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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.

Top 10 Most Read: Antidepressant use during pregnancy, medical graduates’ preparedness for practice and E-therapies for stress, anxiety and depression

3 Feb, 17 | by Ed Sucksmith

January sees 5 new entries into the top 10 most read articles. At number 4 is a cohort study by Anick Bérard and colleagues investigating the association between first-trimester exposure to antidepressants and the risk of major congenital malformations in 18,487 depressed/anxious women from Quebec, Canada. Results indicate that antidepressants increase the risk of a wide range of organ-specific malformations. At number 6 is a systematic review and meta-analysis by Tea Reljic and colleagues suggesting that, in terminally ill patients, active treatment targeted at underlying disease does not have a demonstrable impact on overall survival compared to palliative care.

Also making its way into the top ten is a rapid review of the literature examining the preparedness of UK graduates for practice as junior doctors. Whilst the review indicates that junior doctors are well prepared in a number of different areas of practice, some problem areas are identified including safe and legal prescribing, multidisciplinary team-working, handovers, breaking bad news to patients, learning needs and reflective practice.

Other new entries this month include a systematic review of life expectancy among individuals with non-cancer chronic disease and a survey of web and smartphone apps used and recommended for stress, anxiety or depression by the National Health Service in England. Fenton et al.’s systematic review of dietary acid load, alkaline water and cancer moves up four positions to become January’s most read article.


Rank Author(s) Title
1 Fenton et al. Systematic review of the association between dietary acid load, alkaline water and cancer
2 Ravnskov et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
3 Boulton et al. How much sugar is hidden in drinks marketed to children? A survey of fruit juices, juice drinks and smoothies
4 Bérard et al. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort
5 Murdoch  et al. Selling falsehoods? A cross-sectional study of Canadian naturopathy, homeopathy, chiropractic and acupuncture clinic website claims relating to allergy and asthma
6 Reljic et al. Treatment targeted at underlying disease versus palliative care in terminally ill patients: a systematic review
7 Hole et al. How long do patients with chronic disease expect to live? A systematic review of the literature
8 Bennion et al. E-therapies in England for stress, anxiety or depression: what is being used in the NHS? A survey of mental health services
9 Monrouxe et al. How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014
10 Steele et al. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study

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

BMJ Open: highlights from 2016 in review

19 Jan, 17 | by Yaiza del Pozo Martin

In 2011 BMJ Open appeared on the medical publishing scene becoming, in only five years, the world’s largest general medical journal (2015 – Five years old and growing). Another year has passed since then, and thanks to defining our distinctive identity, and being rigorous, open and transparent, we have continued to grow consistently and steadily, publishing over 2000 articles last year.

To celebrate this new milestone in our ongoing journey, we are highlighting a selection of articles that gained significant attention in 2016 and exemplify BMJ Open’s unique approach.


Alcohol use: closure of the male-female gap

Systematic review – Addiction

The article that received the highest Altmetric score (1618) last year is a systematic review and meta-regression analysis confirming the closing male-female gap in alcohol use and its related harms. According to the latest Global report on alcohol and health of the WHO, in 2012, about 3.3 million deaths, 5.9% of all global deaths, were attributable to alcohol consumption. As explained in the article by Slade and colleagues from the National Drug and Alcohol Research Centre in Australia, historically, the prevalence of alcohol use and related harms has been between 2 and 12 times higher in men than women. However, the emerging evidence collected in recent decades suggests that alcohol use has changed in younger generations towards closing the male-female gap, and this is indeed what this systematic review of published literature shows.  Beyond confirming the premise, this analysis highlights the importance of working on reducing the harmful use of alcohol in both male and female youngsters as they age to prevent further deleterious effects.

