BMJ medicine最新文献

{"title":"Trends in hypertension prevalence, control, and antihypertensive use in England from 2003 to 2021: insights from annual, nationwide Health Surveys for England.","authors":"Catherine Graham, James Steckelmacher, Jai Prashar, Ayesha Ahmed, Maxim Capel, Neil R Poulter, Peter Sedgwick Sever, Ajay Kumar Gupta","doi":"10.1136/bmjmed-2025-001556","DOIUrl":"10.1136/bmjmed-2025-001556","url":null,"abstract":"<p><strong>Objective: </strong>To determine the annual trends over two decades in hypertension diagnosis, true hypertension prevalence, and control and use of antihypertensive drugs in England.</p><p><strong>Design: </strong>Annual, representative, nationwide Health Surveys for England from 2003 to 2021.</p><p><strong>Setting: </strong>Nationally representative sample consisting of participants from private households, identified through stratified, national, multistage sampling.</p><p><strong>Participants: </strong>67 242 people older than 16 years surveyed between 2003 and 2021.</p><p><strong>Results: </strong>Between 2003 and 2021, the prevalence of measured hypertension decreased significantly from 37.8% in 2003 to 33.2% in 2018 (average annual percentage change (AAPC) -0.9%, 95% confidence interval -1.6% to -0.6%). Mean population systolic and diastolic blood pressure decreased significantly between 2003 to 2019 (systolic blood pressure from 128.7 to 124.0 mm Hg, AAPC -0.15%, -0.21% to -0.11%; diastolic blood pressure from 73.7 to 71.8 mm Hg, AAPC -0.12%, -0.20% to -0.04%). The prevalence of those with undiagnosed hypertension in the community decreased from 32.6% in 2003 to 23.7% in 2011, gradually worsening thereafter, with a steep increase in 2021 when 32.4% of those with hypertension were undiagnosed (AAPC -1.04%, -1.92% to -0.22%). Among people diagnosed (known) with hypertension, the proportion of those with blood pressure controlled to target increased across the study period (AAPC 1.66%, 0.04% to 2.27%), but this was mainly driven by the significant increase from 47.3% in 2003 to 56.5% in 2009 (AAPC 3.62%, 1.52% to 5.74%). A plateau was observed from 2011 onwards when there was no further significant improvement in the proportion of people with diagnosed (known) hypertension and blood pressure controlled to target. People with diagnosed (known) but uncontrolled hypertension showed a small but significant decrease in the mean number (standard deviation) of antihypertensive drugs used during the study period from 2.17 (0.86) in 2003 to 2.14 (0.96) in 2021 (AAPC -0.18%, -0.68% to -0.03%). Those with diagnosed (known) and controlled hypertension had no significant change in the mean number of drugs used.</p><p><strong>Conclusions: </strong>These findings indicate that there was a significant improvement in hypertension prevalence and control in the 2000s, with a plateau after 2011. The prevalence of undiagnosed hypertension in the community reduced in the early 2000s and 2010s, but has since returned to the same level as two decades ago.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001556"},"PeriodicalIF":10.0,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12666190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in evaluating whole genome sequencing for newborn screening: series of systematic reviews and roadmap for evidence generation for policy advisers.","authors":"Karoline Freeman, Dylan Taylor, Jacqueline Dinnes, Corinna C A Clark, Inès Kander, Katie Scandrett, Shivashri Chockalingam, Naila Dracup, Rachel Court, Furqan Butt, Cristina Visintin, James R Bonham, David Elliman, Graham Shortland, Anne Mackie, Zosia Helena Miedzybrodzka, Sian Mair Morgan, Felicity Kate Boardman, Yemisi Takwoingi, Bethany Shinkins, Aileen Clarke, Sian Taylor-Phillips","doi":"10.1136/bmjmed-2025-001726","DOIUrl":"10.1136/bmjmed-2025-001726","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Abstract: &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate systematic review approaches to synthesising evidence for policy advisers who are considering whether to screen newborns for hundreds of rare diseases using whole genome sequencing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Series of systematic reviews and roadmap for evidence generation for policy advisers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;Medline, Embase, Science Citation Index, Cochrane Library.