Journal Cover The Lancet
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   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [3031 journals]
  • Patterns of global health financing and potential future spending on
           health
    • Abstract: Publication date: Available online 20 April 2017
      Source:The Lancet
      Author(s): Jose Eduardo Gomez-Gonzalez, Nidia Ruth Reyes


      PubDate: 2017-04-20T19:17:34Z
       
  • Evolution and patterns of global health financing 1995–2014: development
           assistance for health, and government, prepaid private, and out-of-pocket
           health spending in 184 countries
    • Abstract: Publication date: Available online 19 April 2017
      Source:The Lancet
      Author(s): Global Burden of Disease Health Financing Collaborator NetworkJosephDielemanMadelineCampbellAbigailChapinErikaEldrenkampVictoria YFanAnnieHaakenstadJenniferKatesYingyingLiuTaylorMatyaszAngelaMicahAlexReynoldsNafisSadatMatthew TSchneiderReedSorensenTimEvansDavidEvansChristophKurowskiAjayTandonKaja MAbbasSemaw FeredeAberaAliasghar AhmadKiadaliriKedir YimamAhmedMuktar BeshirAhmedKhurshidAlamRezaAlizadeh-NavaeiAla'aAlkerwiErfanAminiWalidAmmarStephen MarcAmrockCarl Abelardo TAntonioTesfay MehariAteyLeticiaAvila-BurgosAshishAwasthiAleksandraBaracOscar AlbertoBernalAddisu ShunuBeyeneTariku JibatBeyeneCharlesBirungiHabtamu MellieBizuayehuNicholas J KBreitbordeLuceroCahuana-HurtadoRuben EstanislaoCastroFerranCatalia-LopezKoustuvDalalPieterde JagerSamath DDharmaratneManishaDubeyCarla Sofia e SaFarinhaAndreFaroAndrea BFeiglFlorianFischerJoseph Robert AndersonFitchettNataliyaFoigtAbabi ZergawGirefRahulGuptaSamerHamidiHilda LHarbSimon IHayDeliaHendrieMasakoHorinoMikkJürissonMihajlo BJakovljevicMehdiJavanbakhtDennyJohnJost BJonasSeyed M.KarimiYoung-HoKhangJagdishKhubchandaniYun JinKimJonas MKingeKristopher JKrohnHassan Magdy AbdEl RazekMohammed Magdy AbdEl RazekAzeemMajeedRezaMalekzadehFelixMasiyeToniMeierAtteMeretojaTed RMillerErkin MMirrakhimovShafiuMohammedVinayNangiaStefanoOlgiatiAbdalla SidahmedOsmanMayowa OOwolabiTejasPatelAngel J PaterninaCaicedoDavid MPereiraJulianPerelmanSuzannePolinderAnwarRafayVafaRahimi-MovagharRajesh KumarRaiUshaRamChhabi LalRanabhatHirbo ShoreRobaJosephSalamaMilojeSavicSadaf GSepanlouMark GShrimeRoberto TchioTalongwaBraden J TeAoFabrizioTediosiAzeb GebresilassieTesemaAlan JThomsonRuoyanTobe-GaiRomanTopor-MadryEduardo AUndurragaTommiVasankariFrancesco SViolanteAndreaWerdeckerTissaWijeratneGelinXuNaohiroYonemotoMustafa ZYounisChuanhuaYuZoubidaZaidiMaysaaEl Sayed ZakiChristopher J LMurray
      Background An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. Methods We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Findings Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. Interpretation Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pur...
      PubDate: 2017-04-20T19:17:34Z
       
  • Future and potential spending on health 2015–40: development assistance
           for health, and government, prepaid private, and out-of-pocket health
           spending in 184 countries
    • Abstract: Publication date: Available online 19 April 2017
      Source:The Lancet
      Author(s): Global Burden of Disease Health Financing Collaborator NetworkJoseph LDielemanMadelineCampbellAbigailChapinErikaEldrenkampVictoria YFanAnnieHaakenstadJenniferKatesZhiyinLiTaylorMatyaszAngelaMicahAlexReynoldsNafisSadatMatthew TSchneiderReedSorensenKaja MAbbasSemaw FeredeAberaAliasghar AhmadKiadaliriMuktar BeshirAhmedKhurshidAlamRezaAlizadeh-NavaeiAla'aAlkerwiErfanAminiWalidAmmarCarl Abelardo TAntonioTesfay MehariAteyLeticiaAvila-BurgosAshishAwasthiAleksandraBaracTezera MoshagoBerhetoAddisu ShunuBeyeneTariku JibatBeyeneCharlesBirungiHabtamu MellieBizuayehuNicholas J KBreitbordeLuceroCahuana-HurtadoRuben EstanislaoCastroFerranCatalia-LopezKoustuvDalalSamath DDharmaratneManishaDubeyAndéFaroAndrea BFeiglFlorianFischerJoseph R AndersonFitchettNataliyaFoigtAbabi ZergawGirefRahulGuptaSamerHamidiHilda LHarbSimon IHayDeliaHendrieMasakoHorinoMikkJürissonMihajlo BJakovljevicMehdiJavanbakhtDennyJohnJost BJonasSeyed MKarimiYoung-HoKhangJagdishKhubchandaniYun JinKimJonas MKingeKristopher JKrohnRickyLeungHassan Magdy AbdEl RazekMohammed Magdy AbdEl RazekAzeemMajeedRezaMalekzadehDeborah CarvalhoMaltaAtteMeretojaTed RMillerErkin MMirrakhimovShafiuMohammedGedefawMollaVinayNangiaStefanoOlgiatiMayowa OOwolabiTejasPatelAngel J PaterninaCaicedoDavid MPereiraJulianPerelmanSuzannePolinderAnwarRafayVafaRahimi-MovagharRajesh KumarRaiUshaRamChhabi LalRanabhatHirbo ShoreRobaMilojeSavicSadaf GSepanlouBraden J TeAoAzeb GebresilassieTesemaAlan JThomsonRuoyanTobe-GaiRomanTopor-MadryEduardo AUndurragaVeronicaVargasTommiVasankariFrancesco SViolanteTissaWijeratneGelinXuNaohiroYonemotoMustafa ZYounisChuanhuaYuZoubidaZaidiMaysaaEl Sayed ZakiChristopher J LMurray
      Background The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods We extracted GDP, government spending in 184 countries from 1980–2015, and health spend data from 1995–2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings We estimated that global spending on health will increase from US$9·21 trillion in 2014 to $24·24 trillion (uncertainty interval [UI] 20·47–29·72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5·3% (UI 4·1–6·8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4·2% (3·8–4·9). High-income countries are expected to grow at 2·1% (UI 1·8–2·4) and low-income countries are expected to grow at 1·8% (1·0–2·8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133–181) per capita in 2030 and $195 (157–258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157–258) per capita was available for health in 2040 in low-income countries. Interpretation Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential. Funding Bill & Melinda Gates Foundation.

