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Journal Cover The Lancet
   Journal TOC RSS feeds Export to Zotero [1100 followers]  Follow    
   Full-text available via subscription Subscription journal
     ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
     Published by Elsevier Homepage  [2566 journals]   [SJR: 7.074]   [H-I: 477]
  • Global health and the media
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Joseph R Fitchett , Lalitha Bhagavatheeswaran



      PubDate: 2014-09-21T15:52:09Z
       
  • Human schistosomiasis: an emerging threat for Europe
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Franck de Laval , Hélène Savini , Elodie Biance-Valero , Fabrice Simon



      PubDate: 2014-09-21T15:52:09Z
       
  • Calling tuberculosis a social disease—an excuse for complacency'
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Petros Isaakidis , Stella Smith , Suman Majumdar , Jennifer Furin , Tony Reid



      PubDate: 2014-09-21T15:52:09Z
       
  • Cardiovascular outcome trials of glucose-lowering strategies in type 2
           diabetes
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): John S Yudkin , Sandeep Vijan , Jeremy B Sussman , Richard Lehman , Ben M Goldacre



      PubDate: 2014-09-21T15:52:09Z
       
  • September 20–26, 2014
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948




      PubDate: 2014-09-21T15:52:09Z
       
  • Climate change and health—action please, not words
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): The Lancet



      PubDate: 2014-09-21T15:52:09Z
       
  • The integration of mental and physical health care
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): The Lancet



      PubDate: 2014-09-21T15:52:09Z
       
  • Mary Renfrew: researcher, reformer, midwife
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): David Holmes



      PubDate: 2014-09-21T15:52:09Z
       
  • Hearing the voice
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Charles Fernyhough



      PubDate: 2014-09-21T15:52:09Z
       
  • Eric Dewailly
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Geoff Watts



      PubDate: 2014-09-21T15:52:09Z
       
  • SDGs: start with maternal, newborn, and child health cluster
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Karlee L Silver , Peter A Singer



      PubDate: 2014-09-21T15:52:09Z
       
  • Disrespect and abuse of women in childbirth: challenging the global
           quality and accountability agendas
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Lynn P Freedman , Margaret E Kruk



      PubDate: 2014-09-21T15:52:09Z
       
  • US President's science panel advises on antibiotic resistance
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Susan Jaffe



      PubDate: 2014-09-21T15:52:09Z
       
  • Crowdfunding for medical research picks up pace
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Nayanah Siva



      PubDate: 2014-09-21T15:52:09Z
       
  • Sink or swim
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Tania Glyde



      PubDate: 2014-09-21T15:52:09Z
       
  • Stories of the wounded EmilyMayhewWounded: the Long Journey Home from the
           Great War2014Vintage BooksLondon9780099584186£8·99
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Joanna Bourke



      PubDate: 2014-09-21T15:52:09Z
       
  • Offline: How to save primary care research
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Richard Horton



      PubDate: 2014-09-21T15:52:09Z
       
  • Meeting needs of childbearing women and newborn infants through
           strengthened midwifery
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Carol Sakala , Mary Newburn



      PubDate: 2014-09-21T15:52:09Z
       
  • Interprofessional collaboration, the only way to Save Every Woman and
           Every Child
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Judith Shamian



      PubDate: 2014-09-21T15:52:09Z
       
  • Melanoma: immune checkpoint blockade story gets better
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Shailender Bhatia , John A Thompson



      PubDate: 2014-09-21T15:52:09Z
       
  • Surgical resection of mesothelioma: an evidence-free practice
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Y C Gary Lee



      PubDate: 2014-09-21T15:52:09Z
       
  • Dementia: a false promise
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): The Lancet



      PubDate: 2014-09-21T15:52:09Z
       
  • Health risks of climate change: act now or pay later
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Andy Haines , Kristie L Ebi , Kirk R Smith , Alistair Woodward



      PubDate: 2014-09-21T15:52:09Z
       
  • The power of midwifery
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Richard Horton , Olaya Astudillo



      PubDate: 2014-09-21T15:52:09Z
       
  • Effective treatment for depression in patients with cancer
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Gary Rodin



      PubDate: 2014-09-21T15:52:09Z
       
  • Cardiovascular outcome trials of glucose-lowering strategies in type 2
           diabetes
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Olga Vaccaro , Maria Masulli , Enzo Bonora , Stefano Del Prato , Gabriele Riccardi



