Hot off the presses! Apr 29 LANCET

The Apr 29 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:

• Ending racial and ethnic health disparities in the USA
  - LANCET 377(9775):1379 (2011)
  
• Physician, heal thyself
  - LANCET 377(9775):1380 (2011)
  
• Tackling cancer and heart disease in people with HIV/AIDS
  - LANCET 377(9775):1380 (2011)
  
• Radial angioplasty: worthy RIVAL, not undisputed winner
  - LANCET 377(9775):1381-1383 (2011)
  
• Pay-for-performance and the Millennium Development Goals
  - LANCET 377(9775):1383-1385 (2011)
  
• Safe injection facilities save lives
  - LANCET 377(9775):1385-1386 (2011)
  
• Stillbirths: breaking the silence of a hidden grief
  - LANCET 377(9775):1386-1388 (2011)
  
• Scrambling for Africa? Universities and global health
  - LANCET 377(9775):1388-1390 (2011)
  
• "Gratuities" for donated organs: ethically indefensible
  - LANCET 377(9775):1390-1391 (2011)
  
• Offline: The wisdom of small rooms
  - LANCET 377(9775):1392 (2011)
  
• How did Sierra Leone provide free health care?
  - LANCET 377(9775):1393-1396 (2011)
  
• The legacies of Francis Galton
  - LANCET 377(9775):1397 (2011)
  
• Fuelling obesity
  - LANCET 377(9775):1398 (2011)
  
• Haja Zainab Bangura: Sierra Leone's tireless Minister of Health
  - LANCET 377(9775):1399 (2011)
  
• A philosopher's view of the long road from RCTs to effectiveness
  - LANCET 377(9775):1400-1401 (2011)
  
• Barbara Evelyn Clayton
  - LANCET 377(9775):1402 (2011)
  
• Checking for plagiarism, duplicate publication, and text recycling
  - LANCET 377(9775):1403 (2011)
  
• Checking for plagiarism, duplicate publication, and text recycling
  - LANCET 377(9775):1403 (2011)
  
• Checking for plagiarism, duplicate publication, and text recycling
  - LANCET 377(9775):1403 (2011)
  
• Access to information is crucial for science
  - LANCET 377(9775):1404 (2011)
  
• Access to information is crucial for science
  - LANCET 377(9775):1404 (2011)
  
• Children and multidrug-resistant tuberculosis
  - LANCET 377(9775):1404-1405 (2011)
  
• Children and multidrug-resistant tuberculosis – Authors' reply
  - LANCET 377(9775):1405 (2011)
  
• Critical illness in developing countries: dying in the dark
  - LANCET 377(9775):1405 (2011)
  
• Critical illness in developing countries: dying in the dark – Authors' reply
  - LANCET 377(9775):1406 (2011)
  
• Global health aid: raise more, spend better
  - LANCET 377(9775):1406-1407 (2011)
  
• Clostridium difficile PCR ribotype 176 in the Czech Republic and Poland
  - LANCET 377(9775):1407 (2011)
  
• Nutritional status and vitamin D3 during antimicrobial treatment
  - LANCET 377(9775):1407-1408 (2011)
  
• Nutritional status and vitamin D3 during antimicrobial treatment – Authors' reply
  - LANCET 377(9775):1408 (2011)
  
• The case for books (and libraries)
  - LANCET 377(9775):1408 (2011)
  
• Department of Error
  - LANCET 377(9775):1408 (2011)
  
• Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial
  - LANCET 377(9775):1409-1420 (2011)
  Background Small trials have suggested that radial access for percutaneous coronary intervention (PCI) reduces vascular complications and bleeding compared with femoral access. We aimed to assess whether radial access was superior to femoral access in patients with acute coronary syndromes (ACS) who were undergoing coronary angiography with possible intervention. Methods The RadIal Vs femorAL access for coronary intervention (RIVAL) trial was a randomised, parallel group, multicentre trial. Patients with ACS were randomly assigned (1:1) by a 24 h computerised central automated voice response system to radial or femoral artery access. The primary outcome was a composite of death, myocardial infarction, stroke, or non-coronary artery bypass graft (non-CABG)-related major bleeding at 30 days. Key secondary outcomes were death, myocardial infarction, or stroke; and non-CABG-related major bleeding at 30 days. A masked central committee adjudicated the primary outcome, components of the primary outcome, and stent thrombosis. All other outcomes were as reported by the investigators. Patients and investigators were not masked to treatment allocation. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT01014273. Findings Between June 6, 2006, and Nov 3, 2010, 7021 patients were enrolled from 158 hospitals in 32 countries. 3507 patients were randomly assigned to radial access and 3514 to femoral access. The primary outcome occurred in 128 (3·7%) of 3507 patients in the radial access group compared with 139 (4·0%) of 3514 in the femoral access group (hazard ratio [HR] 0·92, 95% CI 0·72–1·17; p=0·50). Of the six prespecified subgroups, there was a significant interaction for the primary outcome with benefit for radial access in highest tertile volume radial centres (HR 0·49, 95% CI 0·28–0·87; p=0·015) and in patients with ST-segment elevation myocardial infarction (0·60, 0·38–0·94; p=0·026). The rate of death, myocardial infarction, or stroke at 30 days was 112 (3·2%) of 3507 patients in the radial group compared with 114 (3·2%) of 3514 in the femoral group (HR 0·98, 95% CI 0·76–1·28; p=0·90). The rate of non-CABG-related major bleeding at 30 days was 24 (0·7%) of 3! 507 patients in the radial group compared with 33 (0·9%) of 3514 patients in the femoral group (HR 0·73, 95% CI 0·43–1·23; p=0·23). At 30 days, 42 of 3507 patients in the radial group had large haematoma compared with 106 of 3514 in the femoral group (HR 0·40, 95% CI 0·28–0·57; p<0·0001). Pseudoaneurysm needing closure occurred in seven of 3507 patients in the radial group compared with 23 of 3514 in the femoral group (HR 0·30, 95% CI 0·13–0·71; p=0·006). Interpretation Radial and femoral approaches are both safe and effective for PCI. However, the lower rate of local vascular complications may be a reason to use the radial approach. Funding Sanofi-Aventis, Population Health Research Institute, and Canadian Network for Trials Internationally (CANNeCTIN), an initiative of the Canadian Institutes of Health Research.
• Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation
  - LANCET 377(9775):1421-1428 (2011)
  Background Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. Methods 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a se! ries of individual and household characteristics. Findings Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026–0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. Interpretation The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health. Funding World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluation Fund, the British Economic and Social Research Council, Government of Rwanda, and Global Development Network.
• Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study
  - LANCET 377(9775):1429-1437 (2011)
  Background Overdose from illicit drugs is a leading cause of premature mortality in North America. Internationally, more than 65 supervised injecting facilities (SIFs), where drug users can inject pre-obtained illicit drugs, have been opened as part of various strategies to reduce the harms associated with drug use. We sought to determine whether the opening of an SIF in Vancouver, BC, Canada, was associated with a reduction in overdose mortality. Methods We examined population-based overdose mortality rates for the period before (Jan 1, 2001, to Sept 20, 2003) and after (Sept 21, 2003, to Dec 31, 2005) the opening of the Vancouver SIF. The location of death was determined from provincial coroner records. We compared overdose fatality rates within an a priori specified 500 m radius of the SIF and for the rest of the city. Findings Of 290 decedents, 229 (79·0%) were male, and the median age at death was 40 years (IQR 32–48 years). A third (89, 30·7%) of deaths occurred in city blocks within 500 m of the SIF. The fatal overdose rate in this area decreased by 35·0% after the opening of the SIF, from 253·8 to 165·1 deaths per 100 000 person-years (p=0·048). By contrast, during the same period, the fatal overdose rate in the rest of the city decreased by only 9·3%, from 7·6 to 6·9 deaths per 100 000 person-years (p=0·490). There was a significant interaction of rate differences across strata (p=0·049). Interpretation SIFs should be considered where injection drug use is prevalent, particularly in areas with high densities of overdose. Funding Vancouver Coastal Health, Canadian Institutes of Health Research, and the Michael Smith Foundation for Health Research.
• Priority actions for the non-communicable disease crisis
  - LANCET 377(9775):1438-1447 (2011)
  The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis—leadership, prevention, treatment, international cooperation, and monitoring and accountability—and the delivery of five priority interventions—tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of i! mplementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.
• Stillbirths: Where? When? Why? How to make the data count?
  - LANCET 377(9775):1448-1463 (2011)
  Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible—not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2·65 million stillbirths (uncertainty range 2·08 million to 3·79 million) were estimated worldwide in 2008 (≥1000 g birthweight or ≥28 weeks of gestation). 98% of stillbirths occur in low-income and middle-income countries, and numbers vary from 2·0 per 1000 total births in Finland to more than 40 per 1000 total births in Nigeria and Pakistan. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. In total, an estimated 1·19 million (range 0·82 million to 1·97 million) intrapartum stillbirths occur yearly. Most intrapartum stillbirths are associated with obstetric emergencies, ! whereas antepartum stillbirths are associated with maternal infections and fetal growth restriction. National estimates of causes of stillbirths are scarce, and multiple (>35) classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed. A simple, programme-relevant stillbirth classification that can be used with verbal autopsy would provide a basis for comparable national estimates. A new focus on all deaths around the time of birth is crucial to inform programmatic investment.
• Paroxysmal hip pain
  - LANCET 377(9775):1464 (2011)