BMJ medicine最新文献

{"title":"Characteristics, outcomes, and maternity care experiences of women with children's social care involvement who subsequently died: national cohort study and confidential enquiry.","authors":"Kaat De Backer, Allison Marjorie Felker, Emma Rose, Caroline Bull, Oluwaseun Labisi, Kirsty Kitchen, Claire Mason, Elsa Montgomery, Jane Sandall, Abigail Easter, Marian Knight, Nicola Vousden","doi":"10.1136/bmjmed-2025-001464","DOIUrl":"10.1136/bmjmed-2025-001464","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate maternal mortality in the context of children's social care (CSC) involvement, and to explore the quality of maternity care that women with CSC involvement received.</p><p><strong>Design: </strong>National cohort study and confidential enquiry.</p><p><strong>Setting: </strong>MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) national surveillance dataset for deaths that occurred during pregnancy or up to a year after pregnancy, UK, 2014-22.</p><p><strong>Participants: </strong>1451 women who died during or in the year after pregnancy in the UK; 420 women (28.9%) had CSC involvement. 47 women's healthcare records were included in the confidential enquiry to describe the care of a random sample of women who died during the perinatal period who had CSC involvement.</p><p><strong>Main outcome measures: </strong>Rates and causes of maternal deaths by CSC involvement and quality of care.</p><p><strong>Results: </strong>A third (420/1451, 28.9%) of the women who died during or in the year after pregnancy had CSC involvement for their (unborn) baby. Women with CSC involvement were more likely to be aged ≤20 years (rate ratio 1.85, 95% confidence interval 1.27 to 2.63, compared with those aged 21-29 years), living in the most deprived areas (rate ratio 2.19, 1.42 to 3.50, compared with those least deprived), and less likely to be from black (rate ratio 0.56, 0.35 to 0.84) or Asian ethnic backgrounds (rate ratio 0.26, 0.14 to 0.44, compared with white women) than women who died with no known CSC involvement. Deaths occurred predominantly between six weeks and the year after pregnancy (75%), and higher proportions of deaths were caused by suicide, other psychiatric causes, including substance overdose, and homicide. A confidential enquiry identified that risk assessment and recognition, medication management, coordination of care, and staff competencies were essential components in providing personalised, holistic, and trauma-informed care when dealing with medical and social complexity. Multiple individual and systemic barriers hindered access and engagement with healthcare.</p><p><strong>Conclusions: </strong>Women with CSC involvement who died during or in the year after pregnancy encountered multiple inequalities and were at an increased risk of maternal mortality from psychiatric causes and homicide. A critical review of current care pathways and policy changes is urgently needed to tailor care to the needs of this group of women and to look at the inequalities that disproportionately affect them.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001464"},"PeriodicalIF":10.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638824","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 predicting outcomes from chronic pain management interventions.","authors":"Steven P Cohen, Eric J Wang, Alexandra Roybal, Yian Chen","doi":"10.1136/bmjmed-2024-001143","DOIUrl":"10.1136/bmjmed-2024-001143","url":null,"abstract":"<p><p>Chronic pain is the leading cause of years lost to disability worldwide, by a large margin, affecting 20-34% of the world's population. Chronic pain is the target for an increasing number of invasive and expensive treatments, supported by different levels of evidence. At a time when personalised medicine, driven in part by the growth of artificial intelligence, is surging, a scoping review on the factors that affect pain outcomes for procedural interventions is needed. A scoping review is important because placebo controlled trials for the most commonly used treatments consistently show small-to-moderate effect sizes of <0.5 that are often overshadowed by the placebo effect. In this article, personal characteristics, and social and clinical factors that influence surgical and non-surgical procedure pain and functional outcomes are reviewed, their intersectionality is briefly explored, and the evidence base for how dealing with these factors can influence outcomes is outlined.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001143"},"PeriodicalIF":10.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746318","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":"Correction: Statins for primary prevention of cardiovascular events in people with HIV: target trial and modelling study.","authors":"","doi":"10.1136/bmjmed-2024-001132corr1","DOIUrl":"https://doi.org/10.1136/bmjmed-2024-001132corr1","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1136/bmjmed-2024-001132.].</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001132corr1"},"PeriodicalIF":10.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746317","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":"Epidemiology: a partnership of technical expertise and clinical insight.","authors":"Stephen Burgess, Deborah A Lawlor","doi":"10.1136/bmjmed-2022-000348","DOIUrl":"10.1136/bmjmed-2022-000348","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e000348"},"PeriodicalIF":10.