      PubDate: 2014-09-21T15:52:09Z
       
  • Cardiovascular outcome trials of glucose-lowering strategies in type 2
           diabetes
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Rémy Boussageon



      PubDate: 2014-09-21T15:52:09Z
       
  • Cardiovascular outcome trials of glucose-lowering strategies in type 2
           diabetes–Authors' reply
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Rury R Holman , Harald Sourij , Robert M Califf



      PubDate: 2014-09-21T15:52:09Z
       
  • Prevention of misconduct in clinical trials in Japan
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Yoshiki Yui



      PubDate: 2014-09-21T15:52:09Z
       
  • Department of Error
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948




      PubDate: 2014-09-21T15:52:09Z
       
  • Department of Error
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948




      PubDate: 2014-09-21T15:52:09Z
       
  • Department of Error
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948




      PubDate: 2014-09-21T15:52:09Z
       
  • Integrated collaborative care for comorbid major depression in patients
           with cancer (SMaRT Oncology-2): a multicentre randomised controlled
           effectiveness trial
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Michael Sharpe , Jane Walker , Christian Holm Hansen , Paul Martin , Stefan Symeonides , Charlie Gourley , Lucy Wall , David Weller , Gordon Murray
      Background Medical conditions are often complicated by major depression, with consequent additional impairment of quality of life. We aimed to compare the effectiveness of an integrated treatment programme for major depression in patients with cancer (depression care for people with cancer) with usual care. Methods SMaRT Oncology-2 is a parallel-group, multicentre, randomised controlled effectiveness trial. We enrolled outpatients with major depression from three cancer centres and their associated clinics in Scotland, UK. Participants were randomly assigned in a 1:1 ratio to the depression care for people with cancer intervention or usual care, with stratification (by trial centre) and minimisation (by age, primary cancer, and sex) with allocation concealment. Depression care for people with cancer is a manualised, multicomponent collaborative care treatment that is delivered systematically by a team of cancer nurses and psychiatrists in collaboration with primary care physicians. Usual care is provided by primary care physicians. Outcome data were collected up until 48 weeks. The primary outcome was treatment response (≥50% reduction in Symptom Checklist Depression Scale [SCL-20] score, range 0–4) at 24 weeks. Trial statisticians and data collection staff were masked to treatment allocation, but participants could not be masked to the allocations. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN40568538. Findings 500 participants were enrolled between May 12, 2008, and May 13, 2011; 253 were randomly allocated to depression care for people with cancer and 247 to usual care. 143 (62%) of 231 participants in the depression care for people with cancer group and 40 (17%) of 231 in the usual care group responded to treatment: absolute difference 45% (95% CI 37–53), adjusted odds ratio 8·5 (95% CI 5·5–13·4), p<0·0001. Compared with patients in the usual care group, participants allocated to the depression care for people with cancer programme also had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all timepoints (all p<0·05). During the study, 34 cancer-related deaths occurred (19 in the depression care for people with cancer group, 15 in the usual care group), one patient in the depression care for people with cancer group was admitted to a psychiatric ward, and one patient in this group attempted suicide. None of these events were judged to be related to the trial treatments or procedures. Interpretation Our findings suggest that depression care for people with cancer is an effective treatment for major depression in patients with cancer. It offers a model for the treatment of depression comorbid with other medical conditions. Funding Cancer Research UK and Chief Scientist Office of the Scottish Government.