      PubDate: 2017-04-20T19:17:34Z
       
  • Building the foundations for sustainable development: a case for global
           investment in the capabilities of adolescents
    • Abstract: Publication date: Available online 19 April 2017
      Source:The Lancet
      Author(s): Peter Sheehan, Kim Sweeny, Bruce Rasmussen, Annababette Wils, Howard S Friedman, Jacqueline Mahon, George C Patton, Susan M Sawyer, Eric Howard, John Symons, Karin Stenberg, Satvika Chalasani, Neelam Maharaj, Nicola Reavley, Hui Shi, Masha Fridman, Alison Welsh, Emeka Nsofor, Laura Laski
      Investment in the capabilities of the world's 1·2 billion adolescents is vital to the UN's Sustainable Development Agenda. We examined investments in countries of low income, lower-middle income, and upper-middle income covering the majority of these adolescents globally to derive estimates of investment returns given existing knowledge. The costs and effects of the interventions were estimated by adapting existing models and by extending methods to create new modelling tools. Benefits were valued in terms of increased gross domestic product and averted social costs. The initial analysis showed high returns for the modelled interventions, with substantial variation between countries and with returns generally higher in low-income countries than in countries of lower-middle and upper-middle income. For interventions targeting physical, mental, and sexual health (including a human papilloma virus programme), an investment of US$4·6 per capita each year from 2015 to 2030 had an unweighted mean benefit to cost ratio (BCR) of more than 10·0, whereas, for interventions targeting road traffic injuries, a BCR of 5·9 (95% CI 5·8–6·0) was achieved on investment of $0·6 per capita each year. Interventions to reduce child marriage ($3·8 per capita each year) had a mean BCR of 5·7 (95% CI 5·3–6·1), with the effect high in low-income countries. Investment to increase the extent and quality of secondary schooling is vital but will be more expensive than other interventions—investment of $22·6 per capita each year from 2015 to 2030 generated a mean BCR of 11·8 (95% CI 11·6–12·0). Investments in health and education will not only transform the lives of adolescents in resource-poor settings, but will also generate high economic and social returns. These returns were robust to substantial variation in assumptions. Although the knowledge base on the impacts of interventions is limited in many areas, and a major research effort is needed to build a more complete investment framework, these analyses suggest that comprehensive investments in adolescent health and wellbeing should be given high priority in national and international policy.

      PubDate: 2017-04-20T19:17:34Z
       
  • Securing investments to realise the social and economic rights of
           adolescents
    • Abstract: Publication date: Available online 19 April 2017
      Source:The Lancet
      Author(s): Shanthi Ameratunga, Kumanan Rasanathan


      PubDate: 2017-04-20T19:17:34Z
       
  • The future of the NHS
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): The Lancet


      PubDate: 2017-04-20T19:17:34Z
       
  • Defunding the UNFPA: sign of the times
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): The Lancet


      PubDate: 2017-04-20T19:17:34Z
       
  • Syphilis: an ancient disease in a modern era
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): The Lancet


      PubDate: 2017-04-20T19:17:34Z
       
  • Fixation methods in the management of hip fractures
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Morad Chughtai, Anton Khlopas, Michael A Mont


      PubDate: 2017-04-20T19:17:34Z
       
  • Does intensity matter in aphasia rehabilitation?
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Linda Worrall, Abby Foster


      PubDate: 2017-04-20T19:17:34Z
       
  • Early life deprivation: is the damage already done?
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Frank C Verhulst


      PubDate: 2017-04-20T19:17:34Z
       
  • Palliative care in humanitarian crises: always something to offer
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Richard A Powell, Lisa Schwartz, Elysée Nouvet, Brett Sutton, Mila Petrova, Joan Marston, Daniel Munday, Lukas Radbruch


      PubDate: 2017-04-20T19:17:34Z
       
  • Offline: When The Lancet went to the Vatican
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Richard Horton


      PubDate: 2017-04-20T19:17:34Z
       
  • Syria chemical attacks: preparing for the unconscionable
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): John Zarocostas


      PubDate: 2017-04-20T19:17:34Z
       
  • Research needed to prevent MERS coronavirus outbreaks
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Sharmila Devi


      PubDate: 2017-04-20T19:17:34Z
       
  • Accounting for polio survivors in the post-polio world
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Sophie Cousins


      PubDate: 2017-04-20T19:17:34Z
       
  • Is it all in the stars?
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Helen Bynum, Bill Bynum


      PubDate: 2017-04-20T19:17:34Z
       
  • The penicillin girls (and guys)
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Kelley Swain


      PubDate: 2017-04-20T19:17:34Z
       
  • Keith Martin—crusader for health and the planet
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Pamela Das


      PubDate: 2017-04-20T19:17:34Z
       
  • The headache in history and culture
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Joanna Bourke


      PubDate: 2017-04-20T19:17:34Z
       
  • Lars Olof Lennart Nilsson
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Geoff Watts


      PubDate: 2017-04-20T19:17:34Z
       
  • Health systems resilience: meaningful construct or catchphrase?
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Victoria Haldane, Suan-Ee Ong, Fiona Leh-Hoon Chuah, Helena Legido-Quigley


      PubDate: 2017-04-20T19:17:34Z
       
  • Private water operators' contribution to realising the right to water
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Jack Moss


      PubDate: 2017-04-20T19:17:34Z
       
  • Maternal deaths and humanitarian crises
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Arthur Erken


      PubDate: 2017-04-20T19:17:34Z
       
  • Prevention of early-onset pre-eclampsia
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Lionel Carbillon


