The BMJ最新文献

{"title":"Decolonising women’s health innovation","authors":"Tiffany Nassiri-Ansari, Alana Gall, Samuel Oji Oti, Sawsan Abdulrahim, Emma L M Rhule","doi":"10.1136/bmj-2025-085683","DOIUrl":"https://doi.org/10.1136/bmj-2025-085683","url":null,"abstract":"Tiffany Nassiri-Ansari and colleagues set out how a decolonial feminist approach to innovation could produce greater gender equality and health equity The field of women’s health innovation is growing rapidly, yet it has focused mainly on technological solutions. Despite the global scope and ambition of advocates and innovators, feminist and decolonial perspectives remain largely absent. These perspectives are vital to discover whose voices and priorities shape innovation, and to improve how the field allocates funding, directs investments, and ensures inclusive representation and leadership. For too long, communities have had “innovative” solutions imposed on them under the banners of novelty and progress, without regard for contextual fit1 or alignment with local priorities.2 In addition to being a potential waste of often scarce resources, such interventions often reinforce power imbalances, sustaining top-down decision making and restricting opportunities for affected communities to shape the solutions that affect them. In many cases they have perpetuated, rather than dismantled, the inequities they claim to tackle. Centring decolonial feminist values in gender and health innovation is not a new idea. Where activists, community leaders, researchers, and funders have rejected exclusionary, top-down processes in favour of collective, inclusive ones, tangible improvements in health and wellbeing have followed.3 Building on that tradition, this article, part of the BMJ Collection on Women’s Health Innovation (bmj.com/collections/womens-health-innovation), calls for a deliberate reimagining of how women’s health innovation is defined, developed, and delivered. To understand why such a shift is necessary, it is essential to consider how the enduring structures and logics of coloniality shape health systems, research, and innovation and, in turn, the health and wellbeing of women and gender diverse people worldwide. Coloniality refers to the enduring systems of power, knowledge, and being that emerged from colonisation and which continue to shape the modern world. These structures …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255695","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":"Digital health technologies to transform women’s health innovation and inclusive research","authors":"Bola Grace, Lauren A Wise, Marzena Nieroda, Jennifer Egbunike, Nafisat O Usman","doi":"10.1136/bmj-2025-085682","DOIUrl":"https://doi.org/10.1136/bmj-2025-085682","url":null,"abstract":"Bola Grace and colleagues argue that using digital health technologies ethically can increase the scope and scale of research and connect systems to improve women’s health Despite comprising over half the global population, women bear a disproportionate burden of adverse health outcomes with unique challenges.1 Historically, women were routinely excluded from clinical trials because of concerns about risks during pregnancy, fluctuating hormones, and a bias that viewed men’s bodies as the norm for medical research.2 Recently, there has been a gradual increase in the inclusion of women in clinical research; however, across a broader range of health conditions there is still room for improvement. Barriers faced by women in research participation include access, education, low incentives, digital literacy, transportation, time commitment, and research design.3 Addressing factors that influence inequities in women’s health requires innovation, not only in treatments and technologies but also in research designs and methodologies. Digital health technologies (DHTs) —defined as “systems that use computing platforms, connectivity, software, or sensors for health care and related uses”4—have facilitated the inclusion of diverse populations throughout the research lifecycle by improving accessibility, engagement, efficiency, and personalisation of interventions. In this article, part of a BMJ Collection on Women’s Health Innovation (www.bmj.com/collections/womens-health-innovation), we describe how DHTs, together with inclusive designs across the research lifecycle, can transform research from an extractive to a participatory process driving inclusion in scope, scale, and systems for improving women’s health. Social determinants of health refer to “the conditions in which people are born, grow, live, work and age, and people’s access to power, money and resources.”5 Historically, the approaches used in health research have often failed women through exclusion largely based on social determinants of health. Moving beyond these historical limitations requires a deliberate effort to adopt and integrate innovative approaches …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255693","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":"Leadership and culture change to advance innovation in women’s health","authors":"Sapna Kedia, Sylvia Kiwuwa-Muyingo, Radhika Uppal, Julius Kirimi Sindi, Evelyn Gitau","doi":"10.1136/bmj-2025-085994","DOIUrl":"https://doi.org/10.1136/bmj-2025-085994","url":null,"abstract":"Sapna