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[Editorial] The global HIV/AIDS epidemic—progress and challenges  Voir?

On July 20, UNAIDS released their annual report on the status of the global HIV/AIDS epidemic, which also includes a comprehensive analysis of progress towards ending AIDS as a public health threat. The latest epidemiological estimates and programmatic data from 168 countries in all regions were reviewed. Worldwide, AIDS-related deaths have declined from a peak of about 1·9 million in 2005 to around 1·0 million in 2016, largely due to treatment scale-up—for the first time more than half of people with HIV are estimated to be on treatment.

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[Editorial] Medical education reform in China  Voir?

On July 11, the State Council of China introduced bold plans to revolutionise medical education, effective immediately. Gone will be Soviet-era training in which doctors spent their career in one hospital, and over-crowded outpatient clinics that too often underutilised the expertise of staff and underserved the needs of patients. Instead, medical schools are asked to admit more, higher calibre students, and provide better quality teaching that is accredited by the Chinese Medical Doctor Association.

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[Editorial] Growing concerns of hepatitis E in Europe  Voir?

Hepatitis E virus (HEV) infection is an important cause of acute viral hepatitis worldwide, with an increasing incidence in Europe since 2010. Although it is difficult to know the real incidence because most HEV infections are asymptomatic or self-limiting, in some people—such as immunosuppressed individuals or those with pre-existing liver disease—HEV infection can progress to chronic disease.

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[Comment] Guided graded exercise self-help as a treatment of fatigue in chronic fatigue syndrome  Voir?

In The Lancet, Lucy Clark and colleagues1 show that, in the GETSET trial (n=211), patients with chronic fatigue syndrome who were treated with a 12 week guided graded exercise self-help programme in addition to ongoing specialist medical care had significantly lower mean fatigue score (reduction by 4·2 points [95% CI 2·3–6·1], p<0·0001; effect size 0·53) and higher self-reported physical function score (increase by 6·3 points [1·8–10·8], p=0·006; effect size 0·20) than did patients managed with specialist medical care alone.

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[Comment] Informing health choices in low-resource settings  Voir?

Because of the abundance of health information, available via multiple sources, it is important that individuals be able to critically appraise health claims to make well informed decisions. This is of even greater importance in low-income countries where individuals cannot afford to invest in ineffective treatments. Indeed, public health practitioners have long touted the importance of health education; for example, a variety of well tested and updated curricula to prevent adolescent pregnancy and HIV have shown positive health outcomes across low-income and high-income communities.

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[Comment] Saving lives with equity—the efficient route to the SDGs  Voir?

2 years have now passed since the world's governments adopted the Sustainable Development Goals (SDGs). Apart from embracing some bold targets for 2030, they pledged that each country would undertake a best endeavour to “reach the furthest behind first” and achieve the goals for every group, with noone left behind.1 These commitments put equity—the idea of equality with fairness—at the heart of the SDGs. UNICEF has reinforced the case for equity in its new report, Narrowing The Gaps: the Power of Investing in the Poorest Children.

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[Comment] 90-90-90 and ending AIDS: necessary and feasible  Voir?

More than three decades into the global HIV pandemic, there are still 2·1 million new infections each year and 36·7 million people are living with HIV.1 By mid-2016, 18·2 million people were on antiretroviral treatment—about 50% of people living with HIV.1 Yet in 2015, 15 million people living with HIV were estimated to be unaware of their status and 1·1 million died of AIDS-related complications, despite the fact that US$19 billion was invested in HIV in low-income and middle-income countries.1

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[Comment] The International AIDS Society—Lancet Commission on the future of the HIV response and global health  Voir?

HIV/AIDS has been the most severe and widespread infectious disease pandemic of our time—with more than 75 million people infected, more than 40 million deaths, and some 38 million people living with the virus in 2017 and requiring lifelong, daily treatment to stay well.1 Yet by any measure, the global response to the HIV/AIDS pandemic has been one of the extraordinary success stories of modern medicine, public health, human rights, and global solidarity. By 2016, more than 18 million people living with HIV had started life-sustaining antiretroviral therapy,2 and new preventive interventions, including pre-exposure prophylaxis (PrEP) and treatment as prevention,3 have shown remarkable effectiveness.

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[Comment] Offline: NCDs—why are we failing?  Voir?

Why is the global health community failing to respond effectively to the rising burden of non-communicable diseases (NCDs)? The answer can be summed up in one word—fear. Fear of a species-threatening pandemic. A pervasive fear that has displaced all other health concerns. Anxiety among political elites is causing a recalibration of priorities among global health leaders. In his first speech to staff in Geneva this month, WHO's new Director-General, Tedros Adhanom Ghebreyesus, named four urgent issues: health emergencies; universal health coverage; women's, children's, and adolescents’ health; and climate change.

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[World Report] The HIV response in Ukraine: at a crossroads  Voir?

The Ukrainian Government is looking to shoulder more of the burden of the response to the HIV epidemic in the midst of a complicated health-care overhaul. Andrew Green reports from Kiev.
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[World Report] The UN adopts treaty to ban the use of nuclear weapons  Voir?

