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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.

Salt, eating disorders and the impact of funding deadlines: most read articles in April

6 May, 14 | by flee

This month’s most read article was Krijthe et al.’s study on non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation. Newly-published papers in the top ten most read include He et al.’s paper on salt reduction in England, and it’s relationship to blood pressure, stroke and ischaemic heart disease mortality and also Räisänen et al.’s paper on the role of gendered constructions of eating disorders in delayed help-seeking in men. Also proving popular for another month, is the cross sectional study on symptoms related to GSM radiation from mobile phone bases by Gómez-Perretta et el.

 

Rank Author(s) Title
1 Krijthe et al. Non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation: a population-based follow-up study
2 He et al. Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality
3 Herbert et al. The impact of funding deadlines on personal workloads, stress and family relationships: a qualitative study of Australian researchers
4 Gómez-Perretta et al. Subjective symptoms related to GSM radiation from mobile phone base stations: a cross-sectional study
5 Räisänen et al. The role of gendered constructions of eating disorders in delayed help-seeking in men: a qualitative interview study
6 Rao et al. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis
7 Wager et al. Awareness and enforcement of guidelines for publishing industry-sponsored medical research among publication professionals: the Global Publication Survey
8 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 
9 Larney et al. Opioid substitution therapy as a strategy to reduce deaths in prison: retrospective cohort study
10 Krusche et al. Mindfulness online: an evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression

 

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

 

Very overweight teens face stigma, discrimination, and isolation

30 Apr, 14 | by fpearson

Very overweight teens face a social world of stigma, discrimination, and isolation because of their body size, reveals an analysis of their views, published in the online journal BMJ Open.

And they have to overcome many other additional barriers to lose weight, making it especially hard for them to shed the pounds, the findings suggest.

The latest figures suggest that roughly two out of ten 11 to 15 year olds in England are classified as obese. But evidence on what young people think about larger body size is hard to come by.

The researchers therefore scanned 18 research databases in the fields of health, public health, education, social science and social care; 54 relevant websites; and six key journals, looking for published data on young people’s views of body size.

They focused on UK teens between the ages of 12 and 18, all of whom had taken part in in-depth or semi-structured interviews and/or focus groups, between 1997 and 2010. They excluded any research dealing only with eating disorders.

They found 30 relevant studies, involving just over 1400 12-18 year olds. Young people had talked about three main areas: general and societal perceptions of differing body sizes; what it was like to be overweight; and what it was like to try and lose excess weight.

The analysis revealed that young people of all body sizes in the UK predominantly felt that the social implications of a large body size were more important than the health consequences.

In general, young people thought that individuals were responsible for their own body size. They associated excess weight with negative stereotypes of laziness, greed, and a lack of control. And they felt that being overweight made an individual less attractive and opened them up to bullying and teasing.

Young people who were already overweight tended to blame themselves for their size. And those who were classified as very overweight said they had been bullied and physically and verbally assaulted, particularly at school. They endured beatings, kickings, name-calling, deliberate and prolonged isolation by peers, and sniggering/whispering.

Some young people described coping strategies, such as seeking out support from others. But the experiences of being overweight included feeling excluded, ashamed, marked out as different, isolated, ridiculed and ritually humiliated. Everyday activities, such as shopping and socialising, were difficult.

Overweight young people described others’ responses to their appearance as a key factor in loss of confidence, anxiety, loneliness and depression, and a vicious circle of subsequent comfort eating and further weight gain.

The level of ridicule they faced made it hard for them to take part in exercise to lose weight, but so too did breathlessness on exertion and other complications of overweight, such as asthma.

And the ready availability of calorie dense foods, poor dietary advice, and constant pressure to lose weight were cited as other barriers to achieving a healthy weight.

Few studies asked young people what would help them cope better with these pressures, but less judgemental responses from health professionals, and the support and encouragement of family and friends were seen as important.

“The perspectives of young people in the UK, when synthesised across the spectrum of body sizes, paint a picture of a stigmatising and abusive social world,” write the authors.

And they add: “Approaches that merely educate and admonish individuals about lifestyles and being overweight are not only insufficient but also potentially counter-productive.”

Lower salt intake likely to have had key role in plummeting cardiovascular disease deaths in past decade

14 Apr, 14 | by flee

The 15% fall in dietary salt intake over the past decade in England is likely to have had a key role in the 40% drop in deaths from heart disease and stroke over the same period, concludes research published in BMJ Open.

But average intake across the nation is still far too high, warn the authors. And much greater effort is needed to curb the salt content of the foods we eat, they insist.

