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The Lancet
Journal Prestige (SJR): 14.934
Citation Impact (citeScore): 9
Number of Followers: 2387  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
Published by Elsevier Homepage  [3159 journals]
  • New opportunities for malaria vector control
    • Abstract: Publication date: Available online 10 August 2018Source: The LancetAuthor(s): John E Gimnig, Eric Ochomo
       
  • Prevention of Ebola virus disease through vaccination: where we are in
           2018
    • Abstract: Publication date: Available online 10 August 2018Source: The LancetAuthor(s): Yves Lévy, Clifford Lane, Peter Piot, Abdul Habib Beavogui, Mark Kieh, Bailah Leigh, Seydou Doumbia, Eric D'Ortenzio, Claire Lévy-Marchal, Jerome Pierson, Deborah Watson-Jones, Vinh-Kim Nguyen, Heidi Larson, Julia Lysander, Christine Lacabaratz, Rodolphe Thiebaut, Augustin Augier, David Ishola, Stephen Kennedy, Geneviève Chêne
       
  • A Brexit miscalculation
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Mark Tinsley
       
  • Urinary sodium excretion, blood pressure, cardiovascular disease, and
           mortality: a community-level prospective epidemiological cohort study
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Andrew Mente, Martin O'Donnell, Sumathy Rangarajan, Matthew McQueen, Gilles Dagenais, Andreas Wielgosz, Scott Lear, Shelly Tse Lap Ah, Li Wei, Rafael Diaz, Alvaro Avezum, Patricio Lopez-Jaramillo, Fernando Lanas, Prem Mony, Andrzej Szuba, Romaina Iqbal, Rita Yusuf, Noushin Mohammadifard, Rasha Khatib, Khalid YusoffSummaryBackgroundWHO recommends that populations consume less than 2 g/day sodium as a preventive measure against cardiovascular disease, but this target has not been achieved in any country. This recommendation is primarily based on individual-level data from short-term trials of blood pressure (BP) without data relating low sodium intake to reduced cardiovascular events from randomised trials or observational studies. We investigated the associations between community-level mean sodium and potassium intake, cardiovascular disease, and mortality.MethodsThe Prospective Urban Rural Epidemiology study is ongoing in 21 countries. Here we report an analysis done in 18 countries with data on clinical outcomes. Eligible participants were adults aged 35–70 years without cardiovascular disease, sampled from the general population. We used morning fasting urine to estimate 24 h sodium and potassium excretion as a surrogate for intake. We assessed community-level associations between sodium and potassium intake and BP in 369 communities (all>50 participants) and cardiovascular disease and mortality in 255 communities (all>100 participants), and used individual-level data to adjust for known confounders.Findings95 767 participants in 369 communities were assessed for BP and 82 544 in 255 communities for cardiovascular outcomes with follow-up for a median of 8·1 years. 82 (80%) of 103 communities in China had a mean sodium intake greater than 5 g/day, whereas in other countries 224 (84%) of 266 communities had a mean intake of 3–5 g/day. Overall, mean systolic BP increased by 2·86 mm Hg per 1 g increase in mean sodium intake, but positive associations were only seen among the communities in the highest tertile of sodium intake (p5·08–7·49; change 0·37 events per 1000 years, –0·03 to 0·78, p=0·0712). A strong association was seen with stroke in China (mean sodium intake 5·58 g/day, 0·42 events per 1000 years, 95% CI 0·16 to 0·67, p=0·0020) compared with in other countries (4·49 g/day, –0·26 events, –0·46 to –0·06, p=0·0124; p
       
