The BMJ最新文献

{"title":"Children’s right to oral health: what about water fluoridation?","authors":"Richard Turner","doi":"10.1136/bmj.q2511","DOIUrl":"https://doi.org/10.1136/bmj.q2511","url":null,"abstract":"The editorial on children’s right to oral health mentions that 514 million children have untreated carious lesions in their primary teeth.1 It emphasises the importance of upstream policies such as reducing sugar consumption but makes no mention of water fluoridation. As Niger Carter, chief …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665274","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":"Restructuring endometriosis care","authors":"Prathiba M De Silva, Sharon Dixon, Ginisha Vekaria","doi":"10.1136/bmj.q2416","DOIUrl":"https://doi.org/10.1136/bmj.q2416","url":null,"abstract":"Women need better coordination between primary and secondary care Endometriosis affects as many as 10% of women of reproductive age, or 190 million women globally.1 It can cause debilitating chronic pelvic pain and infertility, with treatment, work loss, and healthcare estimated to cost £12.5bn annually in the UK alone.2 The 2024 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report audited the care provided to 941 patients with surgically confirmed endometriosis and included the review of data from 120 general practitioners (GPs) and 623 specialists, alongside organisational data from 167 hospitals.3 The report highlights examples of effective, timely, holistic, and patient centred care across all settings but also reminds us that we could and should do better for many women with endometriosis, throughout their care journey. Specific challenges discussed include the long timeframe to and difficulties in diagnosing and treating endometriosis, the lack of coordination between primary and secondary care, and the difficulty in accessing supportive services. No clinical findings specifically correlate with a diagnosis of endometriosis, so GPs must often consider other conditions that have similar presenting symptoms. This may …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665312","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":"G20 and the global south: opportunities for global health","authors":"Maria de Lourdes Aguiar Oliveira, Natalie Mayet, Johanna Hanefeld, Anne Meierkord","doi":"10.1136/bmj.q2536","DOIUrl":"https://doi.org/10.1136/bmj.q2536","url":null,"abstract":"Leadership by southern countries is focusing attention on health equity Countries in the Group of 20 (G20) represent two thirds of the world’s population, and it is a major forum for international cooperation. In recent years it has intensified its focus on global health, starting with the creation of a G20 health working group in 2017. The G20 presidency rotates annually. It is currently held by Brazil, which was preceded by India and Indonesia, and will move to South Africa in 2025. This rotation through countries in the global south is providing opportunities to review the G20 agenda through a southern leadership lens. At the core of this agenda is global health, which cannot be detached from financial, climate, and economic considerations.1 Brazil has made its presidency …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665359","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":"Lack of abortion care is a threat to women’s health in Latin America","authors":"Mercedes Colomar, Veronica Fiol","doi":"10.1136/bmj.q2530","DOIUrl":"https://doi.org/10.1136/bmj.q2530","url":null,"abstract":"Inequalities and restrictions to sexual and reproductive health and rights are endangering women, write Mercedes Colomar and Veronica Fiol In 1994, the International Conference on Population and Development established a groundbreaking framework recognising reproductive rights as human rights.1 This framework prioritised people and human rights in development—rather than population control. Thirty years on, stark inequalities in sexual and reproductive health and rights persist across national, regional, and global levels. Poor access and restrictions on abortion are contributing to maternal mortality in Latin America and the Caribbean. In many contexts, women have limited autonomy and decision making power over their health, exacerbating poor health outcomes. Unsafe abortion is a serious public health problem and poses a particular risk to women’s health—especially in countries where abortion is clandestine and often dangerous. The impact of unsafe abortion is particularly severe in young, impoverished, and less educated women. Studies on clandestine abortions in places where abortion is highly restricted show that women with higher incomes have a greater chance of accessing safer abortion methods than those with lower incomes.2 Legislative restrictions, inadequate …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665271","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":"Non-hormonal management of vasomotor symptoms of menopause","authors":"Sebastian Geraci, Satu Kuokkanen, Erika Banks","doi":"10.1136/bmj.q2486","DOIUrl":"https://doi.org/10.1136/bmj.q2486","url":null,"abstract":"A new treatment option for women unable to take hormone replacement therapy Up to 80% of women experience vasomotor symptoms, including hot flushes and night sweats, during menopausal transition.1234567 These symptoms can persist for years before and after menopause, substantially impacting quality of life by impairing sleep, mood, and cognitive functioning.23456789101112 Approximately 32-46% of women describe their vasomotor symptoms as moderate to severe and would warrant treatment; studies suggest that the median total length of vasomotor symptoms is 7.4 years.4569 An effective treatment of vasomotor symptoms is hormonal therapy, but this treatment is not appropriate for everyone and only about 10% of women worldwide with vasomotor symptoms report using hormonal therapy.23561011131415 Contraindications to hormonal therapy and concerns for adverse effects with prolonged hormonal therapy use may contribute to its low use.2345679 Non-hormonal alternatives to manage vasomotor symptoms are available but these alternatives are generally considered less efficacious than hormonal therapy.6910111314 Furthermore, before 2023, paroxetine was the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665276","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":"Brazil’s G20 leadership offers glimmers of hope for global health equity","authors":"Deisy Ventura, Anne-Emanuelle Birn, Ruth Iguiñiz Romero, Michael Knipper","doi":"10.1136/bmj.q2517","DOIUrl":"https://doi.org/10.1136/bmj.q2517","url":null,"abstract":"The