Hot off the presses! Dec 03 LANCET

The Dec 03 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:

• Striving for universal health coverage
  - LANCET 376(9755):1799 (2010)
  
• Female genital mutilation and social change
  - LANCET 376(9755):1800 (2010)
  
• McPolicy: bringing you the Big Mac society
  - LANCET 376(9755):1800 (2010)
  
• Doctors and climate change
  - LANCET 376(9755):1801-1802 (2010)
  
• Health co-benefits of policies to tackle climate change
  - LANCET 376(9755):1802-1804 (2010)
  
• Childhood pneumonia: a neglected, climate-sensitive disease?
  - LANCET 376(9755):1804-1805 (2010)
  
• Delirium treatment: an unmet challenge
  - LANCET 376(9755):1805-1807 (2010)
  
• Mobile phones to improve HIV treatment adherence
  - LANCET 376(9755):1807-1808 (2010)
  
• Paediatric mortality related to H1N1 infection in England
  - LANCET 376(9755):1808-1810 (2010)
  
• What do children die from in India today?
  - LANCET 376(9755):1810-1811 (2010)
  
• Offline: Urgency and concern about home births
  - LANCET 376(9755):1812 (2010)
  
• Haiti still gripped by cholera as election looms
  - LANCET 376(9755):1813-1814 (2010)
  
• Crime and unjust punishment in Russia
  - LANCET 376(9755):1815-1816 (2010)
  
• Enjoying the high life—drugs in history and culture
  - LANCET 376(9755):1817 (2010)
  
• Debating drug policy and the path to change
  - LANCET 376(9755):1818 (2010)
  
• A Chinese puzzle
  - LANCET 376(9755):1819 (2010)
  
• Peter Goldsworthy
  - LANCET 376(9755):1819 (2010)
  
• Neuron overload and the juggling physician
  - LANCET 376(9755):1820-1821 (2010)
  
• David Geraint James
  - LANCET 376(9755):1822 (2010)
  
• Facing up to the threat in China
  - LANCET 376(9755):1823 (2010)
  
• Facing up to the threat in China
  - LANCET 376(9755):1823 (2010)
  
• Facing up to the threat in China
  - LANCET 376(9755):1823-1824 (2010)
  
• Is antiretroviral therapy modifying the HIV epidemic?
  - LANCET 376(9755):1824 (2010)
  
• Is antiretroviral therapy modifying the HIV epidemic?
  - LANCET 376(9755):1824-1825 (2010)
  
• Is antiretroviral therapy modifying the HIV epidemic? – Authors' reply
  - LANCET 376(9755):1825 (2010)
  
• Licence for Botox in so-called chronic migraine
  - LANCET 376(9755):1825-1826 (2010)
  
• Licence for Botox in so-called chronic migraine – Response from MHRA
  - LANCET 376(9755):1826 (2010)
  
• Improving surgery service delivery in context
  - LANCET 376(9755):1826-1827 (2010)
  
• Cancer funding in developing countries: the next health-care crisis?
  - LANCET 376(9755):1827 (2010)
  
• Migration, health, and care in French overseas territories
  - LANCET 376(9755):1827-1828 (2010)
  
• Compassionate optimism
  - LANCET 376(9755):1828 (2010)
  
• Department of Error
  - LANCET 376(9755):1828 (2010)
  
• Department of Error
  - LANCET 376(9755):1828 (2010)
  
• Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial
  - LANCET 376(9755):1829-1837 (2010)
  Background Delirium is frequently diagnosed in critically ill patients and is associated with adverse outcome. Impaired cholinergic neurotransmission seems to have an important role in the development of delirium. We aimed to establish the effect of the cholinesterase inhibitor rivastigmine on the duration of delirium in critically ill patients. Methods Patients (aged ≥18 years) who were diagnosed with delirium were enrolled from six intensive care units in the Netherlands, and treated between November, 2008, and January, 2010. Patients were randomised (1:1 ratio) to receive an increasing dose of rivastigmine or placebo, starting at 0·75 mL (1·5 mg rivastigmine) twice daily and increasing in increments to 3 mL (6 mg rivastigmine) twice daily from day 10 onwards, as an adjunct to usual care based on haloperidol. The trial pharmacist generated the randomisation sequence by computer, and consecutively numbered bottles of the study drug according to this sequence to conceal allocation. The primary outcome was the duration of delirium during hospital admission. Analysis was by intention to treat. Duration of delirium was censored for patients who died or were discharged from hospital while delirious. Patients, medical staff, and investigators were masked to treatment allocation. Members of the data safety and monitoring boar! d (DSMB) were unmasked and did interim analyses every 3 months. This trial is registered with ClinicalTrials.gov, number NCT00704301. Findings Although a sample size of 440 patients was planned, after inclusion of 104 patients with delirium who were eligible for the intention-to-treat analysis (n=54 on rivastigmine, n=50 on placebo), the DSMB recommended that the trial be halted because mortality in the rivastigmine group (n=12, 22%) was higher than in the placebo group (n=4, 8%; p=0·07). Median duration of delirium was longer in the rivastigmine group (5·0 days, IQR 2·7–14·2) than in the placebo group (3·0 days, IQR 1·0–9·3; p=0·06). Interpretation Rivastigmine did not decrease duration of delirium and might have increased mortality so we do not recommend use of rivastigmine to treat delirium in critically ill patients. Funding ZonMw, the Netherlands Brain Foundation, and Novartis.
• Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial
  - LANCET 376(9755):1838-1845 (2010)
  Background Mobile (cell) phone communication has been suggested as a method to improve delivery of health services. However, data on the effects of mobile health technology on patient outcomes in resource-limited settings are limited. We aimed to assess whether mobile phone communication between health-care workers and patients starting antiretroviral therapy in Kenya improved drug adherence and suppression of plasma HIV-1 RNA load. Methods WelTel Kenya1 was a multisite randomised clinical trial of HIV-infected adults initiating antiretroviral therapy (ART) in three clinics in Kenya. Patients were randomised (1:1) by simple randomisation with a random number generating program to a mobile phone short message service (SMS) intervention or standard care. Patients in the intervention group received weekly SMS messages from a clinic nurse and were required to respond within 48 h. Randomisation, laboratory assays, and analyses were done by investigators masked to treatment allocation; however, study participants and clinic staff were not masked to treatment. Primary outcomes were self-reported ART adherence (>95% of prescribed doses in the past 30 days at both 6 and 12 month follow-up visits) and plasma HIV-1 viral RNA load suppression (<400 copies per mL) at 12 months. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT00830622. Findings Between May, 2007, and October, 2008, we randomly assigned 538 participants to the SMS intervention (n=273) or to standard care (n=265). Adherence to ART was reported in 168 of 273 patients receiving the SMS intervention compared with 132 of 265 in the control group (relative risk [RR] for non-adherence 0·81, 95% CI 0·69–0·94; p=0·006). Suppressed viral loads were reported in 156 of 273 patients in the SMS group and 128 of 265 in the control group, (RR for virologic failure 0·84, 95% CI 0·71–0·99; p=0·04). The number needed to treat (NNT) to achieve greater than 95% adherence was nine (95% CI 5·0–29·5) and the NNT to achieve viral load suppression was 11 (5·8–227·3). Interpretation Patients who received SMS support had significantly improved ART adherence and rates of viral suppression compared with the control individuals. Mobile phones might be effective tools to improve patient outcome in resource-limited settings. Funding US President's Emergency Plan for AIDS Relief.
• Paediatric mortality related to pandemic influenza A H1N1 infection in England: an observational population-based study
  - LANCET 376(9755):1846-1852 (2010)
