Hot off the presses! Jun 10 Lance

The Jun 10 issue of the Lance is now up on Pubget (About Lance): 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:

• Hope for health in Nigeria
  - Lance 377(9781):1891 (2011)
  
• Specialist nurses and lung cancer
  - Lance 377(9781):1892 (2011)
  
• Ensuring HIV treatment for all in the USA
  - Lance 377(9781):1892 (2011)
  
• Can India achieve a balance of sexes at birth?
  - Lance 377(9781):1893-1894 (2011)
  
• Gene therapy for critical limb ischaemia: the TAMARIS trial
  - Lance 377(9781):1894-1896 (2011)
  
• Spinal cord injury: time to move
  - Lance 377(9781):1896-1898 (2011)
  
• Higher education and health care in Brazil
  - Lance 377(9781):1898-1900 (2011)
  
• Oxford University should stop investing in arms companies
  - Lance 377(9781):1900-1902 (2011)
  
• A blueprint for country-driven development
  - Lance 377(9781):1902-1903 (2011)
  
• Offline: "Sex is good and we should all enjoy it"
  - Lance 377(9781):1904 (2011)
  
• China's organ transplant system in transition
  - Lance 377(9781):1905-1906 (2011)
  
• Ethiopia gears up for more major health reforms
  - Lance 377(9781):1907-1908 (2011)
  
• Recipe for survival
  - Lance 377(9781):1909 (2011)
  
• David Eagleman
  - Lance 377(9781):1910 (2011)
  
• Doctor
  - Lance 377(9781):1910 (2011)
  
• Lomita Bekele: delivering health care to an Ethiopian village
  - Lance 377(9781):1911 (2011)
  
• The quiet art revisited
  - Lance 377(9781):1912-1913 (2011)
  
• G Alan Marlatt
  - Lance 377(9781):1914 (2011)
  
• Open letter to UK Prime Minister David Cameron and Health Secretary Andrew Lansley on safety of medicines
  - Lance 377(9781):1915 (2011)
  
• Global trends in body-mass index
  - Lance 377(9781):1915-1916 (2011)
  
• Global trends in body-mass index
  - Lance 377(9781):1916-1917 (2011)
  
• Global trends in body-mass index
  - Lance 377(9781):1917 (2011)
  
• Global trends in body-mass index – Authors' reply
  - Lance 377(9781):1917-1918 (2011)
  
• C-reactive protein in the Heart Protection Study
  - Lance 377(9781):1918 (2011)
  
• C-reactive protein in the Heart Protection Study – Authors' reply
  - Lance 377(9781):1918-1919 (2011)
  
• Eltrombopag for chronic immune thrombocytopenia
  - Lance 377(9781):1919 (2011)
  
• Eltrombopag for chronic immune thrombocytopenia – Authors' reply
  - Lance 377(9781):1919-1920 (2011)
  
• Improvement of air quality in low-income countries
  - Lance 377(9781):1920 (2011)
  