Along the same lines reads this noteworthy article published last week in our Communications section. The authors explored how the UK media and online news represent women’s and men’s drinking habits to identify ways of better aligning news reporting of harmful drinking with the current evidence drawn by studies such as the one above, and the latest UK alcohol guidelines, which are gender-neutral in their recommendations. Patterson and colleagues show that the image the UK media presents of women’s ‘binge’ drinking is at odds with the existing epidemiological evidence, and may reinforce unrealistic gender stereotypes and hinder public compliance of the neutral-gender weekly alcohol consumption limits. The report emphasizes the need to engage with the media to shift its framing of ‘binge’ drinking away from specific groups and contexts, and focus it instead on the health risks of specific drinking behaviours.

Slade et al. updated Altmetrics

Patterson et al. updated Altmetrics



Confident fathers have happier children

Longitudinal observational study – Paediatrics

The third most disseminated article of last year with an Altmetric score of 1076 set out to explore the influence of paternal involvement in early child-rearing and its potential impact on the children’s pre-adolescent behavioural outcomes.

The study included more than 10,000 children that lived with both parents during the first year of age. The researchers evaluated paternal involvement during this year through fathers’ emotional response to the child; the frequency of fathers’ involvement in domestic and childcare activities; and fathers’ feelings of security in their role as parent and partner. The outcome of early paternal involvement was measured assessing the behaviour of the children as they reached 9 and 11 years of age. This long term analysis allowed Opondo and colleagues to establish that rather than the quantity of direct involvement in childcare, it is the psychological and emotional paternal involvement in children’s early upbringing, that associates with positive behavioural outcomes in children. Particularly, how new fathers see themselves as parents and adjust to the role seems to be a key factor for successful parenting.

Opondo et al. updated Altmetrics



Sweet end: ultra-processed foods and drinks

Observational studies – Nutrition and metabolism

Two enlightening observational studies published in BMJ Open last year revealed two of the main dietary sources of added sugar and emphasized the need to reduce their consumption to control weight gain, caries, and the risk of diabetes and cardiovascular disease.

The first study by Martinez-Steele and colleagues showed that ultra-processed foods, containing five times the content of added sugars than minimally processed foods, make up almost 60% of the calories and 90% of the added sugars consumed in the US. The second study, conducted in the UK, investigated the amount of sugars in fruit juices, juice drinks and smoothies marketed to children. The researchers determined that the mean sugars content in drinks marketed to children was 7 g/100 ml, which is ‘unacceptably high’ as expressed by the authors.

Source: Pixabay – Licensed under Creative Commons CC0 1.0.

The new updated WHO guideline on Sugars intake for adults and children calls for a further reduction of free sugars intake to less than 5% of total energy intake, and as demonstrated by these studies, avoiding ultra-processed foods and drinks is crucial to attain this goal.

Martinez-Steele et al. updated Altmetrics

Boulton et al. updated Altmetrics



How many failed attempts it takes to quit smoking?

Longitudinal cohort study – Addiction

Tobacco use is one of the main risk factors for a number of chronic conditions, including cancer, lung diseases, and cardiovascular disorders, and the number one cause of preventable mortality (WHO report on the global tobacco epidemic 2015). Despite the extensive awareness of the negative effects of tobacco in our health, millions worldwide continue to smoke. This is partly explained by the difficulty it takes to quit this habit, which is clearly illustrated in this quote of Mark Twain, ‘Quitting smoking is easy: I’ve done it thousands of times’.

This popular study published in BMJ Open aimed to provide a realistic approximation of the estimate number of quit attempts prior to quitting successfully, including in the analyses both successful and unsuccessful quitters. Applying different analyses to the data collected by the Ontario Tobacco Survey, the authors concluded that before quitting successfully, 30 attempts are made on average. This study helps assisting the clinical expectations of doctors and smokers alike, and establishes for the first time that for many smokers it may take 30 or more quit attempts before being successful. These striking results suggest that further increasing the frequency of these attempts could be decisive in reducing smoking prevalence.

Chaiton et al. updated Altmetrics



‘You can’t be a person and a doctor’

Qualitative research article – Medical education and training

BMJ Open has carved out a niche in qualitative research, and one of the recent highlights in this type of study design investigated the work-life balance of doctors undertaking postgraduate medical training in the UK. Generally, medical trainees spend long hours at work typically supplemented with revision and completion of other training duties. In this timely qualitative analysis published at the end of the year, researchers conducted focus groups and interviews with medical trainees and trainers exposing a lack of work-life balance that negatively impacts on the learning and well-being of medical students. Particularly, this work-life imbalance affected those with children and especially women who faced a lack of less-than-full-time positions and discriminatory attitudes.

