At a time when access to NHS dentistry has reached crisis point, it is good to see oral health featured in The BMJ .1 The authors rightly raise awareness of the crucial importance of upholding children’s right to oral health at a population level and on a global scale. I affirm their advocacy for upstream public health approaches. It bears repeating …
{"title":"Children’s right to oral health—day to day, right from the start","authors":"Jenny C Harris","doi":"10.1136/bmj.r54","DOIUrl":"https://doi.org/10.1136/bmj.r54","url":null,"abstract":"At a time when access to NHS dentistry has reached crisis point, it is good to see oral health featured in The BMJ .1 The authors rightly raise awareness of the crucial importance of upholding children’s right to oral health at a population level and on a global scale. I affirm their advocacy for upstream public health approaches. It bears repeating …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jon Glasby, Clenton Farquharson, Catherine Needham, Kate Hamblin
Overhaul of policy and funding is needed now 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.”2 Meanwhile, 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 budget in the current financial year. More than one third have had to make in-year budget savings, in addition to the almost £1bn of savings planned for 2024-25.7 The government has proposed an independent commission, chaired by …
{"title":"Adult social care reform cannot afford to wait","authors":"Jon Glasby, Clenton Farquharson, Catherine Needham, Kate Hamblin","doi":"10.1136/bmj.r63","DOIUrl":"https://doi.org/10.1136/bmj.r63","url":null,"abstract":"Overhaul of policy and funding is needed now 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.”2 Meanwhile, 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 budget in the current financial year. More than one third have had to make in-year budget savings, in addition to the almost £1bn of savings planned for 2024-25.7 The government has proposed an independent commission, chaired by …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"30 20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julia M A Sinclair, Melinda King, Steven Masson, Ian Gilmore
Sustained funding is needed for screening and care, but industry must also shoulder costs 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.3 The 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.567 The 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 liver disease.1213 Successive …
{"title":"UK needs national strategy to tackle alcohol related harms","authors":"Julia M A Sinclair, Melinda King, Steven Masson, Ian Gilmore","doi":"10.1136/bmj.r38","DOIUrl":"https://doi.org/10.1136/bmj.r38","url":null,"abstract":"Sustained funding is needed for screening and care, but industry must also shoulder costs 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.3 The 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.567 The 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 liver disease.1213 Successive …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142986474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The BMJ widely discussed the assisted dying bill that is currently at the committee stage in the UK parliament.1 Having 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. …
{"title":"Medical and political paternalism and the end of life","authors":"Charlotte Augst","doi":"10.1136/bmj.r34","DOIUrl":"https://doi.org/10.1136/bmj.r34","url":null,"abstract":"The BMJ widely discussed the assisted dying bill that is currently at the committee stage in the UK parliament.1 Having 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. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"336 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Enrolling the right number and type of patient is crucial Sepsis is a life threatening syndrome initiated by microorganisms.1 Severe and often lethal injuries (eg, shock, multiorgan failure, and metabolic derangements) are the manifestation of the syndrome, with systemic inflammatory cascade activation and circulating mediators thought to cause host injury. Scores of trials evaluating host-immune modifiers, many of which were the initial ventures of a new biotech industry 30 years ago, did not improve patient outcomes in sepsis.2 Undaunted by this history, investigators in the linked trial(doi:10.1136/bmj-2024-082583) evaluated another immune therapy, thymosin-α-1, in patients with sepsis, enrolling 1106 participants at 22 sites in China.3 The trial compared thymosin-α-1 with placebo plus usual care in a blinded randomised trial evaluating all cause mortality at 28 days. The results showed 24% mortality with thymosin versus 23% in the control group (hazard ratio 0.99, 95% confidence interval 0.77 to 1.77), which indicate no improvement with thymosin. Several positive aspects of the trial’s design include a superiority hypothesis with direct patient-outcomes of all cause mortality using inferential statistics, rather than non-inferiority hypotheses on surrogate endpoints using descriptive statistics commonly used in infection …