  • Excess mortality and cardiovascular disease in young adults with type 1
           diabetes in relation to age at onset: a nationwide, register-based cohort
           study
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Araz Rawshani, Naveed Sattar, Stefan Franzén, Aidin Rawshani, Andrew T Hattersley, Ann-Marie Svensson, Björn Eliasson, Soffia GudbjörnsdottirSummaryBackgroundPeople with type 1 diabetes are at elevated risk of mortality and cardiovascular disease, yet current guidelines do not consider age of onset as an important risk stratifier. We aimed to examine how age at diagnosis of type 1 diabetes relates to excess mortality and cardiovascular risk.MethodsWe did a nationwide, register-based cohort study of individuals with type 1 diabetes in the Swedish National Diabetes Register and matched controls from the general population. We included patients with at least one registration between Jan 1, 1998, and Dec 31, 2012. Using Cox regression, and with adjustment for diabetes duration, we estimated the excess risk of all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, acute myocardial infarction, stroke, cardiovascular disease (a composite of acute myocardial infarction and stroke), coronary heart disease, heart failure, and atrial fibrillation. Individuals with type 1 diabetes were categorised into five groups, according to age at diagnosis: 0–10 years, 11–15 years, 16–20 years, 21–25 years, and 26–30 years.Findings27 195 individuals with type 1 diabetes and 135 178 matched controls were selected for this study. 959 individuals with type 1 diabetes and 1501 controls died during follow-up (median follow-up was 10 years). Patients who developed type 1 diabetes at 0–10 years of age had hazard ratios of 4·11 (95% CI 3·24–5·22) for all-cause mortality, 7·38 (3·65–14·94) for cardiovascular mortality, 3·96 (3·06–5·11) for non-cardiovascular mortality, 11·44 (7·95–16·44) for cardiovascular disease, 30·50 (19·98–46·57) for coronary heart disease, 30·95 (17·59–54·45) for acute myocardial infarction, 6·45 (4·04–10·31) for stroke, 12·90 (7·39–22·51) for heart failure, and 1·17 (0·62–2·20) for atrial fibrillation. Corresponding hazard ratios for individuals who developed type 1 diabetes aged 26–30 years were 2·83 (95% CI 2·38–3·37) for all-cause mortality, 3·64 (2·34–5·66) for cardiovascular mortality, 2·78 (2·29–3·38) for non-cardiovascular mortality, 3·85 (3·05–4·87) for cardiovascular disease, 6·08 (4·71–7·84) for coronary heart disease, 5·77 (4·08–8·16) for acute myocardial infarction, 3·22 (2·35–4·42) for stroke, 5·07 (3·55–7·22) for heart failure, and 1·18 (0·79–1·77) for atrial fibrillation; hence the excess risk differed by up to five times across the diagnosis age groups. The highest overall incidence rate, noted for all-cause mortality, was 1·9 (95% CI 1·71–2·11) per 100 000 person-years for people with type 1 diabetes. Development of type 1 diabetes before 10 years of age resulted in a loss of 17·7 life-years (95% CI 14·5–20·4) for women and 14·2 life-years (12·1–18·2) for men.InterpretationAge at onset of type 1 diabetes is an important determinant of survival, as well as all cardiovascular outcomes, with highest excess risk in women. Greater focus on cardioprotection might be warranted in people with early-onset type 1 diabetes.FundingSwedish Heart and Lung Foundation.
       
  • Department of Error
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s):
       
  • Department of Error
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s):
       
  • Department of Error
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s):
       
  • Reducing child mortality in England
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Allison Streetly, Elizabeth Dormandy
       
  • Zero tolerance on claims of harassment at UN agency
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Brian Gerard Williams
       
  • A century ago: Carlo Forlanini and the first successful treatment of
           tuberculosis
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Maria Carla Garbarino, Valentina Cani, Paolo Mazzarello
       
  • The increase of suicide rates: the need for a paradigm shift
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Maurizio Pompili
       
  • Electronic cigarettes: adolescent health and wellbeing – Authors'
           reply
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): John N Newton, Martin Dockrell, Tim Marczylo
       
  • Electronic cigarettes: adolescent health and wellbeing
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Matthew J Peters
       
  • Electronic cigarettes: adolescent health and wellbeing
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Aki Nilanga Bandara, Vahid Mehrnoush
       
  • The future of radiology: adding value to clinical care
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Marc Dewey
       
  • Palliative care and the endless cycle of serious health-related suffering
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Sébastien Moine, Scott A Murray, Kirsty Boyd, Yvonne Engels, Geoff Mitchell, European Association for Palliative Care Primary Care Reference Group
       
  • Re-expansion pulmonary oedema
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Alice Petiot, Sammy Tawk, Benoît Ghaye
       
  • Arthur Jay Moss
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Geoff Watts
       
  • Beyond precision: embracing the politics of global health numbers
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Morten Jerven
       
  • Home truths
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Tania Glyde
       
  • Making peace with our faulty hearts
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Laura Coates
       
  • Biosimilars for insulin: a cost-saving alternative'
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Chris McCall
       
  • Breast cancer in Venezuela: back to the 20th century
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Hildegard Willer
       
  • New regulations to cut valproate-exposed pregnancies
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Arjune Sen, Lina Nashef
       
  • Salt and heart disease: a second round of “bad science”'
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Franz H Messerli, Louis Hofstetter, Sripal Bangalore
       
