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[Editorial] Accountability is key for protecting health workers
On Sept 22, 2017, during the 72nd Session of the UN General Assembly, experts and representatives from international non-governmental organisations (NGOs) and UN member states convened for Protecting Health Care in Armed Conflict. The high-level side event was a collaboration between the Permanent Missions of Canada, the Netherlands, Spain, and UK, and The Lancet –American University of Beirut Commission and the Safeguarding Health in Conflict Coalition. (Source: LANCET)
Source: LANCET - September 29, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Imagine a world free from hunger and malnutrition
On Sept 15, the UN Food and Agriculture Organization (FAO) published its annual comprehensive report, The State of Food Security and Nutrition in the World: Building Resilience for Peace and Food Security. Since its first publication in 1947, this annual report has been called The State of Food and Agriculture, but this year's title has been expanded to include the word nutrition. Also for the first time, this year's report has a wider authorship group including UN Partners —the International Fund for Agricultural Development (IFAD), UNICEF, the World Food Programme (WFP), and WHO. (Source: LANCET)
Source: LANCET - September 29, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Department of Error] Department of Error
Woodcock A, Vestbo J, Bakerly ND, et al. Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial. Lancet 2017; 390: 2247 –55—In table 1 of this Article (published online first on Sept 10, 2017), the number of patients in the fluticasone furoate and vilanterol group who had one exacerbation in the previous year before randomisation should be 472, and the number of patients in this group who had more than one exacer bation in this time should be 264. (Source: LANCET)
Source: LANCET - September 28, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Clinical Picture] Vanishing lung syndrome: giant bullous emphysema
A 44-year-old man with a 17-year history of tobacco and cannabis use presented to the emergency department with acute dyspnoea and left-sided pleuritic chest pain. He had no other medical conditions and took no regular medications. On examination he was thin and hypoxic, with a silent, hyper-resonant left hemithorax. Chest radiograph showed a large left upper lobe bulla (figure), and an incidental air rifle pellet. He was given pulmonary rehabilitation, started on regular inhaled therapy with regular tiotropium and budesonide-formoterol and salbutamol as required, and given smoking cessation support. (Source: LANCET)
Source: LANCET - September 28, 2017 Category: General Medicine Authors: Peter Davies, Christine Bradley Tags: Clinical Picture Source Type: research

[Articles] Efficacy and immunogenicity of a Vi-tetanus toxoid conjugate vaccine in the prevention of typhoid fever using a controlled human infection model of Salmonella Typhi: a randomised controlled, phase 2b trial
Vi-TT is a highly immunogenic vaccine that significantly reduces typhoid fever cases when assessed using a stringent controlled model of typhoid infection. Vi-TT use has the potential to reduce both the burden of typhoid fever and associated health inequality. (Source: LANCET)
Source: LANCET - September 28, 2017 Category: General Medicine Authors: Celina Jin, Malick M Gibani, Maria Moore, Helene B Juel, Elizabeth Jones, James Meiring, Victoria Harris, Jonathan Gardner, Anna Nebykova, Simon A Kerridge, Jennifer Hill, Helena Thomaides-Brears, Christoph J Blohmke, Ly-Mee Yu, Brian Angus, Andrew J Poll Tags: Articles Source Type: research

[Comment] Typhoid vaccine development with a human challenge model
Experimental human typhoid fever challenge was first described in 1896 by Wright, who vaccinated two men against typhoid fever and challenged one with what was then known as Salmonella typhosa.1 While challenge models are sometimes controversial, they offer enormous potential to study the pathogenesis of disease and to accelerate vaccine development, particularly in human-restricted pathogens such as Salmonella enterica serovar Typhi. The Maryland typhoid human challenge model, which ran from 1952 to 1974, led to insights into typhoid fever and facilitated the development of live attenuated typhoid vaccine Ty21a. (Source: LANCET)
Source: LANCET - September 28, 2017 Category: General Medicine Authors: Nicholas A Feasey, Myron M Levine Tags: Comment Source Type: research

