Monthly Archives: October 2013

Avoidable Hospital Admissions Crisis (BBC News / NAO)

Posted on October 31, 2013 by Dementia and Elderly Care News

Summary Too many emergency admissions to hospitals in England take place according to the National Audit Office. There were 5.3 million such admissions during the last financial year, which represents a 47% rise over 15 years. Many of the individuals involved are frail elderly patients who … Continue reading →

Posted in Acute Hospitals, BBC News, Commissioning, Community Care, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), In the News, Integrated Care, Management of Condition, National, National Audit Office, NHS, NHS Confederation, Patient Care Pathway, Quick Insights, Standards, UK, Universal Interest | Tagged 999 Ambulance Service, Accident and Emergency Departments, Admission Avoidance, Alignment of Services Across Health and Social Care Sectors, Ambulance Services, Avoidable Admissions, Avoidable Rehospitalisations, BBC Health News, Bed Days, Bed Occupancy, Care of Frail Older People With Complex Needs, Demographic Changes, Demographic Time-Bomb, Demographics, Emergency Admission Rates in UK, Emergency Admissions, Emergency Bed Use, Emergency Care, Emergency Care Pathway, Emergency Readmissions, Emergency Readmissions to Hospital, Emergency Services, Factors Behind Increasing Emergency Admissions, Frail Older People With Complex Needs, Good Practice in Managing Emergency Admissions, Good Practice in Reducing Emergency Admissions, GP Home Visits, GP Out-of-Hours Services, Hospital Accident and Emergency Departments, Hospital Admission Rates, Hot Clinics, Marginal Rate Emergency Tariff, Multi-Specialty Teams Across Hospital and Community, NHS Direct / 111, Out of Hours Care, Out of Hours Services, Patient Admission, Patient Flow Diagrams, Patient Flows, Payment System for Hospital Activity, Preventable Hospital Admissions, Re-Admission NHS Hospitals, Reducing Bed Days, Reducing Unnecessary Admissions, Reducing Unscheduled Admissions, Senior Clinical Input, Social Demographics, Unnecessary Hospital Admissions, Unplanned Hospital Admissions, Unscheduled Admissions, Urgent and Emergency Care, Urgent and Emergency Services, Whole System Patient Flows | Leave a comment

Community Resource Teams in Pembrokeshire: Integration of Health and Social Care (King’s Fund)

Posted on October 31, 2013 by Dementia and Elderly Care News

Summary The final King’s Fund case study (funded by Aetna and the Aetna Foundation), in the “Co-ordinated care for people with complex chronic conditions” series, investigates integrated health and social care teams, known as Community Resource Teams (CRTs), working with … Continue reading →

Posted in Commissioning, Community Care, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, King's Fund, Management of Condition, National, Patient Care Pathway, Person-Centred Care, Personalisation, Practical Advice, Quick Insights, Standards, UK, Universal Interest, Wales | Tagged Acute Response Team (ART), Admission Avoidance, Aetna (US), Aetna Foundation, Avoidable Admissions, Avoidable Rehospitalisations, Barriers to Integration, Benefits of Integrated Care, Care Closer to Home Project, Care Integration, Carmarthenshire, Ceredigion, Chronic Conditions Nurse Practitioners (CCNPs), Community and Voluntary Sector, Community Psychiatric Nurses, Community Resource Teams (CRTs), Community Resource Teams in Pembrokeshire, Complex Care, Complex Chronic Conditions, Complex Needs, Continuous Improvement, Continuous Learning, Cooperation With Acute Sector, Coordinated Care, Critical Reflection and Analysis, Delayed Transfers of Care, Discharge Coordination, Discharge Planning, Discharge Support, Frail Older People With Complex Needs, Functional Integration, Hywel Dda Health Board, Integrated and Community-Based Care, Integrated Care and Support, Integrated Care Pathway, Integrated Commissioning, Integrated Discharge Process, Integrated Services, Integrated Teams, Integration, Integration of Health and Social Care, Joint Discharge Team (JDT), Length of Stay (LoS), Models of Care: Integrated Models, Multi-Agency Integration, Multi-Agency Support Team (MAST), Patient Targeting and Risk Stratification, Pembrokeshire, Pembrokeshire County Council, Preventable Hospital Admissions, Preventative Care, Prevention Programmes, Preventive Support: Risk Stratification for Case Finding, Quality Improvement, Red Amber Green: RAG Coding, Risk Stratification, Rurality, Support for People with Complex Needs, Team Culture, Value of Volunteering, Voluntary Sector, Voluntary Sector Provision, Voluntary Sector Strategic Partnerships, Volunteering, Volunteers: Part of Care Team | Leave a comment

