The Lancet South Africa series proposes three strategies to address public sector workforce needs, affordable national health insurance, and competent leadership. The authors also discuss the decline in clinical research activity and capacity, as well as health inequities in South Africa, highlighting the need for jobs and cooperation ...
The country's health system faces historical roots of racism, apartheid, and economic inequalities, contributing to poor health outcomes and a high burden of HIV/AIDS. Despite being a middle-income country, South Africa has worse health outcomes than many lower-income countries.
A study estimates that implementing basic neonatal care and prevention of mother-to-child transmission could save up to 37,200 children's lives annually in South Africa. The interventions are estimated to cost US$1.5 billion per year, but the authors argue that the costs are affordable and effective implementation is the key gap.
The number of people aged 60 or over in South Africa is projected to triple by 2025, leading to a doubling of cardiovascular deaths. The burden of non-communicable diseases is expected to increase as antiretroviral therapy reduces mortality from HIV/AIDS.
The article discusses South Africa's paradox of poor health outcomes amidst high health expenditures and supportive programmes. The authors identify leadership, innovation, and priority actions needed to achieve better health outcomes and tackle pressing challenges such as HIV/AIDS and non-communicable diseases.
The study highlights South Africa's high injury death rate and its disproportionate impact on women, particularly intimate partner homicide rates. The authors emphasize the need for a comprehensive national action plan to address these social issues.
A randomised controlled trial found online CBT to be more effective than usual care in treating depression. After 8 months, 42% of patients had recovered, compared to 26% in the control group.
A study published in The Lancet found that Afghan children are experiencing high rates of mental health problems and trauma, with girls being disproportionately affected. School-based initiatives to address child mental health are crucial, but challenges exist due to inadequate resources and strain on the education system.
Despite being one of the wealthiest nations, the US struggles with health coverage, with an estimated 47 million citizens lacking any coverage. In contrast, poorer countries like Costa Rica and Cuba have achieved impressive prepaid coverage. The authors argue that universal health financing schemes can improve social sectors like educa...
A phase 3 trial found that anti-T cell globulin (ATG) reduces the incidence of both acute and chronic graft-versus-host disease (GVHD) in transplant patients. This results in improved survival rates and reduced complications without compromising overall survival or increasing relapse rates.
The PROTECT AF study found that percutaneous closure of the left atrial appendage (LAA) is a viable option for stroke prevention in patients with non-valvular atrial fibrillation. The device-based approach showed non-inferior efficacy to long-term warfarin therapy, but higher safety event rates.
Researchers found that urinary albumin to creatine ratio is a powerful and independent predictor of heart failure prognosis, even in patients without diabetes or kidney disease. A high ratio was associated with increased risk of death from cardiovascular causes and hospital admission for worsening heart failure.
A randomized trial found that targeting systolic blood pressure below 130 mmHg reduced left ventricular hypertrophy and clinical events, compared to a target of 140 mmHg. The study suggests that lowering systolic blood pressure in nondiabetic patients with hypertension may be beneficial.
Patients with chronic respiratory disorders who received early noninvasive ventilation after extubation had a lower risk of death and respiratory failure compared to those given conventional oxygen therapy. Non-invasive ventilation was associated with an 83% decreased risk of respiratory failure after extubation.
Oral sodium clodronate reduces death by 23% and increases overall survival to 30% at 5 years for patients with advanced prostate cancer. However, in men with localized disease, clodronate shows no improvement in overall survival.
Patients who received radiotherapy for low-grade glioma brain tumors showed significant cognitive decline compared to those who did not receive treatment. The study found that attentional functioning, executive functioning, and information processing speed were lower in patients given radiotherapy. Deferring treatment or using modern r...
A recent study published in The Lancet Infectious Diseases suggests that extending the vaccination policy could be a more clinically effective and cost-effective strategy for treating seasonal flu. The study analyzed the effectiveness of antiviral treatments and found that vaccination may be a better option for healthy adults, while th...
Researchers suggest that OCD should be classified as a separate disorder due to its symptomatically heterogeneous nature and genetic factors contributing 27-47% of variance. Treatment trials indicate promise for medications like D-cycloserine combined with exposure and response prevention therapy.
High-field post-mortem MRI is a reliable option for examining human fetuses after death, providing good images and better image quality than conventional MRI. Traditional autopsy did not provide superior diagnostic accuracy compared to high-field MRI in some cases.
A new study published in The Lancet found that adding a TNF antagonist like infliximab to methotrexate treatment improves symptoms for patients with early rheumatoid arthritis who have not responded well to methotrexate alone. This approach can prevent overtreatment and reduce side effects and costs.
Adding anesthetic lidocaine to radiocolloid injection improves patient comfort without compromising SLN identification, reducing pain and discomfort for patients with early breast cancer. The study concludes that this practice should be introduced as standard.
The dioxin poisoning of Victor Yushchenko demonstrates the importance of monitoring TCDD and its metabolites in human tissues. Metabolites were predominantly found in faeces, indicating a slow metabolism by the liver and skin.
A study published in The Lancet recommends inducing labor at 37 weeks for pregnant women with mild hypertensive disorders like gestational hypertension or mild pre-eclampsia. This approach reduces the risk of poor maternal outcomes, severe hypertension, HELLP syndrome, and caesarean sections.
A randomized controlled trial found that raltegravir-based combination treatment is effective and well-tolerated in treatment-naive patients, with faster action and fewer adverse events than efavirenz. The study included 281 patients given raltegravir and 282 given efavirenz.
The IMCI strategy has improved health-worker skills, health-system support, and family and community practices, leading to increased care-seeking and community treatment. However, its impact on mortality rates was not statistically significant, despite a decrease in stunting among children aged 2-5 years.
