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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.

Few UK family doctors seem to be treating obesity/overweight appropriately

12 Jan, 15 | by flee

Patient health records suggest limited evidence of weight management in primary care

Few UK family doctors seem to be treating overweight/obesity appropriately, with some not treating it all, suggests an analysis of patient records published in BMJ Open.

The researchers scrutinised the anonymised health records of more than 90,000 obese and overweight adults, whose data had been entered into the Clinical Practice Research Datalink (CPRD) between 2005 and 2012.

The CPRD is the largest primary care database in the world, and contains the health records of over 5% of the UK population, submitted by 680 general practices.

The researchers looked at all the weight management options provided, including lifestyle advice, specialist referrals, and prescription of obesity drugs.

The average age of the patients was 56. Some 60% were overweight and 40% were obese, including 5% who were morbidly obese with abody mass index (BMI) of 40kg/m2 or more.

Between 2005 and 2012, no weight management intervention was recorded for most (90%) of the overweight patients. Many practices didn’t record any interventions at all for obese patients during this time.

A weight management intervention was more likely to be recorded in the health records of obese patients, but it was still not documented in more than 80% of those with simple obesity.

Patients with severe obesity were more than three times as likely to be offered weight management, but this was still not recorded in the case notes of over half (59%) of them.

Lifestyle change, including dietary advice and exercise, was the most common weight management plan offered in all but the most severely obese patients, for whom drug treatment was the most commonly recorded intervention.

And there was little documented evidence that progress on weight loss had been tracked after an intervention had been introduced.

Monitoring progress on weight loss in the first year after an intervention was most frequently recorded in the case notes of patients who had been referred to specialist services (34%). But it was only recorded for one in five of those given lifestyle advice and one in four of those prescribed an obesity drug.

There was no evidence that outcomes were being monitored for any intervention after five years.

Factors associated with weight loss intervention included older age, type 2 diabetes, and depression, with morbid obesity the strongest predictor of weight management provision. Women, former smokers, and those from disadvantaged backgrounds were also more likely to be treated for overweight/obesity.

The researchers point out that the findings might simply be the result of poor documentation, and that brief advice may have been offered, but not recorded in the patient’s notes.

On the other hand, the findings “might also indicate a lack of patient access to appropriate body weight management interventions in primary care due to a lack of clinician awareness or confidence in treating obesity,” they write.

The reasons for this might include too little time to tackle the issue in consultations, doubts about the success of weight loss attempts, greater use of drugs to treat obesity related risk factors and disease, and possibly ‘normalisation’ of excessive body weight.

Nevertheless, they conclude: “The results of this study suggest that primary care interventions given to patients with the aim of reducing weight are underutilised, and that follow up to determine their success is poor.”

And they emphasise: “The growing burden of obesity on primary healthcare services and lack of long term follow up on the effectiveness of these treatments supports the use of structured recording of interventions for weight management.”

Antipsychotics, vitamin D and alcohol consumption: Most read articles in December

5 Jan, 15 | by flee

December’s most read articles include a cohort study by Marston  et al. on the prescribing of antipsychotics in UK primary care. We also have a paper which focuses on the impact of Australia’s introduction of tobacco plain packs by Dunlop et al., as well as featuring articles by Shi et al and their paper on how equity is addressed in clinical practice guidelines, and Caulfield et al’s paper on representations of the health value of vitamin D supplementation in newspapers.

 

Rank Author(s) Title
1 Marston et al. Prescribing of antipsychotics in UK primary care: a cohort study
2 Dunlop et al. Impact of Australia’s introduction of tobacco plain packs on adult smokers’ pack-related perceptions and responses: results from a continuous tracking survey
3 Anderson et al. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis
4 Yri et al. Cognitive function in idiopathic intracranial hypertension: a prospective case–control study
5 Amer et al. Effects of dietary sodium and the DASH diet on the occurrence of headaches: results from randomised multicentre DASH-Sodium clinical trial
6 Bull et al. Are interventions for low-income groups effective in changing healthy eating, physical activity and smoking behaviours? A systematic review and meta-analysis
7 Shi et al. How equity is addressed in clinical practice guidelines: a content analysis
8 Caulfield et al. Representations of the health value of vitamin D supplementation in newspapers: media content analysis
9 King et al.  Redesigning the ‘choice architecture’ of hospital prescription charts: a mixed methods study incorporating in situ simulation testing
10 Jensen et al. Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones; a cross-sectional study among 1221 young Danish men