{"title":"Immunotherapies for sepsis and the impact of study design","authors":"John H Powers, Charles Natanson","doi":"10.1136/bmj.r48","DOIUrl":"https://doi.org/10.1136/bmj.r48","url":null,"abstract":"Enrolling the right number and type of patient is crucial Sepsis is a life threatening syndrome initiated by microorganisms.1 Severe and often lethal injuries (eg, shock, multiorgan failure, and metabolic derangements) are the manifestation of the syndrome, with systemic inflammatory cascade activation and circulating mediators thought to cause host injury. Scores of trials evaluating host-immune modifiers, many of which were the initial ventures of a new biotech industry 30 years ago, did not improve patient outcomes in sepsis.2 Undaunted by this history, investigators in the linked trial(doi:10.1136/bmj-2024-082583) evaluated another immune therapy, thymosin-α-1, in patients with sepsis, enrolling 1106 participants at 22 sites in China.3 The trial compared thymosin-α-1 with placebo plus usual care in a blinded randomised trial evaluating all cause mortality at 28 days. The results showed 24% mortality with thymosin versus 23% in the control group (hazard ratio 0.99, 95% confidence interval 0.77 to 1.77), which indicate no improvement with thymosin. Several positive aspects of the trial’s design include a superiority hypothesis with direct patient-outcomes of all cause mortality using inferential statistics, rather than non-inferiority hypotheses on surrogate endpoints using descriptive statistics commonly used in infection …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142986473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We must resolve how thawing of permafrost as a result of climate change could resurface pathogens with the potential to infect humans, writes Kris A Murray There is nothing permanent about permafrost. Models suggest that between 24% and 70% of existing permafrost will thaw by 2100 owing to climate change.1 This is a frightening prospect—permafrost covers almost a quarter of the northern hemisphere and a few areas elsewhere. The thaw is changing the form and function of these frozen ecosystems,2 by releasing much that has been firmly underfoot or safely stored away in ice, including carbon dioxide and methane that will contribute to further global warming; subsiding ground that is destabilising arctic infrastructure; and revealing mummified wildlife, livestock, and people and their pathogens within. A frequently headlining risk from permafrost thaw is the emergence of long frozen microbes often called zombie viruses, although bacteria, fungi, and other potential pathogens also lie beneath. Together, they are feared for their potential to resurrect and become infectious again, potentially even sparking another pandemic.3 Yet opinions …
{"title":"Keep it in the ground: climate change could prompt the reemergence of zombie pathogens","authors":"Kris A Murray","doi":"10.1136/bmj.r46","DOIUrl":"https://doi.org/10.1136/bmj.r46","url":null,"abstract":"We must resolve how thawing of permafrost as a result of climate change could resurface pathogens with the potential to infect humans, writes Kris A Murray There is nothing permanent about permafrost. Models suggest that between 24% and 70% of existing permafrost will thaw by 2100 owing to climate change.1 This is a frightening prospect—permafrost covers almost a quarter of the northern hemisphere and a few areas elsewhere. The thaw is changing the form and function of these frozen ecosystems,2 by releasing much that has been firmly underfoot or safely stored away in ice, including carbon dioxide and methane that will contribute to further global warming; subsiding ground that is destabilising arctic infrastructure; and revealing mummified wildlife, livestock, and people and their pathogens within. A frequently headlining risk from permafrost thaw is the emergence of long frozen microbes often called zombie viruses, although bacteria, fungi, and other potential pathogens also lie beneath. Together, they are feared for their potential to resurrect and become infectious again, potentially even sparking another pandemic.3 Yet opinions …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wei Hu, Chunrong Tao, Li Wang, Zhongjun Chen, Di Li, Wenhuo Chen, Tingyu Yi, Lihua Xu, Chuanqing Yu, Tao Wang, Xiaoxi Yao, Tao Cui, Guangxiong Yuan, Junfeng Su, Li Chen, Zhiming Zhou, Zhengfei Ma, Junjun Wang, Benxiao Wang, Hongxing Han, Hao Wang, Jie Chen, Peiyang Zhou, Zhihua Cao, Youquan Ren, Xueli Cai, Huaizhang Shi, Guang Zhang, Liping Yu, Xingyun Yuan, Jinglun Li, Guoyong Zeng, Chuyuan Ni, Tong Li, Yingchun Wu, Yuwen Li, Kai Li, Yong Liu, Yao Wang, Yu Jin, Hanwen Liu, Jianshang Wen, Jun Sun, Yuyou Zhu, Rui Li, Chao Zhang, Tianlong Liu, Jianlong Song, Li Wang, Juan Cheng, Adnan I Qureshi, Thanh N Nguyen, Jeffrey L Saver, Raul G Nogueira, Xinfeng Liu
