British medical bulletin最新文献

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.

Introduction: The National Institute for Health and Care Excellence guidelines for post-traumatic stress disorder (PTSD) were published in 2018, based on research up until that point. In this review, we summarize the current state of the evidence and discuss the findings of systematic reviews and meta-analyses published between 2019 and 2024.

Sources of data: We include peer-reviewed systematic reviews and meta-analyses published within the last 5 years.

Areas of agreement: Reviews and meta-analyses continue to support the efficacy, and cost-effectiveness, of trauma-focused psychological interventions, particularly Trauma-Focused Cognitive-Behavioural Therapy and Eye Movement Desensitization and Reprocessing.

Areas of controversy: Despite their demonstrated efficacy, dropout rates from psychological interventions for PTSD remain high. There has also been a rapid proliferation of research into novel interventions for treating PTSD. However, much of this research is of low quality and lacks head-to-head comparisons with established interventions.

Growing points: Novel methods of delivery of established treatments are being developed, including using virtual reality, intensive forms of treatment, and digital and remote methods of delivery.

Areas timely for developing research: More qualitative research to explore recipients' experiences of interventions. More good-quality research and head-to-head comparisons of treatments.

Introduction or background: Hypertension is a critical health risks that significantly affect the quality of life in older adults. Physical activity programs tailored to the needs of specific populations have proven effective in mitigating these risks.

Sources of data: The study employed a single-group pretest-posttest design to evaluate the effects of recreational football interventions on body composition and blood pressure (BP). The independent variable was time (pretest, midtest, and posttest), and the dependent variables were body composition and BP. Nineteen male participants (mean ± SD age: 65.9 ± 2.85 years) were included in the study and participated in a 24-week recreational soccer (RS) program consisting of 1-hour sessions twice a week. Body composition parameters [body mass, fat mass, and body mass index (BMI)] were assessed using dual-energy X-ray absorptiometry, while BP was measured using a semi-automated monitor following guidelines. Statistical analyses, including the Friedman and Wilcoxon signed-rank tests with Bonferroni correction, revealed significant improvements in body mass (${mathrm{chi}}^2(2)=22.73,Ple .001$), fat mass (${mathrm{chi}}^2(2)=22.88,Ple .001$), and BMI $ ({mathrm{chi}}^2(2)=22.73,Ple .001$). Additionally, reductions in systolic BP (${mathrm{chi}}^2(2)=9.08,Ple .011$), diastolic BP (${mathrm{chi}}^2(2)=15.62,Ple .001$), and mean BP (${mathrm{chi}}^2(2)=16.33,Ple .001$) were observed.

Areas of agreement: The results support previous findings that aerobic and group-based physical activity can improve cardiovascular and metabolic health in older adults.

Areas of controversy: The single-group design and small sample size limit the ability to generalize findings. Future randomized controlled trials are needed to establish causality.

Growing points: This study provides new evidence on the use of RS as a feasible, enjoyable, and effective intervention to improve body composition and BP in older adults.

Areas timely for developing research: Future studies should focus on the long-term effects of RS, its impact on bone mineral density, and its comparative efficacy versus other exercise modalities for aging populations.

Introduction: To improve patient satisfaction after total knee arthroplasty (TKA), retention of the infrapatellar fat pad (IPFP) is advocated.

Source of data: Recently published literature identified from PubMed, EMBASE, Scopus, and Google Scholar.

Areas of agreement: TKA is routinely performed in patients with end-stage joint osteoarthritis, but 18% to 11% of patients are unsatisfied after surgery.

Areas of controversy: Clinical investigations that compared IPFP resection versus retention are limited.

Growing points: Following the 2020 PRISMA statement, the present systematic review compared resection versus retention of the IPFP in TKA in range of motion (ROM), patellar height, patient-reported outcome measures (PROMs), and complications.

Areas timely for developing research: At a mean duration of 18.4 ± 6.6 months of follow-up, no difference was found in ROM, patellar height, PROMs, and the rate of pain in the anterior aspect of the knee. The outcomes of TKA are not influenced by IPFP retention or excision. Based on the available scientific literature, surgeons could retain the IPFP if suitable visibility and exposure are possible, but resect it if necessary to facilitate exposure during TKA. Further high-level randomized controlled trials with sustained follow-up periods are required to prove the superiority of one surgical technique over the other.

Introduction: Acute type 3b injuries of the hamstring muscle complex (HMC) are prevalent in sports, often lead to prolonged recovery, and demonstrate a high recurrence. Conservative rehabilitation is standard, and adjunct therapies such as radial extracorporeal shock wave therapy (rESWT) may offer additional benefits.

Sources of data: This randomized controlled trial, with blinding of patients and assessors, included 36 semi-professional athletes with ultrasound-confirmed acute type 3b HMC injuries. Participants received either real or sham rESWT in combination with an 8-week structured rehabilitation program. The primary outcome was time to return to sport; secondary outcomes included post-treatment muscle strength, patient satisfaction, and re-injury rate.

Areas of agreement: Progressive rehabilitation is effective for muscle injuries. rESWT is a safe, non-invasive modality with high therapeutic potential in musculoskeletal conditions.

Areas of controversy: Questions remain regarding the ideal rESWT protocol for acute muscle injuries, including optimal dosing, frequency, and timing relative to injury onset.

Growing points: The addition of rESWT resulted in a statistically significant reduction in return-to-sport time [25.4 ± 3.5 (mean ± SD) days with rESWT vs 28.3 ± 4.5 days with sham rESWT; P = .037]. In elite and semi-professional athletes, even modest reductions in downtime can carry meaningful performance and economic benefits. Furthermore, only the rESWT group avoided strength deficits in the previously injured leg, suggesting improved functional recovery.

