The BMJ最新文献_第3页

John Christopher Howard

The BMJ Pub Date : 2025-04-01 DOI: 10.1136/bmj.r621

Diane Howard

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Trump 2.0 sends “a ripple of fear” through the reproductive health community fighting for safe abortions worldwide

The BMJ Pub Date : 2025-04-01 DOI: 10.1136/bmj.r627

British Medical Journal Publishing Group

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Migrants in limbo and the doctors struggling to provide care

The BMJ Pub Date : 2025-04-01 DOI: 10.1136/bmj.q2438

Sally Howard

{"title":"Migrants in limbo and the doctors struggling to provide care","authors":"Sally Howard","doi":"10.1136/bmj.q2438","DOIUrl":"https://doi.org/10.1136/bmj.q2438","url":null,"abstract":"Caring for migrants in immigration removal centres can present GPs with complex practical and ethical difficulties, Sally Howard reports Several cases haunt Alan Mitchell from his 14 years as a general practitioner at Dungavel House immigration removal centre in Scotland (box). One man was deported to East Asia with a large bowel tumour that a prison GP had failed to find under examination, despite a textbook anal protrusion. The discovery of the tumour did not prevent the man’s deportation. Then there was the detainee with advanced multiple sclerosis whose symptoms had gone untreated for years owing to fear that GPs would report him to the Home Office. There were also avoidable deaths, Mitchell says, from cancers and communicable diseases—the result of late presentation. These losses, he says, “are all part of providing care to this highly vulnerable population.” Mitchell retired from his role at Dungavel House last June but remains the immigration removal centres lead for the Royal College of General Practitioners’ secure environments group. It’s a year and a half since the publication of the Brook House Inquiry report,2 which was commissioned to investigate the mistreatment of detainees at Brook House immigration removal centre near Gatwick Airport in Sussex between 1 April and 31 August 2017. And there are concerns that guidance set out by the report on a range of matters, including the use of force, has not been implemented across centres. Immigration removal centres are one of the most challenging settings for GPs to practise in, presenting ethical quandaries for clinicians navigating between vulnerable patients’ best interests and Home Office pressures that can conflict with clinical independence. The health of people in immigration removal centres is often poor. A 2021 review of the clinical literature found that three quarters of people in immigration detention in the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745086","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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How Trump’s trade war will break global medicine supply chains

The BMJ Pub Date : 2025-04-01 DOI: 10.1136/bmj.r648

Flynn Murphy

{"title":"How Trump’s trade war will break global medicine supply chains","authors":"Flynn Murphy","doi":"10.1136/bmj.r648","DOIUrl":"https://doi.org/10.1136/bmj.r648","url":null,"abstract":"The supply chains that deliver drugs to patients around the world are surprisingly brittle. Donald Trump’s trade war—with both allies and rivals—could break them. Flynn Murphy reports When hurricane Helene flooded a North Carolina plant that made 60% of the US’s intravenous fluids in October 20241 it was a grimly familiar situation. The damage worsened a shortage that had lingered since hurricane Maria hit the same company’s production in Puerto Rico in 2017. Medical procedures had to be altered to reduce the use of IV products. Fluids were rationed and surgeries postponed, and some patients had to get by with sports drinks.2 It took three months to bring the crisis under control. A broader, more intractable crisis has replaced it. Trump’s aggressive reconfiguration of US trade relations and a pledge to make all of the country’s essential drugs and their inputs at home is threatening the stability of medical supply chains that have only just recovered from covid. Additionally, tariffs targeting both traditional US allies and rivals are likely to hamper progress already made on relocating some medical sourcing from key exporter China to other countries. ### Trump’s China beef “Our enemy” is what President Donald Trump has called China. Yet China holds an intractable position in global healthcare supply chains—particularly for generic drugs, medical devices and supplies, and even some emerging treatments like antibody drug coagulates. China is also a key source of many of the materials required to manufacture and test drugs, such as those used to make active pharmaceutical ingredients (APIs), APIs themselves, and excipients such as binders, fillers, and lubricants. Years of US efforts to mitigate reliance on China has created room for Canada, Costa Rica, India, Ireland, Mexico, and others to grow their own export industries. But they are now in Trump’s tariff crosshairs too. And most …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745099","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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Helen Salisbury: Improved access is meaningless without increased capacity

The BMJ Pub Date : 2025-04-01 DOI: 10.1136/bmj.r641

Helen Salisbury

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Clinical care for patients at risk of psychosis related violence

The BMJ Pub Date : 2025-04-01 DOI: 10.1136/bmj.r603

Seena Fazel, Belinda Lennox

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Tuberculosis in the UK

The BMJ Pub Date : 2025-03-31 DOI: 10.1136/bmj.r604

Jessica L Potter, Felicity Perrin, Emily Shaw, Samara Barnes, Marc Lipman

{"title":"Tuberculosis in the UK","authors":"Jessica L Potter, Felicity Perrin, Emily Shaw, Samara Barnes, Marc Lipman","doi":"10.1136/bmj.r604","DOIUrl":"https://doi.org/10.1136/bmj.r604","url":null,"abstract":"Multipronged action is needed to reverse rising rates Tuberculosis (TB) is the world’s oldest pandemic, accounting for around a billion deaths in the past two centuries.1 In the UK, after more than a decade of declining incidence, numbers are on the rise. In 2024, 5480 people became unwell with TB in England—up 13% from 2023, the largest increase recorded since 1970, and reflecting a trend that started in 2021.2 The TB Action Plan for England 2021-263 commits the country to meet the World Health Organization target of eliminating TB by 2035.4 But achieving the required 18% annual rate reduction from 2025 is not certain. TB is linked to conditions of poverty. People who become unwell with the disease face stigma, financial precarity, digital exclusion, language barriers, and housing insecurity.5 They need the scaffolding provided by support networks to enable them to receive the health and social care required to complete treatment successfully. TB exists on a spectrum between asymptomatic latent infection and active disease. Around 80% of active cases in the UK occur among people born in countries where TB is common.6 Intersecting vulnerabilities such as HIV, deprivation, homelessness, asylum seeker status, and incarceration …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"56 78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736644","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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Standing up for science in an age of political interference

