for Journals by Title or ISSN
for Articles by Keywords
help
Followed Journals
Journal you Follow: 0
 
Sign Up to follow journals, search in your chosen journals and, optionally, receive Email Alerts when new issues of your Followed Journals are published.
Already have an account? Sign In to see the journals you follow.
Journal Cover The Lancet
  [SJR: 11.563]   [H-I: 514]   [1593 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [2969 journals]
  • The economic burden of physical inactivity: a global analysis of major
           non-communicable diseases
    • Abstract: Publication date: Available online 28 July 2016
      Source:The Lancet
      Author(s): Ding Ding, Kenny D Lawson, Tracy L Kolbe-Alexander, Eric A Finkelstein, Peter T Katzmarzyk, Willem van Mechelen, Michael Pratt
      Background The pandemic of physical inactivity is associated with a range of chronic diseases and early deaths. Despite the well documented disease burden, the economic burden of physical inactivity remains unquantified at the global level. A better understanding of the economic burden could help to inform resource prioritisation and motivate efforts to increase levels of physical activity worldwide. Methods Direct health-care costs, productivity losses, and disability-adjusted life-years (DALYs) attributable to physical inactivity were estimated with standardised methods and the best data available for 142 countries, representing 93·2% of the world's population. Direct health-care costs and DALYs were estimated for coronary heart disease, stroke, type 2 diabetes, breast cancer, and colon cancer attributable to physical inactivity. Productivity losses were estimated with a friction cost approach for physical inactivity related mortality. Analyses were based on national physical inactivity prevalence from available countries, and adjusted population attributable fractions (PAFs) associated with physical inactivity for each disease outcome and all-cause mortality. Findings Conservatively estimated, physical inactivity cost health-care systems international $ (INT$) 53·8 billion worldwide in 2013, of which $31·2 billion was paid by the public sector, $12·9 billion by the private sector, and $9·7 billion by households. In addition, physical inactivity related deaths contribute to $13·7 billion in productivity losses, and physical inactivity was responsible for 13·4 million DALYs worldwide. High-income countries bear a larger proportion of economic burden (80·8% of health-care costs and 60·4% of indirect costs), whereas low-income and middle-income countries have a larger proportion of the disease burden (75·0% of DALYs). Sensitivity analyses based on less conservative assumptions led to much higher estimates. Interpretation In addition to morbidity and premature mortality, physical inactivity is responsible for a substantial economic burden. This paper provides further justification to prioritise promotion of regular physical activity worldwide as part of a comprehensive strategy to reduce non-communicable diseases. Funding None.


      PubDate: 2016-07-28T11:46:50Z
       
  • Progress in physical activity over the Olympic quadrennium
    • Abstract: Publication date: Available online 28 July 2016
      Source:The Lancet
      Author(s): James F Sallis, Fiona Bull, Regina Guthold, Gregory W Heath, Shigeru Inoue, Paul Kelly, Adewale L Oyeyemi, Lilian G Perez, Justin Richards, Pedro C Hallal
      On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban (vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs.


      PubDate: 2016-07-28T11:46:50Z
       
  • Scaling up physical activity interventions worldwide: stepping up to
           larger and smarter approaches to get people moving
    • Abstract: Publication date: Available online 28 July 2016
      Source:The Lancet
      Author(s): Rodrigo S Reis, Deborah Salvo, David Ogilvie, Estelle V Lambert, Shifalika Goenka, Ross C Brownson
      The global pandemic of physical inactivity requires a multisectoral, multidisciplinary public-health response. Scaling up interventions that are capable of increasing levels of physical activity in populations across the varying cultural, geographic, social, and economic contexts worldwide is challenging, but feasible. In this paper, we review the factors that could help to achieve this. We use a mixed-methods approach to comprehensively examine these factors, drawing on the best available evidence from both evidence-to-practice and practice-to-evidence methods. Policies to support active living across society are needed, particularly outside the health-care sector, as demonstrated by some of the successful examples of scale up identified in this paper. Researchers, research funders, and practitioners and policymakers in culture, education, health, leisure, planning, and transport, and civil society as a whole, all have a role. We should embrace the challenge of taking action to a higher level, aligning physical activity and health objectives with broader social, environmental, and sustainable development goals.


