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.
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.
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.
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.
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.
Sexual harassment and assault investigation at UNAIDS draws attention to an endemic problem. Critics say the UN's internal system is flawed and call for external oversight. John Zarocostas reports.
“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.
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.
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.
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.
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.
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.
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
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.
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).
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.
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.
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.
We welcome the opportunity to respond to the letters about The Lancet Commission1 on dementia prevention, intervention, and care.
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.