Sinusoidal obstruction syndrome (SOS), better known as veno-occlusive disease, is a serious and life-threatening complication that mainly occurs after high-dose myeloablative conditioning therapy and haemopoietic stem-cell transplantation (HSCT). The disease can affect about 20% of such patients and is characterised clinically by increased serum bilirubin concentrations, tender hepatomegaly, fluid retention, and weight gain. Liver injury occurs early after transplantation and results in occluded venules, sinusoidal fibrosis, and hepatocyte necrosis.

Defibrotide prophylaxis seems to reduce incidence of veno-occlusive disease and is well tolerated. Thus, such prophylaxis could present a useful clinical option for this serious complication of HSCT.

Adverse drug events1 are a major problem for patient safety. A systematic review estimated that 18 adverse drug events per 100 outpatients, including almost seven preventable events, occur yearly.2 Preventable adverse drug events are caused by errors such as inappropriate prescription, medication discrepancies, non-adherence, and failure to monitor for side-effects or disease control. More than 20 years of research into medication safety has shown the efficacy of several interventions, including computer provider order entry, electronic decision support, and some pharmacist interventions.

Acute ST-elevation myocardial infarction (STEMI) is a major cause of cardiac death. In the late 1970s, Rentrop and colleagues1 used intracoronary delivery of a thrombolytic agent to dissolve the occlusive thrombus and re-establish coronary flow, after which intravenous thrombolysis became the standard of care. Use of primary percutaneous coronary intervention has grown rapidly because of evidence that it is more effective than thrombolysis alone. Potent antithrombotic agents such as platelet glycoprotein IIb–IIIa inhibitors, including abciximab, have increased the options available to interventional cardiologists.

The PINCER intervention is an effective method for reducing a range of medication errors in general practices with computerised clinical records.

In patients with STEMI undergoing primary percutaneous coronary intervention, intracoronary as compared to intravenous abciximab did not result in a difference in the combined endpoint of death, reinfarction, or congestive heart failure. Since intracoronary abciximab bolus administration is safe and might be related to reduced rates of congestive heart failure the intracoronary route might be preferred if abciximab is indicated.

I concur with Richard Horton's observation that the key message to be drawn from the study on malaria mortality by Christopher Murray and colleagues,1 from the Institute of Health Metrics and Evaluation at the University of Washington in Seattle, is that “donor investments into the Global Fund over the past decade have produced astonishing results. Hundreds of thousands of lives have been saved thanks to the distribution of insecticide-treated bednets and antimalarial drugs.”2

We are writing as paediatricians and members of the UK's Royal College of Paediatrics and Child Health to call for England's Health and Social Care Bill to be withdrawn. If passed, we believe that the Bill will have an extremely damaging effect on the health care of children and their families and their access to high-quality, effective services. We see no prospect for improvement to the Bill sufficient to safeguard the rights of access to health care by children and their families. In our view, no adequate justification for the Bill has been made.

Valid, reliable, comparable, and timely statistics for levels, trends, and inequalities in morbidity and mortality by cause are essential to monitor progress towards improvements in population health, and to plan the delivery of health services. In The Lancet, Michael Baker and colleagues1 describe trends and inequalities in hospital admissions for infectious and non-infectious diseases by cause between 1989 and 2008. With use of a national hospital database in New Zealand, the investigators noted a relative increase of 51·3% in the age-standardised rate of hospital admissions for infectious diseases from 1989–93 to 2004–08, with the greatest increase noted in the indigenous Māori (age-standardised rate ratio 2·15, 95% CI 2·14–2·16) and Pacific peoples (2·35, 2·34–2·37) compared with those of European or other ethnic grouping; and in the most socioeconomically deprived quintile (2·81, 2·80–2·83) compared with the least deprived quintile.

The latest alcohol-related harm statistics from the UK's Office of National Statistics (ONS) were released on Jan 26, 2012,1 and provide an opportunity to re-evaluate the projections of alcohol-related liver deaths that we previously reported in this journal with 2008 data.2 Using the standard ONS definition,3 alcohol-related liver deaths in England and Wales fell from 6470 in 2008 to 6230 in 2009, but then increased again to 6317 in 2010.4 These data do not include the wider spectrum of alcohol attributable mortality, which would also include acute deaths from accidents, violence, and suicide or from chronic diseases, such as hypertension, stroke, cardiovascular disease, and cancers of the breast and gastrointestinal tract.

