The Lancet RSS Feed: current issue. The Lancet is a weekly medical journal, renowned for the publication of high-quality peer-reviewed research from around the world. It provides context and insight to advancements in medicine and health worldwide.
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[Viewpoint] Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11
Mental disorders specifically associated with stress are exceptional in needing external events to have caused psychiatric symptoms for a diagnosis to be made. The specialty of stress-associated disorders is characterised by lively debates, including about the extent to which human suffering should be medicalised, and the purported overuse of the diagnosis of post-traumatic stress disorder (PTSD). Most common mental disorders are potentiated or exacerbated by stress and childhood adversity. Clinicians might inadvertently gravitate towards diagnoses of disorders specifically associated with stress whenever a significant stressor can be identified, because this approach provides a way to understand the person's experience of symptoms, as a function of external events, that is more likely to be acceptable to the person.
On July 1, 2012, a 47-year-old man sustained a crush injury of the left hand and was admitted to the Hand Emergency Unit, Conception Hospital, Marseille Public Hospitals, Marseille, France, with a large palmar skin defect. Emergency reconstruction of the palmar wound was done with a radial forearm flap. From day 2 to day 6 after surgery, ten leeches were applied to the flap to treat venous congestion, and oral ciprofloxacin prophylaxis (1 g per day) was given. On day 6, the patient developed a body temperature of 37·8°C.
The American Lung Association has released a report assessing levels of air pollution across the USA in 2009–11. Overall air quality has improved in the past decade, but more than 42% of Americans still live in cities in which pollution reaches dangerously high concentrations. Merced, CA, and Bakersfield, CA, had the highest levels of year-round particle pollution.
Today's Lancet and Lancet Respiratory Medicine feature a Series on tobacco control ahead of the 2013 American Thoracic Society conference in Philadelphia, PA, USA, on May 17–22. Worldwide, tobacco use kills about 6 million people per year, and most of the deaths are in Asia. In WHO's South East Asian region, an estimated 1·3 million people die every year from tobacco-related disease, whereas in the Western Pacific region, two people die every minute. All these premature deaths are preventable.
“It can't go on like this” is a common response to a desperate situation: yet too often it can, and it does. Such is the case with the US Department of Defense's detention facilities at the Guantanamo Bay naval base in Cuba. In 2009, US President Barack Obama signed an Executive Order “to effect the appropriate disposition of individuals currently detained…and promptly to close detention facilities”. 4 years on, the facilities—and an estimated 166 detainees—remain. At the time of going to press, it has been reported that 100 detainees are on hunger strike, and about 40 extra medical staff have arrived.
In just over three decades, AIDS has exacted a severe toll on human health and drawn inspiring responses from patients, researchers, and doctors. HIV infection is, consequently, less an incurable disease of specific population groups and more a chronic but manageable illness, at least in high-income countries. Major challenges remain, however.
In their Series paper on tobacco control, Corinne Husten and Lawrence Deyton describe the regulatory activities of the US Food and Drug Administration (FDA) in relation to the 2009 Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act). They express optimism that the Tobacco Control Act will contribute to the eradication of morbidity and mortality caused by tobacco in the USA.
[Comment] Linking child survival and child development for health, equity, and sustainable development
Considerable progress has been made over the past decade towards Millennium Development Goal 4. The number of deaths among children younger than 5 years has declined from 12 million in 1990 to 6·9 million in 2011. But do the surviving children have an equal chance to realise their human potential, achieve social justice, and contribute to sustainable development? The global community has an obligation to ensure that all children develop to full capacity, not only as a human right but also for equitable prosperity and sustainable progress of societies.
In The Lancet, Cem Gabay and colleagues report the results of the ADACTA study. This study shows the overall superiority of monotherapy with the biological disease-modifying antirheumatic drug (DMARD) tocilizumab compared with monotherapy with the biological DMARD adalimumab for treatment of patients with very active rheumatoid arthritis who are intolerant to the non-biological DMARD methotrexate, or for whom continued methotrexate treatment is inappropriate.