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;200 conditions included in Genomics England's Generation Study were stratified into five groups and one condition randomly selected from each group using criteria designed to maximise variability and availability of data. 30 systematic reviews were undertaken (five conditions, six review questions) about penetrance, detection rate, accuracy, benefit of earlier treatment, and benefits and harms of screening for the five conditions (search from inception to November 2023). Results were synthesised and reviewer time recorded. Genomic studies of newborn screening cohorts that reported penetrance were systematically reviewed using a non-condition specific approach (search inception to January 2024). The conditions and genes selected for reporting by these studies were identified. ClinGen was explored for synthesising evidence. All approaches were assessed by considering review effort and level and quality of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The five conditions selected for systematic review were pyridoxine dependent epilepsy, heritable retinoblastoma, X linked hypophosphataemic rickets, familial haemophagocytic lymphohistiocytosis, and medium chain acyl-CoA dehydrogenase deficiency. 19 689 titles were screened and 268 papers included that addressed two of six research questions (detection rate and treatment benefit). No studies were identified for the remaining four research questions. Total reviewer time for five conditions was seven months. A team of five reviewers would take over 20 years to conduct similar reviews for 200 conditions. 10 published genomic studies of newborn screening cohorts were identified with a total of 76 268 newborns. The number of conditions screened for varied from 74 to 903, with low concordance (two of 1453 genes were included in all 10 studies). Selection of conditions was primarily based on clinical opinion. All studies reported and acted on genetic findings considered clinically significant, preventing collection of penetrance data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Current evidence synthesis methods are neither feasible nor fruitful to provide policy advisers like the UK National Screening Committee with the evidence needed to understand the benefits and harms of newborn screening for multiple conditions using whole genome sequencing because the evidence is not available to synthesise. Evidence should be created through studies that only report pathogenic variants to parents and clinicians where penetrance and exp","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001726"},"PeriodicalIF":9.3,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12658509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse outcomes in patients with a diagnosis of an eating disorder: primary care cohort study with linked secondary care and mortality records.","authors":"Catharine Morgan, Matthew J Carr, Carolyn A Chew-Graham, Terence W O'Neill, Rachel Elvins, Nav Kapur, Roger T Webb, Darren M Ashcroft","doi":"10.1136/bmjmed-2025-001438","DOIUrl":"10.1136/bmjmed-2025-001438","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the short and long term adverse physical and mental health outcomes, all cause mortality, and natural and unnatural deaths in individuals with a diagnosis of an eating disorder compared with a matched cohort without these disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Primary care cohort study with linked secondary care and mortality records.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;English primary care electronic health records from the Clinical Practice Research Datalink, linked to Hospital Episode Statistics for hospital records and the Office for National Statistics for mortality data, 1 January 1998 to 30 November 2018.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;24 709 patients, aged 10-44 years, with a diagnosis of an eating disorder, matched by age, sex, and general practice with up to 20 comparators without an eating disorder (n=493 001). Disorders examined were anorexia nervosa, bulimia nervosa, binge eating disorder, and all other types combined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Physical health conditions, mental health conditions, and mortality (all cause and cause specific). Hazard ratios and cumulative incidences were calculated to compare outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Individuals with eating disorders had substantially higher risks for coded adverse physical, mental health, and mortality outcomes. Within the first year after a diagnosis of an eating disorder, these individuals were six times more likely to develop renal failure (hazard ratio 6.0, 95% confidence interval (CI) 4.2 to 8.5; excess 15 events per 10 000 individuals, 95% CI 11 to 21) and nearly seven times more likely to develop liver disease (hazard ratio 6.7, 3.8 to 11.7; excess 6 per 10 000, 4 to 11). Risks were still increased after five years (hazard ratio for renal failure 