      PubDate: 2016-07-28T11:46:50Z
       
  • Gender equality in sport for improved public health
    • Abstract: Publication date: Available online 28 July 2016
      Source:The Lancet
      Author(s): Wendy J Brown, Gregore I Mielke, Tracy L Kolbe-Alexander



      PubDate: 2016-07-28T11:46:50Z
       
  • Renewing commitments to physical activity targets in Thailand
    • Abstract: Publication date: Available online 28 July 2016
      Source:The Lancet
      Author(s): Thitikorn Topothai, Orana Chandrasiri, Nucharapon Liangruenrom, Viroj Tangcharoensathien



      PubDate: 2016-07-28T11:46:50Z
       
  • Update on the global pandemic of physical inactivity
    • Abstract: Publication date: Available online 28 July 2016
      Source:The Lancet
      Author(s): Lars Bo Andersen, Jorge Mota, Loretta Di Pietro



      PubDate: 2016-07-28T11:46:50Z
       
  • Physical activity—time to take it seriously and regularly
    • Abstract: Publication date: Available online 28 July 2016
      Source:The Lancet
      Author(s): Pamela Das, Richard Horton



      PubDate: 2016-07-28T11:46:50Z
       
  • Does physical activity attenuate, or even eliminate, the detrimental
           association of sitting time with mortality? A harmonised meta-analysis
           of data from more than 1 million men and women
    • Abstract: Publication date: Available online 28 July 2016
      Source:The Lancet
      Author(s): Ulf Ekelund, Jostein Steene-Johannessen, Wendy J Brown, Morten Wang Fagerland, Neville Owen, Kenneth E Powell, Adrian Bauman, I-Min Lee
      Background High amounts of sedentary behaviour have been associated with increased risks of several chronic conditions and mortality. However, it is unclear whether physical activity attenuates or even eliminates the detrimental effects of prolonged sitting. We examined the associations of sedentary behaviour and physical activity with all-cause mortality. Methods We did a systematic review, searching six databases (PubMed, PsycINFO, Embase, Web of Science, Sport Discus, and Scopus) from database inception until October, 2015, for prospective cohort studies that had individual level exposure and outcome data, provided data on both daily sitting or TV-viewing time and physical activity, and reported effect estimates for all-cause mortality, cardiovascular disease mortality, or breast, colon, and colorectal cancer mortality. We included data from 16 studies, of which 14 were identified through a systematic review and two were additional unpublished studies where pertinent data were available. All study data were analysed according to a harmonised protocol, which categorised reported daily sitting time and TV-viewing time into four standardised groups each, and physical activity into quartiles (in metabolic equivalent of task [MET]-hours per week). We then combined data across all studies to analyse the association of daily sitting time and physical activity with all-cause mortality, and estimated summary hazard ratios using Cox regression. We repeated these analyses using TV-viewing time instead of daily sitting time. Findings Of the 16 studies included in the meta-analysis, 13 studies provided data on sitting time and all-cause mortality. These studies included 1 005 791 individuals who were followed up for 2–18·1 years, during which 84 609 (8·4%) died. Compared with the referent group (ie, those sitting <4 h/day and in the most active quartile [>35·5 MET-h per week]), mortality rates during follow-up were 12–59% higher in the two lowest quartiles of physical activity (from HR=1·12, 95% CI 1·08–1·16, for the second lowest quartile of physical activity [<16 MET-h per week] and sitting <4 h/day; to HR=1·59, 1·52–1·66, for the lowest quartile of physical activity [<2·5 MET-h per week] and sitting >8 h/day). Daily sitting time was not associated with increased all-cause mortality in those in the most active quartile of physical activity. Compared with the referent (<4 h of sitting per day and highest quartile of physical activity [>35·5 MET-h per week]), there was no increased risk of mortality during follow-up in those who sat for more than 8 h/day but who also reported >35·5 MET-h per week of activity (HR=1·04; 95% CI 0·99–1·10). By contrast, those who sat the least (<4 h/day) and were in the lowest activity quartile (<2·5 MET-h per week) had a significantly increased risk of dying during follow-up (HR=1·27, 95% CI 1·22–1·31). Six studies had data on TV-viewing time (N=465 450; 43 740 deaths). Watching TV for 3 h or more per day was associated with increased mortality regardless of physical activity, except in the most active quartile, where mortality was significantly increased only in people who watched TV for 5 h/day or more (HR=1·16, 1·05–1·28). Interpretation High levels of moderate intensity physical activity (ie, about 60–75 min per day) seem to eliminate the increased risk of death associated with high sitting time. However, this high activity level attenuates, but does not eliminate the increased risk associated with high TV-viewing time. These results provide further evidence on the benefits of physical activity, particularly in societies where increasing numbers of people have to sit for long hours for work and may also inform future public health recommendations. Funding None.


