Hot off the presses! Nov 11 Lancet

The Nov 11 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:

• November 5â€"11, 2011
  - Lancet 378(9803):i (2011)
  
• The good news about cancer in developing countries
  - Lancet 378(9803):1605 (2011)
  
• Torture in Syria's hospitals
  - Lancet 378(9803):1606 (2011)
  
• Care for children undergoing surgery: we are not there yet
  - Lancet 378(9803):1606 (2011)
  
• A new method of surfactant administration in preterm infants
  - Lancet 378(9803):1607-1608 (2011)
  
• Optimum excision margins for melanoma
  - Lancet 378(9803):1608-1610 (2011)
  
• Beyond accountability: learning from large-scale evaluations
  - Lancet 378(9803):1610-1612 (2011)
  
• The Lancetâ€"University of Oslo Commission on Global Governance for Health, in collaboration with the Harvard Global Health Institute
  - Lancet 378(9803):1612-1613 (2011)
  
• A global scope for global healthâ€"including mental health
  - Lancet 378(9803):1613-1615 (2011)
  
• Offline: The hypocritic oath
  - Lancet 378(9803):1616 (2011)
  
• Sound and fury after stem cell ruling
  - Lancet 378(9803):1617 (2011)
  
• Mending mental health in Misrata
  - Lancet 378(9803):1618 (2011)
  
• A requiem for the fallen from the early days of AIDS
  - Lancet 378(9803):1619 (2011)
  
• Re-imagining disability
  - Lancet 378(9803):1620 (2011)
  
• A search for wisdom
  - Lancet 378(9803):1621-1622 (2011)
  
• Iodine deficiency in UK schoolgirls
  - Lancet 378(9803):1623 (2011)
  
• Iodine deficiency in UK schoolgirls
  - Lancet 378(9803):1623 (2011)
  
• Iodine deficiency in UK schoolgirls
  - Lancet 378(9803):1623-1624 (2011)
  
• Iodine deficiency in UK schoolgirls â€" Authors' reply
  - Lancet 378(9803):1624 (2011)
  
• 5 versus 10 days of ceftriaxone for bacterial meningitis in children
  - Lancet 378(9803):1624-1625 (2011)
  
• 5 versus 10 days of ceftriaxone for bacterial meningitis in children
  - Lancet 378(9803):1625 (2011)
  
• 5 versus 10 days of ceftriaxone for bacterial meningitis in children â€" Authors' reply
  - Lancet 378(9803):1625-1626 (2011)
  
• Editorial code of conduct
  - Lancet 378(9803):1626 (2011)
  
• Mandating influenza vaccination in health-care workers
  - Lancet 378(9803):1626 (2011)
  
• Lead poisoning in China
  - Lancet 378(9803):e3 (2011)
  
• Lead poisoning in China â€" Authors' reply
  - Lancet 378(9803):e3-e4 (2011)
  
• Environmental and food contamination with plasticisers in China
  - Lancet 378(9803):e4 (2011)
  
• Arabic roots of modern medicine
  - Lancet 378(9803):e4-e5 (2011)
  
• Department of Error
  - Lancet 378(9803):1626 (2011)
  
• Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial
  - Lancet 378(9803):1627-1634 (2011)
  Background Surfactant is usually given to mechanically ventilated preterm infants via an endotracheal tube to treat respiratory distress syndrome. We tested a new method of surfactant application to spontaneously breathing preterm infants to avoid mechanical ventilation. Method In a parallel-group, randomised controlled trial, 220 preterm infants with a gestational age between 26 and 28 weeks and a birthweight less than 1·5 kg were enrolled in 12 German neonatal intensive care units. Infants were independently randomised in a 1:1 ratio with variable block sizes, to standard treatment or intervention, and randomisation was stratified according to centre and multiple birth status. Masking was not possible. Infants were stabilised with continuous positive airway pressure and received rescue intubation if necessary. In the intervention group, infants received surfactant treatment during spontaneous breathing via a thin catheter inserted into the trachea by laryngoscopy if they needed a fraction of inspired oxygen more than 0·30. The primary endpoint was need for any mechanical ventilation, or being not ventilated but having a partial pressure of carbon dioxide more than 65 mm Hg (8·6 kPa) or a fraction of inspired oxygen more than 0·60, or both, fo! r more than 2 h between 25 h and 72 h of age. Analysis was by intention to treat. This study is registered, number ISRCTN05025922. Findings 108 infants were assigned to the intervention group and 112 infants to the standard treatment group. All infants were analysed. On day 2 or 3 after birth, 30 (28%) infants in the intervention group were mechanically ventilated versus 51 (46%) in the standard treatment group (number needed to treat 6, 95% CI 3–20, absolute risk reduction 0·18, 95% CI 0·30–0·05, p=0·008). 36 (33%) infants in the intervention group were mechanically ventilated during their stay in the hospital compared with 82 (73%) in the standard treatment group (number needed to treat: 3, 95% CI 2–4, p<0·0001). The intervention group had significantly fewer median days on mechanical ventilation, (0 days. IQR 0–3 vs 2 days, 0–5) and a lower need for oxygen therapy at 28 days (30 infants [30%] vs 49 infants [45%], p=0·032) compared with the standard treatment group. We recorded no differences between groups for mortality (seven deaths in the intervention group vs five in the standard treatment ! group) and serious adverse events (21 vs 28). Interpretation The application of surfactant via a thin catheter to spontaneously breathing preterm infants receiving continuous positive airway pressure reduces the need for mechanical ventilation. Funding German Ministry of Research and Technology, University of Lübeck, and Chiesi Pharmaceuticals.
• 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial
  - Lancet 378(9803):1635-1642 (2011)
  Background Optimum surgical resection margins for patients with clinical stage IIA–C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin. Methods We undertook a randomised controlled trial in nine European centres. Patients with cutaneous melanoma thicker than 2 mm, at clinical stage IIA–C, were allocated to have either a 2-cm or a 4-cm surgical resection margin. Patients were randomised in a 1:1 allocation to one of the two groups and stratified by geographic region. Randomisation was done by sealed envelope or by computer generated lists with permuted blocks. Our primary endpoint was overall survival. The trial was not masked at any stage. Analyses were by intention to treat. Adverse events were not systematically recorded. The study is registered with ClinicalTrials.gov, number NCT01183936. Findings 936 patients were enrolled from Jan 22, 1992, to May 19, 2004; 465 were randomly allocated to treatment with a 2-cm resection margin, and 471 to receive treatment with a 4-cm resection margin. One patient in each group was lost to follow-up but included in the analysis. After a median follow-up of 6·7 years (IQR 4·3–9·5) 181 patients in the 2-cm margin group and 177 in the 4-cm group had died (hazard ratio 1·05, 95% CI 0·85–1·29; p=0.64). 5-year overall survival was 65% (95% CI 60–69) in the 2-cm group and 65% (40–70) in the 4-cm group (p=0·69). Interpretation Our findings suggest that a 2-cm resection margin is sufficient and safe for patients with cutaneous melanoma thicker than 2 mm. Funding Swedish Cancer Society and Stockholm Cancer Society.
• Assessment of population-level effect of Avahan, an HIV-prevention initiative in India
  - Lancet 378(9803):1643-1652 (2011)
  Background The aim of Avahan, the India AIDS Initiative, was to reduce HIV transmission in the general population through large-scale prevention interventions focused on high-risk groups. It was launched in 2003 in six states with a total population of 300 million and a high HIV burden. We assessed the population-level effect of the first phase of Avahan (2003–08). Methods Population prevalence was estimated by use of adjustment factors from the national HIV sentinel surveillance data obtained annually from antenatal clinics. A mixed-effects multilevel regression model was developed to estimate the association between intervention intensity and population HIV prevalence trends, taking into account differences in the underlying epidemic trends in states and other potential confounders, and to estimate the number of HIV infections averted with Avahan. Findings 80 (61%) of 131 districts in the six Avahan states received funding from Avahan for HIV prevention, as the only or shared source. Greater intensity of Avahan, measured as amount of grant per HIV population (medians US$24–432 in the six states), was significantly associated with lower HIV prevalence in Andhra Pradesh (p=0·004), Karnataka (p=0·004), and Maharashtra (p=0·008) states; this association was not significant in Tamil Nadu (p=0·06), Manipur (p=0·62), and Nagaland (p=0·67). Overall, we estimated that 100 178 HIV infections (95% CI 25 897–207 713) were averted at the population level from 2003 up to 2008 as a result of Avahan. Interpretation The results of our analysis suggest that Avahan had a beneficial effect in reducing HIV prevalence at the population level over 5 years of programme implementation in some of the states. With stagnating funding for HIV prevention globally, our findings support investment in well planned and managed HIV prevention programmes in low-income and middle-income countries. Funding Bill & Melinda Gates Foundation.
• Purtscher-like retinopathy caused by acute pancreatitis
  - Lancet 378(9803):1653 (2011)
  
• Human resources for mental health care: current situation and strategies for action
  - Lancet 378(9803):1654-1663 (2011)
  A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce car! egiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries.
• Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis
  - Lancet 378(9803):1664-1675 (2011)
  This report reviews the evidence for the types of human rights violations experienced by people with mental and psychosocial disabilities in low-income and middle-income countries as well as strategies to prevent these violations and promote human rights in line with the UN Convention on the Rights of Persons with Disabilities (CRPD). The article draws on the views, expertise, and experience of 51 people with mental and psychosocial disabilities from 18 low-income and middle-income countries as well as a review of English language literature including from UN publications, non-governmental organisation reports, press reports, and the academic literature.
• Never too old
  - Lancet 378(9803):1676 (2011)