2.6, 95% CI 2.0 to 3.4; hazard ratio for liver disease 3.7, 2.3 to 6.0), with cumulative excesses of 110 (95% CI 87 to 136) and 26 (17 to 39) per 10 000 individuals at 10 years for renal failure and liver disease, respectively. Mental health coded outcomes were markedly increased in the short term for depression (hazard ratio 7.3, 95% CI 6.6 to 8.1; excess 596 per 10 000 individuals, 95% CI 545 to 650) and self-harm (hazard ratio 9.4, 8.2 to 10.7; excess 309 per 10 000, 279 to 342) at one year. Mortality was also higher: within the first year, the risk of all cause mortality was more than fourfold (hazard ratio 4.6, 95% CI 3.1 to 7.0; excess 10 per 10 000 individuals, 95% CI 7 to 15) and was fivefold for unnatural deaths (hazard ratio 5.1, 2.2 to 11.9; excess 30 per 100 000, 13 to 61). Risks persisted beyond five years (hazard ratio 2.2, 95% CI 1.8 to 2.7 for all cause mortality; hazard ratio 3.2, 1.9 to 5.4 for unnatural deaths), corresponding to 43 (95% CI 33 to 54) excess all cause deaths per 10 000 individuals and 184 (125 to 262) excess unnatural deaths per 100 000 at five years. At 10 years, 95 (95% CI 75 to 118) excess all cause deaths per 10 00","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001438"},"PeriodicalIF":10.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12636977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145590048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to recognise the risks to patients after an eating disorder diagnosis.","authors":"Ethan Nella, Jennifer Couturier","doi":"10.1136/bmjmed-2025-002261","DOIUrl":"10.1136/bmjmed-2025-002261","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e002261"},"PeriodicalIF":9.3,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12636938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse led telephonic palliative care versus specialty outpatient palliative care: pragmatic, randomised clinical trial.","authors":"Corita R Grudzen, Mara Flannery, Kaitlyn Van Allen, Allison Cuthel, Rebecca Liddicoat Yamarik, Audrey Tan, Susan E Cohen, Paige Comstock Barker, Abraham A Brody, Cheryl Herchek, Nina Siman, Keith S Goldfeld","doi":"10.1136/bmjmed-2025-001392","DOIUrl":"10.1136/bmjmed-2025-001392","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the effectiveness of nurse led telephonic palliative care versus specialty outpatient palliative care on quality of life, symptom burden, loneliness, and healthcare use, after attending the emergency department.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Pragmatic, randomised clinical trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Emergency Medicine Palliative Care Access (EMPallA) randomised controlled trial enrolling participants from 18 emergency departments in 15 geographically diverse healthcare systems in nine US states, from 1 April 2018 to 30 June 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Of 39 254 eligible patients, 1283 adults who visited the emergency department, were aged ≥50 years, who spoke English or Spanish, and had advanced cancer or end stage organ failure, were randomised to receive nurse led telephonic palliative care (n=639) or specialty outpatient palliative care (n=644).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;The nurse led telephonic palliative care arm consisted of weekly or biweekly calls over six months made by registered nurses certified in hospice and palliative care. For the specialty outpatient palliative care arm, patients had one visit each month for six months with a specialty trained hospice and palliative medicine provider.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;The primary outcome was change in patient reported quality of life at six months, measured by the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. Secondary outcomes were change in symptom burden and patient reported loneliness after six months, and healthcare use, measured as the number of emergency department revisits, inpatient days, and hospice use, from enrolment to 12 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;639 patients were assigned to nurse telephonic services and 434 (68%) engaged in care until death, or until they required hospice services or graduated from the programme. For specialty outpatient palliative care, 644 patients were assigned and 344 (53%) attended one or more visits, with an average of 2.7 visits. The mean change in FACT-G scores over six months for the nurse telephonic arm (n=418) was 3.7 (95% confidence interval (CI) 2.3 to 5.1) points compared with 3.1 (1.6 to 4.6) for those in the specialty outpatient care arm (n=409). In the model including all patients who survived to six months (n=1090), the estimated