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[Editorial] Patient safety: too little, but not too late

Sab, 14/09/2019 - 00:00
The first-ever World Patient Safety Day is taking place on Sept 17, 2019. Every day, countless patients worldwide are put at risk by unsafe care and end up requiring treatment for ailments caused by the very system that was supposed to help them get better. Protecting patients from errors, injuries, accidents, and infections is an essential goal for every health system, but no health system has so far successfully addressed patient safety.

[Editorial] Let's talk about dementia

Sab, 14/09/2019 - 00:00
On Sept 1, kicking off World Alzheimer's Month, Alzheimer's Disease International joined forces with the Pan American Health Organization, launching Let's Talk About Dementia, a campaign aiming “to demystify dementia and to get people talking”. The ambition is to encourage discussion in families and with health providers to reduce the stigma associated with Alzheimer's disease and all forms of dementia. Events elsewhere include the Age Against the Machine festival in the UK, which offers a practical workshop on making homes, workplaces, or projects dementia-friendly and a performance of How to Keep Time, which looks at the effects of dementia on speech, memory, and family life.

[Editorial] Tuberculosis needs accelerated and continued attention

Sab, 14/09/2019 - 00:00
Ahead of the annual meeting of the European Respiratory Society (Madrid, Spain, Sept 28–Oct 2), we publish together with The Lancet Respiratory Medicine a three-part Series on tuberculosis. This Series, which focuses on the management of drug-resistant tuberculosis, challenges in childhood tuberculosis, and the state of vaccine development, will be discussed in a special symposium at the conference. Tuberculosis is now the most common and deadly infectious disease. An estimated 1·6 million people die from the disease annually, including 230 000 children.

[Comment] Balancing body and mind: selecting the optimal antipsychotic

Sab, 14/09/2019 - 00:00
The burden of schizophrenia remains high, with one in 100 people affected globally over a lifetime.1 Symptoms are disabling, with auditory hallucinations, delusions, lack of motivation, cognitive impairment, and functional deficits. Despite advances in our understanding of the biological underpinnings of the illness, cure remains elusive. Antipsychotic medications are the mainstay of pharmacological treatment, but selecting the optimal medication for the individual patient is a delicate balance between efficacy and physical side-effects.

[Comment] Financing universal health coverage: four steps to go from aspiration to action

Sab, 14/09/2019 - 00:00
A UN High-Level Meeting on Universal Health Coverage (UHC) will be convened during the 74th session of the UN General Assembly on Sept 23, 2019. Most countries support the aspirations of UHC and have committed to its principles.1 Less has been articulated about how to deliver this goal. In many low-income and middle-income countries, health-care systems are inadequate and providers rely on patients' out-of-pocket payments. Those who are poor and sick cannot access care or avoid seeking care because they are unable to pay.

[Comment] Offline: Why we must listen to critical friends

Sab, 14/09/2019 - 00:00
The UK is becoming a “narrowly nationalistic country”. Political instability is endemic. The nation is approaching a “second civil war”. Extreme remarks from an extreme personality? Hardly. Eliza Manningham-Buller worked for MI5, Britain's Security Service, for over 30 years, ending her career as its Director General from 2002 to 2007. She now sits in the House of Lords and is Chair of the Wellcome Trust. Manningham-Buller is the quintessential insider's insider. She was delivering the John Snow Society's annual Pumphandle Lecture last week at the London School of Hygiene & Tropical Medicine.

[World Report] Health providers urged to help to eradicate modern slavery

Sab, 14/09/2019 - 00:00
Millions of people are victims of modern slavery, and experts say that countries are failing to stop it. Should health-care workers do more? John Zarocostas reports.

[Perspectives] Towards a tricorder for diagnosing paediatric conditions

Sab, 14/09/2019 - 00:00
Paediatric patients introduce a unique challenge for health care: information about symptoms in infants and children is usually obtained second-hand from the parents. Typically, diagnosis of paediatric conditions relies on physical examination and objective tests during a visit with a health professional. Yet digital diagnostics are now in development for assessing some common paediatric conditions that are not serious or life-threatening. These technologies could have the potential to change elements of paediatric care.

[Perspectives] A doctor's choice

Sab, 14/09/2019 - 00:00
Does a doctor always know what is in the best interests of a patient? And should the personal values of a patient be subordinated to the medical perspective in all cases? Doctors' ethical conundrums have featured in plays such as Henrik Ibsen's An Enemy of the People (1882) and George Bernard Shaw's The Doctor's Dilemma (1906). In 1912, Arthur Schnitzler's Professor Bernhardi took the exploration of medical ethics to a new level by introducing issues of religion and the clash between medical decisions and growing antisemitism in Europe.

[Perspectives] The pain and glory of ageing

Sab, 14/09/2019 - 00:00
Cinematic reflection on ageing is often about the extremes of life, such as in Pixar's Up, The Company of Strangers by Cynthia Scott, and Michael Haneke's Amour. But the transition from middle age to early old age is also a key time for reflection, recalibration, and refocus of the meaning of life and reconciliation of suffering, mistakes, and successes.

