The Lancet

Michael S Hofman,Louise Emmett,Shahneen Sandhu,Amir Iravani,Anthony M Joshua,Jeffrey C Goh,David A Pattison,Thean Hsiang Tan,Ian D Kirkwood,Siobhan Ng,Roslyn J Francis,Craig Gedye,Natalie K Rutherford,Andrew Weickhardt,Andrew M Scott,Sze-Ting Lee,Edmond M Kwan,Arun A Azad,Shakher Ramdave,Andrew D Redfern,William Macdonald,Alex Guminski,Edward Hsiao,Wei Chua,Peter Lin,Alison Y Zhang,Margaret M McJannett,Martin R Stockler,John A Violet,Scott G Williams,Andrew J Martin,Ian D Davisfor the TheraP Trial Investigators and the Australian and New Zealand Urogenital and Prostate Cancer Trials Group

doi : 10.1016/S0140-6736(21)00237-3

VOLUME 397, ISSUE 10276, P797-804, FEBRUARY 27, 2021

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Impact and cost-effectiveness of a lethal house lure against malaria transmission in central Côte d'Ivoire: a two-arm, cluster-randomised controlled trial

Eleanore D Sternberg,Jackie Cook,Ludovic P Ahoua Alou,Serge Brice Assi,Alphonsine A Koffi,Dimi T Doudou,Carine J Aoura,Rosine Z Wolie,Welbeck A Oumbouke,Eve Worrall,Immo Kleinschmidt,Raphael N'Guessan,Matthew B Thomas

doi : 10.1016/S0140-6736(21)00250-6

VOLUME 397, ISSUE 10276, P805-815, FEBRUARY 27, 2021

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Effectiveness and cost-effectiveness of reactive, targeted indoor residual spraying for malaria control in low-transmission settings: a cluster-randomised, non-inferiority trial in South Africa

David Bath,Jackie Cook,John Govere,Phillemon Mathebula,Natashia Morris,Khumbulani Hlongwana,Jaishree Raman,Ishen Seocharan,Alpheus Zitha,Matimba Zitha,Aaron Mabuza,Frans Mbokazi,Elliot Machaba,Erik Mabunda,Eunice Jamesboy,Joseph Biggs,Chris Drakeley,Devanand Moonasar,Rajendra Maharaj,Maureen Coetzee,Catherine Pitt,Immo Kleinschmidt

doi : 10.1016/S0140-6736(21)00251-8

VOLUME 397, ISSUE 10276, P816-827, FEBRUARY 27, 2021

Increasing insecticide costs and constrained malaria budgets could make universal vector control strategies, such as indoor residual spraying (IRS), unsustainable in low-transmission settings. We investigated the effectiveness and cost-effectiveness of a reactive, targeted IRS strategy.

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Testicular cancer with neurological symptoms indicates brain metastases

Nima Nassiri,Marissa Maas,Kian Asanad,Giovanni Cacciamani,Jamal Nabhani

doi : 10.1016/S0140-6736(21)00211-7

VOLUME 397, ISSUE 10276, E7, FEBRUARY 27, 2021

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The inverse care law re-examined: a global perspective

Richard Cookson,Tim Doran,Miqdad Asaria,Indrani Gupta,Fiorella Parra Mujica

doi : 10.1016/S0140-6736(21)00243-9

VOLUME 397, ISSUE 10276, P828-838, FEBRUARY 27, 2021

An inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Investing in more integrated universal health coverage and stronger primary care, delivered in proportion to need, can improve population health and reduce health inequality. However, trade-offs sometimes exist between health policy objectives. Health-care technologies, policies, and resourcing should be subjected to distributional analysis of their equity impacts, to ensure the objective of reducing health inequalities is kept in sight.

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Endometriosis is a chronic systemic disease: clinical challenges and novel innovations

Hugh S Taylor,Alexander M Kotlyar,Valerie A Flores

doi : 10.1016/S0140-6736(21)00389-5

VOLUME 397, ISSUE 10276, P839-852, FEBRUARY 27, 2021

Endometriosis is a common disease affecting 5–10% of women of reproductive age globally. However, despite its prevalence, diagnosis is typically delayed by years, misdiagnosis is common, and delivery of effective therapy is prolonged. Identification and prompt treatment of endometriosis are essential and facilitated by accurate clinical diagnosis. Endometriosis is classically defined as a chronic, gynaecological disease characterised by endometrial-like tissue present outside of the uterus and is thought to arise by retrograde menstruation. However, this description is outdated and no longer reflects the true scope and manifestations of the disease. The clinical presentation is varied, the presence of pelvic lesions is heterogeneous, and the manifestations of the disease outside of the female reproductive tract remain poorly understood. Endometriosis is now considered a systemic disease rather than a disease predominantly affecting the pelvis. Endometriosis affects metabolism in liver and adipose tissue, leads to systemic inflammation, and alters gene expression in the brain that causes pain sensitisation and mood disorders. The full effect of the disease is not fully recognised and goes far beyond the pelvis. Recognition of the full scope of the disease will facilitate clinical diagnosis and allow for more comprehensive treatment than currently available. Progestins and low-dose oral contraceptives are unsuccessful in a third of symptomatic women globally, probably as a result of progesterone resistance. Oral gonadotropin-releasing hormone (GnRH) antagonists constitute an effective and tolerable therapeutic alternative when first-line medications do not work. The development of GnRH antagonists has resulted in oral drugs that have fewer side-effects than other therapies and has allowed for rapid movement between treatments to optimise and personalise endometriosis care. In this Review, we discuss the latest understanding of endometriosis as a systemic disease with multiple manifestations outside the parameters of classic gynaecological disease.

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