Journal Cover The Lancet
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   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [3031 journals]
  • Patterns of global health financing and potential future spending on
           health
    • Authors: Jose Eduardo Gomez-Gonzalez; Nidia Ruth Reyes
      Pages: 1955 - 1956
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Jose Eduardo Gomez-Gonzalez, Nidia Ruth Reyes


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31001-2
       
  • Rituximab as first-line treatment of pemphigus
    • Authors: Enno Schmidt
      Pages: 1956 - 1958
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Enno Schmidt


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)30787-0
       
  • Looming threat of Asian tobacco companies to global health
    • Authors: Kelley Lee; Jappe Eckhardt
      Pages: 1958 - 1960
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Kelley Lee, Jappe Eckhardt


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31223-0
       
  • Maternal mortality in Afghanistan: setting achievable targets
    • Authors: Stewart Britten
      Pages: 1960 - 1962
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Stewart Britten


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31284-9
       
  • Computer-assisted diagnosis for skin cancer: have we been outsmarted?
    • Authors: Victoria J Mar; Richard A Scolyer; Georgina V Long
      Pages: 1962 - 1964
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Victoria J Mar, Richard A Scolyer, Georgina V Long


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31285-0
       
  • Arab youth respond to the Lancet Commission on adolescent health and
           wellbeing
    • Authors: Hala Alaouie; Ahmed Ali; Rima Afifi
      Pages: 1964 - 1965
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Hala Alaouie, Ahmed Ali, Rima Afifi


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31286-2
       
  • Offline: Israel and Palestine—a joint search for the truth
    • Authors: Richard Horton
      First page: 1966
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Richard Horton


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31330-2
       
  • Famine in South Sudan
    • Authors: Sharmila Devi
      Pages: 1967 - 1970
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Sharmila Devi


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31351-x
       
  • Instinct versus science
    • Authors: Sarah Moss
      Pages: 1972 - 1973
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Sarah Moss


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31293-x
       
  • Brain Diaries: two hemispheres of interest
    • Authors: Kelley Swain
      First page: 1973
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Kelley Swain


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31294-1
       
  • Julie Moore: NHS leader who walks the wards
    • Authors: Geoff Watts
      First page: 1974
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Geoff Watts


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31295-3
       
  • John Elliotson, Thomas Wakley, and the mesmerism feud
    • Authors: Wendy Moore
      Pages: 1975 - 1976
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Wendy Moore


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31296-5
       
  • Involving adolescents in the discussion about SDGs
    • Authors: Aki N Bandara
      First page: 1979
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Aki N Bandara


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31318-1
       
  • Addressing underlying causes of violence against doctors in India
    • Authors: Siddhartha P Kar
      Pages: 1979 - 1980
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Siddhartha P Kar


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31297-7
       
  • First-line rituximab combined with short-term prednisone versus prednisone
           alone for the treatment of pemphigus (Ritux 3): a prospective,
           multicentre, parallel-group, open-label randomised trial
    • Authors: Pascal Joly; Maud Maho-Vaillant; Catherine Prost-Squarcioni; Vivien Hebert; Estelle Houivet; Sébastien Calbo; Frédérique Caillot; Marie Laure Golinski; Bruno Labeille; Catherine Picard-Dahan; Carle Paul; Marie-Aleth Richard; Jean David Bouaziz; Sophie Duvert-Lehembre; Philippe Bernard; Frederic Caux; Marina Alexandre; Saskia Ingen-Housz-Oro; Pierre Vabres; Emmanuel Delaporte; Gaelle Quereux; Alain Dupuy; Sebastien Debarbieux; Martine Avenel-Audran; Michel D'Incan; Christophe Bedane; Nathalie Bénéton; Denis Jullien; Nicolas Dupin; Laurent Misery; Laurent Machet; Marie Beylot-Barry; Olivier Dereure; Bruno Sassolas; Thomas Vermeulin; Jacques Benichou; Philippe Musette
      Pages: 2031 - 2040
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Pascal Joly, Maud Maho-Vaillant, Catherine Prost-Squarcioni, Vivien Hebert, Estelle Houivet, Sébastien Calbo, Frédérique Caillot, Marie Laure Golinski, Bruno Labeille, Catherine Picard-Dahan, Carle Paul, Marie-Aleth Richard, Jean David Bouaziz, Sophie Duvert-Lehembre, Philippe Bernard, Frederic Caux, Marina Alexandre, Saskia Ingen-Housz-Oro, Pierre Vabres, Emmanuel Delaporte, Gaelle Quereux, Alain Dupuy, Sebastien Debarbieux, Martine Avenel-Audran, Michel D'Incan, Christophe Bedane, Nathalie Bénéton, Denis Jullien, Nicolas Dupin, Laurent Misery, Laurent Machet, Marie Beylot-Barry, Olivier Dereure, Bruno Sassolas, Thomas Vermeulin, Jacques Benichou, Philippe Musette
      Background High doses of corticosteroids are considered the standard treatment for pemphigus. Because long-term corticosteroid treatment can cause severe and even life-threatening side-effects in patients with this disease, we assessed whether first-line use of rituximab as adjuvant therapy could improve the proportion of patients achieving complete remission off-therapy, compared with corticosteroid treatment alone, while decreasing treatment side-effects of corticosteroids. Methods We did a prospective, multicentre, parallel-group, open-label, randomised trial in 25 dermatology hospital departments in France (Ritux 3). Eligible participants were patients with newly diagnosed pemphigus aged 18–80 years being treated for the first time (not at the time of a relapse). We randomly assigned participants (1:1) to receive either oral prednisone alone, 1·0 or 1·5 mg/kg per day tapered over 12 or 18 months (prednisone alone group), or 1000 mg of intravenous rituximab on days 0 and 14, and 500 mg at months 12 and 18, combined with a short-term prednisone regimen, 0·5 or 1·0 mg/kg per day tapered over 3 or 6 months (rituximab plus short-term prednisone group). Follow-up was for 3 years (study visits were scheduled weekly during the first month of the study, then monthly until month 24, then an additional visit at month 36). Treatment was assigned through central computer-generated randomisation, with stratification according to disease-severity (severe or moderate, based on Harman's criteria). The primary endpoint was the proportion of patients who achieved complete remission off-therapy at month 24 (intention-to-treat analysis). This study is registered with ClinicalTrials.gov, number NCT00784589. Findings Between May 10, 2010, and Dec 7, 2012, we enrolled 91 patients and randomly assigned 90 to treatment (90 were analysed; 1 patient withdrew consent before the random assignment). At month 24, 41 (89%) of 46 patients assigned to rituximab plus short-term prednisone were in complete remission off-therapy versus 15 (34%) of 44 assigned to prednisone alone (absolute difference 55 percentage points, 95% CI 38·4–71·7; p<0·0001. This difference corresponded to a relative risk of success of 2·61 (95% CI 1·71–3·99, p<0·0001), corresponding to 1·82 patients (95% CI 1·39–2·60) who would need to be treated with rituximab plus prednisone (rather than prednisone alone) for one additional success. No patient died during the study. More severe adverse events of grade 3–4 were reported in the prednisone-alone group (53 events in 29 patients; mean 1·20 [SD 1·25]) than in the rituximab plus prednisone group (27 events in 16 patients; mean 0·59 [1·15]; p=0·0021). The most common of these events in both groups were diabetes and endocrine disorder (11 [21%] with prednisone alone vs six [22%] with rituximab plus prednisone), myopathy (ten [19%] vs three [11%]), and bone disorders (five [9%] vs five [19%]). Interpretation Data from our trial suggest that first-line use of rituximab plus short-term prednisone for patients with pemphigus is more effective than using prednisone alone, with fewer adverse events. Funding French Ministry of Health, French Society of Dermatology, Roche.