Experiences of the Patient Journey into Alzheimer’s Disease (Alzheimer’s Society)

Posted on October 30, 2013 by Dementia and Elderly Care News

Summary This research report, from Lilly UK and the Alzheimer’s Society, explores the experience of progression through stages in the development of dementia, from the early signs to diagnosis and beyond. Full Text Link Reference The ‘patient journey’ for people … Continue reading →

Posted in Acute Hospitals, Alzheimer's Society, Charitable Bodies, Community Care, Diagnosis, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Management of Condition, National, Patient Care Pathway, Person-Centred Care, Personalisation, Practical Advice, Quick Insights, UK, Universal Interest | Tagged Age-Related Memory Loss, Alzheimer Experience, Anger (Upon Disclosure of Diagnosis, Assessment and Diagnosis, Barriers to Early Diagnosis, Carer's Experience of Dementia, Carers’ Experiences of the Dementia Journey, Coping Mechanisms, Coping Strategies, Coping with Memory Loss, Dementia Diagnosis, Diagnosis and Referral, Diagnosis of Alzheimer's Disease, Diagnosis of Dementia, Disclosure, Disclosure of Diagnosis, Eli Lilly, Emotions (Upon Disclosure of Diagnosis, Experiences, Experiences of Diagnosis, Experiences of the Transition to Dementia, Fear (Upon Disclosure of Diagnosis, Frustration (Upon Disclosure of Diagnosis, Impact of Diagnosis, Initial Onset and Diagnosis, Lilly, Lilly UK, Living Well After Diagnosis, Loss (Upon Disclosure of Diagnosis, Mapping the Patient Journey, Memory Clinics, Memory Lapses, Memory Loss, Memory Services, Mild Memory Problems, NHS Memory Clinics, Patient Experience, Patient Journey into Alzheimer's Disease, Post-Diagnosis Support, Psychological Coping Skills, Service User Experience, Support and Coping Mechanisms, upon, User Experience | Leave a comment

Three Patient Information Leaflets from Parkinson’s UK (Parkinson’s UK)

Posted on October 29, 2013 by Dementia and Elderly Care News

Summary Three further briefings, tailored specifically to the information needs of patients, families and carers, have been produced by the charity Parkinson’s UK. Mild Memory Problems This briefing offers insights into the symptoms of mild cognitive impairment and offers practical … Continue reading →

Posted in Charitable Bodies, For Carers (mostly), For Nurses and Therapists (mostly), For Social Workers (mostly), Management of Condition, Mental Health, National, Parkinson's Disease, Patient Care Pathway, Patient Information, Person-Centred Care, Practical Advice, Quick Insights, UK, Universal Interest | Tagged Advice and Information, Dementia with Lewy Bodies, Dementia With Lewy Bodies (DLB), Information About Services, Information and Advice, Information and Education, Information and Support for Carers, Information for Carers, Information Needs of Carers, Lewy Bodies, Lewy Body Dementia, Lewy Body Parkinson Disease, Lewy Body Society, Memory Problems, Mild Cognitive Impairment (MCI), Mild Memory Problems, Parkinson’s Dementia, Parkinson’s UK, Parkinson’s UK (Parkinsons Disease Society), Patient Information, Patient Information Factsheet | Leave a comment

South Devon and Torbay: Community Virtual Wards and Proactive Case Management (King’s Fund)

Posted on October 29, 2013 by Dementia and Elderly Care News

Summary This King’s Fund case study (funded by Aetna and the Aetna Foundation) investigates community virtual wards based in GP practices within South Devon and Torbay Clinical Commissioning Group (CCG). The community virtual wards were introduced by Devon Primary Care … Continue reading →