      PubDate: 2017-04-20T19:17:34Z
       
  • Prevention of early-onset pre-eclampsia – Authors' reply
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Marc A Rodger


      PubDate: 2017-04-20T19:17:34Z
       
  • Prolonged glucocorticoid treatment in acute respiratory distress syndrome
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): G Umberto Meduri, Reed A C Siemieniuk


      PubDate: 2017-04-20T19:17:34Z
       
  • Prolonged glucocorticoid treatment in acute respiratory distress syndrome
           – Authors' reply
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Rob Mac Sweeney, Daniel F McAuley


      PubDate: 2017-04-20T19:17:34Z
       
  • Beyond ESPAC-4: better surgery and systemic therapy
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Eftychia E Psarelli, Richard Jackson, John P Neoptolemos, Daniel H Palmer, Paula Ghaneh, Christopher M Halloran, Markus W Büchler


      PubDate: 2017-04-20T19:17:34Z
       
  • Stoop to conquer: preventing stroke and dementia together
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Vladimir Hachinski


      PubDate: 2017-04-20T19:17:34Z
       
  • Department of Error
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078


      PubDate: 2017-04-20T19:17:34Z
       
  • Fracture fixation in the operative management of hip fractures (FAITH): an
           international, multicentre, randomised controlled trial
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) InvestigatorsAaronNauthAaron T.CreekAbbyZellarAbdel-RahmanLawendyAdamDowrickAjayGuptaAkhilDadiAlbertvan KampenAlbertYeeAlexander C.de VriesAlexanderde Mol van OtterlooAlishaGaribaldiAllenLiewAllison W.McIntyreAmal ShankarPrasadAmanda W.RomeroAmarRanganAmberOattAmirSanghaviAmy L.FoleyAndersKarlstenAndreaDolencAndrewBucknillAndrewChiaAndrewEvansAndrewGongAndrew H.SchmidtAndrew J.MarcantonioAndrewJenningsAngelaWardAngshumanKhannaAnilRaiAnke B.SmitsAnnamarie D.HoranAnne ChristineBrekkeAnnetteFlynnAravinDuraikannanAreStødleArie B.van VugtArleneLutherArthur W.ZurcherArvindJainAsgeirAmundsenAshMoaveniAshleyCarrAteetSharmaAustin D.HillAxelTrommerB. SachidanandaRaiBarbaraHilemanBartSchreursBartVerhoevenBenjamin B.BardenBernhardFlatøyBerry I.CleffkenBertheBøeBertrandPereyBirgit C.HanuschBradWeeningBramFiooleBramRijbroekBrett D.CristBrettHallidayBrettPetersonBrianMullisC. GlenRichardsonCallumClarkCarlos A.SagebienCarmen C.van der PolCarolBowlerCatherine A.HumphreyCatherineCoadyCees L.KoppertChadColesChadiTannouryCharles J.DePaoloChrisGaytonChrisHerriottChristinaReevesChristinaTieszerChristineDobbChristopher G.AndersonClaireSageClaudineCuentoClifford B.JonesCoks H.R.BosmanColleenLinehanCor P.van der HartCoreyHendersonCourtland G.LewisCraig A.DavisCraigDonohueCyrilMauffreyD.C.SundareshDana J.FarrellDaniel B.WhelanDanielHorwitzDanielStinnerDariusViskontasDarren M.RoffeyDavidAlexanderDavid E.KargesDavidHakDavidJohnstonDavidLoveDavid M.WrightDavid P.ZamoranoDavid R.GoetzDavidSandersDavidStephenDavidYenDavideBardanaDavy JOlakkengilDeannaLawsonDeborahMaddockDebra L.SietsemaDeebaPourmandDennisDen HartogDerekDoneganDianeHeels-AnsdellDianeNamDominicInmanDoryBoyerDougLiDouglasGibulaDustin M.PriceDylan J.WatsonE. MarkHammerbergEdward T.C.H.TanEelco J.R.de GraafElise BergVesterhusElizabethRoperEltonEdwardsEmil H.SchemitschEric R.HammacherEric R.HendersonEricaWhatleyErick T.TorresErik G.J.VermeulenErinFinnEsther M.M.Van LieshoutEugene K.WaiEvan R.BannisterEvelynKileEvert B.M.TheunissenEwan D.RitchieFarahKhanFarhadMoolaFionaHowellsFrankde NiesFrank H.W.M.van der HeijdenFrank R.A.J.de MeulemeesterFredeFrihagenFredrikNilsenG. BenSchmidtG.H. RobertAlbersGarland K.GudgerJrGarthJohnsonGaryGruenGaryZohmanGauravSharmaGavinWoodGeert W.M.TetterooGeirHjorthaugGeirJomaasGeoffDonaldGeoffrey RyanRieserGeraldReardonGerard P.SlobogeanGert RRoukemaGijs A.VisserGilbertMoatsheGillianHornerGlynisRoseGordonGuyattGrahamChuterGregEtheringtonGregory J. DellaRoccaGuriEkåsGwendolynDobbinH. MichaelLemkeHamishCurryHanBoxmaHannahGisselHansKrederHansKuikenHans L.F.BromHans-ChristophPapeHarm Mvan der VisHarvinderBediHeather A.VallierHeatherBrienHeatherSilvaHeikeNewmanHelenaViveirosHenkvan der HoevenHenryAhnHermanJohalHermanRijnaHeynStockmannHong A.JosaputraHopeCarlisleIgorvan der BrandImroDawsonIvanTarkinIvanWongJ. AndrewParrJ. AndrewTrenholmJ. CarelGoslingsJ. DavidAmiraultJ. ScottBroderickJaap P.SnellenJacco A.C.ZijlJaimoAhnJamesFickeJamesIrrgangJamesPowellJames R.RinglerJamesShaerJames T.MonicaJanBiertJanBosmaJan EgilBrattgjerdJan Paul M.FrölkeJanWilleJanakiramanRajakumarJane E.WalkerJanell K.BakerJanos P.ErtlJean Paul P.M.de VriesJean W.M.GardeniersJedediahMayJeffYachJennifer T.HidyJerald R.WestbergJeremy A.HallJeroenvan MulkenJessica CooperMcBethJochemHoogendoornJodi M.HoffmanJoe JosephCherianJohn A.TanksleyJr.JohnClarke-JenssenJohn D.AdamsJohnEsterhaiJohn F.TilzeyJohnMurnaghanJohn P.KetzJohn S.GarfiJohnSchwappachJohn T.GorczycaJohnWyrickJonasRydingeJonathan L.ForetJonathan M.GrossJonathan P.KeeveJoostMeijerJoris J.G.ScheepersJosephBaeleJosephO'NeilJoseph R.CassJoseph R.HsuJulesDumaisJuliaLeeJulie A.SwitzerJulieAgelJustin E.RichardsJustin W.LanganKahnTurckanKailiPecorellaKamalRaiKamranAurangKarlShivelyKarlijnvan WessemKarynMoonKateEkeKatieErwinKatrineMilnerKees JanPonsenKelliMillsKellyApostleKellyJohnstonKellyTraskKentStroheckerKenyaStringfellowKevin K.KruseIIIKevinTetsworthKhalisMitchellKieranBrownerKimHemlockKimberlyCarcaryKnutJørgen HaugKristaNobleKristinRobbinsKrystalPaytonKyle J.JerayL. JosephRubinoLauren A.NastoffLauren C.LefflerLaurents P.S.StassenLawrence K.O'MalleyIILawrence M.SpechtLehanaThabaneLeo M.G.GeeraedtsLeslie E.ShellLinda K.AndersonLinda S.EickhoffLindseyLyleLindseyPillingLisaBuckinghamLisa K.CannadaLisa M.WildLizDulaney-CripeLodewijk M.S.J.PoelhekkeLonnekeGovaertLuTonLucksyKottamLuke P.H.LeenenLydiaClipperLyle T.JacksonLynneHamptonMaarten C.de Waal MalefijtMaarten P.SimonsMaartenvan der ElstMaarten W.G.A.BronkhorstMaheshBhatiaMarcSwiontkowskiMargaret J.LoboMarilynSwintonMarinisPirpirisMariusMolundMarkGichuruMarkGlazebrookMarkHarrisonMarkJenkinsMarkMacLeodMark R.de VriesMark S.ButlerMarkkuNousiainenMartijnevan 't RietMartin C.TynanMartinCampoMartin G.EversdijkMartin J.HeetveldMartinRichardsonMaryBreslinMaryFanMattEdisonMatthewNapieralaMatthiasKnobeMatthiasRussMauriZomarMauritsde BrauwMaxEsserMeghanHurleyMelissa E.PetersMelissaLorenzoMengnaiLiMichaelArchdeaconMichaelBiddulphMichaelCharltonMichael D.McDonaldMichael D.McKeeMichaelDunbarMichael E.TorchiaMichaelGrossMichaelHewittMichaelHoltMichael J.PraysonMichael J.R.EdwardsMichael L.BeckishMichael L.BrennanMichael P.DohmMichael S.H.KainMichelleVogtMichelleYuMichiel H.J.VerhofstadMichiel J.M.SegersMichiel J.M.SegersMichiel P.C.SiroenMikeReedMilena R.VicenteMilko M.M.BruijninckxMittalTrivediMohitBhandariMolly M.MooreMonicaKunzMortenSmedsrudNaveenPallaNeerajJainNico J.M.OutNicoleSimunovicNicoleSimunovicNiels W.L.SchepOliverMüllerOnno R.GuicheritOscar J.F.Van WaesOtisWangPascal G.DoorneboschPatriciaSeuffertPatrick J.HeskethPatrickWeinrauchPaulDuffyPaulKellerPaul M.LaffertyPaulPincusPaulTornettaIIIPaulZalzalPaulaMcKayPeter A.ColePeter D.de RooijPeterHullPeter M.N.Y.M.GoPeterPatkaPeterSiskaPeterWeingartenPhilipKregorPhilipStahelP...
      PubDate: 2017-04-20T19:17:34Z
       