[Health Policy] How will Brexit affect health and health services in the UK? Evaluating three possible scenarios
The process of leaving the European Union (EU) will have profound consequences for health and the National Health Service (NHS) in the UK. In this paper, we use the WHO health system building blocks framework to assess the likely effects of three scenarios we term soft Brexit, hard Brexit, and failed Brexit. We conclude that each scenario poses substantial threats. The workforce of the NHS is heavily reliant on EU staff. Financing of health care for UK citizens in the EU and vice versa is threatened, as is access to some capital funds, while Brexit threatens overall economic performance. (Source: LANCET)
Source: LANCET - September 28, 2017 Category: General Medicine Authors: Nick Fahy, Tamara Hervey, Scott Greer, Holly Jarman, David Stuckler, Mike Galsworthy, Martin McKee Tags: Health Policy Source Type: research

[Articles] Global, regional, and subregional classification of abortions by safety, 2010 –14: estimates from a Bayesian hierarchical model
Increased efforts are needed, especially in developing countries, to ensure access to safe abortion. The paucity of empirical data is a limitation of these findings. Improved in-country data for health services and innovative research to address these gaps are needed to improve future estimates. (Source: LANCET)
Source: LANCET - September 27, 2017 Category: General Medicine Authors: Bela Ganatra, Caitlin Gerdts, Cl émentine Rossier, Brooke Ronald Johnson, Özge Tunçalp, Anisa Assifi, Gilda Sedgh, Susheela Singh, Akinrinola Bankole, Anna Popinchalk, Jonathan Bearak, Zhenning Kang, Leontine Alkema Tags: Articles Source Type: research

[Comment] Estimating abortion safety: advancements and challenges
In The Lancet, Bela Ganatra and colleagues1 present an innovative and important analysis of global abortion safety, in which they attempt to move beyond the binary understanding (safe or unsafe) of abortion safety. As the availability of misoprostol increases, and abortion telemedicine services reach more women worldwide, fewer women are undergoing abortions with invasive or outdated methods and more women are having abortions outside of formal health-care systems.2 These changes prompt a need for rethinking how we view and measure abortion safety. (Source: LANCET)
Source: LANCET - September 27, 2017 Category: General Medicine Authors: Kristina Gemzell-Danielsson, Amanda Cleeve Tags: Comment Source Type: research

[Articles] Mapping under-5 and neonatal mortality in Africa, 2000 –15: a baseline analysis for the Sustainable Development Goals
In the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is precarious at best. By producing under-5 and neonatal mortality rates at multiple levels of geospatial resolution over time, this study provides key information for decision makers to target interventions at populations in the greatest need. In an era when precision public health increasingly has the potential to transform the design, implementation, and impact of health programmes, our 5  × 5 km estimates of child mortality in Africa provide a baseline against which loc...
Source: LANCET - September 25, 2017 Category: General Medicine Authors: Nick Golding, Roy Burstein, Joshua Longbottom, Annie J Browne, Nancy Fullman, Aaron Osgood-Zimmerman, Lucas Earl, Samir Bhatt, Ewan Cameron, Daniel C Casey, Laura Dwyer-Lindgren, Tamer H Farag, Abraham D Flaxman, Maya S Fraser, Peter W Gething, Harry S Gi Tags: Articles Source Type: research

[Comment] Precision public health: mapping child mortality in Africa
Spurred by Millennium Development Goal (MDG) 4, substantial progress in reducing child deaths was made between 1990 and 2015 around the world. The global under-5 mortality rate decreased from 90 ·6 deaths per 1000 livebirths in 1990 to 42·5 in 2015, a reduction of 53%.1 This equated to a worldwide reduction in annual number of under-5 deaths from 12·7 million to 5·9 million.1 Although this is an enormous accomplishment, and has been celebrated, these and other analyses have made clear t hat achievements varied considerably by cause of death,2 region,3,4 and country. (Source: LANCET)
Source: LANCET - September 25, 2017 Category: General Medicine Authors: Gail Davey, Kebede Deribe Tags: Comment Source Type: research

