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Journal Cover   The Lancet
  [SJR: 11.563]   [H-I: 514]   [1347 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [2800 journals]
  • Iraq's health services curtailed by funding shortfall
    • Abstract: Publication date: Available online 24 August 2015
      Source:The Lancet
      Author(s): Sharmila Devi



      PubDate: 2015-08-25T03:45:16Z
       
  • Floods in Myanmar damage hundreds of health facilities
    • Abstract: Publication date: Available online 24 August 2015
      Source:The Lancet
      Author(s): Talha Burki



      PubDate: 2015-08-25T03:45:16Z
       
  • Iron deficiency anaemia
    • Abstract: Publication date: Available online 24 August 2015
      Source:The Lancet
      Author(s): Anthony Lopez, Patrice Cacoub, Iain C Macdougall, Laurent Peyrin-Biroulet
      Anaemia affects roughly a third of the world's population; half the cases are due to iron deficiency. It is a major and global public health problem that affects maternal and child mortality, physical performance, and referral to health-care professionals. Children aged 0–5 years, women of childbearing age, and pregnant women are particularly at risk. Several chronic diseases are frequently associated with iron deficiency anaemia—notably chronic kidney disease, chronic heart failure, cancer, and inflammatory bowel disease. Measurement of serum ferritin, transferrin saturation, serum soluble transferrin receptors, and the serum soluble transferrin receptors–ferritin index are more accurate than classic red cell indices in the diagnosis of iron deficiency anaemia. In addition to the search for and treatment of the cause of iron deficiency, treatment strategies encompass prevention, including food fortification and iron supplementation. Oral iron is usually recommended as first-line therapy, but the most recent intravenous iron formulations, which have been available for nearly a decade, seem to replenish iron stores safely and effectively. Hepcidin has a key role in iron homoeostasis and could be a future diagnostic and therapeutic target. In this Seminar, we discuss the clinical presentation, epidemiology, pathophysiology, diagnosis, and acute management of iron deficiency anaemia, and outstanding research questions for treatment.


      PubDate: 2015-08-25T03:45:16Z
       
  • Postural modification to the standard Valsalva manoeuvre for emergency
           treatment of supraventricular tachycardias (REVERT): a randomised
           controlled trial
    • Abstract: Publication date: Available online 24 August 2015
      Source:The Lancet
      Author(s): Andrew Appelboam, Adam Reuben, Clifford Mann, James Gagg, Paul Ewings, Andrew Barton, Trudie Lobban, Mark Dayer, Jane Vickery, Jonathan Benger
      Background The Valsalva manoeuvre is an internationally recommended treatment for supraventricular tachycardia, but cardioversion is rare in practice (5–20%), necessitating the use of other treatments including adenosine, which patients often find unpleasant. We assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness. Methods We did a randomised controlled, parallel-group trial at emergency departments in England. We randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fibrillation and flutter) in a 1:1 ratio to undergo a modified Valsalva manoeuvre (done semi-recumbent with supine repositioning and passive leg raise immediately after the Valsalva strain), or a standard semi-recumbent Valsalva manoeuvre. A 40 mm Hg pressure, 15 s standardised strain was used in both groups. Randomisation, stratified by centre, was done centrally and independently, with allocation with serially numbered, opaque, sealed, tamper-evident envelopes. Patients and treating clinicians were not masked to allocation. The primary outcome was return to sinus rhythm at 1 min after intervention, determined by the treating clinician and electrocardiogram and confirmed by an investigator masked to treatment allocation. This study is registered with Current Controlled Trials (ISRCTN67937027). Findings We enrolled 433 participants between Jan 11, 2013, and Dec 29, 2014. Excluding second attendance by five participants, 214 participants in each group were included in the intention-to-treat analysis. 37 (17%) of 214 participants assigned to standard Valsalva manoeuvre achieved sinus rhythm compared with 93 (43%) of 214 in the modified Valsalva manoeuvre group (adjusted odds ratio 3·7 (95% CI 2·3–5·8; p<0·0001). We recorded no serious adverse events. Interpretation In patients with supraventricular tachycardia, a modified Valsalva manoeuvre with leg elevation and supine positioning at the end of the strain should be considered as a routine first treatment, and can be taught to patients. Funding National Institute for Health Research.