Credit: Dr. Farouk – Licensed under Creative Commons 2.0.


The study revealed that to buffer some pressure of the demanding training, the profession should be looking at structural factors, such as developing a strong social support network, both fostering positive relationships at work and those with family and friends outside work, in order to reduce burnout and improve the well-being of medical trainees.

Rich et al. updated Altmetrics


Top 10 most read: Work-life balance of doctors in training, ultra-processed foods and added sugars in the US diet, and quality of life and visual function in patients with age-related macular degeneration

4 Jan, 17 | by Hemali Bedi

December’s top 10 most read list sees eight new entries. At number one this month is a qualitative study by Rich et al, which investigates the work-life balance of doctors undertaking post graduate mTired Docedical training in the UK. The authors conducted semistructured focus groups and interviews with medical trainees and trainers and found a lack of work life balance that negatively impacts on learning and well-being. In particular, women with children were the most affected.

Other new entries include a cross sectional study by Steele et al, which found that ultra-processed foods make up over half of all calories consumed in the US diet, and contribute to almost 90% of all added sugar intake. This study also received a press release.

Fenton et al’s systematic review on the associations between dietary acid, alkaline water and cancer incidence and treatment outcomes has dropped to fifth place in this month’s list. Jonas et al reached number six with a systematic review and meta-analysis examining the efficacy of surgery and invasive procedures for various conditions. The study concludes that the effects of surgery and other invasive procedures are uncertain, particularly in pain-related conditions.

Finally, at number 10 this month is a systematic review by Taylor et al, which looks into the affect of age-related macular degeneration (AMD) on visual function and quality of life (QoL) in patients living with the condition.

Rank Author(s) Title
1 Rich et al. “You can’t be a person and a doctor”: the work-life balance of doctors in training – a qualitative study
2 Ravnskov et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
3 Steele et al. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study
4 Murdoch et al. Selling falsehoods? A cross-sectional study of Canadian naturopathy, homeopathy, chiropractic and acupuncture clinic website claims relating to allergy and asthma
5 Fenton et al. Systematic review of the association between dietary acid load, alkaline water and cancer
6 Leary et al. Mining routinely collected acute data to reveal non-linear relationships between nurse staffing levels and outcomes
7 Jonas et al. To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials
8 Opondo et al.  Father involvement in early child-rearing and behavioural outcomes in their pre-adolescent children: evidence from the ALSPAC UK birth cohort
9 Oliva et al. Gut feelings in the diagnostic process of Spanish GPs: a focus group study
10 Taylor et al. How does age-related macular degeneration affect real-world visual ability and quality of life? A systematic review

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

Paternal involvement in child-rearing, health anxiety, and the global epidemiology of alcohol use: Most read articles in November

9 Dec, 16 | by Emma Gray

Paternal involvement in early child-rearing, health anxiety and risk of ischaemic heart disease, and the global epidemiology of alcohol use

The Top 10 Most Read list for November contains a number of new entries including papers on the reasons for retraction of articles, and the relationship between earlobe creases and coronary artery disease. At number one this month is a longitudinal study by Reece et al, which looks into the possibility that cannabis-exposed patients may be ageing more quickly. Entering the list at four and five respectively, are Farren et al and Berge et al with studies on the emotional distress in women after early pregnancy loss and the prospective association of health anxiety with ischaemic heart disease. A study on the involvement of fathers in early child-rearing on behaviour and development in their pre-adolescent children by Opondo et al reaches number six, finding that psychological and emotional aspects of paternal involvement in children’s early upbringing, particularly how new fathers see themselves as parents and adjust to the role, is associated with positive outcomes in children. It also received a press release and some attention on social media. Finally, returning at number eight this month, we have a popular article on birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women by Slade et al, which concludes that the male-female gap in indicators of alcohol use and related harms is closing.