Posted in Charitable Bodies, Commissioning, Community Care, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, King's Fund, Management of Condition, Models of Dementia Care, National, NHS, Patient Care Pathway, Person-Centred Care, Personalisation, Practical Advice, Quick Insights, Standards, UK, Universal Interest | Tagged Aetna (US), Aetna Foundation, Avoidable Admissions, Care Coordinators, Case Management, CCGs, Chronic and Severe Illness, Chronic Care, Chronic Diseases, Chronic Illnesses, Clinical Commissioning Groups (CCGs), Combined Predictive Model, Community Care, Community Care Services, Community Nursing, Community Support Services, Community Virtual Wards, Coordinated Care, Coordination of Care, Dedicated Care Coordination, Devon County Council, Devon Predictive Model (DPM), Devon Primary Care Trust, Direct Enhanced Service (DES) Payments, Emergency Admissions, Emergency Readmissions, Emergency Readmissions to Hospital, Exeter City Council, GP Facilitators, GP Practice, GP-Led Commissioning, GPs, Holistic Approaches, Holistic Care, Holistic Care Assessments, Holistic Co-ordinated Care, Holistic Needs Assessment, Integrated Care Coordinators, Integration, Locality Working, Long-Term Conditions (LTCs), Multi-Agency Integration, Multi-Agency Working, Multi-Disciplinary Working, Multiagency Teams, Multidisciplinary Rehabilitation Team Care, Multidisciplinary Team Care, Multiple Chronic Disease, Multiple Needs, Patient Assessment, Patient Assessment of Chronic Illness Care (PACIC), Patient Care, Personalised Case Management, Plymouth, Predictive Modelling, Predictive Risk Models, Preventable Hospital Admissions, Prevention, Preventive Care, Preventive Services, Preventive Support: Risk Stratification for Case Finding, Proactive Care, Proactive Case Management, Quality of Care, Responsible GPs, Risk Prediction and Stratification Activities, Risk Stratification, Risk Stratification for Case Finding, Secondary Uses Service (SUS), Shortlisting, South Devon, South Devon and Torbay, South Devon and Torbay Clinical Commissioning Group (CCG), Torbay, Torbay Council, Torbay Primary Care Trust (PCT), Virtual Wards, Virtual Wards to Reduce Readmissions | Leave a comment

NHS Complaints Review Report (BBC News)

Posted on October 28, 2013 by Dementia and Elderly Care News

Summary The government-backed review investigating how the NHS in England handles complaints has been published. An achievement of this review is to have persuaded twelve important organisations to sign-up to a series of pledges. Recommendations include improving quality of care, improving how … Continue reading →

Posted in Acute Hospitals, BBC News, CQC: Care Quality Commission, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Health Education England (HEE), In the News, National, NHS, NHS England, Patient Care Pathway, Person-Centred Care, Quick Insights, Standards, UK, Universal Interest | Tagged Action Against Medical Accidents, Acute Care, Acute Hospitals, BBC Health News, Candour, Care of Older Adults in Acute NHS Trusts, Comments and Complaints, Complaint and Redress, Complaint Handling, Complaints, Dementia Care in Acute Settings, Formal Complaints, Formal Complaints Process, Francis Inquiry Report, Hospital Complaints, Mid Staffordshire NHS Foundation Trust Inquiry, NHS Complaints Process, NHS Complaints System: Department of Health Review, NHS Constitution and Whistleblowing, NHS Hospital Complaints, NHS Hospital Complaints System, Nursing and Midwifery Council (NMC), Openness, Openness and Transparency, Patient Complaints, Principles of Good Complaint Handling, Reactions to the Francis Inquiry Report, Report of Mid Staffordshire NHS Foundation Trust Public Inquiry, Responses to the Francis Inquiry Report, Review of NHS Complaints System, Statutory Duty of Candour, Transparency, Transparency and Accountability, User Complaints, Whistleblowing | Leave a comment

Alzheimer’s Disease: Genetics Research Breakthrough (BBC News / NHS Choices / Nature Genetics)

