Thursday, October 6, 2011

Hot off the presses! Oct 14 Lancet

The Oct 14 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:

  • Rediscovering the Americas
    - Lancet 378(9799):1275 (2011)
  • It's time to kill this Bill
    - Lancet 378(9799):1276 (2011)
  • Early child development—a winning combination
    - Lancet 378(9799):1276 (2011)
  • Early childhood development—global action is overdue
    - Lancet 378(9799):1277-1278 (2011)
  • Smoking cessation: crucial to target women as well as men
    - Lancet 378(9799):1278-1279 (2011)
  • Should antipsychotics take pole position in mania treatment?
    - Lancet 378(9799):1279-1281 (2011)
  • Malaria and bacteraemia in African children
    - Lancet 378(9799):1281-1282 (2011)
  • NCDs: celebrating success, moving forward
    - Lancet 378(9799):1283-1284 (2011)
  • Diabetes—call for papers
    - Lancet 378(9799):1285 (2011)
  • Offline: Sisters and brothers
    - Lancet 378(9799):1286 (2011)
  • Medical community urged to defend Bahraini doctors
    - Lancet 378(9799):1287 (2011)
  • Russia set to tighten restrictions on abortion
    - Lancet 378(9799):1288 (2011)
  • Pharma in the jungle
    - Lancet 378(9799):1289 (2011)
  • Jacques Miller: immunologist who discovered role of the thymus
    - Lancet 378(9799):1290 (2011)
  • Five decades of MRSA: controversy and uncertainty continues
    - Lancet 378(9799):1291-1292 (2011)
  • A new era for global tuberculosis control
    - Lancet 378(9799):1293 (2011)
  • A new era for global tuberculosis control
    - Lancet 378(9799):1293 (2011)
  • Medical schools in sub-Saharan Africa
    - Lancet 378(9799):1293-1294 (2011)
  • Medical schools in sub-Saharan Africa
    - Lancet 378(9799):1294 (2011)
  • Medical schools in sub-Saharan Africa
    - Lancet 378(9799):1294-1295 (2011)
  • Medical schools in sub-Saharan Africa – Authors' reply
    - Lancet 378(9799):1295 (2011)
  • Networking request from a pharmaceutical company?
    - Lancet 378(9799):1295-1296 (2011)
  • Multiple rejections: role of the writing process
    - Lancet 378(9799):1296 (2011)
  • Department of Error
    - Lancet 378(9799):1296 (2011)
  • Department of Error
    - Lancet 378(9799):1296 (2011)
  • Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies
    - Lancet 378(9799):1297-1305 (2011)
    Background Prevalence of smoking is increasing in women in some populations and is a risk factor for coronary heart disease. Whether smoking confers the same excess risk of coronary heart disease for women as it does for men is unknown. Therefore, we aimed to estimate the effect of smoking on coronary heart disease in women compared with men after accounting for sex differences in other major risk factors. Methods We undertook a systematic review and meta-analysis of prospective cohort studies published between Jan 1, 1966, and Dec 31, 2010, from four online databases. We selected cohort studies that were stratified by sex with measures of relative risk (RR), and associated variability, for coronary heart disease and current smoking compared with not smoking. We pooled data with a random effects model with inverse variance weighting, and estimated RR ratios (RRRs) between men and women. Findings We reviewed 8005 abstracts and included 26 articles with data for 3 912 809 individuals and 67 075 coronary heart disease events from 86 prospective trials. In 75 cohorts (2·4 million participants) that adjusted for cardiovascular risk factors other than coronary heart disease, the pooled adjusted female-to-male RRR of smoking compared with not smoking for coronary heart disease was 1·25 (95% CI 1·12–1·39, p<0·0001). This outcome was unchanged after adjustment for potential publication bias and there was no evidence of important between-study heterogeneity (p=0·21). The RRR increased by 2% for every additional year of study follow-up (p=0·03). In pooled data from 53 studies, there was no evidence of a sex difference in the RR between participants who had previously smoked compared with those who never had (RRR 0·96, 95% CI 0·86–1·08, p=0·53). Interpretation Whether mechanisms underlying the sex difference in risk of coronary heart disease are biological or related to differences in smoking behaviour between men and women is unclear. Tobacco-control programmes should consider women, particularly in those countries where smoking among young women is increasing in prevalence. Funding None.
  • Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis
    - Lancet 378(9799):1306-1315 (2011)
    Background Conventional meta-analyses have shown inconsistent results for efficacy of pharmacological treatments for acute mania. We did a multiple-treatments meta-analysis, which accounted for both direct and indirect comparisons, to assess the effects of all antimanic drugs. Methods We systematically reviewed 68 randomised controlled trials (16 073 participants) from Jan 1, 1980, to Nov 25, 2010, which compared any of the following pharmacological drugs at therapeutic dose range for the treatment of acute mania in adults: aripiprazole, asenapine, carbamazepine, valproate, gabapentin, haloperidol, lamotrigine, lithium, olanzapine, quetiapine, risperidone, topiramate, and ziprasidone. The main outcomes were the mean change on mania rating scales and the number of patients who dropped out of the allocated treatment at 3 weeks. Analysis was done by intention to treat. Findings Haloperidol (standardised mean difference [SMD] −0·56 [95% CI −0·69 to −0·43]), risperidone (–0·50 [–0·63 to −0·38), olanzapine (–0·43 [–0·54 to −0·32], lithium (–0·37 [–0·63 to −0·11]), quetiapine (–0·37 [–0·51 to −0·23]), aripiprazole (–0·37 [–0·51 to −0·23]), carbamazepine (–0·36 [–0·60 to −0·11], asenapine (–0·30 [–0·53 to −0·07]), valproate (–0·20 [–0·37 to −0·04]), and ziprasidone (–0·20 [–0·37 to −0·03]) were significantly more effective than placebo, whereas gabapentin, lamotrigine, and topiramate were not. Haloperidol had the highest number of significant differences and was significantly more effective than lithium (SMD −0·19 [95% CI −0·36 to −0·01]), quetiapine (–0·19 [–0·37 to 0·01]), aripiprazole (–0·19 [–0·36 to −0·02]), carbamazepine (–0·20 [–0·36 to −0·01]), asenapine (–0·26 [–0·52 to 0·01]), valproate (–0·36 [–0·56 to −0�! �15]), ziprasidone −0·36 [–0·56 to −0·15]), lamotrigine (–0·48 [–0·77 to −0·19]), topiramate (–0·63 [–0·84 to −0·43]), and gabapentin (–0·88 [−1·40 to −0·36]). Risperidone and olanzapine had a very similar profile of comparative efficacy, being more effective than valproate, ziprasidone, lamotrigine, topiramate, and gabapentin. Olanzapine, risperidone, and quetiapine led to significantly fewer discontinuations than did lithium, lamotrigine, placebo, topiramate, and gabapentin. Interpretation Overall, antipsychotic drugs were significantly more effective than mood stabilisers. Risperidone, olanzapine, and haloperidol should be considered as among the best of the available options for the treatment of manic episodes. These results should be considered in the development of clinical practice guidelines. Funding None.
  • Relation between falciparum malaria and bacteraemia in Kenyan children: a population-based, case-control study and a longitudinal study
    - Lancet 378(9799):1316-1323 (2011)
    Background Many investigators have suggested that malaria infection predisposes individuals to bacteraemia. We tested this hypothesis with mendelian randomisation studies of children with the malaria-protective phenotype of sickle-cell trait (HbAS). Methods This study was done in a defined area around Kilifi District Hospital, Kilifi, Kenya. We did a matched case-control study to identify risk factors for invasive bacterial disease, in which cases were children aged 3 months to 13 years who were admitted to hospital with bacteraemia between Sept 16, 1999, and July 31, 2002. We aimed to match two controls, by age, sex, location, and time of recruitment, for every case. We then did a longitudinal case-control study to assess the relation between HbAS and invasive bacterial disease as malaria incidence decreased. Cases were children aged 0–13 years who were admitted to hospital with bacteraemia between Jan 1, 1999, and Dec 31, 2007. Controls were born in the study area between Jan 1, 2006, and June 23, 2009. Finally, we modelled the annual incidence of bacteraemia against the community prevalence of malaria during 9 years with Poisson regression. Results In the matched case-control study, we recruited 292 cases—we recruited two controls for 236, and one for the remaining 56. Sickle-cell disease, HIV, leucocyte haemozoin pigment, and undernutrition were positively associated with bacteraemia and HbAS was strongly negatively associated with bacteraemia (odds ratio 0·36; 95% CI 0·20–0·65). In the longitudinal case-control study, we assessed data from 1454 cases and 10 749 controls. During the study period, the incidence of admission to hospital with malaria per 1000 child-years decreased from 28·5 to 3·45, with a reduction in protection afforded by HbAS against bacteraemia occurring in parallel (p=0·0008). The incidence of hospital admissions for bacteraemia per 1000 child-years also decreased from 2·59 to 1·45. The bacteraemia incidence rate ratio associated with malaria parasitaemia was 6·69 (95% CI 1·31–34·3) and, at a community parasite prevalence of 29% in 1999, 62% (8·2–91) of bacteraemia cases were ! attributable to malaria. Interpretation Malaria infection strongly predisposes individuals to bacteraemia and can account for more than half of all cases of bacteraemia in malaria-endemic areas. Interventions to control malaria will have a major additional benefit by reducing the burden of invasive bacterial disease. Funding Wellcome Trust.
  • Haemorrhagic herpes zoster
    - Lancet 378(9799):1324 (2011)
  • Inequality in early childhood: risk and protective factors for early child development
    - Lancet 378(9799):1325-1338 (2011)
    Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce children's risk exposure and to promote development in affecte! d children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the world's poorest children and reduce persistent inequalities.
  • Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries
    - Lancet 378(9799):1339-1353 (2011)
    This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrolment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include children's educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrolment to 25% or 50% in every low-income a! nd middle-income country showed a benefit-to-cost ratio ranging from 6·4 to 17·6, depending on preschool enrolment rate and discount rate.
  • Maculopapular lesions in the Central African Republic
    - Lancet 378(9799):1354 (2011)

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