• Trends in selective abortions of girls in India: analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011
  - Lance 377(9781):1921-1928 (2011)
  Background India's 2011 census revealed a growing imbalance between the numbers of girls and boys aged 0–6 years, which we postulate is due to increased prenatal sex determination with subsequent selective abortion of female fetuses. We aimed to establish the trends in sex ratio by birth order from 1990 to 2005 with three nationally representative surveys and to quantify the totals of selective abortions of girls with census cohort data. Methods We assessed sex ratios by birth order in 0·25 million births in three rounds of the nationally representative National Family Health Survey covering the period from 1990 to 2005. We estimated totals of selective abortion of girls by assessing the birth cohorts of children aged 0–6 years in the 1991, 2001, and 2011 censuses. Our main statistic was the conditional sex ratio of second-order births after a firstborn girl and we used 3-year rolling weighted averages to test for trends, with differences between trends compared by linear regression. Findings The conditional sex ratio for second-order births when the firstborn was a girl fell from 906 per 1000 boys (99% CI 798–1013) in 1990 to 836 (733–939) in 2005; an annual decline of 0·52% (p for trend=0·002). Declines were much greater in mothers with 10 or more years of education than in mothers with no education, and in wealthier households compared with poorer households. By contrast, we did not detect any significant declines in the sex ratio for second-order births if the firstborn was a boy, or for firstborns. Between the 2001 and 2011 censuses, more than twice the number of Indian districts (local administrative areas) showed declines in the child sex ratio as districts with no change or increases. After adjusting for excess mortality rates in girls, our estimates of number of selective abortions of girls rose from 0–2·0 million in the 1980s, to 1·2–4·1 million in the 1990s, and to 3·1–6·0 million in the 2000s. Each 1% decline in child sex ratio at age! s 0–6 years implied 1·2–3·6 million more selective abortions of girls. Selective abortions of girls totalled about 4·2–12·1 million from 1980–2010, with a greater rate of increase in the 1990s than in the 2000s. Interpretation Selective abortion of girls, especially for pregnancies after a firstborn girl, has increased substantially in India. Most of India's population now live in states where selective abortion of girls is common. Funding US National Institutes of Health, Canadian Institute of Health Research, International Development Research Centre, and Li Ka Shing Knowledge Institute.
• Effect of fibroblast growth factor NV1FGF on amputation and death: a randomised placebo-controlled trial of gene therapy in critical limb ischaemia
  - Lance 377(9781):1929-1937 (2011)
  Background Patients with critical limb ischaemia have a high rate of amputation and mortality. We tested the hypothesis that non-viral 1 fibroblast growth factor (NV1FGF) would improve amputation-free survival. Methods In this phase 3 trial (EFC6145/TAMARIS), 525 patients with critical limb ischaemia unsuitable for revascularisation were enrolled from 171 sites in 30 countries. All had ischaemic ulcer in legs or minor skin gangrene and met haemodynamic criteria (ankle pressure <70 mm Hg or a toe pressure <50 mm Hg, or both, or a transcutaneous oxygen pressure <30 mm Hg on the treated leg). Patients were randomly assigned to either NV1FGF at 0·2 mg/mL or matching placebo (visually identical) in a 1:1 ratio. Randomisation was done with a central interactive voice response system by block size 4 and was stratified by diabetes status and country. Investigators, patients, and study teams were masked to treatment. Patients received eight intramuscular injections of their assigned treatment in the index leg on days 1, 15, 29, and 43. The primary endpoint was time to major amputation or death at 1 year analysed by intention to treat with a log-rank test using a multivariate Cox proportional hazar! d model. This trial is registered with ClinicalTrials.gov, number NCT00566657. Findings 259 patients were assigned to NV1FGF and 266 to placebo. All 525 patients were analysed. The mean age was 70 years (range 50–92), 365 (70%) were men, 280 (53%) had diabetes, and 248 (47%) had a history of coronary artery disease. The primary endpoint or components of the primary did not differ between treatment groups, with major amputation or death in 86 patients (33%) in the placebo group, and 96 (36%) in the active group (hazard ratio 1·11, 95% CI 0·83–1·49; p=0·48). No significant safety issues were recorded. Interpretation TAMARIS provided no evidence that NV1FGF is effective in reduction of amputation or death in patients with critical limb ischaemia. Thus, this group of patients remains a major therapeutic challenge for the clinician. Funding Sanofi-Aventis, Paris, France.
• Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study
  - Lance 377(9781):1938-1947 (2011)
  Background Repeated periods of stimulation of the spinal cord and training increased the ability to control movement in animal models of spinal cord injury. We hypothesised that tonic epidural spinal cord stimulation can modulate spinal circuitry in human beings into a physiological state that enables sensory input from standing and stepping movements to serve as a source of neural control to undertake these tasks. Methods A 23-year-old man who had paraplegia from a C7–T1 subluxation as a result of a motor vehicle accident in July 2006, presented with complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment. After 170 locomotor training sessions over 26 months, a 16-electrode array was surgically placed on the dura (L1–S1 cord segments) in December 2009, to allow for chronic electrical stimulation. Spinal cord stimulation was done during sessions that lasted up to 250 min. We did 29 experiments and tested several stimulation combinations and parameters with the aim of the patient achieving standing and stepping. Findings Epidural stimulation enabled the man to achieve full weight-bearing standing with assistance provided only for balance for 4·25 min. The patient achieved this standing during stimulation using parameters identified as specific for standing while providing bilateral load-bearing proprioceptive input. We also noted locomotor-like patterns when stimulation parameters were optimised for stepping. Additionally, 7 months after implantation, the patient recovered supraspinal control of some leg movements, but only during epidural stimulation. Interpretation Task-specific training with epidural stimulation might reactivate previously silent spared neural circuits or promote plasticity. These interventions could be a viable clinical approach for functional recovery after severe paralysis. Funding National Institutes of Health and Christopher and Dana Reeve Foundation.
• Cutaneous larva migrans
  - Lance 377(9781):1948 (2011)
  
• Chronic non-communicable diseases in Brazil: burden and current challenges
  - Lance 377(9781):1949-1961 (2011)
  Non-communicable diseases (NCDs) have become a major health priority in Brazil—72% of all deaths were attributable to NCDs in 2007. They are also the main source of disease burden, with neuropsychiatric disorders being the single largest contributor. Morbidity and mortality due to NCDs are greatest in the poor population. Although the crude NCD mortality increased 5% between 1996 and 2007, age-standardised mortality declined by 20%. Declines were primarily for cardiovascular and chronic respiratory diseases, in association with the successful implementation of health policies that lead to decreases in smoking and the expansion of access to primary health care. Of note, however, the prevalence of diabetes and hypertension is rising in parallel with that of excess weight; these increases are associated with unfavourable changes of diet and physical activity. Brazil has implemented major policies for the prevention of NCDs, and its age-adjusted NCD mortality is falling ! by 1·8% per year. However, the unfavourable trends for most major risk factors pose an enormous challenge and call for additional and timely action and policies, especially those of a legislative and regulatory nature and those providing cost-effective chronic care for individuals affected by NCDs.
• Violence and injuries in Brazil: the effect, progress made, and challenges ahead
  - Lance 377(9781):1962-1975 (2011)
  Although there are signs of decline, homicides and traffic-related injuries and deaths in Brazil account for almost two-thirds of all deaths from external causes. In 2007, the homicide rate was 26·8 per 100 000 people and traffic-related mortality was 23·5 per 100 000. Domestic violence might not lead to as many deaths, but its share of violence-related morbidity is large. These are important public health problems that lead to enormous individual and collective costs. Young, black, and poor men are the main victims and perpetrators of community violence, whereas poor black women and children are the main victims of domestic violence. Regional differentials are also substantial. Besides the sociocultural determinants, much of the violence in Brazil has been associated with the misuse of alcohol and illicit drugs, and the wide availability of firearms. The high traffic-related morbidity and mortality in Brazil have been linked to the chosen model for the transport sys! tem that has given priority to roads and private-car use without offering adequate infrastructure. The system is often poorly equipped to deal with violations of traffic rules. In response to the major problems of violence and injuries, Brazil has greatly advanced in terms of legislation and action plans. The main challenge is to assess these advances to identify, extend, integrate, and continue the successful ones.
• The great pretender
  - Lance 377(9781):1976 (2011)