      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)30070-3
       
  • Caustic ingestion
    • Authors: Mircea Chirica; Luigi Bonavina; Michael D Kelly; Emile Sarfati; Pierre Cattan
      Pages: 2041 - 2052
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Mircea Chirica, Luigi Bonavina, Michael D Kelly, Emile Sarfati, Pierre Cattan
      Corrosive ingestion is a rare but potentially devastating event and, despite the availability of effective preventive public health strategies, injuries continue to occur. Most clinicians have limited personal experience and rely on guidelines; however, uncertainty persists about best clinical practice. Ingestions range from mild cases with no injury to severe cases with full thickness necrosis of the oesophagus and stomach. CT scan is superior to traditional endoscopy for stratification of patients to emergency resection or observation. Oesophageal stricture is a common consequence of ingestion and newer stents show some promise; however, the place of endoscopic stenting for corrosive strictures is yet to be defined. We summarise the evidence to provide a plan for managing these potentially life-threatening injuries and discuss the areas where further research is required to improve outcomes.

      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(16)30313-0
       
  • New metrics for the Lancet Standing Commission on Liver Disease in the UK
    • Authors: Roger Williams; Graeme Alexander; Richard Aspinall; Joanne Bosanquet; Ginette Camps-Walsh; Matthew Cramp; Natalie Day; Anil Dhawan; John Dillon; Jessica Dyson; James Ferguson; Graham Foster; Richard Gardner; Sir Ian Gilmore; Lesley Hardman; Mark Hudson; Deirdre Kelly; Andrew Langford; Stephen Liversedge; Kieran Moriarty; Philip Newsome; John O'Grady; Rachel Pryke; Liz Rolfe; Harry Rutter; Stephen Ryder; Marianne Samyn; Nick Sheron; Alison Taylor; Jeremy Thompson; Julia Verne; Andrew Yeoman
      Pages: 2053 - 2080
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Roger Williams, Graeme Alexander, Richard Aspinall, Joanne Bosanquet, Ginette Camps-Walsh, Matthew Cramp, Natalie Day, Anil Dhawan, John Dillon, Jessica Dyson, James Ferguson, Graham Foster, Richard Gardner, Sir Ian Gilmore, Lesley Hardman, Mark Hudson, Deirdre Kelly, Andrew Langford, Stephen Liversedge, Kieran Moriarty, Philip Newsome, John O'Grady, Rachel Pryke, Liz Rolfe, Harry Rutter, Stephen Ryder, Marianne Samyn, Nick Sheron, Alison Taylor, Jeremy Thompson, Julia Verne, Andrew Yeoman


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(16)32234-6
       
  • In support of the candidacy of Dr Tedros Adhanom Ghebreyesus for WHO DG
    • Authors: Kesetebirhan Admasu
      Abstract: Publication date: Available online 23 May 2017
      Source:The Lancet
      Author(s): Kesetebirhan Admasu


      PubDate: 2017-05-24T18:37:03Z
      DOI: 10.1016/s0140-6736(17)31425-3
       
  • Diagnosis of pulmonary embolism: progress after many YEARS
    • Authors: Stavros V Konstantinides
      Abstract: Publication date: Available online 23 May 2017
      Source:The Lancet
      Author(s): Stavros V Konstantinides


