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Journal Cover The Lancet
  [SJR: 14.638]   [H-I: 600]   [1651 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [3039 journals]
  • Department of Error
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051


      PubDate: 2016-09-25T03:35:05Z
       
  • Department of Error
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051


      PubDate: 2016-09-25T03:35:05Z
       
  • Department of Error
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051


      PubDate: 2016-09-25T03:35:05Z
       
  • Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for
           complex perianal fistulas in Crohn's disease: a phase 3 randomised,
           double-blind controlled trial
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Julián Panés, Damián García-Olmo, Gert Van Assche, Jean Frederic Colombel, Walter Reinisch, Daniel C Baumgart, Axel Dignass, Maria Nachury, Marc Ferrante, Lili Kazemi-Shirazi, Jean C Grimaud, Fernando de la Portilla, Eran Goldin, Marie Paule Richard, Anne Leselbaum, Silvio Danese
      Background Complex perianal fistulas in Crohn's disease are challenging to treat. Allogeneic, expanded, adipose-derived stem cells (Cx601) are a promising new therapeutic approach. We aimed to assess the safety and efficacy of Cx601 for treatment-refractory complex perianal fistulas in patients with Crohn's disease. Methods We did this randomised, double-blind, parallel-group, placebo-controlled study at 49 hospitals in seven European countries and Israel from July 6, 2012, to July 27, 2015. Adult patients (≥18 years) with Crohn's disease and treatment-refractory, draining complex perianal fistulas were randomly assigned (1:1) using a pre-established randomisation list to a single intralesional injection of 120 million Cx601 cells or 24 mL saline solution (placebo), with stratification according to concomitant baseline treatment. Treatment was administered by an unmasked surgeon, with a masked gastroenterologist and radiologist assessing the therapeutic effect. The primary endpoint was combined remission at week 24 (ie, clinical assessment of closure of all treated external openings that were draining at baseline, and absence of collections >2 cm of the treated perianal fistulas confirmed by masked central MRI). Efficacy was assessed in the intention-to-treat (ITT) and modified ITT populations; safety was assessed in the safety population. This study is registered with ClinicalTrials.gov, number NCT01541579. Findings 212 patients were randomly assigned: 107 to Cx601 and 105 to placebo. A significantly greater proportion of patients treated with Cx601 versus placebo achieved combined remission in the ITT (53 of 107 [50%] vs 36 of 105 [34%]; difference 15·2%, 97·5% CI 0·2–30·3; p=0·024) and modified ITT populations (53 of 103 [51%] vs 36 of 101 [36%]; 15·8%, 0·5–31·2; p=0·021). 18 (17%) of 103 patients in the Cx601 group versus 30 (29%) of 103 in the placebo group experienced treatment-related adverse events, the most common of which were anal abscess (six in the Cx601 group vs nine in the placebo group) and proctalgia (five vs nine). Interpretation Cx601 is an effective and safe treatment for complex perianal fistulas in patients with Crohn's disease who did not respond to conventional or biological treatments, or both. Funding TiGenix.

      PubDate: 2016-09-25T03:35:05Z
       
  • GEMS extend understanding of childhood diarrhoea
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Karen H Keddy, Anthony M Smith, Nicola A Page


      PubDate: 2016-09-25T03:35:05Z
       
  • Mesenchymal stem cells for fistulising Crohn's disease
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Rachele Ciccocioppo, Gino Roberto Corazza


