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Journal Cover The Lancet
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   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [3041 journals]
  • Schizophrenia, primary negative symptoms, and soft outcomes in psychiatry
    • Authors: Stefan Leucht; John M Davis
      Pages: 1077 - 1078
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Stefan Leucht, John M Davis


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30181-2
       
  • Educating religious leaders to create demand for medical male circumcision
    • Authors: Nelson K Sewankambo; David K Mafigiri
      Pages: 1080 - 1082
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Nelson K Sewankambo, David K Mafigiri


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30318-5
       
  • Modifying the trajectory of asthma—are there lessons from the use of
           biologics in rheumatology?
    • Authors: J Mark FitzGerald; Paul Emery
      Pages: 1082 - 1084
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): J Mark FitzGerald, Paul Emery


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30600-1
       
  • Beyond health: five global policy metaphors for civil registration and
           vital statistics
    • Authors: Claire E Brolan; Hebe N Gouda; Carla AbouZahr; Alan D Lopez
      Pages: 1084 - 1085
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Claire E Brolan, Hebe N Gouda, Carla AbouZahr, Alan D Lopez


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30753-5
       
  • Offline: China's rejuvenation in health
    • Authors: Richard Horton
      First page: 1086
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Richard Horton


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30761-4
       
  • UK NHS–Home Office agreement undermines patient trust
    • Authors: Becky McCall
      First page: 1087
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Becky McCall


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30767-5
       
  • Venezuela's economic crisis hampers HIV/AIDS treatment
    • Authors: Joe Parkin Daniels
      Pages: 1088 - 1089
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Joe Parkin Daniels


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30768-7
       
  • Profile: Centre for Clinical Brain Sciences, Edinburgh, UK
    • Authors: Fiona Mitchell
      First page: 1090
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Fiona Mitchell


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30769-9
       
  • An enduring mission at America's iconic public hospital
    • Authors: Dave A Chokshi
      First page: 1092
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Dave A Chokshi


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30707-9
       
  • Efi Latsoudi: in solidarity with refugees
    • Authors: Sarah Boseley
      First page: 1093
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Sarah Boseley


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30708-0
       
  • Virtue in deficit: the 9-year-old hero
    • Authors: Havi Carel
      Pages: 1094 - 1095
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Havi Carel


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30709-2
       
  • Thomas Earl Starzl
    • Authors: Geoff Watts
      First page: 1096
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Geoff Watts


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30710-9
       
  • Safety and efficacy of statins
    • Authors: John Abramson; Harriet G Rosenberg; Nicholas Jewell; James M Wright
      First page: 1097
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): John Abramson, Harriet G Rosenberg, Nicholas Jewell, James M Wright


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30713-4
       
  • Safety and efficacy of statins
    • Authors: Fabrice Bonnet; Pierre Poulizac; Jean-Philippe Joseph
      Pages: 1097 - 1098
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Fabrice Bonnet, Pierre Poulizac, Jean-Philippe Joseph


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30712-2
       
  • Safety and efficacy of statins
    • Authors: Simon B Dimmitt; Hans G Stampfer; Jennifer H Martin
      First page: 1098
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Simon B Dimmitt, Hans G Stampfer, Jennifer H Martin


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30716-x
       
  • Safety and efficacy of statins
    • Authors: Paul D Thompson; Beth Taylor
      Pages: 1098 - 1099
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Paul D Thompson, Beth Taylor


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30718-3
       
  • Safety and efficacy of statins – Authors' reply
    • Authors: Rory Collins; Jane Armitage; Colin Baigent; George Davey Smith; Liam Smeeth
      Pages: 1099 - 1100
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Rory Collins, Jane Armitage, Colin Baigent, George Davey Smith, Liam Smeeth


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30717-1
       
  • Lessons from the controversy over statins
    • Authors: Fiona Godlee
      Pages: 1100 - 1101
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Fiona Godlee


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30721-3
       
  • Remediating “Lessons from the controversy over statins”
    • Authors: John Abramson; Harriet G Rosenberg; Nicholas Jewell; James M Wright
      Pages: 1101 - 1102
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): John Abramson, Harriet G Rosenberg, Nicholas Jewell, James M Wright