      PubDate: 2016-07-28T11:46:50Z
       
  • Pedro Hallal: putting physical activity at the heart of better health
    • Abstract: Publication date: Available online 28 July 2016
      Source:The Lancet
      Author(s): Richard Lane



      PubDate: 2016-07-28T11:46:50Z
       
  • Reduce vascular risk to prevent dementia?
    • Abstract: Publication date: Available online 27 July 2016
      Source:The Lancet
      Author(s): Lon S Schneider



      PubDate: 2016-07-28T11:46:50Z
       
  • Innovation and surgical clinical trials
    • Abstract: Publication date: Available online 26 July 2016
      Source:The Lancet
      Author(s): Erik Mayer, Ara Darzi



      PubDate: 2016-07-28T11:46:50Z
       
  • Effectiveness of a 6-year multidomain vascular care intervention to
           prevent dementia (preDIVA): a cluster-randomised controlled trial
    • Abstract: Publication date: Available online 26 July 2016
      Source:The Lancet
      Author(s): Eric P Moll van Charante, Edo Richard, Lisa S Eurelings, Jan-Willem van Dalen, Suzanne A Ligthart, Emma F van Bussel, Marieke P Hoevenaar-Blom, Marinus Vermeulen, Willem A van Gool
      Background Cardiovascular risk factors are associated with an increased risk of dementia. We assessed whether a multidomain intervention targeting these factors can prevent dementia in a population of community-dwelling older people. Methods In this open-label, cluster-randomised controlled trial, we recruited individuals aged 70–78 years through participating general practices in the Netherlands. General practices within each health-care centre were randomly assigned (1:1), via a computer-generated randomisation sequence, to either a 6-year nurse-led, multidomain cardiovascular intervention or control (usual care). The primary outcomes were cumulative incidence of dementia and disability score (Academic Medical Center Linear Disability Score [ALDS]) at 6 years of follow-up. The main secondary outcomes were incident cardiovascular disease and mortality. Outcome assessors were masked to group assignment. Analyses included all participants with available outcome data. This trial is registered with ISRCTN, number ISRCTN29711771. Findings Between June 7, 2006, and March 12, 2009, 116 general practices (3526 participants) within 26 health-care centres were recruited and randomly assigned: 63 (1890 participants) were assigned to the intervention group and 53 (1636 participants) to the control group. Primary outcome data were obtained for 3454 (98%) participants; median follow-up was 6·7 years (21 341 person-years). Dementia developed in 121 (7%) of 1853 participants in the intervention group and in 112 (7%) of 1601 participants in the control group (hazard ratio [HR] 0·92, 95% CI 0·71–1·19; p=0·54). Mean ALDS scores measured during follow-up did not differ between groups (85·7 [SD 6·8] in the intervention group and 85·7 [7·1] in the control group; adjusted mean difference −0·02, 95% CI −0·38 to 0·42; p=0·93). 309 (16%) of 1885 participants died in the intervention group, compared with 269 (16%) of 1634 participants in the control group (HR 0·98, 95% CI 0·80–1·18; p=0·81). Incident cardiovascular disease did not differ between groups (273 [19%] of 1469 participants in the intervention group and 228 [17%] of 1307 participants in the control group; HR 1·06, 95% CI 0·86–1·31; p=0·57). Interpretation A nurse-led, multidomain intervention did not result in a reduced incidence of all-cause dementia in an unselected population of older people. This absence of effect might have been caused by modest baseline cardiovascular risks and high standards of usual care. Future studies should assess the efficacy of such interventions in selected populations. Funding Dutch Ministry of Health, Welfare and Sport; Dutch Innovation Fund of Collaborative Health Insurances; and Netherlands Organisation for Health Research and Development.


