The BMJ最新文献

{"title":"Time restricted eating and exercise training before and during pregnancy for people with increased risk of gestational diabetes: single centre randomised controlled trial (BEFORE THE BEGINNING)","authors":"MA Jafar Sujan, Hanna MS Skarstad, Guro Rosvold, Stine L Fougner, Turid Follestad, Kjell Å Salvesen, Trine Moholdt","doi":"10.1136/bmj-2024-083398","DOIUrl":"https://doi.org/10.1136/bmj-2024-083398","url":null,"abstract":"Objective To determine the effect of a prepregnancy lifestyle intervention on glucose tolerance in people at higher risk of gestational diabetes mellitus. Design Single centre randomised controlled trial (BEFORE THE BEGINNING). Setting University hospital in Trondheim, Norway. Participants 167 participants with at least one risk factor for gestational diabetes mellitus who contemplated pregnancy. Intervention The participants were randomly allocated (1:1) to a lifestyle intervention or a standard care control group. The intervention consisted of exercise training and time restricted eating, started before pregnancy and continued throughout pregnancy. Exercise volume was set using a physical activity metric that translates heart rate into a score (personal activity intelligence, PAI), with the goal of ≥100 weekly PAI points. Time restricted eating involved consuming all energy within ≤10 hours/day for at least five days a week. Main outcome measures Two hour plasma glucose level in an oral glucose tolerance test at gestational week 28. The primary analysis used an intention-to-treat principle. Results 167 participants were enrolled from 2 October 2020 to 12 May 2023: 84 in the intervention group and 83 in the control group, out of whom 111 became pregnant (56 in intervention group and 55 in control group). One participant in the intervention group was excluded from the analysis because of prepregnancy diabetes. Pregnancy data from one participant in the control group were excluded from the analysis because of twin pregnancy. The intervention had no significant effect on two hour plasma glucose level in an oral glucose tolerance test at gestational week 28 (mean difference 0.48 mmol/L, 95% confidence interval −0.05 to 1.01, P=0.08). In the prepregnancy period, 31/83 participants (37%) in the intervention group adhered to prespecified criteria, whereas 24/55 participants (44%) in the intervention group who became pregnant fulfilled these criteria. During the prepregnancy period, the average eating window was 9.9 hours/day (standard deviation 1.2) and the average number of weekly PAI points was 111 (standard deviation 54), but the adherence to both intervention components decreased during pregnancy. Conclusions A combination of time restricted eating and exercise training started before and continued throughout pregnancy had no significant effect on glycaemic control in late pregnancy. Trial registration ClinicalTrials.gov [NCT04585581][1]. All individual deidentified participant data and statistical codes are available on Zenodo data repository. The code used to analyse the data in the paper can be found in the supplementary files. The data underlying the findings in this paper are openly and publicly available and can be found here: <https://doi.org/10.5281/zenodo.15675472>. For problems accessing the data, please contact the corresponding author. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04585581&atom=%2Fbmj%2F390%2Fbmj-2024-0","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017575","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":"RFK Jr is grilled over vaccines and CDC chaos at fiery US Senate hearing.","authors":"Janice Hopkins Tanne","doi":"10.1136/bmj.r1882","DOIUrl":"https://doi.org/10.1136/bmj.r1882","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"47 1","pages":"r1882"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018241","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":"David Nabarro: global health troubleshooter who helped coordinate UN emergency responses to Ebola and covid","authors":"John Illman","doi":"10.1136/bmj.r1809","DOIUrl":"https://doi.org/10.1136/bmj.r1809","url":null,"abstract":"Doctors who achieve prominence may be lucky if they become a notable figure as early as their 30s; David Nabarro, who went on to manage global health emergencies, first became a public figure in 1967—at the age of 17. In a BBC1 documentary, The Younger Generation , Nabarro described how he led a group of 400 community service volunteers in York for the charity Youth Action, in between boarding at Oundle School in Northamptonshire and studying medicine at Worcester College, Oxford. Writing about Nabarro in the Guardian , the surgeon, academic, and former health minister Ara Darzi said, “That experience—coordinating efforts for maximum impact—presaged a life in public service spent urging, cajoling, and commanding others to work together.” Nabarro’s leadership of the UN’s Scaling Up Nutrition (SUN) Movement was a spectacular example of his rare talent. He received the 2018 World Food Prize award, the so-called Nobel prize of food and agriculture, after uniting 54 countries to deliver SUN. SUN Movement’s evidence based nutritional programmes resulted in 10 million fewer children with stunting, according to the prize citation. Nabarro was born …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009361","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":"What