BMJ : British Medical Journal最新文献

{"title":"Bird flu: First paediatric case in US is confirmed in California.","authors":"Owen Dyer","doi":"10.1136/bmj.q2657","DOIUrl":"https://doi.org/10.1136/bmj.q2657","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2657"},"PeriodicalIF":105.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seven days in medicine: 20-26 November 2024.","authors":"","doi":"10.1136/bmj.q2639","DOIUrl":"https://doi.org/10.1136/bmj.q2639","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2639"},"PeriodicalIF":105.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary menopausal hormone therapy and risk of cardiovascular disease: Swedish nationwide register based emulated target trial.","authors":"Therese Johansson, Torgny Karlsson, Dana Bliuc, Daniel Schmitz, Weronica E Ek, Alkistis Skalkidou, Jacqueline R Center, Åsa Johansson","doi":"10.1136/bmj-2023-078784","DOIUrl":"10.1136/bmj-2023-078784","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of contemporary menopausal hormone therapy on the risk of cardiovascular disease according to the route of administration and combination of hormones.</p><p><strong>Design: </strong>Nationwide register based emulated target trial.</p><p><strong>Setting: </strong>Swedish national registries.</p><p><strong>Participants: </strong>919 614 women aged 50-58 between 2007 and 2020 without hormone therapy use in the previous two years, identified from the Swedish population.</p><p><strong>Interventions: </strong>138 nested trials were designed, starting each month from July 2007 until December 2018. Using the prescription registry data for that specific month, women who had not used hormone therapy in the previous two years were assigned to one of eight treatment groups: oral combined continuous, oral combined sequential, oral unopposed oestrogen, oral oestrogen with local progestin, tibolone, transdermal combined, transdermal unopposed oestrogen, or non-initiators of menopausal hormone therapy.</p><p><strong>Main outcome measures: </strong>Hazard ratios with 95% confidence intervals were estimated for venous thromboembolism, as well as for ischaemic heart disease, cerebral infarction, and myocardial infarction separately and as a composite cardiovascular disease outcome. Treatment effects were estimated by contrasting initiators and non-initiators in observational analogues to \"intention-to-treat\" analyses and continuous users versus never users in \"per protocol\" analyses.</p><p><strong>Results: </strong>A total of 77 512 women were initiators of any menopausal hormone therapy and 842 102 women were non-initiators. 24 089 women had an event recorded during the follow-up: 10 360 (43.0%) had an ischaemic heart disease event, 4098 (17.0%) had a cerebral infarction event, 4312 (17.9%) had a myocardial infarction event, and 9196 (38.2%) had a venous thromboembolic event. In intention-to-treat analyses, tibolone was associated with an increased risk of cardiovascular disease (hazard ratio 1.52, 95% confidence interval 1.11 to 2.08) compared with non-initiators. Initiators of tibolone or oral oestrogen-progestin therapy had a higher risk of ischaemic heart disease (1.46 (1.00 to 2.14) and 1.21 (1.00 to 1.46), respectively). A higher risk of venous thromboembolism was observed for oral continuous oestrogen-progestin therapy (1.61, 1.35 to 1.92), sequential therapy (2.00, 1.61 to 2.49), and oestrogen-only therapy (1.57, 1.02 to 2.44). Additional results in per protocol analyses showed that use of tibolone was associated with a higher risk of cerebral infarction (1.97, 1.02 to 3.78) and myocardial infarction (1.94, 1.01 to 3.73).</p><p><strong>Conclusions: </strong>Use of oral oestrogen-progestin therapy was associated with an increased risk of heart disease and venous thromboembolism, whereas the use of tibolone was associated with an increased risk of ischaemic heart disease, cerebral infarction, and myocardial","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"e078784"},"PeriodicalIF":105.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncologists in India condemn former cricketer's claims that diet cured his wife's cancer.","authors":"Neeta Lal","doi":"10.1136/bmj.q2664","DOIUrl":"https://doi.org/10.1136/bmj.q2664","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2664"},"PeriodicalIF":105.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions for the management of long covid (post-covid condition): living systematic review.","authors":"Dena Zeraatkar, Michael Ling, Sarah Kirsh, Tanvir Jassal, Mahnoor Shahab, Hamed Movahed, Jhalok Ronjan Talukdar, Alicia Walch, Samantha Chakraborty, Tari Turner, Lyn Turkstra, Roger S McIntyre, Ariel Izcovich, Lawrence Mbuagbaw, Thomas Agoritsas, Signe A Flottorp, Paul Garner, Tyler Pitre, Rachel J Couban, Jason W Busse","doi":"10.1136/bmj-2024-081318","DOIUrl":"10.1136/bmj-2024-081318","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness of interventions for the management of long covid (post-covid condition).