Latest Articles Include:
- What has the Gates Foundation done for global health?
- Lancet 373(9675):1577 (2009)
- A UK Google for guidelines
- Lancet 373(9675):1578 (2009)
- Pre-empting a pandemic—fact or fiction?
- Lancet 373(9675):1578 (2009)
- Voglibose for prevention of type 2 diabetes mellitus
- Lancet 373(9675):1579-1580 (2009)
- Resuscitation at birth and long-term follow-up
- Lancet 373(9675):1581-1582 (2009)
- Home-based management of malaria in the era of urbanisation
- Lancet 373(9675):1582-1584 (2009)
- Accelerating the health impact of the Gates Foundation
- Lancet 373(9675):1584-1585 (2009)
- Primary health care as a route to health security
Chan M - Lancet 373(9675):1586-1587 (2009)
- Certification of brain death: take care
- Lancet 373(9675):1587-1589 (2009)
- Arterial blood measurements in climbers on Mount Everest
- Lancet 373(9675):1589-1590 (2009)
- Influenza begs many questions
- Lancet 373(9675):1590 (2009)
- Questions raised over response to influenza A outbreak
- Lancet 373(9675):1591-1592 (2009)
- US Senate confirms new health secretary
- Lancet 373(9675):1593 (2009)
- Global Fund looks to boost private sector contributions
- Lancet 373(9675):1594 (2009)
- Does autism need a cure?
- Lancet 373(9675):1595-1596 (2009)
- Witness to birth days
- Lancet 373(9675):1596 (2009)
- Time for a fat tax?
- Lancet 373(9675):1597 (2009)
- Geoffrey Norman
- Lancet 373(9675):1597 (2009)
- Female patients and practitioners in medieval Islam
- Lancet 373(9675):1598-1599 (2009)
- Sir John Royden Maddox
- Lancet 373(9675):1600 (2009)
- 10-day below-knee cast for management of severe ankle sprains
- Lancet 373(9675):1601 (2009)
- 10-day below-knee cast for management of severe ankle sprains
- Lancet 373(9675):1601 (2009)
- 10-day below-knee cast for management of severe ankle sprains
- Lancet 373(9675):1602 (2009)
- 10-day below-knee cast for management of severe ankle sprains – Authors' reply
- Lancet 373(9675):1602-1603 (2009)
- Was the Pope wrong?
- Lancet 373(9675):1603 (2009)
- Was the Pope wrong?
- Lancet 373(9675):1603 (2009)
- Was the Pope wrong?
- Lancet 373(9675):1603-1604 (2009)
- Was the Pope wrong?
- Lancet 373(9675):1604 (2009)
- Buried data and the UK Healthcare Commission's legacy
- Lancet 373(9675):1604-1605 (2009)
- Let's make the studies within systematic reviews count
- Lancet 373(9675):1605 (2009)
- NICE head injury guidelines pre-empted two millennia ago
- Lancet 373(9675):1605-1606 (2009)
- Department of Error
- Lancet 373(9675):1606 (2009)
- Department of Error
- Lancet 373(9675):1606 (2009)
- Voglibose for prevention of type 2 diabetes mellitus: a randomised, double-blind trial in Japanese individuals with impaired glucose tolerance
- Lancet 373(9675):1607-1614 (2009)
Background The increased prevalence of type 2 diabetes mellitus is a major concern for health providers. We therefore assessed whether voglibose, an α-glucosidase inhibitor, could prevent the development of type 2 diabetes in high-risk Japanese individuals with impaired glucose tolerance. Methods 1780 eligible patients on a standard diet and taking regular exercise with impaired glucose tolerance were randomly assigned to oral voglibose 0·2 mg three times a day (n=897) or placebo (n=883) in a multicentre, double-blind, parallel group trial. Treatment was continued until participants developed type 2 diabetes (primary endpoint) or normoglycaemia (secondary endpoint), or for a minimum of 3 years, subject to the findings of an interim analysis. Analysis was by full analysis set. This trial is registered with the University Hospital Medical Information Network (UMIN) clinical trials registry, number UMIN 000001109. Findings In the interim analysis, voglibose was better than placebo (p=0·0026) in individuals treated for an average of 48·1 weeks (SD 36·3). Patients treated with voglibose had a lower risk of progression to type 2 diabetes than did those on placebo (50 of 897 vs 106 of 881; hazard ratio 0·595, 95% CI 0·433–0·818; p=0·0014). More people in the voglibose group achieved normoglycaemia than did those in the placebo group (599 of 897 vs 454 of 881; 1·539, 1·357–1·746; p<0·0001). 810 (90%) of 897 patients in the voglibose group had adverse events versus 750 (85%) of 881 in the placebo group. Serious adverse events (all one each) in the voglibose group were cholecystitis, colonic polyp, rectal neoplasm, inguinal hernia, liver dysfunction, and subarachnoid haemorrhage, and in the placebo group were cerebral infarction and cholecystitis. Interpretation Voglibose, in addition to lifestyle modification, can reduce the development of type 2 diabetes in high-risk Japanese individuals with impaired glucose tolerance. Funding Takeda. - Resuscitation at birth and cognition at 8 years of age: a cohort study
