Hot off the presses! Nov 26 LANCET

The Nov 26 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:

• Respect and care for the older person
  - LANCET 376(9754):1711 (2010)
  
• Shortage of streptomycin: time for a change of approach?
  - LANCET 376(9754):1712 (2010)
  
• Promoting women in science and medicine
  - LANCET 376(9754):1712 (2010)
  
• Aspirin to prevent colorectal cancer: time to act?
  - LANCET 376(9754):1713-1714 (2010)
  
• Corticosteroids: short-term gain for long-term pain?
  - LANCET 376(9754):1714-1715 (2010)
  
• India's invisible malaria burden
  - LANCET 376(9754):1716-1717 (2010)
  
• Service personnel move to NHS mental health inpatient care
  - LANCET 376(9754):1717-1719 (2010)
  
• Measles eradication: past is prologue
  - LANCET 376(9754):1719-1720 (2010)
  
• Stronger national public health institutes for global health
  - LANCET 376(9754):1721-1722 (2010)
  
• The Lancet/Global Forum essay competition winners 2010
  - LANCET 376(9754):1723 (2010)
  
• Fast food feud at Golden Gate
  - LANCET 376(9754):1723 (2010)
  
• Offline: Naming and shaming
  - LANCET 376(9754):1724 (2010)
  
• Tackling the booming trade in counterfeit drugs
  - LANCET 376(9754):1725-1726 (2010)
  
• Healing the mental scars of combat
  - LANCET 376(9754):1727-1728 (2010)
  
• In pursuit of happiness
  - LANCET 376(9754):1729 (2010)
  
• Textile DNA
  - LANCET 376(9754):1730 (2010)
  
• CDC's Thomas Frieden—protecting health and reducing costs
  - LANCET 376(9754):1731 (2010)
  
• Cool intimacies of care for contemporary clinical practice
  - LANCET 376(9754):1732-1733 (2010)
  
• Arthur Rosenbaum
  - LANCET 376(9754):1734 (2010)
  
• Trastuzumab for gastric cancer treatment
  - LANCET 376(9754):1735 (2010)
  
• Trastuzumab for gastric cancer treatment – Authors' reply
  - LANCET 376(9754):1735-1736 (2010)
  
• Trastuzumab for gastric cancer treatment
  - LANCET 376(9754):1736 (2010)
  
• Trastuzumab for gastric cancer treatment – Authors' reply
  - LANCET 376(9754):1736-1737 (2010)
  
• Telemonitoring—or better follow-up?
  - LANCET 376(9754):1737 (2010)
  
• Telemonitoring—or better follow-up? – Authors' reply
  - LANCET 376(9754):1737-1738 (2010)
  
• HDL cholesterol and residual risk of first cardiovascular events
  - LANCET 376(9754):1738 (2010)
  
• HDL cholesterol and residual risk of first cardiovascular events – Authors' reply
  - LANCET 376(9754):1738-1739 (2010)
  
• Missing centenarians in Japan: a new ageism
  - LANCET 376(9754):1739 (2010)
  
• Ethiopia struggles to make its voice heard
  - LANCET 376(9754):1739-1740 (2010)
  
• Facebook: a new trigger for asthma?
  - LANCET 376(9754):1740 (2010)
  
• Department of Error
  - LANCET 376(9754):1740 (2010)
  
• Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials
  - LANCET 376(9754):1741-1750 (2010)
  Background High-dose aspirin (≥500 mg daily) reduces long-term incidence of colorectal cancer, but adverse effects might limit its potential for long-term prevention. The long-term effectiveness of lower doses (75–300 mg daily) is unknown. We assessed the effects of aspirin on incidence and mortality due to colorectal cancer in relation to dose, duration of treatment, and site of tumour. Methods We followed up four randomised trials of aspirin versus control in primary (Thrombosis Prevention Trial, British Doctors Aspirin Trial) and secondary (Swedish Aspirin Low Dose Trial, UK-TIA Aspirin Trial) prevention of vascular events and one trial of different doses of aspirin (Dutch TIA Aspirin Trial) and established the effect of aspirin on risk of colorectal cancer over 20 years during and after the trials by analysis of pooled individual patient data. Results In the four trials of aspirin versus control (mean duration of scheduled treatment 6·0 years), 391 (2·8%) of 14 033 patients had colorectal cancer during a median follow-up of 18·3 years. Allocation to aspirin reduced the 20-year risk of colon cancer (incidence hazard ratio [HR] 0·76, 0·60–0·96, p=0·02; mortality HR 0·65, 0·48–0·88, p=0·005), but not rectal cancer (0·90, 0·63–1·30, p=0·58; 0·80, 0·50–1·28, p=0·35). Where subsite data were available, aspirin reduced risk of cancer of the proximal colon (0·45, 0·28–0·74, p=0·001; 0·34, 0·18–0·66, p=0·001), but not the distal colon (1·10, 0·73–1·64, p=0·66; 1·21, 0·66–2·24, p=0·54; for incidence difference p=0·04, for mortality difference p=0·01). However, benefit increased with scheduled duration of treatment, such that allocation to aspirin of 5 years or longer reduced risk of proximal colon cancer by about 70% (0·35, 0·20–0·63; 0·24, 0·11–0·52; both p<0·0001) an! d also reduced risk of rectal cancer (0·58, 0·36–0·92, p=0·02; 0·47, 0·26–0·87, p=0·01). There was no increase in benefit at doses of aspirin greater than 75 mg daily, with an absolute reduction of 1·76% (0·61–2·91; p=0·001) in 20-year risk of any fatal colorectal cancer after 5-years scheduled treatment with 75–300 mg daily. However, risk of fatal colorectal cancer was higher on 30 mg versus 283 mg daily on long-term follow-up of the Dutch TIA trial (odds ratio 2·02, 0·70–6·05, p=0·15). Interpretation Aspirin taken for several years at doses of at least 75 mg daily reduced long-term incidence and mortality due to colorectal cancer. Benefit was greatest for cancers of the proximal colon, which are not otherwise prevented effectively by screening with sigmoidoscopy or colonoscopy. Funding None.
• Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials
  - LANCET 376(9754):1751-1767 (2010)
  Background Few evidence-based treatment guidelines for tendinopathy exist. We undertook a systematic review of randomised trials to establish clinical efficacy and risk of adverse events for treatment by injection. Methods We searched eight databases without language, publication, or date restrictions. We included randomised trials assessing efficacy of one or more peritendinous injections with placebo or non-surgical interventions for tendinopathy, scoring more than 50% on the modified physiotherapy evidence database scale. We undertook meta-analyses with a random-effects model, and estimated relative risk and standardised mean differences (SMDs). The primary outcome of clinical efficacy was protocol-defined pain score in the short term (4 weeks, range 0–12), intermediate term (26 weeks, 13–26), or long term (52 weeks, ≥52). Adverse events were also reported. Findings 3824 trials were identified and 41 met inclusion criteria, providing data for 2672 participants. We showed consistent findings between many high-quality randomised controlled trials that corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms. For example, in pooled analysis of treatment for lateral epicondylalgia, corticosteroid injection had a large effect (defined as SMD>0·8) on reduction of pain compared with no intervention in the short term (SMD 1·44, 95% CI 1·17–1·71, p<0·0001), but no intervention was favoured at intermediate term (−0·40, −0·67 to −0·14, p<0·003) and long term (−0·31, −0·61 to −0·01, p=0·05). Short-term efficacy of corticosteroid injections for rotator-cuff tendinopathy is not clear. Of 991 participants who received corticosteroid injections in studies that reported adverse events, only one (0·1%) had a serious adverse event (te! ndon rupture). By comparison with placebo, reductions in pain were reported after injections of sodium hyaluronate (short [3·91, 3·54–4·28, p<0·0001], intermediate [2·89, 2·58–3·20, p<0·0001], and long [3·91, 3·55–4·28, p<0·0001] terms), botulinum toxin (short term [1·23, 0·67–1·78, p<0·0001]), and prolotherapy (intermediate term [2·62, 1·36–3·88, p<0·0001]) for treatment of lateral epicondylalgia. Lauromacrogol (polidocanol), aprotinin, and platelet-rich plasma were not more efficacious than was placebo for Achilles tendinopathy, while prolotherapy was not more effective than was eccentric exercise. Interpretation Despite the effectiveness of corticosteroid injections in the short term, non-corticosteroid injections might be of benefit for long-term treatment of lateral epicondylalgia. However, response to injection should not be generalised because of variation in effect between sites of tendinopathy. Funding None.
• Adult and child malaria mortality in India: a nationally representative mortality survey
  - LANCET 376(9754):1768-1774 (2010)
