The Lancet RSS Feed: current issue. The Lancet is a weekly medical journal, renowned for the publication of high-quality peer-reviewed research from around the world. It provides context and insight to advancements in medicine and health worldwide.
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[Articles] Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis
The modest risk of Guillain-Barré syndrome attributed to vaccination is consistent with previous estimates of the disorder after seasonal influenza vaccination. A risk of this small magnitude would be difficult to capture during routine seasonal influenza vaccine programmes, which have extensive, but comparatively less, safety monitoring. In view of the morbidity and mortality caused by 2009 H1N1 influenza and the effectiveness of the vaccine, clinicians, policy makers, and those eligible for vaccination should be assured that the benefits of inactivated pandemic vaccines greatly outweigh the risks.
[Articles] Vitamin A supplementation every 6 months with retinol in 1 million pre-school children in north India: DEVTA, a cluster-randomised trial
DEVTA contradicts the expectation from other trials that vitamin A supplementation would reduce child mortality by 20–30%, but cannot rule out some more modest effect. Meta-analysis of DEVTA plus eight previous randomised trials of supplementation (in various different populations) yielded a weighted average mortality reduction of 11% (95% CI 5–16, p=0·00015), reliably contradicting the hypothesis of no effect.
[Articles] Population deworming every 6 months with albendazole in 1 million pre-school children in north India: DEVTA, a cluster-randomised trial
Existing ICDS village staff can be organised to deliver simple pre-school interventions sustainably for many years at low cost, but regular deworming had little effect on mortality in this lightly infected pre-school population.
[Series] Bottlenecks, barriers, and solutions: results from multicountry consultations focused on reduction of childhood pneumonia and diarrhoea deaths
Millions of children still die unnecessarily from pneumonia and diarrhoea, mainly in resource-poor settings. A series of collaborative consultations and workshops involving several hundred academic, public health, governmental and private sector stakeholders were convened to identify the key barriers to progress and to issue recommendations. Bottlenecks impairing access to commodities included antiquated supply management systems, insufficient funding for drugs, inadequate knowledge about interventions by clients and providers, health worker shortages, poor support for training or retention of health workers, and a failure to convert national policies into action plans.
Global under-5 mortality has fallen rapidly from 12 million deaths in 1990, to 6·9 million in 2011; however, this number still falls short of the target of a two-thirds reduction or a maximum of 4 million deaths by 2015. Acceleration of reductions in deaths due to pneumonia and diarrhoea, which together account for about 2 million child deaths every year, is essential if the target is to be met. Scaling up of existing interventions against the two diseases to 80% and immunisation to 90% would eliminate more than two-thirds of deaths from these two diseases at a cost of US$6·715 billion by 2025.
The decision by Australia's High Court to uphold the constitutionality of the country's ground-breaking tobacco plain packaging laws has been heralded as a victory for national sovereignty over vested interests. However, the ability of governments worldwide to introduce and implement public health policies and laws is increasingly threatened by trade and investment treaties that privilege investors over governments and provide avenues for international corporations to challenge democratically enacted public health policies in different countries.
A 36-year-old woman with unremarkable medical history was referred to our emergency department in November, 2012, with a 10-day history of right-sided pulsating neck pain radiating into the shoulder. The pain started spontaneously and did not respond to analgesics. 4 days after the onset of pain, the patient had numbness on her right side, extending from the mandibular angle to the neck, the clavicular region, and the proximal arm along the deltoid muscle. She further developed right-sided weakness of arm abduction and elbow flexion plus dyspnoea.
President Barack Obama's proposed 2014 budget includes an increase of US$3·9 billion to US health care, as his administration continues with its overhaul of health care in the country. Mental health services will receive a welcome $130 million boost, but funds allocated for Medicare will be cut by $370 million over the next decade.
China will never forget the epidemic of severe acute respiratory syndrome (SARS), for which it paid such a heavy and painful price a decade ago. According to WHO, from Nov 1, 2002, to July 31, 2003, 648 of the 7082 probable cases of SARS in mainland China and Hong Kong died. Many of the patients were front-line health workers. At that time, in the wake of its initial negative response to SARS, as well as proof of its fragmented and ineffective public health system, the Chinese Government's international reputation and domestic credibility were seriously damaged.
At a donor conference on April 9–10 in Brussels, Belgium, the Global Fund to Fight AIDS, Tuberculosis and Malaria presented a compelling case for funding the organisation to not only tackle these diseases but also to accelerate gains against them. The message was simple—increased funding now could dramatically alter the course of these diseases, and eventually bring them under control thanks to recent advances in science, falling treatment costs, and implementation know-how.