Posted on October 28, 2013 by Dementia and Elderly Care News

Summary An international collaboration of geneticists from 145 academic institutions investigating Alzheimer’s Disease have performed a meta-analysis of data about the DNA of 17,000 patients and 37,000 healthy people. Their analysis of genome-wide association studies (GWAS) has identified 21 genetic … Continue reading →

Posted in BBC News, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, International, NHS Digital (Previously NHS Choices), Quick Insights, Universal Interest | Tagged Alzheimer's Gene (APOE4 Gene), Alzheimer's Research UK, APOE, APOE Gene, Apolipoprotein E (APOE) Gene, BBC Health News, Behind the Headlines, Boston University School of Medicine, Boston University School of Public Health, Broca Hospital, Cardiff University, Centre d'Etude du Polymorphisme Humain (CEPH), Centre for Neuropsychiatric Genetics & Genomics: Cardiff University, Centre National de Génotypage, Cholesterol, Collaborative Projects, Collaborative Working, Columbia University, Commissariat à l'Energie Atomique, Critical Appraisals, DNA, Eidgenössische Technische Hochschule, Endocytosis, Erasmus MC University Medical Center: Rotterdam, Fondation Jean Dausset, Genetic Profiling, Genetic Research, Genetic Susceptibility Loci, Genetic Triggers, Genetic Variants, Genetics of Alzheimer's Disease, Genome-Wide Association Studies (GWAS), Gertrude H. Sergievsky Center: Columbia University, Immune System, Innovation in Genetics, INSERM, Institut Génomique, Institut Pasteur de Lille, International Collaborations, Late-Onset Alzheimer's Disease (LOAD), Medical Research Council (MRC), Medical University of Graz, Memory Clinic of Fundació Alzheimer Centre Educacional (ACE). Institut Català de Neurociències Aplicades, Nature Genetics, Netherlands Consortium for Healthy Aging, Neurodegeneration, Neurodegenerative Disease Research, Neurodegenerative Diseases, Perelman School of Medicine: University of Pennsylvania, Research and Innovation, Research Consortia, Single Nucleotide Polymorphisms (SNPs), Systematic Reviews and Meta-Analyses, Taub Institute on Alzheimer's Disease and the Aging Brain, Université Lille 2, University College London Institute of Neurology, University of Bonn, University of Iceland, University of Miami, University of Pennsylvania, University of Washington, University Paris Descartes, Wellcome Trust | Leave a comment

Integrated Care for People with Complex Chronic Conditions: Research Summary (King’s Fund)

Posted on October 27, 2013 by Dementia and Elderly Care News

Summary This King’s Fund report summarises the findings from a 2-year research project (funded by Aetna and the Aetna Foundation) which involved looking at five UK-based programmes delivering coordinated care for people with long-term and complex needs. The aim has … Continue reading →

