British medical bulletin最新文献

Introduction: The effectiveness of digital SBIRT training for improving knowledge/competence and confidence for health promotion, behavioural and/or health outcomes is not established. We aimed to conduct a systematic review examining the effectiveness of digital training for medical and health professionals on screening, brief interventions, and referral to treatment (SBIRT), on knowledge of the health condition/behaviours, their treatments, and onwards referral to services, and/or changes in attitude, skills, or confidence to promote health.

Source of data: MEDLINE, EMBASE, CINAHL, PsycINFO, Epistemonikos, Google Scholar, and SCOPUS. Forty-two articles with 8985 participants, published between January 2001 and April 2024, were included. There were eight randomized controlled trials. Only one study was conducted in the UK.

Areas of agreement: Digital SBIRT training may increase knowledge/competence, confidence, and self-efficacy for SBIRT delivery.Focus is primarily alcohol, tobacco, and substance use. Delivery is mostly web-based programmes, digital patient simulation, or blended learning with a face-to-face component.

Areas of controversy: Comparison between studies is hampered by heterogeneity in study design, target populations, intervention design and content, comparator/control groups, and outcomes assessed.

Growing points: Majority of studies were cohort educational web-based learning. Studies were mostly low quality (13/42 with low risk of bias). Outcomes were diverse and often poorly reported.

Areas timely for developing research: More high-quality research is needed, including assessment of practice, behavioural, and health outcomes. A standardized approach to assuring quality of delivery and testing is required. There is scope to develop, evaluate, and implement SBIRT interventions in a broader range of health promotion areas.

Introduction: This research investigates the epidemiology, underlying mechanisms, and prevention strategies associated with occupational noise-induced hearing loss (ONIHL), while also presenting effective control measures.

Source of data: Relevant literature was sourced from databases such as MEDLINE, PubMed, Embase, Web of Science, and Google Scholar, encompassing articles until February 2025.

Areas of agreement: ONIHL is widely recognized as a common occupational health issue among workers. Additionally, noise can lead to psychological and physiological complications beyond direct auditory damage.

Areas of controversy: The effects of noise differ across individuals, and the precise causes behind ONIHL remain poorly understood, although several pathways have been proposed.

Growing points: New treatment options focused on oxidative stress, inflammation, and neuropathy are being developed through innovative drug delivery systems.

Areas timely for developing research: There is a pressing need for molecular approaches to explore the mechanisms of ONIHL, particularly in the care of individuals with hearing disabilities.

Introduction or background: Physiological tremor is a low-amplitude, high-frequency oscillation of body segments influenced by both mechanical and neurogenic factors. Its modulation by physical exertion has emerged as a potential indicator of neuromuscular fatigue in healthy individuals.

Sources of data: We conducted a systematic search across four databases (PubMed, Scopus, Web of Science, and SPORTDiscus) in accordance with PRISMA 2020 guidelines. Twenty-eight experimental studies involving healthy adults and reporting tremor outcomes post-exertion were included.

Areas of agreement: The majority of studies (68%) reported increased tremor amplitude following resistance-based or fatiguing exercise, aligning with models of neuromuscular fatigue. Accelerometry and surface electromyography were the most common measurement methods.

Areas of controversy: Tremor frequency changes were inconsistently reported, with only 46% of studies documenting downward shifts. Few studies reported test-retest reliability or recovery dynamics, and significant heterogeneity was observed in measurement timing and spectral analysis protocols.

Growing points: There is increasing interest in using physiological tremor as a biomarker of neuromuscular strain. Emerging methods such as empirical mode decomposition and video-microscopy offer promise but remain underutilized and poorly validated.

Areas timely for developing research: Future studies should adopt standardized tremor measurement protocols, including frequency band targeting (e.g. 6-12 Hz), validated analytical pipelines, and consistent timing of data acquisition. There is a critical need for research in diverse populations and contexts, such as female athletes, older adults, and sport-specific exertion models.

Introduction: The discovery of chlorpromazine in 1950 marked a turning point in psychiatry, and, for the first time, effective pharmacological treatments for psychosis became widely used. Over the following decades, antipsychotics became the cornerstone of schizophrenia treatment, yet their fundamental mechanism-dopamine D2 receptor antagonism-has remained largely unchanged. Now, 75 years on, novel drug classes and advances in mechanistic understanding are reshaping the field.

