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Journal Cover The Lancet     [SJR: 7.074]   [H-I: 477]
   [1248 followers]  Follow    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [2585 journals]
  • Corticosteroids and pneumonia: time to change practice
    • Abstract: Publication date: Available online 19 January 2015
      Source:The Lancet
      Author(s): Djillali Annane



      PubDate: 2015-01-21T06:52:10Z
       
  • Blood as medicine: social meanings of blood and the success of Ebola
           trials
    • Abstract: Publication date: Available online 19 January 2015
      Source:The Lancet
      Author(s): Melanie Bannister-Tyrrell , Charlotte Gryseels , Alexandre Delamou , Umberto D'Alessandro , Johan van Griensven , Koen Peeters Grietens



      PubDate: 2015-01-21T06:52:10Z
       
  • A collaborative strategy to tackle tuberculosis in England
    • Abstract: Publication date: Available online 19 January 2015
      Source:The Lancet
      Author(s): Ibrahim Abubakar , H Lucy Thomas , Mike Morgan , Sarah Anderson , Dominik Zenner , Paul Cosford



      PubDate: 2015-01-21T06:52:10Z
       
  • Adjunct prednisone therapy for patients with community-acquired pneumonia:
           a multicentre, double-blind, randomised, placebo-controlled trial
    • Abstract: Publication date: Available online 19 January 2015
      Source:The Lancet
      Author(s): Claudine Angela Blum , Nicole Nigro , Matthias Briel , Philipp Schuetz , Elke Ullmer , Isabelle Suter-Widmer , Bettina Winzeler , Roland Bingisser , Hanno Elsaesser , Daniel Drozdov , Birsen Arici , Sandrine Andrea Urwyler , Julie Refardt , Philip Tarr , Sebastian Wirz , Robert Thomann , Christine Baumgartner , Hervé Duplain , Dieter Burki , Werner Zimmerli , Nicolas Rodondi , Beat Mueller , Mirjam Christ-Crain
      Background Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia. We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia. Methods In this double-blind, multicentre, randomised, placebo-controlled trial, we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerland within 24 h of presentation. Patients were randomly assigned (1:1 ratio) to receive either prednisone 50 mg daily for 7 days or placebo. The computer-generated randomisation was done with variable block sizes of four to six and stratified by study centre. The primary endpoint was time to clinical stability defined as time (days) until stable vital signs for at least 24 h, and analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00973154. Findings From Dec 1, 2009, to May 21, 2014, of 2911 patients assessed for eligibility, 785 patients were randomly assigned to either the prednisone group (n=392) or the placebo group (n=393). Median time to clinical stability was shorter in the prednisone group (3·0 days, IQR 2·5–3·4) than in the placebo group (4·4 days, 4·0–5·0; hazard ratio [HR] 1·33, 95% CI 1·15–1·50, p<0·0001). Pneumonia-associated complications until day 30 did not differ between groups (11 [3%] in the prednisone group and 22 [6%] in the placebo group; odds ratio [OR] 0·49 [95% CI 0·23–1·02]; p=0·056). The prednisone group had a higher incidence of in-hospital hyperglycaemia needing insulin treatment (76 [19%] vs 43 [11%]; OR 1·96, 95% CI 1·31–2·93, p=0·0010). Other adverse events compatible with corticosteroid use were rare and similar in both groups. Interpretation Prednisone treatment for 7 days in patients with community-acquired pneumonia admitted to hospital shortens time to clinical stability without an increase in complications. This finding is relevant from a patient perspective and an important determinant of hospital costs and efficiency. Funding Swiss National Science Foundation, Viollier AG, Nora van Meeuwen Haefliger Stiftung, Julia und Gottfried Bangerter-Rhyner Stiftung.


      PubDate: 2015-01-21T06:52:10Z
       
  • Preventive antibiotic therapy in stroke: PASSed away'
    • Abstract: Publication date: Available online 20 January 2015
      Source:The Lancet
      Author(s): Andreas Meisel



