Issue Links
Stroke: systems of care and rehabilitation
The Lancet
Published: October 29, 2020
Stroke, the third leading cause of death and disability, requires timely delivery of best-practice care to improve patient outcomes. In high-income countries, major developments have streamlined systems of care and improved the speed of recognition, response, triage, and delivery of acute treatments. In low-income and middle-income countries, despite disparities in wealth, education, baseline health indicators, and funding of health-care expenditures, stroke services can be improved with a few adaptations and infrastructural remodelling. This three-part series discusses various aspects of stroke care, challenges, and opportunities for improvement of systems of care and highlights approaches for rapid uptake of evidence-based practice for rehabilitation. Finally, a call to action urges educators and the stroke rehabilitation clinical, research, and not-for-profit communities to work together for greater effect and to accelerate progress.
Functional Gastrointestinal Disorders
The Lancet
Published: October 11, 2020
Functional gastrointestinal disorders, redefined as disorders of gut–brain interaction, are a complex and incompletely understood group of more than 30 chronic conditions, categorised by anatomical location, and diagnosed by standardised criteria. These conditions affect up to 40% of people at any given time, and frequently overlap. More than two-thirds of people will have seen a doctor in the preceding 12 months, 40% use regular medication, and one-in-three will have had potentially unnecessary abdominal surgery for their symptoms, such as hysterectomy or cholecystectomy. Functional gastrointestinal disorders also impact considerably on social functioning and quality of life. They therefore represent a substantial burden to health services, patients, and society as a whole. General principles of treatment are based on a biopsychosocial understanding, with future treatment approaches likely to become more personalised, based on symptoms, pathophysiology, and psychology.
The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion
The Lancet
Published: September 14, 2020
Leading global health and development institutions continue to view non-communicable diseases (NCDs) predominantly through the lens of epidemiological transitions, wherein NCDs are best understood in terms of ageing, urbanisation, lifestyle choices, and affluence. This narrow framing is expressed through the so-called 5 x 5 model, favoured by WHO, of five diseases (cardiovascular disease, cancer, diabetes, chronic respiratory diseases, and mental ill-health) and five risk factors (tobacco use, unhealthy diets, physical inactivity, harmful use of alcohol, and air pollution), and is enshrined in Sustainable Development Goals target 3.4 on reducing NCD mortality.
A future for the world’s children?
A WHO-UNICEF-Lancet Commission
The Lancet
Published: February 18, 2020
The health and wellbeing of children now and in the future depends on overcoming new challenges that are escalating at such speed as to threaten the progress and successes of the past two decades in child health. The climate emergency is rapidly undermining the future survival of all species, and the likelihood of a world in which all children enjoy their right to health appears increasingly out of reach. A second existential threat that is more insidious has emerged: predatory commercial exploitation that is encouraging harmful and addictive activities that are extremely deleterious to young people’s health.