Medical Journal News

bmj;388/jan22_10/r90/FAF1faEric was born in Dundee, first son to William and Annie Mackay and one of eight children. He was brought up in the city, attending Morgan Academy. At the tail end of the second world war Eric trained to “tattie rogue”—finding potatoes that are diseased—progressing to work as a potato inspector.He then studied medicine at St Andrews, where he found he preferred the practical side, becoming a sharp diagnostician. He was a member of the Christian Union and through its international links he met Leonard Van Valen, who became a lifelong friend. In his fourth year of medical school he became president of the union and met his future wife, Joyce Thicknesse, known as Lis.Eric was posted to Egypt for his national service, acting as a medical officer in the Royal Air Force.He married Lis in 1956 and they moved to Matlock in Derbyshire, where he worked as a junior...

Eating disorder services have become worse rather than better over the past few years, MPs have said in a report that says some trusts are discharging patients with a body mass index (BMI) of less than 15 and even as low as 11.1The report from the all party parliamentary group (APPG) on eating disorders calls for a national strategy to tackle an “alarming rise” in eating disorders, which accounted for more than 31 000 admissions in 2023-24. The Royal College of Psychiatrists has also called for a national strategy on eating disorders, saying that “services are struggling to manage demand.”The APPG gathered oral and written evidence over six months from people with experience of eating disorders, as well as clinicians, managers, and academics. It also submitted freedom of information (FoI) requests asking for information about BMI at discharge from January to October 2024.Most trusts said either that they did not...

It is right to highlight that NHS staff felt the “strain and trauma” of caring for patients with covid-19.1 Although the risks of this viral infection have lessened, it is still a hazard for healthcare workers and their patients.Recent advice from the Joint Committee on Vaccination and Immunisation (JCVI)2 does not make provision for healthcare workers in forthcoming rounds of covid-19 vaccination. This advice lacks its previous explicit qualification that separate considerations may apply for this group.3Both good occupational health practice and UK Health and Safety Law4 warrant a more protective and precautionary approach “to ensure health, safety, and welfare at work.”5 That healthcare workers have more than double the of risk of the general population of contracting covid-19 is well recognised, as are the post-acute consequences.6 Furthermore, the acknowledgment3 that measures such as vaccination are “reasonably practicable,”7 as well as WHO advice,8 would weigh heavily in any court judgment...

A police civic volunteer accused of raping and murdering a female junior doctor at the hospital where she worked has been sentenced to life imprisonment by an Indian court.The doctor’s murder last August, and the initially slow response by authorities, made international headlines and triggered nationwide protests, doctors’ strikes, and rioting.1The sentence has prompted outrage from activists, politicians, and the victim’s parents, who asked why the death penalty had not been applied. Capital punishment by hanging was introduced for the most egregious crimes of lethal sexual violence after a national outcry over the 2012 gang rape and murder of a female physiotherapy student on a Delhi bus.But Judge Anirban Das told the court on 20 January, “I do not consider [the doctor’s murder] as a rarest-of-rare crime” that would put it in that category. This went against a submission requesting the death penalty from India’s Central Bureau of Investigation (CBI)....

In this paper by Dell-Kuster and colleagues (BMJ 2020;370:m2917, doi:10.1136/bmj.m2917, published 25 August 2020), the author name “Orestis Ioannidis” was ordered the wrong way round in the submitted manuscript. This has since been corrected in the article and PDF.

I still remember receiving my first letter from Harvard Medical School—and no, it wasn’t an acceptance letter. I was a student in the thick of pre-med requirements, trying to decide on the next institution I would trust with my dream of becoming a doctor. The letter was from Harvard’s Office of Recruitment and Multicultural Affairs, with information to help students like me, who are under-represented in medicine, apply to medical school. I revisited the list of medical schools I was applying to and added Harvard.Initiatives like this one, which are aimed at promoting diversity, equity, and inclusion (DEI), made it clear that I am needed and belong in medicine as a black woman. Today, DEI is under attack—and the effects of anti-DEI rhetoric and legislation on medicine will further marginalise black women, both seeking and providing healthcare, for years to come.In June 2023, the US Supreme Court ruled that race...

