British medical bulletin最新文献

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.

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.