Medical Journal News

Shhhh. Stop eating so loudlyWe’re not talking about crisp crunching in the cinema. “Food noise” refers to the constant and obsessive thoughts some people report having about food.Noise cancelling?In effect, yes. The term is currently being discussed in relation to glucagon-like peptide-1 receptor agonist (GLP-1RA) weight loss drugs, such as semaglutide (Ozempic, Wegovy), liraglutide (Saxenda), and tirzepatide (Mounjaro), with people reporting that these drugs have silenced their internal food chatter. Videos on the subject have gained millions of views on platforms like TikTok,1 and major outlets such as the New York Times have covered the concept.2Where did it come from?The origins of the term aren’t clear, but a Google search shows that the term “food noise” has been around for at least a decade, being used in nutrition blogs3 and by celebrities promoting their brands.4 The meaning of the term seems to have evolved in recent years, however, from the...

In September 2024 NHS England published Principles for providing safe and good quality care in temporary escalation spaces1—in short, a guide to the ethics of corridor care. There wasn’t much fanfare on publication. It wasn’t shouted from the rooftops. Reading the document it is obvious why: this is a protocol issued from a system in serious trouble.It cannot have been easy to draft. The title is a contradiction. Its basic premises are at loggerheads. Safe and good quality care cannot co-exist with treatment in corridors. “Our aim,” says NHS England, “is always to deliver high standards of care for patients in the right place and at the right time.” From the beginning, therefore, it announces its failure. No patient ill enough to be in hospital can be properly cared for in a corridor—or car park, storeroom, or waiting area. Yes, they can be cared for. Yes, it may be better...

I’ve only been working as a foundation year 2 doctor in an emergency department for six weeks and already I’m physically and mentally exhausted. Our department has far too few staff to match the ever increasing demand—a familiar story that is playing out across the country.1Every day I see colleagues working tirelessly to offer the best care they can for their patients, but the current provision doesn’t let us deliver the gold standard care I was taught to give and aspire to provide. As doctors, we’ve had years of practice interacting with patients under our care to hone our empathy. In this dystopian system, however, it’s not only doctors empathising with patients but also patients empathising with doctors. I’ve had patients commiserate with me over the relentless conditions in the emergency department. They can see the environment that my colleagues and I are working in and are often very understanding,...

by Nathaniel Z. Counts, Noemi Kreif, Timothy B. Creedon, David E. Bloom

Background

Federal policy impact analyses in the United States do not incorporate the potential economic benefits of adolescent mental health policies. Understanding the extent to which economic benefits may offset policy costs would support more effective policymaking. This study estimates the relationship between adolescent psychological distress and later health and economic outcomes and uses these estimates to determine the potential economic effects of a hypothetical policy.

Methods and findings

This analysis estimated the relationship between psychological distress in those aged 15 to 17 years in 2000 and economic and health outcomes approximately 10 years later, accounting for an array of explanatory variables using machine learning–enabled methods. The cohort was from the National Longitudinal Study of Youth 1997 and nationally representative of those aged 12 to 18 years in 1997. The cohort included 3,343 individuals under age 18 years in round 4 who completed the Mental Health Inventory-5 (MHI-5). Round 1 captured 50 explanatory variables that covered domains of potential confounders, including basic demographics, neighborhood environment, family resources, family processes, physical health, school quality, and academic skills. The exposure included a binary variable of clinically significant psychological distress (MHI-5 score of less than or equal to 3) and a categorical variable of symptom severity on the MHI-5. Outcomes covered domains of employment, income, total assets at age 30 years, education, and health approximately 10 years later.Forty-seven percent of the cohort were black and Hispanic, and 4.4% had past-month clinically significant psychological distress. Past-month clinically significant psychological distress in adolescence led to a 6-percentage-point (95% confidence interval [CI] [−0.08, −0.03]) reduction in past-year labor force participation 10 years later and $5,658 (95% CI [−6,772, −4,545]) USD fewer past-year wages earned. We used these results to model the labor market impacts of a hypothetical policy that expanded access to mental health preventive care and reached 10% of youth who would have otherwise developed clinically significant psychological distress. We found that the hypothetical policy could lead to $52 (95% credible interval [51,54]) billion USD in federal budget benefits over 10 years from labor supply impacts alone. This study faced limitations, including potential unmeasured confounding, missing data, and challenges to generalizability.