  • Intensive speech and language therapy in patients with chronic aphasia
           after stroke: a randomised, open-label, blinded-endpoint, controlled trial
           in a health-care setting
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Caterina Breitenstein, Tanja Grewe, Agnes Flöel, Wolfram Ziegler, Luise Springer, Peter Martus, Walter Huber, Klaus Willmes, E Bernd Ringelstein, Karl Georg Haeusler, Stefanie Abel, Ralf Glindemann, Frank Domahs, Frank Regenbrecht, Klaus-Jürgen Schlenck, Marion Thomas, Hellmuth Obrig, Ernst de Langen, Roman Rocker, Franziska Wigbers, Christina Rühmkorf, Indra Hempen, Jonathan List, Annette Baumgaertner
      Background Treatment guidelines for aphasia recommend intensive speech and language therapy for chronic (≥6 months) aphasia after stroke, but large-scale, class 1 randomised controlled trials on treatment effectiveness are scarce. We aimed to examine whether 3 weeks of intensive speech and language therapy under routine clinical conditions improved verbal communication in daily-life situations in people with chronic aphasia after stroke. Methods In this multicentre, parallel group, superiority, open-label, blinded-endpoint, randomised controlled trial, patients aged 70 years or younger with aphasia after stroke lasting for 6 months or more were recruited from 19 inpatient or outpatient rehabilitation centres in Germany. An external biostatistician used a computer-generated permuted block randomisation method, stratified by treatment centre, to randomly assign participants to either 3 weeks or more of intensive speech and language therapy (≥10 h per week) or 3 weeks deferral of intensive speech and language therapy. The primary endpoint was between-group difference in the change in verbal communication effectiveness in everyday life scenarios (Amsterdam–Nijmegen Everyday Language Test A-scale) from baseline to immediately after 3 weeks of treatment or treatment deferral. All analyses were done using the modified intention-to-treat population (those who received 1 day or more of intensive treatment or treatment deferral). This study is registered with ClinicalTrials.gov, number NCT01540383. Findings We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (−0·03 points [4·04]; −0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferral (one car accident [in the control group], two common cold [one patient per group], three gastrointestinal or cardiac symptoms [all intervention group], two recurrent stroke [one in intervention group before initiation of treatment, and one before group assignment had occurred]); all were unrelated to study participation. Interpretation 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods. Funding German Federal Ministry of Education and Research and the German Society for Aphasia Research and Treatment.

