Our research into the UN Relief and Works Agency (UNRWA)'s delivery of health services to Palestinian refugees during the Syria crisis1 puts us in a unique position to anticipate the challenges of the organisation's current funding crisis.2 We have conducted over 90 interviews with health workers and managers, a series of systems modelling sessions, and rigorous analysis of UNRWA health data from 2007–16, and conclude the following.
We read with great interest the Seminar (Feb 9, 2017, p 2239)1 on type 2 diabetes by Sudesna Chatterjee and colleagues. However, we were surprised by the articles selected and believe that detailed selection criteria with the level of evidence of reported studies would have been useful to the reader. According to the research method described, we would expect other papers to be cited, including meta-analyses of randomised controlled trials that could have balanced the authors' outlook.2–6 For example, intensive glycaemic control probably has some beneficial effect on diabetic complications, such as non-fatal myocardial infarctions3–5 or retinopathy assessed with the Early Treatment Diabetic Retinopathy Study scale.
In the summary of their Seminar,1 Sudesna Chatterjee and colleagues state that the incidence of type 2 diabetes “continues to rise globally”. There is no evidence to support this claim and most recent literature suggests that, in developed countries, incidence peaked sometime in the last decade and then levelled off or slightly decreased.2–5
We thank A Rosemary Tate for her insightful comments on our Seminar.1 Tate indicates that there is no evidence to support the rise in global incidence of type 2 diabetes mentioned in the summary by citing a number of references published between 2014 and 2017 in the USA and UK.
The global need for new antimalarial drugs and new combinations is enormous and urgent,1,2 but their successful delivery needs resilience to overcome the barriers imposed by expensive and lengthy clinical development plans. Attention is often directed to areas such as southeast Asia, where some antimalarial combinations are failing but transmission intensities are much lower than in sub-Saharan African countries. Children in Africa have frequent and life-threatening malaria infections as they grow up, and these need to be treated safely.
Pyronaridine–artesunate and dihydroartemisinin–piperaquine treatment and retreatment of malaria were well tolerated with efficacy that was non-inferior to first-line ACTs. Greater access to these efficacious treatments in west Africa is justified.
Sudden infant death syndrome (SIDS) remains a leading cause of infant mortality, despite a steadily decreasing incidence since the 1990s.1 The reasons for this decline are debated, but it could be due to methodological reasons (eg, changes in reporting or advances in diagnosis of specific diseases) or a reduction of risks, such as an increase in supine sleeping position for infants, as advocated by the Back to Sleep campaign.2 A better understanding of the causes of SIDS is needed to identify infants at high risk and to develop interventions and guidelines that will prevent SIDS for all infants.
Rare SCN4A variants that directly alter NaV1.4 function occur in infants who had died from SIDS. These variants are predicted to significantly alter muscle membrane excitability and compromise respiratory and laryngeal function. These findings indicate that dysfunction of muscle sodium channels is a potentially modifiable risk factor in a subset of infant sudden deaths.
Following the high school mass-shooting in Parkland, Florida, the hash-tags #GunControl and #GunControlNow have been trending on social media. Because gun control is such a divisive issue among Americans, we suggest an approach that everyone can support. We call for #GunSafetyNow.
Combinatorial inhibition of PTPN12-regulated receptors leads to a broadly effective therapeutic strategy in triple-negative breast cancer
Combinatorial inhibition of PTPN12-regulated receptors leads to a broadly effective therapeutic strategy in triple-negative breast cancer, Published online: 26 March 2018; doi:10.1038/nm.4507
Targeting tyrosine kinase receptors that share the feedback inhibitor PTPN12 leads to broad spectrum therapeutic suppression of triple-negative breast cancer.
Targeting hepatic glutaminase activity to ameliorate hyperglycemia
Targeting hepatic glutaminase activity to ameliorate hyperglycemia, Published online: 26 March 2018; doi:10.1038/nm.4514
In mice, elevated glucagon during type 2 diabetes promotes more hepatic glutamine flux and greater gluconeogenesis, while reducing glutamine metabolism in the liver lowers hyperglycemia.
44% of the world's annual 227 million pregnancies are unintended, of which 56% end in abortion, 32% in an unplanned birth, and 12% in miscarriage. These estimates—from a modelling study authored by the Guttmacher Institute and the University of Massachusetts and published by The Lancet Global Health—form the basis of a Guttmacher report on global abortion published on March 20. This analysis was last performed in 2009, since when the rate of unintended pregnancy and abortion in high-income countries has fallen significantly, concurrent with both an increase in the rate of modern contraception usage and a decrease in the number of unintended pregnancies ending in abortion.
On March 14, the Office for National Statistics released the latest data on child mortality in England and Wales. After decades of progress, both infant and neonatal mortality rates rose for the second consecutive year. Furthermore, in an analysis of 15 similar countries done by the Nuffield Trust and the Royal College of Paediatrics and Child Health, the UK compares badly in seven of 16 indicators of child health.
Menorrhagia is a debilitating condition that negatively affects quality of life, with accompanying symptoms sometimes including severe abdominal pain and persistent and irregular bleeding outside the menstrual cycle. The UK's National Institute for Health and Care Excellence (NICE) estimates that menorrhagia affects up to 25% of women of reproductive age, accounting for 12% of all UK gynaecological specialist referrals.
Leave no one behind. This is the overarching pledge of the Sustainable Development Goals; a pledge that is far from being realised. In 2016, more than 4 million people with tuberculosis were estimated to be undiagnosed or their care and treatment were unknown.1 In the same year, nearly a fifth of the people who were diagnosed and known to be treated for tuberculosis had adverse outcomes, including 1·3 million deaths.1 One reason that millions of people affected by tuberculosis are left behind is an absence of coordinated, international action to combat poverty and inequality.
The Sustainable Development Goals have prioritised ending the epidemic of tuberculosis by 2030. We are therefore at a critical juncture in implementing efforts to control and eliminate tuberculosis. Current efforts have averted 56 million deaths since 2000.1 We also have better diagnostic tools and the promise of a few new, potent agents in the pipeline.2 Yet tuberculosis remains the leading source of infectious disease deaths globally, responsible for 1·7 million deaths in 2016.1 The UN's High-Level Meeting on Tuberculosis, due to take place in New York, USA, later in 2018, represents a unique opportunity to secure a commitment from heads of state and governments for a coordinated global response to end the epidemic.
Is equity the defining objective of global health in the 21st century? Equity is hardwired into every definition of global health. It would be insane to argue otherwise. But global health is too important to allow this assumption to go unchallenged. Global health is about who we are, who we want to be, and how we want to live together on this wounded world of ours. Global health is about everything we hold dear in life. So if we ask what is wrong with our societies today, is the answer really that we have too little equity?
Medicaid work requirements would make the health insurance programme a pathway out of poverty, say top US health officials. Susan Jaffe, The Lancet's Washington correspondent, reports.
A joint campaign from the CUGH, Perlmutter Cancer Center, and the Department of Population Health at NYU Langone Health sets new targets for HPV vaccination rate. Geoff Watts reports.
At a summit in Delhi on March 13, Prime Minister Narendra Modi launched a campaign to end tuberculosis by 2025. Dinesh C Sharma reports.