Pub Date : 2024-11-21DOI: 10.1016/s0140-6736(24)02553-4
No Abstract
无摘要
{"title":"The next 1000 days: the forgotten ages of child health","authors":"","doi":"10.1016/s0140-6736(24)02553-4","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02553-4","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/s0140-6736(24)01937-8
Thomas P Chapman, Jack Satsangi
No Abstract
无摘要
{"title":"Expanding therapeutic options in Crohn's disease","authors":"Thomas P Chapman, Jack Satsangi","doi":"10.1016/s0140-6736(24)01937-8","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)01937-8","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"198 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/s0140-6736(24)02417-6
Ole F Norheim, Angela Y Chang, Sarah Bolongaita, Mariana Barraza-Lloréns, Ayodamope Fawole, Lia Tadesse Gebremedhin, Eduardo González-Pier, Prabhat Jha, Emily K Johnson, Omar Karlsson, Mizan Kiros, Sarah Lewington, Wenhui Mao, Osondu Ogbuoji, Muhammad Pate, Jennifer L Sargent, Xuyang Tang, David Watkins, Gavin Yamey, Dean T Jamison, Richard Peto
Background
Although death in old age is unavoidable, premature death—defined here as death before age 70 years—is not. To assess whether halving premature mortality by 2050 is feasible, we examined the large variation in premature death rates before age 70 years and trends over the past 50 years (1970–2019), covering ten world regions and the 30 most-populous nations. This analysis was undertaken in conjunction with the third report of The Lancet Commission on Investing in Health: Global Health 2050: the path to halving premature death by mid-century.
Methods
In this cross-country analysis of past mortality trends and future directions, all analyses on the probability of premature death (PPD) were conducted using life tables from the UN World Population Prospects 2024. For each sex, country, and year, probability of death was calculated from these life tables with 1-year age-specific mortality rates.
Findings
Globally, PPD decreased from 56% in 1970 to 31% in 2019, although some countries saw reversals because of conflict, social instability, or HIV and AIDS. Child mortality has decreased faster than adult mortality. Among all countries, 34 halved their PPD over three decades between 1970 and 2019. Among the 30 most-populous countries, seven countries, with varying levels of baseline PPD and income, halved their PPD in the past half century. Seven of the most-populous countries had average annual rates of improvement in the period 2010–19 that, if sustained, could lead to a halving of PPD by 2050, including Korea (3·9%), Bangladesh (2·8%), Russia (2·7%), Ethiopia (2·4%), Iran (2·4%), South Africa (2·4%), and Türkiye (2·3%).
Interpretation
Halving premature death by 2050 is feasible, although substantial investments in child and adult health are needed to sustain or accelerate the rate of improvement for high-performing and medium-performing countries. Particular attention must be paid to countries with very low or a worsening rate of improvement in PPD. By reducing premature mortality, more people will live longer and more healthy lives. However, as people live longer, the absolute number of years lived with chronic disease will increase and investments in services reducing chronic disease morbidity are needed.
Funding
The Norwegian Agency for Development Cooperation, the Bill & Melinda Gates Foundation, and a Norwegian Research Council Centre of Excellence grant.
{"title":"Halving premature death and improving quality of life at all ages: cross-country analyses of past trends and future directions","authors":"Ole F Norheim, Angela Y Chang, Sarah Bolongaita, Mariana Barraza-Lloréns, Ayodamope Fawole, Lia Tadesse Gebremedhin, Eduardo González-Pier, Prabhat Jha, Emily K Johnson, Omar Karlsson, Mizan Kiros, Sarah Lewington, Wenhui Mao, Osondu Ogbuoji, Muhammad Pate, Jennifer L Sargent, Xuyang Tang, David Watkins, Gavin Yamey, Dean T Jamison, Richard Peto","doi":"10.1016/s0140-6736(24)02417-6","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02417-6","url":null,"abstract":"<h3>Background</h3>Although death in old age is unavoidable, premature death—defined here as death before age 70 years—is not. To assess whether halving premature mortality by 2050 is feasible, we examined the large variation in premature death rates before age 70 years and trends over the past 50 years (1970–2019), covering ten world regions and the 30 most-populous nations. This analysis was undertaken in conjunction with the third report of <em>The Lancet Commission on Investing in Health: Global Health 2050: the path to halving premature death by mid-century</em>.<h3>Methods</h3>In this cross-country analysis of past mortality trends and future directions, all analyses on the probability of premature death (PPD) were conducted using life tables from the UN World Population Prospects 2024. For each sex, country, and year, probability of death was calculated from these life tables with 1-year age-specific mortality rates.