How would you assess the wellbeing of a child? Would you calculate infant mortality? Or find out whether they had a good pair of shoes? Or simply ask them how they are? UNICEF's newly published Innocenti Report Card 11 uses all of these approaches and more to assess wellbeing in 29 advanced economies. Results for the UK are mixed; overweight and smoking have fallen, but teenage pregnancy is high and infant mortality is double that of Sweden and Finland. However, the methods have weaknesses that might well cast doubt on the conclusions: several of the indicators of wellbeing lack validation and much of the data are self reported and open to cultural biases.
There is much to celebrate in child health. Over the past 20 years, global mortality among children younger than 5 years has decreased by 41%, from 87 deaths per 1000 livebirths in 1990 to 51 in 2011. During the same period, development assistance for maternal, newborn, and child health has increased, and has even done so through the global economic crisis. Recent international initiatives, such as Every Woman Every Child, the UN Commission on Life-Saving Commodities for Women and Children, and A Promise Renewed, have also reinvigorated the child survival agenda.
In 2010, estimates suggest that almost one-third of 135 million births and over two-thirds of approximately 57 million deaths worldwide were unregistered and unrecorded. In the past 40 years, the vital registration systems of the developing world have languished despite overall economic development, leading to what Setel and colleagues label a “scandal of invisibility” among poor and marginalised communities. In the absence of political will, adequate resources, and donor prioritisation, most developing countries have neglected their vital registries
Although early treatment of adolescents with anorexia nervosa—through mobilisation of the family to restore normal eating and weight—is successful in 30–60% of patients, in those with an illness duration of longer than 3 years (as is often the case in adult patients) change is more difficult. Even with the best available psychological treatments, outcomes in those with an established form of the illness are generally poor.
Since 2005, the National Human Genome Research Institute database of published genome-wide association studies (GWAS) has accumulated more than 5110 entries for over 500 traits. The rapid growth of data repositories has enabled researchers to undertake large studies and meta-analyses, and has increased the power for detection of trait-associated variants. In The Lancet, the Psychiatric Genomics Consortium (PGC) describes its analysis of genome-wide single nucleotide polymorphism (SNP) data for 33 332 cases and 27 888 controls distributed among the five major psychiatric disorders in the PGC (major depressive disorder, bipolar disorder, schizophrenia, autism spectrum disorders, and attention deficit hyperactivity disorder).
Paediatric respiratory-tract infections are a common and major source of morbidity and mortality worldwide, particularly in developing countries. Pneumonia is the leading cause of mortality in children younger than 5 years: every year, 1·4–1·6 million young children die from this infection and up to 13% of roughly 155 million episodes are severe enough to warrant hospital admission. Furthermore, children can be a source of drug-resistant pneumococci, as shown by the reduction in rates of adult pneumonia when children received pneumococcal conjugate vaccine.
The encouraging results of the ARROW trial, reported in The Lancet, raise the probability of achieving universal coverage of antiretroviral therapy (ART) for young children with HIV from poor populations. Operational innovations that increase access to ART for children are urgently needed; with more than 330 000 children worldwide newly infected in 2011, greater efforts to expand treatment programmes are essential. ART is life-saving for children, and early diagnosis and treatment reduce mortality and HIV progression by 75%.
Non-communicable diseases (NCDs) accounted for two of every three deaths (34·5 million) worldwide in 2010. Addressing the expected increase in NCDs in low-income and middle-income countries will be crucial to achieving the global goal of a 25% relative reduction in premature death owing to NCDs by 2025. In developing countries the focus should be on getting prevention and treatment programmes right, whereas in high-income countries adherence to existing guidelines is key.
According to the Global Burden of Disease study, chronic obstructive pulmonary disease, lower respiratory infections, and lung cancer were the third, fourth, and fifth most substantial causes of death, respectively, in 2010. Deaths from chronic respiratory diseases are estimated to have totalled 3·78 million in 2010; trachea, bronchus, and lung cancer deaths are estimated to have increased from 1·04 million in 1990 to 1·53 million in 2010, reflecting, among other factors, a substantial rise in smoking-related deaths in developing countries.
Singapore is on the front lines of two global crises. The first is North Korea and the regional destabilisation that might follow if the regime in Pyongyang chooses to turn its war-like rhetoric into something more. The second is H7N9. One cannot overstate the fear that epidemic infectious disease holds over Asian nations. The consequences of, and the panic precipitated by, SARS in April, 2003, is still very much felt today—initial denials, eventual acceptance that a new coronavirus was real, the masks, a mass human flight from China's capital city, political paralysis, the public's devastating loss of trust in officialdom, and a city (a nation, even a region) almost wholly quarantined from the rest of the world.