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Welcome to the BMJ Open blog. BMJ Open is an open access journal, dedicated to publishing medical research from all disciplines and therapeutic areas.

Find out more about the journal here.

We will be updating the blog with news about the journal, highly accessed papers, press coverage, events and matters of interest in the open access and publishing world, and anything else that catches our eye.

Open Access Week: the next generation

20 Oct, 14 | by sjohar

Open Access Week, a global event now entering its eighth year and running from the 20th – 26th October, is an opportunity for the academic and research community to continue to learn about the potential benefits of Open Access, to share what they’ve learned with colleagues, and to help inspire wider participation in helping to make Open Access a new norm in scholarship and research. BMJ Open takes a closer look at this year’s theme as announced by The Scholarly Publishing and Academic Resources Coalition (SPARC) – “Generation Open”. As explained by SPARC, this theme represents the role of the next generation of Open Access advocates, and also what impact any changes within scholarly publishing have upon the careers of scholars and researchers.

So why do we still need an annual Open Access Week? For a long time, establishing the rules and even the definition of Open Access remained an absolute necessity. The radical departure from traditional publishing models meant that early Open Access advocates had to face legitimate questions over the funding and sustainability of this business model, and address the possibility of its misuse (for example, in so-called ‘vanity publishing’). Such questions do, to a point, remain. Educating the publishing community about Open Access, however, has led to so much support that ideas including Open Access Week (and the Open Access Button) were able to flourish and garner a significant following of their own, enabling future generations to better inform others and build upon these foundations. In fact, the team behind the simple genius of the Open Access Button, where being unable to access a research article because of a paywall can be reported on, are/were largely students – how’s about that for ‘Generation Open’?!

At BMJ Open we welcome submissions from students as well as more established authors. We fully support Open Access Week and as such we’ve created a special landing page with some of our most read Open Access content and are offering a 15% discount on article publishing charges on all our fully open and hybrid titles between the 20th October and the 20th November.

Similarly, the shift by many publishers to Open Access continues unabated with hundreds of Open Access journals launched each year by several global publishers offering gold, green and hybrid Open Access options. Importantly, can and will government and institutional policy reflect this to also benefit future researchers who wish to make their work fully accessible? Well, policies introduced within the last few years are on their side. Relatively recent Open Access mandates from organisations such as Research Councils UK (with grant funding for gold Open Access) and the US government (with mandated deposition in public repositories, i.e. green Open Access) will no doubt be continually revised or perhaps even superseded to accommodate the needs of funders, researchers and publishers.

So, as we enter Open Access Week, what will the future hold for Open Access? Will the benefits still need espousing? Will we even need ‘advocates’ or will the foundations of the movement be so ingrained upon future researchers that the days of defending Open Access be reduced to just memories of a different era? Given initial, and, arguably, continuing scepticism, the fact that we are looking to the next generation of scholars to steer the Open Access movement forward is an achievement in itself. The future milestones they will reach and the innovations they will deliver have not yet been determined. Maybe the foundations will be laid at this year’s Open Access Week, but we wait with anticipation for where the next generation of Open Access leaders will take us.

And we will be ready to support them.

Undergraduate bullying,skirt size and tobacco packaging: Most Read Articles in September

6 Oct, 14 | by flee

This month’s top ten most accessed articles includes a systematic review by Abu Dabrh et al. on the health assessment of commercial drivers, Marston et al’s  study on anal sex and young people is still proving to be a popular read,  Timm’s survey reporting on medical undergraduate students and bullying is a new entry, whilst Lusignan et al discuss patient’s online access to electronic health records.