On July 7, the UN voted on a treaty to ban the use of nuclear weapons, to which nuclear powers did not partake. John Zarocostas reports.
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[World Report] Public health commissioner appointed to lead US CDC  Voir?

Brenda Fitzgerald, former Georgia Public Health Commissioner, was named by President Trump as CDC Director. Rita Rubin reports.
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[Perspectives] Tuberculosis  Voir?

No disease better illustrates the difficulties of early modern medical practice than tuberculosis. Arguments over heredity, nutrition, environment, and contagion all came together within the potent cultural frame of a condition that, by the early 19th century, killed about one in five Europeans. Rather than claiming thousands in swift, savage epidemics tuberculosis took its victims slowly, racking their bodies and exhausting their minds. Older names for the disease—consumption and pthisis (from a Greek word meaning to waste away)—reflect the way in which it seemed to destroy the body from within.

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[Perspectives] Putting LGBTQ people back on the canvas of history  Voir?

It's only 50 years since homosexuality was partly decriminalised in England and Wales—the Sexual Offences Act entered the statute books on July 27, 1967. Scotland had to wait until 1980. A milestone like this is an opportunity to reflect on both the huge strides lesbian, gay, bisexual, transgender, and queer (LGBTQ) people have made since—both in terms of legal equality and social acceptance—and to avoid complacency about what remains to be achieved. It also offers a chance to paint LGBTQ people back on to the canvas of history.

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[Perspectives] Taking a dose of Roald Dahl's marvellous medicine  Voir?

With more than 50 000 shows being staged by over 3000 artists in 300 venues, there are performances to suit all tastes at next month's 70th Edinburgh Festival Fringe—but one show at the arts festival has a special sprinkling of literary magic. Tom Solomon, Professor of Neurology and Director of the Institute of Infection and Global Health at the University of Liverpool, UK, will entertain families with his Roald Dahl's Marvellous Medicine show, which will introduce a new generation to Dahl's tales, while allowing older readers to revisit their favourite books.

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[Perspectives] Magic and loss  Voir?

Margaret returns to 1960s London to find John, her fiancé, inexplicably hospitalised. He claims merely to be tired, but rather Margaret finds him much diminished and arranges to meet his doctor. This affords some clarity; it seems a depression John calls “the beast” has returned, having stalked John since he was a young man.

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[Obituary] Simone Veil  Voir?

Former French Health Minister and architect of the law legalising abortion in France. Born in Nice, France, on July 13, 1927, she died at home in Paris, France, on June 30, 2017, aged 89 years.
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[Correspondence] Ending AIDS: myth or reality?  Voir?

In 2014, prompted by the realisation that an expansion of HIV treatment can prevent illness, death, and transmission of infection, the Joint UN Programme on HIV/AIDS announced their 90-90-90 target and goal to end AIDS by 2030.1 This target and goal were informed by the strategic objective that if at least 90% of people infected with HIV knew their status, and at least 90% of those who knew their status were on antiretroviral therapy, and at least 90% of those who were on antiretroviral therapy were virally suppressed, ending AIDS would be achievable by 2030.

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[Correspondence] Nelly Mugo and the response to HIV: more than just PrEP advocacy  Voir?

Tony Kirby recently highlighted the global response to HIV through a profile of Nelly Mugo in The Lancet (April 29, p 1689),1 drawing particular attention to her work on pre-exposure prophylaxis (PrEP). Her impact on HIV policy in Kenya and beyond is also notable for its nuanced appreciation of many other approaches to empowering and supporting serodiscordant couples.

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[Correspondence] New hepatitis C antiviral treatments eliminate the virus  Voir?

The Cochrane Collaboration has published a topical systematic review1 and meta-analysis on direct-acting antivirals (DAA) for chronic hepatitis C virus (HCV) infection. Jakobsen and colleagues1 compared the results of randomised trials of any HCV DAA regimen versus no intervention or placebo. Their review reported data from 138 trials, which included 25 232 participants and encompassed all drugs on the market or under development. The authors confirm treatment has a significant benefit (relative risk 0·44, 95% CI 0·37–0·52, p<0·001), compared with no treatment, in the elimination of the virus from the bloodstream, measured 12–24 weeks after treatment (sustained virological response, SVR); however, they conclude there was “insufficient evidence to judge if DAAs have beneficial or harmful effects on other clinical outcomes for chronic HCV” and that although DAAs might increase SVR, “the clinical implication of the results on this non-validated surrogate outcome is unclear”.

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[Correspondence] Open letter to the UN's new health chief from “Alternative Nobel Prize” laureates  Voir?

We congratulate Tedros Adhanom Ghebreyesus on his election as Director-General of WHO—a job that literally makes the difference between life and death for millions of people around the world.
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[Correspondence] The sun is shining on Cyprus's National Health Service  Voir?

12 years have passed since The Lancet's World Report1 that questioned whether Cyprus would address its substantial health-care challenges, and more than 7 years have passed since we questioned whether any such health-care system would ever be implemented, despite it being “long-awaited” and “carefully planned”.2 On June 16, 2017, the parliament of Cyprus unanimously voted on a game-changing National Health Service—the dawn of a new era for the country's health service and population as a whole.