      PubDate: 2017-05-24T18:37:03Z
      DOI: 10.1016/s0140-6736(17)31291-6
       
  • Simplified diagnostic management of suspected pulmonary embolism (the
           YEARS study): a prospective, multicentre, cohort study
    • Authors: Tom van der Hulle; Whitney Y Cheung; Stephanie Kooij; Ludo F M Beenen; Thomas van Bemmel; Josien van Es; Laura M Faber; Germa M Hazelaar; Christian Heringhaus; Herman Hofstee; Marcel M C Hovens; Karin A H Kaasjager; Rick C J van Klink; Marieke J H A Kruip; Rinske F Loeffen; Albert T A Mairuhu; Saskia Middeldorp; Mathilde Nijkeuter; Liselotte M van der Pol; Suzanne Schol-Gelok; Marije ten Wolde; Frederikus A Klok; Menno V Huisman
      Abstract: Publication date: Available online 23 May 2017
      Source:The Lancet
      Author(s): Tom van der Hulle, Whitney Y Cheung, Stephanie Kooij, Ludo F M Beenen, Thomas van Bemmel, Josien van Es, Laura M Faber, Germa M Hazelaar, Christian Heringhaus, Herman Hofstee, Marcel M C Hovens, Karin A H Kaasjager, Rick C J van Klink, Marieke J H A Kruip, Rinske F Loeffen, Albert T A Mairuhu, Saskia Middeldorp, Mathilde Nijkeuter, Liselotte M van der Pol, Suzanne Schol-Gelok, Marije ten Wolde, Frederikus A Klok, Menno V Huisman
      Background Validated diagnostic algorithms in patients with suspected pulmonary embolism are often not used correctly or only benefit subgroups of patients, leading to overuse of computed tomography pulmonary angiography (CTPA). The YEARS clinical decision rule that incorporates differential D-dimer cutoff values at presentation, has been developed to be fast, to be compatible with clinical practice, and to reduce the number of CTPA investigations in all age groups. We aimed to prospectively evaluate this novel and simplified diagnostic algorithm for suspected acute pulmonary embolism. Methods We did a prospective, multicentre, cohort study in 12 hospitals in the Netherlands, including consecutive patients with suspected pulmonary embolism between Oct 5, 2013, to July 9, 2015. Patients were managed by simultaneous assessment of the YEARS clinical decision rule, consisting of three items (clinical signs of deep vein thrombosis, haemoptysis, and whether pulmonary embolism is the most likely diagnosis), and D-dimer concentrations. In patients without YEARS items and D-dimer less than 1000 ng/mL, or in patients with one or more YEARS items and D-dimer less than 500 ng/mL, pulmonary embolism was considered excluded. All other patients had CTPA. The primary outcome was the number of independently adjudicated events of venous thromboembolism during 3 months of follow-up after pulmonary embolism was excluded, and the secondary outcome was the number of required CTPA compared with the Wells' diagnostic algorithm. For the primary outcome regarding the safety of the diagnostic strategy, we used a per-protocol approach. For the secondary outcome regarding the efficiency of the diagnostic strategy, we used an intention-to-diagnose approach. This trial is registered with the Netherlands Trial Registry, number NTR4193. Findings 3616 consecutive patients with clinically suspected pulmonary embolism were screened, of whom 151 (4%) were excluded. The remaining 3465 patients were assessed of whom 456 (13%) were diagnosed with pulmonary embolism at baseline. Of the 2946 patients (85%) in whom pulmonary embolism was ruled out at baseline and remained untreated, 18 patients were diagnosed with symptomatic venous thromboembolism during 3-month follow-up (0·61%, 95% CI 0·36–0·96) of whom six had fatal pulmonary embolism (0·20%, 0·07–0·44). CTPA was not indicated in 1651 (48%) patients with the YEARS algorithm compared with 1174 (34%) patients, if Wells' rule and fixed D-dimer threshold of less than 500 ng/mL would have been applied, a difference of 14% (95% CI 12–16). Interpretation In our study pulmonary embolism was safely excluded by the YEARS diagnostic algorithm in patients with suspected pulmonary embolism. The main advantage of the YEARS algorithm in our patients is the absolute 14% decrease of CTPA examinations in all ages and across several relevant subgroups. Funding This study was supported by unrestricted grants from the participating hospitals.

      PubDate: 2017-05-24T18:37:03Z
      DOI: 10.1016/s0140-6736(17)30885-1
       
  • Department of Error
    • Abstract: Publication date: Available online 23 May 2017
      Source:The Lancet


      PubDate: 2017-05-24T18:37:03Z
       
  • Ebola outbreak in the DR Congo
    • Authors: Andrew Green
      Abstract: Publication date: Available online 23 May 2017
      Source:The Lancet
      Author(s): Andrew Green


      PubDate: 2017-05-24T18:37:03Z
      DOI: 10.1016/s0140-6736(17)31424-1
       
  • Department of Error
    • Abstract: Publication date: Available online 23 May 2017
      Source:The Lancet


      PubDate: 2017-05-24T18:37:03Z
       
  • Informing health choices in low-resource settings
    • Authors: Laura Gauer Bermudez; Stephanie A Grilo; John S Santelli; Fred M Ssewamala
      Abstract: Publication date: Available online 22 May 2017
      Source:The Lancet
      Author(s): Laura Gauer Bermudez, Stephanie A Grilo, John S Santelli, Fred M Ssewamala


      PubDate: 2017-05-24T18:37:03Z
      DOI: 10.1016/s0140-6736(17)31290-4
       
  • Effects of the Informed Health Choices podcast on the ability of parents
           of primary school children in Uganda to assess claims about treatment
           effects: a randomised controlled trial
    • Authors: Daniel Semakula; Allen Nsangi; Andrew D Oxman; Matt Oxman; Astrid Austvoll-Dahlgren; Sarah Rosenbaum; Angela Morelli; Claire Glenton; Simon Lewin; Margaret Kaseje; Iain Chalmers; Atle Fretheim; Doris Tove Kristoffersen; Nelson K Sewankambo
      Abstract: Publication date: Available online 22 May 2017
      Source:The Lancet
      Author(s): Daniel Semakula, Allen Nsangi, Andrew D Oxman, Matt Oxman, Astrid Austvoll-Dahlgren, Sarah Rosenbaum, Angela Morelli, Claire Glenton, Simon Lewin, Margaret Kaseje, Iain Chalmers, Atle Fretheim, Doris Tove Kristoffersen, Nelson K Sewankambo
      Background As part of the Informed Health Choices project, we developed a podcast called The Health Choices Programme to help improve the ability of people to assess claims about the benefits and harms of treatments. We aimed to evaluate the effects of the podcast on the ability of parents of primary school children in Uganda to assess claims about the effects of treatments. Methods We did this randomised controlled trial in central Uganda. We recruited parents of children aged 10–12 years who were in their fifth year of school at 35 schools that were participating in a linked trial of the Informed Health Choices primary school resources. The parents were randomly allocated (1:1), via a web-based random number generator with block sizes of four and six, to listen to either the Informed Health Choices podcast (intervention group) or typical public service announcements about health issues (control group). Randomisation was stratified by parents' highest level of formal education attained (primary school, secondary school, or tertiary education) and the allocation of their children's school in the trial of the primary school resources (intervention vs control). The primary outcome, measured after listening to the entire podcast, was the mean score and the proportion of parents with passing scores on a test with two multiple choice questions for each of nine key concepts essential to assessing claims about treatments (18 questions in total). We did intention-to-treat analyses. This trial is registered with the Pan African Clinical Trial Registry, number PACTR201606001676150. Findings We recruited parents between July 21, 2016, and Oct 7, 2016. We randomly assigned 675 parents to the podcast group (n=334) or the public service announcement group (n=341); 561 (83%) participants completed follow-up. The mean score for parents in the podcast group was 67·8% (SD 19·6) compared with 52·4% (17·6) in the control group (adjusted mean difference 15·5%, 95% CI 12·5–18·6; p<0·0001). In the podcast group, 203 (71%) of 288 parents had a predetermined passing score (≥11 of 18 correct answers) compared with 103 (38%) of 273 parents in the control group (adjusted difference 34%, 95% CI 26–41; p<0·0001). No adverse events were reported. Interpretation Listening to the Informed Health Choices podcast led to a large improvement in the ability of parents to assess claims about the effects of treatments. Future studies should assess the long-term effects of use of the podcast, the effects on actual health choices and outcomes, and how transferable our findings are to other countries. Funding Research Council of Norway.