Donald Trump declared two national emergencies and issued a spate of executive orders as he was sworn in as US president for the second time on 20 January. At his inauguration Trump immediately declared a national energy emergency and an illegal immigration emergency at the border with Mexico.123This was swiftly followed by a string of executive orders (box), including withdrawing the US from the Paris climate accord and the World Health Organization. The US is the biggest donor to WHO and also contributes scientific expertise.4 The order said the US would withdraw from the WHO “due to the organization’s mishandling of the covid-19 pandemic that arose out of Wuhan, China, and other global health crises, its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states.”It said WHO “continues to demand unfairly onerous payments from the United States, far...

A legal challenge to a refusal by the UK General Medical Council to draw up guidance on safe and lawful practice for physician associates and anaesthesia associates is to be heard in the High Court within the next four months, after a judge gave permission for the case to go ahead and ruled that it should be expedited.Anaesthetists United, a doctors’ advocacy body, is bringing the case together with Marion and Brendan Chesterton, the parents of Emily Chesterton, who died aged 30 from a blood clot on her lungs after two appointments with a physician associate who she thought was a GP. The GMC took over the regulation of associates in December but argues that it is not the right body to create guidance on practice and that it should be left to the medical royal colleges and faculties, which are experts in clinical practice.Anaesthetists United is crowdfunding its costs...

The new NHS hospital buildings promised by former prime minister Boris Johnson will not be completed until at least a decade after the original deadline, the government has announced.1The promise of 40 new hospitals in England by 2030 was made by Johnson in 2019,2 but has been repeatedly delayed.3 When starting his role as health secretary last year, Wes Streeting said he discovered that “funding for the programme was to run out in March this year, with no provision for future years whatsoever. The money simply was not there.”The Labour government has now set out a new plan to deliver the hospital buildings, which it said will be backed up with “up to £15bn over each consecutive five year wave, averaging around £3bn a year from 2030.”Under the plan, 16 hospitals allocated to wave one will start construction between 2025 and 2030, while the nine hospitals in wave two will...

by Aleksandra Turkiewicz, Karin Magnusson, Simon Timpka, Ali Kiadaliri, Andrea Dell-Isola, Martin Englund

Background

Cardiovascular, respiratory, and musculoskeletal disease are among the leading causes of disability in middle-aged and older people. Health and lifestyle factors in youth have known associations with cardiovascular or respiratory disease in adulthood, but largely unknown associations with musculoskeletal disease.

Methods and findings

We included approximately 40,000 18-year-old Swedish males, who completed their conscription examination in 1969 to 1970, followed up until age of 60 years. Exposures of interest were physical health: body mass and height, blood pressure, pulse at rest, muscle strength, cardiorespiratory fitness, and hematocrit; self-reported lifestyle: smoking, alcohol, and drug use; self-reported health: overall, headache and gastrointestinal. We followed the participants through the Swedish National Patient Register for incidence of common musculoskeletal (osteoarthritis, back pain, shoulder lesions, joint pain, myalgia), cardiovascular (ischemic heart disease, atrial fibrillation), and respiratory diseases (asthma, chronic obstructive pulmonary disease, bronchitis). We analyzed the associations using general estimating equations Poisson regression with all exposures included in one model and adjusted for parental education and occupation. We found that higher body mass was associated with higher risk of musculoskeletal (risk ratio [RR] per 1 standard deviation [SD] 1.12 [95% confidence interval, CI 1.09, 1.16]), cardiovascular (RR 1.22 [95% CI 1.17, 1.27] per 1 SD) and respiratory diseases (RR 1.14 [95% CI 1.05, 1.23] per 1 SD). Notably, higher muscle strength and cardiorespiratory fitness were associated with higher risk of musculoskeletal disease (RRs 1.08 [95% CI 1.05, 1.11] and 1.06 [95% CI 1.01, 1.12] per 1 SD difference in exposure), while higher cardiorespiratory fitness was protective against both cardiovascular and respiratory diseases (RRs 0.91 [95% CI 0.85, 0.98] and 0.85 [95% CI 0.73, 0.97] per 1 SD exposure, respectively). We confirmed the adverse effects of smoking, with risk ratios when comparing 11+ cigarettes per day to non-smoking of 1.14 (95% CI 1.06, 1.22) for musculoskeletal, 1.58 (95% CI 1.44, 1.74) for cardiovascular, and 1.93 (95% CI 1.60, 2.32) for respiratory diseases. Self-reported headache (category “often” compared to “never”) was associated with musculoskeletal diseases (RR 1.38 [95% CI 1.21, 1.58]) and cardiovascular diseases (RR 1.29 [95% CI 1.07, 1.56]), but had an inconclusive association with respiratory diseases (RR 1.13 [95% CI 0.79, 1.60]). No large consistent associations were found for other exposures. The most notable associations with specific musculoskeletal conditions were for cardiorespiratory fitness and osteoarthritis (RR 1.23 [95% CI 1.15, 1.32] per 1 SD) and for muscle strength and back pain (RR 1.18 [95% CI 1.12, 1.24] per 1 SD) or shoulder diseases (RR 1.27 [95% CI 1.19, 1.36] per 1 SD). The main limitations include lack of adjustment for genetic factors and environmental exposures from childhood, and that the register data were available for males only.