These findings support the need for stronger prevention efforts for infectious diseases, and reinforce the need to reduce ethnic and social inequalities and to address disparities in broad social determinants such as income levels, housing conditions, and access to health services. Our method could be adapted for infectious disease surveillance in other countries.

Hepatocellular carcinoma is the sixth most prevalent cancer and the third most frequent cause of cancer-related death. Patients with cirrhosis are at highest risk of developing this malignant disease, and ultrasonography every 6 months is recommended. Surveillance with ultrasonography allows diagnosis at early stages when the tumour might be curable by resection, liver transplantation, or ablation, and 5-year survival higher than 50% can be achieved. Patients with small solitary tumours and very well preserved liver function are the best candidates for surgical resection.

The passage of England's Health and Social Care Bill has been highly controversial and unusually prolonged owing to extraordinary public, professional, and parliamentary concern. On Feb 8, 2012, the Bill entered the House of Lords report stage. By this date, 301 amendments had been tabled to the Bill to be moved at report stage; of these, 165 (mainly government) amendments were tabled on Feb 1. This excess of amendments in itself raises serious issues about the processes to ensure the robustness of parliamentary scrutiny.

In The Lancet, Patricia García and colleagues1 report results of the Peru PREVEN study. In this large community-randomised trial, investigators matched 20 Peruvian cities (total population 2·9 million) into ten pairs to compare the effects of a multicomponent intervention for sexually transmissible infections (STIs) over 3 years. As countries of low and middle income continue to urbanise, the inclusion of cities with different socioeconomic profiles in this trial is advantageous.

Between a quarter and a third of young women in sub-Saharan Africa are infected with HIV by the time they reach their early 20s. Structural factors such as poor education, poverty, and gender and power inequalities are important determinants of young women's vulnerability to HIV infection.1,2 However, until now, no rigorously assessed intervention targeting this group has significantly reduced HIV infection and no intervention that targets structural factors has directly affected HIV infection.3,4 In The Lancet, Sarah Baird and colleagues5 report the results of a randomised controlled trial done with adolescent girls in rural Malawi, examining the effects of a cash transfer programme on risk of HIV infection.

Cash transfer programmes can reduce HIV and HSV-2 infections in adolescent schoolgirls in low-income settings. Structural interventions that do not directly target sexual behaviour change can be important components of HIV prevention strategies.

Syndromic management of STIs, mobile-team outreach to FSWs, presumptive treatment for trichomoniasis in FSWs, and condom promotion might reduce the composite prevalence of any of the four curable STIs investigated in this trial.

In the past few decades, improved survival has been reported in patients after acute myocardial infarction.1 Unfortunately, many of these patients develop heart failure despite use of present treatments to prevent progressive left ventricular remodelling after initial myocardial infarction.2 As a result, cardiac stem cell therapies that use autologous bone marrow-derived cells or skeletal myoblasts have been investigated as potential treatments for acute3 and chronic4,5 ischaemic cardiomyopathy (figure).

We show intracoronary infusion of autologous CDCs after myocardial infarction is safe, warranting the expansion of such therapy to phase 2 study. The unprecedented increases we noted in viable myocardium, which are consistent with therapeutic regeneration, merit further assessment of clinical outcomes.

A decline in the productivity of the National Health Service (NHS) in England over the past decade has become a widely accepted fact. In March, 2011, Margaret Hodge, chair of the UK parliamentary Public Accounts Committee and a member of the government during the period in question, asserted that “over the last 10 years, the productivity of NHS hospitals [in the UK] has been in almost continuous decline”.1 Not surprisingly, this highly critical assessment was readily supported by the Secretary of State for Health, Andrew Lansley, who claimed there had been “a 15% reduction in productivity” in the previous year.

Burkitt's lymphoma is a highly aggressive B-cell non-Hodgkin lymphoma and is the fastest growing human tumour. The disease is associated with Epstein-Barr virus and was one of the first tumours shown to have a chromosomal translocation that activates an oncogene (c-MYC). Burkitt's lymphoma is the most common childhood cancer in areas where malaria is holoendemic. The incidence is very high in immunosuppressed patients in non-endemic areas, especially when associated with HIV infection. Outcome with intensive chemotherapy has improved and is now excellent in children, but the prognosis is poor in elderly adults.

