Editorial
William Childress/GettyImages
Drowning: a largely preventable cause of death
For the WHO report see www. who.int/violence_injury_ prevention/global_report_ drowning/en/
Drowning kills 372 000 people each year. It is in the top ten causes of deaths in children and young people: half of those who drown are younger than 25 years, and those younger than 5 years are the most vulnerable. 91% of these deaths occur in low-income and middle-income countries, where water is often entwined culturally with work and transport. On Nov 18, WHO published the Global report on drowning. The report’s figures do not include natural flood disasters, transport-related incidents, drowning as suicide, and non-fatal drowning; thus, their already stark figures could be an underestimate. Low-income and middle-income country drowning rates are 3·4-times greater than those in high-income countries. In Bangladesh, drowning is the leading killer of children aged 1–4 years, and the rate is growing at an alarming speed. The poorest and least educated people are at highest risk wherever drowning occurs: they often lack access to safety resources such as barriers, nor is there an infrastructure in place to teach basic swimming skills. Drowning has an economic effect on already poor groups, both when a family member who provides
income is lost, and when a whole village or community faces the collective devastation of livelihoods due to a flood or natural disaster. The WHO report’s key message is that drowning is largely preventable: through teaching children to swim, through fast reactions to save a person struggling in water, and through quick and correct resuscitation. Ten actions are recommended in three broad categories: community-based; enforcement of policy and legislation, such as ferry regulations, and plans for safety around water; and a call for further research studies. Communitybased actions dominate the recommendations with the fundamental premise that all children be taught basic swimming skills and water safety, and that children and adults learn basic rescue and resuscitation. Swimming skills and safety around water should be a part of daily life when growing up, and teaching the skills needed for effective first-aid care and resuscitation should be a given. As prevention of drowning is within reach, these measures should be non-negotiable throughout the world. The Lancet
Adam Gault/Science Photo Library
Principles to guide type 2 diabetes care in the USA
For the National Diabetes Education Program resource see http://ndep.nih.gov/media/ Guiding_Principles_508.pdf
1822
The USA has the third highest burden of diabetes in the world. 29·1 million people (9·3% of the population) have the disorder, including 8·1 million who are undiagnosed. Of the US adults who have a confirmed diagnosis of diabetes, 90–95% have type 2 diabetes. Reflecting this burden, several US societies, associations, and federal agencies provide advice and (sometimes conflicting) clinical practice guidelines for type 2 diabetes, which can be confusing for practitioners. Which should be followed? A new resource from the National Diabetes Education Program—a partnership between the National Institutes of Health and the Centers for Disease Control and Prevention—aims to help. Guiding Principles for the Care of People With or at Risk for Diabetes focuses on areas across the spectrum of care in which there is general agreement in existing guidelines. The ten guiding principles cover areas such as identification of people with undiagnosed diabetes and prediabetes, provision of self-management education, nutrition therapy, physical activity, control of blood glucose, and management of complications.
The final two principles can be seen as overarching ones. The first is to consider the needs of special populations, including children and high-risk racial and ethnic groups. Such a focus is needed in the USA in view of the growing rates of the disorder in children and the suboptimum care for diabetes that especially occurs in disproportionately affected poor or minority populations. The final guiding principle—to provide patient-centred care, defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values”—is perhaps the most important. The document acknowledges that achieving this goal can be challenging; patient preferences might go against evidence-based guidelines, and discussion of pros and cons and patient goals requires time and effort. As a result, patient-centred care might be seen as worthy but too difficult. However, such an approach is crucial to diabetes; the foundations of treatment and prevention—self-management, improved nutrition, and increased physical activity—are much more likely to be achieved with it than without it. The Lancet www.thelancet.com Vol 384 November 22, 2014
William Childress/GettyImages
Drowning: a largely preventable cause of death
For the WHO report see www. who.int/violence_injury_ prevention/global_report_ drowning/en/
Drowning kills 372 000 people each year. It is in the top ten causes of deaths in children and young people: half of those who drown are younger than 25 years, and those younger than 5 years are the most vulnerable. 91% of these deaths occur in low-income and middle-income countries, where water is often entwined culturally with work and transport. On Nov 18, WHO published the Global report on drowning. The report’s figures do not include natural flood disasters, transport-related incidents, drowning as suicide, and non-fatal drowning; thus, their already stark figures could be an underestimate. Low-income and middle-income country drowning rates are 3·4-times greater than those in high-income countries. In Bangladesh, drowning is the leading killer of children aged 1–4 years, and the rate is growing at an alarming speed. The poorest and least educated people are at highest risk wherever drowning occurs: they often lack access to safety resources such as barriers, nor is there an infrastructure in place to teach basic swimming skills. Drowning has an economic effect on already poor groups, both when a family member who provides
income is lost, and when a whole village or community faces the collective devastation of livelihoods due to a flood or natural disaster. The WHO report’s key message is that drowning is largely preventable: through teaching children to swim, through fast reactions to save a person struggling in water, and through quick and correct resuscitation. Ten actions are recommended in three broad categories: community-based; enforcement of policy and legislation, such as ferry regulations, and plans for safety around water; and a call for further research studies. Communitybased actions dominate the recommendations with the fundamental premise that all children be taught basic swimming skills and water safety, and that children and adults learn basic rescue and resuscitation. Swimming skills and safety around water should be a part of daily life when growing up, and teaching the skills needed for effective first-aid care and resuscitation should be a given. As prevention of drowning is within reach, these measures should be non-negotiable throughout the world. The Lancet
Adam Gault/Science Photo Library
Principles to guide type 2 diabetes care in the USA
For the National Diabetes Education Program resource see http://ndep.nih.gov/media/ Guiding_Principles_508.pdf
1822
The USA has the third highest burden of diabetes in the world. 29·1 million people (9·3% of the population) have the disorder, including 8·1 million who are undiagnosed. Of the US adults who have a confirmed diagnosis of diabetes, 90–95% have type 2 diabetes. Reflecting this burden, several US societies, associations, and federal agencies provide advice and (sometimes conflicting) clinical practice guidelines for type 2 diabetes, which can be confusing for practitioners. Which should be followed? A new resource from the National Diabetes Education Program—a partnership between the National Institutes of Health and the Centers for Disease Control and Prevention—aims to help. Guiding Principles for the Care of People With or at Risk for Diabetes focuses on areas across the spectrum of care in which there is general agreement in existing guidelines. The ten guiding principles cover areas such as identification of people with undiagnosed diabetes and prediabetes, provision of self-management education, nutrition therapy, physical activity, control of blood glucose, and management of complications.
The final two principles can be seen as overarching ones. The first is to consider the needs of special populations, including children and high-risk racial and ethnic groups. Such a focus is needed in the USA in view of the growing rates of the disorder in children and the suboptimum care for diabetes that especially occurs in disproportionately affected poor or minority populations. The final guiding principle—to provide patient-centred care, defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values”—is perhaps the most important. The document acknowledges that achieving this goal can be challenging; patient preferences might go against evidence-based guidelines, and discussion of pros and cons and patient goals requires time and effort. As a result, patient-centred care might be seen as worthy but too difficult. However, such an approach is crucial to diabetes; the foundations of treatment and prevention—self-management, improved nutrition, and increased physical activity—are much more likely to be achieved with it than without it. The Lancet www.thelancet.com Vol 384 November 22, 2014