Rank Author(s) Title
1 Abu Dabrh et al. Health assessment of commercial drivers: a meta-narrative systematic review
2 Marston et al. Anal heterosex among young people and implications for health promotion: a qualitative study in the UK
3 Timm ‘It would not be tolerated in any other profession except medicine’: survey reporting on undergraduates’ exposure to bullying and harassment in their first placement year
4 Rao et al. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis
5 Parand et al. The role of hospital managers in quality and patient safety: a systematic review
6 Baars et al. A 6-year comparative economic evaluation of healthcare costs and mortality rates of Dutch patients from conventional and CAM GPs
7 Lusignan et al. Patients’ online access to their electronic health records and linked online services: a systematic interpretative review
8 Stranges et al. Major health-related behaviours and mental well-being in the general population: the Health Survey for England
9 Fourkala et al. Association of skirt size and postmenopausal breast cancer risk in older women: a cohort study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)
10 Scollo et al. Early evidence about the predicted unintended consequences of standardised packaging of tobacco products in Australia: a cross-sectional study of the place of purchase, regular brands and use of illicit tobacco

 

 

Most read figures are based on pdf downloads and full text views. Abstract views are excluded.

Moderate weekly alcohol intake linked to poorer sperm quality in healthy young men

2 Oct, 14 | by fpearson

Moderate alcohol intake of at least five units every week is linked to poorer sperm quality in otherwise healthy young men, suggests research published in the online journal BMJ Open.

And the higher the weekly tally of units, the worse the sperm quality seems to be, the findings indicate, prompting the researchers to suggest that young men should be advised to steer clear of habitual drinking.

They base their findings on 1221 Danish men between the ages of 18 and 28, all of whom underwent a medical examination to assess their fitness for military service, which is compulsory in Denmark, between 2008 and 2012.

As part of their assessment, the military recruits were asked how much alcohol they drank in the week before their medical exam (recent drinking); whether this was typical (habitual); and how often they binge drank, defined as more than 5 units in one sitting, and had been drunk in the preceding month.

They were also invited to provide a semen sample to check on the quality of their sperm, and a blood sample to check on their levels of reproductive hormones.

The average number of units drunk in the preceding week was 11. Almost two thirds (64%) had binge drunk, while around six out of 10 (59%) said they had been drunk more than twice, during the preceding month.

The analysis showed that after taking account of various influential factors, there was no strong link between sperm quality and either recent alcohol consumption or binge drinking in the preceding month.

But drinking alcohol in the preceding week was linked to changes in reproductive hormone levels, with the effects increasingly more noticeable the higher the tally of units.

Testosterone levels rose, while sex hormone binding globulin (SHBG) fell; similar associations were also evident for the number of times an individual had been drunk or had binge drunk in the preceding month.

Almost half (45%, 553) of the men said that the quantity of alcohol they drank in the preceding week was typical of their weekly consumption.

And in this group the higher the tally of weekly units, the lower was the sperm quality, in terms of total sperm count and the proportion of sperm that were of normal size and shape, after taking account of influential factors.

The effects were evident from 5+ units a week upwards, but most apparent among those who drank 25 or more units every week.
And total sperm counts were 33% lower, and the proportion of normal-looking sperm 51% lower, among those knocking back 40 units a week compared with those drinking 1-5.

Habitual drinking was associated with changes in reproductive hormone levels, although not as strongly as recent drinking, while abstinence was also linked to poorer sperm quality.

This is an observational study, so no definitive conclusions can be drawn about cause and effect. And the researchers point out that the findings could be the result of reverse causation—whereby men with poor quality sperm have an unhealthier lifestyle and behaviours to start with.

But animal studies suggest that alcohol may have a direct impact on sperm quality, they say.
“This is, to our knowledge, the first study among healthy young men with detailed information on alcohol intake, and given the fact that young men in the western world [drink a lot], this is of public health concern, and could be a contributing factor to the low sperm count reported among [them],” they suggest.

And they conclude: “It remains to be seen whether semen quality is restored if alcohol intake is reduced, but young men should be advised that high habitual alcohol intake may affect not only their general health, but also their reproductive health.”

Salty cheese, unprepared graduates and coercive anal sex: most read articles in August

29 Sep, 14 | by fpearson

August’s top ten includes the highly accessed, survey based study by Marston et al. on anal sex amongst young people,  a study on Ecuadorian medical graduates being prepared enough for a year of  compulsory rural service in obstetrics and a popular cross-sectional survey by Hashem et al. of salt content in cheese which concludes that it is a major contributor to salt intake in the UK.