A 32-year-old man presented to the emergency department with 1-month history of continuous chest pain, which was worse with movement and on application of pressure to the anterior chest wall. Physical examination showed a pustule on the sole of his left foot (figure A) and multiple pustules on his palms (figure B). Blood analysis, chest radiography, and ECG results were normal. Microscopy and culture for bacteria of the pustules was negative, as was serology for Treponema pallidum and HIV. Immunological tests were done, but no abnormalities were found.

Early identification and management of disease risk is essential to sustain health and quality of life. Several algorithms have been developed to calculate an individual's risk of coronary heart disease, including the Framingham and the Reynolds risk scores, but these have restricted use in identification of risk for both men and women. Sex-specific determination of risk is crucial in view of the validated sexual dimorphism in incidence, age of onset, progression, treatment efficacy, and morbidity and mortality for coronary artery disease.

The human Y chromosome is associated with risk of coronary artery disease in men of European ancestry, possibly through interactions of immunity and inflammation.

The rising proportional contribution of neonatal mortality to deaths in childhood has featured in international health policy discussions for more than a decade. Low-income and middle-income countries bear the burden of 99% of global neonatal deaths.1 Many infants—perhaps 60 million every year—are born at home.2 Infections account for an estimated 30% of neonatal deaths,1 and the umbilical cord is recognised as a potential entry point for infection, especially in the first few days of life. WHO and UNICEF recommend that newborn babies are visited at home in the first week of life to ensure healthy neonatal care practices, including hygienic cord care.

Chlorhexidine cleansing of a neonate's umbilical cord can save lives, but further studies are needed to establish the best frequency with which to deliver the intervention.

Application of 4% CHX to the umbilical cord was effective in reducing the risk of omphalitis and neonatal mortality in rural Pakistan. Provision of CHX in birth kits might be a useful strategy for the prevention of neonatal mortality in high-mortality settings.

Despite improvements in medical and surgical therapies, infective endocarditis is associated with poor prognosis and remains a therapeutic challenge. Many factors affect the outcome of this serious disease, including virulence of the microorganism, characteristics of the patients, presence of underlying disease, delays in diagnosis and treatment, surgical indications, and timing of surgery. We review the strengths and limitations of present therapeutic strategies and propose future directions for better management of endocarditis according to the most recent research.

Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction that is only partly reversible, inflammation in the airways, and systemic effects or comorbities. The main cause is smoking tobacco, but other factors have been identified. Several pathobiological processes interact on a complex background of genetic determinants, lung growth, and environmental stimuli. The disease is further aggravated by exacerbations, particularly in patients with severe disease, up to 78% of which are due to bacterial infections, viral infections, or both.

The safety scare over Poly Implant Prostheses (PIP) has generated heated discussion about cosmetic surgery, private and public responsibilities, and device regulation.1 What has been absent from this debate, however, are the implications for the National Health Service (NHS) and the UK Government of dealing with medical tourists—people who travel to, or out of, the UK to receive medical treatment using out-of-pocket payment. About 300 000 PIP implants have been sold to 65 countries,2 and Europe has been a major market.

Although suicide is a devastating and tragic event, it is a relatively rare one. Every year in England and Wales, roughly one suicide occurs per 1000 patients in treatment with mental health providers, the group at greatest risk.1 Yet one suicide death is too many, leaving in its wake a legacy of pain and traumatic grief. Reduction, and even elimination, of suicide deaths is a high public health and clinical priority.

Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with substantial present and future morbidity, and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress.

Our findings suggest that aspects of provision of mental health services can affect suicide rates in clinical populations. Investigation of the relation between new initiatives and suicide could help to inform future suicide prevention efforts and improve safety for patients receiving mental health care.

Excellent progress has been made in patients' survival after burn injury during the past five decades. Since the first study in 1949,1 the likelihood of survival has improved substantially, with the last major analysis in 19982 showing that the major determinants of mortality are age older than 60 years and, for all ages, burn size greater than 40% of total body surface area (TBSA) and presence of direct injury to the lung (eg, inhalation injury). The increase in likelihood of survival at all ages, but particularly in children, has largely resulted from early surgical excision of the burn then immediate closure of the wound with the patient's own skin or other biological materials.

