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Children’s right to oral health: what about water fluoridation? 儿童的口腔健康权:氟化水怎么办?
Pub Date : 2024-11-18 DOI: 10.1136/bmj.q2511
Richard Turner
The editorial on children’s right to oral health mentions that 514 million children have untreated carious lesions in their primary teeth.1 It emphasises the importance of upstream policies such as reducing sugar consumption but makes no mention of water fluoridation. As Niger Carter, chief …
关于儿童口腔健康权的社论提到,有 5.14 亿儿童的乳牙龋齿未经治疗。1 社论强调了上游政策的重要性,如减少糖的摄入量,但没有提到水氟化的问题。正如尼日尔的卡特主任所说
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引用次数: 0
Restructuring endometriosis care 重组子宫内膜异位症护理
Pub Date : 2024-11-18 DOI: 10.1136/bmj.q2416
Prathiba M De Silva, Sharon Dixon, Ginisha Vekaria
Women need better coordination between primary and secondary care Endometriosis affects as many as 10% of women of reproductive age, or 190 million women globally.1 It can cause debilitating chronic pelvic pain and infertility, with treatment, work loss, and healthcare estimated to cost £12.5bn annually in the UK alone.2 The 2024 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report audited the care provided to 941 patients with surgically confirmed endometriosis and included the review of data from 120 general practitioners (GPs) and 623 specialists, alongside organisational data from 167 hospitals.3 The report highlights examples of effective, timely, holistic, and patient centred care across all settings but also reminds us that we could and should do better for many women with endometriosis, throughout their care journey. Specific challenges discussed include the long timeframe to and difficulties in diagnosing and treating endometriosis, the lack of coordination between primary and secondary care, and the difficulty in accessing supportive services. No clinical findings specifically correlate with a diagnosis of endometriosis, so GPs must often consider other conditions that have similar presenting symptoms. This may …
妇女需要更好地协调初级和中级医疗 子宫内膜异位症影响着多达 10%的育龄妇女,即全球 1.9 亿妇女。1 子宫内膜异位症可导致慢性盆腔疼痛和不孕症,使人衰弱,据估计,仅在英国,每年的治疗、工作损失和医疗费用就高达 125 亿英镑。2024 年全国患者结果与死亡保密调查(NCEPOD)报告对 941 名经手术确诊的子宫内膜异位症患者所接受的治疗进行了审计,包括对来自 120 名全科医生(GP)和 623 名专科医生的数据以及来自 167 家医院的组织数据进行审查。所讨论的具体挑战包括:诊断和治疗子宫内膜异位症的时间过长和困难、初级和二级护理之间缺乏协调,以及难以获得支持性服务。没有任何临床发现与子宫内膜异位症的诊断具体相关,因此全科医生必须经常考虑具有类似症状的其他疾病。这可能 ...
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引用次数: 0
G20 and the global south: opportunities for global health 20 国集团和全球南部:全球卫生的机遇
Pub Date : 2024-11-18 DOI: 10.1136/bmj.q2536
Maria de Lourdes Aguiar Oliveira, Natalie Mayet, Johanna Hanefeld, Anne Meierkord
Leadership by southern countries is focusing attention on health equity Countries in the Group of 20 (G20) represent two thirds of the world’s population, and it is a major forum for international cooperation. In recent years it has intensified its focus on global health, starting with the creation of a G20 health working group in 2017. The G20 presidency rotates annually. It is currently held by Brazil, which was preceded by India and Indonesia, and will move to South Africa in 2025. This rotation through countries in the global south is providing opportunities to review the G20 agenda through a southern leadership lens. At the core of this agenda is global health, which cannot be detached from financial, climate, and economic considerations.1 Brazil has made its presidency …
南方国家的领导力使人们关注卫生公平 20 国集团(G20)成员国占世界人口的三分之二,是国际合作的主要论坛。近年来,20 国集团加强了对全球卫生的关注,首先是在 2017 年成立了一个 20 国集团卫生工作组。G20 主席国每年轮换一次。目前由巴西担任主席国,之前由印度和印度尼西亚担任,2025 年将由南非担任。这种通过全球南方国家进行的轮换为从南方领导力的视角审视 G20 议程提供了机会。该议程的核心是全球卫生,不能脱离金融、气候和经济因素。
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引用次数: 0
Lack of abortion care is a threat to women’s health in Latin America 缺乏堕胎护理是对拉丁美洲妇女健康的威胁
Pub Date : 2024-11-18 DOI: 10.1136/bmj.q2530
Mercedes Colomar, Veronica Fiol
