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Journal Cover The Lancet
  [SJR: 11.563]   [H-I: 514]   [1574 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [2970 journals]
  • Development assistance for health: past trends, associations, and the
           future of international financial flows for health
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Joseph L Dieleman, Matthew T Schneider, Annie Haakenstad, Lavanya Singh, Nafis Sadat, Maxwell Birger, Alex Reynolds, Tara Templin, Hannah Hamavid, Abigail Chapin, Christopher J L Murray
      Background Disbursements of development assistance for health (DAH) have risen substantially during the past several decades. More recently, the international community's attention has turned to other international challenges, introducing uncertainty about the future of disbursements for DAH. Methods We collected audited budget statements, annual reports, and project-level records from the main international agencies that disbursed DAH from 1990 to the end of 2015. We standardised and combined records to provide a comprehensive set of annual disbursements. We tracked each dollar of DAH back to the source and forward to the recipient. We removed transfers between agencies to avoid double-counting and adjusted for inflation. We classified assistance into nine primary health focus areas: HIV/AIDS, tuberculosis, malaria, maternal health, newborn and child health, other infectious diseases, non-communicable diseases, Ebola, and sector-wide approaches and health system strengthening. For our statistical analysis, we grouped these health focus areas into two categories: MDG-related focus areas (HIV/AIDS, tuberculosis, malaria, child and newborn health, and maternal health) and non-MDG-related focus areas (other infectious diseases, non-communicable diseases, sector-wide approaches, and other). We used linear regression to test for structural shifts in disbursement patterns at the onset of the Millennium Development Goals (MDGs; ie, from 2000) and the global financial crisis (impact estimated to occur in 2010). We built on past trends and associations with an ensemble model to estimate DAH through the end of 2040. Findings In 2015, US$36·4 billion of DAH was disbursed, marking the fifth consecutive year of little change in the amount of resources provided by global health development partners. Between 2000 and 2009, DAH increased at 11·3% per year, whereas between 2010 and 2015, annual growth was just 1·2%. In 2015, 29·7% of DAH was for HIV/AIDS, 17·9% was for child and newborn health, and 9·8% was for maternal health. Linear regression identifies three distinct periods of growth in DAH. Between 2000 and 2009, MDG-related DAH increased by $290·4 million (95% uncertainty interval [UI] 174·3 million to 406·5 million) per year. These increases were significantly greater than were increases in non-MDG DAH during the same period (p=0·009), and were also significantly greater than increases in the previous period (p<0·0001). Between 2000 and 2009, growth in DAH was highest for HIV/AIDS, malaria, and tuberculosis. Since 2010, DAH for maternal health and newborn and child health has continued to climb, although DAH for HIV/AIDS and most other health focus areas has remained flat or decreased. Our estimates of future DAH based on past trends and associations present a wide range of potential futures, although our mean estimate of $64·1 billion (95% UI $30·4 billion to $161·8 billion) shows an increase between now and 2040, although with a large uncertainty interval. Interpretation Our results provide evidence of two substantial shifts in DAH growth during the past 26 years. DAH disbursements increased faster in the first decade of the 2000s than in the 1990s, but DAH associated with the MDGs increased the most out of all focus areas. Since 2010, limited growth has characterised DAH and we expect this pattern to persist. Despite the fact that DAH is still growing, albeit minimally, DAH is shifting among the major health focus areas, with relatively little growth for HIV/AIDS, malaria, and tuberculosis. These changes in the growth and focus of DAH will have critical effects on health services in some low-income countries. Coordination and collaboration between donors and domestic governments is more important than ever because they have a great opportunity and responsibility to ensure robust health systems and service provision for those most in need. Funding Bill & Melinda Gates Foundation.


      PubDate: 2016-06-18T18:02:35Z
       
  • National spending on health by source for 184 countries between 2013 and
           2040
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Joseph L Dieleman, Tara Templin, Nafis Sadat, Patrick Reidy, Abigail Chapin, Kyle Foreman, Annie Haakenstad, Tim Evans, Christopher J L Murray, Christoph Kurowski
      Background A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these changes vary substantially across countries, even at similar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected. Methods We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks. Findings Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42–22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9–3·4) in high-income countries, 3·4% (2·4–4·2) in upper-middle-income countries, 3·0% (2·3–3·6) in lower-middle-income countries, and 2·4% (1·6–3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending. Interpretation Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action. Funding Bill & Melinda Gates Foundation.