Posted in Commissioning, Community Care, End of Life Care, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, International, King's Fund, Management of Condition, Mental Health, Models of Dementia Care, National, Non-Pharmacological Treatments, Patient Care Pathway, Person-Centred Care, Personalisation, Practical Advice, Quick Insights, Standards, UK, Universal Interest, Wales | Tagged Advanced Practice Nurse (APN), Advice and Support, Aetna (US), Aetna Foundation, Alternatives to Hospital Admission, Assigned Accountability, Avoidable Admissions, Avoidable Rehospitalisations, Better Understanding of Dementia for Sandwell (BUDS), Bexley, Bexley Advanced Dementia Care At Home Project, BUDS: Better Understanding of Dementia for Sandwell, Burden on Caregivers, Care Closer to Home Project, Care Co-ordination, Care Coordinators, Care Integration, Care Pathway, Care Plan, Care Planning, Caregiver Distress, Caregiver Support, Carer Assessment, Carer Burden in Dementia, Carer Education, Carer Resilience, Carer Support, Case Finding, Chronic Conditions Nurse Practitioners (CCNPs), Clinical Nurse Specialists (CNS), Co-Production, Community Care, Community Mental Health Services, Community Mental Health Teams, Community Psychiatric Nurse (CPN), Community Resource Teams (CRTs), Community Resource Teams in Pembrokeshire, Community Support, Community Support Services, Community-Based End of Life Nurse, Community-Based Interventions, Community-Based Palliative Care Service, Community-Based Rehabilitation Services, Community-Based Services, Community-Based Support, Complex Care, Complex Chronic Conditions, Complex Needs, Continuing Care, Continuing Care Services in the Community, Coordinated Care, Core 10 (Assessment Tool), Core 10 and WEMWBS, Core-OM, Corenet Software, Cost Analysis, Cost Savings, Cost-Effectiveness, Costs, Counselling Services, Deaths in Usual Place of Residence (DiUPR), Dementia Liaison Services, Dementia Nurse Specialist, Dementia Specialist End of Life Nurse, Dementia Support Services, DiUPR: Deaths in Usual Place of Residence, Dying at Home, End of Life Care, End of Life Care Plans, End-of-Life Care at Home, EOL, Esteem Team: Sandwell, Experiences, Family Support, Functional Integration, Gold Standards Framework (GSF), GPs, Greenwich, Greenwich Advanced Dementia Service (GADS), Greenwich and Bexley, Hampshire, Health and Social Care Integration, Healthcare at Home, Holistic Approaches, Holistic Care Assessments, Holistic Co-ordinated Care, Home Support, Hospice at Home, Hospital at Home, Hywel Dda Health Board, IAPT Programme, IAPT: Improving Access to Psychological Therapies, Improving Access to Psychological Therapies (IAPT) Programme, Information and Advice Services, Integrated and Community-Based Care, Integrated Care Coordinators, Integrated Services, Integrated Services Across Local Authorities, Integration, Integration of Health and Social Care, Liaison Services, Liverpool Care Pathway (LCP), Liverpool Care Pathway for the Dying Patient (LCP), Living at Home, Local Partnerships, Long-Term Conditions (LTCs), Macmillan Cancer Support, MDTs: Multidisciplinary Teams, Mental Health Liaison Services, Metropolitan Borough of Sandwell, Midhurst Macmillan Service, Midhurst Macmillan Service Referral and Discharge, Multi-Disciplinary Working, Multidisciplinary Specialist Teams, Multidisciplinary Team Care, Multidisciplinary Teams, Multiple Referrals to a Single Entry Point, NHS Continuing Care, NHS Electronic Patient Records, NHS West Midlands, Oxleas Advanced Dementia Service, Oxleas NHS Foundation Trust, Oxleas Service Model, Palliative and End-of-Life Care at Home, Palliative Care, Partnership, Partnership and Collaboration, Partnership Working, Patient Experience, Patient Focus, Patient Involvement, Pembrokeshire County Council, Personalised Care Planning, Personalised Care Plans, Preferred Place of Death, Preventable Hospital Admissions, Primary Care, Projecting Older People Population Information, Psychiatric Liaison Services, QUALID: Quality of Life in Late Stage Dementia, Readmissions for Patients with Long Term Conditions, Reducing Admissions to Nursing Care, Reducing Admissions to Residential Care, Reducing Re-Admissions NHS Hospitals, Reducing Unscheduled Admissions, Referrals, Relationship Building, Relative Stress Scale (RSS), Resilience, Responsive Provider Networks, Sandwell and West Birmingham Clinical Commissioning Group, Sandwell Esteem Team, Sandwell Integrated Primary Care Mental Health and Wellbeing Service, Sandwell Wellbeing Hub, Sandwell: West Midlands, Service Integration, Social Services, Specialist Palliative Care, Split Care Assessment and Co-ordination Functions, Standardised Referral Form, Staying at Home, Staying Put, Stepped Care Approach, Stress Reduction, Stress Reduction for Unpaid Family Carers, Support for Carers, Support for People with Complex Needs, Support Networks, Support Workers, Supportive Care, Surrey, Sussex Community Trust, Team Culture, Team Working, Teams, Unplanned Hospital Admissions, User Experience, Volunteers, Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), West Midlands, West Sussex | Leave a comment