      PubDate: 2017-05-24T18:37:03Z
      DOI: 10.1016/s0140-6736(17)31225-4
       
  • Effects of the Informed Health Choices primary school intervention on the
           ability of children in Uganda to assess the reliability of claims about
           treatment effects: a cluster-randomised controlled trial
    • Authors: Allen Nsangi; Daniel Semakula; Andrew D Oxman; Astrid Austvoll-Dahlgren; Matt Oxman; Sarah Rosenbaum; Angela Morelli; Claire Glenton; Simon Lewin; Margaret Kaseje; Iain Chalmers; Atle Fretheim; Yunpeng Ding; Nelson K Sewankambo
      Abstract: Publication date: Available online 22 May 2017
      Source:The Lancet
      Author(s): Allen Nsangi, Daniel Semakula, Andrew D Oxman, Astrid Austvoll-Dahlgren, Matt Oxman, Sarah Rosenbaum, Angela Morelli, Claire Glenton, Simon Lewin, Margaret Kaseje, Iain Chalmers, Atle Fretheim, Yunpeng Ding, Nelson K Sewankambo
      Background Claims about what improves or harms our health are ubiquitous. People need to be able to assess the reliability of these claims. We aimed to evaluate an intervention designed to teach primary school children to assess claims about the effects of treatments (ie, any action intended to maintain or improve health). Methods In this cluster-randomised controlled trial, we included primary schools in the central region of Uganda that taught year-5 children (aged 10–12 years). We excluded international schools, special needs schools for children with auditory and visual impairments, schools that had participated in user-testing and piloting of the resources, infant and nursery schools, adult education schools, and schools that were difficult for us to access in terms of travel time. We randomly allocated a representative sample of eligible schools to either an intervention or control group. Intervention schools received the Informed Health Choices primary school resources (textbooks, exercise books, and a teachers' guide). Teachers attended a 2 day introductory workshop and gave nine 80 min lessons during one school term. The lessons addressed 12 concepts essential to assessing claims about treatment effects and making informed health choices. We did not intervene in the control schools. The primary outcome, measured at the end of the school term, was the mean score on a test with two multiple-choice questions for each of the 12 concepts and the proportion of children with passing scores on the same test. This trial is registered with the Pan African Clinical Trial Registry, number PACTR201606001679337. Findings Between April 11, 2016, and June 8, 2016, 2960 schools were assessed for eligibility; 2029 were eligible, and a random sample of 170 were invited to recruitment meetings. After recruitment meetings, 120 eligible schools consented and were randomly assigned to either the intervention group (n=60, 76 teachers and 6383 children) or control group (n=60, 67 teachers and 4430 children). The mean score in the multiple-choice test for the intervention schools was 62·4% (SD 18·8) compared with 43·1% (15·2) for the control schools (adjusted mean difference 20·0%, 95% CI 17·3–22·7; p<0·00001). In the intervention schools, 3967 (69%) of 5753 children achieved a predetermined passing score (≥13 of 24 correct answers) compared with 1186 (27%) of 4430 children in the control schools (adjusted difference 50%, 95% CI 44–55). The intervention was effective for children with different levels of reading skills, but was more effective for children with better reading skills. Interpretation The use of the Informed Health Choices primary school learning resources, after an introductory workshop for the teachers, led to a large improvement in the ability of children to assess claims about the effects of treatments. The results show that it is possible to teach primary school children to think critically in schools with large student to teacher ratios and few resources. Future studies should address how to scale up use of the resources, long-term effects, including effects on actual health choices, transferability to other countries, and how to build on this programme with additional primary and secondary school learning resources. Funding Research Council of Norway.

      PubDate: 2017-05-24T18:37:03Z
      DOI: 10.1016/s0140-6736(17)31226-6
       
  • Open letter urges WHO to take action on industrial animal farming
    • Authors: Scott Weathers; Sophie Hermanns
      Abstract: Publication date: Available online 22 May 2017
      Source:The Lancet
      Author(s): Scott Weathers, Sophie Hermanns


      PubDate: 2017-05-24T18:37:03Z
      DOI: 10.1016/s0140-6736(17)31358-2
       
  • Realisation of human rights to health and through health
    • Authors: Tarja Halonen; Hina Jilani; Kate Gilmore; Flavia Bustreo
      Abstract: Publication date: Available online 22 May 2017
      Source:The Lancet
      Author(s): Tarja Halonen, Hina Jilani, Kate Gilmore, Flavia Bustreo


      PubDate: 2017-05-24T18:37:03Z
      DOI: 10.1016/s0140-6736(17)31359-4
       
  • Questions around the candidacy of Dr Tedros Adhanom Ghebreyesus for WHO DG
    • Authors: Frank Ashall
      Abstract: Publication date: Available online 19 May 2017
      Source:The Lancet
      Author(s): Frank Ashall


      PubDate: 2017-05-24T18:37:03Z
      DOI: 10.1016/s0140-6736(17)31360-0
       
  • WHO: Director-General campaign closes amid anxiety and hope
    • Authors: Lancet
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): The Lancet


      PubDate: 2017-05-19T16:16:19Z
       
  • Thyroid cancer screening
    • Authors: Lancet
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): The Lancet


      PubDate: 2017-05-19T16:16:19Z
       
  • Policy lacking to prevent adverse health for poor UK children
    • Authors: Lancet
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): The Lancet