 

Rank Author(s) Title
1 Marston et al. Anal heterosex among young people and implications for health promotion: a qualitative study in the UK
2 Abu Dabrh et al. Health assessment of commercial drivers: a meta-narrative systematic review
3 Hsia et al. Variation in charges for 10 common blood tests in California hospitals: a cross-sectional analysis
4 Todd et al. The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England
5 Rao et al. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis
6 Sánchez del Hierro et al. Are recent graduates enough prepared to perform obstetric skills in their rural and compulsory year? A study from Ecuador
7 Hashem et al. Cross-sectional survey of salt content in cheese: a major contributor to salt intake in the UK
8 Zhang et al. Spatial analysis on human brucellosis incidence in mainland China: 2004–2010
9 Jenkins et al. Effect of a 6-month vegan low-carbohydrate (‘Eco-Atkins’) diet on cardiovascular risk factors and body weight in hyperlipidaemic adults: a randomised controlled trial
10 Howick et al. Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA

 

Most read figures are based on pdf downloads and full text views. Abstract views are excluded.

Skirt size increase linked to 33% greater postmenopausal breast cancer risk

24 Sep, 14 | by flee

Going up a skirt size over a period of 10 years between your mid 20s and mid 50s is linked to a 33% greater risk of developing breast cancer after the menopause, finds a large observational study published in BMJ Open.

Overall weight gain during adulthood is known to be a risk factor for breast cancer, but a thickening waist seems to be particularly harmful, indicating the importance of staving off a midriff bulge, the research shows.

The researchers base their findings on almost 93,000 women taking part in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) in England.

The women were all aged over 50, had gone through the menopause, and had no known breast cancer when they entered the study between 2005 and 2010.

At enrolment they provided detailed information on height and weight (BMI); reproductive health; fertility; family history of breast and ovarian cancer; and use of hormonal contraceptives and HRT, all of which influence breast cancer risk.

They were also asked about their current skirt size, and what this had been in their 20s.

After a monitoring period of three to four years they were asked about continuing use of HRT; their general health; a subsequent diagnosis of cancer; and lifestyle, including how much they smoked and drank.

Most of the women were white, educated to university degree level, and overweight at the point of study entry, with a BMI of 25-26.

During the monitoring period, 1090 women developed breast cancer, giving an absolute risk of just over 1%. As expected, infertility treatment, family history of breast/ovarian cancer, and use of HRT were all significantly associated with a heightened risk of being diagnosed with the disease, while pregnancies were protective.

But after taking account of other influential factors, increases in skirt size emerged as the strongest predictor of breast cancer risk.

At the age of 25, the women’s average skirt size had been a UK 12 (US 8; Europe 40-44), and when they entered the study at the average age of 64, it was a 14 (US: 10; Europe 42-46). Skirt size increased over the course of their adult lives in three out of four of the women.

The analysis revealed that going up one skirt size every 10 years was associated with a 33% greater risk of developing breast cancer after the menopause; going up two skirt sizes in the same period was associated with a 77% greater risk.

The researchers estimate that the five year absolute risk of postmenopausal breast cancer rises from 1 in 61 to 1 in 51 with each increase in skirt size every 10 years. Adding BMI to the calculations did not significantly improve the prediction of risk.

As this is an observational study, no definitive conclusions can be drawn about cause and effect, and there is likely to have been some variation in skirt sizing over the years, say the researchers.

But an expanding waistline has been linked to other cancers, including those of the pancreas, lining of the womb, and ovaries, they point out, possibly because midriff fat is more harmful.

“Although the exact mechanism of these relationships need to be better understood, there is a suggestion that body fat around the waist is more metabolically active than adipose tissue elsewhere,” they write, adding that extra fat is known to boost levels of the female hormone oestrogen, on which many breast cancer cells rely for fuel.