Recent Systematic Reviews and Meta-Analyses

Posted on October 27, 2013 by Dementia and Elderly Care News

Bibliographic Citations Recent reviews and meta-analyses on miscellaneous topics are listed below. Some of these articles are available freely. The full-text of the other articles may need a suitable Athens password, a journal subscription or payment for access. Brain Imaging … Continue reading →

Posted in Depression, For Doctors (mostly), For Researchers (mostly), International, Mental Health, Systematic Reviews | Tagged Affective Disorders, Apathy, Apathy / Indifference, Brain Imaging, Cardiovascular Risk, Cerebrotendinous Xanthomatosis, Dementia Quality of Life (DEMQOL), DEMQOL-Proxy, DEMQOL-PROXY-U, DEMQoL-Proxy: Dementia Quality of Life Proxy, DEMQOL-U, DEMQoL: Dementia Quality of Life, Elderly Mental Health, Functional Brain Imaging, Genetic Research, Genetic Testing, Genetic Triggers, Glucocerebrosidase Mutations, IRIS Trial, MRI Brain Imaging, Neurology, Quality of Life Research, Research Methodology, SUMO, Systematic Reviews and Meta-Analyses, Vascular Brain Injury, Vascular Cognitive Impairment, Vascular Dementia | Leave a comment

Global Study of Stroke Statistics: Stroke in Younger People Now More Common (NHS Choices / Lancet / Lancet Global Health)

Posted on October 26, 2013 by Dementia and Elderly Care News

Summary A major international research project – reviewing 119 studies (58 from high-income countries and 61 from low-income / middle-income countries) has discovered – amongst many other statistics – that the proportion of younger people affected by stroke is increasing. Stroke … Continue reading →

Posted in Acute Hospitals, Community Care, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, International, NHS Digital (Previously NHS Choices), Quick Insights, Standards, Statistics, Stroke, Systematic Reviews, UK | Tagged Acute Ischaemic Stroke, Age and Ageing, Ageing, and Risk Factors Study 2010 (GBD 2010), Asia, Australia, Behind the Headlines, Bill and Melinda Gates Foundation, Bute Medical School: University of St Andrews, Capital Medical University (Beijing), China, Columbia University Medical Center, Copenhagen University Hospital Herlev, DALYs, Denmark, Department of Epidemiology and Biostatistics: Imperial College London, Department of Global Health: University of Washington, Division of Clinical Neurosciences: University of Edinburgh, Eastern Europe, Epidemiology, Epidemiology and Statistics, European Stroke Statistics, Federation of National Public Service Personnel Mutual Aid Associations: Tachikawa Hospital, France, GBD 2010 Analytical Technique (DisMod-MR), GBD Stroke Experts Group, Germany, Global Burden of Disease Study, Global Burden of Diseases Injuries, Haemorrhagic Stroke, Health Statistics, Imperial College London, Incidence of Stroke, Institute for Health Metrics and Evaluation: University of Washington, Ireland, Ischaemic Stroke, Japan, Mortality Rates, MRC-HPA Centre for Environment and Health: Imperial College London, National Health Service Borders, National Institutes of Health Heart Lung and Blood Institute (Bethesda USA), National University of Ireland (Galway), National University of Singapore, New Zealand, North America, Nuffield Department of Population Health: University of Oxford, Overall Global Burden of Stroke (DALYs Lost), Premature Mortality, Prevalence of Stroke, Risk Factors of Stroke, Saw Swee Hock School of Public Health, School of Public Health: Imperial College London, Singapore, South Africa, Stroke Prevention, Systematic Reviews and Meta-Analyses, Tachikawa Hospital, University of Auckland, University of Edinburgh, University of Miami, University of Oxford, University of St Andrews, University of the Witwatersrand, University of Washington, USA, Western Europe, World Health Organization (WHO) Global Burden of Disease Database, World Health Organization’s Global Burden of Disease, Yong Loo Lin School of Medicine | Leave a comment

Monthly Archives: October 2013

Alzheimer’s Disease: Genetics Research Breakthrough (BBC News / NHS Choices / Nature Genetics)

Recent Systematic Reviews and Meta-Analyses

Global Study of Stroke Statistics: Stroke in Younger People Now More Common (NHS Choices / Lancet / Lancet Global Health)

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