The Lancet
Jul 12, 2014 Volume 384 Number 9938 p103 – 206 e22 – 29
http://www.thelancet.com/journals/lancet/issue/current

NCD Countdown 2025: accountability for the 25 × 25 NCD mortality reduction target
Robert Beaglehole, Ruth Bonita, Majid Ezzati, George Alleyne, Katie Dain, Sandeep P Kishore, Richard Horton
Preview
In 2012, all countries committed to achieving a 25% reduction in premature mortality from non-communicable diseases (NCDs) by 2025 (the 25 × 25 target). In 2013, countries also agreed to a set of voluntary targets for risk factors and health systems.1 Unlike the Millennium Development Goals (MDGs), which were directed at low-income and middle-income countries, NCD targets are for all countries. Achieving targets for just six NCD risk factors (tobacco and alcohol use, salt intake, obesity, and raised blood pressure and glucose) will come close to achieving the global 25 × 25 target, especially if a more ambitious tobacco reduction target is adopted.

Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial
Tim Weaver PhD a, Nicola Metrebian PhD b Jennifer Hellier MSc c, Prof Stephen Pilling PhD d, Vikki Charles MA b, Nicholas Little MSc d, Dilkushi Poovendran MSc a, Luke Mitcheson DClinPsy e, Frank Ryan D Psychol f, Owen Bowden-Jones FRCPsych g, John Dunn DM f, Anthony Glasper MRCPsych h, Emily Finch MD e, Prof John Strang MD b e
Summary
Background
Poor adherence to treatment diminishes its individual and public health benefit. Financial incentives, provided on the condition of treatment attendance, could address this problem. Injecting drug users are a high-risk group for hepatitis B virus (HBV) infection and transmission, but adherence to vaccination programmes is poor. We aimed to assess whether contingency management delivered in routine clinical practice increased the completion of HBV vaccination in individuals receiving opioid substitution therapy.
Methods
In our cluster randomised controlled trial, we enrolled participants at 12 National Health Service drug treatment services in the UK that provided opioid substitution therapy and nurse-led HBV vaccination with a super-accelerated schedule (vaccination days 0, 7, and 21). Clusters were randomly allocated 1:1:1 to provide vaccination without incentive (treatment as usual), with fixed value contingency management (three £10 vouchers), or escalating value contingency management (£5, £10, and £15 vouchers). Both contingency management schedules rewarded on-time attendance at appointments. The primary outcome was completion of clinically appropriate HBV vaccination within 28 days. We also did sensitivity analyses that examined vaccination completion with full adherence to appointment times and within a 3 month window. The trial is registered with Current Controlled Trials, number ISRCTN72794493.
Findings
Between March 16, 2011, and April 26, 2012, we enrolled 210 eligible participants. Compared with six (9%) of 67 participants treated as usual, 35 (45%) of 78 participants in the fixed value contingency management group met the primary outcome measure (odds ratio 12•1, 95% CI 3•7—39•9; p<0•0001), as did 32 (49%) of 65 participants in the escalating value contingency management group (14•0, 4•2—46•2; p<0•0001). These differences remained significant with sensitivity analyses.
Interpretation
Modest financial incentives delivered in routine clinical practice significantly improve adherence to, and completion of, HBV vaccination programmes in patients receiving opioid substitution therapy. Achievement of this improvement in routine clinical practice should now prompt actual implementation. Drug treatment providers should employ contingency management to promote adherence to vaccination programmes. The effectiveness of routine use of contingency management to achieve long-term behaviour change remains unknown.
Funding
National Institute for Health Research (RP-PG-0707-10149).

The Lancet
Jul 5, 2014 Volume 384 Number 9937 p1-102
Series
The Health of Americans
Challenges of infectious diseases in the USA
Dr Rima F Khabbaz MD a, Robin R Moseley MAT a, Riley J Steiner MPH b, Alexandra M Levitt PhD a, Beth P Bell MD c
Summary
In the USA, infectious diseases continue to exact a substantial toll on health and health-care resources. Endemic diseases such as chronic hepatitis, HIV, and other sexually transmitted infections affect millions of individuals and widen health disparities. Additional concerns include health-care-associated and foodborne infections—both of which have been targets of broad prevention efforts, with success in some areas, yet major challenges remain. Although substantial progress in reduction of the burden of vaccine-preventable diseases has been made, continued cases and outbreaks of these diseases persist, driven by various contributing factors. Worldwide, emerging and reemerging infections continue to challenge prevention and control strategies while the growing problem of antimicrobial resistance needs urgent action. An important priority for control of infectious disease is to ensure that scientific and technological advances in molecular diagnostics and bioinformatics are well integrated into public health. Broad and diverse partnerships across governments, health care, academia, and industry, and with the public, are essential to effectively reduce the burden of infectious diseases.

Viewpoint
Health security in 2014: building on preparedness knowledge for emerging health threats
Ali S Khan, Nicole Lurie
Preview
Ideas, information, and microbes are shared worldwide more easily than ever before. New infections, such as the novel influenza A H7N9 or Middle East respiratory syndrome coronavirus, pay little heed to political boundaries as they spread; nature pays little heed to destruction wrought by increasingly frequent natural disasters. Hospital-acquired infections are hard to prevent and contain, because the bacteria are developing resistance to the therapeutic advances of the 20th century. Indeed, threats come in ever-complicated combinations: a combined earthquake, tsunami, and radiation disaster; blackouts in skyscrapers that require new thinking about evacuations and medically fragile populations; or bombings that require as much psychological profiling as chemical profiling.

Global health and the US Centers for Disease Control and Prevention
Anne Schuchat, Jordan Tappero, John Blandford
Preview
Why is an article about global health included in a special issue on health in the USA? About half the produce that Americans consume is cultivated in other countries, 60 million Americans travel or work outside the USA, and most patients with measles and tuberculosis in the USA acquired their infection elsewhere. Emerging diseases, globalisation of foods and medicines, the rise in antimicrobial resistance, and the ease with which pathogens can be manipulated for good or harm increase each nation’s vulnerability and interdependence.