We established that, in a modern paediatric burn care setting, a burn size of roughly 60% TBSA is a crucial threshold for postburn morbidity and mortality. On the basis of these findings, we recommend that paediatric patients with greater than 60% TBSA burns be immediately transferred to a specialised burn centre. Furthermore, at the burn centre, patients should be treated with increased vigilance and improved therapies, in view of the increased risk of poor outcome associated with this burn size.

On Jan 21, 2012, the UK's Department for International Development announced a fivefold increase in its support for programmes to control neglected tropical diseases (NTDs). The Department's press release1 claimed that the new funding will initially provide 400 million treatments to protect 100 million people from lymphatic filariasis, and to help save 10 million lives that would otherwise be lost to schistosomiasis. Onchocerciasis and dracunculiasis are also to be targeted. Last week, Bill Gates came to London to help renew and expand global commitments.

In The Lancet, Christopher Clark and colleagues1 present data from a systematic review and meta-analysis assessing the available evidence linking differences in blood pressure between arms with both central and peripheral vascular disease. They establish that systolic differences of at least 15 mm Hg are associated with an increased risk of peripheral vascular disease (relative risk 2·5, 95% CI 1·6–3·8) and report weaker but significant associations with cerebrovascular disease and mortality. When subclavian stenoses are angiographically proven, Clark and co-workers estimate that the mean difference in blood pressure between arms is 36·9 mm Hg (95% CI 35·4–38·4), and rates of subclavian stenosis are high when differences are present.

A difference in SBP of 10 mm Hg or more, or of 15 mm Hg or more, between arms might help to identify patients who need further vascular assessment. A difference of 15 mm Hg or more could be a useful indicator of risk of vascular disease and death.

A 5-year-old boy affected with homozygous familial hypercholesterolaemia, diagnosed aged 1 year, was referred to us after having an acute ischaemic cardiac event. He presented with an LDL-cholesterol concentration of 26 mmol/L, and tendon xanthomas at the wrists, knees, and achilles (figure A–C). He had been treated with colestyramine. Coronary angiography showed a complete obstruction of the left coronary artery (figure D; see also webvideo) and a partial obstruction of the right coronary artery, which required stent placement.

In 2010, an estimated 7·6 million children died before their fifth birthday, and more than a million of these deaths were due to pneumonia.1 Although progress is being made in expanding the use of vaccines to prevent pneumonia, many countries have yet to introduce these vaccines, especially the pneumococcal vaccine.2 Correct breastfeeding of children can also help prevent pneumonia deaths, but a high prevalence of suboptimum breastfeeding practices (eg, low rates of exclusive breastfeeding up to 6 months of age) is seen in all regions of the world.

Our practical, quantitative-PCR-based assay reliably identified patients with early-stage non-squamous NSCLC at high risk for mortality after surgical resection.

Public sector LHWs in Pakistan were able to satisfactorily diagnose and treat severe pneumonia at home in rural Pakistan. This strategy might effectively reach children with pneumonia in settings where referral is difficult, and it could be a key component of community detection and management strategies for childhood pneumonia.

In The Lancet, Steven Schwartz and colleagues1 report the first clinical experience of patients treated with cells derived from human embryonic stem cells (hESCs). A patient with Stargardt's macular dystrophy, the most common paediatric macular degeneration, and a patient with dry age-related macular degeneration, the leading cause of blindness in the developed world, each received a subretinal injection of hESC-derived retinal pigment epithelium (RPE). Both disorders are at present thought untreatable and are associated with degeneration of the RPE, which leads to photoreceptor loss and progressive vision deficiency.

Low-risk prostate cancer is a major public health issue in those countries that have embraced prostate-specific antigen screening. Up to one in five American men will be diagnosed with prostate cancer.1 Most of these men will have low-risk disease, meaning an impalpable, low-grade tumour with a prostate-specific antigen concentration of less than 10 ng/mL. Active surveillance provides a period of observation to help men with low-risk disease decide whether or not to be treated.2 Repeated biopsy sampling is used to monitor the cancer, with detection of higher-grade disease used as an indication for radical intervention.