      PubDate: 2014-09-21T15:52:09Z
       
  • Anti-programmed-death-receptor-1 treatment with pembrolizumab in
           ipilimumab-refractory advanced melanoma: a randomised dose-comparison
           cohort of a phase 1 trial
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Caroline Robert , Antoni Ribas , Jedd D Wolchok , F Stephen Hodi , Omid Hamid , Richard Kefford , Jeffrey S Weber , Anthony M Joshua , Wen-Jen Hwu , Tara C Gangadhar , Amita Patnaik , Roxana Dronca , Hassane Zarour , Richard W Joseph , Peter Boasberg , Bartosz Chmielowski , Christine Mateus , Michael A Postow , Kevin Gergich , Jeroen Elassaiss-Schaap , Xiaoyun Nicole Li , Robert Iannone , Scot W Ebbinghaus , S Peter Kang , Adil Daud
      Background The anti-programmed-death-receptor-1 (PD-1) antibody pembrolizumab has shown potent antitumour activity at different doses and schedules in patients with melanoma. We compared the efficacy and safety of pembrolizumab at doses of 2 mg/kg and 10 mg/kg every 3 weeks in patients with ipilimumab-refractory advanced melanoma. Methods In an open-label, international, multicentre expansion cohort of a phase 1 trial, patients (aged ≥18 years) with advanced melanoma whose disease had progressed after at least two ipilimumab doses were randomly assigned with a computer-generated allocation schedule (1:1 final ratio) to intravenous pembrolizumab at 2 mg/kg every 3 weeks or 10 mg/kg every 3 weeks until disease progression, intolerable toxicity, or consent withdrawal. Primary endpoint was overall response rate (ORR) assessed with the Response Evaluation Criteria In Solid Tumors (RECIST, version 1.1) by independent central review. Analysis was done on the full-analysis set (all treated patients with measurable disease at baseline). This study is registered with ClinicalTrials.gov, number NCT01295827. Findings 173 patients received pembrolizumab 2 mg/kg (n=89) or 10 mg/kg (n=84). Median follow-up duration was 8 months. ORR was 26% at both doses—21 of 81 patients in the 2 mg/kg group and 20 of 76 in the 10 mg/kg group (difference 0%, 95% CI −14 to 13; p=0·96). Treatment was well tolerated, with similar safety profiles in the 2 mg/kg and 10 mg/kg groups and no drug-related deaths. The most common drug-related adverse events of any grade in the 2 mg/kg and 10 mg/kg groups were fatigue (29 [33%] vs 31 [37%]), pruritus (23 [26%] vs 16 [19%]), and rash (16 [18%] vs 15 [18%]). Grade 3 fatigue, reported in five (3%) patients in the 2 mg/kg pembrolizumab group, was the only drug-related grade 3 to 4 adverse event reported in more than one patient. Interpretation The results suggest that pembrolizumab at a dose of 2 mg/kg or 10 mg/kg every 3 weeks might be an effective treatment in patients for whom there are few effective treatment options. Funding Merck Sharp and Dohme.


      PubDate: 2014-09-21T15:52:09Z
       
  • Efficacy and cost of video-assisted thoracoscopic partial pleurectomy
           versus talc pleurodesis in patients with malignant pleural mesothelioma
           (MesoVATS): an open-label, randomised, controlled trial
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Robert C Rintoul , Andrew J Ritchie , John G Edwards , David A Waller , Aman S Coonar , Maxine Bennett , Eleonora Lovato , Victoria Hughes , Julia A Fox-Rushby , Linda D Sharples
      Background Malignant pleural mesothelioma incidence continues to rise, with few available evidence-based therapeutic options. Results of previous non-randomised studies suggested that video-assisted thoracoscopic partial pleurectomy (VAT-PP) might improve symptom control and survival. We aimed to compare efficacy in terms of overall survival, and cost, of VAT-PP and talc pleurodesis in patients with malignant pleural mesothelioma. Methods We undertook an open-label, parallel-group, randomised, controlled trial in patients aged 18 years or older with any subtype of confirmed or suspected mesothelioma with pleural effusion, recruited from 12 hospitals in the UK. Eligible patients were randomly assigned (1:1) to either VAT-PP or talc pleurodesis by computer-generated random numbers, stratified by European Organisation for Research and Treatment of Cancer risk category (high vs low). The primary outcome was overall survival at 1 year, analysed by intention to treat (all patients randomly assigned to a treatment group with a final diagnosis of mesothelioma). This trial is registered with ClinicalTrials.gov, number NCT00821860. Findings Between Oct 24, 2003, and Jan 24, 2012, we randomly assigned 196 patients, of whom 175 (88 assigned to talc pleurodesis, 87 assigned to VAT-PP) had confirmed mesothelioma. Overall survival at 1 year was 52% (95% CI 41–62) in the VAT-PP group and 57% (46–66) in the talc pleurodesis group (hazard ratio 1·04 [95% CI 0·76–1·42]; p=0·81). Surgical complications were significantly more common after VAT-PP than after talc pleurodesis, occurring in 24 (31%) of 78 patients who completed VAT-PP versus ten (14%) of 73 patients who completed talc pleurodesis (p=0·019), as were respiratory complications (19 [24%] vs 11 [15%]; p=0·22) and air-leak beyond 10 days (five [6%] vs one [1%]; p=0·21), although not significantly so. Median hospital stay was longer at 7 days (IQR 5–11) in patients who received VAT-PP compared with 3 days (2–5) for those who received talc pleurodesis (p<0·0001). Interpretation VAT-PP is not recommended to improve overall survival in patients with pleural effusion due to malignant pleural mesothelioma, and talc pleurodesis might be preferable considering the fewer complications and shorter hospital stay associated with this treatment. Funding BUPA Foundation.


