{"title":"Amend the Children’s Wellbeing and Schools Bill to protect children from assault","authors":"Andrew G Rowland, Grace Hastie","doi":"10.1136/bmj.r566","DOIUrl":"https://doi.org/10.1136/bmj.r566","url":null,"abstract":"The bill is an important opportunity to finally remove the “reasonable punishment” defence for smacking children in England, write Andrew Rowland and Grace Hastie The Children’s Wellbeing and Schools Bill has now come before the UK parliament.1 The bill recognises the education sector as an important partner in child protection and, encouragingly, proposes the formation of multi-agency child protection teams. Yet there is a glaring missed opportunity to improve children’s wellbeing for generations to come: the bill’s failure to introduce equal protection from assault for children in England.2 This conflicts with the bill’s aim to improve children’s wellbeing, continues the inconsistency of the law in England with international children’s rights,3 and perpetuates an intergenerational cycle of violence towards children. Proposed amendments to the bill offer a chance to change this. Physical punishment of children undoubtedly harms their health, wellbeing, development, and behaviour on an individual …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665865","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}
{"title":"Denying refugees British citizenship is a shameful step backwards","authors":"Angela Burnett, Kolbassia Haoussou","doi":"10.1136/bmj.r569","DOIUrl":"https://doi.org/10.1136/bmj.r569","url":null,"abstract":"Refugees deserve the opportunity to become citizens, but the UK government’s new guidance will exclude and further marginalise them, say Angela Burnett and Kolbassia Haoussou In February 2025 the UK government introduced new guidance1 for assessing the good character requirement of citizenship applications. The updated guidance will make it likely that anyone who has arrived in the UK without permission—which includes travelling by small boat or hidden in a vehicle—will be refused British citizenship. This is despite the UK being a signatory to the 1951 UN Refugee Convention, which stipulates that asylum seekers and refugees should not be penalised for irregular entry.2 Denying refugees the chance to become British citizens breaches the convention and punishes people for the way they have reached sanctuary. Preventing refugees from being recognised as British citizens is a regressive step for the UK. Imposing this policy change means the government is effectively handpicking who is …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665932","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}
{"title":"The resident physicians losing out after private firms took over their hospitals","authors":"Paige Huffman","doi":"10.1136/bmj.r506","DOIUrl":"https://doi.org/10.1136/bmj.r506","url":null,"abstract":"More and more US hospitals are being bought by private equity firms. Sudden closures and layoffs are having a devastating effect on resident doctors’ careers, reports Paige Huffman Liz Calhoun was halfway through her three year emergency physician training when she learnt from a text message that her hospital was closing in three months. She and the other 571 resident physicians at Hahnemann University Hospital in Philadelphia did not know how or where they would finish their training. In the end they didn’t have three months to figure it out: the training programme closed 30 days later. Hahnemann, located in the heart of the city, was a “safety net” hospital, meaning that its staff provided care to patients regardless of their insurance status or ability to pay. At the time of its closure in 2019, Hahnemann made headlines as the model for what can go wrong when a profit driven private equity firm takes over a hospital. In the years since, several other hospitals bought by private equity firms have abruptly closed, leaving their communities’ health, economies, and resident physicians in disarray. Evidence shows that when a private equity firm takes over a hospital, the quality1 of care declines and costs2 for patients rise. Private equity ownership in healthcare also has harmful effects on medical education and the workforce, which is already suffering grave shortages in the US, according to the National Center for Health Workforce Analysis.3 When Hahnemann closed, it left all its resident physicians and first year interns without an accredited programme, including 59 international students who had to find …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665937","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}
The BMJPub Date : 2025-03-21DOI: 10.1136/bmj-2023-078226
Timothy Feeney, Fernando Pires Hartwig, Neil M Davies