      PubDate: 2016-09-25T03:35:05Z
       
  • Measuring the health-related Sustainable Development Goals in 188
           countries: a baseline analysis from the Global Burden of Disease Study
           2015
    • Abstract: Publication date: Available online 21 September 2016
      Source:The Lancet
      Author(s): GBD 2015 SDG CollaboratorsStephen SLimKateAllenZulfiqar ABhuttaLalitDandonaMohammad HForouzanfarNancyFullmanPeter WGethingEllen MGoldbergSimon IHayMollieHolmbergYohannesKinfuMichael JKutzHeidi JLarsonXiaofengLiangAlan DLopezRafaelLozanoClaire RMcNellanAli HMokdadMeghan DMooneyMohsenNaghaviHelen EOlsenDavid MPigottJoshua ASalomonTheoVosHaidongWangAmanuel AlemuAbajobirKalkidan HassenAbateCristianaAbbafatiKaja MAbbasFoadAbd-AllahAbdishakur MAbdulleBijuAbrahamIbrahimAbubakarLaith JAbu-RaddadNiveen M EAbu-RmeilehGebre YitayihAbyuTomAchokiAkindele OlupelumiAdebiyiIsaac AkinkunmiAdedejiKossivi AgbelenkoAfanviAshkanAfshinArnavAgarwalAnuragAgrawalAliasghar AhmadKiadaliriHamidAhmadiehKedir YimamAhmedAli ShafqatAkandaRufus OlusolaAkinyemiTomi FAkinyemijuNadiaAkseerZiyadAl-AlyKhurshidAlamUzmaAlamDeenaAlasfoorFadia SAlBuhairanSaleh FahedAldhahriRobert WilliamAldridgeZewdie AderawAlemuRaghibAliAla'aAlkerwiMohammad ABAlkhateebFrançoisAllaPeterAllebeckChristineAllenRajaaAl-RaddadiKhalid AAltirkawiElena AlvarezMartinNelsonAlvis-GuzmanAzmeraw TAmareAlemayehuAmberbirAdeladza KofiAmegahHereshAminiWalidAmmarStephen MarcAmrockHjalte HAndersenBenjamin OAndersonGregory MAndersonCarl Abelardo TAntonioPalwashaAnwariJohanÄrnlövAlArtamanHamidAsayeshRana JawadAsgharSulemanAtiqueEuripide Frinel G ArthurAvokpahoAshishAwasthiBeatriz Paulina AyalaQuintanillaPeterAzzopardiUmarBachaAlaaBadawiKalpanaBalakrishnanAmitavaBanerjeeAleksandraBaracRyanBarberSuzanne LBarker-ColloTillBärnighausenLope HBarreroTonatiuhBarrientos-GutierrezSanjayBasuTigist AssefaBayouShahrzadBazargan-HejaziJustinBeardsleyNeerajBediEttoreBeghiYannickBéjotMichelle LBellAminu KBelloDerrick ABennettIsabela MBensenorHabibBenzianAdugnawBerhaneEduardoBernabéOscar AlbertoBernalBalem DemtsuBetsuAddisu ShunuBeyeneNeerajBhalaSamirBhattSibhatuBiadgilignKelly ABienhoffBorisBikbovAgnesBinagwahoDonalBisanzioEspenBjertnessJedBloreRupert R ABourneMichaelBraininMichaelBrauerAlexandraBrazinovaNicholas J KBreitbordeDavid MBrodayTraolach SBrughaRachelleBuchbinderZahid AButtLeah ECahillIsmael RicardoCampos-NonatoJulio CesarCampuzanoHélèneCarabinRosarioCárdenasJuan JesusCarreroAustinCarterDanielCaseyValeriaCasoCarlos ACastañeda-OrjuelaJacqueline CastilloRivasFerránCatalá-LópezFiorellaCavalleriPedroCecílioHsing-YiChangJung-ChenChangFiona JCharlsonXuanCheAlan ZianChenPeggy Pei-ChiaChiangMirriamChibalabalaVesper HichilombweChisumpaJee-Young JasmineChoiRajivChowdhuryHanneChristensenLiliana GCiobanuMassimoCirilloMatthew MCoatesMeganCoggeshallAaron JCohenGraham SCookeCyrusCooperLeslie TrumbullCooperBenjamin CCowieJohn ACrumpSolomon AbrhaDamtewRakhiDandonaPaul IDarganJosé dasNevesAdrian CDavisKairatDavletovE Filipade CastroDiegoDe LeoLouisaDegenhardtLiana CDel GobboKebedeDeribeSarahDerrettDon CDes JarlaisAniruddhaDeshpandeGabrielle AdeVeberSubhojitDeySamath DDharmaratnePreet KDhillonEric LDingE RayDorseyKerrie EDoyleTim 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MuthaferKhojaArdeshirKhosraviJagdishKhubchandaniChristianKielingCho-ilKimDanielKimSungroulKimYun JinKimRuth WKimokotiNiranjanKissoonMiiaKivipeltoLuke DKnibbsYoshihiroKokuboDhavalKolteSoewartaKosenGeorgios AKotsakisParvaiz AKoulAiKoyanagiMichaelKravchenkoHansKruegerBarthelemy KuateDefoRicardo SKuchenbeckerErnst JKuipersXie RachelKulikoffVeena SKulkarniG AnilKumarGene FKwanHmwe HKyuAparnaLalDharmesh KumarLalRatilalLallooHiltonLamQingLanSinead MLanganAndersLarssonDennis OdaiLaryeaAsma AbdulLatifJanet LLeasherJamesLeighMallLeinsaluJanniLeungRickyLeungMiriamLeviYichongLiYongmeiLiMargaretLindShaiLinnSteven ELipshultzPatrick YLiuShiweiLiuYangLiuBelinda KLloydLoon-TzianLoGiancarloLogroscinoPaulo ALotufoRobyn MLucasRaimundasLuneviciusMohammed Magdy AbdEl RazekCarlosMagis-RodriguezMahdiMahdaviMarekMajdanAzeemMajeedRezaMalekzadehDeborah CarvalhoMaltaChabila CMapomaDavid JoelMargolisRandall VMartinJoseMartinez-RagaFelixMasiyeAmanda J...
      PubDate: 2016-09-25T03:35:05Z
       