[Comment] Innovating through “interesting times” in global health
The reputed Chinese curse —“May you live in interesting times”—warns of periods of turbulence amid changing power structures and the failure of familiar solutions to meet new challenges. Today, the global health community is certainly living in interesting times. Rising populism and nationalism in the USA and Europe is working against the use of national budgets for international aid and development, despite their inextricable link to domestic health.1 However, such challenges can foster innovative approaches to transform and enhance global health efforts. (Source: LANCET)
Source: LANCET - September 25, 2017 Category: General Medicine Authors: Amie Batson, Michael Merson, Victor Dzau Tags: Comment Source Type: research

[Department of Error] Department of Error
Nomura S, Sakamoto H, Glenn S, et al. Population health and regional variations of disease burden in Japan, 1990 –2015: a systematic subnational analysis for the Global Burden of Disease Study 2015. Lancet 2017; 390: 1521–38—In figure 6 of this Article, the y-axis should have read “Age-standardised death rates per 100 000 people in 2015”. This correction has been made to the online version as of Se pt 21, 2017, and the printed version is correct. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Head injury decision rules in children – Authors' reply
We thank Martin H Osmond and Nathan Kuppermann and colleagues for their responses to our study1 comparing the accuracy of three head injury decision rules, PECARN, CATCH, and CHALICE. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: Franz E Babl, Ed Oakley, Meredith L Borland, Silvia Bressan, Stuart R Dalziel Tags: Correspondence Source Type: research

[Correspondence] Head injury decision rules in children
The well designed Lancet study by Franz E Babl and colleagues1 compares three rules used for neuroimaging in paediatric patients with head trauma. As authors of the PECARN rules,2 we highlight several important points that require consideration. First, the three prediction rules compared were published in 2006, 2009, and 2010, before enrolment for the study by Babl and colleagues began. Therefore, the 10% CT rate noted by Babl and colleagues should be considered in that context, because CT ordering was likely to have been influenced by the rules. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: Nathan Kuppermann, James F Holmes, Peter S Dayan Tags: Correspondence Source Type: research

[Correspondence] Head injury decision rules in children
In The Lancet (June 17, p 2393),1 Franz E Babl and colleagues report a prospective cohort study comparing the accuracy of three head injury decision rules in children: PECARN,2 CATCH,3 and CHALICE.4 As an author of the CATCH rules, I commend Babl and his team for their large prospective external validation study. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: Martin H Osmond Tags: Correspondence Source Type: research

[Correspondence] Exclusive and partial enteral nutrition for Crohn's disease – Authors' reply
We appreciate the letter from Nizar Senussi about the use of exclusive or partial enteral nutrition in children with Crohn's disease. We agree that enteral nutrition has many beneficial effects and is probably underused in practice. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: Subra Kugathasan, Lee A Denson, Jeffrey S Hyams Tags: Correspondence Source Type: research

[Correspondence] Exclusive and partial enteral nutrition for Crohn's disease
In their Article, Subra Kugathasan and colleagues (April 29, p 1710)1 validated a risk-stratification model showing that early anti-tumour necrosis factor α therapy in patients with Crohn's disease was associated with reduced incidence of internal penetrating complications, although not stricturing complications. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: Nizar H Senussi Tags: Correspondence Source Type: research

[Correspondence] Mainstreaming genomic medicine
The recent Editorial published in The Lancet (July 15, p 203)1 in response to the Generation Genome report argued that, because of current pressures in the National Health Service (NHS), coupled with insufficient evidence of clinical usefulness, now may not be the time for mainstreaming genomic medicine. I would like to suggest that there are inherent limitations to the transformative potential of genomics. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: David Bourn Tags: Correspondence Source Type: research

[Correspondence] Hepatitis B and C in Tonkolili Province, Sierra Leone
Although Sierra Leone is, via various international donors, making a huge effort to fight HIV infection by facilitating free testing, treatment, and counselling throughout the country, little has been done to fight hepatitis B and C, because of limited resources. As WHO recommends,1 –3 vaccination against hepatitis B is obligatory for 6-week-old children in Sierra Leone. However, no action is being taken to prevent infection among the adult population, or to prevent the vertical transmission from pregnant women to their newborn children, through vaccination in the first 24 h of life. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: Noemi Garc ía-Tardón, Tom M Gresnigt, Abu B Fofanah, Martin P Grobusch Tags: Correspondence Source Type: research