Conclusions

Our findings showed the impacts of adolescent mental health policies on the federal budget and found potentially large effects on the economy if policies achieve population-level change.

by Karin Källén, Mikael Norman, Charlotte Elvander, Christina Bergh, Verena Sengpiel, Henrik Hagberg, Teresia Svanvik, Ulla-Britt Wennerholm

Background

The risk of perinatal death and severe neonatal morbidity increases gradually after 41 weeks of pregnancy. We evaluated maternal and perinatal outcomes after a national shift from expectancy and induction at 42+0 weeks to a more active management of late-term pregnancies in Sweden offering induction from 41+0 weeks or an individual plan aiming at birth or active labour no later than 42+0 weeks.

Methods and findings

Women with a singleton pregnancy lasting 41+0 weeks or more with a fetus in cephalic presentation (N = 150,370) were included in a nationwide, register-based cohort study. Elective cesarean sections were excluded. Outcomes during period 1, January 2017 to December 2019 (before the shift) versus outcomes during period 2, January 2020 to October 1, 2023 (after the shift) were analysed. For comparison, outcomes of pregnancies lasting 39+0 to 40+6 weeks (N = 358,548) were also studied.Primary outcomes were: First, peri/neonatal death (stillbirth or neonatal death before 28 days); second, composite adverse peri/neonatal outcome (peri/neonatal death, Apgar score <4 at 5 min, hypoxic ischemic encephalopathy grades 1–3, meconium aspiration syndrome, birth trauma, or admission to a neonatal intensive care unit (NICU) ≥4 days); third, composite adverse peri/neonatal outcome excluding admission to NICU; and fourth, emergency cesarean section. Secondary outcomes included the components of the primary composite outcomes. Relative risks (RRs) with 95% confidence intervals (CIs) for binary outcomes period 2 versus period 1 were computed using modified Poisson regression analyses with adjustments for maternal age, parity, body mass index (BMI), smoking, and educational level.Induction rates among pregnancies lasting 41+0 weeks or more increased from 33.7% in period 1 to 52.4% in period 2. Mean (standard deviation) gestational age at birth decreased from 290.7 (2.9) days to 289.6 (2.3) days. Infants born during period 2 were at lower risk of peri/neonatal death compared to infants born during period 1; 0.9/1,000 versus 1.7/1,000 born infants (adjusted RR 0.52; 95% CI [0.38, 0.69]; p < 0.001), and they had a lower risk of having the composite adverse neonatal outcome, both including (50.5/1,000 versus 53.9/1,000, adjusted RR 0.92; 95% CI [0.88, 0.96]; p < 0.001) or excluding NICU admission (18.5/1,000 versus 22.5/1,000, adjusted RR 0.79; 95% CI [0.74, 0.85]; p < 0.001). The cesarean section rate increased from 10.5% in period 1 to 11.9% in period 2 (adjusted RR 1.07; 95% CI [1.04, 1.10]; p < 0.001). For births at 39 to 40 weeks the adjusted RR for peri/neonatal death was 0.86 (95% CI [0.72, 1.02]). One limitation of the study is that we had no data on to what extent monitoring of fetal health was performed.

Conclusions

A more active management of pregnancies lasting 41+0 weeks or more was associated with a decrease in peri/neonatal deaths, and a decrease in composite adverse peri/neonatal outcomes. Increased rate of emergency cesarean sections was observed. Women with pregnancies advancing towards 41 gestational weeks should be given balanced information on the benefits and risks of induction of labour at 41 weeks compared to expectant management until 42 weeks and be offered induction of labour at 41 weeks or active surveillance of pregnancies from 41 weeks in order to decrease peri/neonatal mortality.