Inequalities and restrictions to sexual and reproductive health and rights are endangering women, write Mercedes Colomar and Veronica Fiol In 1994, the International Conference on Population and Development established a groundbreaking framework recognising reproductive rights as human rights.1 This framework prioritised people and human rights in development—rather than population control. Thirty years on, stark inequalities in sexual and reproductive health and rights persist across national, regional, and global levels. Poor access and restrictions on abortion are contributing to maternal mortality in Latin America and the Caribbean. In many contexts, women have limited autonomy and decision making power over their health, exacerbating poor health outcomes. Unsafe abortion is a serious public health problem and poses a particular risk to women’s health—especially in countries where abortion is clandestine and often dangerous. The impact of unsafe abortion is particularly severe in young, impoverished, and less educated women. Studies on clandestine abortions in places where abortion is highly restricted show that women with higher incomes have a greater chance of accessing safer abortion methods than those with lower incomes.2 Legislative restrictions, inadequate …
梅赛德斯-科洛马尔(Mercedes Colomar)和维罗妮卡-菲奥尔(Veronica Fiol)写道:"性与生殖健康及权利方面的不平等和限制正在危及妇女。 1994 年,国际人口与发展会议建立了一个开创性的框架,承认生殖权利是人权。30 年过去了,国家、区域和全球各级在性健康和生殖健康及权利方面仍然存在严重的不平等。在拉丁美洲和加勒比地区,堕胎难和堕胎限制导致孕产妇死亡。在许多情况下,妇女对自身健康的自主权和决策权有限,加剧了不良的健康结果。不安全堕胎是一个严重的公共卫生问题,对妇女的健康构成特别大的风险--尤其是在那些秘密堕胎且往往很危险的国家。不安全堕胎对年轻、贫困和受教育程度较低的妇女的影响尤为严重。在人工流产受到严格限制的地方,对秘密人工流产的研究表明,收入较高的妇女比收入较低的妇女更有机会获得更安全的人工流产方法。
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引用次数: 0
Non-hormonal management of vasomotor symptoms of menopause 更年期血管运动症状的非激素疗法
Pub Date : 2024-11-18 DOI: 10.1136/bmj.q2486
Sebastian Geraci, Satu Kuokkanen, Erika Banks
A new treatment option for women unable to take hormone replacement therapy Up to 80% of women experience vasomotor symptoms, including hot flushes and night sweats, during menopausal transition.1234567 These symptoms can persist for years before and after menopause, substantially impacting quality of life by impairing sleep, mood, and cognitive functioning.23456789101112 Approximately 32-46% of women describe their vasomotor symptoms as moderate to severe and would warrant treatment; studies suggest that the median total length of vasomotor symptoms is 7.4 years.4569 An effective treatment of vasomotor symptoms is hormonal therapy, but this treatment is not appropriate for everyone and only about 10% of women worldwide with vasomotor symptoms report using hormonal therapy.23561011131415 Contraindications to hormonal therapy and concerns for adverse effects with prolonged hormonal therapy use may contribute to its low use.2345679 Non-hormonal alternatives to manage vasomotor symptoms are available but these alternatives are generally considered less efficacious than hormonal therapy.6910111314 Furthermore, before 2023, paroxetine was the …
多达 80% 的妇女在绝经过渡期会出现血管运动症状,包括潮热和盗汗。1234567 这些症状可能会在绝经前后持续数年,通过影响睡眠、情绪和认知功能而严重影响生活质量。血管运动症状的有效治疗方法是激素治疗,但这种治疗方法并不适合所有人,全世界只有约10%的血管运动症状女性报告使用了激素治疗。23561011131415激素治疗的禁忌症和对长期使用激素治疗的不良反应的担忧可能是导致激素治疗使用率低的原因。
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引用次数: 0
Brazil’s G20 leadership offers glimmers of hope for global health equity 巴西在二十国集团(G20)中的领导地位为全球卫生公平带来一线希望
Pub Date : 2024-11-18 DOI: 10.1136/bmj.q2517
Deisy Ventura, Anne-Emanuelle Birn, Ruth Iguiñiz Romero, Michael Knipper
The Rio de Janeiro declarations chart possibilities in an era of inequity, war, climate change, and pandemics, but their shortfalls must be acknowledged, write Deisy Ventura and colleagues On 31 October 2024, the G20 health ministers met in Rio de Janeiro, Brazil, following a series of preparatory meetings held throughout 2024. A recent series in The BMJ suggested priorities for Brazil’s G20 leadership.123 Brazil is taking this opportunity to advance global health diplomacy, but its leadership will need to go beyond formal declarations to address health inequity from a global south perspective. The Rio meeting produced two unanimously adopted declarations. The main, more general, one4 revisits elements from the G20 health declaration issued in 2023.5 These goals include building “more resilient, equitable, sustainable, and inclusive health systems” and implementing universal health coverage in the short term, and reaffirming commitments to the sustainable development goals. The 2024 version introduces new sections on health workforce shortages inequities and the problem of post-covid syndrome, which are welcome additions to overcoming pandemic inequalities. The declaration’s highlight is the launch of the Global Coalition for Local and Regional Production, Innovation, and Equitable Access, with …
2024 年 10 月 31 日,20 国集团卫生部长在巴西里约热内卢举行会议,此前在 2024 年期间举行了一系列筹备会议。123 巴西正借此机会推进全球卫生外交,但其领导力需要超越正式宣言,从全球南部的角度解决卫生不平等问题。里约会议产生了两项一致通过的宣言。5 这些目标包括建设 "更具弹性、公平、可持续和包容性的卫生系统",在短期内实现全民医保,并重申对可持续发展目标的承诺。2024 年版宣言新增了关于医务人员短缺、不平等和后科维氏综合症问题的章节,这是对克服大流行病不平等问题的有益补充。该宣言的亮点是发起了全球地方和区域生产、创新和公平获取联盟,该联盟的成员包括......
