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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.

Women catching up with men in alcohol consumption and its associated harms

24 Oct, 16 | by Emma Gray

Trend most evident among young adults, international analysis shows

Women are catching up with men in terms of their alcohol consumption and its impact on their health, finds an analysis of the available international evidence, spanning over a century and published in the online journal BMJ Open.

The trend, known as ‘sex convergence’, is most evident among young adults, the findings show.

Historically, men have been far more likely than women to drink alcohol and to drink it in quantities that damage their health, with some figures suggesting up to a 12-fold difference between the sexes. But now evidence is beginning to emerge that suggests this gap is narrowing.

In a bid to quantify this trend over time, the researchers pooled the data from 68 relevant international studies out of a total of 314, all of which had been published between 1980 and 2014. All the studies included explicit regional or national comparisons of men’s and women’s drinking patterns across at least two time periods.

The studies included data collected between 1948 and 2014, representing people born as far back as 1891, all the way up to 2000, and including a total sample size of more than 4 million. Sixteen of the studies spanned 20 or more years; five spanned 30 or more.

The researchers used the following criteria to inform their data search: lifetime and/or current alcohol misuse or dependence; alcohol related problems; treatment for alcohol issues; and the timeframe of use and the development of related problems.

And they used 11 key indicators of alcohol use and associated harms for their analysis. These were grouped into three broad categories of: any use, which included quantities and frequency; problematic use, which included binge/heavy drinking; and the prevalence of associated harms.

Births were grouped into cohorts—specific timeframes from 1891 to 2000—all of which spanned 5 years, with the exception of the first (1891-1910) and the last (1991-2000).

The pooled data showed that the gap between the sexes consistently narrowed across all three categories of any use, problematic use, and associated harms over time.

Men born between 1891 and 1910 were twice (2.2) as likely as their female peers to drink alcohol; but this had almost reached parity among those born between 1991 and 2000 (1.1).

The same patterns were evident for problematic use, where the gender gap fell from 3 to 1.2, and for associated harms, where the gender gap fell from 3.6 to 1.3.

After taking account of potential mathematical bias in the calculations, the gender gap fell by 3.2% with each successive five year period of births, but was steepest among those born from 1966 onwards.

The calculation used was not designed to address whether alcohol use is falling among men or rising among women, the researchers caution.

But among the 42 studies that reported some evidence for sex convergence, most indicated that this was driven by greater use of alcohol among women, and 5% of the sex ratios were less than 1, suggesting that women born after 1981 may actually be drinking more than their male peers, say the researchers.

While they did not set out to explain the reasons behind their observed findings, they emphasise that their results “have implications for the framing and targeting of alcohol use prevention and intervention programmes.”

And they conclude: “Alcohol use and alcohol use disorders have historically been viewed as a male phenomenon. The present study calls this assumption into question and suggests that young women in particular should be the target of concerted efforts to reduce the impact of substance use and related harms.”

Most read articles in September: young people’s views on school sex education, gender equity in academic medicine and improving patient safety

7 Oct, 16 | by Hemali Bedi

cellular-1352613_1920September’s most read list sees several new entries as well as some popular non-movers. This month’s top spot still belongs to Ravnskov et al and their systematic review on the associations between low-density-lipoprotein cholesterol and mortality in the elderly. Pound et al come in at number three with a qualitative synthesis of young people’s views and experiences of school sex and relationship education (SRE). They concluded that SRE should be delivered by experts who maintain clear boundaries with students and taught using a ‘sex-positive’ approach – one that aims for young people to enjoy their sexuality in a way that is safe, consensual and healthy.

Other new entries this month include Caffrey et al, who performed a multimethod, qualitative study investigating how a gender equity programme, Athena SWAN, could be enabled and whether  interactions between the programme and the context it is implemented into might produce unintended consequences.

At number ten is a multimethod study by Power et al, looking at whether a large-scale two-phase quality improvement programme achieved its aim to improve patient safety using a harm-free care approach.

See below for a full round up of September’s top 10 most read articles.