      PubDate: 2017-05-19T16:16:19Z
       
  • Epilepsy
    • Authors: Richard Barnett
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Richard Barnett


      PubDate: 2017-05-19T16:16:19Z
       
  • Department of Error
    • Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083


      PubDate: 2017-05-19T16:16:19Z
       
  • Department of Error
    • Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083


      PubDate: 2017-05-19T16:16:19Z
       
  • Department of Error
    • Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083


      PubDate: 2017-05-19T16:16:19Z
       
  • Department of Error
    • Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083


      PubDate: 2017-05-19T16:16:19Z
       
  • Evolution and patterns of global health financing 1995–2014: development
           assistance for health, and government, prepaid private, and out-of-pocket
           health spending in 184 countries
    • Authors: Global Burden; Disease Health Financing Collaborator NetworkJosephDielemanMadelineCampbellAbigailChapinErikaEldrenkampVictoria YFanAnnieHaakenstadJenniferKatesYingyingLiuTaylorMatyaszAngelaMicahAlexReynoldsNafisSadatMatthew TSchneiderReedSorensenTimEvansDavidEvansChristophKurowskiAjayTandonKaja MAbbasSemaw
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Global Burden of Disease Health Financing Collaborator NetworkJosephDielemanMadelineCampbellAbigailChapinErikaEldrenkampVictoria YFanAnnieHaakenstadJenniferKatesYingyingLiuTaylorMatyaszAngelaMicahAlexReynoldsNafisSadatMatthew TSchneiderReedSorensenTimEvansDavidEvansChristophKurowskiAjayTandonKaja MAbbasSemaw FeredeAberaAliasghar AhmadKiadaliriKedir YimamAhmedMuktar BeshirAhmedKhurshidAlamRezaAlizadeh-NavaeiAla'aAlkerwiErfanAminiWalidAmmarStephen MarcAmrockCarl Abelardo TAntonioTesfay MehariAteyLeticiaAvila-BurgosAshishAwasthiAleksandraBaracOscar AlbertoBernalAddisu ShunuBeyeneTariku JibatBeyeneCharlesBirungiHabtamu MellieBizuayehuNicholas J KBreitbordeLuceroCahuana-HurtadoRuben EstanislaoCastroFerranCatalia-LopezKoustuvDalalLalitDandonaRakhiDandonaPieterde JagerSamath DDharmaratneManishaDubeyCarla Sofia e SaFarinhaAndreFaroAndrea BFeiglFlorianFischerJoseph Robert AndersonFitchettNataliyaFoigtAbabi ZergawGirefRahulGuptaSamerHamidiHilda LHarbSimon IHayDeliaHendrieMasakoHorinoMikkJürissonMihajlo BJakovljevicMehdiJavanbakhtDennyJohnJost BJonasSeyed M.KarimiYoung-HoKhangJagdishKhubchandaniYun JinKimJonas MKingeKristopher JKrohnG AnilKumarHassan Magdy AbdEl RazekMohammed Magdy AbdEl RazekAzeemMajeedRezaMalekzadehFelixMasiyeToniMeierAtteMeretojaTed RMillerErkin MMirrakhimovShafiuMohammedVinayNangiaStefanoOlgiatiAbdalla SidahmedOsmanMayowa OOwolabiTejasPatelAngel J PaterninaCaicedoDavid MPereiraJulianPerelmanSuzannePolinderAnwarRafayVafaRahimi-MovagharRajesh KumarRaiUshaRamChhabi LalRanabhatHirbo ShoreRobaJosephSalamaMilojeSavicSadaf GSepanlouMark GShrimeRoberto TchioTalongwaBraden J TeAoFabrizioTediosiAzeb GebresilassieTesemaAlan JThomsonRuoyanTobe-GaiRomanTopor-MadryEduardo AUndurragaTommiVasankariFrancesco SViolanteAndreaWerdeckerTissaWijeratneGelinXuNaohiroYonemotoMustafa ZYounisChuanhuaYuZoubidaZaidiMaysaaEl Sayed ZakiChristopher J LMurray
      Background An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. Methods We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Findings Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. Interpretation Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate pre...
      PubDate: 2017-05-19T16:16:19Z
       
  • Future and potential spending on health 2015–40: development assistance
           for health, and government, prepaid private, and out-of-pocket health
           spending in 184 countries
    • Authors: Global Burden; Disease Health Financing Collaborator NetworkJoseph LDielemanMadelineCampbellAbigailChapinErikaEldrenkampVictoria YFanAnnieHaakenstadJenniferKatesZhiyinLiTaylorMatyaszAngelaMicahAlexReynoldsNafisSadatMatthew TSchneiderReedSorensenKaja
      Abstract: Publication date: 20–26 May 2017
      Source:The Lancet, Volume 389, Issue 10083
      Author(s): Global Burden of Disease Health Financing Collaborator NetworkJoseph LDielemanMadelineCampbellAbigailChapinErikaEldrenkampVictoria YFanAnnieHaakenstadJenniferKatesZhiyinLiTaylorMatyaszAngelaMicahAlexReynoldsNafisSadatMatthew TSchneiderReedSorensenKaja MAbbasSemaw FeredeAberaAliasghar AhmadKiadaliriMuktar BeshirAhmedKhurshidAlamRezaAlizadeh-NavaeiAla'aAlkerwiErfanAminiWalidAmmarCarl Abelardo TAntonioTesfay MehariAteyLeticiaAvila-BurgosAshishAwasthiAleksandraBaracTezera MoshagoBerhetoAddisu ShunuBeyeneTariku JibatBeyeneCharlesBirungiHabtamu MellieBizuayehuNicholas J KBreitbordeLuceroCahuana-HurtadoRuben EstanislaoCastroFerranCatalia-LopezKoustuvDalalLalitDandonaRakhiDandonaSamath DDharmaratneManishaDubeyAndéFaroAndrea BFeiglFlorianFischerJoseph R AndersonFitchettNataliyaFoigtAbabi ZergawGirefRahulGuptaSamerHamidiHilda LHarbSimon IHayDeliaHendrieMasakoHorinoMikkJürissonMihajlo BJakovljevicMehdiJavanbakhtDennyJohnJost BJonasSeyed MKarimiYoung-HoKhangJagdishKhubchandaniYun JinKimJonas MKingeKristopher JKrohnG AnilKumarRickyLeungHassan Magdy AbdEl RazekMohammed Magdy AbdEl RazekAzeemMajeedRezaMalekzadehDeborah CarvalhoMaltaAtteMeretojaTed RMillerErkin MMirrakhimovShafiuMohammedGedefawMollaVinayNangiaStefanoOlgiatiMayowa OOwolabiTejasPatelAngel J PaterninaCaicedoDavid MPereiraJulianPerelmanSuzannePolinderAnwarRafayVafaRahimi-MovagharRajesh KumarRaiUshaRamChhabi LalRanabhatHirbo ShoreRobaMilojeSavicSadaf GSepanlouBraden J TeAoAzeb GebresilassieTesemaAlan JThomsonRuoyanTobe-GaiRomanTopor-MadryEduardo AUndurragaVeronicaVargasTommiVasankariFrancesco SViolanteTissaWijeratneGelinXuNaohiroYonemotoMustafa ZYounisChuanhuaYuZoubidaZaidiMaysaaEl Sayed ZakiChristopher J LMurray
      Background The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods We extracted GDP, government spending in 184 countries from 1980–2015, and health spend data from 1995–2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings We estimated that global spending on health will increase from US$9·21 trillion in 2014 to $24·24 trillion (uncertainty interval [UI] 20·47–29·72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5·3% (UI 4·1–6·8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4·2% (3·8–4·9). High-income countries are expected to grow at 2·1% (UI 1·8–2·4) and low-income countries are expected to grow at 1·8% (1·0–2·8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133–181) per capita in 2030 and $195 (157–258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157–258) per capita was available for health in 2040 in low-income countries. Interpretation Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential. Funding Bill & Melinda Gates Foundation.
      ...
      PubDate: 2017-05-19T16:16:19Z
       