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30720-1
       
  • Recommendations based on value, not cost
    • Authors: Andrew Dillon
      First page: 1102
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Andrew Dillon


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30719-5
       
  • Cariprazine versus risperidone monotherapy for treatment of predominant
           negative symptoms in patients with schizophrenia: a randomised,
           double-blind, controlled trial
    • Authors: György Németh; István Laszlovszky; Pál Czobor; Erzsébet Szalai; Balázs Szatmári; Judit Harsányi; Ágota Barabássy; Marc Debelle; Suresh Durgam; István Bitter; Stephen Marder; W Wolfgang Fleischhacker
      Pages: 1103 - 1113
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): György Németh, István Laszlovszky, Pál Czobor, Erzsébet Szalai, Balázs Szatmári, Judit Harsányi, Ágota Barabássy, Marc Debelle, Suresh Durgam, István Bitter, Stephen Marder, W Wolfgang Fleischhacker
      Background Although predominant negative symptoms of schizophrenia can be severe enough to cause persistent impairment, effective treatment options are lacking. We aimed to assess the new generation antipsychotic cariprazine in adult patients with predominant negative symptoms. Methods In this randomised, double-blind, phase 3b trial, we enrolled adults aged 18–65 years with long-term (>2 year), stable schizophrenia and predominant negative symptoms (>6 months) at 66 study centres (mainly hospitals and university clinics, with a small number of private practices) in 11 European countries. Patients were randomly assigned (1:1) by an interactive web response system to 26 weeks of monotherapy with fixed-dose oral cariprazine (3 mg, 4·5 mg [target dose], or 6 mg per day) or risperidone (3 mg, 4 mg [target dose], or 6 mg per day); previous medication was discontinued over 2 weeks. The primary outcome was change from baseline to week 26 or end of treatment on the Positive and Negative Syndrome Scale factor score for negative symptoms (PANSS-FSNS) analysed in a modified intention-to-treat population of patients who had follow-up assessments within 5 days after last receipt of study drugs with a mixed-effects model for repeated measures. Safety was assessed in all patients who received at least one dose of study drug. This study is registered with EudraCT, number 2012-005485-36. Findings Between May 27, 2013, and Nov 17, 2014, 533 patients were screened and 461 (86%) patients were randomised to treatment (230 for cariprazine and 231 for risperidone); 460 were included in the safety population (one patient discontinued before study drug intake). 227 (99%) of 230 patients in the cariprazine group and 229 (99%) of 230 patients in the risperidone group were included in the modified intention-to-treat population (178 [77%] in each group completed 26 weeks of treatment). Mean daily doses were 4·2 mg (SD 0·6) for cariprazine and 3·8 mg (0·4) for risperidone. Treatment-emergent adverse events (eg, insomnia, akathisia, worsening of schizophrenia, headache, anxiety) were reported in 123 (54%) patients treated with cariprazine and 131 (57%) patients treated with risperidone. Use of cariprazine led to a greater least squares mean change in PANSS-FSNS from baseline to week 26 than did risperidone (−8·90 points for cariprazine vs −7·44 points for risperidone; least squares mean difference −1·46, 95% CI −2·39 to −0·53; p=0·0022; effect size 0·31). One patient in the risperidone group died of a cause regarded as unrelated to treatment. Interpretation Our results support the efficacy of cariprazine in the treatment of predominant negative symptoms of schizophrenia. Funding Gedeon Richter Plc.