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556034","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":"Tackling control risk problems in non-inferiority trials.","authors":"Ian R White, Matteo Quartagno, Abdel G Babiker, Rebecca M Turner, Mahesh Kb Parmar, A Sarah Walker","doi":"10.1136/bmjmed-2023-000845","DOIUrl":"10.1136/bmjmed-2023-000845","url":null,"abstract":"<p><p>Non-inferiority trials aim to show that major disease related outcomes with a new intervention are not importantly worse than with standard care. These trials are useful when the new intervention has some advantages over standard care (eg, toxicity, convenience, or cost). The ability to show non-inferiority, however, is sensitive to the control risk, the outcome frequency under standard care. Two control risk problems are described that can make non-inferiority trials underpowered or uninterpretable, and two ways of tackling these problems are outlined. Firstly, the choice of effect measure used to express the non-inferiority margin is critical: the effect measure must be based on understanding both the clinical setting and the implications for sample size. Which effect measures can lead to smaller or larger sample sizes is shown. Secondly, investigators need to consider, and potentially plan for, the possibility that the observed control risk might differ from the anticipated risk at the design stage of the trial. How the non-inferiority margin can be adapted in the trial analysis in a statistically principled manner is shown.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e000845"},"PeriodicalIF":10.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777044","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":"Detection bias and the role of negative control outcomes.","authors":"Isaac Núñez, Anthony A Matthews","doi":"10.1136/bmjmed-2025-001336","DOIUrl":"10.1136/bmjmed-2025-001336","url":null,"abstract":"<p><p>Investigators, patients, or clinicians knowing which treatment is assigned in pragmatic randomised trials and observational analyses can lead to detection bias (ie, systematic differences in determining outcomes between groups). A structural definition of detection bias with directed acyclic graphs is provided, together with several published examples. Why negative control outcomes are best placed to assess detection bias is discussed, and how to correctly select a negative control outcome for this purpose is explained.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001336"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12172073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318860","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":"Risk factors, impact, and healthcare use related to initial suicide attempts: comprehensive analysis of Swedish population.","authors":"Kejia Hu, Thuy-Dung Nguyen, Karen Borges, Ralf Kuja-Halkola, Agnieszka Butwicka, Isabell Brikell, James J Crowley, Zheng Chang, Brian M D'Onofrio, Henrik Larsson, Paul Lichtenstein, Christian Rück, Cynthia Bulik, Patrick Sullivan, Fang Fang, Yi Lu","doi":"10.1136/bmjmed-2024-001129","DOIUrl":"10.1136/bmjmed-2024-001129","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objective: </strong>To provide a comprehensive analysis of initial suicide attempts, covering incidence, risk factors, outcomes, and healthcare use in the month before and the month after the attempts.</p><p><strong>Design: </strong>Comprehensive analysis of the Swedish population that included three designs: a retrospective cohort study to investigate incidence and healthcare use, a nested case-control study to investigate risk factors, and a matched cohort study to examine subsequent suicide attempts and mortality.</p><p><strong>Setting: </strong>Comprehensive Swedish national registers that include patient diagnoses from hospitals and specialist outpatient care, and cause of death information updated to the end of 2019.</p><p><strong>Participants: </strong>3.7 million people born in Sweden in 1963-98 and followed from age 10 to 57 years.</p><p><strong>Main outcome measure: </strong>First lifetime suicide attempt identified in patient and death registers using ICD (international classification of diseases) codes for intentional self-harm, any self-harm with lethal methods or requiring hospital admission, or any self-harm resulting in death.</p><p><strong>Results: </strong>The lifetime risk of an initial suicide attempt in the study population was 4.6%, with greater risk in females and highest risk between ages 18 and 24. One in 10 families in Sweden had at least one family member who attempted suicide. Overdose and poisoning were the most common methods. Previous psychiatric disorders, general medical diseases, and adverse life events were associated with increased risk of initial suicide attempt, while higher socioeconomic status was associated with decreased risk. People with an initial suicide attempt were at substantially increased risk of subsequent attempts (hazard ratio 23.4), death by suicide (16.4), and all cause mortality (7.3). At least 60% of those who made an initial suicide attempt had a healthcare contact in the month before the attempt.</p><p><strong>Conclusions: </strong>This study provides comprehensive data on the incidence, risk factors, outcomes, and healthcare use of initial suicide attempts in the Swedish population, highlighting the need for systematic prevention efforts for people who have attempted suicide for the first time.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001129"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287403","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":"Association between maternal body mass index and hospital admissions for infection in offspring: longitudinal cohort study.","authors":"Victoria Coathup, Claire Carson, Helen Ashdown, Gillian Santorelli, Maria A Quigley","doi":"10.1136/bmjmed-2024-001050","DOIUrl":"10.1136/bmjmed-2024-001050","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relation between maternal body mass index and hospital admissions for infections in their offspring, and to identify potentially modifiable mediators.