Dietary salt is known to increase blood pressure, which is itself a major risk factor for heart disease and stroke.

The authors base their findings on an analysis of data from more than 31,500 people taking part in the Health Survey for England for the years 2003—when initiatives to curb population salt intake began across the UK—2006, 2008, and 2011.

This survey involves a random representative sample of the adult population of England living in private households, and includes information on diet and blood pressure measurements.

The average population salt intake was calculated from urine collected over a 24 hour period in almost 3000 people who were part of the National Diet and Nutrition Survey between 2003 and 2011. This survey involves random samples of the population.

During this period, nationally collated figures show that stroke deaths fell by 42% while deaths from coronary heart disease dropped by 40% in England.
Similarly, the prevalence of several risk factors for cardiovascular disease also fell, including average cholesterol, blood pressure (3/1.4 mm Hg), and smoking, although average weight (Body Mass Index) rose. And fruit and vegetable consumption rose slightly.

With the exception of increasing weight gain, all these trends, along with better treatment of cardiovascular disease and its risk factors would have probably contributed to the dramatic falls in stroke and heart disease deaths, explain the authors.

But daily salt intake fell by an average of 1.4 g during this period, amounting to a drop of 15%. And among those not taking blood pressure lowering drugs, average blood pressure still fell by 2.7/1.1 mm Hg, even after taking into account other influential factors.

Salt intake was not measured in this particular group, but the substantial fall in salt consumption in the population samples suggests that the decrease in blood pressure would largely have been attributable to less dietary salt rather than to medication, say the authors.

And previously published research suggests that the contribution of blood pressure lowering drugs to population falls in blood pressure is relatively small, they say.

The authors caution that they used several sets of data, involving different people, so were not able to track changes at the individual level, nor were they able to account for physical activity levels.

Nevertheless, they conclude: “The reduction in salt intake is likely to be an important contributor to the falls in blood pressure in England from 2003 to 2011. As a result, the decrease in salt intake would have played an important role in the reduction in stroke and ischaemic heart disease mortality during this period.”

And they go on to say that despite considerable progress, 70% of the adult population is still eating more than the recommended 6g/day, with 80% of intake coming from processed foods.

“Therefore, continuing and much greater efforts are needed to achieve further reductions in salt intake to prevent the maximum number of stroke and heart disease deaths,” they urge.

The perception that eating disorders are a women’s problem delays men getting help

8 Apr, 14 | by fpearson

The widespread perception that only women have eating disorders is preventing men with these problems from getting the help and support they need, indicates a small study published in the online journal BMJ Open.

Estimates suggest that around 1 in 250 women and 1 in 2000 men in the UK have anorexia nervosa, one of the four recognised types of eating disorder – the others being bulimia nervosa; binge eating disorder; and eating disorder not otherwise specified (EDNOS).

The incidence of eating disorders is on the rise among men, with some estimates suggesting that men now account for one in four cases. But poor recognition of the signs and symptoms of eating disorders in men is likely to mean that the true prevalence may be higher, still, say the authors.

They interviewed 39 young people between the ages of 16 and 25, 10 of whom were men, about their experiences of eating disorders, in a bid to gauge the impact of gender on diagnosis, treatment, and support.

The interviews were carried out to inform an online patient resource (Healthtalkonline), and participants were recruited from patient organisations, social media, and healthcare professionals.

Four themes emerged from the interviews: recognition of early signs and symptoms; recognition of the problem; getting help; and initial contact with healthcare and support services.

All the men took some time to realise that their experiences and behaviours were potential signs and symptoms of an eating disorder during which time these became entrenched.

Their behaviours included going days without eating; purging; and obsessive calorie counting, exercise, and weighing. Some also self-harmed and increasingly isolated themselves from others.

The perception that eating disorders are a women’s problem, and particularly a problem for young women, was cited as one of the main reasons why it took them so long to understand what was happening.

One young man, who described himself as “one of the lads,” said he thought eating disorders only affected “fragile teenage girls,” while another said he thought these disorders were “something girls got.”

None of the men was aware of the symptoms of an eating disorder, and friends, family, and teachers were also very slow to recognise the symptoms, frequently putting the changed behaviours down to personal choices.

It was only reaching a crisis point or being admitted as an emergency that triggered the realisation of what was happening to them, the men said.

They also delayed seeking help because they feared they wouldn’t be taken seriously by healthcare professionals, or didn’t know where to go for support.