  • Age at type 1 diabetes onset: a new risk factor and call for focused
           treatment
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): Marina Basina, David M Maahs
       
  • Khan faces tough test as Pakistan's new Prime Minister
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): The Lancet
       
  • Introducing EU-wide surveillance of Lyme neuroborreliosis
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): The Lancet
       
  • Heart failure: the need for improved treatment and care
    • Abstract: Publication date: 11–17 August 2018Source: The Lancet, Volume 392, Issue 10146Author(s): The Lancet
       
  • Principles of DNA methylation and their implications for biology and
           medicine
    • Abstract: Publication date: Available online 9 August 2018Source: The LancetAuthor(s): Yuval Dor, Howard CedarSummaryDNA methylation represents an annotation system for marking the genetic text, thus providing instruction as to how and when to read the information and control transcription. Unlike sequence information, which is inherited, methylation patterns are established in a programmed process that continues throughout development, thus setting up stable gene expression profiles. This DNA methylation paradigm is a key player in medicine. Some changes in methylation closely correlate with age providing a marker for biological ageing, and these same sites could also play a part in cancer. The genome continues to undergo programmed variation in methylation after birth in response to environmental inputs, serving as a memory device that could affect ageing and predisposition to various metabolic, autoimmune, and neurological diseases. Taking advantage of tissue-specific differences, methylation can be used to detect cell death and thereby monitor many common diseases with a simple cell-free circulating-DNA blood test.
       
  • Risankizumab for psoriasis
    • Abstract: Publication date: Available online 7 August 2018Source: The LancetAuthor(s): Abigail Cline, Steven R Feldman
       
  • Anna Morandi: anatomist of Enlightenment Bologna
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Georgina Ferry
       
  • Peer-supported self-management for people discharged from a mental health
           crisis team: a randomised controlled trial
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Sonia Johnson, Danielle Lamb, Louise Marston, David Osborn, Oliver Mason, Claire Henderson, Gareth Ambler, Alyssa Milton, Michael Davidson, Marina Christoforou, Sarah Sullivan, Rachael Hunter, David Hindle, Beth Paterson, Monica Leverton, Jonathan Piotrowski, Rebecca Forsyth, Liberty Mosse, Nicky Goater, Kathleen KellySummaryBackgroundHigh resource expenditure on acute care is a challenge for mental health services aiming to focus on supporting recovery, and relapse after an acute crisis episode is common. Some evidence supports self-management interventions to prevent such relapses, but their effect on readmissions to acute care following a crisis is untested. We tested whether a self-management intervention facilitated by peer support workers could reduce rates of readmission to acute care for people discharged from crisis resolution teams, which provide intensive home treatment following a crisis.MethodsWe did a randomised controlled superiority trial recruiting participants from six crisis resolution teams in England. Eligible participants had been on crisis resolution team caseloads for at least a week, and had capacity to give informed consent. Participants were randomly assigned to intervention and control groups by an unmasked data manager. Those collecting and analysing data were masked to allocation, but participants were not. Participants in the intervention group were offered up to ten sessions with a peer support worker who supported them in completing a personal recovery workbook, including formulation of personal recovery goals and crisis plans. The control group received the personal recovery workbook by post. The primary outcome was readmission to acute care within 1 year. This trial is registered with ISRCTN, number 01027104.Findings221 participants were assigned to the intervention group versus 220 to the control group; primary outcome data were obtained for 218 versus 216. 64 (29%) of 218 participants in the intervention versus 83 (38%) of 216 in the control group were readmitted to acute care within 1 year (odds ratio 0·66, 95% CI 0·43–0·99; p=0·0438). 71 serious adverse events were identified in the trial (29 in the treatment group; 42 in the control group).InterpretationOur findings suggest that peer-delivered self-management reduces readmission to acute care, although admission rates were lower than anticipated and confidence intervals were relatively wide. The complexity of the study intervention limits interpretability, but assessment is warranted of whether implementing this intervention in routine settings reduces acute care readmission.FundingNational Institute for Health Research.
       