{"title":"How to use directed acyclic graphs: guide for clinical researchers","authors":"Timothy Feeney, Fernando Pires Hartwig, Neil M Davies","doi":"10.1136/bmj-2023-078226","DOIUrl":"https://doi.org/10.1136/bmj-2023-078226","url":null,"abstract":"Directed acyclic graphs are commonly used to illustrate and assess the hypothesised causal mechanisms in health and social research. These graphs can illuminate investigators’ assumptions and help clearly describe each possible explanation for associations observed in data given researchers’ assumptions, ranging from causal effects to confounding and selection bias, and thereby help identify variables that can be used to reduce or overcome bias. This article explains how to construct, interpret, and present directed acyclic graphs as part of clinical research studies and how they can help communicate a study’s strengths or limitations. Causal directed acyclic graphs (DAGs) are a type of graph that illustrates an assumed causal structure between variables of interest. These graphs can illustrate assumed links between possible causes (eg, a behaviour or a medical intervention; referred to in this article as exposure) to possible consequences (eg, presence or absence of disease; referred to in this article as outcome).1 While causal graphs have long been used,2 DAGs have a relatively short history in epidemiological research3 but have become widespread as a way to think about the causal structure underlying an exposure-outcome association.45 DAGs can be useful for many purposes, such as helping to identify confounders,67 evaluating potential selection bias,89 and understanding the roles that measurement error1011 and missing data12 might have in effect estimation. Recent papers have highlighted how DAGs can improve epidemiological131415 and clinical studies.16171819 However, they can also aid in understanding descriptive studies (eg, estimating the incidence of disease) and prediction studies (eg, modelling a patient’s risk of disease). These graphs can also help communicate the assumptions necessary to interpret results to collaborators, researchers, reviewers, readers, and editors. Despite their potential utility, wide variation in the use …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665864","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}
{"title":"Ian Bownes: forensic psychiatrist who assessed mental fitness of IRA hunger strikers in the Maze prison","authors":"Matt Limb","doi":"10.1136/bmj.r565","DOIUrl":"https://doi.org/10.1136/bmj.r565","url":null,"abstract":"At the height of the Troubles in the early 1980s Ian Bownes, a young trainee psychiatrist in Northern Ireland, was sent into the notorious H blocks in Belfast’s Maze prison to assess if its paramilitary inmates were mentally fit to go on hunger strikes. It would have been an unsettling experience for anyone to go inside the Maze, which mainly housed republican prisoners. For a young Protestant like Bownes, however, it must have been even tougher. That Bownes did so for many years spoke to his “quiet heroism,” how much his professional opinion was valued, and how fully he was trusted to uphold the confidentiality on which his access depended, says friend and former colleague Harry Kennedy, a professor of forensic psychiatry at the University of Dublin. When Bownes first went into the Maze, republican prisoners were escalating a campaign of protest against the British government. This included demands to reinstate special category status as political prisoners. By October 1981, when their hunger strike ended, 10 inmates had died, including Bobby Sands, an IRA leader and elected MP, who had refused food for 66 days. Bownes would go on to become Northern Ireland’s pioneering “giant” of forensic psychiatry services—work that often placed …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665933","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}
{"title":"NHS England: divorced, beheaded, died","authors":"Kamran Abbasi","doi":"10.1136/bmj.r555","DOIUrl":"https://doi.org/10.1136/bmj.r555","url":null,"abstract":"A butterfly flaps its wings in the Amazon, said the mathematician and meteorologist Edward Lorenz, and later a tornado rages thousands of miles away.1 By contrast, will the demise of NHS England, the behemoth “quango” that oversees the NHS, raise more than a flutter on the “front line” of clinical care? It’s hard to argue that NHS England was ever wanted or loved or that it delivered to expectations, but in a world at war on bureaucracy, of vanishing fiscal space and a need to grow defence budgets, every billion counts. However, redirecting funding to the so called front line is one of the official narratives for disbanding NHS England (doi:10.1136/bmj.r521).2 Cutting several thousand of the staff who run the overlapping bureaucracies of NHS England and the Department of Health and Social Care will save less than £1bn—a big number that nonetheless accounts for a tiny percentage of the NHS’s £192bn budget for the next financial year (doi:10.1136/bmj.r535).34 Whether the few hundreds of millions that might be subsequently released can have a direct impact on clinical care is hard to believe, but whether the opportunities outweigh the risks more broadly requires consideration. Andrew Lansley’s reforms of 2012 gave birth to the NHS Commissioning Board, which became NHS England, an arm’s length body in theory divorced from politics that would run the NHS. Malcolm Grant, chair of the commissioning board …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661264","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}