      PubDate: 2015-08-25T03:45:16Z
       
  • Supraventricular tachycardia: back to basics
    • Abstract: Publication date: Available online 24 August 2015
      Source:The Lancet
      Author(s): Martin Than, William F Peacock



      PubDate: 2015-08-25T03:45:16Z
       
  • Bubble CPAP for pneumonia: perils of stopping trials early
    • Abstract: Publication date: Available online 23 August 2015
      Source:The Lancet
      Author(s): Frank Shann, Theis Lange



      PubDate: 2015-08-25T03:45:16Z
       
  • NICE antimicrobial stewardship: right drug, dose, and time?
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): The Lancet



      PubDate: 2015-08-25T03:45:16Z
       
  • More Americans opting for affordable care
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): The Lancet



      PubDate: 2015-08-25T03:45:16Z
       
  • Disease, disability, and demography—a world in transition
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): The Lancet



      PubDate: 2015-08-25T03:45:16Z
       
  • Transplanting suboptimum organs: medico-legal implications
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Matthew Dyson, Christopher J Watson, Kathleen Liddell, Nicola Padfield, J Andrew Bradley, Kourosh Saeb-Parsy



      PubDate: 2015-08-25T03:45:16Z
       
  • Transitioning health systems for multimorbidity
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Rifat Atun



      PubDate: 2015-08-25T03:45:16Z
       
  • Closing the divide: the Harvard Global Equity Initiative–Lancet
           Commission on global access to pain control and palliative care
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Felicia M Knaul, Paul E Farmer, Afsan Bhadelia, Philippa Berman, Richard Horton



      PubDate: 2015-08-25T03:45:16Z
       
  • Sexual health, human rights, and law
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Rajat Khosla, Lale Say, Marleen Temmerman



      PubDate: 2015-08-25T03:45:16Z
       
  • Trans health care in the USA: a long way to go
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Rita Rubin



      PubDate: 2015-08-25T03:45:16Z
       
  • Madagascar's health challenges
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Sima Barmania



      PubDate: 2015-08-25T03:45:16Z
       
  • Hidden histories of light therapy
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Kelley Swain



      PubDate: 2015-08-25T03:45:16Z
       
  • The visionary art of Stanley Spencer
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Thomas Wright



      PubDate: 2015-08-25T03:45:16Z
       
  • Marcia Stefanick: women's west coast initiatives lead to wisdom
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Geoff Watts



      PubDate: 2015-08-25T03:45:16Z
       
  • Metaphors and medically unexplained symptoms
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Eben S Schwartz



      PubDate: 2015-08-25T03:45:16Z
       
  • Paul J Lioy
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Alison Snyder



      PubDate: 2015-08-25T03:45:16Z
       
  • The need for global primary care development indicators
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Michael R Kidd, Maria Inez Padula Anderson, Ehimatie M Obazee, Pratap N Prasad, Luisa M Pettigrew



      PubDate: 2015-08-25T03:45:16Z
       
  • Health security and political and economic determinants of Ebola
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Mahomed S Patel, Christine B Phillips



      PubDate: 2015-08-25T03:45:16Z
       
  • Social and political remedies needed for the Ebola tragedy
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): David Sanders, David McCoy, David Legge, Anne-Emmanuelle Birn, Amit Sengupta



      PubDate: 2015-08-25T03:45:16Z
       
  • The right to the highest attainable standard of health
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Peter Hall



      PubDate: 2015-08-25T03:45:16Z
       
  • An achievable goal: control and elimination of schistosomiasis
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Lorenzo Savioli, Alan Fenwick, David Rollinson, Marco Albonico, Shaali Makame Ame



      PubDate: 2015-08-25T03:45:16Z
       
  • Tackling obesity: challenges ahead
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Bettina Utz, Vincent De Brouwere



      PubDate: 2015-08-25T03:45:16Z
       
  • Tackling obesity: challenges ahead
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Amanda Brondani Mucellini, Gisele Gus Manfro, Patrícia Pelufo Silveira



      PubDate: 2015-08-25T03:45:16Z
       
  • Tackling obesity: challenges ahead
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Gerard Bodeker, Fredi Kronenberg



