Objective To determine whether a single low dose of esketamine administered after childbirth reduces postpartum depression in mothers with prenatal depression. Design Randomised, double blind, placebo controlled trial with two parallel arms. Setting Five tertiary care hospitals in China, 19 June 2020 to 3 August 2022. Participants 364 mothers aged ≥18 years who had at least mild prenatal depression as indicated by Edinburgh postnatal depression scale scores of ≥10 (range 0-30, with higher...| The BMJ
Objective To investigate change in mental health after smoking cessation compared with continuing to smoke. Design Systematic review and meta-analysis of observational studies. Data sources Web of Science, Cochrane Central Register of Controlled Trials, Medline, Embase, and PsycINFO for relevant studies from inception to April 2012. Reference lists of included studies were hand searched, and authors were contacted when insufficient data were reported. Eligibility criteria for selecting studie...| The BMJ
Objective To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. Design Systematic review and network meta-analysis. Methods Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the ...| The BMJ
NHS staff must immediately stop using any artificial intelligence ambient scribe tools that have not been officially registered for medical use in the UK, NHS England has said. The use of ambient voice technology (AVT) tools that do not meet NHS standards poses a risk to patient safety, and many AI companies offering services to the NHS have not met basic governance standards, a letter from NHS England warns. NHS England’s national chief clinical information officer, Alec Price-Forbes, wrot...| The BMJ
Objective To examine the effects of drug treatment for attention deficit/hyperactivity disorder (ADHD) on suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality. Design Emulation of target trials. Setting Linkage of national registers in Sweden, 2007-20. Participants People aged 6-64 years with a new diagnosis of ADHD, who either started or did not start drug treatment for ADHD within three months of diagnosis. Main outcome measures First and recurren...| The BMJ
The care provided to young people with gender incongruence or gender related stress by the NHS is in limbo. In July 2022 NHS England announced its intention to close its only specialist youth gender clinic by the spring of 2023 and replace it with two regional services, the first of several. But this timeline looks highly unlikely. Families under the care of the Gender Identity Development Service (GIDS) at London’s Tavistock and Portman NHS Foundation Trust say that clinicians have been le...| The BMJ
More children and adolescents are identifying as transgender and are being offered medical treatment, especially in the US—but some providers and European authorities are urging caution because of a lack of strong evidence. Jennifer Block reports Last October the American Academy of Pediatrics (AAP) gathered inside the Anaheim Convention Center in California for its annual conference. Outside, several dozen people rallied to hear speakers including Abigail Martinez, a mother whose child beg...| The BMJ
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Objective To quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways. Design Systematic review and meta-analysis. Data sources Published studies in Medline from 1 January 2000 to 10 April 2020. Eligibility criteria for selecting studies Curative, neoadjuvant, and adjuvant indications for surgery, systemic treatment, or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and nec...| The BMJ
A decision to cancel a planned update of a Cochrane systematic review of exercise therapy for chronic fatigue syndrome has met with anger from a group advising the review and the patient community. The decision has reignited calls for the review,1 which includes studies only up to May 2014, to be withdrawn for being outdated and misleading. The review recommends exercise therapy to treat myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), concluding that this “probably has a positi...| The BMJ
Objective To evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes. Design Systematic umbrella review of existing meta-analyses. Data sources MEDLINE, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews, as well as manual searches of reference lists from 2009 to June 2023. Eligibility criteria for selecting studies Systematic reviews and meta-analyses ...| The BMJ
Objective To compare the effectiveness of interventions for the management of long covid (post-covid condition). Design Living systematic review. Data sources Medline, Embase, CINAHL, PsycInfo, Allied and Complementary Medicine Database, and Cochrane Central Register of Controlled Trials from inception to December 2023. Eligibility criteria Trials that randomised adults (≥18 years) with long covid to drug or non-drug interventions, placebo or sham, or usual care. Results 24 trials with 3695...| The BMJ
People around the world are watching with disbelief as the new US government closes down its aid programme, withdraws from the World Health Organization (WHO) and the Paris agreement on climate change, deletes datasets that do not fit with its ideology, refuses to pay adequate overhead to universities—so halting research and bankrupting many, and insists that certain words are not used in federal documents, including federally funded research. The words that must not be used include bias, b...| The BMJ
