Hot off the presses! Jan 29 Lancet

The Jan 29 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:

• Growth of aid and the decline of humanitarianism
  - Lancet 375(9711):253 (2010)
  
• Improving the management of gout
  - Lancet 375(9711):254 (2010)
  
• The uncaped health crusader of New York City
  - Lancet 375(9711):254 (2010)
  
• Estimating the number of civilian deaths from armed conflicts
  - Lancet 375(9711):255-257 (2010)
  
• Psychiatric problems in medically evacuated service members
  - Lancet 375(9711):257-259 (2010)
  
• Domestic and political violence: the Palestinian predicament
  - Lancet 375(9711):259-260 (2010)
  
• Provision of secondary care in fragile state contexts
  - Lancet 375(9711):260-261 (2010)
  
• Rethinking surgical care in conflict
  - Lancet 375(9711):262-263 (2010)
  
• Ticagrelor in ACS: redefining a new standard of care?
  - Lancet 375(9711):263-265 (2010)
  
• Offline: Who will be our John Hersey?
  - Lancet 375(9711):266 (2010)
  
• Helping earthquake-hit Haiti
  - Lancet 375(9711):267-268 (2010)
  
• Yemen conflict takes its toll on civilians
  - Lancet 375(9711):269-270 (2010)
  
• The currency of conflict
  - Lancet 375(9711):271-272 (2010)
  
• Children in conflict
  - Lancet 375(9711):272 (2010)
  
• Khalif Bile Mohamud: responding to crises and conflict in Pakistan
  - Lancet 375(9711):273 (2010)
  
• Who owns health inequalities?
  - Lancet 375(9711):274-275 (2010)
  
• Edmund Neville Hey
  - Lancet 375(9711):276 (2010)
  
• Unseen scars of conflict
  - Lancet 375(9711):277 (2010)
  
• Community treatments for heroin and crack cocaine addiction
  - Lancet 375(9711):277 (2010)
  
• Community treatments for heroin and crack cocaine addiction
  - Lancet 375(9711):277-278 (2010)
  
• Community treatments for heroin and crack cocaine addiction
  - Lancet 375(9711):278 (2010)
  
• Community treatments for heroin and crack cocaine addiction – Authors' reply
  - Lancet 375(9711):278-279 (2010)
  
• Homoeopathic remedies and drug-regulatory authorities
  - Lancet 375(9711):279 (2010)
  
• Homoeopathic remedies and drug-regulatory authorities
  - Lancet 375(9711):279-280 (2010)
  
• Dose-dense paclitaxel for advanced ovarian cancer
  - Lancet 375(9711):280 (2010)
  
• Dose-dense paclitaxel for advanced ovarian cancer
  - Lancet 375(9711):280-281 (2010)
  
• Dose-dense paclitaxel for advanced ovarian cancer – Authors' reply
  - Lancet 375(9711):281 (2010)
  
• Maintenance therapy for non-small-cell lung cancer
  - Lancet 375(9711):281-282 (2010)
  
• The undernutrition epidemic: an urgent health priority
  - Lancet 375(9711):282 (2010)
  
• Department of Error
  - Lancet 375(9711):282 (2010)
  
• Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study
  - Lancet 375(9711):283-293 (2010)
  Background Variation in and irreversibility of platelet inhibition with clopidogrel has led to controversy about its optimum dose and timing of administration in patients with acute coronary syndromes. We compared ticagrelor, a more potent reversible P2Y12 inhibitor with clopidogrel in such patients. Methods At randomisation, an invasive strategy was planned for 13 408 (72·0%) of 18 624 patients hospitalised for acute coronary syndromes (with or without ST elevation). In a double-blind, double-dummy study, patients were randomly assigned in a one-to-one ratio to ticagrelor and placebo (180 mg loading dose followed by 90 mg twice a day), or to clopidogrel and placebo (300–600 mg loading dose or continuation with maintenance dose followed by 75 mg per day) for 6–12 months. All patients were given aspirin. The primary composite endpoint was cardiovascular death, myocardial infarction, or stroke. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00391872. Findings 6732 patients were assigned to ticagrelor and 6676 to clopidogrel. The primary composite endpoint occurred in fewer patients in the ticagrelor group than in the clopidogrel group (569 [event rate at 360 days 9·0%] vs 668 [10·7%], hazard ratio 0·84, 95% CI 0·75–0·94; p=0·0025). There was no difference between clopidogrel and ticagrelor groups in the rates of total major bleeding (691 [11·6%] vs 689 [11·5%], 0·99 [0·89–1·10]; p=0·8803) or severe bleeding, as defined according to the Global Use of Strategies To Open occluded coronary arteries, (198 [3·2%] vs 185 [2·9%], 0·91 [0·74–1·12]; p=0·3785). Interpretation Ticagrelor seems to be a better option than clopidogrel for patients with acute coronary syndromes for whom an early invasive strategy is planned. Funding AstraZeneca.
• Patterns of mortality rates in Darfur conflict
  - Lancet 375(9711):294-300 (2010)
  Background Several mortality estimates for the Darfur conflict have been reported since 2004, but few accounted for conflict dynamics such as changing displacement and causes of deaths. We analyse changes over time for crude and cause-specific mortality rates, and assess the effect of displacement on mortality rates. Methods Retrospective mortality surveys were gathered from an online database. Quasi-Poisson models were used to assess mortality rates with place and period in which the survey was done, and the proportions of displaced people in the samples were the explanatory variables. Predicted mortality rates for five periods were computed and applied to population data taken from the UN's series about Darfur to obtain the number of deaths. Findings 63 of 107 mortality surveys met all criteria for analysis. Our results show significant reductions in mortality rates from early 2004 to the end of 2008, although rates were higher during deployment of fewer humanitarian aid workers. In general, the reduction in rate was more important for violence-related than for diarrhoea-related mortality. Displacement correlated with increased rates of deaths associated with diarrhoea, but also with reduction in violent deaths. We estimated the excess number of deaths to be 298 271 (95% CI 178 258–461 520). Interpretation Although violence was the main cause of death during 2004, diseases have been the cause of most deaths since 2005, with displaced populations being the most susceptible. Any reduction in humanitarian assistance could lead to worsening mortality rates, as was the case between mid 2006 and mid 2007. Funding US Department of State Bureau of Population, Refugees and Migration, and UK Department for International Development funded the complex emergency database project; and European Commission funded the MICROCON project.
• Diagnoses and factors associated with medical evacuation and return to duty for service members participating in Operation Iraqi Freedom or Operation Enduring Freedom: a prospective cohort study
  - Lancet 375(9711):301-309 (2010)
  Background Anticipation of the types of injuries that occur in modern warfare is essential to plan operations and maintain a healthy military. We aimed to identify the diagnoses that result in most medical evacuations, and ascertain which demographic and clinical variables were associated with return to duty. Methods Demographic and clinical data were prospectively obtained for US military personnel who had been medically evacuated from Operation Iraqi Freedom or Operation Enduring Freedom (January, 2004–December, 2007). Diagnoses were categorised post hoc according to the International Classification of Diseases codes that were recorded at the time of transfer. The primary outcome measure was return to duty within 2 weeks. Findings 34 006 personnel were medically evacuated, of whom 89% were men, 91% were enlisted, 82% were in the army, and 86% sustained an injury in Iraq. The most common reasons for medical evacuation were: musculoskeletal and connective tissue disorders (n=8104 service members, 24%), combat injuries (n=4713, 14%), neurological disorders (n=3502, 10%), psychiatric diagnoses (n=3108, 9%), and spinal pain (n=2445, 7%). The factors most strongly associated with return to duty were being a senior officer (adjusted OR 2·01, 95% CI 1·71–2·35, p<0·0001), having a non-battle-related injury or disease (3·18, 2·77–3·67, p<0·0001), and presenting with chest or abdominal pain (2·48, 1·61–3·81, p<0·0001), a gastrointestinal disorder (non-surgical 2·32, 1·51–3·56, p=0·0001; surgical 2·62, 1·69–4·06, p<0·0001), or a genitourinary disorder (2·19, 1·43–3·36, p=0·0003). Covariates associated with a decreased probability of return to duty were serving in the navy or co! ast guard (0·59, 0·45–0·78, p=0·0002), or marines (0·86, 0·77–0·96, p=0·0083); and presenting with a combat injury (0·27, 0·17–0·44, p<0·0001), a psychiatric disorder (0·28, 0·18–0·43, p<0·0001), musculoskeletal or connective tissue disorder (0·46, 0·30–0·71, p=0·0004), spinal pain (0·41, 0·26–0·63, p=0·0001), or other wound (0·54, 0·34–0·84, p=0·0069). Interpretation Implementation of preventive measures for service members who are at highest risk of evacuation, forward-deployed treatment, and therapeutic interventions could reduce the effect of non-battle-related injuries and disease on military readiness. Funding John P Murtha Neuroscience and Pain Institute, and US Army Regional Anesthesia and Pain Management Initiative.
• Association between exposure to political violence and intimate-partner violence in the occupied Palestinian territory: a cross-sectional study
  - Lancet 375(9711):310-316 (2010)
  Background Intimate-partner violence might increase during and after exposure to collective violence. We assessed whether political violence was associated with male-to-female intimate-partner violence in the occupied Palestinian territory. Methods A nationally representative, cross-sectional survey was done between Dec 18, 2005, and Jan 18, 2006, by the Palestinian Central Bureau of Statistics. 4156 households were randomly selected with a multistage random cluster design, from which 3815 ever-married women aged 15–64 years were identified. We restricted our analysis to presently married women (n=3510, 92% participation rate), who completed a short version of the revised conflict tactics scales and exposure to political violence inventory. Exposure to political violence was characterised as the husband's direct exposure, his indirect exposure via his family's experiences, and economic effects of exposure on the household. We used adjusted multinomial logistic regression models to estimate odds ratios (ORs) for association between political violence and intimate-partner violence. Findings Political violence was significantly related to higher odds of intimate-partner violence. ORs were 1·89 (95% CI 1·29–2·76) for physical and 2·23 (1·49–3·35) for sexual intimate-partner violence in respondents whose husbands were directly exposed to political violence compared with those whose husbands were not directly exposed. For women whose husbands were indirectly exposed, ORs were 1·61 (1·25–2·07) for physical and 1·97 (1·49–2–60) for sexual violence, compared with those whose husbands were not indirectly exposed. Economic effects of exposure were associated with increased odds of intimate-partner violence in the Gaza Strip only. Interpretation Because exposure to political violence is associated with increased odds of intimate-partner violence, and exposure to many traumas is associated with poor health, a range of violent exposures should be assessed when establishing the need for psychosocial interventions in conflict settings. Funding Palestinian National Authority, Core Funding Group, Program in Health Disparities Research at the University of Minnesota.
• Impaled head
  - Lancet 375(9711):317 (2010)
  