<h3>Findings</h3>Globally, PPD decreased from 56% in 1970 to 31% in 2019, although some countries saw reversals because of conflict, social instability, or HIV and AIDS. Child mortality has decreased faster than adult mortality. Among all countries, 34 halved their PPD over three decades between 1970 and 2019. Among the 30 most-populous countries, seven countries, with varying levels of baseline PPD and income, halved their PPD in the past half century. Seven of the most-populous countries had average annual rates of improvement in the period 2010–19 that, if sustained, could lead to a halving of PPD by 2050, including Korea (3·9%), Bangladesh (2·8%), Russia (2·7%), Ethiopia (2·4%), Iran (2·4%), South Africa (2·4%), and Türkiye (2·3%).<h3>Interpretation</h3>Halving premature death by 2050 is feasible, although substantial investments in child and adult health are needed to sustain or accelerate the rate of improvement for high-performing and medium-performing countries. Particular attention must be paid to countries with very low or a worsening rate of improvement in PPD. By reducing premature mortality, more people will live longer and more healthy lives. However, as people live longer, the absolute number of years lived with chronic disease will increase and investments in services reducing chronic disease morbidity are needed.<h3>Funding</h3>The Norwegian Agency for Development Cooperation, the Bill & Melinda Gates Foundation, and a Norwegian Research Council Centre of Excellence grant.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-21DOI: 10.1016/s0140-6736(24)02419-x
Derrick H Y Chong, Sylvia Pasternak, Trudy Taylor, Sam Armstrong, Kerri Purdy, Luke Y C Chen
Section snippets
Contributors
We were all involved in providing care for the patient. We were all involved in writing and editing the manuscript. Written consent for publication was obtained from the patient.
Declaration of interests
We declare no competing interests.
Acknowledgments
LYCC's work is supported by the Hsu & Taylor Family through the UBC & VGH Foundation.
{"title":"Skin biopsy findings of dyskeratotic keratinocytes and vacuolar interface change in a patient with Still's disease","authors":"Derrick H Y Chong, Sylvia Pasternak, Trudy Taylor, Sam Armstrong, Kerri Purdy, Luke Y C Chen","doi":"10.1016/s0140-6736(24)02419-x","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02419-x","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Contributors</h2>We were all involved in providing care for the patient. We were all involved in writing and editing the manuscript. Written consent for publication was obtained from the patient.</section></section><section><section><h2>Declaration of interests</h2>We declare no competing interests.</section></section><section><section><h2>Acknowledgments</h2>LYCC's work is supported by the Hsu & Taylor Family through the UBC & VGH Foundation.</section></section>","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-20DOI: 10.1016/s0140-6736(24)02476-0
Bassam Abu Hamad, Zeina Jamaluddine, Sarah Aly, Mohammad Salayma, Yara Asi, Hani Mowafi, Francesco Checchi, Miho Sato, Asli Bali, Paul Spiegel
No Abstract
无摘要
{"title":"UNRWA's work is at risk again","authors":"Bassam Abu Hamad, Zeina Jamaluddine, Sarah Aly, Mohammad Salayma, Yara Asi, Hani Mowafi, Francesco Checchi, Miho Sato, Asli Bali, Paul Spiegel","doi":"10.1016/s0140-6736(24)02476-0","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02476-0","url":null,"abstract":"No Abstract","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142673397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-20DOI: 10.1016/s0140-6736(24)02315-8
Jianmin Liu, Yu Zhou, Lei Zhang, Zifu Li, Wenhuo Chen, Yueqi Zhu, Xiaoxi Yao, Liyong Zhang, Shen Liu, Ya Peng, Ming Wei, Quanbin Zhang, Hansheng Shu, Shouchun Wang, Wenhua Liu, Shu Wan, Tong Li, Yibin Fang, Hongxing Han, Guang Zhang, T Yu
<h3>Background</h3>The effectiveness of using a balloon guide catheter during endovascular thrombectomy in patients with acute ischaemic stroke due to large vessel occlusion of the anterior circulation remains uncertain. We aimed to assess the effectiveness and safety of using a balloon guide catheter during endovascular thrombectomy, compared with using a conventional guide catheter, in this patient population.<h3>Methods</h3>We conducted a multicentre, open-label, blinded-endpoint, randomised controlled trial at 28 hospitals in China. Adults aged 18 years or older with acute ischaemic stroke who were able to receive endovascular thrombectomy within 24 h after symptom onset, according to local guidelines, were eligible. Patients were randomly assigned (1:1) to the balloon guide catheter group or the conventional guide catheter group using a central internet-based system with a minimisation algorithm. The treating physicians and patients were aware of treatment allocation, but clinical outcomes were collected by local trained physicians who were masked. Neurological assessments were performed at baseline, 24 h after randomisation, and at 7 days or hospital discharge (whichever occurred first). The primary outcome was functional recovery, assessed by change in modified Rankin Scale (mRS) scores (ranging from 0 [no symptoms] to 6 [death]) at 90 days in the intention-to-treat population and obtained from structured interviews. Treatment effect was estimated using ordinal logistic regression with adjustment for site and baseline prognostic factors (time from symptom onset to randomisation, the preferred thrombectomy strategy, baseline National Institutes of Health Stroke Scale score, prestroke function [estimated mRS score], and age). This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, <span><span>NCT05592054</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span> (terminated).