[Perspectives] Battling for life: the wartime work of Janet Vaughan

Sab, 14/09/2019 - 00:00
In A Room of One's Own, Virginia Woolf fabricated an imaginary novel about two young women who worked in a medical laboratory. Pretending that this fictional book actually existed, she described her feelings on reading that Chloe and Olivia “were engaged in mincing liver, which is, it seems, a cure for pernicious anaemia”. In real life, Woolf's friend and distant relative Janet Vaughan was employed as a clinical pathologist at University College Hospital, where she had secretly arranged for anaemic patients to be given liver.

[Obituary] John Henderson

Sab, 14/09/2019 - 00:00
Paediatrician and expert on asthma and child and infant respiratory systems. Born in Renfrew, UK, on Feb 11, 1958, he died of pancreatic cancer in Bristol, UK, on July 24, 2019, aged 61 years.

[Correspondence] Recurring acute encephalitis syndrome outbreaks in Bihar, India

Sab, 14/09/2019 - 00:00
The death of 154 undernourished children from acute encephalitis syndrome in a short period of 3 weeks1 is deeply concerning. The World Report by Patralekha Chatterjee1 is a timely update on a situation that recurs almost every year in Bihar, India. Chatterjee rightly pinpoints undernutrition, inadequate health facilities, and poor awareness among the local population as contributing factors to these deaths.

[Correspondence] Parasitic encephalitis in immunocompetent individuals

Sab, 14/09/2019 - 00:00
Arun Venkatesan and colleagues1 adeptly presented the infectious and autoimmune causes of acute encephalitis in immunocompetent adults. According to the authors, viruses are the largest group of acute encephalitis causative agents. The authors also listed bacterial, fungal, and parasitic causes of acute encephalitis. In the parasitic section, Acanthoemeba species, Naegleria fowleri, Balamuthia mandrillaris, and Baylisascaris procyonis are listed. However, it seems that some of the important parasitic causes of acute encephalitis are missed (appendix).

[Correspondence] Parasitic encephalitis in immunocompetent individuals – Authors' reply

Sab, 14/09/2019 - 00:00
We thank Amir Abdoli for his comments. Our intention in this Seminar1 was to bring together knowledge about the most important infectious causes, along with information about the rapidly growing field of autoimmune encephalitis, to provide a single comprehensive approach. Previously, the two have been dealt with rather separately, despite the large overlap in clinical features. As indicated in the titles of the tables in the Seminar,1 selected causes of encephalitis in immunocompetent individuals were presented.

[Correspondence] Polio vaccination controversy in Pakistan

Sab, 14/09/2019 - 00:00
The Global Polio Eradication Initiative reports Pakistan as the only country with consistent barriers preventing vaccination and the eradication of the disease. The barriers are linked to religious extremism and sometimes to global political interests.1 The Government of Pakistan has managed the issues by involving social mobilisers2 and religious leaders3 and by deploying police officials1 to ensure the smooth running of the vaccination programmes. However, the emergence of 53 new polio cases in the country between January and August, 2019, which is more cases than in past 3 years,4 has led to calls for additional stringent measures to cope with the situation in the years ahead.

[Correspondence] Militaries and global health

Sab, 14/09/2019 - 00:00
We share Joshua Michaud and colleagues'1 concern regarding military actors' violations of international humanitarian law, particularly attacks on civilians, health workers and health facilities. However, we believe that discussions about how best to respond to such violations would benefit from a nuanced approach.

[Correspondence] Militaries and global health

Sab, 14/09/2019 - 00:00
We can appreciate the temptation for public health practitioners and researchers to partner with our well funded militaries and police to deliver health benefits. Still, we warn of the danger in pursuing such pragmatic partnerships.

[Correspondence] Militaries and global health – Authors' reply

Sab, 14/09/2019 - 00:00
We appreciate the comments by Jonathan Kennedy and colleagues referencing some of the challenges inherent in military engagement in global health. Kennedy and colleagues state that the Geneva Conventions have become outdated given the realities of current conflicts, and believe only a redefinition and redesign of international humanitarian law can address the weaknesses of the current system. We agree that new ways of war require re-envisioning international humanitarian law and a failure to fully adapt and broaden these requirements to current circumstances are key weaknesses.

[Correspondence] Developing country: an outdated term in The Lancet

Sab, 14/09/2019 - 00:00
In January, 2019, two years after his death, Hans Rosling's final book, Factfulness,1 was published in translation in Japan. It quickly became a bestseller. As Rosling mentioned in the book, he was opposed to dividing the world into two types of countries: developed and developing; high-income and low-income; us and them. In using the words developing country, Rosling explained that we live with an outdated mindset. The progress and achievements of the countries labelled as developing are so diverse that it would be misleading to lump all the countries together based on a single criterion.