Objective To assess whether intra-arterial tenecteplase administered after successful endovascular recanalisation improves outcomes in patients with acute arterial occlusion of the posterior circulation. Design Multicentre randomised controlled trial. Setting 31 hospitals in China, 24 January 2023 to 24 August 2023. Participants 208 patients with successful recanalisation (grade 2b50-3 on the extended thrombolysis in cerebral infarction scale) of an occlusion in the V4 segment of the vertebral artery; proximal, middle, or distal segment of the basilar artery; or P1 segment of the posterior cerebral artery: 104 were randomly allocated to receive tenecteplase and 104 to receive standard care. Interventions Intra-arterial tenecteplase (0.0625 mg/kg, maximum dose 6.25 mg) administered proximal to the residual thrombus (if still present) or distal to the origin of the main pontine perforator branches over 15 seconds, or endovascular treatment only (control group). Main outcome measures The primary outcome was freedom from disability (modified Rankin scale score 0 or 1) at 90 days after randomisation. Primary safety outcomes included symptomatic intracranial haemorrhage within 36 hours and all cause mortality at 90 days. All efficacy and safety analyses were conducted by intention to treat and adjusted for age, pre-stroke modified Rankin scale score, time from onset of moderate to severe stroke (National Institutes of Health stroke scale score ≥6) to randomisation, hypertension, and baseline stroke severity. Results At 90 days, 36 patients (34.6%) in the tenecteplase group and 27 (26.0%) in the control group had a modified Rankin scale score of 0 or 1 (adjusted risk ratio 1.36, 95% confidence interval 0.92 to 2.02; P=0.12). Mortality at 90 days was similar between the tenecteplase and control groups: 29 (27.9%) v 28 (26.9%), adjusted risk ratio 1.13, 0.73 to 1.74. Symptomatic intracranial haemorrhage within 36 hours occurred in eight patients (8.3%) in the tenecteplase group and three (3.1%) in the control group (adjusted risk ratio 3.09, 0.78 to 12.20). Conclusions In patients with acute ischaemic stroke due to acute posterior large or proximal vessel occlusion, intra-arterial tenecteplase administered after successful recanalisation was not associated with a statistically significant reduction in combined disability and mortality at 90 days. Trial registration ClinicalTrials.gov [NCT05684172.][1] Data collected for the study, including deidentified individual participant data and a data dictionary defining each field in the set, can be made available to researchers on reasonable request and after signing appropriate data sharing agreements. Data access requests should be sent to the corresponding author. Such requests must be approved by the respective ethics boards and appropriate data custodians. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05684172.&atom=%2Fbmj%2F388%2Fbmj-2024-080489.atom
{"title":"Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial","authors":"Wei Hu, Chunrong Tao, Li Wang, Zhongjun Chen, Di Li, Wenhuo Chen, Tingyu Yi, Lihua Xu, Chuanqing Yu, Tao Wang, Xiaoxi Yao, Tao Cui, Guangxiong Yuan, Junfeng Su, Li Chen, Zhiming Zhou, Zhengfei Ma, Junjun Wang, Benxiao Wang, Hongxing Han, Hao Wang, Jie Chen, Peiyang Zhou, Zhihua Cao, Youquan Ren, Xueli Cai, Huaizhang Shi, Guang Zhang, Liping Yu, Xingyun Yuan, Jinglun Li, Guoyong Zeng, Chuyuan Ni, Tong Li, Yingchun Wu, Yuwen Li, Kai Li, Yong Liu, Yao Wang, Yu Jin, Hanwen Liu, Jianshang Wen, Jun Sun, Yuyou Zhu, Rui Li, Chao Zhang, Tianlong Liu, Jianlong Song, Li Wang, Juan Cheng, Adnan I Qureshi, Thanh N Nguyen, Jeffrey L Saver, Raul G Nogueira, Xinfeng Liu","doi":"10.1136/bmj-2024-080489","DOIUrl":"https://doi.org/10.1136/bmj-2024-080489","url":null,"abstract":"Objective To assess whether intra-arterial tenecteplase administered after successful endovascular recanalisation improves outcomes in patients with acute arterial occlusion of the posterior circulation. Design Multicentre randomised controlled trial. Setting 31 hospitals in China, 24 January 2023 to 24 August 2023. Participants 208 patients with successful recanalisation (grade 2b50-3 on the extended thrombolysis in cerebral infarction scale) of an occlusion in the V4 segment of the vertebral artery; proximal, middle, or distal segment of the basilar artery; or P1 segment of the posterior cerebral artery: 104 were randomly allocated to receive tenecteplase and 104 to receive standard care. Interventions Intra-arterial tenecteplase (0.0625 mg/kg, maximum dose 6.25 mg) administered proximal to the residual thrombus (if still present) or distal to the origin of the main pontine perforator branches over 15 seconds, or endovascular treatment only (control group). Main outcome measures The primary outcome was freedom from disability (modified Rankin scale score 0 or 1) at 90 days after randomisation. Primary safety outcomes included symptomatic intracranial haemorrhage within 36 hours and all cause mortality at 90 days. All efficacy and safety analyses were conducted by intention to treat and adjusted for age, pre-stroke modified Rankin scale score, time from onset of moderate to severe stroke (National Institutes of Health stroke scale score ≥6) to randomisation, hypertension, and baseline stroke severity. Results At 90 days, 36 patients (34.6%) in the tenecteplase group and 27 (26.0%) in the control group had a modified Rankin scale score of 0 or 1 (adjusted risk ratio 1.36, 95% confidence interval 0.92 to 2.02; P=0.12). Mortality at 90 days was similar between the tenecteplase and control groups: 29 (27.9%) v 28 (26.9%), adjusted risk ratio 1.13, 0.73 