[Perspectives] Going “round the bend” in prisoner of war camps
On Feb 12, 1945, Second Lieutenant Francis Stewart, taken prisoner of war (POW) by the Germans almost 5 years before, recorded the challenges he faced. He could not concentrate. His memory was failing. He was struggling with constant noise in his room. “The exhaustion”, he wrote “was not only physical but mental as well,& for 3 days I was plagued by the prisoner's perpetual bogey that I might really be going ‘round the bend’”. This “perpetual bogey” occurred in POW camps across Europe in World War 2. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: Clare Makepeace Tags: Perspectives Source Type: research

[World Report] Health in Angola in the wake of the presidential election
The progress that had been made to improve health for the Angolan people after a long civil war could be lost among an economic crisis. Andrew Green reports. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: Andrew Green Tags: World Report Source Type: research

[Comment] Offline: The post-American age
Consider Singapore for a moment. In progress towards the health-related Sustainable Development Goals, Singapore ranks first out of 188 nations (the UK is tenth; the USA, 24th). In measures of the quality of medical care (the Healthcare Access and Quality Index), Singapore ranks 21st (the UK is 30th; the USA, 35th). In this month's world university rankings, produced by the Times Higher Education, the National University of Singapore (NUS) was 22nd. NUS is now the leading university in Asia. Singapore, all 241 square miles of it, became a sovereign nation in 1965. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research

[Comment] Beating NCDs can help deliver universal health coverage
In WHO's drive to ensure good health and care for all, there is a pressing need to step up global and national action on non-communicable diseases (NCDs), and the factors that put so many people at risk of illness and death from these conditions worldwide. By action, we mean coordinated action that is led by the highest levels of government and that inserts health concerns into all policy making —from trade and finance to education, environment, and urban planning. Action needs to go beyond government and must bring in civil society, academia, business, and other stakeholders to promote health. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: Tabar é Ramón Vázquez, Tedros Adhanom Ghebreyesus Tags: Comment Source Type: research

[Editorial] An annual spotlight on Australian general practice
On Sept 13, the Royal Australian College of General Practitioners (RACGP) published an inaugural Gene-ral Practice: Health of the Nation report. Their analysis will become an annual review of Australian general practice: to plan for a future workforce, to track conditions most commonly presented by patients, and to gauge general practitioner (GP) job satisfaction and discontent. The RACGP represents 35  000 members and 17 000 Fellows, treating Australia's population of 24 million. (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Last days of the Rohingya of Rakhine
While the UN Security Council issued a statement last week calling to end the violence against the Rohingya Muslim population of Northern Rakhine State, Myanmar, military forces were burning more villages. In 3 weeks, over 400  000 people (more than half of them children and 400 newborn babies) have made the perilous boat voyage to Bangladesh, fleeing a violent campaign of scorched homes, killings, rapes, and landmine injuries. Although Nobel Laureate Aung San Suu Kyi finally broke her silence this week condemning all h uman rights violations in Rakhine, she fell short of criticising the notorious Tatmadaw national army,...
Source: LANCET - September 22, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] For universal health coverage, tomorrow is today
In a Comment published alongside the Lancet Series America: Equity and Inequality in Health in April, 2017, Senator Bernie Sanders (I-VT) wrote: “Today, we must do everything we can to prevent the repeal of the [Affordable Care Act (ACA)] and oppose attempts by the Trump administration to undermine it by failing to enforce the law or promulgating regulations that would sabotage it. Tomorrow, we must work to join the rest of the industriali sed world and guarantee health care to all citizens through a Medicare-for-all single-payer system.” (Source: LANCET)
Source: LANCET - September 22, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] The effect of physical activity on mortality and cardiovascular disease in 130  000 people from 17 high-income, middle-income, and low-income countries: the PURE study
Higher recreational and non-recreational physical activity was associated with a lower risk of mortality and CVD events in individuals from low-income, middle-income, and high-income countries. Increasing physical activity is a simple, widely applicable, low cost global strategy that could reduce deaths and CVD in middle age. (Source: LANCET)
Source: LANCET - September 21, 2017 Category: General Medicine Authors: Scott A Lear, Weihong Hu, Sumathy Rangarajan, Danijela Gasevic, Darryl Leong, Romaina Iqbal, Amparo Casanova, Sumathi Swaminathan, R M Anjana, Rajesh Kumar, Annika Rosengren, Li Wei, Wang Yang, Wang Chuangshi, Liu Huaxing, Sanjeev Nair, Rafael Diaz, Hany Tags: Articles Source Type: research