  • No small task: therapeutic targeting of Lp(a) for cardiovascular disease
    • Abstract: Publication date: Available online 21 September 2016
      Source:The Lancet
      Author(s): Mark W Feinberg


      PubDate: 2016-09-25T03:35:05Z
       
  • Antisense oligonucleotides targeting apolipoprotein(a) in people with
           raised lipoprotein(a): two randomised, double-blind, placebo-controlled,
           dose-ranging trials
    • Abstract: Publication date: Available online 21 September 2016
      Source:The Lancet
      Author(s): Nicholas J Viney, Julian C van Capelleveen, Richard S Geary, Shuting Xia, Joseph A Tami, Rosie Z Yu, Santica M Marcovina, Steven G Hughes, Mark J Graham, Rosanne M Crooke, Stanley T Crooke, Joseph L Witztum, Erik S Stroes, Sotirios Tsimikas
      Background Elevated lipoprotein(a) (Lp[a]) is a highly prevalent (around 20% of people) genetic risk factor for cardiovascular disease and calcific aortic valve stenosis, but no approved specific therapy exists to substantially lower Lp(a) concentrations. We aimed to assess the efficacy, safety, and tolerability of two unique antisense oligonucleotides designed to lower Lp(a) concentrations. Methods We did two randomised, double-blind, placebo-controlled trials. In a phase 2 trial (done in 13 study centres in Canada, the Netherlands, Germany, Denmark, and the UK), we assessed the effect of IONIS-APO(a)Rx, an oligonucleotide targeting apolipoprotein(a). Participants with elevated Lp(a) concentrations (125–437 nmol/L in cohort A; ≥438 nmol/L in cohort B) were randomly assigned (in a 1:1 ratio in cohort A and in a 4:1 ratio in cohort B) with an interactive response system to escalating-dose subcutaneous IONIS-APO(a)Rx (100 mg, 200 mg, and then 300 mg, once a week for 4 weeks each) or injections of saline placebo, once a week, for 12 weeks. Primary endpoints were mean percentage change in fasting plasma Lp(a) concentration at day 85 or 99 in the per-protocol population (participants who received more than six doses of study drug) and safety and tolerability in the safety population. In a phase 1/2a first-in-man trial, we assessed the effect of IONIS-APO(a)-LRx, a ligand-conjugated antisense oligonucleotide designed to be highly and selectively taken up by hepatocytes, at the BioPharma Services phase 1 unit (Toronto, ON, Canada). Healthy volunteers (Lp[a] ≥75 nmol/L) were randomly assigned to receive a single dose of 10–120 mg IONIS-APO(a)LRx subcutaneously in an ascending-dose design or placebo (in a 3:1 ratio; single-ascending-dose phase), or multiple doses of 10 mg, 20 mg, or 40 mg IONIS-APO(a)LRx subcutaneously in an ascending-dose design or placebo (in an 8:2 ratio) at day 1, 3, 5, 8, 15, and 22 (multiple-ascending-dose phase). Primary endpoints were mean percentage change in fasting plasma Lp(a) concentration, safety, and tolerability at day 30 in the single-ascending-dose phase and day 36 in the multiple-ascending-dose phase in participants who were randomised and received at least one dose of study drug. In both trials, the randomised allocation sequence was generated by Ionis Biometrics or external vendor with a permuted-block randomisation method. Participants, investigators, sponsor personnel, and clinical research organisation staff who analysed the data were all masked to the treatment assignments. Both trials are registered with ClinicalTrials.gov, numbers NCT02160899 and NCT02414594. Findings From June 25, 2014, to Nov 18, 2015, we enrolled 64 participants to the phase 2 trial (51 in cohort A and 13 in cohort B). 35 were randomly assigned to IONIS-APO(a)Rx and 29 to placebo. At day 85/99, participants assigned to IONIS-APO(a)Rx had mean Lp(a) reductions of 66·8% (SD 20·6) in cohort A and 71·6% (13·0) in cohort B (both p<0·0001 vs pooled placebo). From April 15, 2015, to Jan 11, 2016, we enrolled 58 healthy volunteers to the phase 1/2a trial of IONIS-APO(a)-LRx. Of 28 participants in the single-ascending-dose phase, three were randomly assigned to 10 mg, three to 20 mg, three to 40 mg, six to 80 mg, six to 120 mg, and seven to placebo. Of 30 participants in the multiple-ascending-dose phase, eight were randomly assigned to 10 mg, eight to 20 mg, eight to 40 mg, and six to placebo. Significant dose-dependent reductions in mean Lp(a) concentrations were noted in all single-dose IONIS-APO(a)-LRx groups at day 30. In the multidose groups, IONIS-APO(a)-LRx resulted in mean reductions in Lp(a) of 66% (SD 21·8) in the 10 mg group, 80% (SD 13·7%) in the 20 mg group, and 92% (6·5) in the 40 mg group (p=0·0007 for all vs placebo) at day 36. Both antisense oligonucleotides were safe. There were two serious adverse events (myocardial infarctions) in the IONIS-APO(a)Rx phase 2 trial, one in the IONIS-APO(a)Rx and one in the placebo group, but neither were thought to be treatment related. 12% of injections with IONIS-APO(a)Rx were associated with injection-site...
      PubDate: 2016-09-25T03:35:05Z
       