      PubDate: 2016-07-28T11:46:50Z
       
  • Robot-assisted laparoscopic prostatectomy versus open radical retropubic
           prostatectomy: early outcomes from a randomised controlled phase 3 study
    • Abstract: Publication date: Available online 26 July 2016
      Source:The Lancet
      Author(s): John W Yaxley, Geoffrey D Coughlin, Suzanne K Chambers, Stefano Occhipinti, Hema Samaratunga, Leah Zajdlewicz, Nigel Dunglison, Rob Carter, Scott Williams, Diane J Payton, Joanna Perry-Keene, Martin F Lavin, Robert A Gardiner
      Background The absence of trial data comparing robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy is a crucial knowledge gap in uro-oncology. We aimed to compare these two approaches in terms of functional and oncological outcomes and report the early postoperative outcomes at 12 weeks. Method In this randomised controlled phase 3 study, men who had newly diagnosed clinically localised prostate cancer and who had chosen surgery as their treatment approach, were able to read and speak English, had no previous history of head injury, dementia, or psychiatric illness or no other concurrent cancer, had an estimated life expectancy of 10 years or more, and were aged between 35 years and 70 years were eligible and recruited from the Royal Brisbane and Women's Hospital (Brisbane, QLD). Participants were randomly assigned (1:1) to receive either robot-assisted laparoscopic prostatectomy or radical retropubic prostatectomy. Randomisation was computer generated and occurred in blocks of ten. This was an open trial; however, study investigators involved in data analysis were masked to each patient's condition. Further, a masked central pathologist reviewed the biopsy and radical prostatectomy specimens. Primary outcomes were urinary function (urinary domain of EPIC) and sexual function (sexual domain of EPIC and IIEF) at 6 weeks, 12 weeks, and 24 months and oncological outcome (positive surgical margin status and biochemical and imaging evidence of progression at 24 months). The trial was powered to assess health-related and domain-specific quality of life outcomes over 24 months. We report here the early outcomes at 6 weeks and 12 weeks. The per-protocol populations were included in the primary and safety analyses. This trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12611000661976. Findings Between Aug 23, 2010, and Nov 25, 2014, 326 men were enrolled, of whom 163 were randomly assigned to radical retropubic prostatectomy and 163 to robot-assisted laparoscopic prostatectomy. 18 withdrew (12 assigned to radical retropubic prostatectomy and six assigned to robot-assisted laparoscopic prostatectomy); thus, 151 in the radical retropubic prostatectomy group proceeded to surgery and 157 in the robot-assisted laparoscopic prostatectomy group. 121 assigned to radical retropubic prostatectomy completed the 12 week questionnaire versus 131 assigned to robot-assisted laparoscopic prostatectomy. Urinary function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (74·50 vs 71·10; p=0·09) or 12 weeks post-surgery (83·80 vs 82·50; p=0·48). Sexual function scores did not differ significantly between the radical retropubic prostatectomy group and robot-assisted laparoscopic prostatectomy group at 6 weeks post-surgery (30·70 vs 32·70; p=0·45) or 12 weeks post-surgery (35·00 vs 38·90; p=0·18). Equivalence testing on the difference between the proportion of positive surgical margins between the two groups (15 [10%] in the radical retropubic prostatectomy group vs 23 [15%] in the robot-assisted laparoscopic prostatectomy group) showed that equality between the two techniques could not be established based on a 90% CI with a Δ of 10%. However, a superiority test showed that the two proportions were not significantly different (p=0·21). 14 patients (9%) in the radical retropubic prostatectomy group versus six (4%) in the robot-assisted laparoscopic prostatectomy group had postoperative complications (p=0·052). 12 (8%) men receiving radical retropubic prostatectomy and three (2%) men receiving robot-assisted laparoscopic prostatectomy experienced intraoperative adverse events. Interpretation These two techniques yield similar functional outcomes at 12 weeks. Longer term follow-up is needed. In the interim, we encourage patients to choose an experienced surgeon they trust and with whom they have rapport, rather than a specific surgical approach. Funding
      PubDate: 2016-07-28T11:46:50Z
       