      PubDate: 2015-01-21T06:52:10Z
       
  • The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomised
           open-label masked endpoint clinical trial
    • Abstract: Publication date: Available online 20 January 2015
      Source:The Lancet
      Author(s): Willeke F Westendorp , Jan-Dirk Vermeij , Elles Zock , Imke J Hooijenga , Nyika D Kruyt , Hans J L W Bosboom , Vincent I H Kwa , Martijn Weisfelt , Michel J M Remmers , Robert ten Houten , A H C M (Tobien) Schreuder , Sarah E Vermeer , Ewout J van Dijk , Diederik W J Dippel , Marcel G W Dijkgraaf , Lodewijk Spanjaard , Marinus Vermeulen , Tom van der Poll , Jan M Prins , Frederique H Vermeij , Yvo B W E M Roos , Ruud P Kleyweg , Henk Kerkhoff , Matthijs C Brouwer , Aeilko H Zwinderman , Diederik van de Beek , Paul J Nederkoorn
      Background In adults with acute stroke, infections occur commonly and are associated with an unfavourable functional outcome. In the Preventive Antibiotics in Stroke Study (PASS) we aimed to establish whether or not preventive antimicrobial therapy with a third-generation cephalosporin, ceftriaxone, improves functional outcome in patients with acute stroke. Methods In this multicentre, randomised, open-label trial with masked endpoint assessment, patients with acute stroke were randomly assigned to intravenous ceftriaxone at a dose of 2 g, given every 24 h intravenously for 4 days, in addition to stroke unit care, or standard stroke unit care without preventive antimicrobial therapy; assignments were made within 24 h after symptom onset. The primary endpoint was functional outcome at 3 months, defined according to the modified Rankin Scale and analysed by intention to treat. The primary analysis was by ordinal regression of the primary outcome. Secondary outcomes included death, infection rates, antimicrobial use, and length of hospital stay. Participants and caregivers were aware of treatment allocation but assessors of outcome were masked to group assignment. This trial is registered with controlled-trials.com, number ISRCTN66140176. Findings Between July 6, 2010, and March 23, 2014, a total of 2550 patients from 30 sites in the Netherlands, including academic and non-academic medical centres, were randomly assigned to the two treatment groups: 1275 patients to ceftriaxone and 1275 patients to standard treatment (control group). 12 patients (seven in the ceftriaxone group and five in the control group) withdrew consent immediately after randomisation, leaving 2538 patients available for the intention-to-treat-analysis (1268 in the ceftriaxone group and 1270 in the control group). 2514 (99%) of 2538 patients (1257 in each group) completed 3-month follow-up. Preventive ceftriaxone did not affect the distribution of functional outcome scores on the modified Rankin Scale at 3 months (adjusted common odds ratio 0·95 [95% CI 0·82–1·09], p=0·46). Preventive ceftriaxone did not result in an increased occurrence of adverse events. Overgrowth infection with Clostridium difficile occurred in two patients (<1%) in the ceftriaxone group and none in the control group. Interpretation Preventive ceftriaxone does not improve functional outcome at 3 months in adults with acute stroke. The results of our trial do not support the use of preventive antibiotics in adults with acute stroke. Funding Netherlands Organization for Health Research and Development, Netherlands Heart Foundation, and the European Research Council.


      PubDate: 2015-01-21T06:52:10Z
       
  • Male sex workers: practices, contexts, and vulnerabilities for HIV
           acquisition and transmission
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Stefan David Baral , M Reuel Friedman , Scott Geibel , Kevin Rebe , Borche Bozhinov , Daouda Diouf , Keith Sabin , Claire E Holland , Roy Chan , Carlos F Cáceres
      Male sex workers who sell or exchange sex for money or goods encompass a very diverse population across and within countries worldwide. Information characterising their practices, contexts where they live, and their needs is limited, because these individuals are generally included as a subset of larger studies focused on gay men and other men who have sex with men (MSM) or even female sex workers. Male sex workers, irrespective of their sexual orientation, mostly offer sex to men and rarely identify as sex workers, using local or international terms instead. Growing evidence indicates a sustained or increasing burden of HIV among some male sex workers within the context of the slowing global HIV pandemic. Several synergistic facilitators could be potentiating HIV acquisition and transmission among male sex workers, including biological, behavioural, and structural determinants. Criminalisation and intersectional stigmas of same-sex practices, commercial sex, and HIV all augment risk for HIV and sexually transmitted infections among male sex workers and reduce the likelihood of these people accessing essential services. These contexts, taken together with complex sexual networks among male sex workers, define this group as a key population underserved by current HIV prevention, treatment, and care services. Dedicated efforts are needed to make those services available for the sake of both public health and human rights. Evidence-based and human rights-affirming services dedicated specifically to male sex workers are needed to improve health outcomes for these men and the people within their sexual networks.


