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[Articles] Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial

Novel flash glucose testing reduced the time adults with well controlled type 1 diabetes spent in hypoglycaemia. Future studies are needed to assess the effectiveness of this technology in patients with less well controlled diabetes and in younger age groups.

2016-09-23

[Comment] Available at a flash: a new way to check glucose

Type 1 diabetes accounts for 5–10% of diabetes cases diagnosed worldwide.1 Hypoglycaemia is common and can limit efforts to tighten glucose control, lower quality of life,2 and increase mortality.3 Insulin analogues, structured education, insulin pump therapy, and continuous glucose monitoring have helped to decrease the burden of hypoglycaemia,4,5 but it remains considerable.

2016-09-23

[Seminar] Spontaneous subarachnoid haemorrhage

Subarachnoid haemorrhage is an uncommon and severe subtype of stroke affecting patients at a mean age of 55 years, leading to loss of many years of productive life. The rupture of an intracranial aneurysm is the underlining cause in 85% of cases. Survival from aneurysmal subarachnoid haemorrhage has increased by 17% in the past few decades, probably because of better diagnosis, early aneurysm repair, prescription of nimodipine, and advanced intensive care support. Nevertheless, survivors commonly have cognitive impairments, which in turn affect patients' daily functionality, working capacity, and quality of life.

2016-09-23

[Seminar] Stroke

In the past decade, the definition of stroke has been revised and major advances have been made for its treatment and prevention. For acute ischaemic stroke, the addition of endovascular thrombectomy of proximal large artery occlusion to intravenous alteplase increases functional independence for a further fifth of patients. The benefits of aspirin in preventing early recurrent ischaemic stroke are greater than previously recognised. Other strategies to prevent recurrent stroke now include direct oral anticoagulants as an alternative to warfarin for atrial fibrillation, and carotid stenting as an alternative to endarterectomy for symptomatic carotid stenosis.

2016-09-23

[Viewpoint] Care of non-communicable diseases in emergencies

Emergencies include natural disasters such as earthquakes and severe meteorological events, but also armed conflict and its consequences, such as civil disruption and refugee crises (sometimes termed chronic emergencies).1 The health component of the humanitarian response to emergencies has traditionally focused on management of acute conditions such as trauma and infectious illnesses.2 However, non-communicable diseases (NCDs) such as diabetes, hypertension, cardiovascular disease, cancer, and chronic lung disease are now leading causes of disability and death in low-income and middle-income countries (LMICs)3 and disaster-prone areas.

2016-09-23

[Review] Neglected tropical diseases: progress towards addressing the chronic pandemic

The concept of neglected tropical diseases (NTDs) emerged more than a decade ago and has been recognised as a valid way to categorise diseases that affect the poorest individuals. Substantial progress in control and elimination has been achieved and policy momentum has been generated through continued bilateral, philanthropic, and non-governmental development organisation (NGDO) support, and donations of drugs from pharmaceutical companies. WHO has defined a Roadmap to reach 2020 targets, which was endorsed by member states in a World Health Assembly Resolution in 2013.

2016-09-23

[Correspondence] Where economics and epidemics collide: migrant workers and emerging infections

Following widespread criticism about inadequate action during the Ebola epidemic in west Africa,1 the global response is once again being tested by two re-emerging infectious disease threats in the form of Zika and yellow fever viruses. The public health and scientific responses to these challenges have been unprecedented.

2016-09-23

[Series] Quality maternity care for every woman, everywhere: a call to action

To improve maternal health requires action to ensure quality maternal health care for all women and girls, and to guarantee access to care for those outside the system. In this paper, we highlight some of the most pressing issues in maternal health and ask: what steps can be taken in the next 5 years to catalyse action toward achieving the Sustainable Development Goal target of less than 70 maternal deaths per 100 000 livebirths by 2030, with no single country exceeding 140? What steps can be taken to ensure that high-quality maternal health care is prioritised for every woman and girl everywhere? We call on all stakeholders to work together in securing a healthy, prosperous future for all women.

2016-09-23

[Series] Next generation maternal health: external shocks and health-system innovations

In this Series we document the substantial progress in the reduction of maternal mortality and discuss the current state of science in reducing maternal mortality. However, maternal health is also powerfully influenced by the structures and resources of societies, communities, and health systems. We discuss the shocks from outside of the field of maternal health that will influence maternal survival including economic growth in low-income and middle-income countries, urbanisation, and health crises due to disease outbreaks, extreme weather, and conflict.

2016-09-23

[Series] Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide

On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused.