Sources of data: This review synthesizes findings from clinical trials, neurobiological research, and pharmacological studies, highlighting the evolution of antipsychotic treatment.

Areas of agreement: Antipsychotics reduce positive symptoms, but their efficacy for negative and cognitive symptoms is limited. Clozapine remains the gold standard for treatment-resistant schizophrenia.

Areas of controversy: The typical/atypical distinction is increasingly seen as outdated. The dopamine hypothesis, while central, does not fully explain schizophrenia.

Growing points: Emerging nondopaminergic treatments-such as the muscarinic agonist xanomeline-trospium-offer new therapeutic avenues.

Areas timely for developing research: Further research is needed to determine the clinical utility of nondopaminergic drugs, refine stratified treatment approaches, and integrate precision psychiatry into psychosis management.

Introduction or background: Altitude training is a well-established strategy for improving athletic performance, particularly in endurance sports. Hypoxic exposure induces physiological adaptations through oxygen sensing and erythropoietic mechanisms. However, the comparative effects of aerobic and anaerobic training on hematological and biochemical markers under different altitude conditions have not yet been adequately investigated.

Sources of data: This prospective cohort study included 24 trained male athletes (aged 19-23) who were randomly assigned to aerobic or anaerobic training groups (n = 12 per group). Training was conducted at simulated altitudes of 0 m, 1700 m, 2450 m, and 3200 m for 8 weeks. Biomarkers such as hypoxia-induced factor 1-alpha (HIF-1α), hemoglobin, erythropoietin (EPO), iron, hepcidin, and nitric oxide (NO) were measured using ELISA and standard biochemical methods.

Areas of agreement: Consistent with previous literature, both aerobic and anaerobic training resulted in altitude-induced increases in hemoglobin levels. Aerobic training was associated with earlier activation of hypoxia-related markers such as HIF-1α and NO, supporting the role of moderate altitude exposure in stimulating adaptive molecular responses.

Areas of controversy: While EPO is generally expected to increase with altitude exposure, this study found a decrease in EPO levels across altitudes in the aerobic group, while a significant increase was observed only at 3200 m in the anaerobic group. Interpretation of hepcidin dynamics also differs between training modalities, highlighting the complexity of iron regulation under hypoxic stress.

Growing points: This study highlights the different timing and magnitude of biomarker responses to aerobic and anaerobic training at various altitudes. It suggests that aerobic exercise triggers earlier molecular responses, while anaerobic training elicits delayed or blunted adaptations.

Areas timely for developing research: Further research is needed to optimize altitude training protocols tailored to specific exercise modalities and targeted physiological adaptations. Future studies could examine gender differences, longer training durations, and additional markers of oxidative stress and inflammation to expand on these findings.

Background: In recent years, there has been a substantial increase in international competitions and recreational leagues in female soccer. Small-sided games (SSGs) and high-intensity interval training (HIIT) are considered effective training methods to enhance physical fitness in soccer players. Due to the limited research comparing these two protocols in female athletes, this systematic review and meta-analysis aimed to evaluate their effects on change of direction (COD), sprint time (ST), vertical jump (VJ), and endurance performance (END).

Sources of data: PubMed, Scopus, Web of Science, and SPORTDiscus databases were searched for original scientific articles up to 28 June 2025.

Areas of agreement: Results showed a significant effect favouring SSGs over HIIT protocols in improving COD, while no significant differences were found regarding ST, VJ, and END.

Areas of controversy: The limited and heterogeneous data currently available prevent definitive conclusions and sustain ongoing debate on this topic.

Growing points: This study provides a foundation for future research comparing SSGs and HIIT-based interventions in female soccer players.

Areas timely for developing research: Future research should focus on: (i) analyzing different SSG formats in adult participants; (ii) detailed examination of the benefits derived both from longer durations of short HIIT and large-sided games; and (iii) investigating performance improvements in young female soccer players across varying competitive levels and stages of maturation.

Background: Empathy is widely recognized for improving patient outcomes, including reduced pain and anxiety and improved satisfaction, and its absence can cause harm. Meanwhile, use of artificial intelligence (AI)-based chatbots in healthcare is rapidly expanding, with one in five general practitioners using generative AI to assist with tasks such as writing letters. Some studies suggest AI chatbots can outperform human healthcare professionals (HCPs) in empathy, though findings are mixed and lack synthesis.