[Comment] Physical activity lowers mortality and heart disease risks
In The Lancet, Scott A Lear and colleagues1 report results from a large cohort of 130  843 participants from 17 countries (including four low-income countries and seven middle-income countries) investigating the beneficial dose-dependent associations of all forms of physical activity with reduced mortality and cardiovascular disease risks.1 This is another confirmation that physica l activity has definite and dose-dependent benefits for lowering risks of all-cause mortality and cardiovascular disease (heart attacks, stroke, and heart failure). (Source: LANCET)
Source: LANCET - September 21, 2017 Category: General Medicine Authors: Shifalika Goenka, I-Min Lee Tags: Comment Source Type: research

[Comment] Ethnic cleansing in Myanmar: the Rohingya crisis and human rights
A humanitarian crisis of enormous scale and scope is unfolding in western Myanmar's Rakhine State and its border zone with Bangladesh. More than 420  000 Rohingya women, children, and men have fled widespread violence in Rakhine State in the past 3 weeks.1 Some 240 000 of them are children, according to UNICEF.2 (Source: LANCET)
Source: LANCET - September 21, 2017 Category: General Medicine Authors: Chris Beyrer, Adeeba Kamarulzaman Tags: Comment Source Type: research

[Articles] Efficiency and safety of varying the frequency of whole blood donation (INTERVAL): a randomised trial of 45  000 donors
Over 2 years, more frequent donation than is standard practice in the UK collected substantially more blood without having a major effect on donors' quality of life, physical activity, or cognitive function, but resulted in more donation-related symptoms, deferrals, and iron deficiency. (Source: LANCET)
Source: LANCET - September 20, 2017 Category: General Medicine Authors: Emanuele Di Angelantonio, Simon G Thompson, Stephen Kaptoge, Carmel Moore, Matthew Walker, Jane Armitage, Willem H Ouwehand, David J Roberts, John Danesh, INTERVAL Trial Group Tags: Articles Source Type: research

[Comment] The price of blood is measured in iron
Volunteer blood donors give about 500 mL of whole blood, approximately 10% of their total blood volume. After removal of plasma during processing, each mL of packed red blood cells contains 1 mg of iron. Thus, 200 –250 mg iron are removed from the donor at each donation depending on their haematocrit. Since average iron stores are only 250 mg in women and 1000 mg in men, repeated donation produces iron deficiency in many donors.1 Iron deficiency induced by blood donation has potential for untoward effects, including impaired neurocognitive development in teenagers or in the fetus of a donor who becomes pregnant. (Source: LANCET)
Source: LANCET - September 20, 2017 Category: General Medicine Authors: Alan E Mast, Edward L Murphy Tags: Comment Source Type: research

[Articles] Changes in cause-specific neonatal and 1 –59-month child mortality in India from 2000 to 2015: a nationally representative survey
To meet the 2030 Sustainable Development Goals for child mortality, India will need to maintain the current trajectory of 1 –59-month mortality and accelerate declines in neonatal mortality (to>5% annually) from 2015 onwards. Continued progress in reduction of child mortality due to pneumonia, diarrhoea, malaria, and measles at 1 –59 months is feasible. Additional attention to low birthweight is required. (Source: LANCET)
Source: LANCET - September 19, 2017 Category: General Medicine Authors: Million Death Study Collaborators Tags: Articles Source Type: research

[Comment] Child mortality: the challenge for India and the world
Earlier this year, one of us took part in a policy dialogue about child health in Bangladesh. On being presented with evidence of increasing mortality among children younger than 5 years in parts of Bangladesh, a senior government official rightly enquired whether or not disaggregated (regional) cause of death data had been collected that could help explain this deviation from the national trend and guide responses. Sadly, our answer was “no”. That is exactly the kind of data gap that the work by the Million Death Study Collaborators1 published in The Lancet was designed to address. (Source: LANCET)
Source: LANCET - September 19, 2017 Category: General Medicine Authors: Shams El Arifeen, Honorati Masanja, Ahmed Ehsanur Rahman Tags: Comment Source Type: research