      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30060-0
       
  • Effect of ileal bile acid transporter inhibitor GSK2330672 on pruritus in
           primary biliary cholangitis: a double-blind, randomised,
           placebo-controlled, crossover, phase 2a study
    • Authors: Vinod S Hegade; Stuart F W Kendrick; Robert L Dobbins; Sam R Miller; Douglas Thompson; Duncan Richards; James Storey; George E Dukes; Margaret Corrigan; Ronald P J Oude Elferink; Ulrich Beuers; Gideon M Hirschfield; David E Jones
      Pages: 1114 - 1123
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Vinod S Hegade, Stuart F W Kendrick, Robert L Dobbins, Sam R Miller, Douglas Thompson, Duncan Richards, James Storey, George E Dukes, Margaret Corrigan, Ronald P J Oude Elferink, Ulrich Beuers, Gideon M Hirschfield, David E Jones
      Background Up to 70% of patients with primary biliary cholangitis develop pruritus (itch) during the course of their disease. Treatment of pruritus in primary biliary cholangitis is challenging and novel therapies are needed. Ursodeoxycholic acid, the standard first-line treatment for primary biliary cholangitis, is largely ineffective for pruritus. We investigated the efficacy and safety of GSK2330672, a selective inhibitor of human ileal bile acid transporter (IBAT), in patients with primary biliary cholangitis with pruritus. Methods We conducted this phase 2a, double-blind, randomised, placebo-controlled, crossover trial in two UK medical centres. Following 2 weeks of open placebo run-in, patients were randomly assigned in a 1:1 ratio with a block size of 4 to receive GSK2330672 or placebo twice daily during two consecutive 14-day treatment periods in a crossover sequence. The treatment periods were followed by a 14-day single-blinded placebo follow-up period. The primary endpoints were safety of GSK2330672, assessed using clinical and laboratory parameters, and tolerability as rated by the Gastrointestinal Symptom Rating Scale. The secondary endpoints were changes in pruritus scores measured using the 0 to 10 numerical rating scale (NRS), primary biliary cholangitis-40 (PBC-40) itch domain score and 5-D itch scale, changes in serum total bile acids and 7 alpha hydroxy-4-cholesten-3-one (C4), and changes in the pharmacokinetic parameters of ursodeoxycholic acid and its conjugates. The trial was registered with ClinicalTrials.gov, number NCT01899703. Findings Between March 10, 2014, and Oct 7, 2015, we enrolled 22 patients. 11 patients were assigned to receive intervention followed by placebo (sequence 1), and 11 patients were assigned to receive placebo followed by intervention (sequence 2). One patient assigned to sequence 2 withdrew consent prior to receiving randomised therapy. One patient did not attend the placebo follow-up period, but was included in the final analysis. GSK2330672 treatment for 14 days was safe with no serious adverse events reported. Diarrhoea was the most frequent adverse event during treatment with GSK2330672 (seven with GSK2330672 vs one with placebo) and headache was the most frequent adverse event during treatment with placebo (seven with placebo vs six with GSK2330672). After GSK2330672 treatment, the percentage changes from baseline itch scores were −57% (95% CI −73 to −42, p<0·0001) in the NRS, −31% (−42 to −20, p<0·0001) in the PBC-40 itch domain and −35% (−45 to −25, p<0·0001) in the 5-D itch scale. GSK2330672 produced significantly greater reduction from baseline than the double-blind placebo in the NRS (−23%, 95% CI −45 to −1; p=0·037), PBC-40 itch domain, (−14%, −26 to −1; p=0·034), and 5-D itch scale (−20%, −34 to −7; p=0·0045). After GSK2330672 treatment, serum total bile acid concentrations declined by 50% (95% CI −37 to −61, p<0·0001) from 30 to 15 μM, with a significant 3·1-times increase (95% CI 2·4 to 4·0, p<0·0001) in serum C4 concentrations from 7·9 to 24·7ng/mL. Interpretation In patients with primary biliary cholangitis with pruritus, 14 days of ileal bile acid transporter inhibition by GSK2330672 was generally well tolerated without serious adverse events, and demonstrated efficacy in reducing pruritus severity. GSK2330672 has the potential to be a significant and novel advance for the treatment of pruritus in primary biliary cholangitis. Diarrhoea, the most common adverse event associated with GSK2330672 treatment, might limit the long-term use of this drug. Funding GlaxoSmithKline and National Institute for Health Research.

