Hot off the presses! Feb 18 LANCET

The Feb 18 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:

• An epidemic of risk factors for cardiovascular disease
  - LANCET 377(9765):527 (2011)
  
• Tobacco companies expand their epidemic of death
  - LANCET 377(9765):528 (2011)
  
• School: a place for children to learn their HIV status?
  - LANCET 377(9765):528 (2011)
  
• Stemming the global tsunami of cardiovascular disease
  - LANCET 377(9765):529-532 (2011)
  
• Securing the right to health for all in India
  - LANCET 377(9765):532-533 (2011)
  
• Southeast Asia: an emerging focus for global health
  - LANCET 377(9765):534-535 (2011)
  
• Mobilising the world for chronic NCDs
  - LANCET 377(9765):536-537 (2011)
  
• Sharing research data to improve public health
  - LANCET 377(9765):537-539 (2011)
  
• Offline: He'll fly his astral plane
  - LANCET 377(9765):540 (2011)
  
• European societies form biomedical alliance
  - LANCET 377(9765):541-542 (2011)
  
• Pedestrians at risk in Peru
  - LANCET 377(9765):543-544 (2011)
  
• A masterful biography of Camillo Golgi
  - LANCET 377(9765):545-546 (2011)
  
• Dark harvest
  - LANCET 377(9765):546 (2011)
  
• Hermaphrodite
  - LANCET 377(9765):547 (2011)
  
• Chay Oh May
  - LANCET 377(9765):547 (2011)
  
• The ancient origins of prosthetic medicine
  - LANCET 377(9765):548-549 (2011)
  
• Ernest Armstrong McCulloch
  - LANCET 377(9765):550 (2011)
  
• The end of the National Health Service?
  - LANCET 377(9765):551 (2011)
  
• Drugs and harm to society
  - LANCET 377(9765):551 (2011)
  
• Drugs and harm to society
  - LANCET 377(9765):551-552 (2011)
  
• Drugs and harm to society
  - LANCET 377(9765):552 (2011)
  
• Drugs and harm to society
  - LANCET 377(9765):552-553 (2011)
  
• Drugs and harm to society
  - LANCET 377(9765):553-554 (2011)
  
• Drugs and harm to society
  - LANCET 377(9765):554 (2011)
  
• Drugs and harm to society
  - LANCET 377(9765):554 (2011)
  
• Drugs and harm to society – Authors' reply
  - LANCET 377(9765):555 (2011)
  
• Medical student electives: potential for global health?
  - LANCET 377(9765):555 (2011)
  
• Identification of incestuous parental relationships by SNP-based DNA microarrays
  - LANCET 377(9765):555-556 (2011)
  