  • Sania Nishtar is the health leader that the world needs
    • Authors: George Alleyne; Cary Cooper; Pekka Puska; Robert Beaglehole; Ruth Bonita; Alexandre Kalache; Mohamed Abdi Jama; Fareed Minhas; Samad Shera
      Abstract: Publication date: Available online 18 May 2017
      Source:The Lancet
      Author(s): George Alleyne, Cary Cooper, Pekka Puska, Robert Beaglehole, Ruth Bonita, Alexandre Kalache, Mohamed Abdi Jama, Fareed Minhas, Samad Shera


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31356-9
       
  • Open letter to WHO DG candidates: reply from David Nabarro
    • Authors: David Nabarro
      Abstract: Publication date: Available online 18 May 2017
      Source:The Lancet
      Author(s): David Nabarro


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31357-0
       
  • Healthcare Access and Quality Index based on mortality from causes
           amenable to personal health care in 195 countries and territories,
           1990–2015: a novel analysis from the Global Burden of Disease Study 2015
           
    • Authors: GBD 2015; Healthcare Access Quality CollaboratorsRyan MBarberNancyFullmanReed DSorensenThomasBollykyMartinMcKeeEllenNolteAmanuel AlemuAbajobirKalkidan HassenAbateCristianaAbbafatiKaja
      Abstract: Publication date: Available online 18 May 2017
      Source:The Lancet
      Author(s): GBD 2015 Healthcare Access and Quality CollaboratorsRyan MBarberNancyFullmanReed J DSorensenThomasBollykyMartinMcKeeEllenNolteAmanuel AlemuAbajobirKalkidan HassenAbateCristianaAbbafatiKaja MAbbasFoadAbd-AllahAbdishakur MAbdulleAhmed AbdulahiAbdurahmanSemaw FeredeAberaBijuAbrahamGirmatsion FissehaAbrehaKelemeworkAdaneAdemola LukmanAdelekanIfedayo Morayo OAdetifaAshkanAfshinArnavAgarwalSanjay KumarAgarwalSunilkumarAgarwalAnuragAgrawalAliasghar AhmadKiadaliriAlirezaAhmadiKedir YimamAhmedMuktar BeshirAhmedRufus OlusolaAkinyemiTomi FAkinyemijuNadiaAkseerZiyadAl-AlyKhurshidAlamNooreAlamSayed SaidulAlamZewdie AderawAlemuKefyalew AddisAleneLilyAlexanderRaghibAliSyed DanishAliRezaAlizadeh-NavaeiAla'aAlkerwiFrançoisAllaPeterAllebeckChristineAllenRajaaAl-RaddadiUbaiAlsharifKhalid AAltirkawiElena AlvarezMartinNelsonAlvis-GuzmanAzmeraw TAmareErfanAminiWalidAmmarJoshuAmo-AdjeiYaw AmpemAmoakoBenjamin OAndersonSofiaAndroudiHosseinAnsariMustafa GeletoAnshaCarl Abelardo TAntonioJohanÄrnlövAlArtamanHamidAsayeshRezaAssadiAyalewAstatkieTesfay MehariAteySulemanAtiqueNiguse TadeleAtnafuSachin RAtreLeticiaAvila-BurgosEuripide Frinel G ArthurAvokpahoBeatriz Paulina AyalaQuintanillaAshishAwasthiNebiyu NegussuAyelePeterAzzopardiHuda Omer BaSaleemTillBärnighausenUmarBachaAlaaBadawiAmitavaBanerjeeAleksandraBaracMiguel ABarbozaSuzanne LBarker-ColloLope HBarreroSanjayBasuBernhard TBauneKaleabBayeYibeltal TebekawBayouShahrzadBazargan-HejaziNeerajBediEttoreBeghiYannickBéjotAminu KBelloDerrick ABennettIsabela MBensenorAdugnawBerhaneEduardoBernabéOscar AlbertoBernalAddisu ShunuBeyeneTariku JibatBeyeneZulfiqar ABhuttaSibhatuBiadgilignBorisBikbovSait MentesBirlikCharlesBirungiStanBiryukovDonalBisanzioHabtamu MellieBizuayehuDipanBoseMichaelBraininMichaelBrauerAlexandraBrazinovaNicholas J KBreitbordeHermannBrennerZahid AButtRosarioCárdenasLuceroCahuana-HurtadoIsmael RicardoCampos-NonatoJosipCarJuan JesusCarreroDanielCaseyValeriaCasoCarlos ACastañeda-OrjuelaJacqueline CastilloRivasFerránCatalá-LópezPedroCecilioKellyCercyFiona JCharlsonAlan ZChenAdrienneChewMirriamChibalabalaChioma EzinneChibuezeVesper HichilombweChisumpaAbdulaal AChitheerRajivChowdhuryHanneChristensenDevasahayam JesudasChristopherLiliana GCiobanuMassimoCirilloMegan SCoggeshallLeslie TrumbullCooperMonicaCortinovisJohn ACrumpKoustuvDalalHadiDanawiLalitDandonaRakhiDandonaPaul IDarganJosedas NevesGailDaveyDragos