Rank Author(s) Title
1 Reece et al. Cannabis exposure as an interactive cardiovascular risk factor and accelerant of organismal ageing: a longitudinal study
2 Ravnskov et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
3 Spoelman et al. Effect of an evidence-based website on healthcare usage: an interrupted time-series study
4 Farren et al. Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study
5 Berge et al. Health anxiety and risk of ischaemic heart disease: a prospective cohort study linking the Hordaland Health Study (HUSK) with the Cardiovascular Diseases in Norway (CVDNOR) project
6 Opondo et al. Father involvement in early child-rearing and behavioural outcomes in their pre-adolescent children: evidence from the ALSPAC UK birth cohort
7 Wang et al. Relationship between diagonal earlobe creases and coronary artery disease as determined via angiography
8 Slade et al. Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression
9 Hashem et al. Cross-sectional survey of the amount of free sugars and calories in carbonated sugar-sweetened beverages on sale in the UK
10 Moylan et al. Why articles are retracted: a retrospective cross-sectional study of retraction notices at BioMed Central

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

Study reveals lack of supporting evidence for claims about fertility treatments

28 Nov, 16 | by Emma Gray

Many claims made by UK fertility clinics about the benefits of treatments beyond standard IVF procedures are not backed up by evidence, finds a study published in the online journal BMJ Open.

These can range from £50 for a single screening blood test to as much as £8000 for egg freezing packages.

The researchers, led by Professor Carl Heneghan at Oxford University’s Centre for Evidence Based Medicine (CEBM), say “there is a need for more information on interventions to be made available by fertility centres, to support well informed treatment decisions.”

The findings will be part of a Panorama undercover investigation broadcast on Monday 28 November at 8.30pm on BBC One.

Infertility is a significant problem, affecting about 1 in 7 UK couples, many of whom seek medical help to have a child.

UK fertility centres are regulated by the Human Fertilisation and Embryology Authority (HFEA). But despite this regulation it has been suggested that some of the treatments offered on top of routine IVF might not be evidence based, are costly, and some clinics might be using techniques that have not been stringently tested.

So the researchers set out to record claims of benefit for treatments offered on top of standard IVF by UK fertility centre websites – and identify the evidence used to support these claims.

A total of 74 fertility centre websites, incorporating 1401 web pages were examined for claims. The team found 276 claims of benefit relating to 41 different fertility interventions made by 60 of the 74 centres.

79 (29%) of the claims included numbers to explain the chances of improved fertility outcomes, but the team identified only 13 websites where any references were included, which referred to just 16 published references. Of these 16 references, only five were high level systematic review evidence.

The authors point to some study limitations, but say it is unlikely that a repeat of their analysis would change the pattern of findings substantially.

“Our findings demonstrate that whilst many claims were made on the benefits of fertility treatments, there was a lack of supporting evidence cited, with the majority of the websites providing no sources for claims made,” they conclude.

In a linked analysis published by The BMJ, Professor Heneghan and colleagues searched for evidence to support 38 interventions offered by UK fertility centres on top of standard IVF, focusing on the key outcome of live birth rates.

They found that most treatments are not supported by good evidence. The National Institute for Health and Care Excellence (NICE) provides clear advice on only 13 (34%) of the 38 interventions investigated, and systematic reviews (the highest level of available evidence) were available for only 27.

They also found that information on harms is often poorly reported.

People seeking fertility treatment need good quality evidence to make informed choices, they write. The current approach by HFEA leaves patients and clinicians to seek evidence for themselves or from staff in private clinics selling fertility services.

“We do not believe this approach is realistic.”

They say there is “an urgent need for randomised controlled trials for many interventions that are currently being offered” and call for changes in guidance to help couples make informed decisions.

Panorama: Inside Britain’s Fertility Business will be broadcast on Monday 28 November at 8:30pm on BBC One

BBC Panorama will reveal that 26 out of 27 so-called “add-on” treatments being offered by UK fertility clinics have no good scientific evidence from trials that they improve the chance of having a baby.  Some may even be harmful.