Rio de Janeiro declarations chart possibilities in an era of inequity, war, climate change, and pandemics, but their shortfalls must be acknowledged, write Deisy Ventura and colleagues On 31 October 2024, the G20 health ministers met in Rio de Janeiro, Brazil, following a series of preparatory meetings held throughout 2024. A recent series in The BMJ suggested priorities for Brazil’s G20 leadership.123 Brazil is taking this opportunity to advance global health diplomacy, but its leadership will need to go beyond formal declarations to address health inequity from a global south perspective. The Rio meeting produced two unanimously adopted declarations. The main, more general, one4 revisits elements from the G20 health declaration issued in 2023.5 These goals include building “more resilient, equitable, sustainable, and inclusive health systems” and implementing universal health coverage in the short term, and reaffirming commitments to the sustainable development goals. The 2024 version introduces new sections on health workforce shortages inequities and the problem of post-covid syndrome, which are welcome additions to overcoming pandemic inequalities. The declaration’s highlight is the launch of the Global Coalition for Local and Regional Production, Innovation, and Equitable Access, with …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665315","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":"Efficacy and safety of fezolinetant for moderate-severe vasomotor symptoms associated with menopause in individuals unsuitable for hormone therapy: phase 3b randomised controlled trial","authors":"Katrin Schaudig, Xuegong Wang, Céline Bouchard, Angelica Lindén Hirschberg, Antonio Cano, Marla Shapiro C M, Petra Stute, Xi Wu, Kentaro Miyazaki, Ludmila Scrine, Rossella E Nappi","doi":"10.1136/bmj-2024-079525","DOIUrl":"https://doi.org/10.1136/bmj-2024-079525","url":null,"abstract":"Objectives To assess the efficacy and safety of the non-hormonal, neurokinin 3 receptor antagonist, fezolinetant, to treat moderate-severe vasomotor symptoms associated with menopause in individuals unsuitable for hormone therapy. Design Phase 3b randomised controlled trial. Setting 16 countries. Participants 453 individuals aged 40-65 years with moderate-severe vasomotor symptoms associated with menopause who were considered unsuitable candidates for hormone therapy (contraindicated, caution (based on medical history), stoppers (previous discontinuation of hormone therapy), or averse (informed choice not to use hormone therapy)) were randomised to receive fezolinetant (n=227) or placebo (n=226). Intervention Fezolinetant 45 mg or placebo once daily for 24 weeks. Main outcome measures The primary endpoint was mean change in daily frequency of moderate-severe vasomotor symptoms from baseline to week 24. Secondary endpoints were mean change in symptom severity, sleep disturbance using the Patient-Reported Outcome Measurement Information System Sleep Disturbance Short Form (PROMIS SD-SF) 8b total score, and safety. Results 370 (81.7%) participants completed the study (fezolinetant=195, placebo group=175). The safety and full analysis sets comprised 452 participants who received at least one dose of study drug. Mean age was 54.5 (standard deviation 4.7) years and most of the participants (435 (96.7%) were white and categorised as either hormone therapy averse (168 (37.2%)) or caution (165 (36.5%)). At week 24, fezolinetant significantly reduced the frequency (least squares mean difference –1.93, 95% confidence interval (CI) –2.64 to –1.22; P<0.001) and severity of vasomotor symptoms (–0.39, –0.57 to –0.21; P<0.001). At week 24, the fezolinetant group had a greater reduction in sleep disturbance (PROMIS SD-SF 8b total score) compared with placebo (–2.5, –3.9 to –1.1; P<0.001). Improvements over placebo were observed as early as week 1. Both groups showed similar incidences of treatment emergent adverse events (TEAEs, 147 (65.0%) in the fezolinetant group, 138 (61.1%) in the placebo group) and serious TEAEs (10 (4.4%) and 8 (3.5%), respectively). The most common TEAEs in the fezolinetant group were covid-19 (30 (13.3%)), headache (20 (8.8%)), and fatigue (13 (5.8%)). Conclusions Fezolinetant was efficacious and well tolerated over a six month period for treating moderate-severe vasomotor symptoms in individuals considered unsuitable for hormone therapy. These results highlight the utility of fezolinetant as an effective treatment option for those who have contraindications to or choose not to use hormone therapy. Trial registration ClinicalTrials.gov [NCT05033886][1]; EudraCT 2021-001685-38. Researchers may request access to anonymised participant level data, trial level data, and protocols from Astellas sponsored clinical trials at [www.clinicalstudydatarequest.com][2]. For the Astellas criteria on data sharing, see <https://clinicalstudydatarequest.c","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142665268","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":"Vinit Sheshnath Vedpathak","authors":"Omkar Vedpathak, Shreya Kumar, Nutan Vedpathak, Nikhil Kaushik","doi":"10.1136/bmj.q2519","DOIUrl":"https://doi.org/10.1136/bmj.q2519","url":null,"abstract":"Vinit was born in Mumbai, India. He graduated from the Maharashtra University of Health Sciences in 1981 and came to the UK in 1989. After working in Dover, Lincoln, and Birmingham …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637734","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":"Olumade Adetola Okubadejo","authors":"Deyo Okubadejo","doi":"10.1136/bmj.q2527","DOIUrl":"https://doi.org/10.1136/bmj.q2527","url":null,"abstract":"Made Okubadejo was born in Lagos, Nigeria. He attended school at Igbobi College where he was the school organist. He worked as a teacher and a clerk in the Nigerian government’s chief secretary’s office before coming to the UK to take his A levels in Norwich at the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637739","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 Samuel Hopton","authors":"Barny Hopton","doi":"10.1136/bmj.q2520","DOIUrl":"https://doi.org/10.1136/bmj.q2520","url":null,"abstract":"David was born in Sale and attended Calday Grange Grammar School, then Sale County Grammar School. Following medical school in Manchester and house jobs, he spent two years in national service. This was followed by attachments to the 2nd Battalion Parachute Regiment and the Special Air Service, formative years with time in north Africa, Cyprus, Kuwait, and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637736","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}