  • Department of Error
    • Abstract: Publication date: Available online 22 September 2016
      Source:The Lancet


      PubDate: 2016-09-25T03:35:05Z
       
  • Aquagenic wrinkling of the palms: a diagnostic clue to cystic fibrosis
           carrier status and non-classic disease
    • Abstract: Publication date: Available online 22 September 2016
      Source:The Lancet
      Author(s): Justyn M Thomas, Alana Durack, Anne Sterling, Pamela M Todd, Nevianna Tomson


      PubDate: 2016-09-25T03:35:05Z
       
  • A call to action and a lifecourse strategy to address the global burden of
           raised blood pressure on current and future generations: the Lancet
           Commission on hypertension
    • Abstract: Publication date: Available online 23 September 2016
      Source:The Lancet
      Author(s): Michael H Olsen, Sonia Y Angell, Samira Asma, Pierre Boutouyrie, Dylan Burger, Julio A Chirinos, Albertino Damasceno, Christian Delles, Anne-Paule Gimenez-Roqueplo, Dagmara Hering, Patricio López-Jaramillo, Fernando Martinez, Vlado Perkovic, Ernst R Rietzschel, Giuseppe Schillaci, Aletta E Schutte, Angelo Scuteri, James E Sharman, Kristian Wachtell, Ji Guang Wang


      PubDate: 2016-09-25T03:35:05Z
       
  • City planning and population health: a global challenge
    • Abstract: Publication date: Available online 23 September 2016
      Source:The Lancet
      Author(s): Billie Giles-Corti, Anne Vernez-Moudon, Rodrigo Reis, Gavin Turrell, Andrew L Dannenberg, Hannah Badland, Sarah Foster, Melanie Lowe, James F Sallis, Mark Stevenson, Neville Owen
      Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.