And their experiences of the healthcare system were mixed. They said they often had to wait a long time for specialist referral and had sometimes been misdiagnosed, or, as in one case, told by the doctor “to man up.” They complained of insufficient information about eating disorders targeted specifically at men.

“Men with eating disorders are underdiagnosed, undertreated and under researched,” write the authors.

“Our findings suggest that men may experience particular problems in recognising that they may have an eating disorder as a result of the continuing cultural construction of eating disorders as uniquely or predominantly a female problem,” they add.

This perception has “also been embedded in clinical practice,” they note, adding that in order to improve the outlook for men with eating disorders, “early detection is imperative.”

Eating disorders cost the NHS between £50 and £70 million, while anorexia has the highest death rate of all adolescent psychiatric conditions, they point out.

Painkillers linked to heightened irregular heartbeat risk in older adults

8 Apr, 14 | by flee

Current and recent use of painkillers/anti-inflammatories may be linked to a heightened risk of an irregular heartbeat (atrial fibrillation) among older adults, finds a large population study published in BMJ Open.

Atrial fibrillation has itself been linked to stroke, heart failure, and reduced life expectancy, while previously published research has linked the use of non-steroidal anti-inflammatory drugs, or NSAIDs, to a heightened risk of cardiovascular problems, including heart attack.

The research team regularly monitored the heart health of 8423 people taking part in the Rotterdam Study, a population based study that has been tracking the development of ill health and associated risk factors among adults aged 55 and older since 1990 in one district of Rotterdam, The Netherlands.

New and current cases of atrial fibrillation were diagnosed using heart tracer recordings (ECGs) while details of drugs prescribed to study participants was gathered from pharmacies collaborating on the research project.

The average of the study participants was 68.5, and over half of them (58%) were women.

During the average monitoring period, which spanned just under 13 years, 857 of the 8423 participants developed atrial fibrillation, 261 of whom had never used NSAIDs when they were diagnosed, while 554 had used NSAIDs in the past, and 42 were currently taking these drugs.

Current use was associated with a 76% greater risk of atrial fibrillation than never use, after taking account of other risk factors, such as age, sex, and underlying cardiovascular problems.

Similarly, recent use (with the preceding 30 days) of these drugs was linked to an 84% greater risk of atrial fibrillation. While there was a trend for higher doses to be linked to a correspondingly higher risk, this trend was not statistically significant.

NSAIDs may contribute to atrial fibrillation because they inhibit the production of the enzyme cyclo-oxygenase, which may increase blood pressure as a result of fluid retention, suggest the authors.

Alternatively, use of NSAIDs may indicate underlying inflammation, which may increase the risk of atrial fibrillation, they say.

But whatever the explanation, “the underlying mechanism behind this association [between NSAIDs and atrial fibrillation] deserves further attention,” they conclude.

Deadlines, dementia, and radiation: Most read articles in March

4 Apr, 14 | by fpearson

March’s most read article was Gómez-Perretta et al.’s study on symptoms related to GSM radiation from mobile phone base stations. Newly-published papers in the top ten most read include Aziz Dhedhi et al.’s narrative analysis of GP’s accounts on the meaning of ‘timely’ diagnosis of dementia and also Herbert et al.’s paper on Australian researchers and the impact of funding deadlines on personal workloads, stress and family relationships. Also popular last month was a case-control study on birth characteristics in a clinical sample of women seeking infertility treatment by Vikström et el.

Rank Author(s) Title
1 Gómez-Perretta et al. Subjective symptoms related to GSM radiation from mobile phone base stations: a cross-sectional study
2 Herbert et al. The impact of funding deadlines on personal workloads, stress and family relationships: a qualitative study of Australian researchers
3 Rao et al. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis
4 Saadia Aziz Dhedhi et al. Timely’ diagnosis of dementia: what does it mean? A narrative analysis of GPs’ accounts
5 Krusche et al. Mindfulness online: an evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression
6 Honein-AbouHaidar et al. Benefits and barriers to participation in colorectal cancer screening: a protocol for a systematic review and synthesis of qualitative studies
7 Taylor et al. Prevalence and incidence rates of autism in the UK: time trend from 2004–2010 in children aged 8 years
8 Vikström et al. Birth characteristics in a clinical sample of women seeking infertility treatment: a case–control study
9 Carpenter et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies
10 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

 

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

 

Social media, autism and diet patterns: Most read articles in February

24 Mar, 14 | by flee

The most-read article in February was Brurberg et al.’s systematic review of case definitions for chronic fatigue syndrome. Hsiao et al.’s paper on road traffic injury mortality has also been popular. Other newly-published papers in the top ten most read include Jenkins et al.’s randomised controlled trial on the effect of a vegan low-carbohydrate diet on cardiovascular risk factors and body weight in hyperlipidaemic adults, and Williams et al.’s article on social media interventions for diet and exercise behaviours.

