The BMJ最新文献

{"title":"Effect of universal no-cost coverage on use of long-acting reversible contraception and all prescription contraception: population based, controlled, interrupted time series analysis","authors":"Laura Schummers, Lucy Cheng, Martin Odendaal, Elisabet Rodriguez-Llorian, I Fan Kuo, Wendy V Norman, Amanda Black, Andrea Stucchi, Mary Helmer-Smith, Elizabeth Nethery, Amanda Downey, G Emmanuel Guindon, Kim McGrail, Erin A Brennand, Sabrina Lee, Amy Metcalfe, Stirling Bryan, Elizabeth K Darling, Stefania Bertazzon, Vanessa Poliquin, Nathan C Nickel, Fiona Clement, Michael R Law","doi":"10.1136/bmj-2024-083874","DOIUrl":"https://doi.org/10.1136/bmj-2024-083874","url":null,"abstract":"Objective To estimate effects of a policy introducing universal, no-cost public coverage for prescription contraception on use in British Columbia, Canada. Design Population based, controlled, interrupted time series analysis. Setting 10 Canadian provinces. Participants Prescription medications dispensed to reproductive aged (15-49 years) female residents of British Columbia, Canada, compared with a synthetic control derived from the nine other Canadian provinces and a population based cohort of 859 845 female individuals in British Columbia (age 15-49 years) between 1 April 2021 and 30 June 2024. Intervention Introduction of a universal contraception coverage policy in April 2023, where the public insurer pays 100% of prescription costs. Outcome measures Number of monthly dispensations for long-acting reversible contraception (LARC) and number of monthly dispensations for all forms of prescription contraception (including LARC), percentage of reproductive aged female residents using LARC and using all forms of prescription contraception, and the proportion of people using prescription contraception who use LARC (LARC market share). Segmented regression models were used to estimate policy effects by comparing the expected outcome values after 15 months of the policy (ie, the counterfactual, derived from trends before the policy and changes in the control) with the observed values, with 95% confidence intervals (CIs) estimated using bootstrapping. Results In April 2021, 3249 (95% CI 3066 to 3391) LARC prescriptions were dispensed in British Columbia, with a declining slope trend of −17 (−30 to −7) fewer dispensed per month before the policy. Monthly LARC dispensations increased by 1050 (942 to 1487) immediately after British Columbia’s policy change and saw a steady increasing trend after the policy introduction. An additional 1273 (963 to 1698) monthly LARC prescriptions were dispensed 15 months after policy implementation compared with the expected volume, representing an estimated 1.49-fold (1.34 to 1.77) increase. Dispensations for all prescription contraception (including LARC) increased by 1981 (356 to 3324) per month, representing a 1.04-fold (1.01 to 1.07) increase. Among the 859 845 female residents aged 15-49 years in the population, 9.1% were using LARC in April 2021. 15 months after the policy, 11 375 (10 273 to 13 013) more individuals were using LARC than expected without the policy, representing an additional 1.3% (1.2% to 1.5%) of the population. The policy led to an additional 1.7% (1.5% to 2.3%) of the population using any prescription contraception. 15 months after the policy, the LARC market share was 1.9% (1.2% to 2.3%) higher than expected. Conclusions Universal, no-cost public coverage in British Columbia increased prescription contraception use overall, driven by increased LARC use. As such, cost seems to be an important contributor to contraception use and method selection at the population level. The code used to analyse ","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"123 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715669","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":"Why I . . . teach piano","authors":"Erin Dean","doi":"10.1136/bmj.r1490","DOIUrl":"https://doi.org/10.1136/bmj.r1490","url":null,"abstract":"Consultant surgeon Sam Turner speaks to Erin Dean about how playing and teaching piano helps him destress and brings him joy Playing the piano has been a source of joy and peace since childhood for consultant renal transplantation surgeon Sam Turner. For the past 12 years he has found a new passion in music, by teaching the piano to others. Turner, who works for North Bristol NHS Trust, started playing the piano at the age of 7, after going along to lessons with his mother, who was also learning to play. “I spent many, many hours just playing and along the way completed all eight grade exams while at school,” he says. At 18 Turner started medical school, leaving home and the piano. In his fourth year, however, when he was missing playing, he was given an electric piano. This piano moved with him 16 times …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"129 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715672","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":"Ambient scribing risks loss of the cognitive benefits of writing","authors":"Nick Lown","doi":"10.1136/bmj.r1518","DOIUrl":"https://doi.org/10.1136/bmj.r1518","url":null,"abstract":"Stokel-Walker summarises the artificial intelligence (AI) tools being used to record doctor-patient conversations.1 I encourage clinicians who are using ambient scribing to familiarise themselves with the concept of cognitive