- Lancet 373(9675):1615-1622 (2009)
Background Mild cerebral injury might cause subtle defects in cognitive function that are only detectable as the child grows older. Our aim was to determine whether infants receiving resuscitation after birth, but with no symptoms of encephalopathy, have reduced intelligence quotient (IQ) scores in childhood. Methods Three groups of infants were selected from the Avon Longitudinal Study of Parents and Children: infants who were resuscitated at birth but were asymptomatic for encephalopathy and had no further neonatal care (n=815), those who were resuscitated and had neonatal care for symptoms of encephalopathy (n=58), and the reference group who were not resuscitated, were asymptomatic for encephalopathy, and had no further neonatal care (n=10 609). Cognitive function was assessed at a mean age of 8·6 years (SD 0·33); a low IQ score was defined as less than 80. IQ scores were obtained for 5953 children with a shortened version of the Weschler intelligence scale for children (WISC-III), the remaining 5529 were non-responders. All children did not complete all parts of the test, and therefore multiplied IQ values comparable to the full-scale test were only available for 5887 children. Results were adjusted for clinical and social covariates. Chained equations were used to impute missing ! values of covariates. Findings In the main analysis at 8 years of age (n=5887), increased risk of a low IQ score was recorded in both resuscitated infants asymptomatic for encephalopathy (odds ratio 1·65 [95% CI 1·13–2·43]) and those with symptoms of encephalopathy (6·22 [1·57–24·65]). However, the population of asymptomatic infants was larger than that of infants with encephalopathy, and therefore the population attributable risk fraction for an IQ score that might be attributable to the need for resuscitation at birth was 3·4% (95% CI 0·5–6·3) for asymptomatic infants and 1·2% (0·2–2·2) for those who developed encephalopathy. Interpretation Infants who were resuscitated had increased risk of a low IQ score, even if they remained healthy during the neonatal period. Resuscitated infants asymptomatic for encephalopathy might result in a larger proportion of adults with low IQs than do those who develop neurological symptoms consistent with encephalopathy. Funding Wellcome Trust. - Home management of malaria with artemether-lumefantrine compared with standard care in urban Ugandan children: a randomised controlled trial
- Lancet 373(9675):1623-1631 (2009)
Background Home management of malaria—the presumptive treatment of febrile children with antimalarial drugs—is advocated to ensure prompt effective treatment of the disease. We assessed the effect of home delivery of artemether-lumefantrine on the incidence of antimalarial treatment and on clinical outcomes in children from an urban setting with fairly low malaria transmission. Methods In Kampala, Uganda, 437 children aged between 1 and 6 years from 325 households were randomly assigned by a computer-generated sequence to receive home delivery of prepackaged artemether-lumefantrine for presumptive treatment of febrile illnesses (n=225) or current standard of care (n=212). Randomisation was done by household after a pilot period of 1 month. After randomisation, study participants were followed up for an additional 12 months and information on their health and treatment of illnesses was obtained by use of monthly questionnaires and household diaries, which were completed by the participants' carers. The primary outcome was treatment incidence density per person-year. Analysis of the primary outcome was done on the modified intention-to-treat population, which included all participants apart from those excluded before data collection. This trial is registered with ClinicalTrials.gov, number NCT00115921. Findings Eight participants in the