Hot off the presses! Oct 15 LANCET

The Oct 15 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:

• A year of German celebrations and new beginnings
  - LANCET 376(9748):1195 (2010)
  
• Media power—for good and for ill
  - LANCET 376(9748):1196 (2010)
  
• FDA: regulators or abdicators?
  - LANCET 376(9748):1196 (2010)
  
• Academic medicine must take its global role: the M8 Alliance of Academic Health Centers and Medical Universities
  - LANCET 376(9748):1197-1198 (2010)
  
• Measuring and improving health-system productivity
  - LANCET 376(9748):1198-1200 (2010)
  
• Global health governance—the response to infectious diseases
  - LANCET 376(9748):1200-1201 (2010)
  
• Is sucrose an effective analgesic for newborn babies?
  Lasky RE van Drongelen W - LANCET 376(9748):1201-1203 (2010)
  
• Acute coronary syndromes: finding meaning in OASIS 7
  Stone GW - LANCET 376(9748):1203-1205 (2010)
  
• Active case-finding for TB in the community: time to act
  Getahun H Raviglione M - LANCET 376(9748):1205-1206 (2010)
  
• Public health insecticide development: a status of hiatus
  - LANCET 376(9748):1207 (2010)
  
• Japan—a call for research papers
  - LANCET 376(9748):1207 (2010)
  
• Offline: Interdisciplinary synergies
  - LANCET 376(9748):1208 (2010)
  
• Pakistan moves to tackle acid violence
  - LANCET 376(9748):1209-1210 (2010)
  
• Romania's health system lurches into new crisis
  - LANCET 376(9748):1211-1212 (2010)
  
• Choking on corruption—reforming Pakistan's health system
  - LANCET 376(9748):1213-1214 (2010)
  
• Looking into the body
  - LANCET 376(9748):1214 (2010)
  
• Manisha Gupte—working to empower women in rural India
  - LANCET 376(9748):1215 (2010)
  
• The doctor who would be king
  - LANCET 376(9748):1216-1217 (2010)
  
• Ralph George Hendrickse
  - LANCET 376(9748):1218 (2010)
  
• Intimate-partner violence and HIV in South African women
  - LANCET 376(9748):1219 (2010)
  
• Intimate-partner violence and HIV in South African women
  - LANCET 376(9748):1219 (2010)
  
• Intimate-partner violence and HIV in South African women – Authors' reply
  - LANCET 376(9748):1219-1220 (2010)
  
• Free light-chains and renal disorders: when small is worse
  - LANCET 376(9748):1220 (2010)
  
• Free light-chains and renal disorders: when small is worse
  - LANCET 376(9748):1221 (2010)
  
• Free light-chains and renal disorders: when small is worse
  - LANCET 376(9748):1221 (2010)
  
• Free light-chains and renal disorders: when small is worse – Authors' reply
  - LANCET 376(9748):1221-1222 (2010)
  
• What is the AAP's real view on medical involvement in ritual cutting of children?
  - LANCET 376(9748):1222 (2010)
  
• What is the AAP's real view on medical involvement in ritual cutting of children? – Response from the American Academy of Pediatrics
  - LANCET 376(9748):1222 (2010)
  
• CONSORT 2010: comments
  - LANCET 376(9748):1222-1223 (2010)
  
• Estimates of mortality in children younger than 5 years for Burkina Faso
  - LANCET 376(9748):1223-1224 (2010)
  
• Self-harm on either side of the pond
  - LANCET 376(9748):1224 (2010)
  
• Department of Error
  - LANCET 376(9748):1224 (2010)
  
• Department of Error
  - LANCET 376(9748):1224 (2010)
  
• Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial
  Slater R Cornelissen L Fabrizi L Patten D Yoxen J Worley A Boyd S Meek J Fitzgerald M - LANCET 376(9748):1225-1232 (2010)
  Background Many infants admitted to hospital undergo repeated invasive procedures. Oral sucrose is frequently given to relieve procedural pain in neonates on the basis of its effect on behavioural and physiological pain scores. We assessed whether sucrose administration reduces pain-specific brain and spinal cord activity after an acute noxious procedure in newborn infants. Methods In this double-blind, randomised controlled trial, 59 newborn infants at University College Hospital (London, UK) were randomly assigned to receive 0·5 mL 24% sucrose solution or 0·5 mL sterile water 2 min before undergoing a clinically required heel lance. Randomisation was by a computer-generated randomisation code, and researchers, clinicians, participants, and parents were masked to the identity of the solutions. The primary outcome was pain-specific brain activity evoked by one time-locked heel lance, recorded with electroencephalography and identified by principal component analysis. Secondary measures were baseline behavioural and physiological measures, observational pain scores (PIPP), and spinal nociceptive reflex withdrawal activity. Data were analysed per protocol. This study is registered, number ISRCTN78390996. Findings 29 infants were assigned to receive sucrose and 30 to sterilised water; 20 and 24 infants, respectively, were included in the analysis of the primary outcome measure. Nociceptive brain activity after the noxious heel lance did not differ significantly between infants who received sucrose and those who received sterile water (sucrose: mean 0·10, 95% CI 0·04–0·16; sterile water: mean 0·08, 0·04–0·12; p=0·46). No significant difference was recorded between the sucrose and sterile water groups in the magnitude or latency of the spinal nociceptive reflex withdrawal recorded from the biceps femoris of the stimulated leg. The PIPP score was significantly lower in infants given sucrose than in those given sterile water (mean 5·8, 95% CI 3·7–7·8 vs 8·5, 7·3–9·8; p=0·02) and significantly more infants had no change in facial expression after sucrose administration (seven of 20 [35%] vs none of 24; p<0·0001). Interpretation Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief. Funding Medical Research Council.
• Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial
  Mehta SR Tanguay JF Eikelboom JW Jolly SS Joyner CD Granger CB Faxon DP Rupprecht HJ Budaj A Avezum A Widimsky P Steg PG Bassand JP Montalescot G Macaya C Di Pasquale G Niemela K Ajani AE White HD Chrolavicius S Gao P Fox KA Yusuf S on behalf of the CURRENT-OASIS 7 trial investigators - LANCET 376(9748):1233-1243 (2010)
  Background Clopidogrel and aspirin are the most commonly used antiplatelet therapies for percutaneous coronary intervention (PCI). We assessed the effect of various clopidogrel and aspirin regimens in prevention of major cardiovascular events and stent thrombosis in patients undergoing PCI. Methods The CURRENT-OASIS 7 trial was undertaken in 597 centres in 39 countries. 25 086 individuals with acute coronary syndromes and intended early PCI were randomly assigned to double-dose (600 mg on day 1, 150 mg on days 2–7, then 75 mg daily) versus standard-dose (300 mg on day 1 then 75 mg daily) clopidogrel, and high-dose (300–325 mg daily) versus low-dose (75–100 mg daily) aspirin. Randomisation was done with a 24 h computerised central automated voice response system. The clopidogrel dose comparison was double-blind and the aspirin dose comparison was open label with blinded assessment of outcomes. This prespecified analysis is of the 17 263 individuals who underwent PCI. The primary outcome was cardiovascular death, myocardial infarction, or stroke at 30 days. Analyses were by intention to treat, adjusted for propensity to undergo PCI. This trial is registered with ClinicalTrials.gov, number NCT00335452. Findings 8560 patients were assigned to double-dose and 8703 to standard-dose clopidogrel (8558 and 8702 completed 30-day follow-up, respectively), and 8624 to high-dose and 8639 to low-dose aspirin (8622 and 8638 completed 30-day follow-up, respectively). Compared with the standard dose, double-dose clopidogrel reduced the rate of the primary outcome (330 events [3·9%] vs 392 events [4·5%]; adjusted hazard ratio 0·86, 95% CI 0·74–0·99, p=0·039) and definite stent thrombosis (58 [0·7%] vs 111 [1·3%]; 0·54 [0·39–0·74], p=0·0001). High-dose and low-dose aspirin did not differ for the primary outcome (356 [4·1%] vs 366 [4·2%]; 0·98, 0·84–1·13, p=0·76). Major bleeding was more common with double-dose than with standard-dose clopidogrel (139 [1·6%] vs 99 [1·1%]; 1·41, 1·09–1·83, p=0·009) and did not differ between high-dose and low-dose aspirin (128 [1·5%] vs 110 [1·3%]; 1·18, 0·92–1·53, p=0·20). Interpretation In patients undergoing PCI for acute coronary syndromes, a 7-day double-dose clopidogrel regimen was associated with a reduction in cardiovascular events and stent thrombosis compared with the standard dose. Efficacy and safety did not differ between high-dose and low-dose aspirin. A double-dose clopidogrel regimen can be considered for all patients with acute coronary syndromes treated with an early invasive strategy and intended early PCI. Funding Sanofi-Aventis and Bristol-Myers Squibb.
• Comparison of two active case-finding strategies for community-based diagnosis of symptomatic smear-positive tuberculosis and control of infectious tuberculosis in Harare, Zimbabwe (DETECTB): a cluster-randomised trial