artefacts: artefacts that “maintain, display, or operate upon information in order to serve a representational function”2—that is, a physical thing that helps us …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"122 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701490","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":"US immigration detention centers threaten health and human rights","authors":"Vicki B Gaubeca","doi":"10.1136/bmj.r1561","DOIUrl":"https://doi.org/10.1136/bmj.r1561","url":null,"abstract":"Unsafe conditions and abusive practices are systemic in immigration detention facilities, writes Vicki B Gaubeca “We had to sleep on a bus for two nights, sitting on hard seats and shackled,” and they “only allowed us to use the bathroom once” explained a man in his late 40s in an interview with Human Rights Watch. He was describing being held by US Immigration and Customs Enforcement (ICE) agents on a parked bus for almost 48 hours in front of the Krome North Service Processing Center near Miami, Florida, in March 2025. Experiences like this are part of a pattern of abusive and harmful practices and conditions in US detention facilities. In a new report, “You Feel Like Your Life is Over”: Abusive Practices at Three Florida Immigration Detention Centers Since January 2025 , Human Rights Watch, Americans for Immigrant Justice, and Sanctuary of the South documented the conditions and treatment of people detained at these centers.1 Everyone we interviewed said they had been held in overcrowded and unsanitary conditions and subjected to degrading treatment. Some described being denied prompt …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701489","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":"Skin cancer prevention and sunscreens","authors":"Anna Nicholson, Rachel Abbott, Caradee Y Wright, Perdy Kamali, Craig Sinclair","doi":"10.1136/bmj-2025-085121","DOIUrl":"https://doi.org/10.1136/bmj-2025-085121","url":null,"abstract":"### What you need to know A parent visits their general practitioner with their 1 year old child, who is due to receive several vaccinations. During the appointment, the parent asks whether it is OK to start using infant sunscreen formulations, as they have heard there is a risk that sunscreens can be unsafe for infants, and that they can cause skin reactions. You observe that the infant has fair skin. The parent notes their child has sensitive skin, which is easily irritated, and asks for your recommendation. Skin cancer is the most commonly diagnosed cancer worldwide.1 The Global Burden of Disease study shows rates of skin cancer continue to rise, largely owing to an aging population.12 The most common skin cancers include keratinocyte cancers, basal cell cancer and cutaneous squamous cell cancer, and melanoma. Deaths due to melanoma are projected to increase by about 68% from 2020 to 2040.1 Although improvements in treatments for advanced melanoma have reduced mortality rates globally, these therapies are expensive and contribute to the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701704","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":"When I use a word . . . “Publish or perish”: adverse effects","authors":"Jeffrey K Aronson","doi":"10.1136/bmj.r1577","DOIUrl":"https://doi.org/10.1136/bmj.r1577","url":null,"abstract":"I have previously defined the “publish or perish” doctrine as “An aphorism that describes the pressure on an academic to have innovative scholarly material published in reputable journals or other forms of scholarly output, sufficiently often, in order to avoid demotion, dismissal, failure to progress in one’s scholarly career, or diminishing the status or reputation of one’s scholarly community or discipline.” The doctrine has been responsible, at least in part, for many deleterious effects on academic practice: increased numbers of publications, accompanied by an increase in the numbers of co-authors on each paper; a reduction in the quality of the work being published; wasted resources and the reproducibility crisis; stifling of innovation; increased research misconduct of different types; the burgeoning of paper mills and predatory journals; increasing numbers of retractions of published work; increased burnout among senior academics and an increased reluctance on the part of trainees to enter research; and diversion of attention from teaching to research. I have previously defined the “publish or perish” doctrine as “An aphorism that describes the pressure on an academic to have innovative scholarly material published in reputable journals or other forms of scholarly output, sufficiently often, in order to avoid demotion, dismissal, failure to progress in one’s scholarly career, or diminishing the status or reputation of one’s scholarly community or discipline.”1 I call it a doctrine, which is defined in the Oxford English Dictionary ( OED ) as “That which is taught or laid down as true concerning a particular subject or department of knowledge.”2 The doctrine states that if you do not publish you will perish. Others have attached a range of other words …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710575","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 protections for healthcare enshrined in international humanitarian law are under severe strain in an increasingly war-torn world","authors":"Dominic Norcliffe-Brown, Andrew