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[Comment] Beyond repellents: spatial emanators for the control of malaria in Africa
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02754-5/fulltext?rss=yes
Spatial repellents have been used as commercial household bite prevention products since the early 1900s, but significant research into their application for public health only began in the 2000s. Spatial repellents have since evolved from formats requiring frequent replacement (daily or weekly) and external energy sources (such as mosquito coils, or fan–heat assisted release) to spatial emanator formats that passively dispense the active ingredient for months without heat or combustion. This makes them more suitable for public health use as they do not require electricity or regular compliance.
[Articles] Effect of a spatial repellent on malaria incidence in an area of western Kenya characterised by high malaria transmission, insecticide resistance, and universal coverage of insecticide treated nets (part of the AEGIS Consortium): a cluster-randomised, controlled trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02253-0/fulltext?rss=yes
Our trial provides the first evidence of a demonstrative spatial repellent protective efficacy in reducing risk of malaria infection in an African setting characterised by high malaria transmission, pyrethroid resistant malaria vectors, and high coverage of insecticide treated nets. Results support spatial repellent products as a beneficial component of malaria prevention.
[Correspondence] The perils of RFK Junior's anti-vaccine leadership for public health
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02603-5/fulltext?rss=yes
With global measles cases surging more than 20% in a year, the spectre of an anti-vaccine leader like Robert F Kennedy Junior at the helm of US health policy has alarmed public health experts. Kennedy, a well-known vaccine sceptic, has long promoted dangerous misconceptions about vaccines, and his influence could worsen an already dire situation.
[Articles] Effects of non-pharmacological interventions on depressive and anxiety symptoms in pregnant women: a systematic review and network meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00590-X/fulltext?rss=yes
Our findings indicate that mindfulness therapy significantly reduces the risk of depressive and anxiety symptoms in both high-risk pregnancy population and healthy populations. Therefore, when selecting non-pharmacologic therapies for managing depressive and anxiety symptoms during pregnancy, it is recommended that this therapy be considered. We cannot overlook the limitations of this study. For example, some interventions, such as muscle acupoint therapy for depressive symptoms and relaxation therapy for anxiety symptoms, have limited literature support.
[Review] Interventions used to reduce infectious aerosol concentrations in hospitals—a review
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00569-8/fulltext?rss=yes
The key finding is that infectious aerosol concentration improvement measures based on filtration, inactivation, improved air flow dynamics, and ventilation reduce the likelihood of nosocomial infections. However limitations of such approaches must be considered such as noise pollution and effects on ambient humidity. Whilst these efforts can contribute to improved air quality in hospitals, they should be considered with the other interacting factors such as microclimates, room dimensions and use of chemical products that effect air quality.
[Articles] Associations of dietary choline intake and kidney function with hyperuricemia in Chinese children and adolescents: a cross-sectional study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00591-1/fulltext?rss=yes
Moderate to high intake of dietary choline (181.20–357.92 mg/d), particularly phosphatidylcholine (120.22–207.58 mg/d), and betaine (189.24–282.37 mg/d), may reduce the odds of HUA by improving glomerular filtration function. Further interventional studies are needed to establish causal relationships.
[Articles] Global assessment of leukemia care quality: insights from the quality of care index (QCI) from 1990 to 2021
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00575-3/fulltext?rss=yes
The QCI serves as an effective metric for evaluating the quality of leukemia care. Our findings reveal a strong association between leukemia QCI and regional economic and educational development. Age is a critical factor, with an aging population contributing to a potential decline in QCI. These results underscore the urgent need for targeted interventions to enhance health services for older adults and to improve care quality in economically disadvantaged regions.
[Comment] Guselkumab in the IL-23 inhibition landscape for ulcerative colitis
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02262-1/fulltext?rss=yes
The search for effective therapies in ulcerative colitis, a chronic inflammatory condition affecting the colon and rectum with a relapsing–remitting course, has been a long and challenging journey, especially for patients who do not reach remission with the current treatment options. Therapeutic limitations, such as the therapeutic ceiling, especially for bio-exposed patients, and the loss of response over time with long-term remission rates below 50% with advanced therapies, highlight the complexity of treating ulcerative colitis.
[Articles] Development and validation of a machine learning-based model to predict survival in patients with cirrhosis after transjugular intrahepatic portosystemic shunt
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00580-7/fulltext?rss=yes
This study developed a RF model that better predicted 1-year survival for patients with cirrhosis after TIPS placement than the other scores.
[Articles] Noninvasive respiratory support following extubation in critically ill adults with obesity: a systematic review and network meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00581-9/fulltext?rss=yes
The results suggest that compared to COT and HFNC, NIV alone or with HFNC reduces reintubation in critically ill patients with obesity after extubation. Compared to HFNC, NIV alone or with HFNC reduces mortality. The number needed to treat with NIV or NIV + HFNC to avoid one death was 15. These findings support the application of NIV to mitigate extubation failure in critically ill adults with obesity.