Kedia and colleagues argue that equitable leadership, supported by training and systemic reform and rooted in marginalised groups’ experiences and community insight, can transform the innovation cycle, from research and development to delivery, making health technologies more inclusive and impactful When women are excluded from leadership, women’s health innovation is incomplete and inequitable and will continue to fall short. Women, especially those from low and middle income countries, remain under-represented in senior positions across global health institutions, research leadership, and innovation funding, even when the research and innovation concerns their own communities.1 Grant making mechanisms often favour institutions with extensive administrative infrastructure and previous funding experience, limiting access for women from under-resourced settings.2 Furthermore, institutional cultures reflect gendered expectations around leadership style, mobility, and availability. Historical systems that reward linear and uninterrupted career trajectories are misaligned with the realities of many women researchers, who may be balancing care giving responsibilities or facing other gendered constraints. The absence of women, particularly those from low and middle income countries, in research and innovation leadership has profound implications not only for equity but also for the effectiveness and relevance of health innovation and its impact on health outcomes. Clinical and medical research remains predominantly led by men. For example, many cardiovascular drug trials in South Asia have primarily enrolled men,3 resulting in diagnostic and treatment protocols that are based on male physiology and inadequately tested for effectiveness in women. In addition, health conditions that uniquely or disproportionately affect women, such as endometriosis and maternal morbidity, continue to be under-researched and underfunded.4 Beyond this, a broader spectrum of women’s health problems across the life course is often rendered invisible owing to the persistent focus on reproductive health.5 In this article, we argue that equitable leadership in health research …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255697","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":"Trump’s war on diversity in medical education could shorten Americans’ lives","authors":"Gavin Yamey, Michael D Green","doi":"10.1136/bmj.r2133","DOIUrl":"https://doi.org/10.1136/bmj.r2133","url":null,"abstract":"Building a diverse medical workforce is a crucial step to improving population health outcomes, write Gavin Yamey and Michael D Green The Trump administration and its allies have recently taken several steps to ensure that medical schools in the US dismantle all diversity, equity, and inclusion (DEI) policies. The consequences that this will have for Americans’ health are likely to be catastrophic because research has shown that having a physician workforce that represents the population can improve patients’ experiences and outcomes.12 In July 2025, the conservative non-profit organisation America First Legal, which was founded by Trump adviser Stephen Miller and has been described as an “attack dog” for the Trump administration,3 filed a complaint to the US Justice Department against the Johns Hopkins University School of Medicine. It alleges that the school’s promotion of DEI actively discriminates against people on the basis of race, sex, and other identity based characteristics.4 Even before Trump’s return to power, Miller had reportedly planned to “change the government’s interpretation of civil rights-era laws to focus on ‘anti-white racism’ rather than discrimination against people of colour.”5 In May, an executive order targeted the use of DEI based standards in accrediting medical schools and medical residency programs.6 More recently, the secretary of health and human services, Robert F Kennedy Jr, and education secretary Linda McMahon sent our institution, Duke University, a …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"122 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255690","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":"Priorities in addressing rifampicin resistant TB","authors":"Tom A Yates, Jessica L Potter, Rouxjeane Venter","doi":"10.1136/bmj.r1983","DOIUrl":"https://doi.org/10.1136/bmj.r1983","url":null,"abstract":"Progress in testing and trial design are needed Rifampicin is a critical component of tuberculosis (TB) treatment regimens. Recent positive developments in rifampicin resistant TB—the emergence of new drugs and treatment regimens, declines in incidence, and improvements in the proportion of people being diagnosed and successfully treated—are now threatened by the rapid emergence of resistance to other critical drugs and by poor political choices.1 Failure to diagnose rifampicin resistance, and rifampicin resistant TB with additional resistance to critical second line drugs, in a timely manner, risks poor clinical outcomes, acquired resistance, and transmission of resistant strains.23 There are two types of drug susceptibility tests—genotypic and phenotypic. Genotypic tests identify genetic mutations that cause drug resistance. Phenotypic tests identify resistance by observing the organism’s