Countries are urged to prioritize post-marketing surveillance to address H1N1 vaccine safety concerns. The US is advised to support dose-sparing strategies to avoid depletion of the already short vaccine supply.
A recent study found that pregnant women with H1N1 flu are at increased risk of severe disease and complications, highlighting the need for prompt antiviral treatment. The study suggests that vaccination should also be prioritized for pregnant women once available, in line with US guidelines.
A growing number of British academics claim that EU regulations are hindering their ability to conduct clinical research, with some facing delays of over 2 years due to excessive paperwork. Researchers argue that the current system requires lengthy protocols and multiple forms, leading to administrative burdens.
The International Agency for Research on Cancer (IARC) has reclassified sunbeds and UV radiation as Group 1 carcinogens, increasing the risk of skin melanoma by 75% among young users. The IARC also found a positive association between UV-emitting tanning devices and ocular melanoma.
A meta-analysis of 50,000 patients found GPs accurately diagnose only about half of those with depression, while misdiagnosing others. The authors suggest additional consultation time and repeated assessments to improve accuracy.
A new trial shows that chemotherapy plus radiotherapy, either with or without surgery, are viable options for patients with stage IIIA (N2) non-small-cell lung cancer. The treatment improved overall survival and progression-free survival rates compared to standard concurrent chemotherapy and radiotherapy alone.
The US Department of Defense has been criticized for its handling of medical care at Guantanamo Bay, with a report highlighting concerns over the use of medical personnel in interrogation and force-feeding of detainees on hunger strike. Independent examinations of released detainees have shown severe psychological damage from detention.
Blast injuries are physically and psychologically devastating, with conservative estimates showing a four-fold increase in events and an eight-fold increase in injuries. The authors emphasize the need for every physician involved in emergency care to understand blast injury patterns and management, highlighting the importance of carefu...
Studies indicate that immunosuppressed populations, including HIV/AIDS patients, cancer patients, transplant recipients, and those on haemodialysis, are at higher risk for flu infection. Vaccination has shown promise in reducing flu cases, but more research is needed to assess vaccine efficacy and timing for optimal protection.
A review of past epidemics suggests that early and prolonged school closure can reduce the number of cases at the peak of a flu pandemic, but has limited impact on total cases. School closures are associated with significant social and economic costs, including disruption to healthcare systems and key services.
In sub-Saharan Africa, MSM are a high-risk group for HIV infection, with prevalence rates often 10 times higher than in the general population. The lack of access to vital services, including condoms and education, exacerbates the issue.
A letter to The Lancet criticizes the British National Party's use of a white doctor in their election campaign, which could have influenced voters and damaged relationships with ethnic minority patients. The authors argue that doctors' neutrality should not be used to promote political parties.
A randomized trial in Uganda found that circumcision of HIV-infected men did not reduce HIV transmission to female partners. The study enrolled 922 uncircumcised men and their female partners, with a higher proportion of women infected in the intervention group.
A study found sunitinib to be safe and well-tolerated in patients with brain metastases, poor performance status, and elderly age groups. Median progression-free and overall survival were 10.9 and 18.4 months respectively.
A groundbreaking surgery has enabled Connie Culp to regain facial function and appearance after being shot in the face with a shotgun. The procedure involved a 22-hour operation to connect donor tissues to her disfigured structures, resulting in restored smell, eating, drinking, and intelligible speech.
A 16-year-old girl, Hannah Clark, has made a remarkable recovery after having her transplanted heart removed 10.5 years after it was implanted. Her own heart had recovered sufficiently to operate on its own, allowing the donor heart to be removed without major complications.
A study found that clozapine, restricted due to safety concerns, is associated with lower mortality compared to other antipsychotics. Long-term use of any antipsychotic reduces mortality by around 20%, indicating restrictions may have caused thousands of extra deaths worldwide.
A randomized controlled trial found that adding probiotics to conventional high-energy ready-to-use therapeutic foods did not improve nutritional cure rates or reduce mortality in severely malnourished African children. However, the study suggests a possible observation of reduced outpatient mortality in HIV-positive children.
A study published in The Lancet found that economic crises are associated with rising suicide rates, particularly among working-age populations. Active labor market programs can help reduce the negative impact of unemployment on mortality rates, especially if implemented with adequate social protection mechanisms.
The HPV-16/18 AS04-adjuvanted vaccine shows high efficacy against precancerous cervical lesions, with cross-protective efficacy against other oncogenic HPV types. The vaccine also demonstrates efficacy in universal mass vaccination and catch-up programmes, potentially reducing cervical cancer incidence.
A phase III randomised controlled trial found that famotidine reduces the development of stomach ulcers by 90% and upper-intestinal ulcers by 95% compared to placebo. The study also showed fewer adverse events in the famotidine group.
The health gap between Indigenous and non-Indigenous peoples is attributed to cultural loss, poverty, and colonialism. The authors highlight the importance of addressing social determinants of health and promoting Indigenous wellbeing through cultural revitalization and community-based strategies.
The review highlights the alarming burden of disease on Indigenous infants and children, with vaccine-preventable diseases still prevalent in many groups. Chronic diseases related to lifestyle factors have also surged, with diabetes rates 18 times higher among Aboriginal children than non-Indigenous counterparts.
Bilateral pallidal deep brain stimulation has been shown to improve movement skills and quality of life in some patients with dystonia-choreoathetosis cerebral palsy. The treatment resulted in sustained improvement in motor symptoms, but variability in response was observed.
A randomised controlled trial shows ketamine is a safe alternative to etomidate for intubating critically ill patients, reducing adrenal insufficiency risk. The study's results suggest pharmacological knowledge may be crucial for successful emergency intubation.