2016-09-23

[Comment] Quality, equity, and dignity for women and babies

This Lancet Series on maternal health1–6 comes just 1 year after countries committed to the Sustainable Development Goals (SDGs). The SDGs call on all stakeholders to leave no one behind in addressing the unfinished agenda for maternal and child health. The Global Strategy for Women's, Children's and Adolescents' Health (Global Strategy)7 calls for integrated solutions to prevent maternal, newborn, and child deaths and stillbirths and to realise a world where women and children thrive and transform their communities and nations.

2016-09-23

[Series] Drivers of maternity care in high-income countries: can health systems support woman-centred care?

In high-income countries, medical interventions to address the known risks associated with pregnancy and birth have been largely successful and have resulted in very low levels of maternal and neonatal mortality. In this Series paper, we present the main care delivery models, with case studies of the USA and Sweden, and examine the main drivers of these models. Although nearly all births are attended by a skilled birth attendant and are in an institution, practice, cadre, facility size, and place of birth vary widely; for example, births occur in homes, birth centres, midwifery-led birthing units in hospitals, and in high intervention hospital birthing facilities.

2016-09-23

[Series] The scale, scope, coverage, and capability of childbirth care

All women should have access to high quality maternity services—but what do we know about the health care available to and used by women? With a focus on low-income and middle-income countries, we present data that policy makers and planners can use to evaluate whether maternal health services are functioning to meet needs of women nationally, and potentially subnationally. We describe configurations of intrapartum care systems, and focus in particular on where, and with whom, deliveries take place.

2016-09-23

[Comment] Implementation and aspiration gaps: whose view counts?

The Lancet's Maternal Health Series1–6 paints a sobering picture of the state of maternal health today. The Series focuses on the “mismatch between burden and coverage”, which “exposes a crucial gap in quality of care”6 and spotlights the millions of pregnant women and adolescents who never get access to services at all. But 30 years after the start of the safe motherhood initiative, this mismatch exposes something else as well: a dangerous disconnect between the way the global health community has framed problems, proposed strategies, and pushed solutions, and the lived experience of people and providers.

2016-09-23

[Series] Diversity and divergence: the dynamic burden of poor maternal health

Maternal health is a big issue and is central to sustainable development. Each year, about 210 million women become pregnant and about 140 million newborn babies are delivered—the sheer scale of maternal health alone makes maternal well being and survival vital concerns. In this Series paper, we adopt primarily a numerical lens to illuminate patterns and trends in outcomes, but recognise that understanding of poor maternal health also warrants other perspectives, such as human rights. Our use of the best available evidence highlights the dynamic burden of maternal health problems.

2016-09-23

[Comment] Maternal health: time for a radical reappraisal

It is tempting to see progress towards better maternal health in linear terms. If only, the argument goes, one could scale up evidence-based interventions and policies in all countries for all women, maternal mortality would fall and maternal health would advance. The past year has shown the desperate fallacy in this argument. The mortal dangers and uncertainties faced by millions of women and young mothers who find themselves in the midst of conflict-induced displacement across large parts of the Middle East, Africa, and Europe prove that such idealised notions of progress are little more than a comforting myth.

2016-09-23

[World Report] Frontline: Helping women deliver in South Sudan

Claire Reading is a midwife in Somerset, UK, who has worked in England's National Health Service since 2007. On her second mission with Médecins Sans Frontières (MSF), she is serving as a midwife supervisor at a primary care health clinic in the remote South Sudanese town, Bentiu.

2016-09-23

[Perspectives] Picturing health: challenges for Syrian refugees in Turkey

Although about 2·7 million refugees from Syria are registered in Turkey, most do not live in official refugee camps. The Turkish Government is working with UNHCR and other partners on a response, but many refugees find themselves in compromised conditions.

2016-09-23

[Correspondence] The need for innovation and implementation research for maternal and newborn health

Despite substantial progress during the Millennium Development Goals era, figures remain staggering: 303 000 women died due to pregnancy or childbirth-related causes in 2015;1 225 million women wanting to avoid pregnancy do not use safe and effective family planning;2 and 45% of all under-5 deaths happen during the neonatal period.3

2016-09-23

[Articles] Antisense oligonucleotides targeting apolipoprotein(a) in people with raised lipoprotein(a): two randomised, double-blind, placebo-controlled, dose-ranging trials

IONIS-APO(a)-LRx is a novel, tolerable, potent therapy to reduce Lp(a) concentrations. IONIS-APO(a)-LRx might mitigate Lp(a)-mediated cardiovascular risk and is being developed for patients with elevated Lp(a) concentrations with existing cardiovascular disease or calcific aortic valve stenosis.

2016-09-23
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