      PubDate: 2015-01-17T06:49:50Z
       
  • Sex, statins, and statistics
    • Abstract: Publication date: Available online 14 January 2015
      Source:The Lancet
      Author(s): Lori Mosca



      PubDate: 2015-01-17T06:49:50Z
       
  • Virological response after 6 week triple-drug regimens for hepatitis C: a
           proof-of-concept phase 2A cohort study
    • Abstract: Publication date: Available online 13 January 2015
      Source:The Lancet
      Author(s): Anita Kohli , Anuoluwapo Osinusi , Zayani Sims , Amy Nelson , Eric G Meissner , Lisa L Barrett , Dimitra Bon , Miriam M Marti , Rachel Silk , Colleen Kotb , Chloe Gross , Tim A Jolley , Sreetha Sidharthan , Tess Petersen , Kerry Townsend , D'Andrea Egerson , Rama Kapoor , Emily Spurlin , Michael Sneller , Michael Proschan , Eva Herrmann , Richard Kwan , Gebeyehu Teferi , Rohit Talwani , Gabbie Diaz , David E Kleiner , Brad J Wood , Jose Chavez , Stephen Abbott , William T Symonds , G Mani Subramanian , Phillip S Pang , John McHutchison , Michael A Polis , Anthony S Fauci , Henry Masur , Shyam Kottilil
      Background Direct-acting antiviral drugs have a high cure rate and favourable tolerability for patients with hepatitis C virus (HCV). Shorter courses could improve affordability and adherence. Sofosbuvir and ledipasvir with ribavirin have high efficacy when taken for 8 weeks but not for 6 weeks. We assessed whether the addition of a third direct-acting antiviral drug to sofosbuvir and ledipasvir would allow a shorter treatment duration. Methods In this single-centre, open-label, phase 2A trial, we sequentially enrolled treatment-naive patients with HCV genotype 1 infection into three treatment groups: 12 weeks of sofosbuvir and ledipasvir; 6 weeks of sofosbuvir, ledipasvir, and GS-9669; or 6 weeks of sofosbuvir, ledipasvir, and GS-9451. Patients and investigators were not masked to treatment assignment. The primary endpoint was the propotion of patients with sustained viral response at 12 weeks after treatment completion (SVR12), assessed by serum HCV RNA concentrations lower than 43 IU/mL (the lower limit of quantification). We did an intention-to-treat analysis for the primary endpoint and adverse events. This study is registered with ClinicalTrials.gov, number NCT01805882. Findings Between Jan 11, 2013, and Dec 17, 2013, we enrolled 60 patients, and sequentially assigned them into three groups of 20. We noted an SVR12 in all 20 patients (100%, 95% CI 83–100) allocated to sofosbuvir and ledipasvir for 12 weeks; in 19 (95%, 75–100) of the 20 patients allocated to sofosbuvir, ledipasvir, and GS-9669 for 6 weeks (one patient relapsed 2 weeks after completion of treatment); and in 19 (95%, 75–100%) of the 20 patients allocated to sofosbuvir, ledipasvir, and GS-9451 for 6 weeks (one patient was lost to follow-up after reaching sustained viral response at 4 weeks). Most adverse events were mild and no patients discontinued treatment. Two serious adverse events occurred (pain after a post-treatment liver biopsy and vertigo), both unrelated to study drugs. Interpretation In this small proof-of-concept study, two different three-drug regimens that were given for 6 weeks resulted in high cure rates for HCV infection with excellent tolerability. Addition of a third potent direct-acting antiviral drug can reduce the duration of treatment required to achieve sustained viral response in patients with chronic HCV genotype 1 infection without cirrhosis. Funding National Institute of Allergy and Infectious Diseases (NIAID), National Cancer Institute and Clinical Center Intramural Program, German Research Foundation, National Institutes of Health, Gilead Sciences.