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[Correspondence] NHS manifesto: the missing piece of the puzzle  Voir?

The NHS Manifesto published in The Lancet by Nigel Crisp and colleagues (Dec 10, 2016, e24)1 is a broadly compelling one, and yet it mirrors an error made by National Health Service (NHS) England's Five Year Forward View2 in calling for a major transformation of the UK's largest public service without acknowledging the importance of public engagement in those plans. To be sure, Crisp and colleagues1 call for services to be made patient-centred, and for patients and carers to be engaged “in decision making and care”.

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[Correspondence] NHS manifesto: the missing piece of the puzzle – Authors' reply  Voir?

We welcome the interest our Lancet NHS Manifesto1 has generated. In it we call, among other things, for the UK government to take a leadership role in helping to accelerate transformation of the National Health Service (NHS) to a people-centred system. In so doing, we fully agree with Ellen Stewart and colleagues about the importance of encouraging health system transformation in partnership with the wider public.

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[Correspondence] Diagnostic accuracy of the PROMIS study  Voir?

We commend Hashim Ahmed and colleagues (Jan 19, p 815)1 for their rigorous evaluation of multi-parametric MRI (MP-MRI), which indicated that prostate biopsy can potentially be avoided in approximately 27% of patients with a negative MP-MRI result. Deciding how to proceed with a patient who has a positive MP-MRI result is equally important. Notably, the authors did not compare histopathological correlation for MP-MRI with template prostate mapping biopsy (TPM) to assess whether disease was found in the region of interest.

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[Correspondence] Diagnostic accuracy of the PROMIS study – Authors’ reply  Voir?

We thank Simpa S Salami and colleagues for raising three important issues.
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[Articles] Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial  Voir?

GES is a safe intervention that might reduce fatigue and, to a lesser extent, physical disability for patients with chronic fatigue syndrome. These findings need confirmation and extension to other health-care settings.
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[Articles] Effects of the Informed Health Choices primary school intervention on the ability of children in Uganda to assess the reliability of claims about treatment effects: a cluster-randomised controlled trial  Voir?

The use of the Informed Health Choices primary school learning resources, after an introductory workshop for the teachers, led to a large improvement in the ability of children to assess claims about the effects of treatments. The results show that it is possible to teach primary school children to think critically in schools with large student to teacher ratios and few resources. Future studies should address how to scale up use of the resources, long-term effects, including effects on actual health choices, transferability to other countries, and how to build on this programme with additional primary and secondary school learning resources.

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[Articles] Effects of the Informed Health Choices podcast on the ability of parents of primary school children in Uganda to assess claims about treatment effects: a randomised controlled trial  Voir?

Listening to the Informed Health Choices podcast led to a large improvement in the ability of parents to assess claims about the effects of treatments. Future studies should assess the long-term effects of use of the podcast, the effects on actual health choices and outcomes, and how transferable our findings are to other countries.

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[Clinical Picture] Synchronous distal phalangeal metastases from primary non-small-cell lung cancer  Voir?

A 78-year-old man was admitted to hospital for treatment of stage IIIa squamous cell carcinoma of the lung. He reported a 4 week history of pain, erythema, and oedema in the left middle finger tip, which impaired his sleep and hand function. The patient denied any preceding trauma, and had no clinical or laboratory features of systemic infection. He also reported increasing pain in the contralateral little finger tip, with mild oedema and erythema developing in the preceding fortnight.

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[Seminar] Dilated cardiomyopathy  Voir?

Dilated cardiomyopathy is defined by the presence of left ventricular dilatation and contractile dysfunction. Genetic mutations involving genes that encode cytoskeletal, sarcomere, and nuclear envelope proteins, among others, account for up to 35% of cases. Acquired causes include myocarditis and exposure to alcohol, drugs and toxins, and metabolic and endocrine disturbances. The most common presenting symptoms relate to congestive heart failure, but can also include circulatory collapse, arrhythmias, and thromboembolic events.

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[Review] Progress in evidence-based medicine: a quarter century on  Voir?

In response to limitations in the understanding and use of published evidence, evidence-based medicine (EBM) began as a movement in the early 1990s. EBM's initial focus was on educating clinicians in the understanding and use of published literature to optimise clinical care, including the science of systematic reviews. EBM progressed to recognise limitations of evidence alone, and has increasingly stressed the need to combine critical appraisal of the evidence with patient's values and preferences through shared decision making.

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[Viewpoint] A developmental approach to the prevention of hypertension and kidney disease: a report from the Low Birth Weight and Nephron Number Working Group  Voir?

In 2008, the World Health Assembly endorsed WHO's Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) 2013–2020,1 based on the realisation that NCDs cause more deaths worldwide than do communicable diseases. This plan strongly advocates prevention as the most effective strategy to curb NCDs. Furthermore, the life-course approach, which was highlighted in the Minsk Declaration,2 reflects increasing recognition that early development affects later-life health and disease.

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Dernière mise à jour : 27/07/2017 : 14:43


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