VDavitoiuKairatDavletovDiegoDe LeoLiana CDel GobboBorjadel Pozo-CruzRobert PDellavalleKebedeDeribeAmareDeribewDon CDes JarlaisSubhojitDeySamath DDharmaratneDanielDickerEric LDingKlaraDokovaE RayDorseyKerrie EDoyleManishaDubeyRebeccaEhrenkranzChristian LyckeEllingsenIqbalElyazarAhmadaliEnayatiSergey PetrovichErmakovBabakEshratiAlirezaEsteghamatiKaraEstepThomasFürstImad D AFaghmousFanuel Belayneh BekeleFanuelEmerito Jose AquinoFaraonTalha AFaridCarla Sofia e SaFarinhaAndreFaroMaryam SFarvidFarshadFarzadfarValery LFeiginAndrea BFeiglSeyed-MohammadFereshtehnejadJefferson GFernandesJoão CFernandesTesfaye RegassaFeyissaFlorianFischerChristinaFitzmauriceThomas DFlemingNataliyaFoigtKyle JForemanMohammad HForouzanfarRichard CFranklinJosephFrostadTsegaye TeweldeG/hiwotEmmanuelaGakidouKetevanGambashidzeAmiranGamkrelidzeWayneGaoAlberto LGarcia-BasteiroTeshomeGebreAmanuel TesfayGebremedhinMengistu WeldayGebremichaelAlemseged AregayGebruAmha AdmasieGelayeJohanna MGeleijnseRicardGenova-MalerasKatherine BGibneyAbabi ZergawGirefMelkamu DedefoGishuGiorgiaGiussaniWilliam WGodwinAudraGoldEllen MGoldbergPhilimon NGonaAmadorGoodridgeSameer ValiGopalaniAtsushiGotoNicholasGraetzFelixGreavesMaxGriswoldPeter ImreGubanHarish ChanderGugnaniPrakash CGuptaRahulGuptaRajeevGuptaTanushGuptaVipinGuptaTesfa DejenieHabtewoldNimaHafezi-NejadDemewozHaileAlemayehu DesalegneHailuGessessew BugssaHailuAlexHakuzimanaRandah RibhiHamadehMitiku TeshomeHambisaSamerHamidiMouhanadHammamiGraeme JHankeyYuantaoHaoHilda LHarbHabtamu AberaHareriJosep MariaHaroMohammad SadeghHassanvandRasmusHavmoellerRoderick JHaySimon IHayDeliaHendrieIleana BeatrizHeredia-PiHans WHoekMasakoHorinoNobuyukiHoritaH DeanHosgoodAung SoeHtetGuoqingHuHsiangHuangJohn JHuangBethany MHuntleyChantalHuynhKim MoesgaardIburgBogdan VasileIleanuKaireInnosAsnake ArarsaIrensoNaderJahanmehrMihajlo BJakovljevicPeterJamesSpencer LewisJamesMehdiJavanbakhtSudha PJayaramanAchala UpendraJayatillekePanniyammakalJeemonVivekanandJhaDennyJohnCatherineJohnsonSarah CJohnsonJost BJonasKnudJuelZubairKabirYogeshwarKalkondeRitulKamalHaidongKanAndreKarchCorine KakiziKaremaSeyed MKarimiAmirKasaeianNicholas JKassebaumAnshulKastorSrinivasa VittalKatikireddiKonstantinKazanjanPeter NjengaKeiyoroLauraKemmerAndrew HaddonKempAndre PascalKengneAmene AbebeKerboMaiaKereselidzeChandrasekharan NairKesavachandranYousef SalehKhaderIbrahimKhalilAbdur RahmanKhanEjaz AhmadKhanGulfarazKhanYoung-HoKhangAbdullah Tawfih AbdullahKhojaIrmaKhonelidzeJagdishKhubchandaniGetiye DejenuKibretDanielKimPaulineKimYun JinKimRuth WKimokotiYohannesKinfuNiranjanKissoonMiiaKivipeltoYoshihiroKokuboAnneliKolkDhavalKolteJacek AKopecSoewartaKosenParvaiz AKoulAiKoyanagiMichaelKravchenkoSanjayKrishnaswamiKristopher JKrohnBarthelemy KuateDefoBurcu KucukBicerErnst JKuipersVeena SKulkarniG AnilKumarFekede AsefaKumsaMichaelKutzHmwe HKyuAnton Carl JonasLagerAparnaLalDharmesh KumarLalRatilalLallooTeaLallukkaQingLanSinead MLanganVan CLansinghHeidi JLarsonAndersLarssonDennis OdaiLaryeaAsma AbdulLatifAlicia Elena BeatrizLawrynowiczJanet LLeasherJamesLeighMallLeinsaluCheru TesemaLeshargieJanniLeungRickyLeungMiriamLeviXiaofengLiangStephen SLimMargaretLindShaiLinnSteven ELipshultzPatrickLiuYangLiuLoon-TzianLoGiancarloLogroscinoAlan DLopezScott ALorchPaulo ALotufoRafaelLozanoRaimundasLuneviciusRonan ALyonsErlyn Rachelle KingMacarayanMark TMackayHassan Magdy AbdEl RazekMohammed Magdy AbdEl RazekMahdiMahdaviAzeemMajeedRezaMalekzadehDebor...
      PubDate: 2017-05-19T16:16:19Z
       
  • Account for primary health care when indexing access and quality
    • Authors: Felicity Goodyear-Smith; Chris van Weel
      Abstract: Publication date: Available online 18 May 2017
      Source:The Lancet
      Author(s): Felicity Goodyear-Smith, Chris van Weel