 

Update: Tuesday 30th September

Clarification: skirt size increase linked to 33% greater postmenopausal breast cancer risk

[Association of skirt size and postmenopausal breast cancer risk in older women: a cohort study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) Doi 10.1136/nmjopen-2014-005400]The release issued last week didn’t make it clear that the heightened breast cancer risk was associated with a skirt size increase every 10 years between the mid 20s and mid 60s, rather than one skirt size increase over 10 years during that timeframe.

We do our very best to ensure that the releases we issue are accurate and clear, and have in place a comprehensive review process. But on this occasion it didn’t work as well as it should have done, for which we can only apologise.

Gun deaths twice as high among African Americans as white citizens in US

18 Sep, 14 | by fpearson

Gun deaths are twice as high among African Americans as they are among white citizens in the US, finds a study of national data, published in the online journal BMJ Open.

But the national figures, which have remained relatively steady over the past decade, mask wide variation in firearms deaths by ethnicity and state, the findings show.

The researchers looked at all recorded gun deaths across the USA between 2000 and 2010, to include murders, suicides, and unintentional shooting, using data from the Injury Statistics Query and Reporting System.

Hawaii recorded the lowest rate of gun deaths at 3.02 per 100 000 citizens, while the District of Columbia topped the league table at 21.71 per 100 000. Rates rose in Florida and Massachusetts, largely owing to more gun deaths among people of white and non-Hispanic ethnicities, and an increase in the gun related murder rate.

Firearm deaths fell in Arizona, California, Illinois, Maryland, Nevada, New York, North Carolina, and the District of Columbia, mostly among people of Hispanic and African-American ethnicities.

Nationally, unintentional firearm deaths fell significantly, but the number of gun related murders and suicides remained unchanged. In California, the fall in gun deaths was largely attributable to a reduction in suicides.

The national rate of gun deaths was twice as high among African-Americans as it was among people of white ethnicity. But these deaths fell in seven states and DC, compared with comparable falls in only four states among people of white ethnicity. Similarly, rates of gun deaths among Hispanics fell in four states, and rose among non-Hispanics in nine states.

The authors point out that the patterns of gun deaths they found didn’t seem to reflect firearm control efforts and legislation in individual states. Some of the states with the most stringent gun laws showed an expected fall in firearm deaths, while some with strong gun control laws reported an increase.

For example, The Brady Center to Prevent Gun Violence ranked Massachusetts the third most restrictive state for firearm legislation, while Florida was ranked 40th in 2011.

After Massachusetts passed its tough law restricting gun use in 1998, gun ownership rates plummeted, yet violent crimes and murders increased, possibly because of an influx of firearms from neighbouring states with weaker firearm laws, suggest the authors. And in Florida gun deaths rose, despite an overall fall in violent crime over the same period.

Clamping down on gun violence may require a broader approach, including curbing firearm availability and ramping up interstate border controls on the transport of firearms, the authors conclude.

Plain cigarette packs don’t hurt small retailers or boost trade in illicit tobacco

28 Aug, 14 | by flee

Plain packs for tobacco products don’t hurt small retailers, flood the market with very cheap cigarettes, or boost the trade in illicit tobacco, finds research on the early experience of the policy in Australia, and published in journal BMJ Open.

The findings suggest there is no evidence for these particular arguments against the policy, put forward by the tobacco industry, say the researchers.

Australia was the first country in the world to introduce standardised packaging for tobacco products in December 2012. New Zealand, Ireland, and the UK are currently considering similar legislation.

The researchers wanted to find out if the policy would deter people from buying their tobacco from small independent retailers, prompt a rise in the availability of cheap products sourced from Asia, and increase the use of illicitly traded tobacco, as predicted by the tobacco industry.

They therefore quizzed adult smokers on the phone about their tobacco purchasing habits a year before the plain packaging policy was introduced in 2011; during roll-out in 2012; and one year after implementation.

All participants were already taking part in an annual representative population survey about smoking and health in the Australian state of Victoria, which yielded around 4000 interviews in total for each of the years.

The researchers wanted to know if there had been any changes in the proportions of people buying from supermarkets rather than small independent retailers, and whether smokers had switched to very cheap cigarettes sourced from Asia or illicit unbranded tobacco.