to 1.74. Symptomatic intracranial haemorrhage within 36 hours occurred in eight patients (8.3%) in the tenecteplase group and three (3.1%) in the control group (adjusted risk ratio 3.09, 0.78 to 12.20). Conclusions In patients with acute ischaemic stroke due to acute posterior large or proximal vessel occlusion, intra-arterial tenecteplase administered after successful recanalisation was not associated with a statistically significant reduction in combined disability and mortality at 90 days. Trial registration ClinicalTrials.gov [NCT05684172.][1] Data collected for the study, including deidentified individual participant data and a data dictionary defining each field in the set, can be made available to researchers on reasonable request and after signing appropriate data sharing agreements. Data access requests should be sent to the corresponding author. Such requests must be approved by the respective ethics boards and appropriate data custodians. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05684172.&atom=%2Fbmj%2F388%2Fbmj-2024-080489.atom","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medical apprenticeships were scrapped to avoid creating a two tiered system in medical education, writes Rob Tucker The government has reportedly ceased further funding of the controversial doctor apprenticeship programmes.1 The scheme has faced considerable opposition from the medical community and lobbying by the BMA from the start. Proponents initially argued that these programmes would widen access into medicine, but this argument began to fall apart as further details emerged. Medical doctor apprenticeships would not have delivered on the aim of expanding access into medicine, instead we need effective widening participation schemes in medical education. The timelines to deliver the medical apprenticeships were always tight. In 2022, NHS England set out a tender for medical schools to develop a new programme offering the use of the apprenticeship levy funding for the first time to medical degrees. The pilot medical schools were confirmed in January 2023. NHS England then needed to find willing local employment providers, …
{"title":"Halting medical doctor degree apprenticeships is a sensible decision","authors":"Rob Tucker","doi":"10.1136/bmj.r66","DOIUrl":"https://doi.org/10.1136/bmj.r66","url":null,"abstract":"Medical apprenticeships were scrapped to avoid creating a two tiered system in medical education, writes Rob Tucker The government has reportedly ceased further funding of the controversial doctor apprenticeship programmes.1 The scheme has faced considerable opposition from the medical community and lobbying by the BMA from the start. Proponents initially argued that these programmes would widen access into medicine, but this argument began to fall apart as further details emerged. Medical doctor apprenticeships would not have delivered on the aim of expanding access into medicine, instead we need effective widening participation schemes in medical education. The timelines to deliver the medical apprenticeships were always tight. In 2022, NHS England set out a tender for medical schools to develop a new programme offering the use of the apprenticeship levy funding for the first time to medical degrees. The pilot medical schools were confirmed in January 2023. NHS England then needed to find willing local employment providers, …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
“Cycle syncing”—a trend promoted by wellness influencers who claim that aligning work tasks with the menstrual cycle improves productivity—has drawn scepticism from medical experts. Sangeetha Nadarajah reports Advocates of cycle syncing argue that tailoring work tasks to the different menstrual phases can optimise productivity and performance. Some influencers provide paid coaching, including “cycle based” business coaching and workshops on “cycle syncing for feminine leadership.” Proponents such as the podcast host and chiropractor Mindy Pelz and the author Kate Northrup contend that a woman’s decision making abilities fluctuate throughout the cycle, potentially affecting the effectiveness of her work.1 They suggest that women should leverage these fluctuations to their advantage, postponing certain tasks during phases where they feel less confident in making decisions.1 However, medical experts have pointed out that these claims lack evidence and may perpetuate harmful gender stereotypes. Nanette Santoro, an obstetrician and faculty member in the Division of Reproductive Endocrinology and Infertility at the University of Colorado, warns that these claims disregard the complexity of hormonal fluctuations. “The presumption that all women experience predictable variations in performance due to their menstrual cycle is an oversimplification,” says Santoro. Women may feel impaired if they have an underlying medical condition affected by menstruation, such as heavy bleeding, severe pain, hormonal imbalances, polycystic ovary syndrome, postural orthostatic tachycardia syndrome, premenstrual dysphoric disorder, or menstrual migraines. However, there’s no evidence to support claims that women experience significant cognitive impairment or reduced work performance solely due to hormonal changes associated with their menstrual cycle (boxes 1 and 2). Box 1 ### The menstrual cycle The menstrual cycle consists of four distinct phases, each characterised by hormonal fluctuations and physiological changes. Menstrual hormone fluctuations vary widely from cycle to cycle and day to day. Most women have nearly 450 menstrual cycles over 30-40 years.2 During the menstrual … RETURN TO TEXT
