Thursday, June 30, 2011

Hot off the presses! Jul 08 Lancet

The Jul 08 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:

  • The need for asylum
    - Lancet 378(9785):1 (2011)
  • A new era for global tuberculosis control?
    - Lancet 378(9785):2 (2011)
  • Drug advertising in The Lancet
    - Lancet 378(9785):2 (2011)
  • Global control of diabetes: information for action
    - Lancet 378(9785):3-4 (2011)
  • Outpatient management of pulmonary embolism
    - Lancet 378(9785):5-6 (2011)
  • Text messaging in smoking cessation: the txt2stop trial
    - Lancet 378(9785):6-7 (2011)
  • Development assistance for health: trends and prospects
    - Lancet 378(9785):8-10 (2011)
  • Group B streptococcal vaccine for resource-poor countries
    - Lancet 378(9785):11-12 (2011)
  • Calling all photographers: Highlights 2011
    - Lancet 378(9785):13 (2011)
  • Offline: "A singular lack of foresight"
    - Lancet 378(9785):14 (2011)
  • Japan's slow recovery
    - Lancet 378(9785):15-16 (2011)
  • Global food crisis takes heavy toll on east Africa
    - Lancet 378(9785):17-18 (2011)
  • Arabic roots of modern medicine
    - Lancet 378(9785):19-20 (2011)
  • Heartfelt drama
    - Lancet 378(9785):20 (2011)
  • Richard Reznick: leading innovator of surgical education
    - Lancet 378(9785):21 (2011)
  • Ign├íc Semmelweis—celebrating a flawed pioneer of patient safety
    - Lancet 378(9785):22-23 (2011)
  • Rajanikant Arole
    - Lancet 378(9785):24 (2011)
  • Consent in emergency care research
    - Lancet 378(9785):25 (2011)
  • Consent in emergency care research
    - Lancet 378(9785):25 (2011)
  • Consent in emergency care research
    - Lancet 378(9785):25-26 (2011)
  • Consent in emergency care research
    - Lancet 378(9785):26 (2011)
  • Consent in emergency care research
    - Lancet 378(9785):26-27 (2011)
  • Consent in emergency care research – Authors' reply
    - Lancet 378(9785):27 (2011)
  • Early administration of tranexamic acid in trauma patients
    - Lancet 378(9785):27-28 (2011)
  • Early administration of tranexamic acid in trauma patients – Authors' reply
    - Lancet 378(9785):28 (2011)
  • Don't forget family planning
    - Lancet 378(9785):29 (2011)
  • The importance of climate change to health
    - Lancet 378(9785):29-30 (2011)
  • Pharmaceutical company advertising in The Lancet
    - Lancet 378(9785):30 (2011)
  • Department of Error
    - Lancet 378(9785):30 (2011)
  • Department of Error
    - Lancet 378(9785):30 (2011)
  • National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants
    - Lancet 378(9785):31-40 (2011)
    Background Data for trends in glycaemia and diabetes prevalence are needed to understand the effects of diet and lifestyle within populations, assess the performance of interventions, and plan health services. No consistent and comparable global analysis of trends has been done. We estimated trends and their uncertainties in mean fasting plasma glucose (FPG) and diabetes prevalence for adults aged 25 years and older in 199 countries and territories. Methods We obtained data from health examination surveys and epidemiological studies (370 country-years and 2·7 million participants). We converted systematically between different glycaemic metrics. For each sex, we used a Bayesian hierarchical model to estimate mean FPG and its uncertainty by age, country, and year, accounting for whether a study was nationally, subnationally, or community representative. Findings In 2008, global age-standardised mean FPG was 5·50 mmol/L (95% uncertainty interval 5·37–5·63) for men and 5·42 mmol/L (5·29–5·54) for women, having risen by 0·07 mmol/L and 0·09 mmol/L per decade, respectively. Age-standardised adult diabetes prevalence was 9·8% (8·6–11·2) in men and 9·2% (8·0–10·5) in women in 2008, up from 8·3% (6·5–10·4) and 7·5% (5·8–9·6) in 1980. The number of people with diabetes increased from 153 (127–182) million in 1980, to 347 (314–382) million in 2008. We recorded almost no change in mean FPG in east and southeast Asia and central and eastern Europe. Oceania had the largest rise, and the highest mean FPG (6·09 mmol/L, 5·73–6·49 for men; 6·08 mmol/L, 5·72–6·46 for women) and diabetes prevalence (15·5%, 11·6–20·1 for men; and 15·9%, 12·1–20·5 for women) in 2008. Mean FPG and diabetes prevalence in 2008 were also high in south Asia, Latin America and the Caribbean, and central Asia, north Afri! ca, and the Middle East. Mean FPG in 2008 was lowest in sub-Saharan Africa, east and southeast Asia, and high-income Asia-Pacific. In high-income subregions, western Europe had the smallest rise, 0·07 mmol/L per decade for men and 0·03 mmol/L per decade for women; North America had the largest rise, 0·18 mmol/L per decade for men and 0·14 mmol/L per decade for women. Interpretation Glycaemia and diabetes are rising globally, driven both by population growth and ageing and by increasing age-specific prevalences. Effective preventive interventions are needed, and health systems should prepare to detect and manage diabetes and its sequelae. Funding Bill & Melinda Gates Foundation and WHO.
  • Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial
    - Lancet 378(9785):41-48 (2011)
    Background Although practice guidelines recommend outpatient care for selected, haemodynamically stable patients with pulmonary embolism, most treatment is presently inpatient based. We aimed to assess non-inferiority of outpatient care compared with inpatient care. Methods We undertook an open-label, randomised non-inferiority trial at 19 emergency departments in Switzerland, France, Belgium, and the USA. We randomly assigned patients with acute, symptomatic pulmonary embolism and a low risk of death (pulmonary embolism severity index risk classes I or II) with a computer-generated randomisation sequence (blocks of 2–4) in a 1:1 ratio to initial outpatient (ie, discharged from hospital ≤24 h after randomisation) or inpatient treatment with subcutaneous enoxaparin (≥5 days) followed by oral anticoagulation (≥90 days). The primary outcome was symptomatic, recurrent venous thromboembolism within 90 days; safety outcomes included major bleeding within 14 or 90 days and mortality within 90 days. We used a non-inferiority margin of 4% for a difference between inpatient and outpatient groups. We included all enrolled patients in the primary analysis, excluding those lost to follow-up. This trial is registered with, number N! CT00425542. Findings Between February, 2007, and June, 2010, we enrolled 344 eligible patients. In the primary analysis, one (0·6%) of 171 outpatients developed recurrent venous thromboembolism within 90 days compared with none of 168 inpatients (95% upper confidence limit [UCL] 2·7%; p=0·011). Only one (0·6%) patient in each treatment group died within 90 days (95% UCL 2·1%; p=0·005), and two (1·2%) of 171 outpatients and no inpatients had major bleeding within 14 days (95% UCL 3·6%; p=0·031). By 90 days, three (1·8%) outpatients but no inpatients had developed major bleeding (95% UCL 4·5%; p=0·086). Mean length of stay was 0·5 days (SD 1·0) for outpatients and 3·9 days (SD 3·1) for inpatients. Interpretation In selected low-risk patients with pulmonary embolism, outpatient care can safely and effectively be used in place of inpatient care. Funding Swiss National Science Foundation, Programme Hospitalier de Recherche Clinique, and the US National Heart, Lung, and Blood Institute. Sanofi-Aventis provided free drug supply in the participating European centres.
  • Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial
    - Lancet 378(9785):49-55 (2011)
    Background Smoking cessation programmes delivered via mobile phone text messaging show increases in self-reported quitting in the short term. We assessed the effect of an automated smoking cessation programme delivered via mobile phone text messaging on continuous abstinence, which was biochemically verified at 6 months. Methods In this single-blind, randomised trial, undertaken in the UK, smokers willing to make a quit attempt were randomly allocated, using an independent telephone randomisation system, to a mobile phone text messaging smoking cessation programme (txt2stop), comprising motivational messages and behavioural-change support, or to a control group that received text messages unrelated to quitting. The system automatically generated intervention or control group texts according to the allocation. Outcome assessors were masked to treatment allocation. The primary outcome was self-reported continuous smoking abstinence, biochemically verified at 6 months. All analyses were by intention to treat. This study is registered, number ISRCTN 80978588. Findings We assessed 11 914 participants for eligibility. 5800 participants were randomised, of whom 2915 smokers were allocated to the txt2stop intervention and 2885 were allocated to the control group; eight were excluded because they were randomised more than once. Primary outcome data were available for 5524 (95%) participants. Biochemically verified continuous abstinence at 6 months was significantly increased in the txt2stop group (10·7% txt2stop vs 4·9% control, relative risk [RR] 2·20, 95% CI 1·80–2·68; p<0·0001). Similar results were obtained when participants that were lost to follow-up were treated as smokers (268 [9%] of 2911 txt2stop vs 124 [4%] of 2881 control [RR 2·14, 95% CI 1·74–2·63; p<0·0001]), and when they were excluded (268 [10%] of 2735 txt2stop vs 124 [4%] of 2789 control [2·20, 1·79–2·71; p<0·0001]). No significant heterogeneity was shown in any of the prespecified subgroups. Interpretation The txt2stop smoking cessation programme significantly improved smoking cessation rates at 6 months and should be considered for inclusion in smoking cessation services. Funding UK Medical Research Council, Primary Care Research Networks.