      PubDate: 2017-04-20T19:17:34Z
       
  • Child-to-adult neurodevelopmental and mental health trajectories after
           early life deprivation: the young adult follow-up of the longitudinal
           English and Romanian Adoptees study
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Edmund J S Sonuga-Barke, Mark Kennedy, Robert Kumsta, Nicky Knights, Dennis Golm, Michael Rutter, Barbara Maughan, Wolff Schlotz, Jana Kreppner
      Background Time-limited, early-life exposures to institutional deprivation are associated with disorders in childhood, but it is unknown whether effects persist into adulthood. We used data from the English and Romanian Adoptees study to assess whether deprivation-associated adverse neurodevelopmental and mental health outcomes persist into young adulthood. Methods The English and Romanian Adoptees study is a longitudinal, natural experiment investigation into the long-term outcomes of individuals who spent from soon after birth to up to 43 months in severe deprivation in Romanian institutions before being adopted into the UK. We used developmentally appropriate standard questionnaires, interviews completed by parents and adoptees, and direct measures of IQ to measure symptoms of autism spectrum disorder, inattention and overactivity, disinhibited social engagement, conduct or emotional problems, and cognitive impairment (IQ score <80) during childhood (ages 6, 11, and 15 years) and in young adulthood (22–25 years). For analysis, Romanian adoptees were split into those who spent less than 6 months in an institution and those who spent more than 6 months in an institution. We used a comparison group of UK adoptees who did not experience deprivation. We used mixed-effects regression models for ordered-categorical outcome variables to compare symptom levels and trends between groups. Findings Romanian adoptees who experienced less than 6 months in an institution (n=67 at ages 6 years; n=50 at young adulthood) and UK controls (n=52 at age 6 years; n=39 at young adulthood) had similarly low levels of symptoms across most ages and outcomes. By contrast, Romanian adoptees exposed to more than 6 months in an institution (n=98 at ages 6 years; n=72 at young adulthood) had persistently higher rates than UK controls of symptoms of autism spectrum disorder, disinhibited social engagement, and inattention and overactivity through to young adulthood (pooled p<0·0001 for all). Cognitive impairment in the group who spent more than 6 months in an institution remitted from markedly higher rates at ages 6 years (p=0·0001) and 11 years (p=0·0016) compared with UK controls, to normal rates at young adulthood (p=0·76). By contrast, self-rated emotional symptoms showed a late-onset pattern with minimal differences versus UK controls at ages 11 years (p=0·0449) and 15 years (p=0·17), and then marked increases by young adulthood (p=0·0005), with similar effects seen for parent ratings. The high deprivation group also had a higher proportion of people with low educational achievement (p=0·0195), unemployment (p=0·0124), and mental health service use (p=0·0120, p=0·0032, and p=0·0003 for use when aged <11 years, 11–14 years, and 15–23 years, respectively) than the UK control group. A fifth (n=15) of individuals who spent more than 6 months in an institution were problem-free at all assessments. Interpretation Notwithstanding the resilience shown by some adoptees and the adult remission of cognitive impairment, extended early deprivation was associated with long-term deleterious effects on wellbeing that seem insusceptible to years of nurturance and support in adoptive families. Funding Economic and Social Research Council, Medical Research Council, Department of Health, Jacobs Foundation, Nuffield Foundation.

      PubDate: 2017-04-20T19:17:34Z
       
  • Scleromyxoedema
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Frank van Leersum, Myrurgia Abdul Hamid, Peter Steijlen


      PubDate: 2017-04-20T19:17:34Z
       
  • Syphilis
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Edward W Hook
      Syphilis is a chronic bacterial infection caused by Treponema pallidum that is endemic in low-income countries and and occurs at lower rates in middle-income and high-income countries. The disease is of both individual and public health importance and, in addition to its direct morbidity, increases risk of HIV infection and can cause lifelong morbidity in children born to infected mothers. Without treatment the disease can progress over years through a series of clinical stages and lead to irreversible neurological or cardiovascular complications. Although syphilis is an ancient disease and the principles of recommended management have been established for decades, diagnosis and management are often challenging because of its varied manifestations and difficulty in interpretation of serological tests used to confirm diagnosis and evaluate response to therapy. In North America and western Europe, incidence of syphilis has increased dramatically in the past decade among men who have sex with men, particularly those with coexistent HIV infection. Only one drug, penicillin, is recommended for syphilis treatment and response to therapy is assessed based on changes over months in serological test titres. Treatment for patients who cannot receive penicillin and management of patients who do not serologically respond to treatment are common clinical problems.

      PubDate: 2017-04-20T19:17:34Z
       
  • A rapid evidence review of the effectiveness and cost-effectiveness of
           alcohol control policies: an English perspective
    • Abstract: Publication date: 15–21 April 2017
      Source:The Lancet, Volume 389, Issue 10078
      Author(s): Robyn Burton, Clive Henn, Don Lavoie, Rosanna O'Connor, Clare Perkins, Kate Sweeney, Felix Greaves, Brian Ferguson, Caryl Beynon, Annalisa Belloni, Virginia Musto, John Marsden, Nick Sheron
      This paper reviews the evidence for the effectiveness and cost-effectiveness of policies to reduce alcohol-related harm. Policies focus on price, marketing, availability, information and education, the drinking environment, drink-driving, and brief interventions and treatment. Although there is variability in research design and measured outcomes, evidence supports the effectiveness and cost-effectiveness of policies that address affordability and marketing. An adequate reduction in temporal availability, particularly late night on-sale availability, is effective and cost-effective. Individually-directed interventions delivered to at-risk drinkers and enforced legislative measures are also effective. Providing information and education increases awareness, but is not sufficient to produce long-lasting changes in behaviour. At best, interventions enacted in and around the drinking environment lead to small reductions in acute alcohol-related harm. Overall, there is a rich evidence base to support the decisions of policy makers in implementing the most effective and cost-effective policies to reduce alcohol-related harm.