Dutasteride could provide a beneficial adjunct to active surveillance for men with low-risk prostate cancer.

The hESC-derived RPE cells showed no signs of hyperproliferation, tumorigenicity, ectopic tissue formation, or apparent rejection after 4 months. The future therapeutic goal will be to treat patients earlier in the disease processes, potentially increasing the likelihood of photoreceptor and central visual rescue.

Subclinical thyroid diseases—subclinical hyperthyroidism and subclinical hypothyroidism—are common clinical entities that encompass mild degrees of thyroid dysfunction. The clinical significance of mild thyroid overactivity and underactivity is uncertain, which has led to controversy over the appropriateness of diagnostic testing and possible treatment. In this Seminar, we discuss the definition, epidemiology, differential diagnoses, risks of progression to overt thyroid disease, potential effects on various health outcomes, and management of subclinical hyperthyroidism and subclinical hypothyroidism.

Ultimately, all therapeutic decisions involve balancing the potential clinical benefits of a drug against the risks that it might confer. In the management of bipolar disorder, trial data1 which have re-established the efficacy of lithium in prophylaxis have refocused attention on understanding its tolerability profile. Clinical interest in lithium has further heightened because the substantial risks that ensue from the metabolic syndrome have become apparent with newer alternatives, particularly atypical antipsychotics such as olanzapine.

Insomnia is a prevalent complaint in clinical practice that can present independently or comorbidly with another medical or psychiatric disorder. In either case, it might need treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence. BzRAs are readily available and effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce and most hypnotic drugs are associated with potential adverse effects.

Lithium is associated with increased risk of reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism, and weight gain. There is little evidence for a clinically significant reduction in renal function in most patients, and the risk of end-stage renal failure is low. The risk of congenital malformations is uncertain; the balance of risks should be considered before lithium is withdrawn during pregnancy. Because of the consistent finding of a high prevalence of hyperparathyroidism, calcium concentrations should be checked before and during treatment.

In October, 2010, a 38-year-old woman presented with creeping sensation in her right eye, but without any systemic or visual symptoms. Her medical history was notable only for an unknown insect flying into her right eye during farm work about 3 months earlier. On examination, a live worm was seen moving out from the nasal upper eyelid of the right eye above the conjunctiva (figure A). This was further viewed with anterior segment optical coherence tomography (figure B). When proxymetacaine eye-drops were administered, preparing the eye for surgical exploration, more than two worms were seen moving (figure C, D).

The 41 authors of the Correspondence on the effect of population-based screening on breast cancer mortality (Nov 19, p 1775)1 defend screening by reference to majority and authority. They look only for the benefits of screening and not its harms, and the only scientific claim—that women with screen-detected breast cancer have half the mastectomy rate of women with symptomatic cancers—is seriously misleading. Obviously, cancers detected between rounds are more aggressive than screen-detected ones.

In July, 2010, a 14-year-old boy was admitted to hospital with cyanosis and progressive dyspnoea. Physical examination showed severe symptoms of heart failure. He had well established endocardial fibroelastosis, following postnatal surgical correction of coarctation of the aorta and balloon valvuloplasty for high-grade aortic valve stenosis. In December, 2010, because of worsening congestive heart failure, the patient was categorised as high priority for cardiac transplantation; transplantation was successfully done at the end of the month.

In this Seminar we discuss developments from the past 5 years in the diagnosis, neurobiology, and treatment of major depressive disorder. For diagnosis, psychiatric and medical comorbidity have been emphasised as important factors in improving the appropriate assessment and management of depression. Advances in neurobiology have also increased, and we aim to indicate genetic, molecular, and neuroimaging studies that are relevant for assessment and treatment selection of this disorder. Further studies of depression-specific psychotherapies, the continued application of antidepressants, the development of new treatment compounds, and the status of new somatic treatments are also discussed.

Myocarditis is an underdiagnosed cause of acute heart failure, sudden death, and chronic dilated cardiomyopathy. In developed countries, viral infections commonly cause myocarditis; however, in the developing world, rheumatic carditis, Trypanosoma cruzi, and bacterial infections such as diphtheria still contribute to the global burden of the disease. The short-term prognosis of acute myocarditis is usually good, but varies widely by cause. Those patients who initially recover might develop recurrent dilated cardiomyopathy and heart failure, sometimes years later.