      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30319-7
       
  • Educating religious leaders to promote uptake of male circumcision in
           Tanzania: a cluster randomised trial
    • Authors: Jennifer A Downs; Agrey H Mwakisole; Alphonce B Chandika; Shibide Lugoba; Rehema Kassim; Evarist Laizer; Kinanga A Magambo; Myung Hee Lee; Samuel E Kalluvya; David J Downs; Daniel W Fitzgerald
      Pages: 1124 - 1132
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Jennifer A Downs, Agrey H Mwakisole, Alphonce B Chandika, Shibide Lugoba, Rehema Kassim, Evarist Laizer, Kinanga A Magambo, Myung Hee Lee, Samuel E Kalluvya, David J Downs, Daniel W Fitzgerald
      Background Male circumcision is being widely deployed as an HIV prevention strategy in countries with high HIV incidence, but its uptake in sub-Saharan Africa has been below targets. We did a study to establish whether educating religious leaders about male circumcision would increase uptake in their village. Methods In this cluster randomised trial in northwest Tanzania, eligible villages were paired by proximity (<60 km) and the time that a free male circumcision outreach campaign from the Tanzanian Ministry of Health became available in their village. All villages received the standard male circumcision outreach activities provided by the Ministry of Health. Within the village pairs, villages were randomly assigned by coin toss to receive either additional education for Christian church leaders on scientific, religious, and cultural aspects of male circumcision (intervention group), or standard outreach only (control group). Church leaders or their congregations were not masked to random assignment. The educational intervention consisted of a 1-day seminar co-taught by a Tanzanian pastor and a Tanzanian clinician who worked with the Ministry of Health, and meetings with the study team every 2 weeks thereafter, for the duration of the circumcision campaign. The primary outcome was the proportion of male individuals in a village who were circumcised during the campaign, using an intention-to-treat analysis that included all men in the village. This trial is registered with ClinicalTrials.gov, number NCT 02167776. Findings Between June 15, 2014, and Dec 10, 2015, we provided education for church leaders in eight intervention villages and compared the outcomes with those in eight control villages. In the intervention villages, 52·8% (30 889 of 58 536) of men were circumcised compared with 29·5% (25 484 of 86 492) of men in the eight control villages (odds ratio 3·2 [95% CI, 1·4–7·3]; p=0·006). Interpretation Education of religious leaders had a substantial effect on uptake of male circumcision, and should be considered as part of male circumcision programmes in other sub-Saharan African countries. This study was conducted in one region in Tanzania; however, we believe that our intervention is generalisable. We equipped church leaders with knowledge and tools, and ultimately each leader established the most culturally-appropriate way to promote male circumcision. Therefore, we think that the process of working through religious leaders can serve as an innovative model to promote healthy behaviour, leading to HIV prevention and other clinically relevant outcomes, in a variety of settings. Funding Bill & Melinda Gates Foundation, National Institutes of Health, and the Mulago Foundation.

      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(16)32055-4
       
  • Retinal detachment in severe myopia
    • Authors: Elad Moisseiev; Glenn Yiu
      First page: 1133
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Elad Moisseiev, Glenn Yiu


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(16)31407-6
       
  • Breast cancer
    • Authors: Nadia Harbeck; Michael Gnant
      Pages: 1134 - 1150
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Nadia Harbeck, Michael Gnant
      Breast cancer is one of the three most common cancers worldwide. Early breast cancer is considered potentially curable. Therapy has progressed substantially over the past years with a reduction in therapy intensity, both for locoregional and systemic therapy; avoiding overtreatment but also undertreatment has become a major focus. Therapy concepts follow a curative intent and need to be decided in a multidisciplinary setting, taking molecular subtype and locoregional tumour load into account. Primary conventional surgery is not the optimal choice for all patients any more. In triple-negative and HER2-positive early breast cancer, neoadjuvant therapy has become a commonly used option. Depending on clinical tumour subtype, therapeutic backbones include endocrine therapy, anti-HER2 targeting, and chemotherapy. In metastatic breast cancer, therapy goals are prolongation of survival and maintaining quality of life. Advances in endocrine therapies and combinations, as well as targeting of HER2, and the promise of newer targeted therapies make the prospect of long-term disease control in metastatic breast cancer an increasing reality.

