Hot off the presses! Sep 02 Lancet

The Sep 02 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:

• Urgently needed: a framework convention for obesity control
  - Lancet 378(9793):741 (2011)
  
• Sex imbalance in China
  - Lancet 378(9793):742 (2011)
  
• Addiction: a complex disorder
  - Lancet 378(9793):742 (2011)
  
• The future challenge of obesity
  - Lancet 378(9793):743-744 (2011)
  
• Reversing the tide of obesity
  - Lancet 378(9793):744-746 (2011)
  
• Where next for obesity?
  - Lancet 378(9793):746-747 (2011)
  
• With maturity comes confidence: EBCTCG tamoxifen update
  - Lancet 378(9793):747-749 (2011)
  
• Screening with pulse oximetry for congenital heart disease
  - Lancet 378(9793):749-750 (2011)
  
• Text messaging to improve adherence to malaria guidelines
  - Lancet 378(9793):750-752 (2011)
  
• Rapid mortality falls after risk-factor changes in populations
  - Lancet 378(9793):752-753 (2011)
  
• Offline: Indignez-vous!
  - Lancet 378(9793):754 (2011)
  
• Hungary to introduce broad range of fat taxes
  - Lancet 378(9793):755 (2011)
  
• Frontline medicine: inside Libya
  - Lancet 378(9793):756-757 (2011)
  
• Concerns raised over new US resident physician work hours
  - Lancet 378(9793):758 (2011)
  
• Diets from around the world—quality not quantity
  - Lancet 378(9793):759 (2011)
  
• The social science of obesity
  - Lancet 378(9793):760 (2011)
  
• Boyd Swinburn: combating obesity at the community level
  - Lancet 378(9793):761 (2011)
  
• Changing perceptions of obesity—recollections of a paediatrician
  - Lancet 378(9793):762-763 (2011)
  
• Timothy John Christmas
  - Lancet 378(9793):764 (2011)
  
• Chemotherapy for older patients with colorectal cancer
  - Lancet 378(9793):765 (2011)
  
• Chemotherapy for older patients with colorectal cancer
  - Lancet 378(9793):765 (2011)
  
• Chemotherapy for older patients with colorectal cancer – Authors' reply
  - Lancet 378(9793):765-766 (2011)
  
• The Mediterranean diet: a cultural journey
  - Lancet 378(9793):766-767 (2011)
  
• The Mediterranean diet: a cultural journey – Authors' reply
  - Lancet 378(9793):767 (2011)
  
• Changes in alcohol metabolism after gastric bypass surgery
  - Lancet 378(9793):767-768 (2011)
  
• Continued neglect of ageing of HIV epidemic at UN meeting
  - Lancet 378(9793):768 (2011)
  
• Further analyses of the Myeloma IX Study
  - Lancet 378(9793):768-769 (2011)
  
• China's first rare-disease registry is under development
  - Lancet 378(9793):769-770 (2011)
  
• UK Royal Colleges and health service reform
  - Lancet 378(9793):770 (2011)
  
• Department of Error
  - Lancet 378(9793):770 (2011)
  
• Department of Error
  - Lancet 378(9793):770 (2011)
  
• Department of Error
  - Lancet 378(9793):770 (2011)
  
• Department of Error
  - Lancet 378(9793):770 (2011)
  
• Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials
  - Lancet 378(9793):771-784 (2011)
  Background As trials of 5 years of tamoxifen in early breast cancer mature, the relevance of hormone receptor measurements (and other patient characteristics) to long-term outcome can be assessed increasingly reliably. We report updated meta-analyses of the trials of 5 years of adjuvant tamoxifen. Methods We undertook a collaborative meta-analysis of individual patient data from 20 trials (n=21 457) in early breast cancer of about 5 years of tamoxifen versus no adjuvant tamoxifen, with about 80% compliance. Recurrence and death rate ratios (RRs) were from log-rank analyses by allocated treatment. Findings In oestrogen receptor (ER)-positive disease (n=10 645), allocation to about 5 years of tamoxifen substantially reduced recurrence rates throughout the first 10 years (RR 0·53 [SE 0·03] during years 0–4 and RR 0·68 [0·06] during years 5–9 [both 2p<0·00001]; but RR 0·97 [0·10] during years 10–14, suggesting no further gain or loss after year 10). Even in marginally ER-positive disease (10–19 fmol/mg cytosol protein) the recurrence reduction was substantial (RR 0·67 [0·08]). In ER-positive disease, the RR was approximately independent of progesterone receptor status (or level), age, nodal status, or use of chemotherapy. Breast cancer mortality was reduced by about a third throughout the first 15 years (RR 0·71 [0·05] during years 0–4, 0·66 [0·05] during years 5–9, and 0·68 [0·08] during years 10–14; p<0·0001 for extra mortality reduction during each separate time period). Overall non-breast-cancer mortality was little affected, despite small absolu! te increases in thromboembolic and uterine cancer mortality (both only in women older than 55 years), so all-cause mortality was substantially reduced. In ER-negative disease, tamoxifen had little or no effect on breast cancer recurrence or mortality. Interpretation 5 years of adjuvant tamoxifen safely reduces 15-year risks of breast cancer recurrence and death. ER status was the only recorded factor importantly predictive of the proportional reductions. Hence, the absolute risk reductions produced by tamoxifen depend on the absolute breast cancer risks (after any chemotherapy) without tamoxifen. Funding Cancer Research UK, British Heart Foundation, and Medical Research Council.
• Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study
  - Lancet 378(9793):785-794 (2011)
  Background Screening for congenital heart defects relies on antenatal ultrasonography and postnatal clinical examination; however, life-threatening defects often are not detected. We prospectively assessed the accuracy of pulse oximetry as a screening test for congenital heart defects. Methods In six maternity units in the UK, asymptomatic newborn babies (gestation >34 weeks) were screened with pulse oximetry before discharge. Infants who did not achieve predetermined oxygen saturation thresholds underwent echocardiography. All other infants were followed up to 12 months of age by use of regional and national registries and clinical follow-up. The main outcome was the sensitivity and specificity of pulse oximetry for detection of critical congenital heart defects (causing death or requiring invasive intervention before 28 days) or major congenital heart disease (causing death or requiring invasive intervention within 12 months of age). Findings 20 055 newborn babies were screened and 53 had major congenital heart disease (24 critical), a prevalence of 2·6 per 1000 livebirths. Analyses were done on all babies for whom a pulse oximetry reading was obtained. Sensitivity of pulse oximetry was 75·00% (95% CI 53·29–90·23) for critical cases and 49·06% (35·06–63·16) for all major congenital heart defects. In 35 cases, congenital heart defects were already suspected after antenatal ultrasonography, and exclusion of these reduced the sensitivity to 58·33% (27·67–84·83) for critical cases and 28·57% (14·64–46·30) for all cases of major congenital heart defects. False-positive results were noted for 169 (0·8%) babies (specificity 99·16%, 99·02–99·28), of which six cases were significant, but not major, congenital heart defects, and 40 were other illnesses that required urgent medical intervention. Interpretation Pulse oximetry is a safe, feasible test that adds value to existing screening. It identifies cases of critical congenital heart defects that go undetected with antenatal ultrasonography. The early detection of other diseases is an additional advantage. Funding National Institute for Health Research Health Technology Assessment programme.
• The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial
  - Lancet 378(9793):795-803 (2011)
  Background Health workers' malaria case-management practices often differ from national guidelines. We assessed whether text-message reminders sent to health workers' mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya. Methods From March 6, 2009, to May 31, 2010, we did a cluster-randomised controlled trial at 107 rural health facilities in 11 districts in coastal and western Kenya. With a computer-generated sequence, health facilities were randomly allocated to either the intervention group, in which all health workers received text messages on their personal mobile phones on malaria case-management for 6 months, or the control group, in which health workers did not receive any text messages. Health workers were not masked to the intervention, although patients were unaware of whether they were in an intervention or control facility. The primary outcome was correct management with artemether-lumefantrine, defined as a dichotomous composite indicator of treatment, dispensing, and counselling tasks concordant with Kenyan national guidelines. The primary analysis was by intention to treat. The trial is registered with Current Controlled Trials, ISRCTN72328636. Findings 119 health workers received the intervention. Case-management practices were assessed for 2269 children who needed treatment (1157 in the intervention group and 1112 in the control group). Intention-to-treat analysis showed that correct artemether-lumefantrine management improved by 23·7 percentage-points (95% CI 7·6–40·0; p=0·004) immediately after intervention and by 24·5 percentage-points (8·1–41·0; p=0·003) 6 months later. Interpretation In resource-limited settings, malaria control programmes should consider use of text messaging to improve health workers' case-management practices. Funding The Wellcome Trust.