Objective To evaluate whether a structured online supervised group physical and mental health rehabilitation programme can improve health related quality of life compared with usual care in adults with post-covid-19 condition (long covid). Design Pragmatic, multicentre, parallel group, superiority randomised controlled trial. Setting England and Wales, with home based interventions delivered remotely online from a single trial hub. Participants 585 adults (26-86 years) discharged from NHS hos...| The BMJ
Objective To quantify global intakes of sugar sweetened beverages (SSBs) and trends over time among children and adolescents. Design Population based study. Setting Global Dietary Database. Population Children and adolescents aged 3-19 years in 185 countries between 1990 and 2018, jointly stratified at subnational level by age, sex, parental education, and rural or urban residence. Results In 2018, mean global SSB intake was 3.6 (standardized serving=248 g (8 oz)) servings/week (1.3 (95% unce...| The BMJ
Although difficulties in nutrition research and formulating guidelines fuel ongoing debate, the complexities of dietary fats and overall diet are becoming better understood, argue Nita G Forouhi and colleagues In past decades, dietary guidance has almost universally advocated reducing the intake of total and saturated fat, with the emphasis shifting more recently from total fat to the replacement of saturated fat with polyunsaturated fats and the elimination of trans fat. These recommendation...| The BMJ
Objectives To study the associations between artificial sweeteners from all dietary sources (beverages, but also table top sweeteners, dairy products, etc), overall and by molecule (aspartame, acesulfame potassium, and sucralose), and risk of cardiovascular diseases (overall, coronary heart disease, and cerebrovascular disease). Design Population based prospective cohort study (2009-21). Setting France, primary prevention research. Participants 103 388 participants of the web based NutriNet...| The BMJ
Internal emails show that the US Food and Drug Administration informs employees leaving for industry jobs that, despite restrictions on post-employment lobbying, they are still permitted to influence the agency. Peter Doshi reports During his final three years at the US Food and Drug Administration the physician scientist Doran Fink’s work focused on reviewing covid-19 vaccines. But a decade after joining the agency Fink had accepted a job with Moderna, the covid vaccine manufacturer, and w...| The BMJ
Objective To investigate the effectiveness of primary covid-19 vaccination (first two doses and first booster dose within the recommended schedule) against post-covid-19 condition (PCC). Design Population based cohort study. Setting Swedish Covid-19 Investigation for Future Insights—a Population Epidemiology Approach using Register Linkage (SCIFI-PEARL) project, a register based cohort study in Sweden. Participants All adults (≥18 years) with covid-19 first registered between 27 December ...| The BMJ
Objective To assess the prospective associations between consumption of ultra-processed food and risk of cancer. Design Population based cohort study. Setting and participants 104 980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort (2009-17). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants’ usual consumption for 3300 different food items. These were categorised according to their de...| The BMJ
Leaked documents show that some early commercial batches of Pfizer-BioNTech’s covid-19 vaccine had lower than expected levels of intact mRNA, prompting wider questions about how to assess this novel vaccine platform, writes Serena Tinari As it conducted its analysis of the Pfizer-BioNTech covid-19 vaccine in December, the European Medicines Agency (EMA) was the victim of a cyberattack.1 More than 40 megabytes of classified information from the agency’s review were published on the dark we...| The BMJ
Two years after launching what officials hailed as a five year flagship project for hunting viruses among wildlife to prevent human pandemics, the US Agency for International Development is shuttering the enterprise. David Willman reports A flagship project for the controversial practice of hunting viruses among wildlife in South East Asia, Africa, and Latin America to prevent human outbreaks and pandemics is being quietly dropped by the United States Agency for International Development (USA...| The BMJ
Patients and doctors expect drug regulators to provide an unbiased, rigorous assessment of investigational medicines before they hit the market. But do they have sufficient independence from the companies they are meant to regulate? Maryanne Demasi investigates Over the past decades, regulatory agencies have seen large proportions of their budgets funded by the industry they are sworn to regulate. In 1992, the US Congress passed the Prescription Drug User Fee Act (PDUFA), allowing industry to...| The BMJ
A BMJ investigation has raised concerns that the VAERS system isn’t operating as intended and that signals are being missed. Jennifer Block reports Three weeks after receiving a second dose of a covid vaccine, Robert Sullivan collapsed at home on his treadmill. An anaesthesiologist in Maryland, USA, he was a particularly fit 49 year old: the week before falling ill, he’d been happily skiing at altitude in Colorado. Sullivan was given a diagnosis of sudden onset pulmonary hypertension, whi...| The BMJ
We need less research, better research, and research done for the right reasons What should we think about a doctor who uses the wrong treatment, either wilfully or through ignorance, or who uses the right treatment wrongly (such as by giving the wrong dose of a drug)? Most people would agree that such behaviour was unprofessional, arguably unethical, and certainly unacceptable. What, then, should we think about researchers who use the wrong techniques (either wilfully or in ignorance), use t...| The BMJ