      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(16)31891-8
       
  • The Lancet Countdown: tracking progress on health and climate change
    • Authors: Nick Watts; W Neil Adger; Sonja Ayeb-Karlsson; Yuqi Bai; Peter Byass; Diarmid Campbell-Lendrum; Tim Colbourn; Peter Cox; Michael Davies; Michael Depledge; Anneliese Depoux; Paula Dominguez-Salas; Paul Drummond; Paul Ekins; Antoine Flahault; Delia Grace; Hilary Graham; Andy Haines; Ian Hamilton; Anne Johnson; Ilan Kelman; Sari Kovats; Lu Liang; Melissa Lott; Robert Lowe; Yong Luo; Georgina Mace; Mark Maslin; Karyn Morrissey; Kris Murray; Tara Neville; Maria Nilsson; Tadj Oreszczyn; Christine Parthemore; David Pencheon; Elizabeth Robinson; Stefanie Schütte; Joy Shumake-Guillemot; Paolo Vineis; Paul Wilkinson; Nicola Wheeler; Bing Xu; Jun Yang; Yongyuan Yin; Chaoqing Yu; Peng Gong; Hugh Montgomery; Anthony Costello
      Pages: 1151 - 1164
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Nick Watts, W Neil Adger, Sonja Ayeb-Karlsson, Yuqi Bai, Peter Byass, Diarmid Campbell-Lendrum, Tim Colbourn, Peter Cox, Michael Davies, Michael Depledge, Anneliese Depoux, Paula Dominguez-Salas, Paul Drummond, Paul Ekins, Antoine Flahault, Delia Grace, Hilary Graham, Andy Haines, Ian Hamilton, Anne Johnson, Ilan Kelman, Sari Kovats, Lu Liang, Melissa Lott, Robert Lowe, Yong Luo, Georgina Mace, Mark Maslin, Karyn Morrissey, Kris Murray, Tara Neville, Maria Nilsson, Tadj Oreszczyn, Christine Parthemore, David Pencheon, Elizabeth Robinson, Stefanie Schütte, Joy Shumake-Guillemot, Paolo Vineis, Paul Wilkinson, Nicola Wheeler, Bing Xu, Jun Yang, Yongyuan Yin, Chaoqing Yu, Peng Gong, Hugh Montgomery, Anthony Costello
      The Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be “the greatest global health opportunity of the 21st century”. The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. These focus areas form the five thematic working groups of the Lancet Countdown and represent different aspects of the complex association between health and climate change. These thematic groups will provide indicators for a global overview of health and climate change; national case studies highlighting countries leading the way or going against the trend; and engagement with a range of stakeholders. The Lancet Countdown ultimately aims to report annually on a series of indicators across these five working groups. This paper outlines the potential indicators and indicator domains to be tracked by the collaboration, with suggestions on the methodologies and datasets available to achieve this end. The proposed indicator domains require further refinement, and mark the beginning of an ongoing consultation process—from November, 2016 to early 2017—to develop these domains, identify key areas not currently covered, and change indicators where necessary. This collaboration will actively seek to engage with existing monitoring processes, such as the UN Sustainable Development Goals and WHO's climate and health country profiles. The indicators will also evolve over time through ongoing collaboration with experts and a range of stakeholders, and be dependent on the emergence of new evidence and knowledge. During the course of its work, the Lancet Countdown will adopt a collaborative and iterative process, which aims to complement existing initiatives, welcome engagement with new partners, and be open to developing new research projects on health and climate change.