difference in average change in quality of life was 0.71 (95% CI -1.19 to 2.61) points higher in the nurse led telephonic palliative care arm. The analysis did not show any clinically meaningful differences in the change in quality of life between the treatment arms. Also, no important differences between groups were found for secondary outcomes or in subgroup analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The results of the study provided no clear evidence that nurse led telephonic palliative care improved quality of life, or any secondary outcomes, relative to specialty out","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001392"},"PeriodicalIF":10.0,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12612767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with: problems of using exploratory multivariable regression to identify causal risk factors.","authors":"Dan Lewer, Thomas Brothers, Elizabeth O'Nions, John Pickavance","doi":"10.1136/bmjmed-2025-001375","DOIUrl":"10.1136/bmjmed-2025-001375","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001375"},"PeriodicalIF":9.3,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12574381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High risk human papillomavirus versus cytological screening over two rounds in Finnish screening programme for cervical cancer: population based cohort study.","authors":"Iiris Juulia Turunen, Ilkka Kalliala, Maiju Pankakoski, Veli-Matti Partanen","doi":"10.1136/bmjmed-2025-001435","DOIUrl":"10.1136/bmjmed-2025-001435","url":null,"abstract":"<p><strong>Objective: </strong>To compare routine high risk human papillomavirus (hrHPV) screening with cytological screening in two screening rounds in a well established, routine screening programme for cervical cancer.</p><p><strong>Design: </strong>Population based cohort study.</p><p><strong>Setting: </strong>Finland's Mass Screening Registry, 2012-22, with diagnostic follow-up examinations until October 2024.</p><p><strong>Participants: </strong>1 180 491 women participating at least once in cytological test (PAP smear) or hrHPV based cervical cancer screening between 2012 and 2022.</p><p><strong>Main outcome measures: </strong>Numbers and proportions of attendees, positive routine test results, follow-up screening referrals, colposcopy referrals, and incidence of cervical intraepithelial neoplasia ≥grade 2 (CIN2+) in the first and second hrHPV and cytological screening rounds. Results adjusted for age, year, region, and education.</p><p><strong>Results: </strong>Data for 1 574 688 full screening rounds were analysed. The overall referral rate for colposcopy was 3.37% (n=12 273) in the hrHPV group and 0.98% (n=11 895) in the cytology group, with an adjusted risk ratio of 2.97 (95% confidence interval (CI) 2.87 to 3.07). The overall rate for detection of CIN2+ was 0.92% in the hrHPV group and 0.35% in the cytology group, with an adjusted risk ratio of 2.17 (2.04 to 2.31). For the second hrHPV screening round compared with the first screening round, the adjusted risk ratio was 0.77 (0.71 to 0.84) for referral for colposcopy and 0.57 (0.46 to 0.72) for detection of CIN2+. Actual rates for referral for colposcopy were 3.54% (n=11 709) in the first hrHPV screening round and 2.42% (n=564) in the second screening round. The rate for detection of CIN2+ for hrHPV screening was 0.98% (n=3 248) in the first hrHPV screening round and 0.38% (n=88) in the second screening round. In cytological screening, no observed reduction was seen in either the referral rate or CIN2+ findings. After a negative hrHPV test in the first screening round, CIN2+ was detected in only 0.2% of women (n=44/314 286) in the second screening round.</p><p><strong>Conclusions: </strong>Within a well established, population based national screening programme, the results of the study indicated that hrHPV screening with a five year interval was effective and safe. hrHPV screening identified precancerous lesions earlier than cytological screening. The incidence of CIN2+ was low in the second screening round in women with a negative hrHPV test result in the initial round and in those aged ≥50 years, and hence a longer screening interval for specific subgroups should be considered.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001435"},"PeriodicalIF":10.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequalities in hormone replacement therapy prescribing in UK primary care: population based cohort study.","authors":"Jennifer A Hirst, Wema Meranda Mtika, Carol Coupland, Sharon Dixon, Julia Hippisley-Cox, Sarah Hillman","doi":"10.1136/bmjmed-2025-001349","DOIUrl":"10.1136/bmjmed-2025-001349","url":null,"abstract":"<p><strong>Objective: </strong>To quantify prescribing of hormone replacement therapy (HRT) in women aged 40-60 years by type of HRT and length of use, and to determine sociodemographic factors associated with receiving a HRT prescription.