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31289-8
       
  • Top ten endometriosis research priorities in the UK and Ireland
    • Authors: Andrew W Horne; Philippa T K Saunders; Ibtisam M Abokhrais; Lyndsey Hogg
      Abstract: Publication date: Available online 18 May 2017
      Source:The Lancet
      Author(s): Andrew W Horne, Philippa T K Saunders, Ibtisam M Abokhrais, Lyndsey Hogg


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31344-2
       
  • Dr Tedros Adhanom Ghebreyesus is the best candidate for WHO DG
    • Authors: Peter Byass
      Abstract: Publication date: Available online 17 May 2017
      Source:The Lancet
      Author(s): Peter Byass


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31354-5
       
  • Towards therapeutic choices in ulcerative colitis
    • Authors: David Laharie
      Abstract: Publication date: Available online 17 May 2017
      Source:The Lancet
      Author(s): David Laharie


      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)31263-1
       
  • Department of Error
    • Abstract: Publication date: Available online 17 May 2017
      Source:The Lancet


      PubDate: 2017-05-19T16:16:19Z
       
  • Anti-MAdCAM antibody (PF-00547659) for ulcerative colitis (TURANDOT): a
           phase 2, randomised, double-blind, placebo-controlled trial
    • Authors: Séverine Vermeire; William J Sandborn; Silvio Danese; Xavier Hébuterne; Bruce A Salzberg; Maria Klopocka; Dino Tarabar; Tomas Vanasek; Miloš Greguš; Paul A Hellstern; Joo Sung Kim; Miles P Sparrow; Kenneth J Gorelick; Michelle Hinz; Alaa Ahmad; Vivek Pradhan; Mina Hassan-Zahraee; Robert Clare; Fabio Cataldi; Walter Reinisch
      Abstract: Publication date: Available online 17 May 2017
      Source:The Lancet
      Author(s): Séverine Vermeire, William J Sandborn, Silvio Danese, Xavier Hébuterne, Bruce A Salzberg, Maria Klopocka, Dino Tarabar, Tomas Vanasek, Miloš Greguš, Paul A Hellstern, Joo Sung Kim, Miles P Sparrow, Kenneth J Gorelick, Michelle Hinz, Alaa Ahmad, Vivek Pradhan, Mina Hassan-Zahraee, Robert Clare, Fabio Cataldi, Walter Reinisch
      Background PF-00547659 is a fully human monoclonal antibody that binds to human mucosal addressin cell adhesion molecule-1 (MAdCAM-1) to selectively reduce lymphocyte homing to the intestinal tract. We aimed to assess the efficacy and safety of PF-00547659 in patients with moderate to severe ulcerative colitis. Methods This phase 2, randomised, double-blind, placebo-controlled clinical trial recruited patients aged 18–65 years from 105 centres in 21 countries, with a history (≥3 months) of active ulcerative colitis extending more than 15 cm beyond the anal verge (with a total Mayo score ≥6 and a Mayo endoscopic subscore ≥2) who had failed or were intolerant to at least one conventional therapy. Patients were stratified by previous anti-TNFα treatment, and randomly assigned by a computer-generated randomisation schedule to receive a subcutaneous injection of 7·5 mg, 22·5 mg, 75 mg, or 225 mg PF-00547659 or placebo at baseline, then every 4 weeks. Patients, investigators, and sponsors were blinded to the treatment. The primary endpoint was the proportion of patients achieving remission (total Mayo score ≤2 with no individual subscore >1 and rectal bleeding subscore ≤1) at week 12. The efficacy analysis included all patients who received at least one dose of the randomised treatment; the safety analysis was done according to treatment received. All p values were one-sided and multiplicity-adjusted. This study is registered with ClinicalTrials.gov, number NCT01620255. Findings Between Nov 2, 2012, and Feb 4, 2016, we screened 587 patients; 357 were eligible and randomly assigned to receive placebo (n=73) or PF-00547659 at doses of 7·5 mg (n=71), 22·5 mg (n=72), 75 mg (n=71), or 225 mg (n=70). Remission rates at week 12 were significantly greater in three of four active-treatment groups than in the placebo group (2·7% [two of 73]): 7·5 mg (11·3% [eight of 71]), 22·5 mg (16·7% [12 of 72]), 75 mg (15·5% [11 of 71]), and 225 mg (5·7% [four of 70]). These rates corresponded to a stratum-adjusted (anti-TNFα-naive and anti-TNFα-experienced) risk difference versus placebo of 8·0% for 7·5 mg (90% CI 1·9 to 14, p=0·0425), 12·8% for 22·5 mg (5·6 to 19·9, p=0·0099), 11·8% for 75 mg (4·8 to 18·8, p=0·0119), and 2·6% for 225 mg (−1·2 to 6·4, p=0·1803). Four of 73 (5·5%) patients had a serious adverse event in the placebo group, ten of 71 (14·1%) in the 7·5 mg group, one of 70 (1·4%) in the 22·5 mg group, three of 73 (4·1%) in the 75 mg group, and three of 70 (4·3%) in the 225 mg group. No safety signal was observed for the study drug. Interpretation PF-00547659 was safe and well tolerated in this patient population, and better than placebo for induction of remission in patients with moderate to severe ulcerative colitis. The greatest clinical effects were observed with the 22·5 mg and 75 mg doses. Funding Pfizer.

      PubDate: 2017-05-19T16:16:19Z
      DOI: 10.1016/s0140-6736(17)30930-3
       
  • Open letter to WHO DG candidates: reply from Sania Nishtar
    • Authors: Sania Nishtar
      Abstract: Publication date: Available online 9 May 2017
      Source:The Lancet
      Author(s): Sania Nishtar


      PubDate: 2017-05-15T03:30:18Z
      DOI: 10.1016/s0140-6736(17)31254-0
       
  • Dr David Nabarro is the best candidate for WHO Director-General
    • Authors: Sally C Davies
      Abstract: Publication date: Available online 8 May 2017
      Source:The Lancet
      Author(s): Sally C Davies


      PubDate: 2017-05-10T03:04:22Z
      DOI: 10.1016/s0140-6736(17)31255-2
       
 
 
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