In all, responses were received from just under 2000 smokers. They showed no change in the places smokers usually bought their tobacco from between 2011 and 2013.

Almost two thirds of respondents said they bought their tobacco from supermarkets in 2011 (65.4%) and in 2013 (65.7%). Similarly, there was no fall in the proportion who bought from small independent retailers: just over 9% said they bought their tobacco in these outlets in 2012 and just over 11% said they did so in 2013.

Use of low cost Asian brands was low, and scarcely changed between 2011, when it was 1.1%, and 2013, when it was 0.9%. And use of illicit unbranded tobacco didn’t increase either: this was 2.3% in 2011, and 1.9% in 2013.

In 2013, just 2.6% of cigarette smokers said they had bought one or more packs that did not comply with the new regulations—and so may have been contraband— within the preceding three months.

And 1.7% said they had bought from informal sources, such as a market stall or the back of a van, on one or more occasions over the past 12 months.

The researchers admit that the surveys were restricted to the State of Victoria where only a quarter of the population of Australia lives, so may not be applicable elsewhere.  And any potential unintended consequences of the standardised packaging legislation should continue to be monitored, they say.

But they conclude: “In the meantime, this study provides no evidence of the unintended consequences of standardised packaging predicted by opponents [having] happened one year after implementation.”

BMJ Open now publishes cohort profiles

22 Aug, 14 | by Richard Sands, Managing Editor

 

BMJ Open currently publishes articles reporting research results or study protocols. We have now expanded our scope to include cohort profiles, articles that describe major, ongoing research cohorts.

What’s the difference between a protocol, a cohort profile and a research paper?
Detailed information about cohort profiles is in our instructions for authors. In brief, cohort profiles will describe large, collaborative prospective studies that identify a group of participants and follow them for long periods. They will usually be population based, with sufficient funding to ensure their intended lifespan, and the original investigators must welcome wide use of the datasets beyond their own research group.

We will publish cohort profiles to provide information on a cohort’s establishment that goes beyond what can reasonably be described in the methods section of a research paper and to advise other researchers of existing datasets and opportunities for collaboration.

If a study has yet to begin recruiting participants, is still recruiting or is still collecting baseline data, please submit the study protocol. If you have completed baseline recruitment and have at least baseline data to publish, we would consider this a cohort profile as long as the cohort meets our other requirements.

We publish protocols to alert researchers to forthcoming research and to explain how specific research questions will be answered. Research papers are traditional results papers and should address a specific research question. Many cohort studies are conducted at a single institution by a single research group with no plans to answer further questions. Here “cohort study” is a research method. We welcome protocol and results papers for these studies but would not consider cohort profiles.

Why publish cohort profiles?
When presented with cohort studies to review, editors, peer reviewers and readers often think “exactly how were patients recruited? how representative were they of the wider population? were the questionnaires used to gather information on diet reliable?” and so on; things that too often are not well enough reported in research papers.

There is a clear advantage to publishing detailed profiles of ongoing cohort studies in an open access journal like BMJ Open, so anyone interested can easily access them when planning or appraising studies that arise from them. We hope to generate an ongoing database for answering many different research questions.

Will cohort profiles be peer-reviewed?
Cohort profiles will be externally peer-reviewed as normal, regardless of the cohort’s age or funding status and article publishing charges will apply as for research papers.

Anal sex between young men and women often seems coercive and painful

13 Aug, 14 | by flee

Anal sex between young men and women often seems coercive and painful, suggests research published in BMJ Open.

Feedback from young people reveals an oppressive culture around anal sex, with some young men apparently neglecting or not caring about young women’s consent or pleasure – both when they have anal sex and when they talk about it with their friends.

More open discussion is needed to challenge the culture and attitudes surrounding anal sex between young men and women—a subject that people often find  difficult to talk about in many social contexts, say the researchers.

They interviewed 130 16-18 year olds from diverse social and economic backgrounds living in different parts of the country: London; an industrial city in the north; and a rural area in the south west.

The interviews explored the range and meaning of different sexual practices, and included nine group and 71 individual in-depth discussions in 2010, and further interviews of 43 of the in-depth interviewees in 2011.

