Hot off the presses! Sep 19 Lancet

The Sep 19 issue of the Lancet is now up on Pubget (About Lancet): if you're at a subscribing institution, just click the link in the latest link at the home page. (Note you'll only be able to get all the PDFs in the issue if your institution subscribes to Pubget.)

Latest Articles Include:

• Sexual and reproductive health and climate change
  - Lancet 374(9694):949 (2009)
  
• Emergency care in the USA
  - Lancet 374(9694):950 (2009)
  
• Induced labour for pre-eclampsia and gestational hypertension
  Johnson DD - Lancet 374(9694):951-952 (2009)
  
• House screening for malaria control
  - Lancet 374(9694):954-955 (2009)
  
• Traditional health practitioners in South Africa
  - Lancet 374(9694):956-957 (2009)
  
• Health and climate change
  - Lancet 374(9694):961-962 (2009)
  
• Australia considers string of preventive health measures
  - Lancet 374(9694):963 (2009)
  
• Questions remain over validity of EUROCARE data
  - Lancet 374(9694):964-965 (2009)
  
• Concerns grow over Cambodia's "AIDS colony"
  - Lancet 374(9694):966 (2009)
  
• Skewering myths about relations between science and religion
  - Lancet 374(9694):967-968 (2009)
  
• Francis Collins: Director of the US National Institutes of Health
  - Lancet 374(9694):969 (2009)
  
• Bioengineered bodies and the moral imagination
  - Lancet 374(9694):970-971 (2009)
  
• Martti Karvonen
  - Lancet 374(9694):972 (2009)
  
• Politicians must heed health effects of climate change
  - Lancet 374(9694):973 (2009)
  
• Climate change is not the biggest global health threat
  - Lancet 374(9694):973-974 (2009)
  
• Did alcohol protect against death from breast cancer in Russia?
  - Lancet 374(9694):975 (2009)
  
• Did alcohol protect against death from breast cancer in Russia? – Authors' reply
  - Lancet 374(9694):975-976 (2009)
  
• Alcohol and global health: focus on acute pancreatitis needed
  - Lancet 374(9694):976-977 (2009)
  
• Alcohol and global health: focus on acute pancreatitis needed – Authors' reply
  - Lancet 374(9694):977 (2009)
  
• Reducing harm from alcohol: what about unrecorded products?
  - Lancet 374(9694):977 (2009)
  
• Carrier screening for cystic fibrosis
  - Lancet 374(9694):978 (2009)
  
• Carrier screening for cystic fibrosis – Authors' reply
  - Lancet 374(9694):978 (2009)
  
• Department of Error
  - Lancet 374(9694):978 (2009)
  
• Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomised controlled trial
  Koopmans CM Bijlenga D Groen H Vijgen SM Aarnoudse JG Bekedam DJ van den Berg PP de Boer K Burggraaff JM Bloemenkamp KW Drogtrop AP Franx A de Groot CJ Huisjes AJ Kwee A van Loon AJ Lub A Papatsonis DN van der Post JA Roumen FJ Scheepers HC Willekes C Mol BW van Pampus MG for the HYPITAT study group - Lancet 374(9694):979-988 (2009)
  Background Robust evidence to direct management of pregnant women with mild hypertensive disease at term is scarce. We investigated whether induction of labour in women with a singleton pregnancy complicated by gestational hypertension or mild pre-eclampsia reduces severe maternal morbidity. Methods We undertook a multicentre, parallel, open-label randomised controlled trial in six academic and 32 non-academic hospitals in the Netherlands between October, 2005, and March, 2008. We enrolled patients with a singleton pregnancy at 36–41 weeks' gestation, and who had gestational hypertension or mild pre-eclampsia. Participants were randomly allocated in a 1:1 ratio by block randomisation with a web-based application system to receive either induction of labour or expectant monitoring. Masking of intervention allocation was not possible. The primary outcome was a composite measure of poor maternal outcome—maternal mortality, maternal morbidity (eclampsia, HELLP syndrome, pulmonary oedema, thromboembolic disease, and placental abruption), progression to severe hypertension or proteinuria, and major post-partum haemorrhage (>1000 mL blood loss). Analysis was by intention to treat and treatment effect is presented as relative risk. This study is registered, number ISRCTN081! 32825. Findings 756 patients were allocated to receive induction of labour (n=377 patients) or expectant monitoring (n=379). 397 patients refused randomisation but authorised use of their medical records. Of women who were randomised, 117 (31%) allocated to induction of labour developed poor maternal outcome compared with 166 (44%) allocated to expectant monitoring (relative risk 0·71, 95% CI 0·59–0·86, p<0·0001). No cases of maternal or neonatal death or eclampsia were recorded. Interpretation Induction of labour is associated with improved maternal outcome and should be advised for women with mild hypertensive disease beyond 37 weeks' gestation. Funding ZonMw.
• Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials
  - Lancet 374(9694):989-997 (2009)
  Background Proton-pump inhibitors (PPIs) are often prescribed in combination with thienopyridines. Conflicting data exist as to whether PPIs diminish the efficacy of clopidogrel. We assessed the association between PPI use, measures of platelet function, and clinical outcomes for patients treated with clopidogrel or prasugrel. Methods In the PRINCIPLE-TIMI 44 trial, the primary outcome was inhibition of platelet aggregation at 6 h assessed by light-transmission aggregometry. In the TRITON-TIMI 38 trial, the primary endpoint was the composite of cardiovascular death, myocardial infarction, or stroke. In both studies, PPI use was at physician's discretion. We used a multivariable Cox model with propensity score to assess the association of PPI use with clinical outcomes. Findings In the PRINCIPLE-TIMI 44 trial, 201 patients undergoing elective percutaneous coronary intervention were randomly assigned to prasugrel (n=102) or high-dose clopidogrel (n=99). Mean inhibition of platelet aggregation was significantly lower for patients on a PPI than for those not on a PPI at 6 h after a 600 mg clopidogrel loading dose (23·2±19·5% vs 35·2±20·9%, p=0·02), whereas a more modest difference was seen with and without a PPI after a 60 mg loading dose of prasugrel (69·6±13·5% vs 76·7±12·4%, p=0·054). In the TRITON-TIMI 38 trial, 13 608 patients with an acute coronary syndrome were randomly assigned to prasugrel (n=6813) or clopidogrel (n=6795). In this study, 33% (n=4529) of patients were on a PPI at randomisation. No association existed between PPI use and risk of the primary endpoint for patients treated with clopidogrel (adjusted hazard ratio [HR] 0·94, 95% CI 0·80–1·11) or prasugrel (1·00, 0·84–1·20). Interpretation The current findings do not support the need to avoid concomitant use of PPIs, when clinically indicated, in patients receiving clopidogrel or prasugrel. Funding Daiichi Sankyo Company Limited and Eli Lilly and Company sponsored the trials. This analysis had no funding.
• Effect of two different house screening interventions on exposure to malaria vectors and on anaemia in children in The Gambia: a randomised controlled trial
  - Lancet 374(9694):998-1009 (2009)
  Background House screening should protect people against malaria. We assessed whether two types of house screening—full screening of windows, doors, and closing eaves, or installation of screened ceilings—could reduce house entry of malaria vectors and frequency of anaemia in children in an area of seasonal malaria transmission. Methods During 2006 and 2007, 500 occupied houses in and near Farafenni town in The Gambia, an area with low use of insecticide-treated bednets, were randomly assigned to receive full screening, screened ceilings, or no screening (control). Randomisation was done by computer-generated list, in permuted blocks of five houses in the ratio 2:2:1. Screening was not treated with insecticide. Exposure to mosquitoes indoors was assessed by fortnightly light trap collections during the transmission season. Primary endpoints included the number of female Anopheles gambiae sensu lato mosquitoes collected per trap per night. Secondary endpoints included frequency of anaemia (haemoglobin concentration <80 g/L) and parasitaemia at the end of the transmission season in children (aged 6 months to 10 years) who were living in the study houses. Analysis was by modified intention to treat (ITT), including all randomised houses for which there were some outcome data and all children from those houses ! who were sampled for haemoglobin and parasitaemia. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN51184253. Findings 462 houses were included in the modified ITT analysis (full screening, n=188; screened ceilings, n=178; control, n=96). The mean number of A gambiae caught in houses without screening was 37·5 per trap per night (95% CI 31·6–43·3), compared with 15·2 (12·9–17·4) in houses with full screening (ratio of means 0·41, 95% CI 0·31–0·54; p<0·0001) and 19·1 (16·1–22·1) in houses with screened ceilings (ratio 0·53, 0·40–0·70; p<0·0001). 755 children completed the study, of whom 731 had complete clinical and covariate data and were used in the analysis of clinical outcomes. 30 (19%) of 158 children from control houses had anaemia, compared with 38 (12%) of 309 from houses with full screening (adjusted odds ratio [OR] 0·53, 95% CI 0·29–0·97; p=0·04), and 31 (12%) of 264 from houses with screened ceilings (OR 0·51, 0·27–0·96; p=0·04). Frequency of parasitaemia did not differ between intervention and control groups. Interpretation House screening substantially reduced the number of mosquitoes inside houses and could contribute to prevention of anaemia in children. Funding Medical Research Council.
• Distinctly different purpura on different arms
  - Lancet 374(9694):1010 (2009)
  
• Violence and injuries in South Africa: prioritising an agenda for prevention
  - Lancet 374(9694):1011-1022 (2009)
  Violence and injuries are the second leading cause of death and lost disability-adjusted life years in South Africa. The overall injury death rate of 157·8 per 100 000 population is nearly twice the global average, and the rate of homicide of women by intimate partners is six times the global average. With a focus on homicide, and violence against women and children, we review the magnitude, contexts of occurrence, and patterns of violence, and refer to traffic-related and other unintentional injuries. The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking, and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement. Although there have been advances in development of services for victims of violence, innovation from non-governmental orga! nisations, and evidence from research, there has been a conspicuous absence of government stewardship and leadership. Successful prevention of violence and injury is contingent on identification by the government of violence as a strategic priority and development of an intersectoral plan based on empirically driven programmes and policies.
• Achieving the health Millennium Development Goals for South Africa: challenges and priorities
  - Lancet 374(9694):1023-1031 (2009)
  15 years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The effect of the unprecedented HIV/AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potential of South Africa to attain the Millennium Development Goals (MDGs). However The Lancet's Series on South Africa has identified several examples of leadership and innovation that point towards a different future scenario. We discuss the type of vision, leadership, and priority actions needed to achieve such a change. We still have time to change the health trajectory of the country, and even meet the MDGs. The South African Government, installed in April, 2009, has the mandate and potential to address the public health emergencies facing the country—will they do so or will another opportunity and many more lives be lost?
• Child undernutrition, tropical enteropathy, toilets, and handwashing
  - Lancet 374(9694):1032-1035 (2009)
  
• H1N1 pneumonitis treated with intravenous zanamivir
  - Lancet 374(9694):1036 (2009)