      PubDate: 2016-06-18T18:02:35Z
       
  • Self-medicating in the opioid crisis
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): The Lancet



      PubDate: 2016-06-18T18:02:35Z
       
  • Pride in autistic diversity
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): The Lancet



      PubDate: 2016-06-18T18:02:35Z
       
  • Out-of-pocket payments in Nigeria
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Bolaji Samson Aregbeshola



      PubDate: 2016-06-18T18:02:35Z
       
  • Department of Error
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037




      PubDate: 2016-06-18T18:02:35Z
       
  • Neuropsychiatric safety and efficacy of varenicline, bupropion, and
           nicotine patch in smokers with and without psychiatric disorders (EAGLES):
           a double-blind, randomised, placebo-controlled clinical trial
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Robert M Anthenelli, Neal L Benowitz, Robert West, Lisa St Aubin, Thomas McRae, David Lawrence, John Ascher, Cristina Russ, Alok Krishen, A Eden Evins
      Background Substantial concerns have been raised about the neuropsychiatric safety of the smoking cessation medications varenicline and bupropion. Their efficacy relative to nicotine patch largely relies on indirect comparisons, and there is limited information on safety and efficacy in smokers with psychiatric disorders. We compared the relative neuropsychiatric safety risk and efficacy of varenicline and bupropion with nicotine patch and placebo in smokers with and without psychiatric disorders. Methods We did a randomised, double-blind, triple-dummy, placebo-controlled and active-controlled (nicotine patch; 21 mg per day with taper) trial of varenicline (1 mg twice a day) and bupropion (150 mg twice a day) for 12 weeks with 12-week non-treatment follow-up done at 140 centres (clinical trial centres, academic centres, and outpatient clinics) in 16 countries between Nov 30, 2011, and Jan 13, 2015. Participants were motivated-to-quit smokers with and without psychiatric disorders who received brief cessation counselling at each visit. Randomisation was computer generated (1:1:1:1 ratio). Participants, investigators, and research personnel were masked to treatment assignments. The primary endpoint was the incidence of a composite measure of moderate and severe neuropsychiatric adverse events. The main efficacy endpoint was biochemically confirmed continuous abstinence for weeks 9–12. All participants randomly assigned were included in the efficacy analysis and those who received treatment were included in the safety analysis. The trial is registered at ClinicalTrials.gov (number NCT01456936) and is now closed. Findings 8144 participants were randomly assigned, 4116 to the psychiatric cohort (4074 included in the safety analysis) and 4028 to the non-psychiatric cohort (3984 included in the safety analysis). In the non-psychiatric cohort, 13 (1·3%) of 990 participants reported moderate and severe neuropsychiatric adverse events in the varenicline group, 22 (2·2%) of 989 in the bupropion group, 25 (2·5%) of 1006 in the nicotine patch group, and 24 (2·4%) of 999 in the placebo group. The varenicline–placebo and bupropion–placebo risk differences (RDs) for moderate and severe neuropsychiatric adverse events were −1·28 (95% CI −2·40 to −0·15) and −0·08 (−1·37 to 1·21), respectively; the RDs for comparisons with nicotine patch were −1·07 (−2·21 to 0·08) and 0·13 (−1·19 to 1·45), respectively. In the psychiatric cohort, moderate and severe neuropsychiatric adverse events were reported in 67 (6·5%) of 1026 participants in the varenicline group, 68 (6·7%) of 1017 in the bupropion group, 53 (5·2%) of 1016 in the nicotine patch group, and 50 (4·9%) of 1015 in the placebo group. The varenicline–placebo and bupropion–placebo RDs were 1·59 (95% CI −0·42 to 3·59) and 1·78 (−0·24 to 3·81), respectively; the RDs versus nicotine patch were 1·22 (−0·81 to 3·25) and 1·42 (−0·63 to 3·46), respectively. Varenicline-treated participants achieved higher abstinence rates than those on placebo (odds ratio [OR] 3·61, 95% CI 3·07 to 4·24), nicotine patch (1·68, 1·46 to 1·93), and bupropion (1·75, 1·52 to 2·01). Those on bupropion and nicotine patch achieved higher abstinence rates than those on placebo (OR 2·07 [1·75 to 2·45] and 2·15 [1·82 to 2·54], respectively). Across cohorts, the most frequent adverse events by treatment group were nausea (varenicline, 25% [511 of 2016 participants]), insomnia (bupropion, 12% [245 of 2006 participants]), abnormal dreams (nicotine patch, 12% [251 of 2022 participants]), and headache (placebo, 10% [199 of 2014 participants]). Efficacy treatment comparison did not differ by cohort. Interpretation The study did not show a significant increase in neuropsychiatric adverse events attributable to varenicline or bupropion relative to nicotine patch or placebo. Varenicline was more effective than placebo, nicotine patch, and bupropion in helping smokers achieve abstinence, whereas bupropion and nicotine patch were more effective than placebo.
      PubDate: 2016-06-18T18:02:35Z
       