      PubDate: 2017-04-20T19:17:34Z
       
  • Systemic sclerosis
    • Abstract: Publication date: Available online 13 April 2017
      Source:The Lancet
      Author(s): Christopher P Denton, Dinesh Khanna
      Systemic sclerosis, also called scleroderma, is an immune-mediated rheumatic disease that is characterised by fibrosis of the skin and internal organs and vasculopathy. Although systemic sclerosis is uncommon, it has a high morbidity and mortality. Improved understanding of systemic sclerosis has allowed better management of the disease, including improved classification and more systematic assessment and follow-up. Additionally, treatments for specific complications have emerged and a growing evidence base supports the use of immune suppression for the treatment of skin and lung fibrosis. Some manifestations of the disease, such as scleroderma renal crisis, pulmonary arterial hypertension, digital ulceration, and gastro-oesophageal reflux, are now treatable. However, the burden of non-lethal complications associated with systemic sclerosis is substantial and is likely to become more of a challenge. Here, we review the clinical features of systemic sclerosis and describe the best practice approaches for its management. Furthermore, we identify future areas for development.

      PubDate: 2017-04-20T19:17:34Z
       
  • Targeting interleukin 23 for Crohn's disease: finding the right drug for
           the right patient
    • Authors: Stephen Hanauer
      Abstract: Publication date: Available online 12 April 2017
      Source:The Lancet
      Author(s): Stephen B Hanauer


      PubDate: 2017-04-14T05:06:38Z
       
  • Induction therapy with the selective interleukin-23 inhibitor risankizumab
           in patients with moderate-to-severe Crohn's disease: a randomised,
           double-blind, placebo-controlled phase 2 study
    • Authors: Brian Feagan; William Sandborn Geert DHaens Arthur Kaser Marc Ferrante
      Abstract: Publication date: Available online 12 April 2017
      Source:The Lancet
      Author(s): Brian G Feagan, William J Sandborn, Geert D'Haens, Julián Panés, Arthur Kaser, Marc Ferrante, Edouard Louis, Denis Franchimont, Olivier Dewit, Ursula Seidler, Kyung-Jo Kim, Markus F Neurath, Stefan Schreiber, Paul Scholl, Chandrasena Pamulapati, Bojan Lalovic, Sudha Visvanathan, Steven J Padula, Ivona Herichova, Adina Soaita, David B Hall, Wulf O Böcher
      Background The interleukin-23 pathway is implicated genetically and biologically in the pathogenesis of Crohn's disease. We aimed to assess the efficacy and safety of risankizumab (BI 655066, Boehringer Ingelheim, Ingelheim, Germany), a humanised monoclonal antibody targeting the p19 subunit of interleukin-23, in patients with moderately-to-severely active Crohn's disease. Methods In this randomised, double-blind, placebo-controlled phase 2 study, we enrolled patients at 36 referral sites in North America, Europe, and southeast Asia. Eligible patients were aged 18–75 years, with a diagnosis of Crohn's disease for at least 3 months, assessed as moderate-to-severe Crohn's disease at screening, defined as a Crohn's Disease Activity Index (CDAI) of 220–450, with mucosal ulcers in the ileum or colon, or both, and a Crohn's Disease Endoscopic Index of Severity (CDEIS) of at least 7 (≥4 for patients with isolated ileitis) on ileocolonoscopy scored by a masked central reader. Patients were randomised 1:1:1 using an interactive response system to a double-blind investigational product, and stratified by previous exposure to TNF antagonists (yes vs no). Patients received intravenous 200 mg risankizumab, 600 mg risankizumab, or placebo, at weeks 0, 4, and 8. The primary outcome was clinical remission (CDAI <150) at week 12 (intention-to-treat population). Safety was assessed in patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT02031276. Findings Between March, 2014, and September, 2015, 213 patients were screened, and 121 patients randomised. At baseline, 113 patients (93%) had been previously treated with at least one tumour necrosis factor (TNF) antagonist (which had failed in 96 [79%]). At week 12, 25 (31%) of 82 risankizumab patients (pooled 41 patients in 200 mg and 41 patients in 600 mg arms) had clinical remission versus six (15%) of 39 placebo patients (difference vs placebo 15·0%, 95% CI 0·1 to 30·1; p=0·0489). Ten (24%) of 41 patients who received 200 mg risankizumab had clinical remission (9·0%, −8·3 to 26·2; p=0·31) and 15 (37%) of 41 who received the 600 mg dose (20·9%, 2·6 to 39·2; p=0·0252). 95 (79%) patients had adverse events (32 in the placebo group, 32 randomised to 200 mg risankizumab, 31 randomised to 600 mg risankizumab); 18 had severe adverse events (nine, six, three); 12 discontinued (six, five, one); 24 had serious adverse events (12, nine, three). The most common adverse event was nausea and most common serious adverse event was worsening of underlying Crohn's disease. No deaths occurred. Interpretation In this short-term study, risankizumab was more effective than placebo for inducing clinical remission in patients with active Crohn's disease. Therefore, selective blockade of interleukin-23 via inhibition of p19 might be a viable therapeutic approach in Crohn's disease. Funding Boehringer Ingelheim.

      PubDate: 2017-04-14T05:06:38Z
       
  • NSAIDs for high-risk patients: none, celecoxib, or naproxen?
    • Authors: Patricia McGettigan; Anne-Marie Schjerning Olsen
      Abstract: Publication date: Available online 11 April 2017
      Source:The Lancet
      Author(s): Patricia McGettigan, Anne-Marie Schjerning Olsen


      PubDate: 2017-04-14T05:06:38Z
      DOI: 10.1016/s0140-6736(17)30980-7
       
  • Paediatric head imaging decisions are not child's play
    • Authors: William R Mower
      Abstract: Publication date: Available online 11 April 2017
      Source:The Lancet
      Author(s): William R Mower