      PubDate: 2015-08-25T03:45:16Z
       
  • Tackling obesity: challenges ahead
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Adrian Bauman, Bronwyn McGill, Ken Powell, I-Min Lee, Greg Heath, Michael Pratt, Harold W Kohl, Pedro Hallal



      PubDate: 2015-08-25T03:45:16Z
       
  • The promise of personalised medicine
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Claude Matuchansky



      PubDate: 2015-08-25T03:45:16Z
       
  • Department of Error
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995




      PubDate: 2015-08-25T03:45:16Z
       
  • Department of Error
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995




      PubDate: 2015-08-25T03:45:16Z
       
  • Department of Error
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995




      PubDate: 2015-08-25T03:45:16Z
       
  • Department of Error
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995




      PubDate: 2015-08-25T03:45:16Z
       
  • Global, regional, and national incidence, prevalence, and years lived with
           disability for 301 acute and chronic diseases and injuries in 188
           countries, 1990–2013: a systematic analysis for the Global Burden of
           Disease Study 2013
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Global Burden of Disease Study 2013 CollaboratorsTheoVosRyan MBarberBradBellAmeliaBertozzi-VillaStanBiryukovIanBolligerFionaCharlsonAdrianDavisLouisaDegenhardtDanielDickerLeileiDuanHollyErskineValery LFeiginAlize JFerrariChristinaFitzmauriceThomasFlemingNicholasGraetzCaterinaGuinovartJuanitaHaagsmaGillian MHansenSarah WulfHansonKyle RHeutonHidekiHigashiNicholasKassebaumHmweKyuEvanLaurieXiofengLiangKatherineLofgrenRafaelLozanoMichael FMacIntyreMaziarMoradi-LakehMohsenNaghaviGrantNguyenShaunOdellKatrinaOrtbladDavid AllenRobertsGregory ARothLoganSandarPeter TSerinaJeffrey DStanawayCaitlynSteinerBernadetteThomasStein EmilVollsetHarveyWhitefordTimothy MWolockPengpengYeMaigengZhouMarco AÃvilaGunn MaritAasvangCristianaAbbafatiAyse AbbasogluOzgorenFoadAbd-AllahMuna I AbdelAzizSemaw FAberaVictorAboyansJerry PAbrahamBijuAbrahamIbrahimAbubakarLaith JAbu-RaddadNiveen MEAbu-RmeilehTania CAburtoTomAchokiIlana NAckermanAdemolaAdelekanZanfinaAdemiArsène KAdouJosef CAdsuarJohanArnlovEmilie EAgardhMazin JAl KhabouriSayed SaidulAlamDeenaAlasfoorMohammed IAlbittarMiguel AAlegrettiAlicia VAlemanZewdie AAlemuRafaelAlfonso-CristanchoSamiaAlhabibRaghibAliFrancoisAllaPeterAllebeckPeter JAllenMohammad AbdulAzizAlMazroaUbaiAlsharifElenaAlvarezNelsonAlvis-GuzmanOmidAmeliHereshAminiWalidAmmarBenjamin OAndersonH. RossAndersonCarl Abelardo TAntonioPalwashaAnwariHenryApfelValentain S ArsicArsenijevicAlArtamanRana JAsgharRezaAssadiLydia SAtkinsCharlesAtkinsonAlaaBadawiMaria CBahitTalalBakfalouniKalpanaBalakrishnanShivanthiBalallaAmitavaBanerjeeSuzanne LBarker-ColloSimonBarqueraLarsBarregardLope HBarreroSanjayBasuArindamBasuAmandaBaxterJustinBeardsleyNeerajBediEttoreBeghiTolesaBekeleMichelle LBellCorinaBenjetDerrick ABennettIsabela MBensenorHabibBenzianEduardoBernabeTariku JBeyeneNeerajBhalaAshishBhallaZulfiqarBhuttaKellyBienhoffBorisBikbovAref BinAbdulhakJed DBloreFiona MBlythMegan ABohenskyBerrak BoraBasaraGuilhermeBorgesNatan MBornsteinDipanBoseSoufianeBoufousRupert RBourneLindsay NBoyersMichaelBraininMichaelBrauerCarol EGBrayneAlexandraBrazinovaNicholas JKBreitbordeHermannBrennerAdam DMBriggsPeter MBrooksJonathanBrownTraolach SBrughaRachelleBuchbinderGeoffrey CBuckleGeneBukhmanAndrew GBullochMichaelBurchRichardBurnettRosarioCardenasNorberto LCabralIsmael R CamposNonatoJulio CCampuzanoJonathan