[Articles] Prediction accuracy of discrete choice experiments in health-related research: a systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00544-3/fulltext?rss=yes
DCEs are valuable for capturing health-related preferences and possess reasonable external validity to predict health-related behaviours, particularly for opt-in choices. Contextual factors (e.g., type of intervention, study setting, analysis method) influenced the predictive accuracy.
[Correspondence] Concerns regarding sham-controlled trial of SI joint fusion procedure
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00556-X/fulltext?rss=yes
I congratulate Randers et al. on completing their sham-controlled study on SI joint fusion.1 However, several points warrant further discussion.
[Correspondence] Contrasting results in sacroiliac joint fusion studies: the role of bilateral complaints
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00557-1/fulltext?rss=yes
Randers et al. conducted a double-blind randomized sham surgery-controlled trial to assess the effectiveness of sacroiliac joint fusion (SIJF).1 In their study, 72% of the patients in the surgery group and 65% in the sham group had bilateral complaints. This contrasts with the European RCT where only 35% of surgery group patients had bilateral complaints.2 Notably, the European RCT reported 39% of surgery group patients with bilateral complaints underwent bilateral SIJF. These differences might explain the contradictory results.
[World Report] Making CAR T-cell therapies more affordable
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02719-3/fulltext?rss=yes
CAR T-cell therapies have revolutionised treatment of many diseases, but their expense means many patients are unable to benefit. Kathryn Senior reports.
[Comment] What price is society willing to pay for new drugs?
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02562-5/fulltext?rss=yes
The purpose of England's National Health Service (NHS) is to improve the health and wellbeing of the nation through provision of health care.1 The money available to achieve this purpose is restricted and the cost of providing all possible health care to all possible citizens would vastly exceed the NHS budget. As new drugs emerge, decisions therefore need to be made about whether the health benefits that these drugs offer are sufficient to justify the health benefits that will be foregone elsewhere in the NHS to free up the resources required to pay for them.
[Correspondence] Pandemic financing should learn from revolving funds
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02633-3/fulltext?rss=yes
On Nov 22, 2024, WHO identified that mpox remains a global health crisis.1 Meanwhile, financing for pandemic preparedness and response is in a permanent state of emergency. A revolving fund model could offer an alternative solution. The current approach embodied in The Pandemic Fund has three main limitations. First, most beneficiaries are not investors in the fund. The Pandemic Fund has attracted new donors, such as China, India, and Indonesia, and requires the countries receiving funds to match resources; however, the absence of direct investment from beneficiaries reduces their sense of ownership and the impetus for domestic resource mobilisation.
[Correspondence] Declaration of martial law in South Korea: a threat to democracy
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02792-2/fulltext?rss=yes
On Dec 3, 2024, at 2223 h, South Korean President Yoon Suk Yeol unexpectedly declared nationwide martial law during a televised address. In his brief speech, he alleged that the National Assembly of South Korea had devolved into a “den of pro-North Korean forces and anti-democratic criminals”, justifying the imposition of martial law as a necessary measure to “restore liberal democracy”.1 Despite police and military forces obstructing access to the National Assembly, lawmakers convened and passed a resolution annulling martial law at 0100 h on Dec 4.
[Correspondence] The first 100 days of the mpox response in Africa
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02681-3/fulltext?rss=yes
Africa's low COVID-19 mortality rates concealed important vulnerabilities, including poor health infrastructure and manufacturing constraints,1 highlighting the need for a proactive, continent-wide pandemic response. The emphasis on local solutions to global health challenges was a crucial reason for the Africa Centres for Disease Control and Prevention (CDC) to declare mpox a Public Health Emergency of Continental Security.2 A coordinated and cost-effective continental response platform was created to achieve the 6-month pandemic control goal,3 adopting the Coalition for Epidemic Preparedness Innovations' 100 Days Mission monitoring framework.
[Articles] Identifying biomarker-driven subphenotypes of cardiogenic shock: analysis of prospective cohorts and randomized controlled trials
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00592-3/fulltext?rss=yes
Subphenotypes with the highest concentration of biomarkers of endothelial dysfunction and inflammation (inflammatory) or myocardial injury/fibrosis (cardiopathic) were associated with mortality independently from the SCAI shock stages.
[Articles] Maternal and neonatal complications of pregnant women with bipolar disorder: a systematic review and meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00586-8/fulltext?rss=yes
Despite substantial heterogeneity observed, our findings suggest the presence of a broad spectrum of complications that may affect both pregnant women with bipolar disorder and their newborns. These results can serve as a basis for the development of guidelines for the prevention and management of these complications. We need additional data from other countries, particularly from low-to-moderate income countries.