  • Department of Error
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042




      PubDate: 2016-07-23T03:56:30Z
       
  • Department of Error
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042




      PubDate: 2016-07-23T03:56:30Z
       
  • Department of Error
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042




      PubDate: 2016-07-23T03:56:30Z
       
  • Early rheumatoid arthritis treated with tocilizumab, methotrexate, or
           their combination (U-Act-Early): a multicentre, randomised, double-blind,
           double-dummy, strategy trial
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Johannes W J Bijlsma, Paco M J Welsing, Thasia G Woodworth, Leonie M Middelink, Attila Pethö-Schramm, Corrado Bernasconi, Michelle E A Borm, Cornelis H Wortel, Evert Jan ter Borg, Z Nazira Jahangier, Willemijn H van der Laan, George A W Bruyn, Paul Baudoin, Siska Wijngaarden, Petra A J M Vos, Reinhard Bos, Mirian J F Starmans, Eduard N Griep, Joanna R M Griep-Wentink, Cornelia F Allaart, Anton H M Heurkens, Xavier M Teitsma, Janneke Tekstra, Anne Carien A Marijnissen, Floris P J Lafeber, Johannes W G Jacobs
      Background For patients with newly diagnosed rheumatoid arthritis, treatment aim is early, rapid, and sustained remission. We compared the efficacy and safety of strategies initiating the interleukin-6 receptor-blocking monoclonal antibody tocilizumab with or without methotrexate (a conventional synthetic disease-modifying antirheumatic drug [DMARD]), versus initiation of methotrexate monotherapy in line with international guidelines. Methods We did a 2-year, multicentre, randomised, double-blind, double-dummy, strategy study at 21 rheumatology outpatient departments in the Netherlands. We included patients who had been diagnosed with rheumatoid arthritis within 1 year before inclusion, were DMARD-naive, aged 18 years or older, met current rheumatoid arthritis classification criteria, and had a disease activity score assessing 28 joints (DAS28) of at least 2·6. We randomly assigned patients (1:1:1) to start tocilizumab plus methotrexate (the tocilizumab plus methotrexate arm), or tocilizumab plus placebo-methotrexate (the tocilizumab arm), or methotrexate plus placebo-tocilizumab (the methotrexate arm). Tocilizumab was given at 8 mg/kg intravenously every 4 weeks with a maximum of 800 mg per dose. Methotrexate was started at 10 mg per week orally and increased stepwise every 4 weeks by 5 mg to a maximum of 30 mg per week, until remission or dose-limiting toxicity. We did the randomisation using an interactive web response system. Masking was achieved with placebos that were similar in appearance to the active drug; the study physicians, pharmacists, monitors, and patients remained masked during the study, and all assessments were done by masked assessors. Patients not achieving remission on their initial regimen switched from placebo to active treatments; patients in the tocilizumab plus methotrexate arm switched to standard of care therapy (typically methotrexate combined with a tumour necrosis factor inhibitor). When sustained remission was achieved, methotrexate (and placebo-methotrexate) was tapered and stopped, then tocilizumab (and placebo-tocilizumab) was also tapered and stopped. The primary endpoint was the proportion of patients achieving sustained remission (defined as DAS28 <2·6 with a swollen joint count ≤four, persisting for at least 24 weeks) on the initial regimen and during the entire study duration, compared between groups with a two-sided Cochran-Mantel-Haenszel test. Analysis was based on an intention-to-treat method. This trial was registered at ClinicalTrials.gov, number NCT01034137. Findings Between Jan 13, 2010, and July 30, 2012, we recruited and assigned 317 eligible patients to treatment (106 to the tocilizumab plus methotrexate arm, 103 to the tocilizumab arm, and 108 to the methotrexate arm). The study was completed by a similar proportion of patients in the three groups (range 72–78%). The most frequent reasons for dropout were adverse events or intercurrent illness: 27 (34%) of dropouts, and insufficient response: 26 (33%) of dropouts. 91 (86%) of 106 patients in the tocilizumab plus methotrexate arm achieved sustained remission on the initial regimen, compared with 86 (84%) of 103 in the tocilizumab arm, and 48 (44%) of 108 in the methotrexate arm (relative risk [RR] 2·00, 95% CI 1·59–2·51 for tocilizumab plus methotrexate vs methotrexate, and 1·86, 1·48–2·32 for tocilizumab vs methotrexate, p<0·0001 for both comparisons). For the entire study, 91 (86%) of 106 patients in the tocilizumab plus methotrexate arm, 91 (88%) of 103 in the tocilizumab arm, and 83 (77%) of 108 in the methotrexate arm achieved sustained remission (RR 1·13, 95% CI 1·00–1·29, p=0·06 for tocilizumab plus methotrexate vs methotrexate, 1·14, 1·01–1·29, p=0·0356 for tocilizumab vs methotrexate, and p=0·59 for tocilizumab plus methotrexate vs tocilizumab). Nasopharyngitis was the most common adverse event in all three treatment groups, occurring in 38 (36%) of 106 patients in the tocilizumab plus methotrexate arm, 40 (39%) of 103 in the tocilizumab arm, and 37 (34%) of 108 in the methotrexate arm. T...
      PubDate: 2016-07-23T03:56:30Z
       
  • Outcomes in the trial registry should match those in the protocol –
           Authors' reply
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Andrew J Davidson, Nicola Disma, Jurgen C de Graaff, Davinia E Withington, Mary Ellen McCann



      PubDate: 2016-07-23T03:56:30Z
       
  • Trial registration records, updates, and protocols
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Lisa Askie



      PubDate: 2016-07-23T03:56:30Z
       
  • Control of gonorrhoea and chlamydia in the UK
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Nigel O'Farrell



      PubDate: 2016-07-23T03:56:30Z
       
  • Could clinical symptoms be a predictor of complications in Zika virus
           infection' – Authors' reply
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Simon Cauchemez, Marianne Besnard, Catherine Garel, Arnaud Fontanet, Henri-Pierre Mallet



      PubDate: 2016-07-23T03:56:30Z
       
  • Haemodialysis is a major risk factor for infective endocarditis
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Laura Labriola, Michel Jadoul



      PubDate: 2016-07-23T03:56:30Z
       
  • Haemodialysis is a major risk factor for infective endocarditis –
           Authors' reply
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Thomas J Cahill, Bernard D Prendergast