  • Invasive strategy in acute coronary syndrome – Authors' reply
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Nicolai Tegn, Michael Abdelnoor, Lars Aaberge, Knut Endresen, Bjørn Bendz



      PubDate: 2016-06-18T18:02:35Z
       
  • The double burden of malnutrition associated with poverty
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Hélène Delisle, Malek Batal



      PubDate: 2016-06-18T18:02:35Z
       
  • Regulating illegal drug markets: what legal markets can teach us
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Tonatiuh Barrientos-Gutierrez, Dèsirée Vidaña-Pérez, Rodrigo Zepeda-Tello, Mauricio Hernández-Ávila



      PubDate: 2016-06-18T18:02:35Z
       
  • Treatment false advertisement in China: a tragedy
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Lei Zhang, Jian Zhou, Zhiqing Zhao, Zaiping Jing



      PubDate: 2016-06-18T18:02:35Z
       
  • Invasive strategy in acute coronary syndrome
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Adam Timmis



      PubDate: 2016-06-18T18:02:35Z
       
  • Invasive strategy in acute coronary syndrome
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Rahman Shah



      PubDate: 2016-06-18T18:02:35Z
       
  • Invasive strategy in acute coronary syndrome
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Sunil T Mathew, Aneesh V Pakala, Udho Thadani



      PubDate: 2016-06-18T18:02:35Z
       
  • John Keats: science and sympathy
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Gregory Tate



      PubDate: 2016-06-18T18:02:35Z
       
  • Robert Charles Strunk
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Geoff Watts



      PubDate: 2016-06-18T18:02:35Z
       
  • Late sexual transmission of Zika virus related to persistence in the semen
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Jean Marie Turmel, Pierre Abgueguen, Bruno Hubert, Yves Marie Vandamme, Marianne Maquart, Hélène Le Guillou-Guillemette, Isabelle Leparc-Goffart



      PubDate: 2016-06-18T18:02:35Z
       
  • Zika: neurological and ocular findings in infant without microcephaly
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Camila V Ventura, Mauricio Maia, Natalia Dias, Liana O Ventura, Rubens Belfort



      PubDate: 2016-06-18T18:02:35Z
       
  • Canada's Indigenous suicide crisis
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Paul C Webster



      PubDate: 2016-06-18T18:02:35Z
       
  • Malaria
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Richard Barnett



      PubDate: 2016-06-18T18:02:35Z
       
  • The Lancet Technology: pharming blood
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Naomi Lee



      PubDate: 2016-06-18T18:02:35Z
       
  • Passionate polymath
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Andrew Robinson



      PubDate: 2016-06-18T18:02:35Z
       
  • WHO recommendations on shorter treatment of multidrug-resistant
           tuberculosis
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Giovanni Sotgiu, Simon Tiberi, Lia D'Ambrosio, Rosella Centis, Alimuddin Zumla, Giovanni Battista Migliori



      PubDate: 2016-06-18T18:02:35Z
       
  • Thailand eliminates mother-to-child transmission of HIV and syphilis
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Michel Sidibé, Poonam Khetrapal Singh



      PubDate: 2016-06-18T18:02:35Z
       
  • Offline: Something for the weekend
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Richard Horton



      PubDate: 2016-06-18T18:02:35Z
       
  • US presidential candidates urged to support health research
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Susan Jaffe



      PubDate: 2016-06-18T18:02:35Z
       
  • Yellow fever continues to spread in Angola
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Andrew Green



      PubDate: 2016-06-18T18:02:35Z
       
  • Sickle-cell disease: managing comorbidities
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): The Lancet



      PubDate: 2016-06-18T18:02:35Z
       
  • Safety of smoking cessation drugs for mentally ill patients
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Laurie Zawertailo