  Background Young people (aged 0–18 years) have been disproportionately affected by pandemic influenza A H1N1 infection. We aimed to analyse paediatric mortality to inform clinical and public health policies for future influenza seasons and pandemics. Methods All paediatric deaths related to pandemic influenza A H1N1 infection from June 26, 2009, to March 22, 2010 in England were identified through daily reporting systems and cross-checking of records and were validated by confirmation of influenza infection by laboratory results or death certificates. Clinicians responsible for each individual child provided detailed information about past medical history, presentation, and clinical course of the acute illness. Case estimates of influenza A H1N1 were obtained from the Health Protection Agency. The primary outcome measures were population mortality rates and case-fatality rates. Findings 70 paediatric deaths related to pandemic influenza A H1N1 were reported. Childhood mortality rate was 6 per million population. The rate was highest for children aged less than 1 year. Mortality rates were higher for Bangladeshi children (47 deaths per million population [95% CI 17–103]) and Pakistani children (36 deaths per million population [18–64]) than for white British children (4 deaths per million [3–6]). 15 (21%) children who died were previously healthy; 45 (64%) had severe pre-existing disorders. The highest age-standardised mortality rate for a pre-existing disorder was for chronic neurological disease (1536 per million population). 19 (27%) deaths occurred before inpatient admission. Children in this subgroup were significantly more likely to have been healthy or had only mild pre-existing disorders than those who died after admission (p=0·0109). Overall, 45 (64%) children had received oseltamivir: seven within 48 h of symptom onset. Interpretation Vaccination priority should be for children at increased risk of severe illness or death from influenza. This group might include those with specified pre-existing disorders and those in some ethnic minority groups. Early pre-hospital supportive and therapeutic care is also important. Funding Department of Health, UK
• Causes of neonatal and child mortality in India: a nationally representative mortality survey
  - LANCET 376(9755):1853-1860 (2010)
  Background More than 2·3 million children died in India in 2005; however, the major causes of death have not been measured in the country. We investigated the causes of neonatal and child mortality in India and their differences by sex and region. Methods The Registrar General of India surveyed all deaths occurring in 2001–03 in 1·1 million nationally representative homes. Field staff interviewed household members and completed standard questions about events that preceded the death. Two of 130 physicians then independently assigned a cause to each death. Cause-specific mortality rates for 2005 were calculated nationally and for the six regions by combining the recorded proportions for each cause in the neonatal deaths and deaths at ages 1–59 months in the study with population and death totals from the United Nations. Findings There were 10 892 deaths in neonates and 12 260 in children aged 1–59 months in the study. When these details were projected nationally, three causes accounted for 78% (0·79 million of 1·01 million) of all neonatal deaths: prematurity and low birthweight (0·33 million, 99% CI 0·31 million to 0·35 million), neonatal infections (0·27 million, 0·25 million to 0·29 million), and birth asphyxia and birth trauma (0·19 million, 0·18 million to 0·21 million). Two causes accounted for 50% (0·67 million of 1·34 million) of all deaths at 1–59 months: pneumonia (0·37 million, 0·35 million to 0·39 million) and diarrhoeal diseases (0·30 million, 0·28 million to 0·32 million). In children aged 1–59 months, girls in central India had a five-times higher mortality rate (per 1000 livebirths) from pneumonia (20·9, 19·4–22·6) than did boys in south India (4·1, 3·0–5·6) and four-times higher mortality rate from diarrhoeal disease (17·7, 16·2–19·3) than did! boys in west India (4·1, 3·0–5·5). Interpretation Five avoidable causes accounted for nearly 1·5 million child deaths in India in 2005, with substantial differences between regions and sexes. Expanded neonatal and intrapartum care, case management of diarrhoea and pneumonia, and addition of new vaccines to immunisation programmes could substantially reduce child deaths in India. Funding US National Institutes of Health, International Development Research Centre, Canadian Institutes of Health Research, Li Ka Shing Knowledge Institute, and US Fund for UNICEF.
• Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries
  - LANCET 376(9755):1861-1868 (2010)
  The burden of chronic, non-communicable diseases in low-income and middle-income countries is increasing. We outline a framework for monitoring of such diseases and review the mortality burden and the capacity of countries to respond to them. We show data from WHO data sources and published work for prevalence of tobacco use, overweight, and cause-specific mortality in 23 low-income and middle-income countries with a high burden of non-communicable disease. Data for national capacity for chronic disease prevention and control were generated from a global assessment that was done in WHO member states in 2009–10. Although reliable data for cause-specific mortality are scarce, non-communicable diseases were estimated to be responsible for 23·4 million (or 64% of the total) deaths in the 23 countries that we analysed, with 47% occurring in people who were younger than 70 years. Tobacco use and overweight are common in most of the countries and populations we examined, b! ut coverage of cost-effective interventions to reduce these risk factors is low. Capacity for prevention and control of non-communicable diseases, including monitoring and surveillance operations nationally, is inadequate. A surveillance framework, including a minimum set of indicators covering exposures and outcomes, is essential for policy development and assessment and for monitoring of trends in disease. Technical, human, and fiscal resource constraints are major impediments to the establishment of effective prevention and control programmes. Despite increasing awareness and commitment to address chronic disease, concrete actions by global partners to plan and implement cost-effective interventions are inadequate.
• Universal access to malaria medicines: innovation in financing and delivery
  - LANCET 376(9755):1869-1871 (2010)
  
• A hearty sneeze
  - LANCET 376(9755):1872 (2010)