      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(16)32124-9
       
  • Pancreatic cancer: are more chemotherapy and surgery needed?
    • Authors: Gaël Deplanque; Nicolas Demartines
      Pages: 985 - 986
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): Gaël Deplanque, Nicolas Demartines


      PubDate: 2017-03-11T03:39:47Z
      DOI: 10.1016/s0140-6736(17)30126-5
       
  • Tailoring duration of DAPT with risk scores
    • Authors: Davide Capodanno; Dominick J Angiolillo
      Pages: 987 - 989
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): Davide Capodanno, Dominick J Angiolillo


      PubDate: 2017-03-11T03:39:47Z
      DOI: 10.1016/s0140-6736(17)30591-3
       
  • A quarter-dose quadpill for initial treatment of hypertension
    • Authors: Alan H Gradman
      Pages: 989 - 990
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): Alan H Gradman


      PubDate: 2017-03-11T03:39:47Z
      DOI: 10.1016/s0140-6736(17)30331-8
       
  • Macro-level perspective to reverse recent mortality increases
    • Authors: Anna Zajacova; Jennifer Karas Montez
      Pages: 991 - 992
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): Anna Zajacova, Jennifer Karas Montez


      PubDate: 2017-03-11T03:39:47Z
      DOI: 10.1016/s0140-6736(17)30186-1
       
  • Offline: Planetary health—the great acceleration
    • Authors: Richard Horton
      First page: 993
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): Richard Horton


      PubDate: 2017-03-11T03:39:47Z
      DOI: 10.1016/s0140-6736(17)30698-0
       
  • Trump's foreign aid proposal rattles global health advocates
    • Authors: Sam Loewenberg
      Pages: 994 - 995
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): Sam Loewenberg


      PubDate: 2017-03-11T03:39:47Z
      DOI: 10.1016/s0140-6736(17)30696-7
       
  • Interim leader appointed as Global Fund election restarts
    • Authors: John Zarocostas
      First page: 996
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): John Zarocostas


      PubDate: 2017-03-11T03:39:47Z
      DOI: 10.1016/s0140-6736(17)30692-x
       
  • Scholarship fund for young African scientists facing demise
    • Authors: Geoff Watts
      First page: 997
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): Geoff Watts


      PubDate: 2017-03-11T03:39:47Z
      DOI: 10.1016/s0140-6736(17)30697-9
       
  • Syria suffers as the world watches
    • Authors: Lancet
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): The Lancet


      PubDate: 2017-03-18T15:52:24Z
       
  • Managing arthritis in the USA
    • Authors: Lancet
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): The Lancet


      PubDate: 2017-03-18T15:52:24Z
       
  • Phasing out harmful use of pesticides
    • Authors: Lancet
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): The Lancet


      PubDate: 2017-03-18T15:52:24Z
       
  • An appealing new agent for treating cholestatic pruritus
    • Authors: Albert
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Albert Parés


      PubDate: 2017-03-18T15:52:24Z
       
  • Something else
    • Authors: Niall Boyce
      Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074
      Author(s): Niall Boyce


      PubDate: 2017-03-18T15:52:24Z
       
  • Department of Error
    • Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074


      PubDate: 2017-03-18T15:52:24Z
       
  • Department of Error
    • Abstract: Publication date: 18–24 March 2017
      Source:The Lancet, Volume 389, Issue 10074


