”. Now, some 25 years later, Chen is a member of the Chinese Academy of Sciences, Chancellor of Shanghai Jiao Tong University School of Medicine, and Director of its Laboratory of Cell Differentiation and Apoptosis.

[Perspectives] Do doctors die better than philosophers?

Sáb, 14/04/2018 - 00:00
Death has become quite modish, and being constantly aware of one's mortality is now regarded as an essential component of spiritual and psychological health. My book The Way We Die Now was published in 2016, and since then I have given many talks and written several articles on the subject of death. I am often asked whether all of this talking and writing about death has prepared me any better for my own demise.

[Obituary] Robert Day

Sáb, 14/04/2018 - 00:00
Public health expert who directed the US Fred Hutchinson Cancer Research Center. Born in Framingham, MA, USA, on Oct 22, 1930, he died from lung cancer on Jan 6, 2018, in Seattle, WA, USA, aged 87 years.

[Correspondence] Protecting health care in armed conflict: action towards accountability

Sáb, 14/04/2018 - 00:00
Driven by a deplorable trend of unlawful attacks on health-care facilities and workers in armed conflicts throughout the world, on May 3, 2016, the UN Security Council (UNSC) adopted Resolution 2286 calling for an end to such attacks.1 The Secretary-General followed with recommendations of concrete measures for implementation.2 However, unlawful attacks on health care have continued or intensified in many conflicts, notably in Syria. We, academic institutions, civil society, and co-sponsoring Member States, convened a side event during the 72nd UN General Assembly to focus global attention on this issue and the imperative that Resolution 2286 be implemented.

[Correspondence] Post-trial responsibilities beyond post-trial access

Sáb, 14/04/2018 - 00:00
What happens at the end of a trial when a patient responds to an investigational medication and benefits considerably? Many people believe that this patient should continue to receive the beneficial drug. This belief underlies the idea of post-trial access—providing investigational interventions post-trial to participants who benefited from them—and was formally introduced by the Declaration of Helsinki in 2000. But even if this patient did not benefit from the investigational medication, doing nothing for them at the end of the trial seems ethically problematic.

[Correspondence] mHealth and the legacy of John Snow

Sáb, 14/04/2018 - 00:00
On Jan 14, 2018, during a tense final touchdown in a US National Football League playoff game, numerous Apple Watch users received an alert from their device telling them that they were having potentially harmful arrhythmias.1 Smartphones and wearable technology are increasingly used as public health tools because billions of people worldwide are digital users. In 2020, more than 6 billion people will have smartphone subscriptions.2 Clinicians and researchers can use these devices to effortlessly monitor patients' health and behaviour indicators in real time.

[Correspondence] Beware the medicalisation of loneliness

Sáb, 14/04/2018 - 00:00
Loneliness was recently described in The Lancet as a public health problem that needs to be solved by the medical community (Feb 3, p 426).1 We believe that the medicalisation of loneliness in this way is damaging, especially at a time when the issue is making its way into public understanding.

[Correspondence] Mapping and understanding exclusion

Sáb, 14/04/2018 - 00:00
On behalf of Mental Health Europe I would like to respond to the Lancet's Editorial (Jan 27, p 282)1 written about our Mapping and Understanding Exclusion report.2 Although we welcome the coverage of our report, we were disappointed to see a reference to the need to uphold the status quo on coercive measures, which might lead to confusion regarding the conclusions of our report. The Lancet's Editorial stated that: “Involuntary treatment and detention are a necessary part of mental health care”.1 This statement is contrary to the core message in our report, which recommended that to reduce coercion in mental health services European states should adopt policies and practices that aim to immediately reduce coercion in mental health services and ultimately make such practices by exception only, in line with human rights standards.

[Correspondence] Compulsory admissions in Greece: multifaceted action is required

Sáb, 14/04/2018 - 00:00
It was with great concern that we read the Editorial in The Lancet (Jan 27, p 282)1 regarding institutional and coercive mental health treatment in Europe, in which Greece was among the countries with substantial shortfalls in mental health services and violations of patients' human rights.

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