adjustments can I ask for as a pregnant doctor?","authors":"Elisabeth Mahase","doi":"10.1136/bmj.r1803","DOIUrl":"https://doi.org/10.1136/bmj.r1803","url":null,"abstract":"It’s crucial that pregnant doctors know their rights and who to ask for support, Elisabeth Mahase hears Madeleine Openshaw, GP trainee, says, “Discovering you’re pregnant can bring up many emotions, from excitement to anxiety. It might feel premature, but it’s important that you and your line manager complete a risk assessment early as you may need immediate adjustments to keep you safe. It’s important that you avoid, for example, any ionising radiation or exposure to certain infectious diseases. “While many women will sail through the first trimester without so much as a whiff of nausea, others may feel debilitated by fatigue, insomnia, or vomiting, and thus any other necessary adjustments will vary from case to case. You may feel the need to take time off or to work from home, or move from a patient facing to an administrative role, while you manage your symptoms and your insatiable appetite for biscuits. These requests are usually signed off by your occupational health department (OH), but you can also get a fit note from your GP requesting amended duties if an OH appointment is hard to come by. “As your pregnancy progresses, you may start to feel more yourself or you may develop back pain, ankle swelling, or dizziness. You might feel apprehensive about requesting adjustments at this stage as your managers might make you feel like you’re the first person to ever have asked—but they should be reminded that pregnancy is a …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009366","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":"Sixty seconds on . . . organ transplants for immortality.","authors":"Gareth Iacobucci","doi":"10.1136/bmj.r1884","DOIUrl":"https://doi.org/10.1136/bmj.r1884","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"18 1","pages":"r1884"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018238","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":"Injectable Alzheimer's drug lecanemab approved in US for use at home.","authors":"Owen Dyer","doi":"10.1136/bmj.r1888","DOIUrl":"https://doi.org/10.1136/bmj.r1888","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"35 1","pages":"r1888"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018240","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":"WHO adds controversial cancer and diabetes treatments to essential medicines list.","authors":"Luke Taylor","doi":"10.1136/bmj.r1881","DOIUrl":"https://doi.org/10.1136/bmj.r1881","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"37 1","pages":"r1881"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018236","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 resurgence of malaria in Africa is an avoidable crisis—here’s what we must do","authors":"Jean Kaseya, Nebiyu Dereje","doi":"10.1136/bmj.r1874","DOIUrl":"https://doi.org/10.1136/bmj.r1874","url":null,"abstract":"As malaria resurges and progress in malaria control stalls, Africa’s response must be led and owned by Africans, say Jean Kaseya and Nebiyu Dereje In a world where technological and scientific advances continue to redefine what is possible in public health, the resurgence of malaria in Africa is a glaring and avoidable crisis. Since 2020 the global burden of malaria has continued to rise. The number of cases reached 263 million in 2023 (rising by 11 million from 2022), with the largest increases concentrated in Africa (accounting for 89.7% of the global rise).1 These figures underscore the urgent need for intensified malaria control efforts, particularly in regions affected by conflict, vulnerable to climate change, and where health systems are under strain. After decades of progress, this disease is making a dangerous comeback—fuelled by drug resistance, climate change, weakened health systems, and dwindling global financial commitment. If we fail to act collectively now, we risk reversing hard won gains and jeopardising the health and future of millions of people across the continent. In 2023 malaria killed nearly 600 000 people in Africa—95% of global deaths from this preventable and treatable disease.1 The continent also recorded 246 million cases, and between …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009359","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":"No excuses for not tackling racism and sexism","authors":"David Sellu","doi":"10.1136/bmj.r1865","DOIUrl":"https://doi.org/10.1136/bmj.r1865","url":null,"abstract":"Bamrah and colleagues’ commission paper should be a watershed moment in the way the NHS deals with racism and sexism.1 For too long we have known that these problems existed but not how bad they were or how to tackle …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009364","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":"Physician assistants: Court case against GMC over lack of regulation is dismissed on all grounds.","authors":"Kate Bowie","doi":"10.1136/bmj.r1887","DOIUrl":"https://doi.org/10.1136/bmj.r1887","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"34 1","pages":"r1887"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018237","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}