      PubDate: 2017-03-18T15:52:24Z
       
  • Coronary atherosclerosis in indigenous South American Tsimane: a
           cross-sectional cohort study
    • Authors: Hillard Kaplan; Randall C Thompson; Benjamin C Trumble; L Samuel Wann; Adel H Allam; Bret Beheim; Bruno Frohlich; M Linda Sutherland; James D Sutherland; Jonathan Stieglitz; Daniel Eid Rodriguez; David E Michalik; Chris J Rowan; Guido P Lombardi; Ram Bedi; Angela R Garcia; James K Min; Jagat Narula; Caleb E Finch; Michael Gurven; Gregory S Thomas
      Abstract: Publication date: Available online 17 March 2017
      Source:The Lancet
      Author(s): Hillard Kaplan, Randall C Thompson, Benjamin C Trumble, L Samuel Wann, Adel H Allam, Bret Beheim, Bruno Frohlich, M Linda Sutherland, James D Sutherland, Jonathan Stieglitz, Daniel Eid Rodriguez, David E Michalik, Chris J Rowan, Guido P Lombardi, Ram Bedi, Angela R Garcia, James K Min, Jagat Narula, Caleb E Finch, Michael Gurven, Gregory S Thomas
      Background Conventional coronary artery disease risk factors might potentially explain at least 90% of the attributable risk of coronary artery disease. To better understand the association between the pre-industrial lifestyle and low prevalence of coronary artery disease risk factors, we examined the Tsimane, a Bolivian population living a subsistence lifestyle of hunting, gathering, fishing, and farming with few cardiovascular risk factors, but high infectious inflammatory burden. Methods We did a cross-sectional cohort study including all individuals who self-identified as Tsimane and who were aged 40 years or older. Coronary atherosclerosis was assessed by coronary artery calcium (CAC) scoring done with non-contrast CT in Tsimane adults. We assessed the difference between the Tsimane and 6814 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). CAC scores higher than 100 were considered representative of significant atherosclerotic disease. Tsimane blood lipid and inflammatory biomarkers were obtained at the time of scanning, and in some patients, longitudinally. Findings Between July 2, 2014, and Sept 10, 2015, 705 individuals, who had data available for analysis, were included in this study. 596 (85%) of 705 Tsimane had no CAC, 89 (13%) had CAC scores of 1–100, and 20 (3%) had CAC scores higher than 100. For individuals older than age 75 years, 31 (65%) Tsimane presented with a CAC score of 0, and only four (8%) had CAC scores of 100 or more, a five-fold lower prevalence than industrialised populations (p≤0·0001 for all age categories of MESA). Mean LDL and HDL cholesterol concentrations were 2·35 mmol/L (91 mg/dL) and 1·0 mmol/L (39·5 mg/dL), respectively; obesity, hypertension, high blood sugar, and regular cigarette smoking were rare. High-sensitivity C-reactive protein was elevated beyond the clinical cutoff of 3·0 mg/dL in 360 (51%) Tsimane participants. Interpretation Despite a high infectious inflammatory burden, the Tsimane, a forager-horticulturalist population of the Bolivian Amazon with few coronary artery disease risk factors, have the lowest reported levels of coronary artery disease of any population recorded to date. These findings suggest that coronary atherosclerosis can be avoided in most people by achieving a lifetime with very low LDL, low blood pressure, low glucose, normal body-mass index, no smoking, and plenty of physical activity. The relative contributions of each are still to be determined. Funding National Institute on Aging, National Institutes of Health; St Luke's Hospital of Kansas City; and Paleocardiology Foundation.

      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30752-3
       
  • One attack on a health worker is one too many
    • Authors: Marie-Paule Kieny; Peter Salama; Erin Kenney; James Campbell; Tana Wuliji
      Abstract: Publication date: Available online 15 March 2017
      Source:The Lancet
      Author(s): Marie-Paule Kieny, Peter Salama, Erin Kenney, James Campbell, Tana Wuliji


      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30740-7
       
  • Health workers and the weaponisation of health care in Syria: a
           preliminary inquiry for The Lancet–American University of Beirut
           Commission on Syria
    • Authors: Fouad M Fouad; Annie Sparrow; Ahmad Tarakji; Mohamad Alameddine; Fadi El-Jardali; Adam P Coutts; Nour El Arnaout; Lama Bou Karroum; Mohammed Jawad; Sophie Roborgh; Aula Abbara; Fadi Alhalabi; Ibrahim AlMasri; Samer Jabbour
      Abstract: Publication date: Available online 15 March 2017
      Source:The Lancet
      Author(s): Fouad M Fouad, Annie Sparrow, Ahmad Tarakji, Mohamad Alameddine, Fadi El-Jardali, Adam P Coutts, Nour El Arnaout, Lama Bou Karroum, Mohammed Jawad, Sophie Roborgh, Aula Abbara, Fadi Alhalabi, Ibrahim AlMasri, Samer Jabbour
      The conflict in Syria presents new and unprecedented challenges that undermine the principles and practice of medical neutrality in armed conflict. With direct and repeated targeting of health workers, health facilities, and ambulances, Syria has become the most dangerous place on earth for health-care providers. The weaponisation of health care—a strategy of using people's need for health care as a weapon against them by violently depriving them of it—has translated into hundreds of health workers killed, hundreds more incarcerated or tortured, and hundreds of health facilities deliberately and systematically attacked. Evidence shows use of this strategy on an unprecedented scale by the Syrian Government and allied forces, in what human rights organisations described as a war-crime strategy, although all parties seem to have committed violations. Attacks on health care have sparked a large-scale exodus of experienced health workers. Formidable challenges face health workers who have stayed behind, and with no health care a major factor in the flight of refugees, the effect extends well beyond Syria. The international community has left these violations of international humanitarian and human rights law largely unanswered, despite their enormous consequences. There have been repudiated denunciations, but little action on bringing the perpetrators to justice. This inadequate response challenges the foundation of medical neutrality needed to sustain the operations of global health and humanitarian agencies in situations of armed conflict. In this Health Policy, we analyse the situation of health workers facing such systematic and serious violations of international humanitarian law. We describe the tremendous pressures that health workers have been under and continue to endure, and the remarkable resilience and resourcefulness they have displayed in response to this crisis. We propose policy imperatives to protect and support health workers working in armed conflict zones.