RCarapetisDavid OCarpenterValeriaCasoCarlos ACastaneda-OrjuelaFerranCatala-LopezVineet KChadhaJung-ChenChangHongleiChenWanqingChenPeggy PChiangOdgerelChimed-OchirRajivChowdhuryHanneChristensenCostas AChristophiSumeet SChughMassimoCirilloMeganCoggeshallAaronCohenValentinaColistroSamantha MColquhounAlejandra GContrerasLeslie TCooperCyrusCooperKimberlyCooperriderJosefCoreshMonicaCortinovisMichael HCriquiJohn ACrumpLuciaCuevas-NasuRakhiDandonaLalitDandonaEmilyDansereauHector GDantesPaul IDarganGailDaveyDragos VDavitoiuAnandDayamaVanessaDe la Cruz-GongoraShelley Fde la VegaDiegoDe LeoBorjadel Pozo-CruzRobert PDellavalleKebedeDeribeSarahDerrettDon CDes JarlaisMulukenDessalegnGabrielle AdeVeberSamath DDharmaratneCesarDiaz-TorneEric LDingKlaraDokovaE RDorseyTim RDriscollHerbertDuberAdnan MDurraniKaren MEdmondRichard GEllenbogenMatthiasEndresSergey PErmakovBabakEshratiAlirezaEsteghamatiKaraEstepSamanFahimiFarshadFarzadfarDerek FJFayDavid TFelsonSeyed-MohammadFereshtehnejadJefferson GFernandesCluesa PFerriAbrahamFlaxmanNataliyaFoigtKyle JForemanF Gerry RFowkesRichard CFranklinThomasFurstNeal DFutranBelinda JGabbeFortune GGankpeFrancisco AGarcia-GuerraJohanna MGeleijnseBradford DGessnerKatherine BGibneyRichard FGillumIbrahim AGinawiMauriceGiroudGiorgiaGiussaniShifalikaGoenkaKetevanGoginashviliPhilimonGonaTeresita Gonzalezde CosioRichard AGosselinCarolyn CGotayAtsushiGotoHebe NGoudaRichard lGuerrantHarish CGugnaniDavidGunnellRajeevGuptaRahulGuptaReyna AGutierrezNimaHafezi-NejadHollyHaganYaraHalasaRandah RHamadehHannahHamavidMouhanadHammamiGraeme JHankeyYuantaoHaoHilda LHarbJosep MariaHaroRasmusHavmoellerRoderick JHaySimonHayMohammad THedayatiIleana B HerediaPiPouriaHeydarpourMarthaHijarHans WHoekHoward JHoffmanJohn CHornbergerH. DeanHosgoodMazedaHossainPeter JHotezDamian GHoyMohamedHsairiHowardHuGuoqingHuJohn JHuangChengHuangLaetitiaHuiartAbdullatifHusseiniMarissaIannaroneKim MIburgKaireInnosManamiInoueKathryn HJacobsenSimerjot KJassalPanniyammakalJeemonPaul NJensenVivekanandJhaGuohongJiangYingJiangJost BJonasJonathanJosephKnudJuelHaidongKanAndreKarchChanteKarimkhaniGanesanKarthikeyanRonitKatzAnilKaulNoritoKawakamiDhruv SKaziAndrew HKempAndre PKengneYousef SKhaderShams Eldin AHKhalifaEjaz AKhanGulfarazKhanYoung-HoKhangIrmaKhonelidzeChristianKielingDanielKimSungroulKimRuth WKimokotiYohannesKinfuJonas MKingeBrett MKisselaMiiaKivipeltoLukeKnibbsAnn KristinKnudsenYoshihiroKokuboSoewartaKosenAlexanderKramerMichaelKravchenkoRita VKrishnamurthiSanjayKrishnaswamiBarthelemy KuateDefoBurcu KucukBicerErnst JKuipersVeena SKulkarniKaushalendraKumarG AnilKumarGene FKwanTaaviLaiRatilalLallooHiltonLamQingLanVan CLansinghHeidiLarsonAndersLarssonAlicia EBLawrynowiczJanet LLeasherJong-TaeLeeJamesLeighRickyLeungMiriamLeviBinLiYichongLiYongmeiLiJuanliangStephenLimHsien-HoLinMargaretLindM PatriceLindsaySteven ELipshultzShiweiLiuBelinda KLloydSummer LockettOhnoGiancarloLogroscinoKatharine JLookerAlan DLopezNancyLopez-OlmedoJoannieLortet-TieulentPaulo ALotufoNicolaLowRobyn MLucasRaimundasLuneviciusRonan ALyonsJixiangMaStefanMaMark TMackayMarekMajdanRezaMalekzadehChristopher CMapomaWagnerMarcenesLyn MMarchChrisMargonoGuy BMarksMelvin BMarzanJoseph RMasciAmanda JMason-JonesRichard GMatzopoulosBongani MMayosiTasara TMazorodzeNeil WMcGillJohn JMcGrathMartinMcKeeAbbyMcLainBrian JMcMahonPeter AMeaneyMan MohanMehndirattaFabiolaMejia-RodriguezWubegzierMekonnenYohannes AMelakuMicheleMeltzerZiad AMemishGeorgeMensahAtteMeretojaFrancis AMhimbiraRenataMichaTed RMillerEdward JMillsPhilip BMitchellCharles NMockTerrie EMoffittNorlin...
      PubDate: 2015-08-25T03:45:16Z
       