 

 

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

Concerns raised about variable performance of some UK personal use breathalysers

20 Dec, 14 | by Richard Sands, Managing Editor

 

Ability of devices to detect potentially unsafe alcohol levels prompts questions about regulatory process

The ability of some breathalysers widely sold to the UK public to detect potentially unsafe levels of breath alcohol for driving, varies considerably, reveals research published in BMJ Open.

The findings call into question the regulatory process for approving these sorts of devices for personal use, say the researchers, particularly as false reassurance about a person’s safety to drive could have potentially catastrophic consequences.

The researchers compared the diagnostic accuracy (sensitivity) of three personal use breathalysers to detect alcohol levels at or over the UK legal limit in 208 adults, who were drinking in college bars and pubs in the centre of Oxford, England, in late 2012 and early 2013.

At least 20 minutes after drinking, participants were asked to test the single use Alcosense Single (100 people) or the comparable Dräger Alco-check (108 people), as well as the digital multi-use Alcosense Elite, one minute apart, in random order.

These devices are widely available in leading pharmacies and other major retailers, as well as online.

The participants, whose average age was 20, estimated that they had drunk an average of 6 units of alcohol (46 g) that evening, ranging from 1 to 25 units (8-204 g).

The readings from the three devices were compared with those obtained from a Dräger Alcotest 6510 device, which is used by the police to check drivers’ legal alcohol limits at the roadside.

The legal limit for driving in the UK is 35 ug/100 ml of breath alcohol, and almost one in five (18%; 35) of those tested were at or over this limit, when the police breathalyser was used.

Compared with the police breathalyser, the digital Alcosense Elite had a sensitivity of around 90%, while the Dräger AlcoCheck had a sensitivity of just under 95%, in the main analysis.

But even a sensitivity of 95% means that around 1 in 20 people over the legal driving limit for alcohol would be falsely reassured, say the authors: “We question whether even this would be sufficient sensitivity to assess safety to drive,” they write.

And the Alcosense Single had an even lower sensitivity of only 26%, compared with the police breathalyser, meaning that the device would pick up only around one in four people over the legal limit, shortly after drinking.

And when participants, rather than the researchers, interpreted the results of this device, the sensitivity fell further to 17%.

The researchers acknowledge that the study has limitations. For example, the manufacturers of the Alcosense Elite stipulate that it should be used 30 minutes after drinking, when it was used 20 minutes afterwards in this study, so this may have affected the results for this breathalyser.

And the profile of the drinkers in the study may not be typical of those who are likely to buy breathalysers for personal use, they add. Similarly, the researchers didn’t test the accuracy of the devices when used the day after drinking.

But they say: “Our research suggests that at least some personal breathalysers available for sale to the public are not always sufficiently sensitive to test safety to drive after drinking alcohol, where use of inaccurate information from breathalysers, thought to be accurate, could have catastrophic safety implications for drivers.”

They add: “The fact that these devices are sold in well-established pharmacies, including national chains, does not guarantee sufficient accuracy for safe use.”

Furthermore, regulatory approval, signified by the CE or NF markings, doesn’t appear to have anything to do with accuracy, raising wider questions about how these markings may be perceived by consumers, they point out.

“Our research raises worrying questions about the level of scrutiny that medical tests intended for sale to the public undergo in Europe, and raises wider concerns about how diagnostic accuracy, in particular, is evaluated,” they conclude.

 

Less than half of UK prescriptions for antipsychotics issued for main licensed conditions

18 Dec, 14 | by flee

Less than half of UK prescriptions for antipsychotic drugs are being issued to treat the serious mental illnesses for which they are mainly licensed, reveals research published in BMJ Open.

Instead, they may often be prescribed ‘off label’  to older people with other conditions, such as anxiety and dementia, despite the greater risk of potentially serious side effects in this age group, the findings indicate.

The researchers analysed family doctors’ prescribing patterns for first and second generation antipsychotic drugs across the UK between 2007 and 2011, using data submitted to The Health Improvement Network (THIN) database.

