Lancet
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Global efforts have increased the accuracy and timeliness of estimates of under-5 mortality; however, these estimates fail to use all data available, do not use transparent and reproducible methods, do not distinguish predictions from measurements, and provide no indication of uncertainty around point estimates. We aimed to develop new reproducible methods and reanalyse existing data to elucidate detailed time trends. ⋯ Globally, we are not doing a better job of reducing child mortality now than we were three decades ago. Further improvements in the quality and timeliness of child-mortality measurements should be possible by more fully using existing datasets and applying standard analytical strategies.
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Review Meta Analysis
Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis.
Whether the two drug-eluting stents approved by the US Food and Drug Administration-a sirolimus-eluting stent and a paclitaxel-eluting stent-are associated with increased risks of death, myocardial infarction, or stent thrombosis compared with bare-metal stents is uncertain. Our aim was to compare the safety and effectiveness of these stents. ⋯ The risks of mortality associated with drug-eluting and bare-metal stents are similar. Sirolimus-eluting stents seem to be clinically better than bare-metal and paclitaxel-eluting stents.
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Randomized Controlled Trial Multicenter Study
Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial.
After hip replacement surgery, prophylaxis following discharge from hospital is recommended to reduce the risk of venous thromboembolism. Our aim was to assess the oral, direct thrombin inhibitor dabigatran etexilate for such prophylaxis. ⋯ Oral dabigatran etexilate was as effective as enoxaparin in reducing the risk of venous thromboembolism after total hip replacement surgery, with a similar safety profile.
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We review the evidence on effectiveness of interventions for the treatment and prevention of selected mental disorders in low-income and middle-income countries. Depression can be treated effectively in such countries with low-cost antidepressants or with psychological interventions (such as cognitive-behaviour therapy and interpersonal therapies). Stepped-care and collaborative models provide a framework for integration of drug and psychological treatments and help to improve rates of adherence to treatment. ⋯ The process and effectiveness of scaling up mental health interventions has not been adequately assessed. Such research is needed to inform the continuing process of service reform and innovation. However, we recommend that policymakers should act on the available evidence to scale up effective and cost-effective treatments and preventive interventions for mental disorders.
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The provision of electricity has been a great benefit to society, particularly in health terms, but it also carries health costs. Comparison of different forms of commercial power generation by use of the fuel cycle methods developed in European studies shows the health burdens to be greatest for power stations that most pollute outdoor air (those based on lignite, coal, and oil). The health burdens are appreciably smaller for generation from natural gas, and lower still for nuclear power. ⋯ The negative effects on health of electricity generation from renewable sources have not been assessed as fully as those from conventional sources, but for solar, wind, and wave power, such effects seem to be small; those of biofuels depend on the type of fuel and the mode of combustion. Carbon dioxide (CO2) capture and storage is increasingly being considered for reduction of CO2 emissions from fossil fuel plants, but the health effects associated with this technology are largely unquantified and probably mixed: efficiency losses mean greater consumption of the primary fuel and accompanying increases in some waste products. This paper reviews the state of knowledge regarding the health effects of different methods of generating electricity.