  • Black pleural effusion
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): B Jayakrishnan, Babar Dildar, Dawar M Rizavi, Saif M Al Mubaihsi, Adil Al Kindi



      PubDate: 2015-08-25T03:45:16Z
       
  • Hypertension
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Neil R Poulter, Dorairaj Prabhakaran, Mark Caulfield
      Raised blood pressure is the biggest single contributor to the global burden of disease and to global mortality. The numbers of people affected and the prevalence of high blood pressure worldwide are expected to increase over the next decade. Preventive strategies are therefore urgently needed, especially in less developed countries, and management of hypertension must be optimised. Genetic advances in some rare causes of hypertension have been made lately, but the aggregate effect on blood pressure of all the genetic loci identified to date is small. Hence, intervention on key environmental determinants and effective implementation of trial-based therapies are needed. Three-drug combinations can control hypertension in about 90% of patients but only if resources allow identification of patients and drug delivery is affordable. Furthermore, assessment of optimal drug therapy for each ethnic group is needed.


      PubDate: 2015-08-25T03:45:16Z
       
  • Left ventricular non-compaction cardiomyopathy
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Jeffrey A Towbin, Angela Lorts, John Lynn Jefferies
      Left ventricular non-compaction, the most recently classified form of cardiomyopathy, is characterised by abnormal trabeculations in the left ventricle, most frequently at the apex. It can be associated with left ventricular dilation or hypertrophy, systolic or diastolic dysfunction, or both, or various forms of congenital heart disease. Affected individuals are at risk of left or right ventricular failure, or both. Heart failure symptoms can be induced by exercise or be persistent at rest, but many patients are asymptomatic. Patients on chronic treatment for compensated heart failure sometimes present acutely with decompensated heart failure. Other life-threatening risks of left ventricular non-compaction are ventricular arrhythmias or complete atrioventricular block, presenting clinically as syncope, and sudden death. Genetic inheritance arises in at least 30–50% of patients, and several genes that cause left ventricular non-compaction have been identified. These genes seem generally to encode sarcomeric (contractile apparatus) or cytoskeletal proteins, although, in the case of left ventricular non-compaction with congenital heart disease, disturbance of the NOTCH signalling pathway seems part of a final common pathway for this form of the disease. Disrupted mitochondrial function and metabolic abnormalities have a causal role too. Treatments focus on improvement of cardiac efficiency and reduction of mechanical stress in patients with systolic dysfunction. Further, treatment of arrhythmia and implantation of an automatic implantable cardioverter-defibrillator for prevention of sudden death are mainstays of therapy when deemed necessary and appropriate. Patients with left ventricular non-compaction and congenital heart disease often need surgical or catheter-based interventions. Despite progress in diagnosis and treatment in the past 10 years, understanding of the disorder and outcomes need to be improved.