      PubDate: 2015-01-17T06:49:50Z
       
  • Drug-eluting stents—SORTed
    • Abstract: Publication date: Available online 16 January 2015
      Source:The Lancet
      Author(s): Mark W I Webster , John A Ormiston



      PubDate: 2015-01-17T06:49:50Z
       
  • Acute fulminant endophthalmitis complicating traditional lens couching
    • Abstract: Publication date: Available online 16 January 2015
      Source:The Lancet
      Author(s): Soufiane Berradi , Zouheir Hafidi , Mounir Lezrek , Rajae Daoudi



      PubDate: 2015-01-17T06:49:50Z
       
  • Vitiligo
    • Abstract: Publication date: Available online 15 January 2015
      Source:The Lancet
      Author(s): Khaled Ezzedine , Viktoria Eleftheriadou , Maxine Whitton , Nanja van Geel
      Vitiligo, an acquired pigmentary disorder of unknown origin, is the most frequent cause of depigmentation worldwide, with an estimated prevalence of 1%. The disorder can be psychologically devastating and stigmatising, especially in dark skinned individuals. Vitiligo is clinically characterised by the development of white macules due to the loss of functioning melanocytes in the skin or hair, or both. Two forms of the disease are well recognised: segmental and non-segmental vitiligo (the commonest form). To distinguish between these two forms is of prime importance because therapeutic options and prognosis are quite different. The importance of early treatment and understanding of the profound psychosocial effect of vitiligo will be emphasised throughout this Seminar.


      PubDate: 2015-01-17T06:49:50Z
       
  • Snowflakes in the heart: an ultrasonic marker of severe hypercoagulability
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Louis W Wang , John J Grygiel , John H O'Neill , Diane Fatkin , Michael P Feneley



      PubDate: 2015-01-17T06:49:50Z
       
  • Zotarolimus-eluting durable-polymer-coated stent versus a biolimus-eluting
           biodegradable-polymer-coated stent in unselected patients undergoing
           percutaneous coronary intervention (SORT OUT VI): a randomised
           non-inferiority trial
    • Abstract: Publication date: Available online 16 January 2015
      Source:The Lancet
      Author(s): Bent Raungaard , Lisette Okkels Jensen , Hans-Henrik Tilsted , Evald Høj Christiansen , Michael Maeng , Christian Juhl Terkelsen , Lars Romer Krusell , Anne Kaltoft , Steen Dalby Kristensen , Hans Erik Bøtker , Leif Thuesen , Jens Aarøe , Svend Eggert Jensen , Anton Boel Villadsen , Per Thayssen , Karsten Tange Veien , Knud Nørregaard Hansen , Anders Junker , Morten Madsen , Jan Ravkilde , Jens Flensted Lassen
      Background New-generation drug-eluting coronary stents have reduced the risk of coronary events, especially in patients with complex disease or lesions. To what extent different stent platforms, polymers, and antiproliferative drugs affect outcomes, however, is unclear. We investigated the safety and efficacy of a third-generation stent by comparing a highly biocompatible durable-polymer-coated zotarolimus-eluting stent with a biodegradable-polymer-coated biolimus-eluting stent. Methods This open-label, randomised, multicentre, non-inferiority trial was done at three sites across western Denmark. All patients who presented with stable coronary artery disease or acute coronary syndromes and at least one coronary artery lesion (more than 50% stenosis) from March, 2011, to August, 2012, were assessed for eligibility. Patients were randomly assigned in a 1:1 ratio to receive either the durable-polymer zotarolimus-eluting stent or the biodegradable-polymer biolimus-eluting stent. The primary endpoint was a composite of safety (cardiac death and myocardial infarction not clearly attributable to a non-target lesion) and efficacy (target-lesion revascularisation) at 12 months, analysed by intention to treat. The trial was powered to assess non-inferiority of durable-polymer zotarolimus-eluting stent compared with the biodegradable-polymer biolimus-eluting stent with a predetermined non-inferiority margin of 0·025. This trial is registered with ClinicalTrials.gov, number NCT01956448. Findings Of 7103 screened, 1502 patients with 1883 lesions were assigned to receive the durable-polymer zotarolimus-eluting stent and 1497 patients with 1791 lesions to receive the biodegradable-polymer biolimus-eluting stent. 79 (5·3%) and 75 (5·0%) patients, respectively, met the primary endpoint (absolute risk difference 0·0025, upper limit of one-sided 95% CI 0·016%; p=0·004). The individual components of the primary endpoint did not differ significantly between stent types at 12 months. Interpretation The durable-polymer-coated zotarolimus-eluting stent was non-inferior to the biodegradable-polymer-coated biolimus-eluting stent in unselected patients. Funding Medtronic Cardiovascular and Biosensors Interventional Technologies.