In The Lancet, Josephine Bryant and colleagues provide provocative evidence of transmission of Mycobacterium abscessus subspecies massiliense (M abscessus subsp massiliense) in a UK cystic fibrosis centre. This is a very important finding, since non-tuberculous mycobacterial (NTM) infection is recognised as an emerging cause of lung disease in patients with cystic fibrosis. This study corroborates a recent report from Seattle, USA, that indicated possible transmission of a single strain of M abscessus subsp massiliense at that centre.
Breakthroughs in HIV prevention—including antiretroviral therapy (ART) to reduce the infectiousness of HIV-infected individuals and antiretroviral pre-exposure prophylaxis (PrEP) to reduce the susceptibility of uninfected people—have prompted optimistic discussion about reversal of the global HIV epidemic, particularly in Africa, which has a disproportionate burden. To achieve the potential benefits of these promising strategies, delivery of interventions should be prioritised to those at highest risk, with high uptake through linkages with HIV testing, and in combination with other key prevention interventions, including voluntary medical male circumcision, provision of condoms, and behaviour change.
Global poliomyelitis eradication is almost within reach—this disease persists only in Nigeria, Afghanistan, and Pakistan, which are countries with substantial Muslim populations. Today this ambitious goal is threatened, partly by misinformed and politicised religious views that not only seed suspicion about polio vaccination but recently led to murder of polio workers. In Pakistan, 16 workers engaged in a polio vaccination campaign have been killed since December, 2012, halting vaccination in many parts of the country and placing Pakistan's 2012 gains in poliomyelitis eradication at risk.
The request was sincere. At a symposium held during the 2012 International AIDS Conference in Washington, DC, a serious and thoughtful discussion took place about the role of the church in health care. Richard Dawkins-like interjections against religion, no matter how soundly they might seem based in science, would not have been especially helpful. For the fact is that the Catholic Church is the largest non-governmental provider of health care in the world. In Africa alone, there are over 100 000 clinics and hospitals led by Catholic doctors and nurses, giving care to tens of thousands of people who would otherwise have little or no access to health services.
The incoming director of the Wellcome Trust, Jeremy Farrar, has been officially appointed and will take office in October, replacing Mark Walport. Becky McCall reports.
The US Supreme Court is considering whether to uphold a controversial anti-prostitution provision that health groups argue is detrimental to their HIV/AIDS prevention work. Sharmila Devi reports.
UN agencies are being forced to consider their health and development priorities in Gaza after shortfalls in donor funding for the occupied territory. Sharmila Devi reports.
Souzou: Outsider Art from Japan is a title, and an exhibition, rich with ambiguity. According to Wellcome Collection curator Shamita Sharmacharja, the word souzou has no direct English translation, but has a double meaning in Japanese. In one written form, it means creation; in the other, imagination. The term “outsider art” also suggests a peculiar tension, palpable throughout the exhibition. It was coined in the 1970s following Jean Dubuffet's mid-1940s theory of art brut, which recognised works by artists who were perceived to inhabit the margins of society, such as mental health patients.
Closed for a decade, the reborn Rijksmuseum reopened last month. Its vast collection spans some 800 years and is now presented in chronological order across 80 galleries. More than 30 galleries celebrate the Dutch Golden Age (1600–1700), a time when the nation made great advances in trade, science, and the arts. Among the museum's most well known works are those by Johannes Vermeer, Rembrandt van Rijn, and Jan Steen, which are now displayed to great effect. Not having seen its exemplary collection of 17th-century paintings for some years, my recollection that I would find Rembrandt's sobering The Anatomy Lesson of Dr Joan Deyman (1676) proved to be mistaken.
Next year will mark the 50th anniversary of the Declaration of Helsinki. Consequently, the World Medical Association (WMA) is developing its eighth version of the Declaration. This anniversary presents an excellent opportunity to reconsider the problems of the Declaration and how they can be remedied to ensure the document retains its prominent status.