      PubDate: 2015-08-25T03:45:16Z
       
  • Responsibility and accountability for well informed health-care decisions:
           a global challenge
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Gro Jamtvedt, Marianne Klemp, Berit Mørland, Magne Nylenna



      PubDate: 2015-08-25T03:45:16Z
       
  • Fever and weight loss in a patient with HIV
    • Abstract: Publication date: 22–28 August 2015
      Source:The Lancet, Volume 386, Issue 9995
      Author(s): Emily Martyn, Michael Marks, Simon Edwards, Steven Bandula, Ankur Gupta-Wright, Stephen Morris-Jones, David A Moore



      PubDate: 2015-08-25T03:45:16Z
       
  • Department of Error
    • Abstract: Publication date: Available online 19 August 2015
      Source:The Lancet




      PubDate: 2015-08-22T03:41:42Z
       
  • Working towards better health in humanitarian crises
    • Abstract: Publication date: 15–21 August 2015
      Source:The Lancet, Volume 386, Issue 9994
      Author(s): The Lancet



      PubDate: 2015-08-22T03:41:42Z
       
  • Long working hours: an avoidable cause of stroke'
    • Abstract: Publication date: Available online 19 August 2015
      Source:The Lancet
      Author(s): Urban Janlert



      PubDate: 2015-08-22T03:41:42Z
       
  • Long working hours and risk of coronary heart disease and stroke: a
           systematic review and meta-analysis of published and unpublished data for
           603 838 individuals
    • Abstract: Publication date: Available online 19 August 2015
      Source:The Lancet
      Author(s): Mika Kivimäki, Markus Jokela, Solja T Nyberg, Archana Singh-Manoux, Eleonor I Fransson, Lars Alfredsson, Jakob B Bjorner, Marianne Borritz, Hermann Burr, Annalisa Casini, Els Clays, Dirk De Bacquer, Nico Dragano, Raimund Erbel, Goedele A Geuskens, Mark Hamer, Wendela E Hooftman, Irene L Houtman, Karl-Heinz Jöckel, France Kittel, Anders Knutsson, Markku Koskenvuo, Thorsten Lunau, Ida E H Madsen, Martin L Nielsen, Maria Nordin, Tuula Oksanen, Jan H Pejtersen, Jaana Pentti, Reiner Rugulies, Paula Salo, Martin J Shipley, Johannes Siegrist, Andrew Steptoe, Sakari B Suominen, Töres Theorell, Jussi Vahtera, Peter J M Westerholm, Hugo Westerlund, Dermot O'Reilly, Meena Kumari, G David Batty, Jane E Ferrie, Marianna Virtanen
      Background Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. Methods We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. Findings We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35–40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02–1·26; p=0·02) and incident stroke (1·33, 1·11–1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30–1·42). We recorded a dose–response association for stroke, with RR estimates of 1·10 (95% CI 0·94–1·28; p=0·24) for 41–48 working hours, 1·27 (1·03–1·56; p=0·03) for 49–54 working hours, and 1·33 (1·11–1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001). Interpretation Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours. Funding Medical Research Council, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), US National Institutes of Health, British Heart Foundation.


