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[Editorial] A shared future for all: let's talk about homelessness

Sáb, 20/01/2018 - 00:00
The World Economic Forum meeting in Davos is almost upon us again. From Jan 23 to 26, more than 2500 participants from over 100 countries will contemplate the state of the world in over 400 sessions (and many more side events and corridor conversations). This year's theme, Creating a Shared Future in a Fractured World, is certainly an apt motto in today's geopolitical context. The 48th annual meeting “aims to rededicate leaders from all walks of life to developing a shared narrative to improve the state of the world”—lofty goals in a lofty location.

[Editorial] Preparing for seasonal influenza

Sáb, 20/01/2018 - 00:00
During the current northern hemisphere's winter, seasonal influenza activity has become worrisome. According to the US Centers for Disease Control and Prevention (CDC), influenza activity is affecting the entire continental USA for the first time in 13 years and this year's season might well be severe. In the UK, in the first week of 2018, GP consultation rates for influenza rose 78%, and influenza-confirmed hospitalisations increased by 50% from the previous week, according to Public Health England.

[Editorial] The peril and promise of traffic

Sáb, 20/01/2018 - 00:00
Just after the new year, a bus in Peru plunged off a winding cliffside road following a collision, leading to over 50 deaths. The road lacked guardrails or other safety equipment. The incident dramatically underscores the conclusions from a World Bank Group report published last week, The High Toll of Traffic Injuries. Addressing the burden of road traffic injuries (RTIs) will not only save lives but can greatly increase the social welfare of people in low and middle income countries (LMICs).

[Comment] The Lancet–CAMS Health Summit 2018: a call for abstracts

Sáb, 20/01/2018 - 00:00
The Lancet and the Chinese Academy of Medical Sciences (CAMS) have held three successful health summits in 2015–17 in Beijing, China. We continue to support China's health science research communities and invite abstract submissions from China for the 2018 The Lancet–CAMS Health Summit, to be held on Oct 27–28 in Beijing. Submissions are invited from all aspects of health science, including, but not limited to: translational medicine; clinical medicine; public health; global health; health policy; the environment and ecological systems; primary care; maternal, newborn, child, and adolescent health, health professionalism; and medical education.

[Comment] A time to remember and thank The Lancet's reviewers of 2017

Sáb, 20/01/2018 - 00:00
Charles Dickens's A Christmas Carol provides an excellent opportunity to recalibrate what is important in life. An edgy adaptation by David Edgar is being performed by the Royal Shakespeare Company at Stratford-upon-Avon, UK, until February, 2018. The production emphasises that the social inequalities Dickens and his contemporary, Thomas Wakley—founder of The Lancet—railed at, remain uncomfortably present today. By contrast to the exploitative commercial and criminal relationships portrayed in this story, is the timeless theme of relationships that sustain, nurture, and redeem.

[Comment] Offline: The misuse of universal health coverage

Sáb, 20/01/2018 - 00:00
Health workers are taught to see their purpose as imbued with special human importance. Possessed with the values of knowledge, judgment, respect, responsibility, integrity, compassion, altruism, excellence, continuous improvement, and partnership, medicine is often said to be endowed with particularly moral attributes. This vocational foundation gives ethical momentum to the case for universal health coverage, the big idea of the Sustainable Development Goals. The creation of national health services, we doctors may suggest, are critical humanitarian milestones in the histories of nations.

[World Report] Changes in the US tax system will also affect health care

Sáb, 20/01/2018 - 00:00
The tax overhaul pushed by Republicans could jeopardise the ACA's health insurance marketplaces. Susan Jaffe, The Lancet's Washington correspondent, reports.

[World Report] Bolivia backtracks on malpractice law

Sáb, 20/01/2018 - 00:00
In the midst of a health-care reform, a malpractice law put forward by the government has triggered strikes from the medical community. Amy Booth reports from Cochabamba.

[World Report] Universal health coverage law approved in Egypt

Sáb, 20/01/2018 - 00:00
A universal health coverage law expanding access to health care in Egypt was approved by parliament, ahead of presidential elections. Sharmila Devi reports.

[Perspectives] Type 1 diabetes

Sáb, 20/01/2018 - 00:00
Writing in 1649, the English herbalist Nicholas Culpeper despaired of his patients with diabetes: their “continual pissinge” was resistant to all treatment, and their deaths were rapid and certain. No longer: type 1 diabetes is a striking example of the transformation of the meaning of a diagnosis by application of clinical research. Its history reflects the trajectory of medicine away from heroic interventions and towards long-term treatment, from cure to care.

[Perspectives] Encounters with Indian medicine

Sáb, 20/01/2018 - 00:00
In 1911, an Indian-born medical doctor called Paira Mall was recruited by Henry Wellcome's Historical Medical Museum in London, UK. Overseen by its curator, C J S Thompson, Mall was sent to collect objects from the south Asian subcontinent; artifacts that would capture the art and science of healing throughout the ages, as well as medicinal plants for Wellcome's chemical research labs in the UK. Mall was well travelled, having served as an army surgeon in the Russo–Japanese War. A linguist and an expert in Asian cultures, he was by then fluent in German, French, Italian, Sanskrit, Persian, Hindi, Punjabi, and Arabic (as well as in English).