      PubDate: 2017-04-14T05:06:38Z
      DOI: 10.1016/s0140-6736(17)30932-7
       
  • Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in
           children: a prospective cohort study
    • Authors: Franz E Babl; Meredith L Borland; Natalie Phillips; Amit Kochar; Sarah Dalton; Mary McCaskill; John A Cheek; Yuri Gilhotra; Jeremy Furyk; Jocelyn Neutze; Mark D Lyttle; Silvia Bressan; Susan Donath; Charlotte Molesworth; Kim Jachno; Brenton Ward; Amanda Williams; Amy Baylis; Louise Crowe; Ed Oakley; Stuart R Dalziel
      Abstract: Publication date: Available online 11 April 2017
      Source:The Lancet
      Author(s): Franz E Babl, Meredith L Borland, Natalie Phillips, Amit Kochar, Sarah Dalton, Mary McCaskill, John A Cheek, Yuri Gilhotra, Jeremy Furyk, Jocelyn Neutze, Mark D Lyttle, Silvia Bressan, Susan Donath, Charlotte Molesworth, Kim Jachno, Brenton Ward, Amanda Williams, Amy Baylis, Louise Crowe, Ed Oakley, Stuart R Dalziel
      Background Clinical decision rules can help to determine the need for CT imaging in children with head injuries. We aimed to validate three clinical decision rules (PECARN, CATCH, and CHALICE) in a large sample of children. Methods In this prospective observational study, we included children and adolescents (aged <18 years) with head injuries of any severity who presented to the emergency departments of ten Australian and New Zealand hospitals. We assessed the diagnostic accuracy of PECARN (stratified into children aged <2 years and ≥2 years), CATCH, and CHALICE in predicting each rule-specific outcome measure (clinically important traumatic brain injury [TBI], need for neurological intervention, and clinically significant intracranial injury, respectively). For each calculation we used rule-specific predictor variables in populations that satisfied inclusion and exclusion criteria for each rule (validation cohort). In a secondary analysis, we compiled a comparison cohort of patients with mild head injuries (Glasgow Coma Scale score 13–15) and calculated accuracy using rule-specific predictor variables for the standardised outcome of clinically important TBI. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000463673. Findings Between April 11, 2011, and Nov 30, 2014, we analysed 20 137 children and adolescents attending with head injuries. CTs were obtained for 2106 (10%) patients, 4544 (23%) were admitted, 83 (<1%) underwent neurosurgery, and 15 (<1%) died. PECARN was applicable for 4011 (75%) of 5374 patients younger than 2 years and 11 152 (76%) of 14 763 patients aged 2 years and older. CATCH was applicable for 4957 (25%) patients and CHALICE for 20 029 (99%). The highest point validation sensitivities were shown for PECARN in children younger than 2 years (100·0%, 95% CI 90·7–100·0; 38 patients identified of 38 with outcome [38/38]) and PECARN in children 2 years and older (99·0%, 94·4–100·0; 97/98), followed by CATCH (high-risk predictors only; 95·2%; 76·2–99·9; 20/21; medium-risk and high-risk predictors 88·7%; 82·2–93·4; 125/141) and CHALICE (92·3%, 89·2–94·7; 370/401). In the comparison cohort of 18 913 patients with mild injuries, sensitivities for clinically important TBI were similar. Negative predictive values in both analyses were higher than 99% for all rules. Interpretation The sensitivities of three clinical decision rules for head injuries in children were high when used as designed. The findings are an important starting point for clinicians considering the introduction of one of the rules. Funding National Health and Medical Research Council, Emergency Medicine Foundation, Perpetual Philanthropic Services, WA Health Targeted Research Funds, Townsville Hospital Private Practice Fund, Auckland Medical Research Foundation, A + Trust.

      PubDate: 2017-04-14T05:06:38Z
      DOI: 10.1016/s0140-6736(17)30555-x
       
  • Gastrointestinal safety of celecoxib versus naproxen in patients with
           cardiothrombotic diseases and arthritis after upper gastrointestinal
           bleeding (CONCERN): an industry-independent, double-blind, double-dummy,
           randomised trial
    • Authors: Francis K L Chan; Jessica Y L Ching; Yee Kit Tse; Kelvin Lam; Grace L H Wong; Siew C Ng; Vivian Lee; Kim W L Au; Pui Kuan Cheong; Bing Y Suen; Heyson Chan; Ka Man Kee; Angeline Lo; Vincent W S Wong; Justin C Y Wu; Moe H Kyaw
      Abstract: Publication date: Available online 11 April 2017
      Source:The Lancet
      Author(s): Francis K L Chan, Jessica Y L Ching, Yee Kit Tse, Kelvin Lam, Grace L H Wong, Siew C Ng, Vivian Lee, Kim W L Au, Pui Kuan Cheong, Bing Y Suen, Heyson Chan, Ka Man Kee, Angeline Lo, Vincent W S Wong, Justin C Y Wu, Moe H Kyaw
      Background Present guidelines are conflicting for patients at high risk of both cardiovascular and gastrointestinal events who continue to require non-steroidal anti-inflammatory drugs (NSAIDs). We hypothesised that a cyclooxygenase-2-selective NSAID plus proton-pump inhibitor is superior to a non-selective NSAID plus proton-pump inhibitor for prevention of recurrent ulcer bleeding in concomitant users of aspirin with previous ulcer bleeding. Methods For this industry-independent, double-blind, double-dummy, randomised trial done in one academic hospital in Hong Kong, we screened patients with arthritis and cardiothrombotic diseases who were presenting with upper gastrointestinal bleeding, were on NSAIDs, and require concomitant aspirin. After ulcer healing, an independent staff member randomly assigned (1:1) patients who were negative for Helicobacter pylori with a computer-generated list of random numbers to receive oral administrations of either celecoxib 100 mg twice per day plus esomeprazole 20 mg once per day or naproxen 500 mg twice per day plus esomeprazole 20 mg once per day for 18 months. All patients resumed aspirin 80 mg once per day. Both patients and investigators were masked to their treatments. The primary endpoint was recurrent upper gastrointestinal bleeding within 18 months. The primary endpoint and secondary safety endpoints were analysed in the modified intention-to-treat population. This study was registered with ClinicalTrials.gov, number NCT00153660. Findings Between May 24, 2005, and Nov 28, 2012, we enrolled 514 patients, assigning 257 patients to each study group, all of whom were included in the intention-to-treat population. Recurrent upper gastrointestinal bleeding occurred in 14 patients in the celecoxib group (nine gastric ulcers and five duodenal ulcers) and 31 patients in the naproxen group (25 gastric ulcers, three duodenal ulcers, one gastric ulcer and duodenal ulcer, and two bleeding erosions). The cumulative incidence of recurrent bleeding in 18 months was 5·6% (95% CI 3·3–9·2) in the celecoxib group and 12·3% (8·8–17·1) in the naproxen group (p=0·008; crude hazard ratio 0·44, 95% CI 0·23–0·82; p=0·010). Excluding patients who reached study endpoints, 21 (8%) patients in the celecoxib group and 17 (7%) patients in the naproxen group had adverse events leading to discontinuation of treatment. No treatment-related deaths occurred during the study. Interpretation In patients at high risk of both cardiovascular and gastrointestinal events who require concomitant aspirin and NSAID, celecoxib plus proton-pump inhibitor is the preferred treatment to reduce the risk of recurrent upper gastrointestinal bleeding. Naproxen should be avoided despite its perceived cardiovascular safety. Funding The Research Grant Council of Hong Kong.