Green","doi":"10.1136/bmj.r1242","DOIUrl":"https://doi.org/10.1136/bmj.r1242","url":null,"abstract":"Attacks on healthcare and violations of medical neutrality—the fundamental principle that medical care must operate free of political or military interference—have become alarmingly unexceptional in modern conflicts. Patients have been dragged from hospital beds by security forces. Medical supplies have been looted and blockaded. Hospitals are bombed while others are repurposed for military uses. Doctors are arbitrarily detained, tortured, or even killed. All of these actions represent clear violations of international humanitarian law. Simultaneously, wars are becoming more common, with the number of conflicts increasing dramatically since 2010.1 The Geneva Academy of International Humanitarian Law records over 110 conflicts in the world today.2 From 2021 to the end of 2024, conflict-affected areas increased by two-thirds, encompassing a land mass nearly double the size of India.3 UNICEF has stated that nearly one in five children now live in conflict zones, a record high.4 These two trends—the decrease in respect for medical neutrality and increase in conflict zones—are combining with lethal impact. The recently published Safeguarding Health in Conflict Coalition report for 2024 indicated it was the worst year on …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701709","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 to … write a Minerva Picture or Endgames article for The BMJ?","authors":"Ella Hubbard","doi":"10.1136/bmj.r1429","DOIUrl":"https://doi.org/10.1136/bmj.r1429","url":null,"abstract":"As a medical student, some of the best learning happens at the bedside: patients are some of our most important teachers. But learning from patients doesn't stop when we graduate. Often, these cases teach us the things that textbooks can't: conditions that present in unusual ways, or cases that teach us how complexity and comorbidity affect the way conditions manifest. The BMJ 's Endgames and Minerva Pictures series are a place where medical students and doctors can share these pieces of real world learning. We welcome submissions from medical students writing alongside fully qualified consultants or general practitioners: after all, if you learnt something from a patient, it’s likely that someone else could too. So, here are our editorial team's top tips for how to write a good Endgames or Minerva Picture article: All Minerva Pictures and Endgames articles start with a patient from whom you learnt something. It might be the cutaneous features of zinc deficiency, the x ray features of a boxer’s fracture, or the rash you get after eating undercooked mushrooms: they’re all topics we’ve had cases on in the past year. Importantly, we aren’t looking for rare conditions. For Minerva, we’re looking for uncommon presentations of common conditions. For Endgames, we’re looking for common presentations of common conditions. This is where these articles are a bit different from “standard” case reports, which often focus on clinical rarities. Instead, we’re looking for articles which will educate and interest our broad readership. Remember, a wide range of doctors, healthcare professionals, and medical students read The BMJ , so articles should appeal to those working across a range of specialties: an account of a rare neurosurgical emergency won’t be as useful or …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694107","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":"Battle of the weight loss giants . . . and other research","authors":"Tom Nolan","doi":"10.1136/bmj.r1472","DOIUrl":"https://doi.org/10.1136/bmj.r1472","url":null,"abstract":"Tom Nolan reviews this week’s research Cannabinol—aka CBD—is a modern day tonic for almost any ailment, available in all good vape shops and petrol stations. In 2023, the Food Standards Agency cut the recommended safe dose of CBD from 70 mg per day to 10 mg per day. However, as these are only recommendations for what’s classed as a “novel” food, people will often take much higher doses. A randomised control trial assessed the frequency of abnormal liver enzymes with a higher dose of 5 mg/kg/day. Eight out of 151 participants allocated to take CBD had liver enzyme level elevations greater than three times the upper limit of normal by the end of the 28 …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693978","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":"Cash transfers . . . and other stories","authors":"British Medical Journal Publishing Group","doi":"10.1136/bmj.r1469","DOIUrl":"https://doi.org/10.1136/bmj.r1469","url":null,"abstract":"Among 900 women with epilepsy studied throughout their pregnancy in China, around half remained free of seizures, whereas a quarter experienced deterioration of seizure control ( J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2024-335751). Seizures during gestation, particularly status epilepticus, doubled the risk of neurodevelopmental delay, low birth weight, and fetal death in the offspring, but there was no increase in the incidence of major congenital malformations. Mothers and children in low income households have poorer health than those from high income households. A trial in four cities in the United States explored …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693979","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}