home management group and four in the standard care group were excluded before data collection; therefore, the primary analysis was done in 217 and 208 participants, respectively. The home management group received nearly twice the number of antimalarial treatments as the standard care group (4·66 per person-year vs 2·53 per person-year; incidence rate ratio [IRR] 1·72, 95% CI 1·43–2·06, p<0·0001), and nearly five times the number given to children with microscopically confirmed malaria in a comparable cohort of children (4·66 per person-year vs 1·03 per person-year, IRR 5·19, 95% CI 4·24–6·35, p<0·0001). Clinical data were available for 189 children in the home management group and 176 in the control group at study end; the main reasons for exclusion were movement out of the study area or loss to follow-up. The proportion of participants with parasitaemia at final assessment in the intervention group was lower than in the control gr! oup (four [2%] vs 17 [10%], p=0·006), but there were no other differences in standard malariometric indices, including anaemia. Serious adverse events were captured retrospectively. One child died in each group (home management—severe pneumonia and possible septicaemia; standard care—presumed respiratory failure). Interpretation Although home management of malaria led to prompt treatment of fever, there was little effect on clinical outcomes. The substantial over-treatment suggests that artemether-lumefantrine provided in the home might not be appropriate for large urban areas or settings with fairly low malaria transmission. Funding Gates Malaria Partnership. - Intracerebral haemorrhage
- Lancet 373(9675):1632-1644 (2009)
Intracerebral haemorrhage is an important public health problem leading to high rates of death and disability in adults. Although the number of hospital admissions for intracerebral haemorrhage has increased worldwide in the past 10 years, mortality has not fallen. Results of clinical trials and observational studies suggest that coordinated primary and specialty care is associated with lower mortality than is typical community practice. Development of treatment goals for critical care, and new sequences of care and specialty practice can improve outcome after intracerebral haemorrhage. Specific treatment approaches include early diagnosis and haemostasis, aggressive management of blood pressure, open surgical and minimally invasive surgical techniques to remove clot, techniques to remove intraventricular blood, and management of intracranial pressure. These approaches improve clinical management of patients with intracerebral haemorrhage and promise to reduce mortalit! y and increase functional survival. - The Bill & Melinda Gates Foundation's grant-making programme for global health
- Lancet 373(9675):1645-1653 (2009)
The Bill & Melinda Gates Foundation is a major contributor to global health; its influence on international health policy and the design of global health programmes and initiatives is profound. Although the foundation's contribution to global health generally receives acclaim, fairly little is known about its grant-making programme. We undertook an analysis of 1094 global health grants awarded between January, 1998, and December, 2007. We found that the total value of these grants was US$8·95 billion, of which $5·82 billion (65%) was shared by only 20 organisations. Nevertheless, a wide range of global health organisations, such as WHO, the GAVI Alliance, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, prominent universities, and non-governmental organisations received grants. $3·62 billion (40% of all funding) was given to supranational organisations. Of the remaining amount, 82% went to recipients based in the USA. Just over a third ($3·2! 7 billion) of funding was allocated to research and development (mainly for vaccines and microbicides), or to basic science research. The findings of this report raise several questions about the foundation's global health grant-making programme, which needs further research and assessment. - Towards a new developmental synthesis: adaptive developmental plasticity and human disease
- Lancet 373(9675):1654-1657 (2009)
- Fatal consequences of an ear infection
- Lancet 373(9675):1658 (2009)
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