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引用次数: 0
Efficacy and safety of fezolinetant for moderate-severe vasomotor symptoms associated with menopause in individuals unsuitable for hormone therapy: phase 3b randomised controlled trial 非索内酯治疗与更年期相关的中重度血管运动症状的有效性和安全性:3b 期随机对照试验
Pub Date : 2024-11-18 DOI: 10.1136/bmj-2024-079525
Katrin Schaudig, Xuegong Wang, Céline Bouchard, Angelica Lindén Hirschberg, Antonio Cano, Marla Shapiro C M, Petra Stute, Xi Wu, Kentaro Miyazaki, Ludmila Scrine, Rossella E Nappi
Objectives To assess the efficacy and safety of the non-hormonal, neurokinin 3 receptor antagonist, fezolinetant, to treat moderate-severe vasomotor symptoms associated with menopause in individuals unsuitable for hormone therapy. Design Phase 3b randomised controlled trial. Setting 16 countries. Participants 453 individuals aged 40-65 years with moderate-severe vasomotor symptoms associated with menopause who were considered unsuitable candidates for hormone therapy (contraindicated, caution (based on medical history), stoppers (previous discontinuation of hormone therapy), or averse (informed choice not to use hormone therapy)) were randomised to receive fezolinetant (n=227) or placebo (n=226). Intervention Fezolinetant 45 mg or placebo once daily for 24 weeks. Main outcome measures The primary endpoint was mean change in daily frequency of moderate-severe vasomotor symptoms from baseline to week 24. Secondary endpoints were mean change in symptom severity, sleep disturbance using the Patient-Reported Outcome Measurement Information System Sleep Disturbance Short Form (PROMIS SD-SF) 8b total score, and safety. Results 370 (81.7%) participants completed the study (fezolinetant=195, placebo group=175). The safety and full analysis sets comprised 452 participants who received at least one dose of study drug. Mean age was 54.5 (standard deviation 4.7) years and most of the participants (435 (96.7%) were white and categorised as either hormone therapy averse (168 (37.2%)) or caution (165 (36.5%)). At week 24, fezolinetant significantly reduced the frequency (least squares mean difference –1.93, 95% confidence interval (CI) –2.64 to –1.22; P<0.001) and severity of vasomotor symptoms (–0.39, –0.57 to –0.21; P<0.001). At week 24, the fezolinetant group had a greater reduction in sleep disturbance (PROMIS SD-SF 8b total score) compared with placebo (–2.5, –3.9 to –1.1; P<0.001). Improvements over placebo were observed as early as week 1. Both groups showed similar incidences of treatment emergent adverse events (TEAEs, 147 (65.0%) in the fezolinetant group, 138 (61.1%) in the placebo group) and serious TEAEs (10 (4.4%) and 8 (3.5%), respectively). The most common TEAEs in the fezolinetant group were covid-19 (30 (13.3%)), headache (20 (8.8%)), and fatigue (13 (5.8%)). Conclusions Fezolinetant was efficacious and well tolerated over a six month period for treating moderate-severe vasomotor symptoms in individuals considered unsuitable for hormone therapy. These results highlight the utility of fezolinetant as an effective treatment option for those who have contraindications to or choose not to use hormone therapy. Trial registration ClinicalTrials.gov [NCT05033886][1]; EudraCT 2021-001685-38. Researchers may request access to anonymised participant level data, trial level data, and protocols from Astellas sponsored clinical trials at [www.clinicalstudydatarequest.com][2]. For the Astellas criteria on data sharing, see <https://clinicalstudydatarequest.c
