Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): Gwinyai Masukume, Victor Grech

Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): Jacob J Steinberg, Catherine Skae, Barbara Sampson

Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): Andrew J King, Lars Hanssen, Toby Eyre, Caroline Watson, Ying Ying Peng

Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): Duminda N Wijeysundera, Rupert M Pearse, Mark A Shulman, Tom E F Abbott, Elizabeth Torres, Althea Ambosta, Bernard L Croal, John T Granton, Kevin E Thorpe, Michael P W Grocott, Catherine Farrington, Paul S Myles, Brian H Cuthbertson Background Functional capacity is an important component of risk assessment for major surgery. Doctors' clinical subjective assessment of patients' functional capacity has uncertain accuracy. We did a study to compare preoperative subjective assessment with alternative markers of fitness (cardiopulmonary exercise testing [CPET], scores on the Duke Activity Status Index [DASI] questionnaire, and serum N-terminal pro-B-type natriuretic peptide [NT pro-BNP] concentrations) for predicting death or complications after major elective non-cardiac surgery. Methods We did a multicentre, international, prospective cohort study at 25 hospitals: five in Canada, seven in the UK, ten in Australia, and three in New Zealand. We recruited adults aged at least 40 years who were scheduled for major non-cardiac surgery and deemed to have one or more risk factors for cardiac complications (eg, a history of heart failure, stroke, or diabetes) or coronary artery disease. Functional capacity was subjectively assessed in units of metabolic equivalents of tasks by the responsible anaesthesiologists in the preoperative assessment clinic, graded as poor (〈4), moderate (4–10), or good (>10). All participants also completed the DASI questionnaire, underwent CPET to measure peak oxygen consumption, and had blood tests for measurement of NT pro-BNP concentrations. After surgery, patients had daily electrocardiograms and blood tests to measure troponin and creatinine concentrations until the third postoperative day or hospital discharge. The primary outcome was death or myocardial infarction within 30 days after surgery, assessed in all participants who underwent both CPET and surgery. Prognostic accuracy was assessed using logistic regression, receiver-operating-characteristic curves, and net risk reclassification. Findings Between March 1, 2013, and March 25, 2016, we included 1401 patients in the study. 28 (2%) of 1401 patients died or had a myocardial infarction within 30 days of surgery. Subjective assessment had 19·2% sensitivity (95% CI 14·2–25) and 94·7% specificity (93·2–95·9) for identifying the inability to attain four metabolic equivalents during CPET. Only DASI scores were associated with predicting the primary outcome (adjusted odds ratio 0·96, 95% CI 0·83–0·99; p=0·03). Interpretation Subjectively assessed functional capacity should not be used for preoperative risk evaluation. Clinicians could instead consider a measure such as DASI for cardiac risk assessment. Funding Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research, Innovation and Science, UK National Institute of Academic Anaesthesia, UK Clinical Research Collaboration, Australian and New Zealand College of Anaesthetists, and Monash University.

Description: Publication date: Available online 28 June 2018 Source: The Lancet Author(s): Christopher Dowrick

Description: Publication date: Available online 28 June 2018 Source: The Lancet Author(s): Friends of the UN HLM on NCDsKentBuseRobertMartenSarahHawkesGeorgeAlleynePhillipBakerFranBaumRobertBeagleholeChantalBlouinRuthBonitaLuisaBrumanaJohnButlerSimonCapewellSallyCasswellJosé LuisCastroMickeyChopraHelenClarkKatieDainSandroDemaioAndreaFeiglPatriciaFrenzPeterFribergSharonFrielAmandaGlassmanUnniGopinathanLawrenceGostinSofiaGruskinCorinnaHawkesDavidHipgravePaulaJohnsAlexandraJonesSowmyaKadandaleRogerMagnussonPatricio V.MarquezMartinMcKeeBenjamin MasonMeierCarlos A.MonteiroModiMwatsamaRachelNugentDavidPattersonStefanPetersonYoganPillayJohannaRalstonSrinathReddyJuan A.RiveraSandhyaSinghSudhvirSinghTimSladdenRichardSmithKristinaSperkovaThaksaphonThamarangsiFrancisThompsonDouglasWebb

Description: Publication date: Available online 28 June 2018 Source: The Lancet Author(s): Rajiv Chowdhury, Rian Lawrence, Kim van Daalen, Sarah Hawkes, Joerg Feldmann

Description: Publication date: Available online 28 June 2018 Source: The Lancet Author(s): Nafsiah Mboi, Indra Murty Surbakti, Indang Trihandini, Iqbal Elyazar, Karen Houston Smith, Pungkas Bahjuri Ali, Soewarta Kosen, Kristin Flemons, Sarah E Ray, Jackie Cao, Scott D Glenn, Molly K Miller-Petrie, Meghan D Mooney, Jeffrey L Ried, Dina Nur Anggraini Ningrum, Fachmi Idris, Kemal N Siregar, Pandu Harimurti, Robert S Bernstein, Tikki Pangestu, Yuwono Sidharta, Mohsen Naghavi, Christopher J L Murray, Simon I Hay Background As Indonesia moves to provide health coverage for all citizens, understanding patterns of morbidity and mortality is important to allocate resources and address inequality. The Global Burden of Disease 2016 study (GBD 2016) estimates sources of early death and disability, which can inform policies to improve health care. Methods We used GBD 2016 results for cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 333 causes in Indonesia and in seven comparator countries. Estimates were produced by location, year, age, and sex using methods outlined in GBD 2016. Using the Socio-demographic Index, we generated expected values for each metric and compared these against observed results. Findings In Indonesia between 1990 and 2016, life expectancy increased by 8·0 years (95% uncertainty interval [UI] 7·3–8·8) to 71·7 years (71·0–72·3): the increase was 7·4 years (6·4–8·6) for males and 8·7 years (7·8–9·5) for females. Total DALYs due to communicable, maternal, neonatal, and nutritional causes decreased by 58·6% (95% UI 55·6–61·6), from 43·8 million (95% UI 41·4–46·5) to 18·1 million (16·8–19·6), whereas total DALYs from non-communicable diseases rose. DALYs due to injuries decreased, both in crude rates and in age-standardised rates. The three leading causes of DALYs in 2016 were ischaemic heart disease, cerebrovascular disease, and diabetes. Dietary risks were a leading contributor to the DALY burden, accounting for 13·6% (11·8–15·4) of DALYs in 2016. Interpretation Over the past 27 years, health across many indicators has improved in Indonesia. Improvements are partly offset by rising deaths and a growing burden of non-communicable diseases. To maintain and increase health gains, further work is needed to identify successful interventions and improve health equity. Funding The Bill & Melinda Gates Foundation.

Description: Publication date: Available online 28 June 2018 Source: The Lancet Author(s): Jürgen Braun

Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): The Lancet