  Background National malaria death rates are difficult to assess because reliably diagnosed malaria is likely to be cured, and deaths in the community from undiagnosed malaria could be misattributed in retrospective enquiries to other febrile causes of death, or vice-versa. We aimed to estimate plausible ranges of malaria mortality in India, the most populous country where the disease remains common. Methods Full-time non-medical field workers interviewed families or other respondents about each of 122 000 deaths during 2001–03 in 6671 randomly selected areas of India, obtaining a half-page narrative plus answers to specific questions about the severity and course of any fevers. Each field report was sent to two of 130 trained physicians, who independently coded underlying causes, with discrepancies resolved either via anonymous reconciliation or adjudication. Findings Of all coded deaths at ages 1 month to 70 years, 2681 (3·6%) of 75 342 were attributed to malaria. Of these, 2419 (90%) were in rural areas and 2311 (86%) were not in any health-care facility. Death rates attributed to malaria correlated geographically with local malaria transmission ratesderived independently from the Indian malaria control programme. The adjudicated results show 205 000 malaria deaths per year in India before age 70 years (55 000 in early childhood, 30 000 at ages 5–14 years, 120 000 at ages 15–69 years); 1·8% cumulative probability of death from malaria before age 70 years. Plausible lower and upper bounds (on the basis of only the initial coding) were 125 000–277 000. Malaria accounted for a substantial minority of about 1·3 million unattended rural fever deaths attributed to infectious diseases in people younger than 70 years. Interpretation Despite uncertainty as to which unattended febrile deaths are from malaria, even the lower bound greatly exceeds the WHO estimate of only 15 000 malaria deaths per year in India (5000 early childhood, 10 000 thereafter). This low estimate should be reconsidered, as should the low WHO estimate of adult malaria deaths worldwide. Funding US National Institutes of Health, Canadian Institute of Health Research, Li Ka Shing Knowledge Institute.
• Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness
  - LANCET 376(9754):1775-1784 (2010)
  The obesity epidemic is spreading to low-income and middle-income countries as a result of new dietary habits and sedentary ways of life, fuelling chronic diseases and premature mortality. In this report we present an assessment of public health strategies designed to tackle behavioural risk factors for chronic diseases that are closely linked with obesity, including aspects of diet and physical inactivity, in Brazil, China, India, Mexico, Russia, and South Africa. England was included for comparative purposes. Several population-based prevention policies can be expected to generate substantial health gains while entirely or largely paying for themselves through future reductions of health-care expenditures. These strategies include health information and communication strategies that improve population awareness about the benefits of healthy eating and physical activity; fiscal measures that increase the price of unhealthy food content or reduce the cost of healthy fo! ods rich in fibre; and regulatory measures that improve nutritional information or restrict the marketing of unhealthy foods to children. A package of measures for the prevention of chronic diseases would deliver substantial health gains, with a very favourable cost-effectiveness profile.
• Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries
  - LANCET 376(9754):1785-1797 (2010)
  National health systems need strengthening if they are to meet the growing challenge of chronic diseases in low-income and middle-income countries. By application of an accepted health-systems framework to the evidence, we report that the factors that limit countries' capacity to implement proven strategies for chronic diseases relate to the way in which health systems are designed and function. Substantial constraints are apparent across each of the six key health-systems components of health financing, governance, health workforce, health information, medical products and technologies, and health-service delivery. These constraints have become more evident as development partners have accelerated efforts to respond to HIV, tuberculosis, malaria, and vaccine-preventable diseases. A new global agenda for health-systems strengthening is arising from the urgent need to scale up and sustain these priority interventions. Most chronic diseases are neglected in this dialogue! about health systems, despite the fact that non-communicable diseases (most of which are chronic) will account for 69% of all global deaths by 2030 with 80% of these deaths in low-income and middle-income countries. At the same time, advocates for action against chronic diseases are not paying enough attention to health systems as part of an effective response. Efforts to scale up interventions for management of common chronic diseases in these countries tend to focus on one disease and its causes, and are often fragmented and vertical. Evidence is emerging that chronic disease interventions could contribute to strengthening the capacity of health systems to deliver a comprehensive range of services—provided that such investments are planned to include these broad objectives. Because effective chronic disease programmes are highly dependent on well-functioning national health systems, chronic diseases should be a litmus test for health-systems strengthening.
• Tired legs—a gut diagnosis
  - LANCET 376(9754):1798 (2010)