  • Department of Error
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s):
       
  • Post-publication peer review and evidence appraisals in primary care
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Alain Nathan Sahin, Andrew Goldstein, Chunhua Weng
       
  • Strategies to correct the shortage of paediatricians in China
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Yong Hu, Jianzhong Xu, Weixin Dong, Zhenshan Yuan, Xiaoyang Sun
       
  • Reporting of immune checkpoint inhibitor-associated myocarditis –
           Authors' reply
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Javid J Moslehi, Joe-Elie Salem, Jeffrey A Sosman, Bénédicte Lebrun-Vignes, Douglas B Johnson
       
  • Reporting of immune checkpoint inhibitor-associated myocarditis
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Roberta Noseda, Lara Magro, Anastasios Stathis, Alessandro Ceschi
       
  • Reporting of immune checkpoint inhibitor-associated myocarditis
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Emanuel Raschi, Igor Diemberger, Elisabetta Poluzzi, Fabrizio De Ponti
       
  • Reporting of immune checkpoint inhibitor-associated myocarditis
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Sadeer G Al-Kindi, Guilherme H Oliveira
       
  • Providing quality care on the border with Haiti
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Serena P Koenig, Jennifer Furin
       
  • Gustav Victor Rudolf Born
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Geoff Watts
       
  • In search of lost time
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Barbara K Lipska, Elaine McArdle
       
  • A classic case of scurvy
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Shari Lipner
       
  • HPV vaccine to be offered to boys in England
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Andrew Green
       
  • Measles outbreak in the Americas
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Barbara Fraser
       
  • Opt-out digital health records cause debate in Australia
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Chris McCall
       
  • China's vaccine production scare
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Xun Yuan
       
  • Women making medical history: introducing A Woman's Place
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Georgina Ferry
       
  • Sexual harassment and abuse: when the patient is the perpetrator
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Elizabeth M Viglianti, Andrea L Oliverio, Lisa M Meeks
       
  • Reimagining population health as convergence science
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Victor J Dzau, Celynne A Balatbat
       
  • Peer-delivered self-management programmes in mental health
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): Marcia Valenstein, Paul Pfeiffer
       
  • Half measures on children's mental health
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): The Lancet
       
  • Vaccine scandal and confidence crisis in China
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): The Lancet
       
  • Heatwaves and health
    • Abstract: Publication date: 4–10 August 2018Source: The Lancet, Volume 392, Issue 10145Author(s): The Lancet
       
  • Autism spectrum disorder
    • Abstract: Publication date: Available online 2 August 2018Source: The LancetAuthor(s): Catherine Lord, Mayada Elsabbagh, Gillian Baird, Jeremy Veenstra-VanderweeleSummaryAutism spectrum disorder is a term used to describe a constellation of early-appearing social communication deficits and repetitive sensory–motor behaviours associated with a strong genetic component as well as other causes. The outlook for many individuals with autism spectrum disorder today is brighter than it was 50 years ago; more people with the condition are able to speak, read, and live in the community rather than in institutions, and some will be largely free from symptoms of the disorder by adulthood. Nevertheless, most individuals will not work full-time or live independently. Genetics and neuroscience have identified intriguing patterns of risk, but without much practical benefit yet. Considerable work is still needed to understand how and when behavioural and medical treatments can be effective, and for which children, including those with substantial comorbidities. It is also important to implement what we already know and develop services for adults with autism spectrum disorder. Clinicians can make a difference by providing timely and individualised help to families navigating referrals and access to community support systems, by providing accurate information despite often unfiltered media input, and by anticipating transitions such as family changes and school entry and leaving.
       
  • Ebola Medals returned to the UK Government in protest
    • Abstract: Publication date: Available online 30 July 2018Source: The LancetAuthor(s): Neal Russell, Robert Verrecchia, Clea Kahn, Gillian Goldberg, Darryl Braganza Menezes
       
  • Proposed changes to the Title X Family Planning Program
    • Abstract: Publication date: Available online 27 July 2018Source: The LancetAuthor(s): Jody Steinauer, Philip Darney
       
  • The Lancet–EASL Commission on liver diseases in Europe: overcoming unmet
           needs, stigma, and inequities
    • Abstract: Publication date: Available online 27 July 2018Source: The LancetAuthor(s): Michael P Manns, Patrizia Burra, Jennifer Sargent, Richard Horton, Tom H Karlsen
       