<h3>Findings</h3>Between Feb 7 and Nov 13, 2023, 1698 patients were assessed for eligibility and 329 were randomly assigned to the balloon guide catheter group (n=164) or conventional guide catheter group (n=165) when the trial was paused and subsequently terminated on April 18, 2024, due to safety concerns. The median age was 69 years (IQR 59–76). Of 329 patients, 201 (61%) were male and 128 (39%) were female. Participants in the balloon guide catheter group had significantly worse scores on the mRS at 90 days than those in the conventional guide catheter group (adjusted common odds ratio 0·66 [95% CI 0·45–0·98]; p=0·037). All-cause mortality at 90 days was numerically higher in the balloon guide catheter
{"title":"Balloon guide catheters for endovascular thrombectomy in patients with acute ischaemic stroke due to large-vessel occlusion in China (PROTECT-MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial","authors":"Jianmin Liu, Yu Zhou, Lei Zhang, Zifu Li, Wenhuo Chen, Yueqi Zhu, Xiaoxi Yao, Liyong Zhang, Shen Liu, Ya Peng, Ming Wei, Quanbin Zhang, Hansheng Shu, Shouchun Wang, Wenhua Liu, Shu Wan, Tong Li, Yibin Fang, Hongxing Han, Guang Zhang, T Yu","doi":"10.1016/s0140-6736(24)02315-8","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02315-8","url":null,"abstract":"<h3>Background</h3>The effectiveness of using a balloon guide catheter during endovascular thrombectomy in patients with acute ischaemic stroke due to large vessel occlusion of the anterior circulation remains uncertain. We aimed to assess the effectiveness and safety of using a balloon guide catheter during endovascular thrombectomy, compared with using a conventional guide catheter, in this patient population.<h3>Methods</h3>We conducted a multicentre, open-label, blinded-endpoint, randomised controlled trial at 28 hospitals in China. Adults aged 18 years or older with acute ischaemic stroke who were able to receive endovascular thrombectomy within 24 h after symptom onset, according to local guidelines, were eligible. Patients were randomly assigned (1:1) to the balloon guide catheter group or the conventional guide catheter group using a central internet-based system with a minimisation algorithm. The treating physicians and patients were aware of treatment allocation, but clinical outcomes were collected by local trained physicians who were masked. Neurological assessments were performed at baseline, 24 h after randomisation, and at 7 days or hospital discharge (whichever occurred first). The primary outcome was functional recovery, assessed by change in modified Rankin Scale (mRS) scores (ranging from 0 [no symptoms] to 6 [death]) at 90 days in the intention-to-treat population and obtained from structured interviews. Treatment effect was estimated using ordinal logistic regression with adjustment for site and baseline prognostic factors (time from symptom onset to randomisation, the preferred thrombectomy strategy, baseline National Institutes of Health Stroke Scale score, prestroke function [estimated mRS score], and age). This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT05592054</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (terminated).<h3>Findings</h3>Between Feb 7 and Nov 13, 2023, 1698 patients were assessed for eligibility and 329 were randomly assigned to the balloon guide catheter group (n=164) or conventional guide catheter group (n=165) when the trial was paused and subsequently terminated on April 18, 2024, due to safety concerns. The median age was 69 years (IQR 59–76). Of 329 patients, 201 (61%) were male and 128 (39%) were female. Participants in the balloon guide catheter group had significantly worse scores on the mRS at 90 days than those in the conventional guide catheter group (adjusted common odds ratio 0·66 [95% CI 0·45–0·98]; p=0·037). All-cause mortality at 90 days was numerically higher in the balloon guide catheter ","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"191 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/s0140-6736(24)02089-0
Timo E Strandberg, Petri T Kovanen, Donald M Lloyd-Jones, Frederick J Raal, Raul D Santos, Gerald F Watts
Since the discovery of statins and the Scandinavian Simvastatin Survival Study (4S) results three decades ago, remarkable advances have been made in the treatment of dyslipidaemia, a major risk factor for atherosclerotic cardiovascular disease. Safe and effective statins remain the cornerstone of therapeutic approach for this indication, including for children with genetic dyslipidaemia, and are one of the most widely prescribed drugs in the world. However, despite the affordability of generic statins, they remain underutilised worldwide. The use of ezetimibe to further decrease plasma LDL cholesterol and the targeting of other atherogenic lipoproteins, such as triglyceride-rich lipoproteins and lipoprotein(a), are likely to be required to further reduce atherosclerotic cardiovascular disease events. Drugs directed at these lipoproteins, including gene silencing and editing methods that durably suppress the production of proteins, such as PCSK9 and ANGPTL3, open novel therapeutic options to further reduce the development of atherosclerotic cardiovascular disease.