THIN is a medical research database of a representative sample of anonymised electronic patient records.

Antipsychotic drugs are licensed for serious mental illness accompanied by psychotic episodes, such as schizophrenia, delusional disorders, and bipolar disorder. They are sometimes recommended for complex cases of depression or for short term use in mental health crises.

The researchers focused on the three most commonly prescribed first (haloperidol, chlorpromazine, trifluoperazine) and second (olanzapine, quetiapine, risperidone) generation antipsychotics, looking at the average daily dose, as well as the duration of the treatment.

Between 2007 and 2011, almost 48,000 people were prescribed these drugs. Almost 14,000 were prescribed first generation antipsychotics, almost 28,000 second generation antipsychotics, and almost 6000 were prescribed both.

The prescribing rate was significantly higher in women than in men, and people aged 80 and above were more than twice as likely to be treated with an antipsychotic as those aged 40-49.

Those living in areas of deprivation were more than three times as likely to be prescribed one of these drugs as those living in areas of affluence.

These patterns were mostly the same, irrespective of the generation of drug prescribed.

One in three prescriptions was for an older generation antipsychotic, but less than half of those prescribed them had been diagnosed with a psychotic illness/bipolar disorder.

Not everyone prescribed a second generation drug had been diagnosed with a psychotic illness/bipolar disorder either.  Only around a third (36%) of those prescribed quetiapine and just over six out of 10 prescribed olanzapine had one of these diagnoses.

Among people without these diagnoses, antipsychotics were often prescribed for anxiety, depression, dementia, sleep and personality disorders.

For example, risperidone was prescribed for anxiety in 14% of cases; depression without psychoses in 22% of cases; dementia in 12% of cases; sleep disorders in 11%; and personality disorder in 4% of cases.

When prescribed for these conditions, doses tended to be lower and of shorter duration—except for those being treated for hyperactivity (ADHD) and dementia, where these drugs tended to be prescribed for relatively long periods.

Second generation antipsychotics are not recommended for dementia, because of the increased risk of stroke and death from all causes associated with them in this age group, point out the researchers.

“Reducing the potential harm associated with antipsychotics in dementia has been emphasised as a priority by organisations such as the Department of Health in England and the US Food and Drug Administration,” they write.

And they go on to say: “Our findings suggest that further effort is required to decrease primary care antipsychotic prescriptions in dementia, and that assessing time trends in antipsychotic prescribing in this group is an important area for future research.”

Erik Martin: Author Profile

21 Nov, 14 | by flee

We are happy to introduce a new feature called Author Profiles where we interview BMJ Open authors to find out more about them and their work.

For our first author profile, we spoke to Erik Martin from Deakin University, Australia, to find out more about his research and his thoughts on Open Access. Erik is first author of the article ‘Exploring the implementation of the framework convention on tobacco control in four small island developing states of the Pacific: a qualitative study‘ which has recently won the CAPHIA 2014 Team Award for Excellence and Innovation in Public Health Research.

We welcome our readers’ thoughts and suggestions on this new feature. If you wish to suggest any questions to ask for future profiles you can do so by commenting at the end of the post.

-Tell us about yourself 

I started my career in science to pursue a career which involved making positive changes for society. I chose public health and health promotion as it is a discipline where there is great need and it is possible to make a difference for the betterment of quality of life for people at a population level. Tobacco control always interested me due to the sheer numbers of people it affects despite the fact that it is a human creation and evidence of its harms dates back many decades.

-What are the messages we should take from your paper?

There are a few:

– Tobacco as a public health issue is very far from being over.

– There are many ways in which tobacco control policies can be shaped, from the downstream in terms of legislation and its enforcement, to the upstream in terms of a country’s social, political, economic and cultural environment – just like health itself.

– As a result of the previous point, there are many potential points in which there can be a deviation from what a government says it will do (or what it intends to do) and what can happen on the ground once implemented.

– The Pacific Islands, despite having challenging environments for health policy, are making strong progress towards implementing tobacco control policies and thereby reducing the harm associated with the tobacco epidemic in the region.

-And what limitations should we be aware of?