      PubDate: 2016-09-25T03:35:05Z
       
  • Land use, transport, and population health: estimating the health benefits
           of compact cities
    • Abstract: Publication date: Available online 23 September 2016
      Source:The Lancet
      Author(s): Mark Stevenson, Jason Thompson, Thiago Hérick de Sá, Reid Ewing, Dinesh Mohan, Rod McClure, Ian Roberts, Geetam Tiwari, Billie Giles-Corti, Xiaoduan Sun, Mark Wallace, James Woodcock
      Using a health impact assessment framework, we estimated the population health effects arising from alternative land-use and transport policy initiatives in six cities. Land-use changes were modelled to reflect a compact city in which land-use density and diversity were increased and distances to public transport were reduced to produce low motorised mobility, namely a modal shift from private motor vehicles to walking, cycling, and public transport. The modelled compact city scenario resulted in health gains for all cities (for diabetes, cardiovascular disease, and respiratory disease) with overall health gains of 420–826 disability-adjusted life-years (DALYs) per 100 000 population. However, for moderate to highly motorised cities, such as Melbourne, London, and Boston, the compact city scenario predicted a small increase in road trauma for cyclists and pedestrians (health loss of between 34 and 41 DALYs per 100 000 population). The findings suggest that government policies need to actively pursue land-use elements—particularly a focus towards compact cities—that support a modal shift away from private motor vehicles towards walking, cycling, and low-emission public transport. At the same time, these policies need to ensure the provision of safe walking and cycling infrastructure. The findings highlight the opportunities for policy makers to positively influence the overall health of city populations.

      PubDate: 2016-09-25T03:35:05Z
       
  • Mark Stevenson: systems thinker for cities
    • Abstract: Publication date: Available online 23 September 2016
      Source:The Lancet
      Author(s): Jocalyn Clark


      PubDate: 2016-09-25T03:35:05Z
       
  • Urban design: an important future force for health and wellbeing
    • Abstract: Publication date: Available online 23 September 2016
      Source:The Lancet
      Author(s): Sabine Kleinert, Richard Horton


      PubDate: 2016-09-25T03:35:05Z
       
  • Urban design and transport to promote healthy lives
    • Abstract: Publication date: Available online 23 September 2016
      Source:The Lancet
      Author(s): Shifalika Goenka, Lars Bo Andersen


      PubDate: 2016-09-25T03:35:05Z
       
  • Healthier neighbourhoods through healthier parks
    • Abstract: Publication date: Available online 23 September 2016
      Source:The Lancet
      Author(s): Bill de Blasio


      PubDate: 2016-09-25T03:35:05Z
       
  • Use of science to guide city planning policy and practice: how to achieve
           healthy and sustainable future cities
    • Abstract: Publication date: Available online 23 September 2016
      Source:The Lancet
      Author(s): James F Sallis, Fiona Bull, Ricky Burdett, Lawrence D Frank, Peter Griffiths, Billie Giles-Corti, Mark Stevenson
      Land-use and transport policies contribute to worldwide epidemics of injuries and non-communicable diseases through traffic exposure, noise, air pollution, social isolation, low physical activity, and sedentary behaviours. Motorised transport is a major cause of the greenhouse gas emissions that are threatening human health. Urban and transport planning and urban design policies in many cities do not reflect the accumulating evidence that, if policies would take health effects into account, they could benefit a wide range of common health problems. Enhanced research translation to increase the influence of health research on urban and transport planning decisions could address many global health problems. This paper illustrates the potential for such change by presenting conceptual models and case studies of research translation applied to urban and transport planning and urban design. The primary recommendation of this paper is for cities to actively pursue compact and mixed-use urban designs that encourage a transport modal shift away from private motor vehicles towards walking, cycling, and public transport. This Series concludes by urging a systematic approach to city design to enhance health and sustainability through active transport and a move towards new urban mobility. Such an approach promises to be a powerful strategy for improvements in population health on a permanent basis.