      PubDate: 2014-09-21T15:52:09Z
       
  • Colonic marbling in Clostridium difficile pancolitis
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Paul Stirling , Joseph Shalhoub , Neel Sengupta , Katherine R L Brown



      PubDate: 2014-09-21T15:52:09Z
       
  • Midwifery and quality care: findings from a new evidence-informed
           framework for maternal and newborn care
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Mary J Renfrew , Alison McFadden , Maria Helena Bastos , James Campbell , Andrew Amos Channon , Ngai Fen Cheung , Deborah Rachel Audebert Delage Silva , Soo Downe , Holly Powell Kennedy , Address Malata , Felicia McCormick , Laura Wick , Eugene Declercq
      In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women's views and experiences, effective practices, and maternal and newborn care providers. The framework differentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identified more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our findings support a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires effective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and newborn care systems can benefit from using the quality framework in planning workforce development and resource allocation.


      PubDate: 2014-09-21T15:52:09Z
       
  • The projected effect of scaling up midwifery
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Caroline S E Homer , Ingrid K Friberg , Marcos Augusto Bastos Dias , Petra ten Hoope-Bender , Jane Sandall , Anna Maria Speciale , Linda A Bartlett
      We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the countries with the lowest HDI, 61% of all maternal, fetal, and neonatal deaths could be prevented. Family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies. Midwifery with both family planning and interventions for maternal and newborn health could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care.


      PubDate: 2014-09-21T15:52:09Z
       
  • Multicentric Castleman's disease in Malawi
    • Abstract: Publication date: 20–26 September 2014
      Source:The Lancet, Volume 384, Issue 9948
      Author(s): Satish Gopal , Yuri Fedoriw , Nathan D Montgomery , Coxcilly Kampani , Robert Krysiak , Marcia K Sanders , Dirk P Dittmer , N George Liomba



      PubDate: 2014-09-21T15:52:09Z
       
  • Ebola and human rights in west Africa
    • Abstract: Publication date: Available online 19 September 2014
      Source:The Lancet
      Author(s): Patrick M Eba



      PubDate: 2014-09-21T15:52:09Z
       
  • Putting science into practice for early child development
    • Abstract: Publication date: Available online 19 September 2014
      Source:The Lancet
      Author(s): Anthony Lake , Margaret Chan



      PubDate: 2014-09-21T15:52:09Z
       
  • Universal health coverage and the post-2015 agenda
    • Abstract: Publication date: Available online 18 September 2014
      Source:The Lancet
      Author(s): Marisol Touraine , Hermann Gröhe , Raymonde Goudou Coffie , Subramaniam Sathasivam , Mercedes Juan , El Houssaine Louardi , Awa Call Seck



      PubDate: 2014-09-21T15:52:09Z
       
  • Hurricane aorta
    • Abstract: Publication date: Available online 18 September 2014
      Source:The Lancet
      Author(s): Robert Manka , Christian Binter , Sebastian Kozerke



