Lancet
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Building on the evidence from the first paper in this Series highlighting the fundamental importance of healthy and nurturing environments for children's growth and development in the next 1000 days (ages 2-5 years), this paper summarises the benefits and costs of key strategies to support children's development in this age range. The next 1000 days build on the family-based and health-sector based interventions provided in the first 1000 days and require broader multisectoral programming. Interventions that have been shown to be particularly effective in this age range are the provision of early childhood care and education (ECCE), parenting interventions, and cash transfers. ⋯ The societal cost of not implementing this package at a national and global level (ie, the cost of inaction) is large, with an estimated forgone benefit of 8-19 times the cost of investing in ECCE. We discuss implications of the overall evidence presented in this Series for policy and practice, highlighting the potential of ECCE programming in the next 1000 days as an intervention itself, as well as a platform to deliver developmental screening, growth monitoring, and additional locally required interventions. Providing nurturing care during this period is crucial for maintaining and further boosting children's progress in the first 1000 days, and to allow children to reach optimal developmental trajectories from a socioecological life-course perspective.
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Review
The next 1000 days: building on early investments for the health and development of young children.
Following the first 1000 days of life that span from conception to two years of age, the next 1000 days of a child's life from 2-5 years of age offer a window of opportunity to promote nurturing and caring environments, establish healthy behaviours, and build on early gains to sustain or improve trajectories of healthy development. This Series paper, the first of a two-paper Series on early childhood development and the next 1000 days, focuses on the transition to the next 1000 days of the life course, describes why this developmental period matters, identifies the environments of care, risks, and protective factors that shape children's development, estimates the number of children who receive adequate nurturing care, and examines whether current interventions are meeting children's needs. Paper 2 focuses on the cost of inaction and the implications of not investing in the next 1000 days. ⋯ Intervention research in LMICs in the next 1000 days is scarce. The continuity of developmentally appropriate nurturing care, coordination across health, education, and protection sectors, and the implementation of interventions to support caregivers and improve the quality of education and care remain top priorities in this period. These sectors play key roles in promoting quality early care and education for this age group, which will help maximise developmental potential and opportunities of children globally and help progress towards the achievement of the Sustainable Development Goals.
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Oesophageal cancer is the seventh leading cause of cancer mortality worldwide. Two major pathological subtypes exist: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Epidemiological studies in the last decade have shown a gradual increase in the incidence of oesophageal adenocarcinoma worldwide. ⋯ The success achieved with combined modality therapies, including surgery, chemotherapy, and radiotherapy, to treat locally advanced oesophageal cancer is particularly notable. Immunotherapy has become a crucial treatment for oesophageal cancer, with immune checkpoint inhibitor-based therapies now established as the standard of care in adjuvant and metastatic first-line settings. This Seminar provides an overview of advances in the screening, diagnosis, and treatment of oesophageal squamous cell carcinoma and oesophageal adenocarcinoma, with a particular focus on neoadjuvant therapies for locally advanced oesophageal cancer and immune checkpoint inhibitor-based therapies.
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Cardiogenic shock is a complex syndrome defined by systemic hypoperfusion and inadequate cardiac output arising from a wide array of underlying causes. Although the understanding of cardiogenic shock epidemiology, specific subphenotypes, haemodynamics, and cardiogenic shock severity staging has evolved, few therapeutic interventions have shown survival benefit. ⋯ However, numerous questions remain unanswered, including optimal pharmacotherapy regimens, the role of mechanical circulatory support devices, management of secondary organ dysfunction, and best supportive care. This Review summarises current definitions, pathophysiological principles, and management approaches in cardiogenic shock, and highlights key knowledge gaps to advance individualised shock therapy and the evidence-based ethical use of modern technology and resources in cardiogenic shock.
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Despite the initial hope inspired by the 2015 Paris Agreement, the world is now dangerously close to breaching its target of limiting global multiyear mean heating to 1·5°C. Annual mean surface temperature reached a record high of 1·45°C above the pre-industrial baseline in 2023, and new temperature highs were recorded throughout 2024. The resulting climatic extremes are increasingly claiming lives and livelihoods worldwide. The Lancet Countdown: tracking progress on health and climate change was established the same year the Paris Agreement entered into force, to monitor the health impacts and opportunities of the world’s response to this landmark agreement. Supported through strategic core funding from Wellcome, the collaboration brings together over 300 multidisciplinary researchers and health professionals from around the world to take stock annually of the evolving links between health and climate change at global, regional, and national levels. The 2024 report of the Lancet Countdown, building on the expertise of 122 leading researchers from UN agencies and academic institutions worldwide, reveals the most concerning findings yet in the collaboration’s 8 years of monitoring. ⋯ With climate change breaking dangerous new records and emissions persistently rising, preventing the most catastrophic consequences on human development, health, and survival now requires the support and will of all actors in society. However, data suggest that engagement with health and climate change could be declining across key sectors: the number of governments mentioning health and climate change in their annual UN General Debate statements fell from 50% in 2022 to 35% in 2023, and only 47% of the 58 NDCs updated as of February, 2024, referred to health (indicator 5.4.1). Media engagement also dropped, with the proportion of newspaper climate change articles mentioning health falling 10% between 2022 and 2023 (indicator 5.1). The powerful and trusted leadership of the health community could hold the key to reversing these concerning trends and making people’s wellbeing, health, and survival a central priority of political and financial agendas. The engagement of health professionals at all levels of climate change decision making will be pivotal in informing the redirection of efforts and financial resources away from activities that jeopardise people’s health towards supporting healthy populations, prosperous economies, and a safer future. As concerning records continue to be broken and people face unprecedented risks from climate change, the wellbeing, health, and survival of individuals in every country now hang in the balance.