      PubDate: 2016-09-25T03:35:05Z
       
  • Scaling up physical activity interventions worldwide: stepping up to
           larger and smarter approaches to get people moving
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      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: 2016-09-25T03:35:05Z
       
  • Sport and the city: midtown madness
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Gerard Vreugdenhil, Herman F J Mannaerts


      PubDate: 2016-09-25T03:35:05Z
       
  • Development of bicycle infrastructure for health and sustainability
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Alexander Gorobets


      PubDate: 2016-09-25T03:35:05Z
       
  • China's challenges in promoting physical activity and fitness
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Fuzhong Li, Yu Liu, Wenfei Zhu, Peter Harmer


      PubDate: 2016-09-25T03:35:05Z
       
  • Alcohol and the Sustainable Development Goals
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Heng Jiang, Xiaojun Xiang, Robin Room, Wei Hao


      PubDate: 2016-09-25T03:35:05Z
       
  • Schizophrenia
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Antonio Vita, Stefano Barlati, Luca De Peri, Giacomo Deste, Emilio Sacchetti


      PubDate: 2016-09-25T03:35:05Z
       
  • Progress in physical activity over the Olympic quadrennium
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      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: 2016-09-25T03:35:05Z
       
  • The economic burden of physical inactivity: a global analysis of major
           non-communicable diseases
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      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: 2016-09-25T03:35:05Z
       
  • Pedro Hallal: putting physical activity at the heart of better health
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Richard Lane


      PubDate: 2016-09-25T03:35:05Z
       
  • Health-care provider as witness
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Harvey Max Chochinov


      PubDate: 2016-09-25T03:35:05Z
       
  • Thomas Babington Boulton
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Geoff Watts


      PubDate: 2016-09-25T03:35:05Z
       
  • Children of war: urgent action is needed to save a generation
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Zulfiqar A Bhutta, William J Keenan, Susan Bennett


      PubDate: 2016-09-25T03:35:05Z
       
  • 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: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      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: 2016-09-25T03:35:05Z
       
  • Use of quantitative molecular diagnostic methods to identify causes of
           diarrhoea in children: a reanalysis of the GEMS case-control study
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Jie Liu, James A Platts-Mills, Jane Juma, Furqan Kabir, Joseph Nkeze, Catherine Okoi, Darwin J Operario, Jashim Uddin, Shahnawaz Ahmed, Pedro L Alonso, Martin Antonio, Stephen M Becker, William C Blackwelder, Robert F Breiman, Abu S G Faruque, Barry Fields, Jean Gratz, Rashidul Haque, Anowar Hossain, M Jahangir Hossain, Sheikh Jarju, Farah Qamar, Najeeha Talat Iqbal, Brenda Kwambana, Inacio Mandomando, Timothy L McMurry, Caroline Ochieng, John B Ochieng, Melvin Ochieng, Clayton Onyango, Sandra Panchalingam, Adil Kalam, Fatima Aziz, Shahida Qureshi, Thandavarayan Ramamurthy, James H Roberts, Debasish Saha, Samba O Sow, Suzanne E Stroup, Dipika Sur, Boubou Tamboura, Mami Taniuchi, Sharon M Tennant, Deanna Toema, Yukun Wu, Anita Zaidi, James P Nataro, Karen L Kotloff, Myron M Levine, Eric R Houpt
      Background Diarrhoea is the second leading cause of mortality in children worldwide, but establishing the cause can be complicated by diverse diagnostic approaches and varying test characteristics. We used quantitative molecular diagnostic methods to reassess causes of diarrhoea in the Global Enteric Multicenter Study (GEMS). Methods GEMS was a study of moderate to severe diarrhoea in children younger than 5 years in Africa and Asia. We used quantitative real-time PCR (qPCR) to test for 32 enteropathogens in stool samples from cases and matched asymptomatic controls from GEMS, and compared pathogen-specific attributable incidences with those found with the original GEMS microbiological methods, including culture, EIA, and reverse-transcriptase PCR. We calculated revised pathogen-specific burdens of disease and assessed causes in individual children. Findings We analysed 5304 sample pairs. For most pathogens, incidence was greater with qPCR than with the original methods, particularly for adenovirus 40/41 (around five times), Shigella spp or enteroinvasive Escherichia coli (EIEC) and Campylobactor jejuni o C coli (around two times), and heat-stable enterotoxin-producing E coli ([ST-ETEC] around 1·5 times). The six most attributable pathogens became, in descending order, Shigella spp, rotavirus, adenovirus 40/41, ST-ETEC, Cryptosporidium spp, and Campylobacter spp. Pathogen-attributable diarrhoeal burden was 89·3% (95% CI 83·2–96·0) at the population level, compared with 51·5% (48·0–55·0) in the original GEMS analysis. The top six pathogens accounted for 77·8% (74·6–80·9) of all attributable diarrhoea. With use of model-derived quantitative cutoffs to assess individual diarrhoeal cases, 2254 (42·5%) of 5304 cases had one diarrhoea-associated pathogen detected and 2063 (38·9%) had two or more, with Shigella spp and rotavirus being the pathogens most strongly associated with diarrhoea in children with mixed infections. Interpretation A quantitative molecular diagnostic approach improved population-level and case-level characterisation of the causes of diarrhoea and indicated a high burden of disease associated with six pathogens, for which targeted treatment should be prioritised. Funding Bill & Melinda Gates Foundation.