Rank Author(s) Title
1 Brurberg et al. Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review
2 Rao et al. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis
3 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
4 Krusche et al. Mindfulness online: an evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression
5 Hsiao et al. Road traffic injury mortality and its mechanisms in India: nationally representative mortality survey of 1.1 million homes
6 Brueton et al. Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis
7 Williams et al. Social media interventions for diet and exercise behaviours: a systematic review and meta-analysis of randomised controlled trials
8 Carpenter et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies
9 Baird et al. Guidelines: is bigger better? A review of SIGN guidelines
10 Taylor et al. Prevalence and incidence rates of autism in the UK: time trend from 2004–2010 in children aged 8 years

 

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

Girls born small or underweight twice as likely to be infertile in adulthood

10 Mar, 14 | by flee

Girls born unexpectedly small or underweight seem to be twice as likely to have fertility problems in adulthood as those of normal size at birth, suggests research published in BMJ Open.

Medical advances mean that more underweight and very small babies will survive into adulthood, which might therefore increase the prevalence of fertility problems, say the authors.

But as this is the first research of its kind, further studies will be needed before definitive conclusions can be drawn, they caution.

The researchers base their findings on 1206 women who were born in Sweden from 1973 onwards, and part of a straight couple seeking help for fertility problems at one major centre between 2005 and 2010.

The primary cause of infertility—female, combined, male or unexplained—was gleaned from the patients’ medical records, while details of their birth size, age, and weight were gathered from Sweden’s national medical birth register.

Infertility was attributed to female causes in 38.5% of the cases; male causes in just under 27%; combined causes in just under 7%; and unexplained in 28%.

Around two thirds of the women were of a healthy weight, while around one in four was overweight. One in 20 was obese while almost 2.5% were under weight.

Women whose infertility was attributable to a female cause tended to be heavier than average; excess weight is a known risk factor for infertility.

Just under 4% of the women had been born prematurely; a similar proportion were underweight at birth; while just under 6% were unexpectedly small babies.

Analysis of the data showed that women with fertility problems attributable to a female factor, were almost 2.5 times as likely to have been underweight at birth as those in whom the cause of infertility was attributable to a male factor or unexplained.

Similarly, these women were almost three times as likely to have been born unexpectedly small as those whose primary cause of infertility was unexplained.

These findings held true even after influential factors, including previous motherhood and current weight, were taken into account.

By way of possible explanation, the authors suggest that growth restriction in the womb might affect the developing reproductive organs as previous research has linked fetal growth restriction with reduced ovulation.

And other research has pointed to the fetal origins of some adult diseases, they add.

They caution that the sample size was relatively small and carried out in one geographical area in one country so may not be applicable elsewhere. Further research would be needed before definitive conclusions could be drawn, they say.

But they say that if the associations between low birthweight or small birth size and infertility are confirmed, this may have implications for the prevalence of infertility problems.

“As medical research and care advances, more infants will be born [with low birthweight or small size] and survive, which in turn might influence future need of infertility treatment,” they conclude.

BMJ Open’s 2013 year in review

17 Feb, 14 | by Richard Sands, Managing Editor

 

2013 was another successful year for BMJ Open. Credit and thanks as always goes to our editorial board and especially our peer reviewers for helping make this happen.

BMJ Open’s status as a global journal was confirmed as we received over 2000 submissions from 89 countries and published papers from 60. We published 962 papers, up 47% from 2012.

The number of BMJ Open papers with datasets made available through the open access data repository Dryad passed 50. We signed an agreement to meet the costs of this on authors’ behalf, meaning that authors can preserve and share their data in a way that makes it open, citable, preserved and discoverable at no cost to them.

In mid-year Thomson Reuters calculated a first impact factor for BMJ Open: 1.583. We blogged at the time about why this matters – and why it doesn’t. BMJ is a signatory to the San Francisco Declaration on Research Assessment (DORA) and the impact factor, nice as it is to have, is only one metric among many that can be found on our site. Journal-level and article-level statistics are provided and Altmetric scores can now be found on articles which have them. These give an idea of the shorter-term impact and reach of an article. See below the abstract of this paper for an example.

We are constantly looking for ways to streamline processes for authors. We are working with institutions and funders to help simplify life for authors through our institutional memberships, which apply across journals from BMJ. This initiative eases the administrative burden around organising payment of article publishing charges (APCs) as well as providing authors with discounts. Our APCs remain the same in 2014 as does our generous waivers and discounts policy, which last year saw us waive over £120k in charges.