      PubDate: 2016-06-18T18:02:35Z
       
  • Shaping of a new era for health financing
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Tim Evans, Ariel Pablos-Méndez



      PubDate: 2016-06-18T18:02:35Z
       
  • AIDS 2016: from aspiration to implementation
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Kenneth H Mayer, Olive Shisana, Chris Beyrer



      PubDate: 2016-06-18T18:02:35Z
       
  • The intersection between asthma and acute chest syndrome in children with
           sickle-cell anaemia
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Michael R DeBaun, Robert C Strunk
      Acute chest syndrome is a frequent cause of acute lung disease in children with sickle-cell disease. Asthma is common in children with sickle-cell disease and is associated with increased incidence of vaso-occlusive pain events, acute chest syndrome episodes, and earlier death. Risk factors for asthma exacerbation and an acute chest syndrome episode are similar, and both can present with shortness of breath, chest pain, cough, and wheezing. Despite overlapping risk factors and symptoms, an acute exacerbation of asthma or an episode of acute chest syndrome are two distinct entities that need disease-specific management strategies. Although understanding has increased about asthma as a comorbidity in sickle-cell disease and its effects on morbidity, substantial gaps remain in knowledge about best management.


      PubDate: 2016-06-18T18:02:35Z
       
  • Fetal haemoglobin in sickle-cell disease: from genetic epidemiology to new
           therapeutic strategies
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Guillaume Lettre, Daniel E Bauer
      Sickle-cell disease affects millions of individuals worldwide, but the global incidence is concentrated in Africa. The burden of sickle-cell disease is expected to continue to rise over the coming decades, adding to stress on the health infrastructures of many countries. Although the molecular cause of sickle-cell disease has been known for more than half a century, treatment options remain greatly limited. Allogeneic haemopoietic stem-cell transplantation is the only existing cure but is limited to specialised clinical centres and remains inaccessible for most patients. Induction of fetal haemoglobin production is a promising strategy for the treatment of sickle-cell disease. In this Series paper, we review scientific breakthroughs in epidemiology, genetics, and molecular biology that have brought reactivation of fetal haemoglobin to the forefront of sickle-cell disease research. Improved knowledge of the regulation of fetal haemoglobin production in human beings and the development of genome editing technology now support the design of innovative therapies for sickle-cell disease that are based on fetal haemoglobin.


      PubDate: 2016-06-18T18:02:35Z
       
  • Cardiovascular complications and risk of death in sickle-cell disease
    • Abstract: Publication date: 18–24 June 2016
      Source:The Lancet, Volume 387, Issue 10037
      Author(s): Mark T Gladwin
      In sickle-cell disease, a point mutation in the β-globin chain causes haemoglobin to polymerise within erythrocytes during deoxygenation, altering red blood cell rheology and causing haemolysis. Improvements in health infrastructure, preventive care, and clinical treatments have reduced the morbidity and mortality of sickle-cell disease in developed countries. However, as these patients live longer, the chronic effects of sustained haemolytic anaemia and episodic vaso-occlusive events drive the development of end-organ complications. Cardiopulmonary organ dysfunction and chronic kidney injury have a large effect on morbidity and premature mortality, and typically accelerate in the second decade of life. These processes culminate in the development of pulmonary hypertension, left ventricular diastolic heart disease, dysrhythmia, and sudden death. In this Series paper, we review the mechanisms, clinical features, and epidemiology of major cardiovascular complications in patients with sickle-cell disease and discuss how screening and intervention could reduce their incidence.


      PubDate: 2016-06-18T18:02:35Z
       
  • GIRES: e-learning for transgender health training
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Terry Reed



      PubDate: 2016-06-18T18:02:35Z
       
  • Is Zika a substantial risk for visitors to the Rio de Janeiro Olympic
           Games'
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Eduardo Massad, Francisco Antonio Bezerra Coutinho, Annelies Wilder-Smith



      PubDate: 2016-06-18T18:02:35Z
       
  • Transgender community voices: a participatory population perspective
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Sari Reisner, JoAnne Keatley, Stefan Baral