[Articles] Prevalence of post-acute sequelae of SARS-CoV-2 infection in people living with HIV: a systematic review with meta-analysis
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00572-8/fulltext?rss=yes
Current evidence indicates that the prevalence of Long COVID in adults living with HIV may be high, suggesting the need for increased awareness and education of healthcare providers and policy makers. Evidence on whether HIV positivity increases the risk of Long COVID is limited and inconclusive, highlighting a need for further research to clarify this potential association.
[Articles] Guselkumab in patients with moderately to severely active ulcerative colitis (QUASAR): phase 3 double-blind, randomised, placebo-controlled induction and maintenance studies
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01927-5/fulltext?rss=yes
Guselkumab was effective and safe as induction and maintenance therapy in patients with moderately to severely active ulcerative colitis.
[Articles] Global, regional, and national trends in drug use disorder mortality rates across 73 countries from 1990 to 2021, with projections up to 2040: a global time-series analysis and modelling study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00564-9/fulltext?rss=yes
An increasing trend in global DUD mortality was observed from 1990 to 2021, especially in HICs. Future DUD deaths were also predicted to increase until 2040 at the global level. Therefore, these findings suggest urgent and proactive strategies for DUD to reduce the mortality rates related to DUD are needed. However, further prospective research that accounts for potential confounding factors, such as socioeconomic variables and the quality of reporting data from individual countries, is imperative for more accurate estimation.
[Comment] Assisted dying, complex systems, and global equity in palliative care
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02717-X/fulltext?rss=yes
In November, 2024, the UK Parliament voted to support the Terminally Ill Adults (End of Life) Bill.1 The bill would allow terminally ill adults with a prognosis of less than 6 months to request and be provided with assistance to end their lives. This bill is now at the Committee Stage of the parliamentary process and is expected to continue its passage to eventually become law. This change to UK law will have far-reaching impacts for death, dying, and palliative and end-of-life care for UK citizens.
[Articles] Faecal microbiota transplantation for patients with diabetes type 1 and severe gastrointestinal neuropathy (FADIGAS): a randomised, double-blinded, placebo-controlled trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00579-0/fulltext?rss=yes
FMT was safe and improved clinical outcomes for patients with type 1 diabetes suffering from bowel symptoms.
[Articles] Panitumumab plus 5-fluorouracil and folinic acid or 5-fluorouracil and folinic acid alone as maintenance therapy in RAS wild-type metastatic colorectal cancer (PanaMa, AIO KRK 0212): final efficacy analysis of a randomised, open-label, phase 2 trial
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00583-2/fulltext?rss=yes
Panitumumab plus FU/FA might be considered a standard of care maintenance regimen since a potential re-induction therapy with panitumumab cannot be guaranteed at the time of maintenance treatment decision.
[Correspondence] Possible factors influencing on the effect of minimally invasive sacroiliac joint fusion – a call for further research and discussion
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00555-8/fulltext?rss=yes
We thank Kampkuiper et al., and Dr Capel, for their comments and questions regarding our double-blind randomized placebo-controlled trial comparing minimally invasive sacroiliac joint fusion to sham surgery. Our response focuses on five main points: bilateralism of SIJ symptoms; individual response to SIJ fusion; diagnostic procedures; per-protocol treatment and post-intervention care procedures; and bias and generalizability.
[Articles] The impact of war on people with type 2 diabetes in Ukraine: a survey study
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00587-X/fulltext?rss=yes
This study demonstrated a dramatic cumulative effect of the war on T2D patients’ health. Uncovered direct and indirect war-related risk factors can guide further adjustment of diabetic care in Ukraine to improve T2D patient support.
[Corrigendum] Correction of meta-analysis after retraction of article on the effects of anti-androgens in polycystic ovary syndrome
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00588-1/fulltext?rss=yes
In our published article,1 we evaluated the use of anti-androgens (e.g., finasteride, flutamide, spironolactone) compared with various interventions in the management of polycystic ovary syndrome (PCOS). Our meta-analysis concluded that anti-androgens should not be preferred over combined oral contraceptive pills (COCPs) for treating hyperandrogenism, but may be considered for treating hirsutism when COCPs are contraindicated, poorly tolerated or ineffective after six months.1
[Articles] Population-health impact of new drugs recommended by the National Institute for Health and Care Excellence in England during 2000–20: a retrospective analysis
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02352-3/fulltext?rss=yes
During 2000–20, NHS coverage of new drugs displaced more population health than it generated. Our results highlight the inherent trade-offs between individuals who directly benefit from new drugs and those who forgo health due to the reallocation of resources towards new drugs.