{"title":"Treating bacterial vaginosis … and other research","authors":"Tom Nolan","doi":"10.1136/bmj.r482","DOIUrl":"https://doi.org/10.1136/bmj.r482","url":null,"abstract":"Tom Nolan reviews this week’s research Is it time to treat male partners of women with bacterial vaginosis? A trial in the New England Journal of Medicine recruited women with confirmed bacterial vaginosis infection who also had a regular male partner, and randomised them to either receive treatment for the woman and partner or treatment of the woman only. At 12 weeks, 35% of the 69 women in the partner treatment group and 63% of the 68 in the control group had recurrence, causing the trial to be stopped early (absolute reduction in recurrences of −2.6 recurrences per person-year (95% confidence interval −4.0 to −1.2)). Important limitations of the study include that it …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661374","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}
Hilary Neve, Lynne Jones, Katharine Fallon, Philippa Matthews, Kyra Neubauer, Martin Fisher, Alice Clack, Annie Mitchell, Jethro Purkiss, Marion Neffgen, Kirsten Shukla, Geraldine James, Clare Nickells
{"title":"Climate activism: a necessity to protect public health","authors":"Hilary Neve, Lynne Jones, Katharine Fallon, Philippa Matthews, Kyra Neubauer, Martin Fisher, Alice Clack, Annie Mitchell, Jethro Purkiss, Marion Neffgen, Kirsten Shukla, Geraldine James, Clare Nickells","doi":"10.1136/bmj.r549","DOIUrl":"https://doi.org/10.1136/bmj.r549","url":null,"abstract":"We challenge Shaker’s recent letter, in which he says that criminal behaviour cannot be excused in the name of activism.1 Firstly, the climate crisis is not the “personal belief” of a few activists but an existential threat to health, driven by fossil fuel burning and based on overwhelming scientific evidence.2 Secondly, his statement that “unlawful” climate activism undermines public trust in the medical profession is not supported by a …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661233","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}
Steven Thornton, Siobhan Quenby, N A B Simpson, Andrew Shennan, Phillip Bennett, C Williamson, A L David
{"title":"Revolution in academic medicine: reducing bureaucratic barriers","authors":"Steven Thornton, Siobhan Quenby, N A B Simpson, Andrew Shennan, Phillip Bennett, C Williamson, A L David","doi":"10.1136/bmj.r499","DOIUrl":"https://doi.org/10.1136/bmj.r499","url":null,"abstract":"We support the BMJ Commission on the Future of Academic Medicine’s effort to tackle key challenges in clinical academia.1 One approach we have taken is to work across institutions—for example, in the development of the Tommy’s National Centre for Preterm Birth Research. This fosters cross institutional and interdisciplinary collaboration and helps develop future academics through leadership courses. We also include policy makers and the public to speed up implementation. We agree on many of your suggestions …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661303","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}
{"title":"Surgical treatments for obesity . . . and other stories","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.r485","DOIUrl":"https://doi.org/10.1136/bmj.r485","url":null,"abstract":"Complete 10 year follow-up data were available only for 65% of the 300 adults randomised either to laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass for the treatment of obesity. Even so, it’s fairly clear that Roux-en-Y gastric bypass is the better option for sustained weight reduction and for causing fewer adverse effects. Gastroesophageal reflux was less common after gastric bypass than after sleeve gastrectomy ( JAMA Surg doi:10.1001/jamasurg.2024.7052). Guidelines recommend clinical surveillance rather than early surgery for patients with asymptomatic severe aortic stenosis and a normal left ventricular ejection …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661232","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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