      PubDate: 2015-08-22T03:41:42Z
       
  • Bubble continuous positive airway pressure for children with severe
           pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled
           trial
    • Abstract: Publication date: Available online 19 August 2015
      Source:The Lancet
      Author(s): Mohammod J Chisti, Mohammed A Salam, Jonathan H Smith, Tahmeed Ahmed, Mark A C Pietroni, K M Shahunja, Abu S M S B Shahid, Abu S G Faruque, Hasan Ashraf, Pradip K Bardhan, Sharifuzzaman, Stephen M Graham, Trevor Duke
      Background In developing countries, mortality in children with very severe pneumonia is high, even with the provision of appropriate antibiotics, standard oxygen therapy, and other supportive care. We assessed whether oxygen therapy delivered by bubble continuous positive airway pressure (CPAP) improved outcomes compared with standard low-flow and high-flow oxygen therapies. Methods This open, randomised, controlled trial took place in Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. We randomly assigned children younger than 5 years with severe pneumonia and hypoxaemia to receive oxygen therapy by either bubble CPAP (5 L/min starting at a CPAP level of 5 cm H2O), standard low-flow nasal cannula (2 L/min), or high-flow nasal cannula (2 L/kg per min up to the maximum of 12 L/min). Randomisation was done with use of the permuted block methods (block size of 15 patients) and Fisher and Yates tables of random permutations. The primary outcome was treatment failure (ie, clinical failure, intubation and mechanical ventilation, death, or termination of hospital stay against medical advice) after more than 1 h of treatment. Primary and safety analyses were by intention to treat. We did two interim analyses and stopped the trial after the second interim analysis on Aug 3, 2013, as directed by the data safety and monitoring board. This trial is registered at ClinicalTrials.gov, number NCT01396759. Findings Between Aug 4, 2011, and July 17, 2013, 225 eligible children were recruited. We randomly allocated 79 (35%) children to receive oxygen therapy by bubble CPAP, 67 (30%) to low-flow oxygen therapy, and 79 (35%) to high-flow oxygen therapy. Treatment failed for 31 (14%) children, of whom five (6%) had received bubble CPAP, 16 (24%) had received low-flow oxygen therapy, and ten (13%) had received high-flow oxygen therapy. Significantly fewer children in the bubble CPAP group had treatment failure than in the low-flow oxygen therapy group (relative risk [RR] 0·27, 99·7% CI 0·07–0·99; p=0·0026). No difference in treatment failure was noted between patients in the bubble CPAP and those in the high-flow oxygen therapy group (RR 0·50, 99·7% 0·11–2·29; p=0·175). 23 (10%) children died. Three (4%) children died in the bubble CPAP group, ten (15%) children died in the low-flow oxygen therapy group, and ten (13%) children died in the high-flow oxygen therapy group. Children who received oxygen by bubble CPAP had significantly lower rates of death than the children who received oxygen by low-flow oxygen therapy (RR 0·25, 95% CI 0·07–0·89; p=0·022). Interpretation Oxygen therapy delivered by bubble CPAP improved outcomes in Bangladeshi children with very severe pneumonia and hypoxaemia compared with standard low-flow oxygen therapy. Use of bubble CPAP oxygen therapy could have a large effect in hospitals in developing countries where the only respiratory support for severe childhood pneumonia and hypoxaemia is low-flow oxygen therapy. The trial was stopped early because of higher mortality in the low-flow oxygen group than in the bubble CPAP group, and we acknowledge that the early cessation of the trial reduces the certainty of the findings. Further research is needed to test the feasibility of scaling up bubble CPAP in district hospitals and to improve bubble CPAP delivery technology. Funding International Centre for Diarrhoeal Disease Research, Bangladesh, and Centre for International Child Health, University of Melbourne.


      PubDate: 2015-08-22T03:41:42Z
       
  • Clonorchiasis
    • Abstract: Publication date: Available online 21 August 2015
      Source:The Lancet
      Author(s): Men-Bao Qian, Jürg Utzinger, Jennifer Keiser, Xiao-Nong Zhou
      On Aug 21, 1875, James McConnell published in The Lancet his findings from a post-mortem examination of a 20-year-old Chinese man—undertaken at the Medical College Hospital in Calcutta, India—in whom he found Clonorchis sinensis in the bile ducts. Now, exactly 140 years later, we have a sound understanding of the lifecycle of this liver fluke, including key clinical, diagnostic, and epidemiological features. Developments in the so-called -omics sciences have not only advanced our knowledge of the biology and pathology of the parasite, but also led to the discovery of new diagnostic, drug, and vaccine targets. C sinensis infection is primarily related to liver and biliary disorders, especially cholangiocarcinoma. Clonorchiasis mainly occurs in east Asia, as a result of the region's social-ecological systems and deeply rooted cultural habit of consuming raw freshwater fish. The Kato-Katz technique, applied on fresh stool samples, is the most widely used diagnostic approach. Praziquantel is the treatment of choice and has been considered for preventive chemotherapy. Tribendimidine showed good safety and therapeutic profiles in phase 2 trials and warrants further investigation. Still today, the precise distribution, the exact number of infected people, subtle morbidities and pathogenesis, and the global burden of clonorchiasis are unknown. Integrated control strategies, consisting of preventive chemotherapy; information, education, and communication; environmental management; and capacity building through intersectoral collaboration should be advocated.