In the latest UK Report of the Confidential Enquiries into Maternal Deaths (the CMACE report),1 20 out of 22 deaths related to pre-eclampsia involved substandard care—a disturbing statistic that is higher than for any other cause of maternal death. The substandard care in 63% of these deaths was categorised as major and they were described as “undoubtedly avoidable”. Hypertensive diseases accounted for 17·8% of all direct maternal deaths, an increase in frequency since the last triennial report, while overall death rates have reduced.

5 years ago, the foreign ministers of Brazil, France, Indonesia, Norway, Thailand, Senegal, and South Africa, launched the Global Health and Foreign Policy Initiative1 in recognition of the central importance of health and its connection to multiple global governance processes. In many ways, protecting and enhancing the health of its population is one of the most important goals and duties of any state. With globalisation and increased interdependency among countries, health issues have become even more central to states' interests.

We explored trends in six developed countries in three types of indicators of child maltreatment for children younger than 11 years, since the inception of modern child protection systems in the 1970s. Despite several policy initiatives for child protection, we recorded no consistent evidence for a decrease in all types of indicators of child maltreatment. We noted falling rates of violent death in a few age and country groups, but these decreases coincided with reductions in admissions to hospital for maltreatment-related injury only in Sweden and Manitoba (Canada).

Catholic nuns are committed to leading a celibate, spiritual life in a monastery or convent. In 1713, Italian physician Bernadino Ramazzini1 noted that nuns had an extremely high incidence of that “accursed pest”, breast cancer. Today, the world's 94 790 nuns still pay a terrible price for their chastity because they have a greatly increased risk of breast, ovarian, and uterine cancers: the hazards of their nulliparity.

Use of antiretroviral drugs to prevent sexual transmission of HIV-1 has been a critical priority since their development. In the past 2 years results from seven important prevention trials have been reported (table). One of the trials, HPTN 052,1 showed nearly complete prevention of HIV transmission when viraemia was suppressed. The other studies focused on antiretroviral agents for pre-exposure prophylaxis: two used 1% tenofovir gel (CAPRISA 0042 and VOICE3), four used oral tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) in combination (iPrEX,4 TDF2,5 Partners in Prevention [PIP],6 and Fem-PrEP7), and two used oral TDF alone (VOICE3 and PIP6).

China's aims are to develop an ethical and sustainable organ transplantation system for the Chinese people and to be accepted as a responsible member of the international transplantation community. In 2007, China implemented the Regulation on Human Organ Transplantation, which was the first step towards the establishment of a voluntary organ donation system. Although progress has been made, several ethical and legal issues associated with transplantation in China remain, including the use of organs from executed prisoners, organ scarcity, the illegal organ trade, and transplantation tourism.

Major earthquakes are some of the most devastating natural disasters. The epidemiology of earthquake-related injuries and mortality is unique for these disasters. Because earthquakes frequently affect populous urban areas with poor structural standards, they often result in high death rates and mass casualties with many traumatic injuries. These injuries are highly mechanical and often multisystem, requiring intensive curative medical and surgical care at a time when the local and regional medical response capacities have been at least partly disrupted.

Before effective treatment for tuberculosis became available thousands of people spent time in sanatoria (figure) in the hope of a cure through fresh air, sunlight, adequate nutrition, and micronutrients such as calcium.1 Surgical techniques to promote part or complete lung collapse (eg, artificial pneumothorax, plombage, and thoracoplasty) were also used.1 Although no controlled studies have established the effectiveness of these interventions, the existence of sanatoria led to long-term removal of infectious patients from the community.

Deficiencies in access to surgical care in low-income and middle-income countries are well recognised. Despite the awareness and benchmarks generated by the Millennium Development Goals,1 most sub-Saharan African nations have a negative annual growth rate in the number of physicians compared with their population growth rate.2 In several sub-Saharan African nations, there are only 0·9 physicians per 1000 population, compared with 21 physicians per 1000 population in the UK and 28 per 1000 population in the USA.

In an increasingly globalised world, medical schools need to establish and enhance global health education to ensure that all doctors have the relevant knowledge, skills, and behaviour to practise safely and effectively in their home country. The Global Health Learning Outcomes Working Group, comprised of 12 UK academics, students, and representatives of civil society with expertise in global health and medical education, developed a list of recommended global health competencies for medical students.