      PubDate: 2016-09-25T03:35:05Z
       
  • Physical activity—time to take it seriously and regularly
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Pamela Das, Richard Horton


      PubDate: 2016-09-25T03:35:05Z
       
  • Access to medicines—the status quo is no longer an option
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): The Lancet


      PubDate: 2016-09-25T03:35:05Z
       
  • Fit to serve
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): The Lancet


      PubDate: 2016-09-25T03:35:05Z
       
  • Jumping cultural hurdles to keep fit in the Middle East
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Sharmila Devi


      PubDate: 2016-09-25T03:35:05Z
       
  • Epilepsy—the unwelcome visitor
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Suzanne O'Sullivan


      PubDate: 2016-09-25T03:35:05Z
       
  • Knowledge
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Sam Guglani


      PubDate: 2016-09-25T03:35:05Z
       
  • How the paediatric workforce can address the opioid crisis
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Scott E Hadland, Evan Wood, Sharon Levy


      PubDate: 2016-09-25T03:35:05Z
       
  • Offline: A prescription for prosperity
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Richard Horton


      PubDate: 2016-09-25T03:35:05Z
       
  • Global Fund replenishment meeting nears target amount
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Ann Danaiya Usher


      PubDate: 2016-09-25T03:35:05Z
       
  • EpiPen price hike comes under scrutiny
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Rita Rubin


      PubDate: 2016-09-25T03:35:05Z
       
  • Update on the global pandemic of physical inactivity
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Lars Bo Andersen, Jorge Mota, Loretta Di Pietro


      PubDate: 2016-09-25T03:35:05Z
       
  • Gender equality in sport for improved public health
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Wendy J Brown, Gregore I Mielke, Tracy L Kolbe-Alexander


      PubDate: 2016-09-25T03:35:05Z
       
  • Renewing commitments to physical activity targets in Thailand
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): Thitikorn Topothai, Orana Chandrasiri, Nucharapon Liangruenrom, Viroj Tangcharoensathien


      PubDate: 2016-09-25T03:35:05Z
       
  • Care and society
    • Abstract: Publication date: 24–30 September 2016
      Source:The Lancet, Volume 388, Issue 10051
      Author(s): The Lancet


      PubDate: 2016-09-25T03:35:05Z
       
  • July 23, 2016, in Bamyan, Afghanistan
    • Abstract: Publication date: Available online 16 September 2016
      Source:The Lancet
      Author(s): Gijs Walraven


      PubDate: 2016-09-21T05:44:29Z
       
  • G7 Health Ministers' Kobe Communiqué
    • Abstract: Publication date: Available online 16 September 2016
      Source:The Lancet
      Author(s): Yasuhisa Shiozaki, Jane Philpott, Marisol Touraine, Gottfried Hermann Gröhe, Beatrice Lorenzin, Jeremy Hunt, Sylvia Mathews Burwell, Vytenis Povilas Andriukaitis


      PubDate: 2016-09-21T05:44:29Z
       
  • Coercion in maternity care
    • Abstract: Publication date: Available online 16 September 2016
      Source:The Lancet
      Author(s): Catherine Quarini


      PubDate: 2016-09-21T05:44:29Z
       
 
 
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