</p><p><strong>Design: </strong>Longitudinal cohort study.</p><p><strong>Setting: </strong>Born in Bradford longitudinal, multi-ethnic birth cohort, Bradford, UK. Secondary analysis linked to routine hospital admission data, January 2007 to 3 October 2022.</p><p><strong>Participants: </strong>9540 singleton births between 2007 and 2011, born to 9037 mothers, followed up from birth to about age 15 years.</p><p><strong>Main outcome measures: </strong>Total number of hospital admissions related to infections, between birth and age 15 years, in age categories <1 year, 1-4 years, and 5-15 years.</p><p><strong>Results: </strong>The main study cohort comprised 9540 children and 9037 mothers. About 56% of mothers were overweight or obese. First trimester maternal body mass index was positively associated with rates of hospital admissions for infection across all ages, but associations were significant (P<0.05) only for children born to women with the highest body mass index (obesity grades 2-3). Compared with women with a healthy body mass index, children born to women with obesity grades 2-3 had an adjusted rate ratio of 1.41 (95% confidence interval 1.13 to 1.77) at <1 year and an adjusted rate ratio of 1.53 (1.19 to 1.98) for hospital admissions for infection by age 5-15 years. Similar trends were seen for respiratory and gastrointestinal infections, and multisystem viral infections. Being born by caesarean section and child obesity at aged 4-5 years accounted for 21% and 26% of the association, respectively.</p><p><strong>Conclusions: </strong>In this study, a modest but consistent association between maternal obesity (grades 2-3) and hospital admissions for infection throughout childhood was found. Healthcare professionals and public health campaigns should continue to support mothers to achieve and maintain a healthy body weight before conception and during the postpartum period.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001050"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303793","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":"Metformin for covid-19: systematic review and meta-analysis of randomised controlled trials.","authors":"Saifur R Chowdhury, Nazmul Islam, Qi Zhou, Md Kamrul Hasan, Mahmudur Rahman Chowdhury, Reed Ac Siemieniuk, Arnav Agarwal, Romina Brignardello-Petersen, Thomas Agoritsas, Per Olav Vandvik, Dena Zeraatkar, Gordon Guyatt","doi":"10.1136/bmjmed-2024-001126","DOIUrl":"10.1136/bmjmed-2024-001126","url":null,"abstract":"<p><strong>Objective: </strong>To summarise the effects of metformin on covid-19 to inform a World Health Organization (WHO) clinical practice guideline.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>As part of a living systematic review and network meta-analysis of drug treatments for covid-19 (covid-19 LNMA), a search was performed of the WHO covid-19 database, six Chinese databases, and the Epistemonikos Foundation's Living Overview of the Evidence covid-19 Repository (covid-19 L-OVE).</p><p><strong>Eligibility criteria for selecting studies: </strong>Randomised controlled trials that compared metformin with placebo in patients with acute covid-19 infection.</p><p><strong>Data synthesis: </strong>Frequentist pairwise meta-analyses were performed using the restricted maximum likelihood random effects model. The effects of interventions on selected outcomes were summarised using risk ratios, risk difference, and mean difference when appropriate, along with their corresponding 95% confidence intervals (CIs). To estimate absolute effects, the control arm event rate was used as the baseline risk. The risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool and the certainty of evidence using the GRADE (grading of recommendations assessment, development and evaluation) approach, with the minimally important difference in effect as the threshold.</p><p><strong>Results: </strong>Three randomised controlled trials of 1869 patients were included; one study provided long term follow-up on long covid. Metformin might have little or no impact on mortality (risk ratio 0.76, 95% CI 0.30 to 1.90; risk difference 3 fewer per 1000, 95% CI 8 fewer to 11 more; low certainty). The effects of metformin on admission to hospital because of covid-19 remain uncertain (risk ratio 0.74, 95% CI 0.28 to 1.95; risk difference 15 fewer per 1000, 95% CI 42 fewer to 55 more; very low certainty). Metformin results in little or no difference in adverse effects leading to discontinuation (risk difference 0.2 more per 1000, 95% CI 2.7 fewer to 3.1 more; high certainty). Metformin might decrease the development of long covid (risk ratio 0.6, 95% CI 0.4 to 0.9; risk difference 41 fewer per 1000, 95% CI 62 fewer to 10 fewer; low certainty). However, the effect is based on a single trial of 1126 patients, which has a high risk of bias owing to missing data, and nearly half of the participants were unvaccinated.</p><p><strong>Conclusions: </strong>Current evidence based on randomised trials suggests no significant effect of metformin on acute clinical outcomes in patients with non-severe covid-19. Metformin might reduce the incidence of long covid when used to treat patients with non-severe acute covid-19 infection, but this was suggested by low certainty evidence from a single trial.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001126"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163938","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/bmjmed-2025-001654","DOIUrl":"10.1136/bmjmed-2025-001654","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"4 1","pages":"e001654"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102596","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}