</p><p><strong>Design: </strong>Living systematic review.</p><p><strong>Data sources: </strong>Medline, Embase, CINAHL, PsycInfo, Allied and Complementary Medicine Database, and Cochrane Central Register of Controlled Trials from inception to December 2023.</p><p><strong>Eligibility criteria: </strong>Trials that randomised adults (≥18 years) with long covid to drug or non-drug interventions, placebo or sham, or usual care.</p><p><strong>Results: </strong>24 trials with 3695 patients were eligible. Four trials (n=708 patients) investigated drug interventions, eight (n=985) physical activity or rehabilitation, three (n=314) behavioural, four (n=794) dietary, four (n=309) medical devices and technologies, and one (n=585) a combination of physical exercise and mental health rehabilitation. Moderate certainty evidence suggested that, compared with usual care, an online programme of cognitive behavioural therapy (CBT) probably reduces fatigue (mean difference -8.4, 95% confidence interval (CI) -13.11 to -3.69; Checklist for Individual Strength fatigue subscale; range 8-56, higher scores indicate greater impairment) and probably improves concentration (mean difference -5.2, -7.97 to -2.43; Checklist for Individual Strength concentration problems subscale; range 4-28; higher scores indicate greater impairment). Moderate certainty evidence suggested that, compared with usual care, an online, supervised, combined physical and mental health rehabilitation programme probably leads to improvement in overall health, with an estimated 161 more patients per 1000 (95% CI 61 more to 292 more) experiencing meaningful improvement or recovery, probably reduces symptoms of depression (mean difference -1.50, -2.41 to -0.59; Hospital Anxiety and Depression Scale depression subscale; range 0-21; higher scores indicate greater impairment), and probably improves quality of life (0.04, 95% CI 0.00 to 0.08; Patient-Reported Outcomes Measurement Information System 29+2 Profile; range -0.022-1; higher scores indicate less impairment). Moderate certainty evidence suggested that intermittent aerobic exercise 3-5 times weekly for 4-6 weeks probably improves physical function compared with continuous exercise (mean difference 3.8, 1.12 to 6.48; SF-36 physical component summary score; range 0-100; higher scores indicate less impairment). No compelling evidence was found to support the effectiveness of other interventions, including, among others, vortioxetine, leronlimab, combined probiotics-prebiotics, coenzyme Q10, amygdala and insula retraining, combined L-arginine and vitamin C, inspiratory muscle training, transcranial direct current stimulation, hyperbaric oxygen, a mobile application providing education on long covid.</p><p><strong>Conclusion: </strong>Moderate certainty evidence suggests that CBT and physical and mental health rehabilitation ","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"e081318"},"PeriodicalIF":105.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Government aims to cut waiting lists and improve mental health support to get two million people into work.","authors":"Matthew Limb","doi":"10.1136/bmj.q2655","DOIUrl":"https://doi.org/10.1136/bmj.q2655","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2655"},"PeriodicalIF":105.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How much does the fossil fuel industry fund medical research?","authors":"Hristio Boytchev, Natalie Widmann, Simon Wörpel","doi":"10.1136/bmj.q2589","DOIUrl":"https://doi.org/10.1136/bmj.q2589","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2589"},"PeriodicalIF":105.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doctors' leaders welcome \"long overdue\" plans to regulate NHS managers.","authors":"Gareth Iacobucci","doi":"10.1136/bmj.q2648","DOIUrl":"https://doi.org/10.1136/bmj.q2648","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2648"},"PeriodicalIF":105.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"South Sudan: Surge in admissions for severe malaria among children shows a health system under serious strain.","authors":"Brian Kennedy","doi":"10.1136/bmj.q2649","DOIUrl":"https://doi.org/10.1136/bmj.q2649","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2649"},"PeriodicalIF":105.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COP29: Deal to raise $300bn a year by 2035 for poorer countries is hailed and slated.","authors":"Dominic Murphy","doi":"10.1136/bmj.q2651","DOIUrl":"https://doi.org/10.1136/bmj.q2651","url":null,"abstract":"","PeriodicalId":9201,"journal":{"name":"BMJ : British Medical Journal","volume":"387 ","pages":"q2651"},"PeriodicalIF":105.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}