{"title":"Does menstrual cycle syncing really help productivity?","authors":"Sangeetha Nadarajah","doi":"10.1136/bmj.q2736","DOIUrl":"https://doi.org/10.1136/bmj.q2736","url":null,"abstract":"“Cycle syncing”—a trend promoted by wellness influencers who claim that aligning work tasks with the menstrual cycle improves productivity—has drawn scepticism from medical experts. Sangeetha Nadarajah reports Advocates of cycle syncing argue that tailoring work tasks to the different menstrual phases can optimise productivity and performance. Some influencers provide paid coaching, including “cycle based” business coaching and workshops on “cycle syncing for feminine leadership.” Proponents such as the podcast host and chiropractor Mindy Pelz and the author Kate Northrup contend that a woman’s decision making abilities fluctuate throughout the cycle, potentially affecting the effectiveness of her work.1 They suggest that women should leverage these fluctuations to their advantage, postponing certain tasks during phases where they feel less confident in making decisions.1 However, medical experts have pointed out that these claims lack evidence and may perpetuate harmful gender stereotypes. Nanette Santoro, an obstetrician and faculty member in the Division of Reproductive Endocrinology and Infertility at the University of Colorado, warns that these claims disregard the complexity of hormonal fluctuations. “The presumption that all women experience predictable variations in performance due to their menstrual cycle is an oversimplification,” says Santoro. Women may feel impaired if they have an underlying medical condition affected by menstruation, such as heavy bleeding, severe pain, hormonal imbalances, polycystic ovary syndrome, postural orthostatic tachycardia syndrome, premenstrual dysphoric disorder, or menstrual migraines. However, there’s no evidence to support claims that women experience significant cognitive impairment or reduced work performance solely due to hormonal changes associated with their menstrual cycle (boxes 1 and 2). Box 1 ### The menstrual cycle The menstrual cycle consists of four distinct phases, each characterised by hormonal fluctuations and physiological changes. Menstrual hormone fluctuations vary widely from cycle to cycle and day to day. Most women have nearly 450 menstrual cycles over 30-40 years.2 During the menstrual … RETURN TO TEXT","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A storm is brewing in the NHS medical workforce. The problem is a lack of jobs for doctors, resulting in questions about competition for jobs between local graduates and international medical graduates (IMGs). An artificial bottleneck has been created by pushing for more medical school places in the NHS long term workforce plan,1 despite not enough jobs being available for those graduating.2 The NHS has also ignored the rising tide of locally employed doctors, mostly IMGs.3 A lack of clear direction for these roles leaves those locally employed doctors without career prospects and increases competition for jobs. Additionally, poor planning around the Professional and Linguistic Assessments Board (PLAB) exams has resulted in a growing number of IMGs being available for jobs.4 PLAB exams run regularly and admit more IMGs into the system, contributing to the bottleneck. This cocktail of problems could threaten the fabric of NHS medical teams. We risk a resurgence of rhetoric, seen previously in heated debates …
{"title":"Partha Kar: The new storm propagated by poor medical workforce planning is now upon us","authors":"Partha Kar","doi":"10.1136/bmj.r33","DOIUrl":"https://doi.org/10.1136/bmj.r33","url":null,"abstract":"A storm is brewing in the NHS medical workforce. The problem is a lack of jobs for doctors, resulting in questions about competition for jobs between local graduates and international medical graduates (IMGs). An artificial bottleneck has been created by pushing for more medical school places in the NHS long term workforce plan,1 despite not enough jobs being available for those graduating.2 The NHS has also ignored the rising tide of locally employed doctors, mostly IMGs.3 A lack of clear direction for these roles leaves those locally employed doctors without career prospects and increases competition for jobs. Additionally, poor planning around the Professional and Linguistic Assessments Board (PLAB) exams has resulted in a growing number of IMGs being available for jobs.4 PLAB exams run regularly and admit more IMGs into the system, contributing to the bottleneck. This cocktail of problems could threaten the fabric of NHS medical teams. We risk a resurgence of rhetoric, seen previously in heated debates …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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