      PubDate: 2016-07-23T03:56:30Z
       
  • Outcomes in the trial registry should match those in the protocol
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Henry Drysdale, Eirion Slade, Ben Goldacre, Carl Heneghan



      PubDate: 2016-07-23T03:56:30Z
       
  • Zika virus epidemic: Africa should not be neglected
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Nicolas Meda, Sara Salinas, Thérèse Kagoné, Yannick Simonin, Philippe Van de Perre



      PubDate: 2016-07-23T03:56:30Z
       
  • Could clinical symptoms be a predictor of complications in Zika virus
           infection'
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): André Ricardo Ribas Freitas, Marcelo Henrique Napimoga, Maria Rita Donalisio



      PubDate: 2016-07-23T03:56:30Z
       
  • Sari Reisner—making transgender health visible
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Tony Kirby



      PubDate: 2016-07-23T03:56:30Z
       
  • GIRES: e-learning for transgender health training
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Terry Reed



      PubDate: 2016-07-23T03:56:30Z
       
  • Transgender: why should we care'
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Jamison Green



      PubDate: 2016-07-23T03:56:30Z
       
  • Suzanne Corkin
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Geoff Watts



      PubDate: 2016-07-23T03:56:30Z
       
  • Transgender community voices: a participatory population perspective
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Sari Reisner, JoAnne Keatley, Stefan Baral



      PubDate: 2016-07-23T03:56:30Z
       
  • Sam Winter and Kevan Wylie: pioneers in transgender health
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Richard Lane



      PubDate: 2016-07-23T03:56:30Z
       
  • Peru's transgender community: the battle for rights
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Barbara Fraser



      PubDate: 2016-07-23T03:56:30Z
       
  • Uncertain future for initiative against FGM in the UK
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Sharmila Devi



      PubDate: 2016-07-23T03:56:30Z
       
  • Haemorrhoidal artery ligation versus rubber band ligation for the
           management of symptomatic second-degree and third-degree haemorrhoids
           (HubBLe): a multicentre, open-label, randomised controlled trial
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Steven R Brown, James P Tiernan, Angus J M Watson, Katie Biggs, Neil Shephard, Allan J Wailoo, Mike Bradburn, Abualbishr Alshreef, Daniel Hind
      Background Optimum surgical intervention for low-grade haemorrhoids is unknown. Haemorrhoidal artery ligation (HAL) has been proposed as an efficacious, safe therapy while rubber band ligation (RBL) is a commonly used outpatient treatment. We compared recurrence after HAL versus RBL in patients with grade II–III haemorrhoids. Methods This multicentre, open-label, parallel group, randomised controlled trial included patients from 17 acute UK NHS trusts. We screened patients aged 18 years or older presenting with grade II–III haemorrhoids. We excluded patients who had previously received any haemorrhoid surgery, more than one injection treatment for haemorrhoids, or more than one RBL procedure within 3 years before recruitment. Eligible patients were randomly assigned (in a 1:1 ratio) to either RBL or HAL with Doppler. Randomisation was computer-generated and stratified by centre with blocks of random sizes. Allocation concealment was achieved using a web-based system. The study was open-label with no masking of participants, clinicians, or research staff. The primary outcome was recurrence at 1 year, derived from the patient's self-reported assessment in combination with resource use from their general practitioner and hospital records. Recurrence was analysed in patients who had undergone one of the interventions and been followed up for at least 1 year. This study is registered with the ISRCTN registry, ISRCTN41394716. Findings From Sept 9, 2012, to May 6, 2014, of 969 patients screened, 185 were randomly assigned to the HAL group and 187 to the RBL group. Of these participants, 337 had primary outcome data (176 in the RBL group and 161 in the HAL group). At 1 year post-procedure, 87 (49%) of 176 patients in the RBL group and 48 (30%) of 161 patients in the HAL group had haemorrhoid recurrence (adjusted odds ratio [aOR] 2·23, 95% CI 1·42–3·51; p=0·0005). The main reason for this difference was the number of extra procedures required to achieve improvement (57 [32%] participants in the RBL group and 23 [14%] participants in the HAL group had a subsequent procedure for haemorrhoids). The mean pain 1 day after procedure was 3·4 (SD 2·8) in the RBL group and 4·6 (2·8) in the HAL group (difference −1·2, 95% CI −1·8 to −0·5; p=0·0002); at day 7 the scores were 1·6 (2·3) in the RBL group and 3·1 (2·4) in the HAL group (difference −1·5, −2·0 to −1·0; p<0·0001). Pain scores did not differ between groups at 21 days and 6 weeks. 15 individuals reported serious adverse events requiring hospital admission. One patient in the RBL group had a pre-existing rectal tumour. Of the remaining 14 serious adverse events, 12 (7%) were among participants treated with HAL and two (1%) were in those treated with RBL. Six patients had pain (one treated with RBL, five treated with HAL), three had bleeding not requiring transfusion (one treated with RBL, two treated with HAL), two in the HAL group had urinary retention, two in the HAL group had vasovagal upset, and one in the HAL group had possible sepsis (treated with antibiotics). Interpretation Although recurrence after HAL was lower than a single RBL, HAL was more painful than RBL. The difference in recurrence was due to the need for repeat bandings in the RBL group. Patients (and health commissioners) might prefer such a course of RBL to the more invasive HAL. Funding NIHR Health Technology Assessment programme.