[Perspectives] Health care as a cultural borderland

Sáb, 20/01/2018 - 00:00
As a clinician, how do you best care for patients from a wide variety of backgrounds? Cultural diversity is not merely a matter of pluralism or multiculturalism; it is often accompanied by unequal or inadequate health care. Very often, cultural diversity and health disparity go hand in hand. As a response to such inequities, various forms of cultural competence training are now viewed as an essential curriculum component in medical education programmes and a key element of effective practice. However, these educational innovations have also come under fire.

[Perspectives] Peter Robert Mason

Sáb, 20/01/2018 - 00:00
Clinical microbiologist with a commitment to Zimbabwe. Born in Aldridge, UK, on July 9, 1948, he died of prostate cancer in Amsterdam, the Netherlands, on Sept 28, 2017, aged 69 years.

[Correspondence] A new era for medical education in Colombia

Sáb, 20/01/2018 - 00:00
During Nov 1–3, 2017, most of the Deans of Medicine who belong to the Colombian Association of Faculties of Medicine (ASCOFAME)—a nationwide network of higher education institutions or universities with medical faculties—met in Monteria, Colombia. Their objective was to develop a consensus on medical education.1

[Correspondence] A public health approach to opioid addiction in North America

Sáb, 20/01/2018 - 00:00
Keith Humphreys' Comment in The Lancet (July 29, 2017, p 437)1 describes the main drivers of the opioid crisis in the USA and advocates for global restriction of prescription opioids as an effective public health response to addressing the overdose epidemic. We argue that although the dominant narrative about the opioid crisis circulating around careless prescribing and unscrupulous pharmaceutical companies has some merit, it does not tell the whole story of the epidemic of opioid addiction in North America because it occurs among medical and non-medical opioid users.

[Correspondence] A public health approach to opioid addiction in North America – Author's reply

Sáb, 20/01/2018 - 00:00
I agree with Mohammad Karamouzian and Thomas Kerr that “restricting access to prescription opioids for opioid-naive populations should be included in the primary strategies” in response to the epidemic of opioid overdose and addiction, as discussed in my Comment.1 Karamouzian and Kerr are also correct to note that people currently taking opioids will require different clinical and policy strategies. For example, some people with chronic pain conditions will need to remain on their medication indefinitely because the net costs and benefits of doing so are favourable.

[Correspondence] The definition of acute kidney injury

Sáb, 20/01/2018 - 00:00
We read with interest the Comment in The Lancet by Jon Barasch and colleagues (Feb 25, 2017, p 779)1 with its controversial title “Acute kidney injury: a problem of definition”. We appreciate the opportunity to clarify what is written in the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline on acute kidney injury (AKI),2 in the hope that clinicians will read beyond the headlines. The guideline clearly states that AKI is a clinical diagnosis and stresses the importance of clinical judgment: “While the definitions and classification system discussed in Chapter 2.1 provide a framework for the clinical diagnosis of AKI, they should not be interpreted to replace or to exclude clinical judgment”.

[Correspondence] The definition of acute kidney injury – Authors' reply

Sáb, 20/01/2018 - 00:00
We thank John A Kellum and Norbert Lameire for their letter in response to our Comment.1 An acute increase in serum creatinine (sCr) is caused by direct injury to kidney cells (ie, pathophysiological processes resulting from ischaemia, sepsis, medications, metals, or enzymes) or a compromise in cardiovascular homoeostasis (ie, substantial volume depletion,2 congestive heart failure,3 or portal hypertension4). Hence, we appreciate that an acute rise in sCr can indicate several pathophysiological processes with worsened patient population outcomes.

[Editorial] Children and social media

Sáb, 13/01/2018 - 00:00
Social media is an increasingly common and integral part of people's lives, including those of children, despite a minimum access age of 13 years for some platforms. The reach of social media has outpaced research into potential benefits and harms for younger users. To address this gap, the Children's Commissioner for England, Anne Longfield, published Life in ‘likes’ on Jan 4, to explore the social media experience of children aged 8–12 years.

[Editorial] A new vaccine for typhoid control

Sáb, 13/01/2018 - 00:00
Last week, WHO announced prequalification of the first conjugate vaccine to prevent typhoid (Typbar TCV, manufactured by Bharat Biotech, India) after the publication of randomised controlled trials, including that by Celina Jin and colleagues in The Lancet on Sept 28, 2017. WHO has decided that Typbar TCV was successfully assessed for quality, safety, and efficacy, and it is now approved for distribution by UN agencies. Already in use in India and Nepal in babies older than 6 months, the vaccine is to be licensed for use in infants younger than 2 years.

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