The demand for better coordination and control is heard during and after every major international disaster. We now have the potential framework to meet this demand and we should respond. The World Health Assembly altered WHO's role in disasters after the outbreak of severe acute respiratory syndrome with the 2005 International Health Regulations (IHR) Treaty.1 WHO changed from a mainly passive responder during short-term infectious disease crises to an unprecedented active authority with a mandate to address long-term prevention, preparedness, and response roles and responsibilities.

The year 2011 marks the 150th anniversary of the reunification of Italy. The struggle for unification—or the Risorgimento as it is now remembered—had been long and hard. It began in 1815, after the Congress of Vienna, which followed the Revolutionary and Napoleonic wars, and it culminated in the declaration of the Kingdom of Italy on March 17, 1861.1 But even that was not the end: it took another 10 years of wars and diplomatic manoeuvrings for Venice and Rome, capital of the sovereign Papal States for more than 1000 years, to be incorporated into the new kingdom.

Just as pregnancy is one of many experiences in a woman's life, reproductive health is only one crucial aspect of women's health. Despite the many challenges women face worldwide, with a disproportionate burden in low-income countries, the public health community too often uses only reproductive health indicators when measuring progress in women's health. This practice is shown most recently in the work of the UN Commission on Information and Accountability for Women's and Children's Health, the recommendations of which have the potential to shape how low-income countries collect data and report progress for years to come.

Non-communicable diseases (NCDs)—including cardiovascular diseases, chronic respiratory diseases, cancer, and diabetes—account for about 60% of global deaths, mostly in countries of low or middle income. Tobacco use accounts for a sixth of these deaths.1

The need to improve the status and unleash the potential of women and girls worldwide is increasingly recognised as a moral and a developmental imperative. Within this broad focus of renewed global attention and commitment,1,2 the health of women and children has once again emerged as a top priority.2 In the context of the refreshed pledges, new strategic approaches are needed to move the unfinished agenda on women forward. In one such response, the Harvard School of Public Health has launched a worldwide effort called the Women and Health Initiative.

In 2008, 36 million people died from non-communicable diseases (NCDs).1 By 2020, NCDs are projected to cause almost three quarters as many deaths as communicable, maternal, perinatal, and nutritional diseases, and by 2030 to exceed them as the most common causes of death.2 On Sept 19, 2011, the UN will take an important step towards modification of the future course of NCDs at the High-level Meeting on Non-communicable Diseases. As concerned leaders in government and civil societies working on NCDs, we call for our political leaders to use this opportunity as a bold beginning to transform global strategies on NCDs.

The NCD Alliance1 aims to put non-communicable diseases (NCDs) on the global agenda to address the NCD crisis. Improving outcomes in morbidity and mortality by 2015 will clearly depend to a large extent on tackling the burden of NCDs, especially in developing countries.2

In 2009, according to the Japanese Ministry of Health, Labour, and Welfare, 30 707 people (24·4 per 100 000) committed suicide in Japan.1 Since 1998, when the suicide rate peaked at 31 755 (from 23 494 in 1997), the rate has remained higher than 30 000 per year, thus posing a serious and urgent challenge for Japanese society. Tellingly, the changes in the unemployment and suicide rates have been similar.2 The figure shows the change in suicide and unemployment rates from 1985 to 2009. Suicide rates were significantly correlated with unemployment rates (p<0·0001).

Following the passage of the Health and Social Care Bill, almost all of the English National Health Service (NHS) budget will be spent in a competitive market, via commissioning processes subject to EU competition law, with competitive tendering by “qualified providers”.1 But who will these providers be?

As the winds of social and political change sweep across the Middle East, Qatar has become a beacon of stability and rational discourse. Qatar National Vision 20301—a long-term national leadership strategy—was launched in 2008 and provides the framework for transforming Qatar into an advanced society by achieving major milestones in human, social, economic, and environmental development. As part of this process, Qatar's education system has undergone changes with the introduction of international universities and academic programmes by the Qatar Foundation for Education, Science, and Community Development.

This Comment is a précis of my David E Barmes Global Health Lecture at the National Institutes of Health, Bethesda, MD, USA, on Feb 15, 2011.1