      PubDate: 2016-07-23T03:56:30Z
       
  • Synergies in health and human rights: a call to action to improve
           transgender health
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Sam Winter, Edmund Settle, Kevan Wylie, Sari Reisner, Mauro Cabral, Gail Knudson, Stefan Baral



      PubDate: 2016-07-23T03:56:30Z
       
  • The wisdom of crowds
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Ellen Teesdale



      PubDate: 2016-07-23T03:56:30Z
       
  • Offline: The crisis in scientific publishing
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Richard Horton



      PubDate: 2016-07-23T03:56:30Z
       
  • Concerns raised over future of Medicare in Australia
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Chris McCall



      PubDate: 2016-07-23T03:56:30Z
       
  • Reforming mental health in China and India
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Shiwei Liu, Andrew Page



      PubDate: 2016-07-23T03:56:30Z
       
  • Transgender health: an opportunity for global health equity
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Selina Lo, Richard Horton



      PubDate: 2016-07-23T03:56:30Z
       
  • Does HubBLe spell trouble for HAL'
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Simon P Bach, Nicola S Fearnhead



      PubDate: 2016-07-23T03:56:30Z
       
  • The benefits of aspirin in early secondary stroke prevention
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Graeme J Hankey



      PubDate: 2016-07-23T03:56:30Z
       
  • Towards elimination of viral hepatitis by 2030
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): The Lancet



      PubDate: 2016-07-23T03:56:30Z
       
  • Beyond methotrexate monotherapy for early rheumatoid arthritis
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): David L Scott



      PubDate: 2016-07-23T03:56:30Z
       
  • Protocol disparities and research governance
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): The Lancet



      PubDate: 2016-07-23T03:56:30Z
       
  • Living in colour—American children, race, and wellbeing
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): The Lancet



      PubDate: 2016-07-23T03:56:30Z
       
  • Transgender people: health at the margins of society
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      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: 2016-07-23T03:56:30Z
       
  • The burden of mental, neurological, and substance use disorders in China
           and India: a systematic analysis of community representative
           epidemiological studies
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Fiona J Charlson, Amanda J Baxter, Hui G Cheng, Rahul Shidhaye, Harvey A Whiteford
      Background China and India jointly account for 38% of the world population, so understanding the burden attributed to mental, neurological, and substance use disorders within these two countries is essential. As part of the Lancet/Lancet Psychiatry China–India Mental Health Alliance Series, we aim to provide estimates of the burden of mental, neurological, and substance use disorders for China and India from the Global Burden of Disease Study 2013 (GBD 2013). Methods In this systematic analysis for community representative epidemiological studies, we conducted systematic reviews in line with PRISMA guidelines for community representative epidemiological studies. We extracted estimates of prevalence, incidence, remission and duration, and mortality along with associated uncertainty intervals from GBD 2013. Using these data as primary inputs, DisMod-MR 2.0, a Bayesian meta-regression instrument, used a log rate and incidence-prevalence-mortality mathematical model to develop internally consistent epidemiological models. Disability-adjusted life-year (DALY) changes between 1990 and 2013 were decomposed to quantify change attributable to population growth and ageing. We projected DALYs from 2013 to 2025 for mental, neurological, and substance use disorders using United Nations population data. Findings Around a third of global DALYs attributable to mental, neurological, and substance use disorders were found in China and India (66 million DALYs), a number greater than all developed countries combined (50 million DALYs). Disease burden profiles differed; India showed similarities with other developing countries (around 50% of DALYs attributable to non-communicable disease), whereas China more closely resembled developed countries (around 80% of DALYs attributable to non-communicable disease). The overall population growth in India explains a greater proportion of the increase in mental, neurological, and substance use disorder burden from 1990 to 2013 (44%) than in China (20%). The burden of mental, neurological, and substance use disorders is estimated to increase by 10% in China and 23% in India between 2013 and 2025. Interpretation The current and projected burden of mental, neurological, and substance use disorders in China and India warrants the urgent prioritisation of programmes focused on targeted prevention, early identification, and effective treatment. Funding China Medical Board, Bill & Melinda Gates Foundation.