The main limitation would be that of complexity. Given it is based on the primarily qualitative research on a highly complex issue that is shaped by many forces and is context-dependent and not reproducible in a controlled environment. That being said, this is also a strength as it explores this real world context.

-If you wanted to repeat your study, what would you be looking out for that may have taken you by surprise the first time around?

The time it takes to plan for and conduct research in far away places.

-What impact will your study have on the field?

It adds a level of detail that isn’t common in the public realm, especially in small and developing island nations such as those in the Pacific. It also draws upon political theory, which tends to be under-utilised in public health despite policy often being labelled a barrier to achieving public health goals.

-What still needs to be done in the field?

Many things in many different areas – too many to mention! In tobacco control specifically, there’s a lot more qualitative and quantitative research needed on the implementation and effectiveness of policies that many countries have sought to implement over the last decade.

-What feedback has your article generated?

It has generated positive feedback especially from relevant stakeholders in the region who are interested in and tackling the issues it presents.

-Congratulations on the CAPHIA 2014 Team Award for Excellence and Innovation in Public Health Research award! Tell us about it. How did it feel to win? What does this mean for your research?

The journey of a PhD can sometimes be seen as an insular and quiet one that seldom achieves recognition far beyond the research team, but in this case it was fantastic to receive an award and be recognised amongst some very distinguished peers in public health. It was an honour to receive this award and as well as giving me some great assurance, I believe it brings more welcomed attention to the issues my research aims to address.

-Had you heard of Open Access before submitting to BMJ Open? What are your thoughts about Open Access?

Yes I had – it’s a rather interesting new world for academia which is a field of great tradition. I think Open Access is a great opportunity for earlier career researchers to get their research out there in an increasingly competitive environment. That being said, it also has its challenges as there are several unknowns and it has changed the publishing landscape so rapidly.

-If funding was no object what would be your dream study to run?

I’d like to explore the in-depth experiences of more countries in relation to tobacco control policy. I’d also like to look into what is happening at community levels in extremely remote places that may not have access to the wealth of expertise, resources and information that we do in countries like Australia. Another area that would be interesting (though it’d be more than funding that is the barrier) would be to explore what has gone on behind the closed doors of the tobacco industry in order to shape public health policies.

-What advice would you offer to anyone starting out in the field?

Be patient and diligent and your hard work will be worth it.

-What’s next for you (personally and professionally)?

I’ve recently acquired an Associate Lecturer in Public Health position at the Deakin University School of Medicine, which has been a great experience so far in looking at the teaching side of things and developing my career as an academic. Nonetheless I’m simultaneously interested in continuing my research in tobacco control and perhaps following up on some of the Pacific Island countries I visited in 2011 to see how things have progressed. I’m also interested in exploring tobacco control policy at home in Australia, particularly amongst minority populations which still have very high tobacco use prevalence rates in comparison to the relatively low rate in the general population.

 

Alcohol vs semen quality, Tamiflu trials and mindfulness: The Most Read Articles in October

7 Nov, 14 | by fpearson

October’s most read articles include a cross-sectional study by Jensen et al. on the association of habitual alcohol consumption and reduced semen quality in young men. We also have a report on the risk of bias in industry-funded oseltamivir (Tamiflu) trials by Jefferson et al., and the ever popular paper on a web-based mindfulness course for the relief of anxiety and depression by Krusche et al. has re-entered our top 10.

 

Rank Author(s) Title
1 Abu Dabrh et al. Health assessment of commercial drivers: a meta-narrative systematic review
2 Jensen et al. Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones; a cross-sectional study among 1221 young Danish men
3 Marston et al. Anal heterosex among young people and implications for health promotion: a qualitative study in the UK
4 Rao et al. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis
5 Jefferson et al. Risk of bias in industry-funded oseltamivir trials: comparison of core reports versus full clinical study reports
6 Cobb et al. Diffusion of an evidence-based smoking cessation intervention through Facebook: a randomised controlled trial study protocol
7 Kalesan et al. State-specific, racial and ethnic heterogeneity in trends of firearm-related fatality rates in the USA from 2000 to 2010
8 Stranges et al. Major health-related behaviours and mental well-being in the general population: the Health Survey for England
9 Krusche et al. Mindfulness online: an evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression
10 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)

 

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

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.