• The global obesity pandemic: shaped by global drivers and local environments
  - Lancet 378(9793):804-814 (2011)
  The simultaneous increases in obesity in almost all countries seem to be driven mainly by changes in the global food system, which is producing more processed, affordable, and effectively marketed food than ever before. This passive overconsumption of energy leading to obesity is a predictable outcome of market economies predicated on consumption-based growth. The global food system drivers interact with local environmental factors to create a wide variation in obesity prevalence between populations. Within populations, the interactions between environmental and individual factors, including genetic makeup, explain variability in body size between individuals. However, even with this individual variation, the epidemic has predictable patterns in subpopulations. In low-income countries, obesity mostly affects middle-aged adults (especially women) from wealthy, urban environments; whereas in high-income countries it affects both sexes and all ages, but is disproportionat! ely greater in disadvantaged groups. Unlike other major causes of preventable death and disability, such as tobacco use, injuries, and infectious diseases, there are no exemplar populations in which the obesity epidemic has been reversed by public health measures. This absence increases the urgency for evidence-creating policy action, with a priority on reduction of the supply-side drivers.
• Health and economic burden of the projected obesity trends in the USA and the UK
  - Lancet 378(9793):815-825 (2011)
  Rising prevalence of obesity is a worldwide health concern because excess weight gain within populations forecasts an increased burden from several diseases, most notably cardiovascular diseases, diabetes, and cancers. In this report, we used a simulation model to project the probable health and economic consequences in the next two decades from a continued rise in obesity in two ageing populations—the USA and the UK. These trends project 65 million more obese adults in the USA and 11 million more obese adults in the UK by 2030, consequently accruing an additional 6–8·5 million cases of diabetes, 5·7–7·3 million cases of heart disease and stroke, 492 000–669 000 additional cases of cancer, and 26–55 million quality-adjusted life years forgone for USA and UK combined. The combined medical costs associated with treatment of these preventable diseases are estimated to increase by $48–66 billion/year in the USA and by £1·9–2 billion/year in the UK by 203! 0. Hence, effective policies to promote healthier weight also have economic benefits.
• Quantification of the effect of energy imbalance on bodyweight
  - Lancet 378(9793):826-837 (2011)
  Obesity interventions can result in weight loss, but accurate prediction of the bodyweight time course requires properly accounting for dynamic energy imbalances. In this report, we describe a mathematical modelling approach to adult human metabolism that simulates energy expenditure adaptations during weight loss. We also present a web-based simulator for prediction of weight change dynamics. We show that the bodyweight response to a change of energy intake is slow, with half times of about 1 year. Furthermore, adults with greater adiposity have a larger expected weight loss for the same change of energy intake, and to reach their steady-state weight will take longer than it would for those with less initial body fat. Using a population-averaged model, we calculated the energy-balance dynamics corresponding to the development of the US adult obesity epidemic. A small persistent average daily energy imbalance gap between intake and expenditure of about 30 kJ per day un! derlies the observed average weight gain. However, energy intake must have risen to keep pace with increased expenditure associated with increased weight. The average increase of energy intake needed to sustain the increased weight (the maintenance energy gap) has amounted to about 0·9 MJ per day and quantifies the public health challenge to reverse the obesity epidemic.
• Changing the future of obesity: science, policy, and action
  - Lancet 378(9793):838-847 (2011)
  The global obesity epidemic has been escalating for four decades, yet sustained prevention efforts have barely begun. An emerging science that uses quantitative models has provided key insights into the dynamics of this epidemic, and enabled researchers to combine evidence and to calculate the effect of behaviours, interventions, and policies at several levels—from individual to population. Forecasts suggest that high rates of obesity will affect future population health and economics. Energy gap models have quantified the association of changes in energy intake and expenditure with weight change, and have documented the effect of higher intake on obesity prevalence. Empirical evidence that shows interventions are effective is limited but expanding. We identify several cost-effective policies that governments should prioritise for implementation. Systems science provides a framework for organising the complexity of forces driving the obesity epidemic and has importan! t implications for policy makers. Many parties (such as governments, international organisations, the private sector, and civil society) need to contribute complementary actions in a coordinated approach. Priority actions include policies to improve the food and built environments, cross-cutting actions (such as leadership, healthy public policies, and monitoring), and much greater funding for prevention programmes. Increased investment in population obesity monitoring would improve the accuracy of forecasts and evaluations. The integration of actions within existing systems into both health and non-health sectors (trade, agriculture, transport, urban planning, and development) can greatly increase the influence and sustainability of policies. We call for a sustained worldwide effort to monitor, prevent, and control obesity.
• Lumbar puncture in paediatric stroke
  - Lancet 378(9793):848 (2011)