2222. Changes in health in England, with analysis by English regions and areas of deprivation, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
作者: John N Newton.;Adam D M Briggs.;Christopher J L Murray.;Daniel Dicker.;Kyle J Foreman.;Haidong Wang.;Mohsen Naghavi.;Mohammad H Forouzanfar.;Summer Lockett Ohno.;Ryan M Barber.;Theo Vos.;Jeffrey D Stanaway.;Jürgen C Schmidt.;Andrew J Hughes.;Derek F J Fay.;Russell Ecob.;Charis Gresser.;Martin McKee.;Harry Rutter.;Ibrahim Abubakar.;Raghib Ali.;H Ross Anderson.;Amitava Banerjee.;Derrick A Bennett.;Eduardo Bernabé.;Kamaldeep S Bhui.;Stanley M Biryukov.;Rupert R Bourne.;Carol E G Brayne.;Nigel G Bruce.;Traolach S Brugha.;Michael Burch.;Simon Capewell.;Daniel Casey.;Rajiv Chowdhury.;Matthew M Coates.;Cyrus Cooper.;Julia A Critchley.;Paul I Dargan.;Mukesh K Dherani.;Paul Elliott.;Majid Ezzati.;Kevin A Fenton.;Maya S Fraser.;Thomas Fürst.;Felix Greaves.;Mark A Green.;David J Gunnell.;Bernadette M Hannigan.;Roderick J Hay.;Simon I Hay.;Harry Hemingway.;Heidi J Larson.;Katharine J Looker.;Raimundas Lunevicius.;Ronan A Lyons.;Wagner Marcenes.;Amanda J Mason-Jones.;Fiona E Matthews.;Henrik Moller.;Michele E Murdoch.;Charles R Newton.;Neil Pearce.;Frédéric B Piel.;Daniel Pope.;Kazem Rahimi.;Alina Rodriguez.;Peter Scarborough.;Austin E Schumacher.;Ivy Shiue.;Liam Smeeth.;Alison Tedstone.;Jonathan Valabhji.;Hywel C Williams.;Charles D A Wolfe.;Anthony D Woolf.;Adrian C J Davis.
来源: Lancet. 2015年386卷10010期2257-74页
In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond.
2223. Tuberculosis.
Although the worldwide incidence of tuberculosis has been slowly decreasing, the global disease burden remains substantial (∼9 million cases and ∼1·5 million deaths in 2013), and tuberculosis incidence and drug resistance are rising in some parts of the world such as Africa. The modest gains achieved thus far are threatened by high prevalence of HIV, persisting global poverty, and emergence of highly drug-resistant forms of tuberculosis. Tuberculosis is also a major problem in health-care workers in both low-burden and high-burden settings. Although the ideal preventive agent, an effective vaccine, is still some time away, several new diagnostic technologies have emerged, and two new tuberculosis drugs have been licensed after almost 50 years of no tuberculosis drugs being registered. Efforts towards an effective vaccine have been thwarted by poor understanding of what constitutes protective immunity. Although new interventions and investment in control programmes will enable control, eradication will only be possible through substantial reductions in poverty and overcrowding, political will and stability, and containing co-drivers of tuberculosis, such as HIV, smoking, and diabetes.
2224. Atopic dermatitis.
Atopic dermatitis (also known as atopic eczema) is a chronic inflammatory skin disease that is characterised by intense itching and recurrent eczematous lesions. Although it most often starts in infancy and affects two of ten children, it is also highly prevalent in adults. It is the leading non-fatal health burden attributable to skin diseases, inflicts a substantial psychosocial burden on patients and their relatives, and increases the risk of food allergy, asthma, allergic rhinitis, other immune-mediated inflammatory diseases, and mental health disorders. Originally regarded as a childhood disorder mediated by an imbalance towards a T-helper-2 response and exaggerated IgE responses to allergens, it is now recognised as a lifelong disposition with variable clinical manifestations and expressivity, in which defects of the epidermal barrier are central. Present prevention and treatment focus on restoration of epidermal barrier function, which is best achieved through the use of emollients. Topical corticosteroids are still the first-line therapy for acute flares, but they are also used proactively along with topical calcineurin inhibitors to maintain remission. Non-specific immunosuppressive drugs are used in severe refractory cases, but targeted disease-modifying drugs are being developed. We need to improve understanding of the heterogeneity of the disease and its subtypes, the role of atopy and autoimmunity, the mechanisms behind disease-associated itch, and the comparative effectiveness and safety of therapies.
2227. Adult-onset renal thrombotic microangiopathy and pulmonary arterial hypertension in cobalamin C deficiency.
作者: Steven Grangé.;Soumeya Bekri.;Elise Artaud-Macari.;Arnaud Francois.;Christophe Girault.;Anne-Laure Poitou.;Ygal Benhamou.;Christine Vianey-Saban.;Jean-Francois Benoist.;Valérie Châtelet.;Fabienne Tamion.;Dominique Guerrot.
来源: Lancet. 2015年386卷9997期1011-2页 2228. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial.
作者: Geltrude Mingrone.;Simona Panunzi.;Andrea De Gaetano.;Caterina Guidone.;Amerigo Iaconelli.;Giuseppe Nanni.;Marco Castagneto.;Stefan Bornstein.;Francesco Rubino.
来源: Lancet. 2015年386卷9997期964-73页
Randomised controlled trials have shown that bariatric surgery is more effective than conventional treatment for the short-term control of type-2 diabetes. However, published studies are characterised by a relatively short follow-up. We aimed to assess 5 year outcomes from our randomised trial designed to compare surgery with conventional medical treatment for the treatment of type 2 diabetes in obese patients.
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