      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30741-9
       
  • Department of Error
    • Abstract: Publication date: Available online 15 March 2017
      Source:The Lancet


      PubDate: 2017-03-18T15:52:24Z
       
  • Influenza
    • Authors: Catharine Paules; Kanta Subbarao
      Abstract: Publication date: Available online 13 March 2017
      Source:The Lancet
      Author(s): Catharine Paules, Kanta Subbarao
      Influenza is an acute respiratory illness, caused by influenza A, B, and C viruses, that occurs in local outbreaks or seasonal epidemics. Clinical illness follows a short incubation period and presentation ranges from asymptomatic to fulminant, depending on the characteristics of both the virus and the individual host. Influenza A viruses can also cause sporadic infections or spread worldwide in a pandemic when novel strains emerge in the human population from an animal host. New approaches to influenza prevention and treatment for management of both seasonal influenza epidemics and pandemics are desirable. In this Seminar, we discuss the clinical presentation, transmission, diagnosis, management, and prevention of seasonal influenza infection. We also review the animal–human interface of influenza, with a focus on current pandemic threats.

      PubDate: 2017-03-18T15:52:24Z
      DOI: 10.1016/s0140-6736(17)30129-0
       
  • Cholera
    • Authors: John Clemens; Balakrish Nair Tahmeed Ahmed Firdausi Qadri Jan Holmgren
      Abstract: Publication date: Available online 13 March 2017
      Source:The Lancet
      Author(s): John D Clemens, G Balakrish Nair, Tahmeed Ahmed, Firdausi Qadri, Jan Holmgren
      Cholera is an acute, watery diarrhoeal disease caused by Vibrio cholerae of the O1 or O139 serogroups. In the past two centuries, cholera has emerged and spread from the Ganges Delta six times and from Indonesia once to cause global pandemics. Rational approaches to the case management of cholera with oral and intravenous rehydration therapy have reduced the case fatality of cholera from more than 50% to much less than 1%. Despite improvements in water quality, sanitation, and hygiene, as well as in the clinical treatment of cholera, the disease is still estimated to cause about 100 000 deaths every year. Most deaths occur in cholera-endemic settings, and virtually all deaths occur in developing countries. Contemporary understanding of immune protection against cholera, which results from local intestinal immunity, has yielded safe and protective orally administered cholera vaccines that are now globally stockpiled for use in the control of both epidemic and endemic cholera.

      PubDate: 2017-03-18T15:52:24Z
       
  • You have a new friend request
    • Authors: Lancet
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): The Lancet


      PubDate: 2017-03-11T03:39:47Z
       
  • Evaluating industry's role in vaccine access
    • Authors: Lancet
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): The Lancet


      PubDate: 2017-03-11T03:39:47Z
       
  • Polypills: an essential medicine for cardiovascular disease
    • Authors: Lancet
      Abstract: Publication date: 11–17 March 2017
      Source:The Lancet, Volume 389, Issue 10073
      Author(s): The Lancet


      PubDate: 2017-03-11T03:39:47Z
       
 
 
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