      PubDate: 2016-07-23T03:56:30Z
       
  • Effects of aspirin on risk and severity of early recurrent stroke after
           transient ischaemic attack and ischaemic stroke: time-course analysis of
           randomised trials
    • Abstract: Publication date: 23–29 July 2016
      Source:The Lancet, Volume 388, Issue 10042
      Author(s): Peter M Rothwell, Ale Algra, Zhengming Chen, Hans-Christoph Diener, Bo Norrving, Ziyah Mehta
      Background Aspirin is recommended for secondary prevention after transient ischaemic attack (TIA) or ischaemic stroke on the basis of trials showing a 13% reduction in long-term risk of recurrent stroke. However, the risk of major stroke is very high for only the first few days after TIA and minor ischaemic stroke, and observational studies show substantially greater benefits of early medical treatment in the acute phase than do longer-term trials. We hypothesised that the short-term benefits of early aspirin have been underestimated. Methods Pooling the individual patient data from all randomised trials of aspirin versus control in secondary prevention after TIA or ischaemic stroke, we studied the effects of aspirin on the risk and severity of recurrent stroke, stratified by the following time periods: less than 6 weeks, 6–12 weeks, and more than 12 weeks after randomisation. We compared the severity of early recurrent strokes between treatment groups with shift analysis of modified Rankin Scale (mRS) score. To understand possible mechanisms of action, we also studied the time course of the interaction between effects of aspirin and dipyridamole in secondary prevention of stroke. In a further analysis we pooled data from trials of aspirin versus control in which patients were randomised less than 48 h after major acute stroke, stratified by severity of baseline neurological deficit, to establish the very early time course of the effect of aspirin on risk of recurrent ischaemic stroke and how this differs by severity at baseline. Findings We pooled data for 15 778 participants from 12 trials of aspirin versus control in secondary prevention. Aspirin reduced the 6 week risk of recurrent ischaemic stroke by about 60% (84 of 8452 participants in the aspirin group had an ischaemic stroke vs 175 of 7326; hazard ratio [HR] 0·42, 95% CI 0·32–0·55, p<0·0001) and disabling or fatal ischaemic stroke by about 70% (36 of 8452 vs 110 of 7326; 0·29, 0·20–0·42, p<0·0001), with greatest benefit noted in patients presenting with TIA or minor stroke (at 0–2 weeks, two of 6691 participants in the aspirin group with TIA or minor stroke had a disabling or fatal ischaemic stroke vs 23 of 5726 in the control group, HR 0·07, 95% CI 0·02–0·31, p=0·0004; at 0–6 weeks, 14 vs 60 participants, 0·19, 0·11–0·34, p<0·0001). The effect of aspirin on early recurrent ischaemic stroke was due partly to a substantial reduction in severity (mRS shift analysis odds ratio [OR] 0·42, 0·26–0·70, p=0·0007). These effects were independent of dose, patient characteristics, or aetiology of TIA or stroke. Some further reduction in risk of ischaemic stroke accrued for aspirin only versus control from 6–12 weeks, but there was no benefit after 12 weeks (stroke risk OR 0·97, 0·84–1·12, p=0·67; severity mRS shift OR 1·00, 0·77–1·29, p=0·97). By contrast, dipyridamole plus aspirin versus aspirin alone had no effect on risk or severity of recurrent ischaemic stroke within 12 weeks (OR 0·90, 95% CI 0·65–1·25, p=0·53; mRS shift OR 0·90, 0·37–1·72, p=0·99), but dipyridamole did reduce risk thereafter (0·76, 0·63–0·92, p=0·005), particularly of disabling or fatal ischaemic stroke (0·64, 0·49–0·84, p=0·0010). We pooled data for 40 531 participants from three trials of aspirin versus control in major acute stroke. The reduction in risk of recurrent ischaemic stroke at 14 days was most evident in patients with less severe baseline deficits, and was substantial by the second day after starting treatment (2–3 day HR 0·37, 95% CI 0·25–0·57, p<0·0001). Interpretation Our findings confirm that medical treatment substantially reduces the risk of early recurrent stroke after TIA and minor stroke and identify aspirin as the key intervention. The considerable early benefit from aspirin warrants public education about self-administration after possible TIA. The previously unrecognised effect of aspirin on severity of early recurrent stroke, the diminishing benefit with longer-term use, and the contrasting time course of effects of dipyridamole have implications for understanding mechanisms of action.
      PubDate: 2016-07-23T03:56:30Z
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 54.159.79.18
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-2016