      PubDate: 2014-09-21T15:52:09Z
       
  • Avoiding 40% of the premature deaths in each country, 2010–30:
           review of national mortality trends to help quantify the UN Sustainable
           Development Goal for health
    • Abstract: Publication date: Available online 18 September 2014
      Source:The Lancet
      Author(s): Ole F Norheim , Prabhat Jha , Kesetebirhan Admasu , Tore Godal , Ryan J Hum , Margaret E Kruk , Octavio Gómez-Dantés , Colin D Mathers , Hongchao Pan , Jaime Sepúlveda , Wilson Suraweera , Stéphane Verguet , Addis T Woldemariam , Gavin Yamey , Dean T Jamison , Richard Peto
      Background The UN will formulate ambitious Sustainable Development Goals for 2030, including one for health. Feasible goals with some quantifiable, measurable targets can influence governments. We propose, as a quatitative health target, “Avoid in each country 40% of premature deaths (under-70 deaths that would be seen in the 2030 population at 2010 death rates), and improve health care at all ages”. Targeting overall mortality and improved health care ignores no modifiable cause of death, nor any cause of disability that is treatable (or also causes many deaths). 40% fewer premature deaths would be important in all countries, but implies very different priorities in different populations. Reinforcing this target for overall mortality in each country are four global subtargets for 2030: avoid two-thirds of child and maternal deaths; two-thirds of tuberculosis, HIV, and malaria deaths; a third of premature deaths from non-communicable diseases (NCDs); and a third of those from other causes (other communicable diseases, undernutrition, and injuries). These challenging subtargets would halve under-50 deaths, avoid a third of the (mainly NCD) deaths at ages 50–69 years, and so avoid 40% of under-70 deaths. To help assess feasibility, we review mortality rates and trends in the 25 most populous countries, in four country income groupings, and worldwide. Methods UN sources yielded overall 1970–2010 mortality trends. WHO sources yielded cause-specific 2000–10 trends, standardised to country-specific 2030 populations; decreases per decade of 42% or 18% would yield 20-year reductions of two-thirds or a third. Results Throughout the world, except in countries where the effects of HIV or political disturbances predominated, mortality decreased substantially from 1970–2010, particularly in childhood. From 2000–10, under-70 age-standardised mortality rates decreased 19% (with the low-income and lower-middle-income countries having the greatest absolute gains). The proportional decreases per decade (2000–10) were: 34% at ages 0–4 years; 17% at ages 5–49 years; 15% at ages 50–69 years; 30% for communicable, perinatal, maternal, or nutritional causes; 14% for NCDs; and 13% for injuries (accident, suicide, or homicide). Interpretation Moderate acceleration of the 2000–10 proportional decreases in mortality could be feasible, achieving the targeted 2030 disease-specific reductions of two-thirds or a third. If achieved, these reductions avoid about 10 million of the 20 million deaths at ages 0–49 years that would be seen in 2030 at 2010 death rates, and about 17 million of the 41 million such deaths at ages 0–69 years. Such changes could be achievable by 2030, or soon afterwards, at least in areas free of war, other major effects of political disruption, or a major new epidemic. Funding UK Medical Research Council, Norwegian Agency for Development Cooperation, Centre for Global Health Research, and Bill & Melinda Gates Foundation.


      PubDate: 2014-09-21T15:52:09Z
       
  • Quantifying targets for the SDG health goal
    • Abstract: Publication date: Available online 18 September 2014
      Source:The Lancet
      Author(s): George Alleyne , Robert Beaglehole , Ruth Bonita



      PubDate: 2014-09-21T15:52:09Z
       
  • Towards evidence-based, quantitative Sustainable Development Goals for
           2030
    • Abstract: Publication date: Available online 18 September 2014
      Source:The Lancet
      Author(s): Børge Brende , Bent Høie



      PubDate: 2014-09-21T15:52:09Z
       
  • Richard III: skeletal evidence of perimortem trauma
    • Abstract: Publication date: Available online 16 September 2014
      Source:The Lancet
      Author(s): Heather E Bonney