A former paediatric surgeon has been jailed for five years and seven months for offences committed while operating an unsafe and unsanitary mobile child circumcision service.Mohammad Siddiqui, 58, was sentenced at Inner London Crown Court after pleading guilty in October at Southwark Crown Court to 12 counts of assault occasioning actual bodily harm, five counts of child cruelty, and eight counts of administering a prescription only drug to young and vulnerable patients while ignoring basic hygiene rules.He operated the private home service between June 2012 and November 2013 while working for the NHS as a clinical fellow in paediatric surgery at University Hospital Southampton NHS Foundation Trust. In this role he was able to source the local anaesthetic bupivacaine hydrochloride, a prescription only drug.In 2015 he was struck off the medical register for various failures in performing circumcisions in the homes of four babies. In one case a baby was...

Alcohol is widely available and drunk by around 80% of adults in the UK. No safe level of alcohol consumption has been established,1 and the physical and mental health harms increase (at different rates) with the amount consumed.2 Alcohol is well recognised as a leading preventable cause of cancer.3The health and social harms of alcohol are higher in socially disadvantaged groups4 despite lower rates of use than in more advantaged groups. This “alcohol harm paradox” means that alcohol consumption has the greatest detrimental effect on the most vulnerable in society and is a significant contributor to health inequalities and premature death.567The challenges faced during the covid-19 pandemic89 resulted in an increase in the number of people drinking alcohol at increased and higher risk levels.1011 Deaths from alcohol specific causes in England also rose by 42.2% between 2019 and 2023, the highest number on record, most of them from alcohol related...

Every year, as the weather turns colder, we can’t go far without hearing someone cough or sniffle. The “cold and flu” season is nothing new, but we need to do more to tackle winter illness.The end of 2024 saw a “quademic,” with high incidence of influenza, respiratory syncytial virus (RSV), covid-19, and the winter vomiting bug (norovirus) all putting pressure on the NHS. The number of hospital admissions with influenza rose from 1190 to 5074—more than 300%—from the end of November to the end of December.1 This was triple the number of admissions recorded at the same point last year.As hospitals throughout the UK declare critical incidents, we shouldn’t be surprised by the demand on healthcare services during winter. High rates of hospital admissions with flu aren’t unprecedented: we saw a similar peak in the 2022-23 winter season.2But we should be doing more to tackle the winter viruses that in...

The BMJ widely discussed the assisted dying bill that is currently at the committee stage in the UK parliament.1Having worked for many years now for a health system that gives people more agency and dignity, I thought I had already come across all the arguments of medical paternalism. But I was wrong.What I wasn’t prepared for in the discussion about the assisted dying bill was that the current state of palliative care would be used as an argument for why we shouldn’t have agency. According to some politicians and leaders of the medical profession, it should be palliative care that is fixed, rather than giving choices to patients.2 As if we couldn’t have both.For now, no mainstream politician in the UK is proposing to turn back the tide on women’s right to choose just because maternity services are far too often unsafe.3 No one is saying that women cannot safely...

A wonderfully absurdist NHS fantasy has been doing the rounds on social media. It stemmed from a case vignette in a government document, Reforming Elective Care for Patients,1 in a text box illustrating how patients can be empowered by accessing their results on the NHS App. I’m a great fan of patient empowerment and have nothing against the NHS App. But the illustrative story (which has since been removed) was so hilarious that it deserves to be widely shared.The heroine of the story is Sarah, a patient with sinus pain and hearing loss who goes to her GP surgery and sees a nurse practitioner. You’d reasonably expect that the nurse might recommend steam inhalations or possibly follow NICE guidelines by prescribing a decongestant nasal spray.2 But alas, she seems to be a devotee of expensive, privately financed high tech, so she refers the patient immediately to the local community diagnostic...