      PubDate: 2015-01-17T06:49:50Z
       
  • HIV risk and preventive interventions in transgender women sex workers
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Tonia Poteat , Andrea L Wirtz , Anita Radix , Annick Borquez , Alfonso Silva-Santisteban , Madeline B Deutsch , Sharful Islam Khan , Sam Winter , Don Operario
      Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. The model examines HIV prevention approaches in TSW in two settings (Lima, Peru and San Francisco, CA, USA) to identify which interventions would probably achieve the UN goal of 50% reduction in HIV incidence in 10 years. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population. Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings. We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population.


      PubDate: 2015-01-17T06:49:50Z
       
  • An action agenda for HIV and sex workers
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Chris Beyrer , Anna-Louise Crago , Linda-Gail Bekker , Jenny Butler , Kate Shannon , Deanna Kerrigan , Michele R Decker , Stefan D Baral , Tonia Poteat , Andrea L Wirtz , Brian W Weir , Françoise Barré-Sinoussi , Michel Kazatchkine , Michel Sidibé , Karl-Lorenz Dehne , Marie-Claude Boily , Steffanie A Strathdee
      The women, men, and transgender people who sell sex globally have disproportionate risks and burdens of HIV in countries of low, middle, and high income, and in concentrated and generalised epidemic contexts. The greatest HIV burdens continue to be in African female sex workers. Worldwide, sex workers still face reduced access to needed HIV prevention, treatment, and care services. Legal environments, policies, police practices, absence of funding for research and HIV programmes, human rights violations, and stigma and discrimination continue to challenge sex workers' abilities to protect themselves, their families, and their sexual partners from HIV. These realities must change to realise the benefits of advances in HIV prevention and treatment and to achieve global control of the HIV pandemic. Effective combination prevention and treatment approaches are feasible, can be tailored for cultural competence, can be cost-saving, and can help to address the unmet needs of sex workers and their communities in ways that uphold their human rights. To address HIV in sex workers will need sustained community engagement and empowerment, continued research, political will, structural and policy reform, and innovative programmes. But such actions can and must be achieved for sex worker communities everywhere.


      PubDate: 2015-01-17T06:49:50Z
       
  • Perimortem trauma in King Richard III: a skeletal analysis
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      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: 2015-01-17T06:49:50Z
       
  • 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: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      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: 2015-01-17T06:49:50Z
       
  • Home modifications to reduce injuries from falls in the Home Injury
           Prevention Intervention (HIPI) study: a cluster-randomised controlled
           trial
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Michael D Keall , Nevil Pierse , Philippa Howden-Chapman , Chris Cunningham , Malcolm Cunningham , Jagadish Guria , Michael G Baker
      Background Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. We tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. Methods We did a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. We randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which we derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, we analysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. Findings Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085–1263), the crude rate of fall injuries per person per year was 0·061 in the treatment group and 0·072 in the control group (relative rate 0·86, 95% CI 0·66–1·12). The crude rate of injuries specific to the intervention per person per year was 0·018 in the treatment group and 0·028 in the control group (0·66, 0·43–1·00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0·74, 95% CI 0·58–0·94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0·61, 0·41–0·91). Interpretation Our findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested. Funding Health Research Council of New Zealand.


      PubDate: 2015-01-17T06:49:50Z
       
  • Patient education is crucial for the access to essential medicine
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Hamidreza Mani



      PubDate: 2015-01-17T06:49:50Z
       
  • ASPIRE: international recognition of excellence in medical education
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Ronald M Harden , Trudie E Roberts



      PubDate: 2015-01-17T06:49:50Z
       
  • Sorafenib for patients with differentiated thyroid cancer
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Olivier Huillard , Benoit Blanchet , Jean-Philippe Durand , François Goldwasser



      PubDate: 2015-01-17T06:49:50Z
       
  • Sorafenib for patients with differentiated thyroid cancer
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Pascaline Boudou-Rouquette , Audrey Thomas-Schoemann , Audrey Bellesoeur , François Goldwasser



      PubDate: 2015-01-17T06:49:50Z
       
  • Sorafenib for patients with differentiated thyroid cancer
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Hyo Jin Lee , Hyewon Ryu , Yoon Seok Choi , Ik-Chan Song , Hwan-Jung Yun , Deog-Yeon Jo , Samyong Kim



      PubDate: 2015-01-17T06:49:50Z
       
  • Sorafenib for patients with differentiated thyroid cancer – Authors'
           reply
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Marcia S Brose , Martin Schlumberger , Carol Peña , Christian Kappeler