Areas timely for developing research: Future studies should explore the comparative effectiveness of individualized versus standardized rESWT protocols and investigate its broader applicability across sports disciplines and levels of play.

Introduction or background: Anterior cruciate ligament (ACL) injuries from the accumulated micro-trauma that precedes non-contact mechanical fatigue-related failure in adolescent athletes are increasing. This commentary aims to increase the understanding about how boredom may provide a self-control development stimulus which, in addition to modified sport training, may decrease non-contact ACL injuries.

Sources of data: PubMed, Google Scholar.

Areas of agreement: With improved ACL load monitoring and less frequent use of rigid, unchanging practice tasks, the incidence of these injuries should decrease.

Areas of controversy: Because of boredom, however, adolescent athletes may continue to over train, not complying with neuromuscular control and active rest and recovery activities.

Growing points: This dilemma provides an opportunity to enhance adolescent athlete self-control through adjusted coaching and training strategies using guided autonomy to increase injury prevention program efficacy through improved compliance. In addition to greater global physical, mental, and behavioral health development, improved self-control may also benefit the classroom.

Areas timely for developing research: The conceptual theory that follows should be tested for these context-specific self-control examples: (i) improved compliance with neuromuscular control training, active rest and recovery interventions; (ii) better adherence to modified sports training program intensity, frequency and total volume; and (iii) decreased non-contact, mechanical fatigue-related ACL injury rates.

Background: Sport and health science are undergoing a transformative shift driven by interdisciplinary approaches, technological innovations, and data-driven strategies.

Sources of data: This invited editorial explores key advancements in precision athletic monitoring, holistic well-being, population health initiatives, and innovative training and rehabilitation techniques. The integration of wearable technology, real-time analytics, and psychological interventions enables more personalized and effective strategies to optimize performance and promoting overall health. Additionally, the role of physical activity in mitigating lifestyle-related diseases underscores the importance of tailored public health initiatives.

Areas of agreement: Current consensus in sport and health science highlights that interdisciplinary collaboration-blending physiology, psychology, nutrition, and data analytics-significantly improves both athletic performance and public health outcomes. This progress is driven by precision monitoring technologies, holistic well-being strategies, innovative training methods, and a shared commitment to ethical standards ensuring equitable, responsible application of new health, and performance innovations.

Areas of controversy: As the field progresses, ethical considerations regarding data privacy, accessibility, and equitable application of emerging technologies remain central.

Growing points: Future directions include leveraging artificial intelligence, machine learning, and big data to refine personalized interventions, ensuring that both athletic and public health advancements are sustainable and inclusive.

Areas timely for developing research: Emerging research in sport and health science focuses on harnessing artificial intelligence, machine learning, and big data to develop predictive models and personalized interventions, while tailoring physical activity programmes to diverse population needs based on age, gender, socioeconomic, and cultural factors. Simultaneously, priorities include advancing psychological and mindfulness-based strategies in athletic care, integrating cutting-edge rehabilitation technologies, promoting inclusive public health frameworks for ageing and chronically ill populations, and establishing ethical guidelines for the responsible use of innovative performance and health technologies.

Introduction: Periodized rehabilitation for tendinopathies integrates principles of athletic training into structured protocols to optimize tendon healing and functional recovery minimizing recurrence. This review explores the role of concurrent and phasic periodization strategies in tendon rehabilitation, focusing on optimizing strength, power, and neuromuscular control.

Areas of agreement: Early phases prioritize pain management and load capacity through prolonged isometric contractions, to improve neuromuscular engagement without exacerbating symptoms. Heavy, slow resistance exercises, central to progressive loading, facilitate tendon remodeling and strength development. Subsequent phases incorporate energy storage and release, sport-specific exercises tailored to individual goals, using externally paced movements to enhance motor control and corticospinal drive. Neuroplastic training is promising, aligning physical rehabilitation with cognitive engagement to optimize motor learning and reduce maladaptive patterns.

Areas of controversy: At present, no randomized controlled trials have tested the periodization concept in the management of tendinopathy conditions.

Growing points: Systematic evaluation, including range of motion, tissue flexibility, and limb biomechanics, is necessary to identify and address kinetic chain dysfunctions in patients with tendon ailments. Reintegration into sport or activity should follow clear benchmarks, such as symmetrical strength, pain-free function, and tolerance for high-intensity loads.

Source of data: Analysis of the current literature, and expert opinion.

Areas timely for developing research: This evidence-based framework offers clinicians a practical roadmap for tendon rehabilitation, combining physiological and biomechanical considerations to support safe return to sport or activity. A structured individualized approach ensures optimal recovery by addressing movement dysfunctions, monitoring load tolerance, and reducing the risk of re-injury.

Background: All-inside arthroscopic procedures are now frequently employed to manage chronic lateral ankle instability (CLAI) with satisfactory functional outcomes. Currently, no evidence-based guidelines exist for all-inside arthroscopic procedures for CLAI. Many surgical decisions remain uncertain and challenging.

Sources of data: Published scientific literature in PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane databases.

Areas of agreement: All-inside arthroscopic repair and reconstruction procedures are reliable treatments for CLAI.

Areas of controversy: The all-inside arthroscopic procedures for CLAI present significant challenges, particularly in the following aspects.

Growing points: Given the lack of guidelines for the all-inside arthroscopic procedures for CLAI, this evidence-based clinical practice guideline provides 11 recommendations to address the controversy.

Areas timely for developing research: In patients with CLAI undergoing all-inside arthroscopic procedures, comparative studies are urgently needed to establish the optimal timing for weight-bearing, as well as return to work and sports.