Rank Author(s) Title
1 Ravnskov et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
2 Ferrer et al. Comparative study analysing women’s childbirth satisfaction and obstetric outcomes across two different models of maternity care
3 Pound et al. What do young people think about their school-based sex and relationship education? A qualitative synthesis of young people’s views and experiences
4 Caffrey et al. Gender equity programmes in academic medicine: a realist evaluation approach to Athena SWAN processes
5 Teschke et al. Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share
6 Quigley et al. Association between home birth and breast feeding outcomes: a cross-sectional study in 28,125 mother–infant pairs from Ireland and the UK
7 Pradhan et al. Nutrition interventions for children aged less than 5 years following natural disasters: a systematic review
8 Ma’som et al Attitudes and factors affecting acceptability of self-administered cervicovaginal sampling for human papillomavirus (HPV) genotyping as an alternative to Pap testing among multiethnic Malaysian women
9 Assiri et al Investigating the epidemiology of medication errors and error-related adverse drug events (ADEs) in primary care, ambulatory care and home settings: a systematic review protocol
10 Power et al. Multimethod study of a large-scale programme to improve patient safety using a harm-free care approach

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

Guest blog: Improving peer review using peer-reviewed studies #PeerRevWk16

19 Sep, 16 | by aaldcroft

This week is the second ever “peer review week”. The theme for this year is “Recognition for Review”. Peer review week aims to highlight the importance of peer review, which is a crucial part of the research process. We asked Dr Adrian Barnett, from the Queensland University of Technology, and a member of our editorial board, to survey articles published in BMJ Open that present research on medical publishing and peer review

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It’s challenging to do peer review well and current models of peer review in health and medical research are regularly criticised by researchers who all have personal stories of when peer reviewers got things badly wrong. My own favourite recent example is a reviewer asking us to consider snow in our study of how rainfall impacts on salmonellosis in sub-tropical Queensland.

If we believe in peer review then we should believe in using peer review to improve peer review, and there are interesting studies that have highlighted problems with peer review. This introspective research is part of the growing field of meta-research or research on research, which uses research to examine and improve the entire research process. Such research is sorely needed considering that 85% of current health and medical research is wasted.

BMJ Open welcomes research on peer review and there are 54 papers in the category of “Medical publishing and peer review” including research on peer review as well other important meta-research issues, such as unpublished studies and how research is reported. The first paper in the category from 2011 examined reporting guidelines, and the most recent in 2016 looks at the reporting of conflicts of interest.

Can meta-research help when it comes to the difficult problem of recognition for review? To recognise good peer review we need to judge the quality of peer review, which means reviewing the reviewers.

An observational study compared the quality of reviews for reviewers suggested by authors with reviewers found by editors. The concern is that author-suggested reviewers may be too friendly, and in extreme cases be fake reviewers. The benefit of author-suggested reviewers is that it saves editors time in finding suitable experts. The study found no difference between the quality of reviews, but author-suggested reviewers were far more likely to recommend publication, with 64% of author-recommend reviewers recommending acceptance compared with just 35% of reviewers found by editors. It is possible that many authors suggest reviewers whose views agree with their own and whose work they have cited. Does this count as rigorous peer review, or would it be better if papers were critically analysed by researchers with a variety of views?

Another observational study examined peer reviewers comments for drug trials sponsored by industry compared with non-industry studies. The industry-sponsored studies had fewer comments on poor experimental design and inappropriate statistical analyses, and my guess is (based on personal experience) the industry trials employed more specialist staff because they have bigger budgets.

Both these studies had to spend time and effort reviewing the peer reviewers’ comments, and this extra effort is a key barrier to improving peer review.

Instead of reviewing every review a solution is to randomly check a sample of reviews. This would allow a reasonable number of reviews to be examined and graded in detail. If peer reviewers realise there’s a chance their work will be checked, then they should provide better reviews. The same idea is used by the tax office, who can’t afford to audit everyone but can increase compliance by random auditing.

Another benefit of regular random audits is that it would provide great data for tracking the quality of peer review over time, and allow a journal to ask whether things are getting better, or whether a policy change improved average review quality.

Of course the random tax audit works because there are severe penalties for those who are caught. A peer review audit would likely have to provide positive incentives, which could include a letter of commendation for the best reviews, promotion to the editorial board, or even the well-used incentive of money.

Dr Adrian Barnett is a statistician at the Queensland University of Technology, Brisbane. He works in meta-research which uses research to analyse how research works with the aim of making evidence-based recommendations to increase the value of research. @aidybarnett

School sex education often negative, heterosexist, and out of touch

12 Sep, 16 | by Emma Gray

And taught by poorly trained, embarrassed teachers, say young people

School sex education is often negative, heterosexist, and out of touch, and taught by poorly trained, embarrassed teachers, finds a synthesis of the views and experiences of young people in different countries, published in the online journal BMJ Open.