  • Esomeprazole and aspirin in Barrett's oesophagus (AspECT): a randomised
           factorial trial
    • Abstract: Publication date: Available online 26 July 2018Source: The LancetAuthor(s): Janusz A Z Jankowski, John de Caestecker, Sharon B Love, Gavin Reilly, Peter Watson, Scott Sanders, Yeng Ang, Danielle Morris, Pradeep Bhandari, Stephen Attwood, Krish Ragunath, Bashir Rameh, Grant Fullarton, Art Tucker, Ian Penman, Colin Rodgers, James Neale, Claire Brooks, Adelyn Wise, Stephen JonesSummaryBackgroundOesophageal adenocarcinoma is the sixth most common cause of cancer death worldwide and Barrett's oesophagus is the biggest risk factor. We aimed to evaluate the efficacy of high-dose esomeprazole proton-pump inhibitor (PPI) and aspirin for improving outcomes in patients with Barrett's oesophagus.MethodsThe Aspirin and Esomeprazole Chemoprevention in Barrett's metaplasia Trial had a 2 × 2 factorial design and was done at 84 centres in the UK and one in Canada. Patients with Barrett's oesophagus of 1 cm or more were randomised 1:1:1:1 using a computer-generated schedule held in a central trials unit to receive high-dose (40 mg twice-daily) or low-dose (20 mg once-daily) PPI, with or without aspirin (300 mg per day in the UK, 325 mg per day in Canada) for at least 8 years, in an unblinded manner. Reporting pathologists were masked to treatment allocation. The primary composite endpoint was time to all-cause mortality, oesophageal adenocarcinoma, or high-grade dysplasia, which was analysed with accelerated failure time modelling adjusted for minimisation factors (age, Barrett's oesophagus length, intestinal metaplasia) in all patients in the intention-to-treat population. This trial is registered with EudraCT, number 2004-003836-77.FindingsBetween March 10, 2005, and March 1, 2009, 2557 patients were recruited. 705 patients were assigned to low-dose PPI and no aspirin, 704 to high-dose PPI and no aspirin, 571 to low-dose PPI and aspirin, and 577 to high-dose PPI and aspirin. Median follow-up and treatment duration was 8·9 years (IQR 8·2–9·8), and we collected 20 095 follow-up years and 99·9% of planned data. 313 primary events occurred. High-dose PPI (139 events in 1270 patients) was superior to low-dose PPI (174 events in 1265 patients; time ratio [TR] 1·27, 95% CI 1·01–1·58, p=0·038). Aspirin (127 events in 1138 patients) was not significantly better than no aspirin (154 events in 1142 patients; TR 1·24, 0·98–1·57, p=0·068). If patients using non-steroidal anti-inflammatory drugs were censored at the time of first use, aspirin was significantly better than no aspirin (TR 1·29, 1·01–1·66, p=0·043; n=2236). Combining high-dose PPI with aspirin had the strongest effect compared with low-dose PPI without aspirin (TR 1·59, 1·14–2·23, p=0·0068). The numbers needed to treat were 34 for PPI and 43 for aspirin. Only 28 (1%) participants reported study-treatment-related serious adverse events.InterpretationHigh-dose PPI and aspirin chemoprevention therapy, especially in combination, significantly and safely improved outcomes in patients with Barrett's oesophagus.FundingCancer Research UK, AstraZeneca, Wellcome Trust, and Health Technology Assessment.
       
  • Improving peripheral intravenous catheter failure rates
    • Abstract: Publication date: Available online 26 July 2018Source: The LancetAuthor(s): Alexander P J Vlaar, Beverley J Hunt
       
  • Analysis of clinical benefit, harms, and cost-effectiveness of screening
           women for abdominal aortic aneurysm
    • Abstract: Publication date: Available online 26 July 2018Source: The LancetAuthor(s): Michael J Sweeting, Katya L Masconi, Edmund Jones, Pinar Ulug, Matthew J Glover, Jonathan A Michaels, Matthew J Bown, Janet T Powell, Simon G ThompsonSummaryBackgroundA third of deaths in the UK from ruptured abdominal aortic aneurysm (AAA) are in women. In men, national screening programmes reduce deaths from AAA and are cost-effective. The benefits, harms, and cost-effectiveness in offering a similar programme to women have not been formally assessed, and this was the aim of this study.MethodsWe developed a decision model to assess predefined outcomes of death caused by AAA, life years, quality-adjusted life years, costs, and the incremental cost-effectiveness ratio for a population of women invited to AAA screening versus a population who were not invited to screening. A discrete event simulation model was set up for AAA screening, surveillance, and intervention. Relevant women-specific parameters were obtained from sources including systematic literature reviews, national registry or administrative databases, major AAA surgery trials, and UK National Health Service reference costs.FindingsAAA screening for women, as currently offered to UK men (at age 65 years, with an AAA diagnosis at an aortic diameter of ≥3·0 cm, and elective repair considered at ≥5·5cm) gave, over 30 years, an estimated incremental cost-effectiveness ratio of £30 000 (95% CI 12 000–87 000) per quality-adjusted life year gained, with 3900 invitations to screening required to prevent one AAA-related death and an overdiagnosis rate of 33%. A modified option for women (screening at age 70 years, diagnosis at 2·5 cm and repair at 5·0 cm) was estimated to have an incremental cost-effectiveness ratio of £23 000 (9500–71 000) per quality-adjusted life year and 1800 invitations to screening required to prevent one AAA-death, but an overdiagnosis rate of 55%. There was considerable uncertainty in the cost-effectiveness ratio, largely driven by uncertainty about AAA prevalence, the distribution of aortic sizes for women at different ages, and the effect of screening on quality of life.InterpretationBy UK standards, an AAA screening programme for women, designed to be similar to that used to screen men, is unlikely to be cost-effective. Further research on the aortic diameter distribution in women and potential quality of life decrements associated with screening are needed to assess the full benefits and harms of modified options.FundingUK National Institute for Health Research Health Technology Assessment programme.
       