</p><p><strong>Design: </strong>Population based cohort study.</p><p><strong>Setting: </strong>QResearch database of primary care practices in England, 1 January 2013 to 13 July 2023, and patient electronic health records for prescribing information .</p><p><strong>Participants: </strong>1 978 348 women aged 40-60 years at any time over a 10 year period.</p><p><strong>Main outcome measures: </strong>Overall uptake of two or more prescriptions of the same type of HRT in women of menopausal age, length of use, and association between ethnic group, deprivation, and geographical region and receiving a HRT prescription before and during the eight years since implementation of National Institute for Health and Care Excellence (NICE) guidance on the menopause in 2015 in the UK.</p><p><strong>Results: </strong>The cohort comprised 1 978 348 women with a mean age of 49.4 years, and 76.2% were white women. Overall, 379 911 (19.2%) women received two or more HRT prescriptions. Combination HRT formulations in one prescription were the most frequently prescribed (62.4% of those prescribed HRT), with 43.3% receiving oral and 26.3% transdermal formulations. Mean age at first prescription was 49.8 years. Rates for two or more prescriptions of HRT were higher in white women (22.6%) than in other ethnic groups, ranging from 8.9% in Caribbean women to 3.9% in black African women. Prescription rates decreased with increasing social deprivation, from 24.2% in the most affluent to 10.9% in the most deprived groups. London had lower prescription rates (11.7%) than other regions (all >19%). Multivariable Cox regression showed that non-white ethnic groups had significantly lower HRT prescription rates (hazard ratios 0.85-0.92, P<0.001), and each increase in social deprivation group was associated with lower HRT prescription rates (hazard ratio for the most deprived group 0.92, 95% confidence interval 0.92 to 0.93, P<0.001).</p><p><strong>Conclusions: </strong>This study identified differences in HRT prescribing in England based on ethnic group, socioeconomic status, and geographical location. White women and those in more affluent neighbourhoods were more likely to receive HRT than non-white women and those in more deprived areas. These findings suggest potential inequities that require further exploration.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001349"},"PeriodicalIF":9.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case studies: a guide for researchers, educators, and implementers.","authors":"Trisha Greenhalgh","doi":"10.1136/bmjmed-2025-001623","DOIUrl":"10.1136/bmjmed-2025-001623","url":null,"abstract":"<p><p>Case study is a widely used but poorly understood research method, conducted differently in different disciplines. This paper explores philosophical, theoretical and methodological issues in case study research and outlines how to conduct one. It offers preliminary guidance for policy makers on how to select and use case studies for learning and decision making. In social science research, a case study is a detailed, contextualised account of a clearly delineated, real world phenomenon, prepared prospectively using mostly qualitative methods. Social science case studies can be of various kinds (eg, theoretical or naturalistic, single or multiple, typical or extreme). A public health case study is a historical account of a health threat and how it was managed. An implementation science case study evaluates the implementation of an intervention (usually retrospectively), combining quantitative assessment against predefined objectives with a narrative of how the project unfolded. Educational case studies present real world topics as stories illustrated by data and prompt students to discuss these from different angles. Impact case studies summarise the societal impact of a research programme. Many accounts described as case studies are overly brief and superficial. The paper concludes with a call to improve the quality and consistency (and hence the usefulness) of case studies.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001623"},"PeriodicalIF":10.0,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The critical importance of design decisions in case studies.","authors":"Penelope Hawe","doi":"10.1136/bmjmed-2025-001986","DOIUrl":"10.1136/bmjmed-2025-001986","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001986"},"PeriodicalIF":10.0,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}