      PubDate: 2015-08-22T03:41:42Z
       
  • Moving towards universal health coverage: lessons from 11 country studies
    • Abstract: Publication date: Available online 21 August 2015
      Source:The Lancet
      Author(s): Michael R Reich, Joseph Harris, Naoki Ikegami, Akiko Maeda, Keizo Takemi, Timothy G Evans
      In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls—but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative strategies that address the national political economy context.


      PubDate: 2015-08-22T03:41:42Z
       
  • Percutaneous tibial nerve stimulation in faecal incontinence
    • Abstract: Publication date: Available online 18 August 2015
      Source:The Lancet
      Author(s): Steven D Wexner



      PubDate: 2015-08-18T03:37:58Z
       
  • Department of Error
    • Abstract: Publication date: Available online 16 August 2015
      Source:The Lancet




      PubDate: 2015-08-18T03:37:58Z
       
  • Percutaneous tibial nerve stimulation versus sham electrical stimulation
           for the treatment of faecal incontinence in adults (CONFIDeNT): a
           double-blind, multicentre, pragmatic, parallel-group, randomised
           controlled trial
    • Abstract: Publication date: Available online 18 August 2015
      Source:The Lancet
      Author(s): Charles H Knowles, Emma J Horrocks, Stephen A Bremner, Natasha Stevens, Christine Norton, P Ronan O'Connell, Sandra Eldridge
      Background Percutaneous tibial nerve stimulation (PTNS) is a new ambulatory therapy for faecal incontinence. Data from case series suggest it has beneficial outcomes in 50–80% patients; however its effectiveness against sham electrical stimulation has not been investigated. We therefore aimed to assess the short-term efficacy of PTNS against sham electrical stimulation in adults with faecal incontinence. Methods We did a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial (CONtrol of Faecal Incontinence using Distal NeuromodulaTion [CONFIDeNT]) in 17 specialist hospital units in the UK that had the skills to manage patients with faecal incontinence. Eligible participants aged 18 years or older with substantial faecal incontinence for whom conservative treatments (such as dietary changes and pelvic floor exercises) had not worked, were randomly assigned (1:1) to receive either PTNS (via the Urgent PC neuromodulation system) or sham stimulation (via a transcutaneous electrical nerve stimulation machine to the lateral forefoot) once per week for 12 weeks. Randomisation was done with permuted block sizes of two, four, and six, and was stratified by sex and then by centre for women. Patients and outcome assessors were both masked to treatment allocation for the 14-week duration of the trial (but investigators giving the treatment were not masked). The primary outcome was a clinical response to treatment, which we defined as a 50% or greater reduction in episodes of faecal incontinence per week. We assessed this outcome after 12 treatment sessions, using data from patients' bowel diaries. Analysis was by intention to treat, and missing data were multiply imputed. This trial is registered with the ISRCTN registry, number 88559475, and is closed to new participants. Findings Between Jan 23, 2012, and Oct 31, 2013, we randomly assigned 227 eligible patients (of 373 screened) to receive either PTNS (n=115) or sham stimulation (n=112). 12 patients withdrew from the trial: seven from the PTNS group and five from the sham group (mainly because they could not commit to receiving treatment every week). Two patients (one in each group) withdrew because of an adverse event that was unrelated to treatment (exacerbation of fibromyalgia and rectal bleeding). 39 (38%) of 103 patients with full data from bowel diaries in the PTNS group had a 50% or greater reduction in the number of episodes of faecal incontinence per week compared with 32 (31%) of 102 patients in the sham group (adjusted odds ratio 1·28, 95% CI 0·72–2·28; p=0·396). No serious adverse events related to treatment were reported in the trial. Seven mild, related adverse events were reported in each treatment group, mainly pain at the needle site (four in PTNS, three in sham). Interpretation PTNS given for 12 weeks did not confer significant clinical benefit over sham electrical stimulation in the treatment of adults with faecal incontinence. Further studies are warranted to determine its efficacy in the long term, and in patient subgroups (ie, those with urgency). Funding National Institute for Health Research.


      PubDate: 2015-08-18T03:37:58Z
       
 
 
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