Schools’ failure to acknowledge that sex education is a special subject with unique challenges is doing a huge disservice to young people, and missing a key opportunity to safeguard and improve their sexual health, conclude the researchers.

They base their findings on 55 qualitative studies which explored the views and experiences of young people who had been taught sex and relationship education (SRE) in school based programmes in the UK, Ireland, USA, Australia, New Zealand, Canada, Japan, Iran, Brazil and Sweden between 1990 and 2015.

Most of the participants were aged between 12 and 18.

The researchers synthesised the feedback and found that despite the wide geographical reach of the studies, young people’s views were remarkably consistent.

Two overarching themes emerged to explain most of the data. The first of these was that schools have failed to recognise the distinctive and challenging nature of SRE, for the most part preferring to approach it in exactly the same way as other subjects, say the researchers.

Yet the feedback indicated there are distinct challenges when teaching SRE: in mixed sex classes young men feared humiliation if they weren’t sexually experienced and said they were often disruptive to mask their anxieties; their female class mates felt harassed and judged by them.

Young people also criticised the overly ‘scientific’ approach to sex, which ignored pleasure and desire, and they felt that sex was often presented as a ‘problem’ to be managed. Stereotyping was also common, with women depicted as passive, men as predatory, and little or no discussion of gay, bisexual, or transgender sex.

The second principal theme was that schools seem to find it difficult to accept that some of their students are sexually active, leading to content that is out of touch with the reality of many young people’s lives and a consequent failure to discuss issues that are relevant to them, say the researchers.

This was evident in what young people perceived as an emphasis on abstinence; moralising; and a failure to acknowledge the full range of sexual activities they engaged in.  Sex education was delivered too late, some students felt.

But it also manifest in a failure to deliver helpful and practical information, such as the availability of community health services, what to do if they got pregnant, the pros and cons of different methods of contraception, or the emotions that might accompany sexual relationships.

Young people also disliked having their teachers deliver SRE, not only because they felt teachers were poorly trained and too embarrassed, but also because of the potential for this arrangement to disrupt teacher-pupil relationships and breach boundaries.

The researchers point out that despite its low status and variable content and quality, school based SRE is seen as vital by policy makers for protecting young people from ill health, unwanted pregnancies, sexual abuse and exploitation.

And the evidence suggests that young people themselves want SRE to be taught in schools, using an approach that is ‘sex positive’—one that aims for young people to enjoy their sexuality in a way that is safe, consensual, and healthy.

They conclude: “Schools should acknowledge that sex is a special subject with unique challenges, as well as the fact and range of young people’s sexual activity, otherwise [they] will continue to disengage from SRE, and opportunities for safeguarding and improving their sexual health will be reduced.”

BMJ Open to publish abstracts for the UCL Qualitative Health Research Network symposium

9 Sep, 16 | by aaldcroft

On the Tuesday 7th February 2017, the UCL Qualitative Health Research Network will be hosting their third symposium entitled ‘Engagement, Co-production, and Collaborative Meaning-Making: Collaboration in Qualitative Health Research’, supported by The Wellcome Trust.

Held within the Institute of Child Health, 30 Guildford Street, London, the Network invite all those with an interest in qualitative health research, from policy makers to the general public, to come along and engage in presentations, workshops and discussions on the theme of collaboration.

Abstracts can be submitted up until the closing date of 26th September 2016, with successful submissions published in BMJ Open shortly after the symposium. The call for abstracts and details on of the submission process are available here.

Registration will open in November 2016 but please check the website or follow the QHRN on Twitter to keep up to date on key dates and plans.

Volunteering and mental health, breast feeding outcomes and condom use intentions: Most read articles in August

7 Sep, 16 | by Emma Gray

Association of volunteering and mental well-being, breast feeding outcomes and place of birth, and condom use intentions of heterosexual men

File:FEMA - 15337 - Photograph by Andrea Booher taken on 09-10-2005 in Texas.jpg

The August most read list contains papers with a number of different study designs, on a number of different topics. Returning to the top spot this month is a systematic review on the lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly, by Ravnskov et al. At numbers three and six respectively, we have Quigley et al with a cross-sectional study examining the association between breast feeding outcomes and place of birth, and Tabassum et al with a study on the association of volunteering with mental well-being which also received a press release. Levett et al come in at number eight with randomised controlled trial which concludes that an antenatal integrative medicine education programme in addition to usual care significantly reduced epidural use and caesarean section in nulliparous women. Finally, at number ten is an experimental study by Eleftheriou et al looking at the influence of attractiveness on the condom use intentions of heterosexual men.