ability to grow in the presence of drugs. Some rapid drug susceptibility tests can be performed in the clinic or a local laboratory (near patient), reducing delays in providing results to clinicians. In recent years, rapid near patient drug susceptibility testing has become more widely available. In Peru, rapid near patient phenotypic drug susceptibility testing to multiple critical drugs was rolled out successfully, with associated improvements in clinical outcomes.4 …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255692","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":"Innovative design and modelling to improve sex and gender analysis in clinical trials","authors":"Sanne A E Peters, Bronwyn M Graham, Otavio Berwanger, Katie Harris, Mark Woodward, Jane E Hirst","doi":"10.1136/bmj-2025-085681","DOIUrl":"https://doi.org/10.1136/bmj-2025-085681","url":null,"abstract":"Jane Hirst and colleagues argue that novel modelling approaches using routinely collected data can be only as representative and complete as the original data, and that bridging the sex and gender gap through contemporary, innovative clinical trial designs could be a crucial way forward Although women represent half of the world’s population, they comprise fewer than half of the participants in clinical trials. This has created gaps in knowledge about women’s health, as well as how sex and gender affect health outcomes for everyone.1 For this article, part of the BMJ Collection on Women’s Health Innovation (www.bmj.com/collections/womens-health-innovation), we use definitions of sex and gender as outlined by the MESSAGE project (box 1).2 Historically, self-reported gender has been missing from data collection, with sex captured in a binary manner.3 Ultimately, we view the solutions presented in this article as components of a broader toolkit necessary to begin to represent the complexity of sex and gender in data collection, analysis, and interpretation to influence clinical practice. However, we recognise that modifications or expansions of the toolkit may be needed to ensure adequate consideration of the broader sociocultural constructs relevant to gender, sex and gender interactions, and other intersectional factors. Box 1 ### Definitions of sex and gender2 The terms sex and gender are understood differently in different contexts, societies, groups, and languages. The use of these terms has changed over time and will continue to evolve.RETURN TO TEXT","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255696","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":"How Uganda became an advanced nation in palliative care","authors":"Yemisi Bokinni","doi":"10.1136/bmj.r2099","DOIUrl":"https://doi.org/10.1136/bmj.r2099","url":null,"abstract":"Uganda is the only low income country to attain “advanced” status in a global ranking of palliative care services, just one place behind the US. Yemisi Bokinni reports on what other countries can learn Abigail Simon-Hart has seen the deaths of both her mother and her brother, in very different circumstances. “I grew up with a mother who had cancer four different times, all unrelated,” she says. “Four different times the doctors told us it was terminal, that there was nothing they could do—and she lived for 33 years after the last time they told her she was going to die.” Simon-Hart’s mother died of leukaemia in an Australian hospice in 2013. She recalls, “I was quite shocked as to how much say we had in everything, how much say she had in everything. She got to do some of the things on her bucket list—whatever made her feel slightly more normal within some reasonable level, they were allowed to do. And that kind of humanised everything.” Almost a decade later, in 2022, her brother died after complications from surgery in Nigeria. He remained on a ventilator in the intensive care unit for two and a half months until he went into cardiac arrest. There had been no discussion of what might happen if things didn’t go well, considering his multiple pre-existing comorbidities, and no DNR (do not resuscitate) order was in place. “I don’t blame [the doctors], because I think they honestly thought they could save him. I really think that they felt they were acting in his best interest,” Simon-Hart reflects. “I wasn’t going to tell them to switch the machine off, and that was the trauma. You’d go there and say, God, please either heal him or take him.” The extent of global inequalities in palliative care …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"110 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255691","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":"AI supported diagnostic innovations for impact in global women’s health","authors":"Nina Linder, Dinnah Nyirenda, Andreas Mårtensson, Harrison Kaingu, Billy Ngasala, Johan Lundin","doi":"10.1136/bmj-2025-086009","DOIUrl":"https://doi.org/10.1136/bmj-2025-086009","url":null,"abstract":"Nina Linder and colleagues examine how artificial intelligence could be applied to diagnostic methods that rely on highly trained experts, such as cytological screening for cervical cancer, enabling implementation even in resource limited settings Screening and diagnostic methods are essential for secondary prevention, early detection, and appropriate treatment