• National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants
  - LANCET 377(9765):557-567 (2011)
  Background Excess bodyweight is a major public health concern. However, few worldwide comparative analyses of long-term trends of body-mass index (BMI) have been done, and none have used recent national health examination surveys. We estimated worldwide trends in population mean BMI. Methods We estimated trends and their uncertainties of mean BMI for adults 20 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (960 country-years and 9·1 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean BMI by age, country, and year, accounting for whether a study was nationally representative. Findings Between 1980 and 2008, mean BMI worldwide increased by 0·4 kg/m2 per decade (95% uncertainty interval 0·2–0·6, posterior probability of being a true increase >0·999) for men and 0·5 kg/m2 per decade (0·3–0·7, posterior probability >0·999) for women. National BMI change for women ranged from non-significant decreases in 19 countries to increases of more than 2·0 kg/m2 per decade (posterior probabilities >0·99) in nine countries in Oceania. Male BMI increased in all but eight countries, by more than 2 kg/m2 per decade in Nauru and Cook Islands (posterior probabilities >0·999). Male and female BMIs in 2008 were highest in some Oceania countries, reaching 33·9 kg/m2 (32·8–35·0) for men and 35·0 kg/m2 (33·6–36·3) for women in Nauru. Female BMI was lowest in Bangladesh (20·5 kg/m2, 19·8–21·3) and male BMI in Democratic Republic of the Congo 19·9 kg/m2 (18·2–21·5), with BMI less than 21·5 kg/m2 for both sexes in a few countries in sub-Saharan Afr! ica, and east, south, and southeast Asia. The USA had the highest BMI of high-income countries. In 2008, an estimated 1·46 billion adults (1·41–1·51 billion) worldwide had BMI of 25 kg/m2 or greater, of these 205 million men (193–217 million) and 297 million women (280–315 million) were obese. Interpretation Globally, mean BMI has increased since 1980. The trends since 1980, and mean population BMI in 2008, varied substantially between nations. Interventions and policies that can curb or reverse the increase, and mitigate the health effects of high BMI by targeting its metabolic mediators, are needed in most countries. Funding Bill & Melinda Gates Foundation and WHO.
• National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants
  - LANCET 377(9765):568-577 (2011)
  Background Data for trends in blood pressure are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. However, few worldwide analyses of trends in blood pressure have been done. We estimated worldwide trends in population mean systolic blood pressure (SBP). Methods We estimated trends and their uncertainties in mean SBP for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (786 country-years and 5·4 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean SBP by age, country, and year, accounting for whether a study was nationally representative. Findings In 2008, age-standardised mean SBP worldwide was 128·1 mm Hg (95% uncertainty interval 126·7–129·4) in men and 124·4 mm Hg (123·0–125·9) in women. Globally, between 1980 and 2008, SBP decreased by 0·8 mm Hg per decade (−0·4 to 2·2, posterior probability of being a true decline=0·90) in men and 1·0 mm Hg per decade (−0·3 to 2·3, posterior probability=0·93) in women. Female SBP decreased by 3·5 mm Hg or more per decade in western Europe and Australasia (posterior probabilities ≥0·999). Male SBP fell most in high-income North America, by 2·8 mm Hg per decade (1·3–4·5, posterior probability >0·999), followed by Australasia and western Europe where it decreased by more than 2·0 mm Hg per decade (posterior probabilities >0·98). SBP rose in Oceania, east Africa, and south and southeast Asia for both sexes, and in west Africa for women, with the increases ranging 0·8–1·6 mm Hg per decade in men (posterior probabilities 0·72–0·91) and 1·0–! 2·7 mm Hg per decade for women (posterior probabilities 0·75–0·98). Female SBP was highest in some east and west African countries, with means of 135 mm Hg or greater. Male SBP was highest in Baltic and east and west African countries, where mean SBP reached 138 mm Hg or more. Men and women in western Europe had the highest SBP in high-income regions. Interpretation On average, global population SBP decreased slightly since 1980, but trends varied significantly across regions and countries. SBP is currently highest in low-income and middle-income countries. Effective population-based and personal interventions should be targeted towards low-income and middle-income countries. Funding Funding Bill & Melinda Gates Foundation and WHO.
• National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3·0 million participants
  - LANCET 377(9765):578-586 (2011)
  Background Data for trends in serum cholesterol are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. Previous analyses of trends in serum cholesterol were limited to a few countries, with no consistent and comparable global analysis. We estimated worldwide trends in population mean serum total cholesterol. Methods We estimated trends and their uncertainties in mean serum total cholesterol for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (321 country-years and 3·0 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean total cholesterol by age, country, and year, accounting for whether a study was nationally representative. Findings In 2008, age-standardised mean total cholesterol worldwide was 4·64 mmol/L (95% uncertainty interval 4·51–4·76) for men and 4·76 mmol/L (4·62–4·91) for women. Globally, mean total cholesterol changed little between 1980 and 2008, falling by less than 0·1 mmol/L per decade in men and women. Total cholesterol fell in the high-income region consisting of Australasia, North America, and western Europe, and in central and eastern Europe; the regional declines were about 0·2 mmol/L per decade for both sexes, with posterior probabilities of these being true declines 0·99 or greater. Mean total cholesterol increased in east and southeast Asia and Pacific by 0·08 mmol/L per decade (−0·06 to 0·22, posterior probability=0·86) in men and 0·09 mmol/L per decade (−0·07 to 0·26, posterior probability=0·86) in women. Despite converging trends, serum total cholesterol in 2008 was highest in the high-income region consisting of Australasia, North America, and western ! Europe; the regional mean was 5·24 mmol/L (5·08–5·39) for men and 5·23 mmol/L (5·03–5·43) for women. It was lowest in sub-Saharan Africa at 4·08 mmol/L (3·82–4·34) for men and 4·27 mmol/L (3·99–4·56) for women. Interpretation Nutritional policies and pharmacological interventions should be used to accelerate improvements in total cholesterol in regions with decline and to curb or prevent the rise in Asian populations and elsewhere. Population-based surveillance of cholesterol needs to be improved in low-income and middle-income countries. Funding Bill & Melinda Gates Foundation and WHO.
• Human resources for health in India
  - LANCET 377(9765):587-598 (2011)
  India has a severe shortage of human resources for health. It has a shortage of qualified health workers and the workforce is concentrated in urban areas. Bringing qualified health workers to rural, remote, and underserved areas is very challenging. Many Indians, especially those living in rural areas, receive care from unqualified providers. The migration of qualified allopathic doctors and nurses is substantial and further strains the system. Nurses do not have much authority or say within the health system, and the resources to train them are still inadequate. Little attention is paid during medical education to the medical and public health needs of the population, and the rapid privatisation of medical and nursing education has implications for its quality and governance. Such issues are a result of underinvestment in and poor governance of the health sector—two issues that the government urgently needs to address. A comprehensive national policy for human resou! rces is needed to achieve universal health care in India. The public sector will need to redesign appropriate packages of monetary and non-monetary incentives to encourage qualified health workers to work in rural and remote areas. Such a policy might also encourage task-shifting and mainstreaming doctors and practitioners who practice traditional Indian medicine (ayurveda, yoga and naturopathy, unani, and siddha) and homoeopathy to work in these areas while adopting other innovative ways of augmenting human resources for health. At the same time, additional investments will be needed to improve the relevance, quantity, and quality of nursing, medical, and public health education in the country.
• Emerging infectious diseases in southeast Asia: regional challenges to control
  - LANCET 377(9765):599-609 (2011)
  Southeast Asia is a hotspot for emerging infectious diseases, including those with pandemic potential. Emerging infectious diseases have exacted heavy public health and economic tolls. Severe acute respiratory syndrome rapidly decimated the region's tourist industry. Influenza A H5N1 has had a profound effect on the poultry industry. The reasons why southeast Asia is at risk from emerging infectious diseases are complex. The region is home to dynamic systems in which biological, social, ecological, and technological processes interconnect in ways that enable microbes to exploit new ecological niches. These processes include population growth and movement, urbanisation, changes in food production, agriculture and land use, water and sanitation, and the effect of health systems through generation of drug resistance. Southeast Asia is home to about 600 million people residing in countries as diverse as Singapore, a city state with a gross domestic product (GDP) of US$37 5! 00 per head, and Laos, until recently an overwhelmingly rural economy, with a GDP of US$890 per head. The regional challenges in control of emerging infectious diseases are formidable and range from influencing the factors that drive disease emergence, to making surveillance systems fit for purpose, and ensuring that regional governance mechanisms work effectively to improve control interventions.
• Heat, Oriental sore, and HIV
  - LANCET 377(9765):610 (2011)