Rank Author(s) Title
1 Ravnskov et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
2 Kristensen et al. The effect of statins on average survival in randomised trials, an analysis of end point postponement
3 Quigley et al. Association between home birth and breast feeding outcomes: a cross-sectional study in 28 125 mother-infant pairs from Ireland and the UK
4 Teschke et al. Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share
5 Hill et al. Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways
6 Tabassum et al. Association of volunteering with mental well-being: a lifecourse analysis of a national population-based longitudinal study in the UK
7 Smyth et al. Identification of adults with sepsis in the prehospital environment: a systematic review
8 Levett et al. Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour
9 Jaber et al. New method of preoxygenation for orotracheal intubation in patients with hypoxaemic acute respiratory failure in the intensive care unit, non-invasive ventilation combined with apnoeic oxygenation by high flow nasal oxygen: the randomised OPTINIV study protocol
10 Eleftheriou et al. Does attractiveness influence condom use intentions in heterosexual men? An experimental study

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

Complimentary therapies, well-being and consultants as victims of bullying: Most read articles in July.

11 Aug, 16 | by Fay Pearson

 Tired Doc

July’s top 10 most read papers sees two studies taking into account doctors’ points of view. The first, by Bourne et al., takes a closer look at look at which aspects of the complaints process they find the most stressful. The second, by Shabazz et al., uses a survey of Royal College of Obstetricians and Gynaecologists to explore how significant numbers of consultants in the UK are victims of bullying.

We also have a study by Linton et al., that systematically reviews self-report measures for assessing well-being, and a randomised controlled trial by Levett et al., that concludes that the use of complementary therapies during birth can significantly reduce usage of epidurals and cesarean sections.

Rank Author(s) Title
1  Ravnskov et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
2 Levett, et al. Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour
3 Eleftheriou et al. Does attractiveness influence condom use intentions in heterosexual men? An experimental study
4 Bourne et al. Doctors’ experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data
5 Teschke et al. Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share
6 Kristensen et al. The effect of statins on average survival in randomised trials, an analysis of end point postponement
7 Shabazz,et al. Consultants as victims of bullying and undermining: a survey of Royal College of Obstetricians and Gynaecologists consultant experiences
8 Oudin et al. Association between neighbourhood air pollution concentrations and dispensed medication for psychiatric disorders in a large longitudinal cohort of Swedish children and adolescents
9 Tsubokura et al. Estimated association between dwelling soil contamination and internal radiation contamination levels after the 2011 Fukushima Daiichi nuclear accident in Japan
10 Linton et al. Review of 99 self-report measures for assessing well-being in adults: exploring dimensions of well-being and developments over time

Volunteering in middle age and senior years linked to enhanced mental health

8 Aug, 16 | by Emma Gray

No positive association seen before age of 40, suggesting link varies across life course

Volunteering in middle and older age is linked to good mental health/emotional wellbeing, finds a large study of British adults, published in the online journal BMJ Open.

But no such association was seen before the age of 40, suggesting that the link may be stronger at certain points of the life course, say the researchers.

Previous research has shown that volunteering in older age is associated with better mental and physical health, but it’s unclear whether this extends to other age groups.

The researchers therefore mined responses to the British Household Panel Survey (BHPS), involving a representative sample of adults living in 5000 households in Great Britain.

The BHPS ran every year from 1991 until 2008 before being incorporated into a much larger survey.  It included a wide range of questions on leisure time activities, which covered the frequency of formal volunteering—from at least once a week through to once a year or less, or never.

The BHPS also included a validated proxy for mental health/emotional wellbeing known as the GHQ-12.

The researchers gathered 66,343 responses for 1996, 1998, 2000, 2002, 2004, 2006 and 2008.

Around one in five respondents (21%) said they had volunteered. Women tended to volunteer more than men, and while almost a quarter of those aged 60 to 74 said they volunteered, this proportion dropped to 17% among the youngest age group.

GHQ-12 scores were better (lower) among those who volunteered than among those who had never done so—10.7 vs 11.4—across the entire sample, irrespective of age.

The average GHQ score was the best (lowest) among those who were frequent volunteers and worst (highest) among those who never volunteered.

When age was factored in, the positive association between volunteering and good mental health/emotional wellbeing became apparent at around the age of 40 and continued up into old age (80+).