The BMJ Pub Date : 2025-03-31 DOI: 10.1136/bmj.r638

Kit Yates, Martin McKee, Marleen Bekker, Scott Greer

{"title":"Standing up for science in an age of political interference","authors":"Kit Yates, Martin McKee, Marleen Bekker, Scott Greer","doi":"10.1136/bmj.r638","DOIUrl":"https://doi.org/10.1136/bmj.r638","url":null,"abstract":"Science is under siege. Political forces are undermining expertise, dismantling research institutions, and replacing evidence based policymaking with ideology. This is a global crisis. The covid-19 pandemic underscored the importance of scientific independence. While vaccines, diagnostics, and therapeutics saved many lives, governments that ignored expert advice and downplayed the threat allowed lives to be lost. Sometimes, it became a political battleground as public health experts were vilified and disinformation flourished, with deadly consequences.1 In the US, history is currently being rewritten. Life-saving vaccines are falsely being portrayed as harmful, and researchers are being demonised. Scientific institutions are in disarray, with frozen research grants, staff dismissals, and defunded public health agencies.2 Disinformation is rampant, damaging domestic research and international collaborations. The erosion of scientific credibility threatens global health. This assault on science is also evident in Europe.3 Climate science, vaccine policies, and social research are under attack as populist politicians seek to control narratives rather than confront inconvenient truths. Their strategy is clear. Delegitimise expertise, suppress evidence, and replace objective reality with ideological fictions. The loss of public trust in science threatens everyone. The scientific community cannot remain passive. European nations, having previously faced such threats from Nazi Germany4 …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736642","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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Caring for patients experiencing homelessness

The BMJ Pub Date : 2025-03-31 DOI: 10.1136/bmj-2024-080768

Gemma Ashwell, Andrea E Williamson, Mandy Pattinson, Stephen W Hwang

{"title":"Caring for patients experiencing homelessness","authors":"Gemma Ashwell, Andrea E Williamson, Mandy Pattinson, Stephen W Hwang","doi":"10.1136/bmj-2024-080768","DOIUrl":"https://doi.org/10.1136/bmj-2024-080768","url":null,"abstract":"### What you need to know There has been a worldwide rise in homelessness over the past 10 years.1 On a single night in 2024 roughly 771 480 people in the United States were experiencing homelessness, the highest figure since reporting began in 2007.2 Equivalent figures in England showed that, on a given night in 2024, an estimated 354 016 people were homeless which is 1 in 160 people.3 Health and homelessness are closely interconnected, and there is much that can be done by healthcare professionals to improve the lives of people experiencing homelessness. Here, we explore the health impacts of homelessness and barriers to accessing healthcare, with a focus on adults in high income countries. We also offer practical considerations for clinicians providing care to people experiencing homelessness. Patterns of homelessness are complex and diverse and include rough sleeping; staying in temporary accommodation such as night shelters, hostels, and women’s refuges; and hidden forms of homelessness such as staying with friends, sofa surfing, and living in squats or “beds in sheds.”4 The support needs of people experiencing homelessness are also diverse. A person who has become homeless due to a job loss but without other risk factors may require little support and be able to return to housing quickly. For many, however, homelessness can be a longer term problem, resulting from an accumulation of risks and traumatic experiences at different points along their life course.5 The landmark Marmot Review in 2010 drew widespread attention …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736639","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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How can I support a neurodivergent colleague?

The BMJ Pub Date : 2025-03-31 DOI: 10.1136/bmj.r559

Abi Rimmer

{"title":"How can I support a neurodivergent colleague?","authors":"Abi Rimmer","doi":"10.1136/bmj.r559","DOIUrl":"https://doi.org/10.1136/bmj.r559","url":null,"abstract":"There are ways to make workplaces feel more inclusive for neurodivergent colleagues, Abi Rimmer hears Catriona McVey, final year medical student, says, “Neurodivergent colleagues often bring unique strengths—such as attention to detail and deep focus in specialised areas—but they can also face additional challenges and barriers to success. “Work with them to identify what they personally find difficult, and explore what accommodations can be made at work. Neurodiversity is a spectrum and something that helps an autistic colleague may not be useful for a colleague with attention deficit/hyperactivity disorder (ADHD). Likewise, some people with ADHD might prefer to work alone when they need to concentrate, whereas others find they’re more productive when they can ‘body double’ by working alongside colleagues. “Culture is an important part of supporting neurodivergent colleagues. Neurodivergent problem solving can be unconventional, but still effective. As long as professional standards are met, focus on outcomes rather than rigid processes by being open to different approaches and communication styles. Lack of eye contact or a monotone voice doesn’t necessarily indicate disinterest, a lack of engagement, or rudeness. Being clear and precise, and avoiding ambiguity when communicating, can also be helpful. “Our colleagues need to feel safe to disclose their neurodivergence and ask for support without fear of judgment or exclusion. Many will mask their neurodivergent traits by mirroring the behaviour of neurotypical peers. Masking increases the risk of poor performance, burnout, and mental illness. They are unlikely to feel safe to unmask and be themselves at work if they are fearful of discrimination, stigma, and a lack of support. “We can also make our workplaces more supportive by challenging any misconceptions, biases, or discrimination we come across. For many, neurodivergence meets the legal definition of a disability. If we challenge ‘banter’ at work about other protected characteristics, we …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736646","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}

引用次数: 0