Medical Journal News

The fact that our homes are inextricably linked to our health is not new. “One might have imagined that science and common sense would by now have appreciated the importance of such considerations” reads a letter on housing and health, published in The Lancet in 1922. Access to adequate housing is recognised as a fundamental human right under law. Why then do we continue to allow so many people to live in unhealthy housing conditions? The UN Statistics Division estimated that in 2022, more than 1 billion people lived in urban slums or slum-like conditions, with this figure expected to triple by 2050.

Amblyopia, a neural disorder induced by atypical visual experiences during the crucial period of visual development, affects 2–5% of the global population.1 Despite its prevalence, an optimal treatment protocol remains elusive. Issues, such as poor compliance, challenge the ability to attain an ideal outcome through patching, a primary treatment for amblyopia.2 These challenges have led to the fact that, in traditional strategies, patients with amblyopia usually undergo extended optical treatment (EOT) first to lessen the amount of subsequent patching for a better therapeutic experience.

St Margaret's Church, Westminster Abbey. A service of thanksgiving for the life and work of Professor Roger Greenhalgh. Amid the hymns and bible readings, family and former colleagues remembered the life of this unusual vascular surgeon—a man who cared about whether the techniques he was applying to patients had any evidence to support them at all. As I say, unusual. The Reverend Canon presiding over the event, Ralph Godsall, called Greenhalgh's work “pioneering”. It was. The Lancet had the privilege of publishing some of his most important randomised trials (eg, EVAR 1).

A steep rise in indefinite placement or threat of placement in psychiatric facilities as a means of political repression has been reported. By Ed Holt.

TRANSFORM will recruit hundreds of thousands of men in an effort to identify the most effective screening strategies for prostate cancer. Talha Burki reports.

Countries need to take stronger measures to identify and prosecute perpetrators behind attacks on health-care and aid settings. John Zarocostas reports.

Adolescence is a time of remarkable change and development across physical, cognitive, social, and emotional spheres. Many decisions are taken in adolescence that can influence that individual's life course, such as what occupation they want to pursue, what relationships they want to cultivate, or what interests they want to invest in. But are today's adolescents struggling more than previous generations? In many high-income settings, an increasing number of adolescents are being referred for mental health support.

Writer Camilla Whitehill's ambitions for her new mental-health-themed sitcom Big Mood are straightforward: “I just want people to think it's funny and I want them to like the characters.” With this six-episode series, she has overachieved. Big Mood is frequently laugh-out-loud funny, and the characters are brilliantly drawn and charismatically played. But there is much, much more to this show.

Orthopaedic surgeon and emergency medicine physician. Born in Hatfield, UK, on Jan 5, 1951, he died of a neurodegenerative disease in Oxford, UK, on Dec 7, 2023, aged 72 years.

The oversupply of opioids at hospital discharge presents an opportunity to improve opioid prescribing and patient safety. Studies have shown 67–92% of adult patients reporting receiving excess opioids after surgery discharge, with 42–71% of dispensed tablets unused.1 A minority of patients plan to or actually dispose of unused opioids and even fewer do so by recommended methods,1 increasing the risk of accidental exposure and harm, opioid diversion, and misuse.

In Jessamy Bagenal and colleagues' Comment on surgical research,1 important advancements are acknowledged, but there are additional points that warrant attention.

The Lancet Commission on global surgery reported that the poorest third of the world's population undergoes just 6% of the approximately 313 million major operations performed annually.1 This gap not only denotes vast morbidity and millions of potentially preventable deaths, but also highlights deep-rooted global surgical inequities. Compounded by the challenges of the COVID-19 pandemic,2 these inequities necessitate an immediate, concerted call to action.

In the Lancet Series on the commercial determinants of health, authors warn that policy inertia is enabling the products and practices of some commercial actors to cause substantial harms to health.1 In the digital environment, the actions of commercial actors (including those involved in social media, information and communications technology, and digital health solutions, to name just a few) are contributing both directly and indirectly to health and wellbeing.2

In the 2023 Lancet Series on work and health, the authors describe the risks to mental and physical health from stressful working conditions, such as job strain, workplace bullying, and long working hours. Putting this evidence into a wider context by examining the impact of a stressful work environment alongside lifestyle-related factors on ill-health is important.1

We applaud the 2023 Lancet Series on work and health for drawing attention to the under-recognised aspects of work that make it a fundamental social determinant of health inequalities. We particularly appreciate the Series authors' attention to the low-wage workforce and their expressed concerns about precarity. At the same time, we must also be attuned to the widespread practice of labour exploitation, including extreme exploitation such as human trafficking and hazardous child labour. An estimated 21 million people are in trafficking, bonded, or slave labour situations.

We read with great interest the Lancet Series paper on work-related mental health problems by Reiner Rugulies and colleagues.1 This Series paper was a wake-up call for low-income and middle-income countries (LMICs) to promote a society in which mental health is a universal human right.

Charlotte E Coles and colleagues1 discuss the latest results from the IMPORT HIGH research, a phase 3 randomised trial that assessed three hypofractionated radiation treatments for efficacy and safety. Most patients were scanned while free breathing, with deep-inspiratory breath-hold techniques implemented only at the end of the trial. This may have biased experimental results. In ischaemic heart disease, pneumonia, and pulmonary fibrosis, considerable delayed unfavourable consequences show the possibility for variance.

We read the Article by Charlotte E Coles and colleagues1 with great interest. The use of hypofractionated simultaneous integrated boost (SIB) radiotherapy with a 48 Gy dose in 15 fractions to the tumour bed showed non-inferiority in ipsilateral local relapse compared with sequential boost. In addition, the lower number of treatments for SIB (15) versus sequential boost (23) have a positive effect on the patients themselves and on the health-care system. To achieve dose localisation, an intensity modulated radiotherapy (IMRT) technique was allowed in this study.

The excellent results of the IMPORT HIGH trial,1 published with more than 6 years of median follow-up, suggest that this treatment is adequate for all patients with breast cancer. In the boost versus no boost trial, the risk of relapse at 5 years of follow-up with 66 Gy to the tumour bed was around 3%, which increased to 6·2% at 10 years. But in young patients (aged 41–50 years) the risk of relapse reached 8·7% at 10 years,2 and for those younger than 41 years it was 13·5% at 10 years. These statistics rose to 13·5% and 24·4% at 20 years, respectively.

We thank the IMPORT HIGH trial1 authors for conducting a well designed randomised controlled trial comparing whole-breast radiotherapy with a sequential boost versus two simultaneous integrated boost (SIB) protocols, one with a normal and one with a dose-escalated boost dose. Oncological outcomes were comparable and late toxicity was low; however, more breast induration was detected in the dose-escalated SIB group.