• Gout
  Richette P Bardin T - Lancet 375(9711):318-328 (2010)
  Gout is a common arthritis caused by deposition of monosodium urate crystals within joints after chronic hyperuricaemia. It affects 1–2% of adults in developed countries, where it is the most common inflammatory arthritis in men. Epidemiological data are consistent with a rise in prevalence of gout. Diet and genetic polymorphisms of renal transporters of urate seem to be the main causal factors of primary gout. Gout and hyperuricaemia are associated with hypertension, diabetes mellitus, metabolic syndrome, and renal and cardiovascular diseases. Non-steroidal anti-inflammatory drugs and colchicine remain the most widely recommended drugs to treat acute attacks. Oral corticosteroids could be an alternative to these drugs. Interleukin 1β is a pivotal mediator of acute gout and could become a therapeutic target. When serum uric acid concentrations are lowered below monosodium urate saturation point, the crystals dissolve and gout can be cured. Patient education, appropr! iate lifestyle advice, and treatment of comorbidities are an important part of management of patients with gout.
• Responsibility for protection of medical workers and facilities in armed conflict
  - Lancet 375(9711):329-340 (2010)
  Assaults on patients and medical personnel, facilities, and transports, denial of access to medical services, and misuse of medical facilities and emblems have become a feature of armed conflict despite their prohibition by the laws of war. Strategies to improve compliance with these laws, protection, and accountability are lacking, and regular reporting of violations is absent. A systematic review of the frequency of reporting and types of violations has not been done for more than 15 years. To gain a better understanding of the scope and extent of the problem, we used uniform search criteria to review three global sources of human rights reports in armed conflicts for 2003–08, and in-depth reports on violations committed in armed conflict during 1989–2008. Findings from this review showed deficiencies in the extent and methods of reporting, but also identified three major trends in such assaults: attacks on medical functions seem to be part of a broad assault on ! civilians; assaults on medical functions are used to achieve a military advantage; and combatants do not respect the ethical duty of health professionals to provide care to patients irrespective of affiliation. WHO needs to lead robust and systematic documentation of these violations, and countries and the medical community need to take steps to improve compliance, protection, and accountability.
• Health-care needs of people affected by conflict: future trends and changing frameworks
  - Lancet 375(9711):341-345 (2010)
  
• Major depression: what caused the crisis?
  - Lancet 375(9711):346 (2010)