      PubDate: 2017-04-14T05:06:38Z
      DOI: 10.1016/s0140-6736(17)30981-9
       
  • Estimates and 25-year trends of the global burden of disease attributable
           to ambient air pollution: an analysis of data from the Global Burden of
           Diseases Study 2015
    • Authors: Aaron J Cohen; Michael Brauer; Richard Burnett; H Ross Anderson; Joseph Frostad; Kara Estep; Kalpana Balakrishnan; Bert Brunekreef; Lalit Dandona; Rakhi Dandona; Valery Feigin; Greg Freedman; Bryan Hubbell; Amelia Jobling; Haidong Kan; Luke Knibbs; Yang Liu; Randall Martin; Lidia Morawska; C Arden Pope; Hwashin Shin; Kurt Straif; Gavin Shaddick; Matthew Thomas; Rita van Dingenen; Aaron van Donkelaar; Theo Vos; Christopher J L Murray; Mohammad H Forouzanfar
      Abstract: Publication date: Available online 10 April 2017
      Source:The Lancet
      Author(s): Aaron J Cohen, Michael Brauer, Richard Burnett, H Ross Anderson, Joseph Frostad, Kara Estep, Kalpana Balakrishnan, Bert Brunekreef, Lalit Dandona, Rakhi Dandona, Valery Feigin, Greg Freedman, Bryan Hubbell, Amelia Jobling, Haidong Kan, Luke Knibbs, Yang Liu, Randall Martin, Lidia Morawska, C Arden Pope, Hwashin Shin, Kurt Straif, Gavin Shaddick, Matthew Thomas, Rita van Dingenen, Aaron van Donkelaar, Theo Vos, Christopher J L Murray, Mohammad H Forouzanfar
      Background Exposure to ambient air pollution increases morbidity and mortality, and is a leading contributor to global disease burden. We explored spatial and temporal trends in mortality and burden of disease attributable to ambient air pollution from 1990 to 2015 at global, regional, and country levels. Methods We estimated global population-weighted mean concentrations of particle mass with aerodynamic diameter less than 2·5 μm (PM2·5) and ozone at an approximate 11 km × 11 km resolution with satellite-based estimates, chemical transport models, and ground-level measurements. Using integrated exposure–response functions for each cause of death, we estimated the relative risk of mortality from ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, and lower respiratory infections from epidemiological studies using non-linear exposure–response functions spanning the global range of exposure. Findings Ambient PM2·5 was the fifth-ranking mortality risk factor in 2015. Exposure to PM2·5 caused 4·2 million (95% uncertainty interval [UI] 3·7 million to 4·8 million) deaths and 103·1 million (90·8 million 115·1 million) disability-adjusted life-years (DALYs) in 2015, representing 7·6% of total global deaths and 4·2% of global DALYs, 59% of these in east and south Asia. Deaths attributable to ambient PM2·5 increased from 3·5 million (95% UI 3·0 million to 4·0 million) in 1990 to 4·2 million (3·7 million to 4·8 million) in 2015. Exposure to ozone caused an additional 254 000 (95% UI 97 000–422 000) deaths and a loss of 4·1 million (1·6 million to 6·8 million) DALYs from chronic obstructive pulmonary disease in 2015. Interpretation Ambient air pollution contributed substantially to the global burden of disease in 2015, which increased over the past 25 years, due to population ageing, changes in non-communicable disease rates, and increasing air pollution in low-income and middle-income countries. Modest reductions in burden will occur in the most polluted countries unless PM2·5 values are decreased substantially, but there is potential for substantial health benefits from exposure reduction. Funding Bill & Melinda Gates Foundation and Health Effects Institute.

      PubDate: 2017-04-14T05:06:38Z
      DOI: 10.1016/s0140-6736(17)30505-6
       
  • Department of Error
    • Abstract: Publication date: Available online 10 April 2017
      Source:The Lancet


      PubDate: 2017-04-14T05:06:38Z
       
  • Tallying the bills of mortality from air pollution
    • Authors: Douglas W Dockery; John S Evans
      Abstract: Publication date: Available online 10 April 2017
      Source:The Lancet
      Author(s): Douglas W Dockery, John S Evans


      PubDate: 2017-04-14T05:06:38Z
      DOI: 10.1016/s0140-6736(17)30884-x
       
  • Public Health Science conference: a call for abstracts
    • Authors: Serena Luchenski; Robert W Aldridge; Simon Capewell; Felix Greaves; Anne M Johnson; Ronan A Lyons; Paul Lincoln; Martin McKee; Klim McPherson; Helen Walters; Richard Horton
      Abstract: Publication date: Available online 10 April 2017
      Source:The Lancet
      Author(s): Serena Luchenski, Robert W Aldridge, Simon Capewell, Felix Greaves, Anne M Johnson, Ronan A Lyons, Paul Lincoln, Martin McKee, Klim McPherson, Helen Walters, Richard Horton


      PubDate: 2017-04-14T05:06:38Z
      DOI: 10.1016/s0140-6736(17)30945-5
       
  • America, all things not being equal
    • Authors: Lancet
      Abstract: Publication date: 8–14 April 2017
      Source:The Lancet, Volume 389, Issue 10077
      Author(s): The Lancet


      PubDate: 2017-04-07T12:57:24Z
       
  • Physician burnout: let's talk
    • Authors: Lancet
      Abstract: Publication date: 8–14 April 2017
      Source:The Lancet, Volume 389, Issue 10077
      Author(s): The Lancet


      PubDate: 2017-04-07T12:57:24Z
       
 
 
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