      PubDate: 2015-01-17T06:49:50Z
       
  • Rituximab for patients with nephrotic syndrome
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Jae Il Shin , Andreas Kronbichler



      PubDate: 2015-01-17T06:49:50Z
       
  • Rituximab for patients with nephrotic syndrome
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Dilani F Arnold , Siraj A Misbah



      PubDate: 2015-01-17T06:49:50Z
       
  • Rituximab for patients with nephrotic syndrome – Authors' reply
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Kazumoto Iijima , Mayumi Sako , Kandai Nozu , Hidefumi Nakamura , Shuichi Ito



      PubDate: 2015-01-17T06:49:50Z
       
  • Mónica Roa: legal champion of abortion rights
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Dara Mohammadi



      PubDate: 2015-01-17T06:49:50Z
       
  • Miscarriage: you don't have to be strong for me
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Petra Boynton



      PubDate: 2015-01-17T06:49:50Z
       
  • Maurizio Luisetti
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Geoff Watts



      PubDate: 2015-01-17T06:49:50Z
       
  • Rituximab for patients with nephrotic syndrome
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Mandy G Keijzer-Veen , Diane Hebert , Rulan S Parekh



      PubDate: 2015-01-17T06:49:50Z
       
  • William Blake: the making of the man
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Tamara Lucas



      PubDate: 2015-01-17T06:49:50Z
       
  • Generic prescribing: unfinished business Jeremy AGreeneGeneric: the
           Unbranding of Modern Medicine2014Johns Hopkins University
           Press9781421414935368US$29·95
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Michael D Rawlins



      PubDate: 2015-01-17T06:49:50Z
       
  • Hold that pose
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Kelley Swain



      PubDate: 2015-01-17T06:49:50Z
       
  • Offline: Solving WHO's “persisting weaknesses” (part 2)
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Richard Horton



      PubDate: 2015-01-17T06:49:50Z
       
  • Ebola vaccine trials back on track
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Dara Mohammadi



      PubDate: 2015-01-17T06:49:50Z
       
  • Patients take centre stage at US research institute
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Carrie Arnold



      PubDate: 2015-01-17T06:49:50Z
       
  • Cancer: mixed messages, common purpose
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): The Lancet



      PubDate: 2015-01-17T06:49:50Z
       
  • Outrage…
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): The Lancet



      PubDate: 2015-01-17T06:49:50Z
       
  • Syrian refugees seeking help
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): The Lancet



      PubDate: 2015-01-17T06:49:50Z
       
  • Is the world ready for an Ebola vaccine?
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Bruce Y Lee , William J Moss , Lois Privor-Dumm , Dagna O Constenla , Maria D Knoll , Katherine L O'Brien



      PubDate: 2015-01-17T06:49:50Z
       
  • With thanks to all those who reviewed for The Lancet in 2014
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): William Summerskill



      PubDate: 2015-01-17T06:49:50Z
       
  • Richard III: skeletal evidence of perimortem trauma
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Heather E Bonney



      PubDate: 2015-01-17T06:49:50Z
       
  • Why are sex workers who use substances at risk for HIV?
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Maia Rusakova , Aliya Rakhmetova , Steffanie A Strathdee



      PubDate: 2015-01-17T06:49:50Z
       
  • Home-safety modifications to reduce injuries from falls
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Stephen N Robinovitch , Vicky Scott , Fabio Feldman



      PubDate: 2015-01-17T06:49:50Z
       
  • Towards evidence-based, quantitative Sustainable Development Goals for
           2030
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): Børge Brende , Bent Høie



      PubDate: 2015-01-17T06:49:50Z
       
  • Quantifying targets for the SDG health goal
    • Abstract: Publication date: 17–23 January 2015
      Source:The Lancet, Volume 385, Issue 9964
      Author(s): George Alleyne , Robert Beaglehole , Ruth Bonita



      PubDate: 2015-01-17T06:49:50Z
       
  • Shorter treatments for hepatitis C: another step forward?
    • Abstract: Publication date: Available online 13 January 2015
      Source:The Lancet
      Author(s): Graham R Foster



      PubDate: 2015-01-17T06:49:50Z
       
  • The second act of the Affordable Care Act
    • Abstract: Publication date: 10–16 January 2015
      Source:The Lancet, Volume 385, Issue 9963
      Author(s): The Lancet



      PubDate: 2015-01-17T06:49:50Z
       
 
 
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