Conclusions

While high body mass was a risk factor for all 3 studied groups of diseases, high cardiorespiratory fitness and high muscle strength in youth were associated with increased risk of musculoskeletal disease in middle age. We speculate that these associations are mediated by chronic overload or acute trauma.

by Romain Ragonnet, Angus E. Hughes, David S. Shipman, Michael T. Meehan, Alec S. Henderson, Guillaume Briffoteaux, Nouredine Melab, Daniel Tuyttens, Emma S. McBryde, James M. Trauer

Background

School closures have been a prominent component of the global Coronavirus Disease 2019 (COVID-19) response. However, their effect on viral transmission, COVID-19 mortality and health care system pressure remains incompletely understood, as traditional observational studies fall short in assessing such population-level impacts.

Methods and findings

We used a mathematical model to simulate the COVID-19 epidemics of 74 countries, incorporating observed data from 2020 to 2022 and historical school closure timelines. We then simulated a counterfactual scenario, assuming that schools remained open throughout the study period. We compared the simulated epidemics in terms of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections, deaths, and hospital occupancy pressure. We estimated that school closures achieved moderate to significant burden reductions in most settings over the period 2020 to 2022. They reduced peak hospital occupancy pressure in nearly all countries, with 72 out of 74 countries (97%) showing a positive median estimated effect, and median estimated effect ranging from reducing peak hospital occupancy pressure by 89% in Brazil to increasing it by 19% in Indonesia. The median estimated effect of school closures on COVID-19 deaths ranged from a 73% reduction in Thailand to a 7% increase in the United Kingdom. We estimated that school closures may have increased overall COVID-19 mortality (based on median estimates) in 9 countries (12%), including several European nations and Indonesia. This is attributed to changes in population-level immunity dynamics, leading to a concentration of the epidemic during the Delta variant period, alongside an upward shift in the age distribution of infections. While our estimates were associated with significant uncertainty, our sensitivity analyses exploring the impact of social mixing assumptions revealed robustness in our country-specific conclusions. The main study limitations include the fact that analyses were conducted at the national level, whereas school closure policies often varied by region. Furthermore, some regions, including Africa, were underrepresented due to insufficient data informing the model.