The UK government has announced its approach for social care—establishing yet another commission.1 In its 2024 election manifesto Labour pledged to create a “national care service” (without explaining what this means), tackle low pay for care workers, and “build consensus for the longer term reform needed.”2Meanwhile, social care is in crisis. Analysis suggests that age adjusted spending per person will be at least 5% lower in 2024-25 than in 2009-10, and that an additional £8.3bn a year could be needed by 2032-33 to keep up with rising demand.3 Age UK estimates that two million people aged ≥65 have unmet needs for care and support,4 and analysis by Healthwatch suggests that up to 1.5 million disabled adults of working age could be eligible for social care support but are not receiving it.5 There are 131 000 staff vacancies,6 and some 81% of councils are due to overspend their adult social care...

AbstractObjectiveTo report on complications of conisation and its effects on fertility and stenosis.DesignRegister based nationwide cohort study on routinely collected data using several linked databases.SettingPrimary and secondary care in Denmark, 2006-18.PopulationThe conisation cohort comprised 48 048 conisations on women aged 23-65 who had undergone conisation within 120 days of a cervical biopsy. The biopsy cohort comprised 48 048 biopsies on women who had undergone a cervical biopsy but not conisation who were matched by age and time of procedure. Women were excluded from the conisation cohort before long term outcome analyses if they had undergone hysterectomy, resection of the uterus, or had cervical cancer or any long term outcomes within the 10 years before their conisation.Main outcome measuresBleeding, infection, and gynaecological operations within 30 days of conisation (stratified by age, year of conisation, and number of previous conisations) and long term risk of fertility treatment, fertility consultation, stenosis, cervical dilatation, infertility diagnoses, and death at any point after conisation. Long term outcomes were followed up until death, emigration, diagnosis of cervical cancer, hysterectomy or resection of uterus, or the end of 2018. Long term outcomes were analysed with incidence rate ratios from Cox regression models.ResultsBleeding, infection, and gynaecological operations were registered for 2.81% (n=1351), 0.48% (n=231), and 3.95% (n=1897) of all conisations within 30 days of the procedure, respectively. Women in the conisation cohort had increased risk of stenosis (incidence rate ratio 14.81, 95% confidence interval 7.55 to 29.05, 0.41% v 0.03% (n=176 v 12)) and cervical dilatation (2.68, 2.41 to 2.97, 4.01% v 1.58% (n=1735 v 668)) compared with women in the biopsy cohort. No significant differences were observed for the other outcomes when adjusting for baseline covariates (such as age and region of residence). Cervical suturing after bleeding was associated with a substantial increase in the risk of stenosis and cervical dilatation.ConclusionThis study found higher rates of complications within 30 days of conisation than previous studies with comparable outcome definitions, and a substantially increased risk of stenosis and cervical dilatation for women who had cervical suturing to treat bleeding after conisation. However, these results were based on few events in a small subgroup, and are therefore associated with major uncertainty. This study supports previous findings that conisation does not generally increase rates of infertility treatment or infertility diagnoses.

Private equity’s ownership of US hospitals has led to patient suffering, understaffing, reduced care quality, and health and safety violations, while investors have earned millions, a year long Senate Budget Committee investigation has found.1The bipartisan committee looked at more than a million pages of documents, including emails, board meeting minutes, financial reports, spreadsheets, and loan agreements, relating to two major private equity firms, Apollo Global Management and Leonard Green & Partners.Through studying these documents the committee “uncovered troubling patterns of prioritising profits over patients and of unfulfilled promises.” It identified “systemic issues” such as underinvestment in critical hospital infrastructure and the “pursuit of financial gains through leveraged buyouts and dividend extractions—often to the detriment of patients and hospital operations.”Apollo owns around 220 hospitals through the rural hospital operator Lifepoint Health and a second operator ScionHealth, and Leonard Green & Partners held a majority stake in Prospect Medical Holdings from 2010...

New England Journal of Medicine, Volume 392, Issue 3, Page 249-257, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 239-248, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 286-295, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 296-298, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 258-266, January 16, 2025.

New England Journal of Medicine, Volume 392, Issue 3, Page 308-310, January 16, 2025.