Those who had never volunteered had lower levels of emotional wellbeing, starting at midlife and continuing into old age, compared with those who did volunteer.

The findings held true even after taking account of a range of potentially influential factors, including marital status, educational attainment, social class, and state of health.

By way of an explanation for the findings, the researchers speculate that volunteering at younger ages may just be viewed as another obligation, while social roles and family connections in early middle age may spur people to become involved in community activities, such as in their child’s school.

This is an observational study so no firm conclusions can be drawn about cause and effect, added to which the researchers were not able to gauge the extent of ‘informal’ volunteering, such as helping out neighbours, so couldn’t capture the full spectrum of voluntary activities.

But they nevertheless suggest that the findings show that volunteering may be more meaningful at certain points of the life course, and they call for greater efforts to involve middle aged to older people in some sort of volunteering.

“Volunteering might provide those groups with greater opportunities for beneficial activities and social contacts, which in turn may have protective effects on health status…With the ageing of the population, it is imperative to develop effective health promotion for this last third of life, so that those living longer are healthier,” they write.

Previous research indicates that people who volunteer are likely to have more resources, a larger social network, and more power and prestige, all of which have knock-on effects on physical and mental health, they point out.

“Volunteering may also provide a sense of purpose, particularly for those people who have lost their earnings, because regular volunteering helps maintain social networks, which are especially important for older people who are often socially isolated,” they add.

BMJ Open works with Publons to give credit for peer review

1 Aug, 16 | by aaldcroft

Publons

We’re pleased to announce that BMJ Open has partnered with Publons to help reviewers gain credit for their work.

Publons is a free service for reviewers, which enables them to gain public recognition for the reviews they complete. To take advantage of this service, you will first need to create a profile on Publons. When you submit your review via ScholarOne you will then be asked whether you would like to be credited for your review on Publons. Selecting ‘yes’ means that your review details will automatically be exported.

ORCID integration

In addition, Publons has partnered with ORCID so that reviewers can opt to have their verified review history automatically added to their ORCID profile.

Follow the steps below to make use of this service:

  1. Register for an ORCID profile (if you haven’t already).
  2. Sign in to Publons.
  3. Click on your profile picture in the top right-hand corner and select ‘Settings’.
  4. Under the ‘Reviews’ tab, click on the box ‘Authorise Publons to add reviews to ORCID’. Complete the relevant fields and click ‘Authorise’.
  5. Under the ‘Emails’ tab on the Publons site, add and verify any email addresses you have used for past peer review work.

Top 10 Most Read: Cholesterol and mortality in the elderly, chronic pain in the UK and smokers’ quitting attempts

8 Jul, 16 | by Ed Sucksmith

cigarettes-1221102_960_720

Several new entries make it into our top 10 Most Read list this month. In first place is a systematic review on the associations between low-density-lipoprotein cholesterol and mortality in the elderly. Further down the list is an analysis of Italian medical societies’ websites to examine conflicts of interest between professional medical societies and industry. Other new entries this month include an investigation into the relationship between air pollution and child and adolescent mental health by researchers from Umeå University in Sweden. Using a cohort of over half a million individuals under 18 years of age, the authors found that neighbourhood air pollution concentration is associated with dispensed medications for certain psychiatric disorders. At number 6 is a systematic review and meta-analysis of the prevalence of chronic pain in the UK. The authors conclude that chronic pain affects between one-third and one-half of the population of the UK, corresponding to just under 28 million adults. Lastly, making it in at number 9 is a study by Chaiton and colleagues on smokers’ quitting behaviour. The authors found that it may take as much as 30 or more attempts before a smoker quits successfully.

 

Rank Author(s) Title
1 Ravnskov et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
2 Eleftheriou et al. Does attractiveness influence condom use intentions in heterosexual men? An experimental study
3 Oudin et al. Association between neighbourhood air pollution concentrations and dispensed medication for psychiatric disorders in a large longitudinal cohort of Swedish children and adolescents
4 Fabbri et al. Conflict of interest between professional medical societies and industry: a cross-sectional study of Italian medical societies’ websites
5 Kristensen et al. The effect of statins on average survival in randomised trials, an analysis of end point postponement
6 Fayaz et al. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies
7 Teschke et al. Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share
8 Thomas et al. When procedures meet practice in community pharmacies: qualitative insights from pharmacists and pharmacy support staff
9 Chaiton et al. Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers
10 Fenton et al. Systematic review of the association between dietary acid load, alkaline water and cancer

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