  Corbett EL Bandason T Duong T Dauya E Makamure B Churchyard GJ Williams BG Munyati SS Butterworth AE Mason PR Mungofa S Hayes RJ - LANCET 376(9748):1244-1253 (2010)
  Background Control of tuberculosis in settings with high HIV prevalence is a pressing public health priority. We tested two active case-finding strategies to target long periods of infectiousness before diagnosis, which is typical of HIV-negative tuberculosis and is a key driver of transmission. Methods Clusters of neighbourhoods in the high-density residential suburbs of Harare, Zimbabwe, were randomised to receive six rounds of active case finding at 6-monthly intervals by either mobile van or door-to-door visits. Randomisation was done by selection of discs of two colours from an opaque bag, with one disc to represent every cluster, and one colour allocated to each intervention group before selection began. In both groups, adult (≥16 years) residents volunteering chronic cough (≥2 weeks) had two sputum specimens collected for fluorescence microscopy. Community health workers and cluster residents were not masked to intervention allocation, but investigators and laboratory staff were masked to allocation until final analysis. The primary outcome was the cumulative yield of smear-positive tuberculosis per 1000 adult residents, compared between intervention groups; analysis was by intention to treat. The secondary outcome was change in prevalence of culture-positive tub! erculosis from before intervention to before round six of intervention in 12% of randomly selected households from the two intervention groups combined; analysis was based on participants who provided sputum in the two prevalence surveys. This trial is registered, number ISRCTN84352452. Findings 46 study clusters were identified and randomly allocated equally between intervention groups, with 55 741 adults in the mobile van group and 54 691 in the door-to-door group at baseline. HIV prevalence was 21% (1916/9060) and in the 6 months before intervention the smear-positive case notification rate was 2·8 per 1000 adults per year. The trial was completed as planned with no adverse events. The mobile van detected 255 smear-positive patients from 5466 participants submitting sputum compared with 137 of 4711 participants identified through door-to-door visits (adjusted risk ratio 1·48, 95% CI 1·11–1·96, p=0·0087). The overall prevalence of culture-positive tuberculosis declined from 6·5 per 1000 adults (95% CI 5·1–8·3) to 3·7 per 1000 adults (2·6–5·0; adjusted risk ratio 0·59, 95% CI 0·40–0·89, p=0·0112). Interpretation Wide implementation of active case finding, particularly with a mobile van approach, could have rapid effects on tuberculosis transmission and disease. Funding Wellcome Trust.
• Financing of HIV/AIDS programme scale-up in low-income and middle-income countries, 2009–31
  - LANCET 376(9748):1254-1260 (2010)
  As the global HIV/AIDS pandemic nears the end of its third decade, the challenges of efficient mobilisation of funds and management of resources are increasingly prominent. The aids2031 project modelled long-term funding needs for HIV/AIDS in developing countries with a range of scenarios and substantial variation in costs: ranging from US$397 to $722 billion globally between 2009 and 2031, depending on policy choices adopted by governments and donors. We examine what these figures mean for individual developing countries, and estimate the proportion of HIV/AIDS funding that they and donors will provide. Scenarios for expanded HIV/AIDS prevention, treatment, and mitigation were analysed for 15 representative countries. We suggest that countries will move in increasingly divergent directions over the next 20 years; middle-income countries with a low burden of HIV/AIDS will gradually be able to take on the modest costs of their HIV/AIDS response, whereas low-income count! ries with a high burden of disease will remain reliant upon external support for their rapidly expanding costs. A small but important group of middle-income countries with a high prevalence of HIV/AIDS (eg, South Africa) form a third category, in which rapid scale-up in the short term, matched by outside funds, could be phased down within 10 years assuming strategic investments are made for prevention and efficiency gains are made in treatment.
• Use of mass media campaigns to change health behaviour
  - LANCET 376(9748):1261-1271 (2010)
  Mass media campaigns are widely used to expose high proportions of large populations to messages through routine uses of existing media, such as television, radio, and newspapers. Exposure to such messages is, therefore, generally passive. Such campaigns are frequently competing with factors, such as pervasive product marketing, powerful social norms, and behaviours driven by addiction or habit. In this Review we discuss the outcomes of mass media campaigns in the context of various health-risk behaviours (eg, use of tobacco, alcohol, and other drugs, heart disease risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation). We conclude that mass media campaigns can produce positive changes or prevent negative changes in health-related behaviours across large populations. We assess what contributes to these outcomes, such as concurrent availability of required services and products, availability of co! mmunity-based programmes, and policies that support behaviour change. Finally, we propose areas for improvement, such as investment in longer better-funded campaigns to achieve adequate population exposure to media messages.
• Infant colitis—it's in the genes
  - LANCET 376(9748):1272 (2010)