Conclusions

Our analysis revealed nuanced effects of school closures on COVID-19 dynamics, with reductions in COVID-19 impacts in most countries but negative epidemiological effects in a few others. We identified critical mechanisms for consideration in future policy decisions, highlighting the unpredictable nature of emerging variants and potential shifts in infection demographics associated with school closures.

by Si-Jing Chen, Jian-Yu Que, Ngan Yin Chan, Le Shi, Shirley Xin Li, Joey Wing Yan Chan, Weizhen Huang, Chris Xie Chen, Chi Ching Tsang, Yuen Lam Ho, Charles M. Morin, Ji-Hui Zhang, Lin Lu, Yun Kwok Wing

Background

Increasing evidence suggests that insomnia plays an important role in the development of depression, supporting insomnia intervention as a promising approach to prevent depression in youth. This randomized controlled trial evaluated the effectiveness of app-based cognitive behavioral therapy for insomnia (CBT-I) in preventing future onset of major depressive disorder (MDD) in youth.

Methods and findings

This was a randomized, assessor-blind, parallel group-controlled trial in Chinese youth (aged 15−25 years) with insomnia disorder and subclinical depressive symptoms. Participants were randomly assigned (1:1) to 6-week app-based CBT-I or 6-week app-based health education (HE) delivered through smartphones. Online assessments and telephone clinical interviews were conducted at baseline, post-intervention, 6- and 12-month follow-ups. The primary outcome was time to onset of MDD. The secondary outcomes included depressive symptoms and insomnia at both symptom and disorder levels. Between September 9, 2019, and November 25, 2022, 708 participants (407 females [57%]; mean age, 22.1 years [SD = 1.9]) were randomly allocated to app-based CBT-I group (n = 354) or app-based HE group (n = 354). Thirty-seven participants (10%) in the intervention group and 62 participants (18%) in the control group developed new-onset MDD throughout the 12-month follow-up, with a hazard ratio of 0.58 (95% confidence interval 0.38–0.87; p = 0.008). The number needed to treat to prevent MDD at 1 year was 10.9 (6.8–26.6). The app-based CBT-I group has higher remission rates of insomnia disorder than the controls at post-intervention (52% versus 28%; relative risk 1.83 [1.49–2.24]; p < 0.001) and throughout 12-month follow-up. In addition, the CBT-I group reported a greater decrease in depressive (adjusted difference −1.0 [−1.6 to −0.5]; Cohen’s d = 0.53; p < 0.001) and insomnia symptoms (−2.0 [−2.7 to −1.3], d = 0.78; p < 0.001) than the controls at post-intervention and throughout 6-month follow-up. Insomnia was a mediator of intervention effects on depression. No adverse events related to the interventions were reported.

Conclusions

App-based CBT-I is effective in preventing future onset of major depression and improving insomnia outcomes among youth with insomnia and subclinical depression. These findings highlight the importance of targeting insomnia to prevent the onset of MDD and emphasize the need for wider dissemination of digital CBT-I to promote sleep and mental health in the youth population.

Trial registration

ClinicalTrials.Gov (NCT04069247).

Dean’s profile of consultant cardiologist Rob Egdell is interesting and insightful.1 Unfortunately, it truly highlights how far training has fallen.Egdell acknowledges that the rotational nature of being a resident doctor hinders us from forming interpersonal relationships at work—under the guise of a more “varied” training of course. I agree—in our forced rotation, we do not feel integrated into departments, often not considered “ward staff” and shunned from staffrooms. Many of my colleagues and I can attest to feeling lost, isolated, and transient.I have little reason to doubt Egdell’s ongoing support for his team, and I hope that his current care for them continues. This letter is more a plea to any other consultant or senior registrar who may be reading: it is your responsibility to ensure your resident doctors are supported and welcomed into your departments. We may no longer have firms, but you have the power to reinstate the...

The new plan to improve NHS elective care includes creating and expanding surgical hubs.1 As a surgeon, I feel conflicted. It’s positive if patients with treatable conditions can move forward from the waiting list. But we need to do this with great care to avoid negatively affecting the rest of the NHS, especially for patients deemed ineligible or due to the diversion of staff, training capacity, and funding from existing NHS sites.2We already have over 100 surgical hubs, some delivering 11-20% more efficiency.3 Hubs tend to take patients with few other conditions and relatively low operative risk, whereas patients with more underlying medical conditions and higher risk must wait for a site with medical back-up for their operation. It’s important to consider that half of the patients having procedures are over 604— of whom 63% have multiple comorbidities5 and 32% have obesity.5 We must be careful to avoid surgical hubs...