across a range of women’s health conditions. Cervical cancer provides a compelling example of how screening and timely diagnosis can substantially improve outcomes and drastically reduce mortality, while also reflecting how women’s health priorities have historically been underfunded and under-innovated, especially in low and middle income countries (LMICs). The disease is considered preventable through human papillomavirus (HPV) vaccination and various screening modalities, but there has been limited investment in novel diagnostic tools, and inequities in access to evidence based, cost effective screening prevail, particularly in low resource settings.12 Cervical cancer screening ever in lifetime among women aged 30-49 years, for example, was reported to be 84% in high income countries and 11% in low income countries.1 Artificial intelligence (AI) supported tools, such as cytological cervical cancer screening, self-sampling combined with HPV testing, or AI analysis of cervix images, show great promise and have been successfully implemented at scale in research and clinical settings.3456 Yet their impact in LMICs remains constrained by persistent health system barriers to implementation and scale-up. Uptake of digital technologies is often hindered by systemic barriers including regulatory uncertainty, infrastructure constraints, and competing economic priorities.78 In parallel, molecular HPV testing capabilities and HPV vaccine coverage remain limited in many LMICs, with approximately one in five eligible girls receiving the full course of preventive immunisation.910 Given the 10-20 year lag time before HPV vaccination has a measurable impact on cervical cancer rates, scalable and effective screening remains critical for …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"391 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255698","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":"Designing clinical practice guidelines for equitable, inclusive, and contextualised care","authors":"Awa Naghipour, Eva Becher, Marcel Gemander, Sabine Oertelt-Prigione","doi":"10.1136/bmj-2025-085684","DOIUrl":"https://doi.org/10.1136/bmj-2025-085684","url":null,"abstract":"Sabine Oertelt-Prigione and colleagues argue that European clinical practice guidelines need standardised, inclusive, sex and gender sensitive development to not only guide healthcare but also drive innovation and research agendas As the global governance of healthcare is being reshaped, a timely opportunity and an urgent need exist to institutionalise standardised, equity focused approaches that embed innovation in the design and delivery of care.1 Clinical practice guidelines (CPGs) are essential to this transformation—they are not only endpoints that translate research into care but can also function as upstream influencers that shape research agendas, funding priorities, and innovation pathways.2 Through inclusive sex, gender, and context sensitive processes, CPGs can act as catalysts for advancing women’s and gender sensitive healthcare by identifying and highlighting persistent gaps in data and care, potentially driving innovation in research and service provision. CPGs can thus have a systemic impact beyond their essential role in clinical care. To successfully enact this upstream role, the CPG development process needs to build on strong, inclusive evidence guaranteed by structural and methodological premises and possibly embrace some technological innovations. Women and gender diverse individuals are under-represented and underserved in clinical research and care. Although sex and gender sensitive medicine is expanding and knowledge gaps are being filled as a result of structural interventions such as funding mandates, policy reforms, and publishing prerequisites,3 implementation into clinical practice is lagging behind. Previous reviews from Canada, the US, and Australia have shown the limited attention to sex/gender in national guidelines.456 Sex and gender were either not systematically mentioned in recommendations or used interchangeably—for example, by using “gender” when considering biological sex. Incorrect use of terminology can reduce the target specificity of healthcare interventions, ultimately disadvantaging already underserved populations.7 Furthermore, a lack of adequate inclusion of female participants …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255699","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":"Vaping misperceptions must be challenged","authors":"Sarah E Jackson, Hazel Cheeseman, Katherine East, Jamie Brown","doi":"10.1136/bmj.r2117","DOIUrl":"https://doi.org/10.1136/bmj.r2117","url":null,"abstract":"Mahase reports on the increasing number of people in England who smoke both cigarettes and e-cigarettes (vapes).1 Despite substantial evidence that vaping exposes users to much lower levels of toxicants than smoking,2 most adults in Britain who smoke think that vaping is equally or more harmful.34 This widespread misperception is not just an issue of misinformation—it has important implications for public health. Evidence indicates that it can prevent people from switching completely from smoking to …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145255597","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}