  • Should we screen women for abdominal aortic aneurysm'
    • Abstract: Publication date: Available online 26 July 2018Source: The LancetAuthor(s): Minna Johansson, Karsten Juhl Jørgensen
       
  • Should aspirin and PPIs be recommended for patients with Barrett's
           oesophagus'
    • Abstract: Publication date: Available online 26 July 2018Source: The LancetAuthor(s): Frederik Hvid-Jensen, Asbjørn Mohr Drewes
       
  • Strengthening oral health for universal health coverage
    • Abstract: Publication date: Available online 25 July 2018Source: The LancetAuthor(s): Julian Fisher, Harry-Sam Selikowitz, Manu Mathur, Benoit Varenne
       
  • IVF at 40
    • Abstract: Publication date: Available online 24 July 2018Source: The LancetAuthor(s): Sarah Boseley
       
  • HIV
    • Abstract: Publication date: Available online 23 July 2018Source: The LancetAuthor(s): Jade Ghosn, Babafemi Taiwo, Soraya Seedat, Brigitte Autran, Christine KatlamaSummaryThe benefits of combination antiretroviral therapy (cART) for HIV replication and transmission control have led to its universal recommendation. Many people living with HIV are, however, still undiagnosed or diagnosed late, especially in sub-Saharan Africa, where the HIV disease burden is highest. Further expansion in HIV treatment options, incorporating women-centred approaches, is essential to make individualised care a reality. With a longer life expectancy than before, people living with HIV are at an increased risk of developing non-AIDS comorbidities, such as cardiovascular diseases and cancers. Antiretroviral strategies are evolving towards a decrease in drug burden, and some two-drug combinations have proven efficacy for maintenance therapy. Investigational immune checkpoint inhibitors and broadly neutralising antibodies with effector functions have energised the HIV cure research field as the search for an effective vaccine continues. In this Seminar, we review advances and challenges relating to the goal of an AIDS-free world.
       
  • Outrageous prices of orphan drugs: a call for collaboration
    • Abstract: Publication date: Available online 20 July 2018Source: The LancetAuthor(s): Lucio Luzzatto, Hanna I Hyry, Arrigo Schieppati, Enrico Costa, Steven Simoens, Franz Schaefer, Jonathan C P Roos, Giampaolo Merlini, Helena Kääriäinen, Silvio Garattini, Carla E Hollak, Giuseppe Remuzzi, Tiziano Barbui, Ariela Benigni, Enrico Costa, Erica Daina, Silvio Garattini, Donatella Gramaglia, Carla E M Hollak, Hanna Hyry
       