Rates of cancer are now rising in Americans under 50, and particularly among women, a report from the American Cancer Society has said.12While overall cancer mortality in the US continues to decline, “future gains are threatened by rampant racial inequalities and a growing burden of disease in middle aged and young adults, especially women,” the society’s annual report says. About 80 000 young people aged 20 to 39 are diagnosed with cancer every year in the US and cancer is the fifth leading cause of death in this age group.3The society predicted that this year there will be over 2 million (2 041 910) new cases of cancer and 618 120 cancer deaths in the US, based on data from central cancer registries and collected by the National Center for Health Statistics.Cancers in women under 50 are now 82% higher than men of the same age (141.1 v 77.4 per...

When the previous Trump administration announced its withdrawal from the World Health Organization (WHO), the decision sent shockwaves throughout the world.1 While that decision was reversed by the incoming Biden administration, Trump has done it again. And this time around, he has sufficient time to complete the 12 month withdrawal process. This severing of ties between the world’s largest economy and its foremost public health body represents a major setback for health diplomacy, scientific collaboration, and funding. The repercussions will ripple across borders, leaving WHO weaker and the US isolated when global health challenges demand unity.For decades, WHO has stood as a beacon of international cooperation, coordinating outbreak responses, fostering scientific exchange, setting norms, and providing invaluable technical assistance. The benefits of membership are immense, including disease surveillance, health system strengthening, and health diplomacy. The US helped create WHO and has been a core funder and leader for over 75...

Glucagon-like peptide-1 receptor agonists (GLP-1RAs), used to treat diabetes and for weight loss, may be linked with a reduced risk of substance use and neurocognitive disorders, a US study in people with type 2 diabetes found, but could also carry an increased risk of gastrointestinal disorders and drug induced pancreatitis.1Researchers from the Veterans Affairs St Louis Healthcare System in Missouri used US Department of Veterans Affairs databases to follow 1.96 million people with type 2 diabetes for a median period of 3.7 years and to map associations between GLP-1RA use and 175 health outcomes.The study, published in Nature Medicine, included 215 970 people who used a GLP-1RA, comparing these with 159 465 people who used sulfonylureas, 117 989 who used dipeptidyl peptidase IV (DPP4) inhibitors, 258 614 who used sodium glucose cotransporter-2 (SGLT2) inhibitors, and 1.2 million who used (“usual care”) any non-GLP-1RA antihyperglycaemic drug. Participants were enrolled between October...

The longest running study to date of the effects of diet on cognition appears to support widespread suspicions that processed red meats, such as bacon, hot dogs, sausages and salami, are associated with an elevated risk of developing dementia.Published in Neurology, the journal of the American Academy of Neurology, the study tracked 133 771 US health professionals for an average 40 years, during which time 11 173 cases of dementia were recorded.1Researchers used regular questionnaires to record the eating habits of participants and divided them into three categories based on their consumption of processed red meat. The low group ate on average fewer than 0.1 servings a day, the medium group consumed 0.1 to 0.24 servings a day, and the high group averaged over 0.25 servings a day.In repeated tests administered by telephone, the high consumption group’s global cognition scores trailed those of the low group to a degree consistent...

The conflict in Gaza has been more than a geopolitical and humanitarian crisis—it is a profoundly human tragedy with severe consequences for an entire generation of Palestinian children and young people. Over a year of Israeli airstrikes, bombing, and ground level violence have killed more than 45 000 Palestinians and destroyed infrastructure and essential services. In the leadup to the recent ceasefire deal, which is in place at the time of writing, there had been no safe place left in Gaza. Families are struggling to meet their basic needs. Continuous attacks have obstructed humanitarian efforts, further limiting the delivery of crucial aid. The ceasefire is a critical moment to protect civilians, secure the release of hostages, and scale up humanitarian aid—a glimmer of hope to restore some sense of normalcy for families who have struggled to survive over the past fifteen months and to pave the way for lasting peace.Today,...