[Correspondence] Health professional education on trafficking: the facts matter
As physician leaders of HEAL Trafficking, we were delighted to see human trafficking framed as a health-care issue in The Lancet Editorial “Health providers—helping to disrupt human trafficking” (Aug 5, p 532).1 However, we were dismayed to see the tragic San Antonio case referenced definitively as human trafficking. Smuggling entails helping people cross borders undetected for a fee, whereas human trafficking involves the threat of, or use of, force, coercion, or deception against a victim to exploit them. (Source: LANCET)
Source: LANCET - September 19, 2017 Category: General Medicine Authors: Hanni Stoklosa, Susie B Baldwin Tags: Correspondence Source Type: research

[Comment] The NCDs Cooperative: a call to action
Over the past 20 years, decision makers have largely stood impotent as non-communicable diseases (NCDs) have exploded around the world. Without a dramatic change in strategy, this resounding collective failure will persist. As I travelled the globe as one of three nominees for the Director-General of WHO, I met with 191 country delegations, including heads of state, foreign ministers, and health ministers. The good news on NCDs is that policy makers have both an awareness of the problem and an appetite for change. (Source: LANCET)
Source: LANCET - September 18, 2017 Category: General Medicine Authors: Sania Nishtar Tags: Comment Source Type: research

[Department of Error] Department of Error
GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990 –2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1343–420—Data in Figure 5 have been amended. These corrections have been made to the online version as of Sept 18. (Source: LANCET)
Source: LANCET - September 18, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Department of Error] Department of Error
GBD 2016 SDG Collaborators. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet 2017; 390: 1423 –59—In figure 8B of this Article (published Online First on Sept 12, 2017), the number of indicator targets has been changed from 1 to 9 for Turkmenistan, from 0 to 1 for Afghanistan, and from 1 to 2 for Yemen. Ettore Beghi, Neeraj Bhala, Hélène Carabin, Raimundas Lunevicius, Donald H Silberbe rg, and Caitlyn Steiner have been added to the list of GB...
Source: LANCET - September 18, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Comment] Where is the accountability to adolescents?
Accountability is a loaded concept. For many, the term itself has negative and punitive connotations. When it comes to accountability to adolescents —who number 1·2 billion today1—discourse is rare. Adolescents are the central promise for accelerated, lasting progress on the Global Strategy for Women's, Children's and Adolescents' Health2 and the Sustainable Development Goals (SDGs). But for adolescents, who lack power, vote, and influentia l voice, the notion of accountability to their health, development, and rights is fragile. (Source: LANCET)
Source: LANCET - September 17, 2017 Category: General Medicine Authors: Carmen Barroso, Kul Chandra Gautam, IAP Members Tags: Comment Source Type: research

[Viewpoint] Measuring global health: motivation and evolution of the Global Burden of Disease Study
People everywhere, but particularly those charged with improving the health of populations, want to know whether human beings are living longer and getting healthier. There is an inherent fascination with quantification of levels and patterns of disease, the emergence of new threats to health, and the comparative importance of various risk factors for the health of populations. Before the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) was initiated, no comprehensive assessments of human health were done. (Source: LANCET)
Source: LANCET - September 15, 2017 Category: General Medicine Authors: Christopher J L Murray, Alan D Lopez Tags: Viewpoint Source Type: research

[Global Health Metrics] Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990 –2016: a systematic analysis for the Global Burden of Disease Study 2016
Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. (Source: LANCET)
Source: LANCET - September 15, 2017 Category: General Medicine Authors: GBD 2016 Risk Factors Collaborators Tags: Global Health Metrics Source Type: research

[Global Health Metrics] Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990 –2016: a systematic analysis for the Global Burden of Disease Study 2016
At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. (Source: LANCET)
Source: LANCET - September 15, 2017 Category: General Medicine Authors: GBD 2016 DALYs and HALE Collaborators Tags: Global Health Metrics Source Type: research