      PubDate: 2016-06-18T18:02:35Z
       
  • Serving transgender people: clinical care considerations and service
           delivery models in transgender health
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Kevan Wylie, Gail Knudson, Sharful Islam Khan, Mireille Bonierbale, Suporn Watanyusakul, Stefan Baral
      The World Professional Association for Transgender Health (WPATH) standards of care for transsexual, transgender, and gender non-conforming people (version 7) represent international normative standards for clinical care for these populations. Standards for optimal individual clinical care are consistent around the world, although the implementation of services for transgender populations will depend on health system infrastructure and sociocultural contexts. Some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialised facilities; however, the majority of health-care needs can be delivered by a primary care practitioner. Across high-income and low-income settings alike, there often remains a dearth of educational programming for health-care professionals in transgender health, although the best evidence supports introducing modules on transgender health early during clinical education of clinicians and allied health professionals. While these challenges remain, we review the increasing evidence and examples of the defined roles of the mental health professional in transgender health-care decisions, effective models of health service provision, and available surgical interventions for transgender people.


      PubDate: 2016-06-18T18:02:35Z
       
  • Sam Winter and Kevan Wylie: pioneers in transgender health
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Richard Lane



      PubDate: 2016-06-18T18:02:35Z
       
  • Global health burden and needs of transgender populations: a review
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Sari L Reisner, Tonia Poteat, JoAnne Keatley, Mauro Cabral, Tampose Mothopeng, Emilia Dunham, Claire E Holland, Ryan Max, Stefan D Baral
      Transgender people are a diverse population affected by a range of negative health indicators across high-income, middle-income, and low-income settings. Studies consistently document a high prevalence of adverse health outcomes in this population, including HIV and other sexually transmitted infections, mental health distress, and substance use and abuse. However, many other health areas remain understudied, population-based representative samples and longitudinal studies are few, and routine surveillance efforts for transgender population health are scarce. The absence of survey items with which to identify transgender respondents in general surveys often restricts the availability of data with which to estimate the magnitude of health inequities and characterise the population-level health of transgender people globally. Despite the limitations, there are sufficient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people. To mitigate these risks and foster resilience, a comprehensive approach is needed that includes gender affirmation as a public health framework, improved health systems and access to health care informed by high quality data, and effective partnerships with local transgender communities to ensure responsiveness of and cultural specificity in programming. Consideration of transgender health underscores the need to explicitly consider sex and gender pathways in epidemiological research and public health surveillance more broadly.


      PubDate: 2016-06-18T18:02:35Z
       
  • Sari Reisner—making transgender health visible
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Tony Kirby



      PubDate: 2016-06-18T18:02:35Z
       
  • Synergies in health and human rights: a call to action to improve
           transgender health
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Sam Winter, Edmund Settle, Kevan Wylie, Sari Reisner, Mauro Cabral, Gail Knudson, Stefan Baral



      PubDate: 2016-06-18T18:02:35Z
       
  • Transgender: why should we care'
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Jamison Green



      PubDate: 2016-06-18T18:02:35Z
       
  • Transgender health: an opportunity for global health equity
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Selina Lo, Richard Horton



      PubDate: 2016-06-18T18:02:35Z
       
  • Transgender people: health at the margins of society
    • Abstract: Publication date: Available online 17 June 2016
      Source:The Lancet
      Author(s): Sam Winter, Milton Diamond, Jamison Green, Dan Karasic, Terry Reed, Stephen Whittle, Kevan Wylie
      In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the provision of health care for transgender people across much of the world. Modern research shows much higher numbers of transgender people than were apparent in earlier clinic-based studies, as well as biological factors associated with gender incongruence. We examine research showing that many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health. They often experience difficulties accessing appropriate health care, whether specific to their gender needs or more general in nature. Some governments are taking steps to address human rights issues and provide better legal protection for transgender people, but this action is by no means universal. The mental illness perspective that currently frames health-care provision for transgender people across much of the world is under scrutiny. The WHO diagnostic manual may soon abandon its current classification of transgender people as mentally disordered. Debate exists as to whether there should be a diagnosis of any sort for transgender children below the age of puberty.