  • The global response and unmet actions for HIV and sex workers
    • Abstract: Publication date: Available online 20 July 2018Source: The LancetAuthor(s): Kate Shannon, Anna-Louise Crago, Stefan D Baral, Linda-Gail Bekker, Deanna Kerrigan, Michele R Decker, Tonia Poteat, Andrea L Wirtz, Brian Weir, Marie-Claude Boily, Jenny Butler, Steffanie A Strathdee, Chris BeyrerSummaryFemale, male, and transgender sex workers continue to have disproportionately high burdens of HIV infection in low-income, middle-income, and high-income countries in 2018. 4 years since our Lancet Series on HIV and sex work, our updated analysis of the global HIV burden among female sex workers shows that HIV prevalence is unacceptably high at 10·4% (95% CI 9·5–11·5) and is largely unchanged. Comprehensive epidemiological data on HIV and antiretroviral therapy (ART) coverage are scarce, particularly among transgender women. Sustained coverage of treatment is markedly uneven and challenged by lack of progress on stigma and criminalisation, and sustained human rights violations. Although important progress has been made in biomedical interventions with pre-exposure prophylaxis and early ART feasibility and demonstration projects, limited coverage and retention suggest that sustained investment in community and structural interventions is required for sex workers to benefit from the preventive interventions and treatments that other key populations have. Evidence-based progress on full decriminalisation grounded in health and human rights—a key recommendation in our Lancet Series—has stalled, with South Africa a notable exception. Additionally, several countries have rolled back rights to sex workers further. Removal of legal barriers through the decriminalisation of sex work, alongside political and funding investments to support community and structural interventions, is urgently needed to reverse the HIV trajectory and ensure health and human rights for all sex workers.
       
  • Brazil's health catastrophe in the making
    • Abstract: Publication date: Available online 20 July 2018Source: The LancetAuthor(s): Katarzyna Doniec, Rafael Dall'Alba, Lawrence King
       
  • Effects of aspirin on risks of vascular events and cancer according to
           bodyweight and dose: analysis of individual patient data from randomised
           trials
    • Abstract: Publication date: Available online 17 July 2018Source: The LancetAuthor(s): Peter M Rothwell, Nancy R Cook, J Michael Gaziano, Jacqueline F Price, Jill F F Belch, Maria Carla Roncaglioni, Takeshi Morimoto, Ziyah MehtaSummaryBackgroundA one-dose-fits-all approach to use of aspirin has yielded only modest benefits in long-term prevention of cardiovascular events, possibly due to underdosing in patients of large body size and excess dosing in patients of small body size, which might also affect other outcomes.MethodsUsing individual patient data, we analysed the modifying effects of bodyweight (10 kg bands) and height (10 cm bands) on the effects of low doses (≤100 mg) and higher doses (300–325 mg or ≥500 mg) of aspirin in randomised trials of aspirin in primary prevention of cardiovascular events. We stratified the findings by age, sex, and vascular risk factors, and validated them in trials of aspirin in secondary prevention of stroke. Additionally, we assessed whether any weight or height dependence was evident for the effect of aspirin on 20-year risk of colorectal cancer or any in-trial cancer.ResultsAmong ten eligible trials of aspirin in primary prevention (including 117 279 participants), bodyweight varied four-fold and trial median weight ranged from 60·0 kg to 81·2 kg (p
       
  • Health, transatlantic trade, and President Trump's populism: what American
           Patients First has to do with Brexit and the NHS
    • Abstract: Publication date: Available online 17 July 2018Source: The LancetAuthor(s): Holly Jarman, Martin McKee, Tamara K Hervey
       
  • Addressing the global challenge of snake envenoming
    • Abstract: Publication date: Available online 17 July 2018Source: The LancetAuthor(s): Geoffrey K Isbister, Anjana Silva
       
  • Weight-adjusted aspirin for cardiovascular prevention
    • Abstract: Publication date: Available online 17 July 2018Source: The LancetAuthor(s): Katherine N Theken, Tilo Grosser
       
  • The need for transparency of clinical evidence for medical devices in
           Europe
    • Abstract: Publication date: Available online 17 July 2018Source: The LancetAuthor(s): Alan G Fraser, Eric G Butchart, Piotr Szymański, Enrico G Caiani, Scott Crosby, Peter Kearney, Frans Van de WerfSummaryTo use medical devices rationally, health-care professionals must base their choices of which devices to recommend for individual patients on an objective appraisal of their safety and clinical efficacy. The evidence submitted by manufacturers when seeking approval of their high-risk devices must be publicly available, including technical performance and premarket clinical studies. Giving physicians access to this information supplements the peer-reviewed scientific literature and might be essential for comparing alternative devices within any class. Interested patients should be encouraged to review the evidence for any device that has been recommended for them. The new EU law on medical devices states that the manufacturer is to prepare a summary of the evidence for any implantable or high-risk device. Defining its content, however, has been delegated to implementing legislation, which is now being considered. From a clinical perspective, it is imperative that all evidence reviewed by notified bodies and regulatory authorities is disclosed—with the exception, if justified, only of technical specifications that are considered confidential or manufacturing details that are protected as intellectual property—and public access to this evidence must be guaranteed by EU law. From ethical and other perspectives, there are no grounds for less clinical evidence being available to health-care professionals about the medical devices that they use than is already available for new pharmaceutical products. Full transparency is needed; without it, informed decisions relating to the use of new medical devices will remain impossible.
       