{"title":"Drugs for dyslipidaemia: the legacy effect of the Scandinavian Simvastatin Survival Study (4S)","authors":"Timo E Strandberg, Petri T Kovanen, Donald M Lloyd-Jones, Frederick J Raal, Raul D Santos, Gerald F Watts","doi":"10.1016/s0140-6736(24)02089-0","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)02089-0","url":null,"abstract":"Since the discovery of statins and the Scandinavian Simvastatin Survival Study (4S) results three decades ago, remarkable advances have been made in the treatment of dyslipidaemia, a major risk factor for atherosclerotic cardiovascular disease. Safe and effective statins remain the cornerstone of therapeutic approach for this indication, including for children with genetic dyslipidaemia, and are one of the most widely prescribed drugs in the world. However, despite the affordability of generic statins, they remain underutilised worldwide. The use of ezetimibe to further decrease plasma LDL cholesterol and the targeting of other atherogenic lipoproteins, such as triglyceride-rich lipoproteins and lipoprotein(a), are likely to be required to further reduce atherosclerotic cardiovascular disease events. Drugs directed at these lipoproteins, including gene silencing and editing methods that durably suppress the production of proteins, such as PCSK9 and ANGPTL3, open novel therapeutic options to further reduce the development of atherosclerotic cardiovascular disease.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-18DOI: 10.1016/s0140-6736(24)01389-8
Catherine E Draper, Aisha K Yousafzai, Dana C McCoy, Jorge Cuartas, Jelena Obradović, Sunil Bhopal, Jane Fisher, Joshua Jeong, Sonja Klingberg, Kate Milner, Lauren Pisani, Aditi Roy, Jonathan Seiden, Christopher R Sudfeld, Stephanie V Wrottesley, Günther Fink, Milagros Nores, Mark S Tremblay, Anthony D Okely
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. In low-income and middle-income countries (LMICs), only 62 million children aged 3 and 4 years (25·4%) currently receive adequate nurturing care during the next 1000 days, leaving 181·9 million children exposed to risks that jeopardise their healthy development. Inputs across nurturing care dimensions of health, nutrition, protection, responsive care, and learning vary substantially across countries. In LMICs, although 86·2% of children have a healthy weight in this period, less than one in three children have access to developmental stimulation or are protected from physical punishment, and only 38·8% have access to early childhood care and education services. 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.
{"title":"The next 1000 days: building on early investments for the health and development of young children","authors":"Catherine E Draper, Aisha K Yousafzai, Dana C McCoy, Jorge Cuartas, Jelena Obradović, Sunil Bhopal, Jane Fisher, Joshua Jeong, Sonja Klingberg, Kate Milner, Lauren Pisani, Aditi Roy, Jonathan Seiden, Christopher R Sudfeld, Stephanie V Wrottesley, Günther Fink, Milagros Nores, Mark S Tremblay, Anthony D Okely","doi":"10.1016/s0140-6736(24)01389-8","DOIUrl":"https://doi.org/10.1016/s0140-6736(24)01389-8","url":null,"abstract":"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. In low-income and middle-income countries (LMICs), only 62 million children aged 3 and 4 years (25·4%) currently receive adequate nurturing care during the next 1000 days, leaving 181·9 million children exposed to risks that jeopardise their healthy development. Inputs across nurturing care dimensions of health, nutrition, protection, responsive care, and learning vary substantially across countries. In LMICs, although 86·2% of children have a healthy weight in this period, less than one in three children have access to developmental stimulation or are protected from physical punishment, and only 38·8% have access to early childhood care and education services. 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.","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142670824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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