      PubDate: 2016-06-18T18:02:35Z
       
  • Addition of high-dose cytarabine to immunochemotherapy before autologous
           stem-cell transplantation in patients aged 65 years or younger with mantle
           cell lymphoma (MCL Younger): a randomised, open-label, phase 3 trial of
           the European Mantle Cell Lymphoma Network
    • Abstract: Publication date: Available online 14 June 2016
      Source:The Lancet
      Author(s): Olivier Hermine, Eva Hoster, Jan Walewski, André Bosly, Stephan Stilgenbauer, Catherine Thieblemont, Michal Szymczyk, Reda Bouabdallah, Michael Kneba, Michael Hallek, Gilles Salles, Pierre Feugier, Vincent Ribrag, Josef Birkmann, Roswitha Forstpointner, Corinne Haioun, Mathias Hänel, René Olivier Casasnovas, Jürgen Finke, Norma Peter, Kamal Bouabdallah, Catherine Sebban, Thomas Fischer, Ulrich Dührsen, Bernd Metzner, Georg Maschmeyer, Lothar Kanz, Christian Schmidt, Richard Delarue, Nicole Brousse, Wolfram Klapper, Elizabeth Macintyre, Marie-Hélène Delfau-Larue, Christiane Pott, Wolfgang Hiddemann, Michael Unterhalt, Martin Dreyling
      Background Mantle cell lymphoma is characterised by a poor long-term prognosis. The European Mantle Cell Lymphoma Network aimed to investigate whether the introduction of high-dose cytarabine to immunochemotherapy before autologous stem-cell transplantation (ASCT) improves outcome. Methods This randomised, open-label, parallel-group, phase 3 trial was done in 128 haemato-oncological hospital departments or private practices in Germany, France, Belgium, and Poland. Patients aged 65 years or younger with untreated stage II–IV mantle cell lymphoma were centrally randomised (1:1), with computer-assisted random block selection, to receive either six courses of R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by myeloablative radiochemotherapy and ASCT (control group), or six courses of alternating R-CHOP or R-DHAP (rituximab plus dexamethasone, high-dose cytarabine, and cisplatin) followed by a high-dose cytarabine-containing conditioning regimen and ASCT (cytarabine group). Patients were stratified by study group and international prognostic index. The primary outcome was time to treatment failure from randomisation to stable disease after at least four induction cycles, progression, or death from any cause. Patients with stage II–IV mantle cell lymphoma were included in the primary analysis if treatment was started according to randomisation. For safety analyses, patients were assessed according to the treatment actually started. This study is registered with ClinicalTrials.gov, number NCT00209222. Findings Of 497 patients (median age 55 years [IQR 49–60]) randomised from July 20, 2004, to March 18, 2010, 234 of 249 in the control group and 232 of 248 in the cytarabine group were included in the primary analysis. After a median follow-up of 6·1 years (95% CI 5·4–6·4), time to treatment failure was significantly longer in the cytarabine group (median 9·1 years [95% CI 6·3–not reached], 5 year rate 65% [95% CI 57–71]) than in the control group (3·9 years [3·2–4·4], 40% [33–46]; hazard ratio 0·56; p=0·038). During induction immunochemotherapy, patients who received high-dose cytarabine had increased grade 3 or 4 haematological toxicity (haemoglobin 71 [29%] of 241m vs 19 [8%] of 227 controls; platelets 176 [73%] of 240 vs 21 [9%] of 225), grade 3 or 4 febrile neutropenia (39 [17%] of 230 vs 19 [8%] of 224), and grade 1 or 2 renal toxicity (creatinine 102 [43%] of 236 vs 22 [10%] of 224). The number of ASCT-related deaths was similar (eight [3·4%]) in both groups. Interpretation Immunochemotherapy containing high-dose cytarabine followed by ASCT should be considered standard of care in patients aged 65 years or younger with mantle cell lymphoma. Funding European Commission, Lymphoma Research Foundation, and Roche.


      PubDate: 2016-06-18T18:02:35Z
       
  • Mantle cell lymphoma treatment: plus ça change…
    • Abstract: Publication date: Available online 14 June 2016
      Source:The Lancet
      Author(s): Peter Martin



      PubDate: 2016-06-18T18:02:35Z
       
  • Hearing loss: an important global health concern
    • Abstract: Publication date: 11–17 June 2016
      Source:The Lancet, Volume 387, Issue 10036
      Author(s): The Lancet



      PubDate: 2016-06-18T18:02:35Z
       
  • Dear Mr Ban Ki-moon
    • Abstract: Publication date: 11–17 June 2016
      Source:The Lancet, Volume 387, Issue 10036
      Author(s): The Lancet



      PubDate: 2016-06-18T18:02:35Z
       
  • Missing evidence
    • Abstract: Publication date: 11–17 June 2016
      Source:The Lancet, Volume 387, Issue 10036
      Author(s): The Lancet



      PubDate: 2016-06-18T18:02:35Z
       
 
 
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