  • Vulnerability to snakebite envenoming: a global mapping of hotspots
    • Abstract: Publication date: Available online 17 July 2018Source: The LancetAuthor(s): Joshua Longbottom, Freya M Shearer, Maria Devine, Gabriel Alcoba, Francois Chappuis, Daniel J Weiss, Sarah E Ray, Nicolas Ray, David A Warrell, Rafael Ruiz de Castañeda, David J Williams, Simon I Hay, David M PigottSummaryBackgroundSnakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed.MethodsWe assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but
       
  • End immigration detention: an open letter
    • Abstract: Publication date: Available online 17 July 2018Source: The LancetAuthor(s): Michaela Beder, Michelle Cohen, Katrina Hui, Carolina Jimenez, 2002 individual and 34 organisational signatories
       
  • Monitoring country progress and achievements by making global predictions:
           is the tail wagging the dog'
    • Abstract: Publication date: Available online 13 April 2018Source: The LancetAuthor(s): Ties Boerma, Cesar Victora, Carla Abouzahr
       
  • On reducing the risk of vaccine-associated paralytic poliomyelitis in the
           global transition from oral to inactivated poliovirus vaccine
    • Abstract: Publication date: Available online 5 April 2018Source: The LancetAuthor(s): Xiangdong Peng, Xiaojiang Hu, Miguel A Salazar
       
  • Viroj Tangcharoensathien: master carpenter of Thai health care
    • Abstract: Publication date: Available online 1 February 2018Source: The LancetAuthor(s): Geoff Watts
       
  • A new powerful drug to combat river blindness
    • Abstract: Publication date: Available online 18 January 2018Source: The LancetAuthor(s): Michel Boussinesq
       
  • Single dose moxidectin versus ivermectin for Onchocerca volvulus infection
           in Ghana, Liberia, and the Democratic Republic of the Congo: a randomised,
           controlled, double-blind phase 3 trial
    • Abstract: Publication date: Available online 18 January 2018Source: The LancetAuthor(s): Nicholas O Opoku, Didier K Bakajika, Eric M Kanza, Hayford Howard, Germain L Mambandu, Amos Nyathirombo, Maurice M Nigo, Kambale Kasonia, Safari L Masembe, Mupenzi Mumbere, Kambale Kataliko, Jemmah P Larbelee, Mawolo Kpawor, Kpehe M Bolay, Fatorma Bolay, Simon K Attah, Michel Vaillant, Christine M Halleux, Annette C KueselSummaryBackgroundThe morbidity and socioeconomic effects of onchocerciasis, a parasitic disease that is primarily endemic in sub-Saharan Africa, have motivated large morbidity and transmission control programmes. Annual community-directed ivermectin treatment has substantially reduced prevalence. Elimination requires intensified efforts, including more efficacious treatments. We compared parasitological efficacy and safety of moxidectin and ivermectin.MethodsThis double-blind, parallel group, superiority trial was done in four sites in Ghana, Liberia, and the Democratic Republic of the Congo. We enrolled participants (aged ≥12 years) with at least 10 Onchocerca volvulus microfilariae per mg skin who were not co-infected with Loa loa or lymphatic filariasis microfilaraemic. Participants were randomly allocated, stratified by sex and level of infection, to receive a single oral dose of 8 mg moxidectin or 150 μg/kg ivermectin as overencapsulated oral tablets. The primary efficacy outcome was skin microfilariae density 12 months post treatment. We used a mixed-effects model to test the hypothesis that the primary efficacy outcome in the moxidectin group was 50% or less than that in the ivermectin group. The primary efficacy analysis population were all participants who received the study drug and completed 12-month follow-up (modified intention to treat). This study is registered with ClinicalTrials.gov, number NCT00790998.FindingsBetween April 22, 2009, and Jan 23, 2011, we enrolled and allocated 998 participants to moxidectin and 501 participants to ivermectin. 978 received moxidectin and 494 ivermectin, of which 947 and 480 were included in primary efficacy outcome analyses. At 12 months, skin microfilarial density (microfilariae per mg of skin) was lower in the moxidectin group (adjusted geometric mean 0·6 [95% CI 0·3–1·0]) than in the ivermectin group (4·5 [3·5–5·9]; difference 3·9 [3·2–4·9], p
       
 
 
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