  • Rupture of a giant carotid-ophthalmic aneurysm
    - Lancet 378(9785):56 (2011)
  • Tuberculosis
    - Lancet 378(9785):57-72 (2011)
    Tuberculosis results in an estimated 1·7 million deaths each year and the worldwide number of new cases (more than 9 million) is higher than at any other time in history. 22 low-income and middle-income countries account for more than 80% of the active cases in the world. Due to the devastating effect of HIV on susceptibility to tuberculosis, sub-Saharan Africa has been disproportionately affected and accounts for four of every five cases of HIV-associated tuberculosis. In many regions highly endemic for tuberculosis, diagnosis continues to rely on century-old sputum microscopy; there is no vaccine with adequate effectiveness and tuberculosis treatment regimens are protracted and have a risk of toxic effects. Increasing rates of drug-resistant tuberculosis in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programmes. Moreover, our fundamental understanding of the pathogenesis of this disease is i! nadequate. However, increased investment has allowed basic science and translational and applied research to produce new data, leading to promising progress in the development of improved tuberculosis diagnostics, biomarkers of disease activity, drugs, and vaccines. The growing scientific momentum must be accompanied by much greater investment and political commitment to meet this huge persisting challenge to public health. Our Seminar presents current perspectives on the scale of the epidemic, the pathogen and the host response, present and emerging methods for disease control (including diagnostics, drugs, biomarkers, and vaccines), and the ongoing challenge of tuberculosis control in adults in the 21st century.
  • Hepatitis delta virus
    - Lancet 378(9785):73-85 (2011)
    Hepatitis delta virus (HDV) is a small, defective RNA virus that can infect only individuals who have hepatitis B virus (HBV); worldwide more than 15 million people are co-infected. There are eight reported genotypes of HDV with unexplained variations in their geographical distribution and pathogenicity. The hepatitis D virion is composed of a coat of HBV envelope proteins surrounding the nucleocapsid, which consists of a single-stranded, circular RNA genome complexed with delta antigen, the viral protein. HDV is clinically important because although it suppresses HBV replication, it causes severe liver disease with rapid progression to cirrhosis and hepatic decompensation. The range of clinical presentation is wide, varying from mild disease to fulminant liver failure. The prevalence of HDV is declining in some endemic areas but increasing in northern and central Europe because of immigration. Treatment of HDV is with pegylated interferon alfa; however, response rates! are poor. Increased understanding of the molecular virology of HDV will identify novel therapeutic targets for this most severe form of chronic viral hepatitis.
  • Post-splenectomy and hyposplenic states
    - Lancet 378(9785):86-97 (2011)
    The spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive immunity and in protecting against infections. The impairment of splenic function is defined as hyposplenism, an acquired disorder caused by several haematological and immunological diseases. The term asplenia refers to the absence of the spleen, a condition that is rarely congenital and mostly post-surgical. Although hyposplenism and asplenia might predispose individuals to thromboembolic events, in this Review we focus on infectious complications, which are the most widely recognised consequences of these states. Because of the high mortality, the fulminant course, and the refractoriness to common treatment of overwhelming infections caused by encapsulated bacteria, prevention through vaccination and antibiotic prophylaxis is the basis of the management of patients who have had splenectomy or have hyposplenism. In this Review, we critically assess clinical and diag! nostic aspects of splenic dysfunction and highlight new perspectives in the prevention of overwhelming post-splenectomy infections.
  • Late onset autism and anti-NMDA-receptor encephalitis
    - Lancet 378(9785):98 (2011)

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