Sources of data: We searched multiple databases for studies comparing AI chatbots using large language models with human HCPs on empathy measures. We assessed risk of bias with ROBINS-I and synthesized findings using random-effects meta-analysis where feasible, whilst avoiding double counting.

Areas of agreement: We identified 15 studies (2023-2024). Thirteen studies reported statistically significantly higher empathy ratings for AI, with only two studies situated in dermatology favouring human responses. Of the 15 studies, 13 provided extractable data and were suitable for pooling. Meta-analysis of those 13 studies, all utilising ChatGPT-3.5/4, showed a standardized mean difference of 0.87 (95% CI, 0.54-1.20) favouring AI (P < .00001), roughly equivalent to a two-point increase on a 10-point scale.

Areas of controversy: Studies relied on text-based assessments that overlook non-verbal cues and evaluated empathy through proxy raters.

Growing points: Our findings indicate that, in text-only scenarios, AI chatbots are frequently perceived as more empathic than human HCPs.

Areas timely for developing research: Future research should validate these findings with direct patient evaluations and assess whether emerging voice-enabled AI systems can deliver similar empathic advantages.

Introduction: Hiking is an outdoor activity with not only significant health benefits but also associated risks, especially for individuals with cardiovascular conditions. Current trail recommendations lack personalization, potentially increasing the risk of adverse events during hiking.

Sources of data: Prospective, cross-sectional study combining outpatient cardiopulmonary exercise testing with monitored outdoor hiking. Data were collected via portable gas analysis, heart rate monitors, and an official meteorological station.

Areas of agreement: Hiking intensity and cardiorespiratory responses vary widely. Cardiovascular risk and trail slope were found to influence the exertion required to complete the hike.

Areas of controversy: There is no consensus on how to standardize trail recommendations to account for individual variability.

Growing points: Personalized hiking advice integrating individual fitness, cardiovascular risk, and trail features may enhance safety. Wearable technologies enable real-time adjustment of exertion levels.

Areas for developing research: New tools combining personal health data and environmental features to optimize hiking safety and accessibility should be implemented.

Introduction: Empirical evidence on migrant morbidity suggests that migrant populations have a higher burden of disease compared to non-migrants in high-income destination countries. Yet, empirical evidence on migrant mortality typically shows a lower risk of death compared to non-migrants. Migrants might be living longer lives in worse health-a 'migrant "morbidity-mortality" paradox'.

Sources of data: Peer-reviewed, English-language publications.

Areas of agreement: The paradox has been reported in different destinations, across different migrant groups, and across different health outcomes. It presents most consistently among migrants and women born in low and middle-income countries, and/or when morbidity is self-reported.

Areas of controversy: The majority of the evidence is based upon unlinked, aggregated, cross-sectional prevalence data that has well-known limitations. Nearly all the studies to date have been descriptive, and there is a lack of understanding concerning what might explain this paradox among migrants.

Growing points: That migrants are living longer subject to a higher burden of diseases is a social and public health concern that needs to be further explored and understood through more research.

Areas timely for developing research: We need more evidence of the paradox based upon linked individual-level, incidence-based data that compares the morbidity and mortality risks of the same migrant and non-migrant populations using objective data on morbidity from primary care (general practitioners) or secondary care (hospitalizations). We need to know how widespread the paradox is, which migrant populations are most affected by it, and the potential mechanisms responsible for it.

Background: Many individuals with common mental disorders (CMDs) face challenges after returning to work following sickness absence. Healthcare providers and healthcare systems are well-placed to provide returnees with support which can facilitate sustainable return-to-work.

Sources of data: This narrative review has integrated data and literature from journal articles, reports, book chapters, and official NHS and UK statistics bodies.

Areas of agreement: Individual healthcare providers and healthcare systems can take various actions to support sustainable return-to-work for individuals with CMDs. These include utilizing shared decision-making, maintaining communication with other stakeholders, and delivering suitable interventions. Healthcare leadership systems should prioritize improving relevant provider knowledge and skills as many lack confidence managing cases involving return-to-work.

Areas of controversy: Healthcare providers face uncertainty about which supportive actions fall within their scope of practice.Growing points: Research interest in sustainable return-to-work appears to have grown in recent years.

Areas timely for developing research: Future research should seek to clarify the definition of sustainable return-to-work and examine how resources across system levels can support sustainable return-to-work.