[Global Health Metrics] Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990 –2016: a systematic analysis for the Global Burden of Disease Study 2016
The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. (Source: LANCET)
Source: LANCET - September 15, 2017 Category: General Medicine Authors: GBD 2016 Disease and Injury Incidence and Prevalence Collaborators Tags: Global Health Metrics Source Type: research

[Global Health Metrics] Global, regional, and national age-sex specific mortality for 264 causes of death, 1980 –2016: a systematic analysis for the Global Burden of Disease Study 2016
The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain e...
Source: LANCET - September 15, 2017 Category: General Medicine Authors: GBD 2016 Causes of Death Collaborators Tags: Global Health Metrics Source Type: research

[Global Health Metrics] Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970 –2016: a systematic analysis for the Global Burden of Disease Study 2016
Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. (Source: LANCET)
Source: LANCET - September 15, 2017 Category: General Medicine Authors: GBD 2016 Mortality Collaborators Tags: Global Health Metrics Source Type: research

[Editorial] Life, death, and disability in 2016
In this week's issue of The Lancet, we publish the latest global, regional, and national estimates and analyses from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), covering the period 1990 to 2016. The GBD is a herculean effort that annually tracks disease burden across countries, time, age, and sex. In 2016, there were an estimated 128 ·8 million livebirths and 54·7 million deaths. The good news is that globally, mortality rates have decreased across all age groups over the past five decades. (Source: LANCET)
Source: LANCET - September 15, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Seminar] Hyperparathyroidism
Primary hyperparathyroidism is a common endocrine disorder of calcium metabolism characterised by hypercalcaemia and elevated or inappropriately normal concentrations of parathyroid hormone. Almost always, primary hyperparathyroidism is due to a benign overgrowth of parathyroid tissue either as a single gland (80% of cases) or as a multiple gland disorder (15 –20% of cases). Primary hyperparathyroidism is generally discovered when asymptomatic but the disease always has the potential to become symptomatic, resulting in bone loss and kidney stones. (Source: LANCET)
Source: LANCET - September 15, 2017 Category: General Medicine Authors: John P Bilezikian, Leonardo Bandeira, Aliya Khan, Natalie E Cusano Tags: Seminar Source Type: research

[Articles] Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial
This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use. (Source: LANCET)
Source: LANCET - September 15, 2017 Category: General Medicine Authors: Denice S Feig, Lois E Donovan, Rosa Corcoy, Kellie E Murphy, Stephanie A Amiel, Katharine F Hunt, Elizabeth Asztalos, Jon F R Barrett, J Johanna Sanchez, Alberto de Leiva, Moshe Hod, Lois Jovanovic, Erin Keely, Ruth McManus, Eileen K Hutton, Claire L Meek Tags: Articles Source Type: research

[Comment] Continuous glucose monitoring in pregnant women with type 1 diabetes
The use of continuous glucose monitoring (CGM) has been increasing, especially in patients with type 1 diabetes, partly due to improved accuracy with lower mean amplitude relative difference (about 10%) with the newer or implantable sensors.1,2 Most real-time subcutaneous sensors are approved for 7 days —except for the implantable sensor, which lasts 3 months—and require two calibrations per day.1–3 One on-demand sensor is approved for 14 days and needs no calibrations.2 Improved health outcomes, such as increased time in target and reduced hypoglycaemia, diabetic ketoacidosis, and glucose va riability, a...
Source: LANCET - September 15, 2017 Category: General Medicine Authors: Satish K Garg, Sarit Polsky Tags: Comment Source Type: research

[Viewpoint] California Universal Health Care Bill: an economic stimulus and life-saving proposal
On June 1, 2017, the California Senate approved a bill (Senate Bill 562) to establish universal single-payer health care for all residents. This state legislation comes in the midst of federal proposals to repeal and replace the Affordable Care Act, which are anticipated to almost double the number of uninsured Americans to 51 million in a decade.1 Uninsured individuals have a 40% increased risk of mortality compared with insured individuals,2 such that this loss of coverage would be responsible for an estimated 27  000–95 000 deaths through 2025. (Source: LANCET)
Source: LANCET - September 15, 2017 Category: General Medicine Authors: Alison P Galvani, David P Durham, Sten H Vermund, Meagan C Fitzpatrick Tags: Viewpoint Source Type: research