The group discussions focused on what sexual practices participants had heard of, what they felt about them, and whether they thought their peers would engage in them—and if so, under what circumstances.

During the in-depth discussions, interviewees were also asked what sexual practices they had engaged in, under what circumstances, and how they felt about them. Young people described‚ a culture where men compete to have anal sex with women, even if they expect women to find it painful.

Women also said their male partners repeatedly asked them for anal sex. And their accounts suggest that they had sometimes ended up having anal sex without giving their explicit consent. “Currently, this apparently oppressive context, and indeed the practice of anal heterosex itself, appears to be largely ignored in policy and in sex education for this young age group,” write the researchers.

The interviewees sometimes said that young men wanting to copy what they saw in porn, explained why they had anal sex, but the feedback suggests that other factors are more important, say the researchers.

These include a lack of concern about getting consent, or the levels of pain female partners might experience, and competitiveness among young men to have anal sex with women. ‘People must like it if they do it’ was also given as an explanation by those who hadn’t experienced anal sex, which, the researchers point out, was made alongside the seemingly contradictory expectation that women would find it painful.

Not all men coerce their partners, the researchers emphasise. Some young women may wish to have anal sex, and both partners may find it pleasurable, they add.

But the findings suggest that teachers, parents, and wider society need to talk more openly about anal sex with young people, particularly the importance of “mutuality” – where both partners listen and respond to each others’ desires and concerns, they write.

Attitudes, such as the inevitability of pain for women, or the failure to recognise or reflect on potentially coercive behaviour, seem to go unchallenged, which risks coercion emerging as a dominant element of anal sex, they add.

Cheese still laden with salt, despite many products meeting reduction targets

6 Aug, 14 | by fpearson

The salt content of cheese sold in UK supermarkets remains high, despite many products meeting the recommended government targets on salt reduction, finds research published in the online journal BMJ Open.

And salt content varies widely, even within the same type of cheese, the findings show, prompting the researchers to call for much tougher targets on salt lowering.

A high dietary salt intake is linked to high blood pressure, which is a risk factor for stroke, heart attacks, heart failure and kidney disease. It also increases the risk of stomach cancer and osteoporosis, and is indirectly linked to obesity.

Salt reduction is widely recognised to be one of the most cost effective ways of improving public health, and at the 66th World Assembly, all countries unanimously agreed to cut their salt intake by 30% towards a target of 5 g/day by 2025.

The current recommended dietary salt intake in the UK is 6 g/day, but is widely exceeded, according to dietary surveys. Cheese is a major contributor to dietary salt intake, with the average person consuming 9 kg of cheese every year.

The researchers analysed the salt content (g/100 g) of 612 different cheeses produced in the UK or imported from overseas and sold in the seven major UK supermarket chains in 2012. This information was collected from the product packaging and nutritional information panels.

In general, salt content was high, averaging 1.7 g/100 g of cheese. But salt levels varied widely – and not only among different types of cheese, but also within the same type.

Halloumi and imported blue cheese contained the most salt (2.71 g/100 g), while cottage cheese contained the least (0.55 g/ 100 g).

Among the 394 cheeses with salt reduction targets, most (84.5%) had already met them for 2012.

Cheddar and cheddar-style cheeses are the most popular/best-selling lines and 250 of these products were included in the analysis.

On average, salt content tended to be higher in branded (1.78 g/100 g) than in supermarket own label (1.72 g/ 100 g) cheddar and cheddar-style cheeses.

And more of the supermarket own-label cheeses in this category met the 2012 target for salt reduction than did the branded products: 90% compared with 73%.

“Our finding of a high salt content in cheeses sold in the UK is similar to those observed in the USA, Australia, France, Belgium, Canada, New Zealand, South Africa, and Brazil, showing that high levels of salt in cheese is a global challenge,” write the authors.

But they suggest that UK salt reduction targets could be more ambitious.

“The results indicate that much larger reductions in the amount of salt added to cheese could be made, and more challenging targets need to be set,” they conclude.