目的 评估非激素类神经激肽 3 受体拮抗剂 fezolinetant 治疗不适合接受激素治疗的更年期中重度血管运动症状的有效性和安全性。设计 3b 期随机对照试验。地点 16 个国家。参与者 453 名年龄在 40-65 岁之间、患有与更年期相关的中度-重度血管运动症状、被认为不适合接受激素治疗的人(禁忌症、慎用(基于病史)、停药者(曾停止激素治疗)或厌恶者(知情选择不使用激素治疗))被随机分配到接受非佐利奈坦(227 人)或安慰剂(226 人)治疗。干预措施 Fezolinetant 45 毫克或安慰剂,每天一次,为期 24 周。主要结局指标 主要终点是中度-重度血管运动症状每日发生频率从基线到第24周的平均变化。次要终点为症状严重程度的平均变化、使用患者报告结果测量信息系统睡眠障碍简表(PROMIS SD-SF)8b总分的睡眠障碍以及安全性。结果 370 名(81.7%)参与者完成了研究(非索奈特组=195 人,安慰剂组=175 人)。安全性和全面分析组包括 452 名参与者,他们至少接受了一剂研究药物。平均年龄为 54.5 岁(标准差 4.7),大多数参与者(435 人,占 96.7%)为白人,被归类为激素治疗厌恶者(168 人,占 37.2%)或谨慎者(165 人,占 36.5%)。在第24周,非索内酯显著降低了频率(最小平方均值差-1.93,95%置信区间(CI)-2.64至-1.22;P. [1]:/lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05033886&atom=%2Fbmj%2F387%2Fbmj-2024-079525.atom [2]: http://www.clinicalstudydatarequest.com
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引用次数: 0
Vinit Sheshnath Vedpathak Vinit Sheshnath Vedpathak
Pub Date : 2024-11-15 DOI: 10.1136/bmj.q2519
Omkar Vedpathak, Shreya Kumar, Nutan Vedpathak, Nikhil Kaushik
Vinit was born in Mumbai, India. He graduated from the Maharashtra University of Health Sciences in 1981 and came to the UK in 1989. After working in Dover, Lincoln, and Birmingham …
维尼特出生于印度孟买。他于 1981 年毕业于马哈拉施特拉邦卫生科学大学,1989 年来到英国。他曾在多佛、林肯和伯明翰工作过 ...
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引用次数: 0
Olumade Adetola Okubadejo Olumade Adetola Okubadejo
Pub Date : 2024-11-15 DOI: 10.1136/bmj.q2527
Deyo Okubadejo
Made Okubadejo was born in Lagos, Nigeria. He attended school at Igbobi College where he was the school organist. He worked as a teacher and a clerk in the Nigerian government’s chief secretary’s office before coming to the UK to take his A levels in Norwich at the …
Made Okubadejo 出生于尼日利亚拉各斯。他曾在伊戈比学院(Igbobi College)就读,并担任学校风琴演奏员。他曾在尼日利亚政府的首席秘书办公室担任教师和办事员,后来来到英国,在诺里奇的...
{"title":"Olumade Adetola Okubadejo","authors":"Deyo Okubadejo","doi":"10.1136/bmj.q2527","DOIUrl":"https://doi.org/10.1136/bmj.q2527","url":null,"abstract":"Made Okubadejo was born in Lagos, Nigeria. He attended school at Igbobi College where he was the school organist. He worked as a teacher and a clerk in the Nigerian government’s chief secretary’s office before coming to the UK to take his A levels in Norwich at the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637739","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}
引用次数: 0
David Samuel Hopton 大卫-塞缪尔-霍普顿
Pub Date : 2024-11-15 DOI: 10.1136/bmj.q2520
Barny Hopton
David was born in Sale and attended Calday Grange Grammar School, then Sale County Grammar School. Following medical school in Manchester and house jobs, he spent two years in national service. This was followed by attachments to the 2nd Battalion Parachute Regiment and the Special Air Service, formative years with time in north Africa, Cyprus, Kuwait, and …
大卫出生于萨利,曾就读于卡尔代格兰奇文法学校(Calday Grange Grammar School),后又就读于萨利郡文法学校(Sale County Grammar School)。在曼彻斯特上完医学院并做过家务后,他参加了两年的国民兵役。之后,他加入了伞兵团第二营和特种空勤团,并在北非、塞浦路斯、科威特和......
{"title":"David Samuel Hopton","authors":"Barny Hopton","doi":"10.1136/bmj.q2520","DOIUrl":"https://doi.org/10.1136/bmj.q2520","url":null,"abstract":"David was born in Sale and attended Calday Grange Grammar School, then Sale County Grammar School. Following medical school in Manchester and house jobs, he spent two years in national service. This was followed by attachments to the 2nd Battalion Parachute Regiment and the Special Air Service, formative years with time in north Africa, Cyprus, Kuwait, and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142637736","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}
引用次数: 0
期刊
The BMJ
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