      PubDate: 2014-09-17T15:46:30Z
       
  • Apgar score and the risk of cause-specific infant mortality: a
           population-based cohort study
    • Abstract: Publication date: Available online 15 September 2014
      Source:The Lancet
      Author(s): Stamatina Iliodromiti , Daniel F Mackay , Gordon C S Smith , Jill P Pell , Scott M Nelson
      Background The Apgar score has been used worldwide as an index of early neonatal condition for more than 60 years. With advances in health-care service provision, neonatal resuscitation, and infant care, its present relevance is unclear. The aim of the study was to establish the strength of the relation between Apgar score at 5 min and the risk of neonatal and infant mortality, subdivided by specific causes. Methods We linked routine discharge and mortality data for all births in Scotland, UK between 1992 and 2010. We restricted our analyses to singleton livebirths, in women aged over 10 years, with a gestational age at delivery between 22 and 44 weeks, and excluded deaths due to congenital anomalies or isoimmunisation. We calculated the relative risks (RRs) of neonatal and infant death of neonates with low (0–3) and intermediate (4–6) Apgar scores at 5 min referent to neonates with normal Apgar score (7–10) using binomial log-linear modelling with adjustment for confounders. Analyses were stratified by gestational age at birth because it was a significant effect modifier. Missing covariate data were imputed. Findings Complete data were available for 1 029 207 eligible livebirths. Across all gestational strata, low Apgar score at 5 min was associated with an increased risk of neonatal and infant death. However, the strength of the association (adjusted RR, 95% CI referent to Apgar 7–10) was strongest at term (p<0·0001). A low Apgar (0–3) was associated with an adjusted RR of 359·4 (95% CI 277·3–465·9) for early neonatal death, 30·5 (18·0–51·6) for late neonatal death, and 50·2 (42·8–59·0) for infant death. We noted similar associations of a lower magnitude for intermediate Apgar (4–6). The strongest associations were for deaths attributed to anoxia and low Apgar (0–3) for term infants (RR 961·7, 95% CI 681·3–1357·5) and preterm infants (141·7, 90·1–222·8). No association between Apgar score at 5 min and the risk of sudden infant death syndrome was noted at any gestational age (RR 0·6, 95% CI 0·1–4·6 at term; 1·2, 0·3–4·8 at preterm). Interpretation Low Apgar score at 5 min was strongly associated with the risk of neonatal and infant death. Our findings support its continued usefulness in contemporary practice. Funding None.


      PubDate: 2014-09-17T15:46:30Z
       
  • Perimortem trauma in King Richard III: a skeletal analysis
    • Abstract: Publication date: Available online 16 September 2014
      Source:The Lancet
      Author(s): Jo Appleby , Guy N Rutty , Sarah V Hainsworth , Robert C Woosnam-Savage , Bruno Morgan , Alison Brough , Richard W Earp , Claire Robinson , Turi E King , Mathew Morris , Richard Buckley
      Background Richard III was the last king of England to die in battle, but how he died is unknown. On Sept 4, 2012, a skeleton was excavated in Leicester that was identified as Richard. We investigated the trauma to the skeleton with modern forensic techniques, such as conventional CT and micro-CT scanning, to characterise the injuries and establish the probable cause of death. Methods We assessed age and sex through direct analysis of the skeleton and from CT images. All bones were examined under direct light and multi-spectral illumination. We then scanned the skeleton with whole-body post-mortem CT. We subsequently examined bones with identified injuries with micro-CT. We deemed that trauma was perimortem when we recorded no evidence of healing and when breakage characteristics were typical of fresh bone. We used previous data to identify the weapons responsible for the recorded injuries. Findings The skeleton was that of an adult man with a gracile build and severe scoliosis of the thoracic spine. Standard anthropological age estimation techniques based on dry bone analysis gave an age range between 20s and 30s. Standard post-mortem CT methods were used to assess rib end morphology, auricular surfaces, pubic symphyseal face, and cranial sutures, to produce a multifactorial narrower age range estimation of 30–34 years. We identified nine perimortem injuries to the skull and two to the postcranial skeleton. We identified no healed injuries. The injuries were consistent with those created by weapons from the later medieval period. We could not identify the specific order of the injuries, because they were all distinct, with no overlapping wounds. Three of the injuries—two to the inferior cranium and one to the pelvis—could have been fatal. Interpretation The wounds to the skull suggest that Richard was not wearing a helmet, although the absence of defensive wounds on his arms and hands suggests he was still otherwise armoured. Therefore, the potentially fatal pelvis injury was probably received post mortem, meaning that the most likely injuries to have caused his death are the two to the inferior cranium. Funding The University of Leicester.


      PubDate: 2014-09-17T15:46:30Z
       
  • WHO meeting chooses untried interventions to defeat Ebola
    • Abstract: Publication date: Available online 12 September 2014
      Source:The Lancet
      Author(s): John Maurice



      PubDate: 2014-09-17T15:46:30Z
       
 
 
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