2013 was another big year for open access to UK medical research as the Wellcome Trust and the UK research councils announced updated, tougher OA mandates. Needless to say, authors can meet the requirements of these and all other funders when publishing in BMJ Open simply by clicking a button at submission.

BMJ commissioned research into the publishing priorities of biomedical funders and the results of that research were made available through BMJ Open during Open Access Week. It showed that OA remains a high priority for funders but is only one of a number of strategies they use for wider engagement.

Press coverage of BMJ Open articles was substantial again, in particular around papers on plain packaging of cigarettes, with particular attention paid to this first evidence to emerge from Australia’s policy (e.g. BBC coverage).  Several papers on other hot topics in public health such as physical activity (The Guardian) received widespread coverage, as did papers on subjects as diverse as the ‘war on drugs’ (CNN), sudden infant death syndrome (BBC), new drug discovery (BBC)and male pattern baldness (Times of India).  We also introduced podcasts and video abstracts to help promote these papers.

Coverage and volume are encouraging but it remains important that we concentrate on keeping publication standards high. These make a difference to the quality and trustworthiness of the research we publish. We follow the International Committee of Medical Journal Editors’ recommendations on trial registration and we reject without review any trial report that fails this test. Our view is that publishing trials that don’t meet these standards means publishing articles that are methodologically and ethically unsound. Unfortunately we reject papers because of a lack of registration on a depressingly regular basis. As AllTrials founders, however, we welcome trials that produced so-called ‘negative’ results and we will be blogging more about our commitment to publishing all (properly conducted) trials soon.

In 2013 BMJ Open also introduced a policy, alongside other journals from BMJ, not to consider research funded by the tobacco industry. There’s more on that here.

It was a busy year and all the signs are that it will be an even busier 2014. Thanks again to our reviewers and authors and we look forward to working with you again in the future.

 

 

Tobacco industry claims “plain” packs won’t work based on weak evidence

12 Feb, 14 | by fpearson

Most studies lack policy relevance; and relevant research lacks key indicators of quality, including peer review

A critical evaluation of the volume, relevance and quality of evidence submitted by the tobacco industry to oppose standardised packaging of tobacco products doi:10.1136/bmjopen-2013-003757

Tobacco companies lack strong, relevant evidence to support their claims that standardised (plain) packaging of tobacco products in the UK won’t work, finds research published in BMJ Open.

The aim of plain packaging, with no logos, brand imagery, symbols, or promotional text, is to restrict the already limited opportunities that transnational tobacco companies have to market their products, and deter people from starting smoking.

Australia adopted plain packaging for tobacco products in 2012, the same year that the Department of Health in England held a public consultation on similar plans. The Department then said it wanted to wait for more evidence of the likely impact on tobacco consumption before adopting the policy.

It has since commissioned an independent review of evidence relating to unbranded and standardised packaging, which is due to report this spring.

The researchers analysed evidence cited in submissions made to the Department of Health’s consultation on plain packaging by the UK’s four largest transnational tobacco companies: Imperial Tobacco; Japan Tobacco International; Philip Morris Ltd; and British American Tobacco.

The four companies submitted lengthy consultation responses – 1521 pages in total, of which 328 comprised their main responses and 1193 provided supplementary material.

In these submissions, the companies rejected the conclusions of a systematic review, commissioned by the Department of Health, that there was “strong evidence” that plain packaging would reduce the appeal of tobacco products and increase the prominence of health warnings.

Instead, they argued that there is no evidence that plain packaging would reduce smoking prevalence or deter people from starting to smoke.

The researchers looked at the volume, relevance (subject matter) and quality (as measured by independence from industry, and peer review) of the evidence cited by the companies and compared it with the evidence from the systematic review.

Seventy seven out of 143 pieces of evidence were used to promote the companies’ claim that plain packs “won’t work”. Of these, only 17 (22%) addressed standardised packaging, 14 of which were linked to industry. None was published in peer reviewed journals – a key hallmark of quality.

Compared with the evidence in the systematic review, relevant evidence cited by the tobacco industry was of significantly lower quality.

Across all 77 documents, evidence linked to industry was significantly less likely to have been published in a peer reviewed journal than the independent evidence cited by them.

“With few exceptions, evidence cited by [transnational companies] to promote their claim that standardised packaging ‘won’t work’ lacks either policy relevance or key indicators of quality,” conclude the authors.