“Add-on” treatments include things like additional procedures, additional drugs or devices to house an embryo. They can cost anywhere between £100 and £3000 on top of standard fertility care.

Panorama commissioned Oxford University’s Centre for Evidence-Based Medicine to do the research, which has taken almost a year to complete.  

Researchers identified 27 treatments on offer at UK fertility clinics they considered to be “add-ons”.

Only one treatment – called endometrial scratch – had even moderate quality evidence that shows an increase in the chances of a baby with standard fertility care like IVF.  There are still question marks over the evidence for that treatment.  Due to its limitations the researchers noted there is currently a randomised trial ongoing in the UK to determine its effectiveness.  

One “add-on” treatment called Preimplantation Genetic Screening (PGS) tests embryos for abnormalities. A trial in 2007 discovered that an earlier version of this process may have lowered birth rates.  

Many clinics sell newer, more accurate versions, in some cases for up to £3000.  Initial research looks promising and randomised trials are underway, but as yet there is no high quality evidence from robust trials that these new versions improve your chances of having a baby.

Panorama found evidence that, when marketing this add-on treatment, not all clinics are giving patients the full picture to enable them to make a properly informed decision.  

A Panorama reporter went to a fertility fair in November last year and was not given the full picture about the evidence for PGS by every one of clinics she spoke to.

She approached staff from 18 British and foreign clinics at random, asking if PGS would improve her chances on top of IVF.  She told them she was 38 and had been trying for a baby for a year without success.

Five of the 18 clinics were positive about the treatment. Eight said they would only offer it to women over the age of 40 or those who had experienced repeated IVF failures.  There is currently no good scientific evidence from trials that it can increase the birth rate among women in these categories.

Only five clinics gave the full picture, saying that they would not recommend PGS because it lacked evidence.

Pre-teens whose dads embrace parenthood may be less prone to behavioural issues

22 Nov, 16 | by Emma Gray

How new fathers see themselves in child’s early years seems to be most influential

Kids whose dads adjust well to parenthood and feel confident about their new role may be less likely to have behavioural problems in the run-up to their teens, indicates research published in the online journal BMJ Open.

It’s how fathers see themselves as parents in the child’s early years, rather than the amount of direct childcare they give, that seems to be important, the findings suggest.

The nature of parenting in a child’s early years is thought to influence their short and long term wellbeing and mental health, which are in turn linked to development and educational attainment.

But it’s not entirely clear what impact the father’s role might have, as much of the research to date has tended to characterise paternal involvement in a child’s upbringing as one dimensional.

The researchers therefore drew on data from the Avon Longitudinal Study of Parents and Children (ALSPAC) study, which has been tracking the health of nearly 15,000 children since birth, to assess several aspects of paternal involvement.

The parents of 10,440 children who were living with both their mum and dad at the age of 8 months were asked to complete a comprehensive questionnaire about their and their child’s mental health; their attitudes to parenting; time spent on childcare; their child’s behaviour and development; as well as details of household income/education.

When the children were aged 9 and 11, their behaviour was assessed using the strength and difficulties questionnaire (SDQ). This covers emotional symptoms, behaviour (conduct) problems, hyperactivity, peer relationship issues, and helpfulness (pro-social behaviour).

Fathers’ parental involvement was measured by asking them to rate their level of agreement with 58 statements, reflecting the amount of direct childcare they engaged in, including household chores; their attitudes to parenting; the relationship with their child; and how they felt about the birth 8 weeks and 8 months afterwards.

The final analysis was based on almost 7000 9 year olds and nearly 6500 of the same children at the age of 11.

Three key factors emerged in relation to the children’s SDQ scores: (1)  fathers’ emotional response to the baby and their parenting role; (2) how much time the dads spent on direct childcare; and (3) how well they adjusted to their new role, including how confident they felt in their abilities as a parent and partner.

But emotional response and confidence in their new role were most strongly associated with lower odds of behavioural problems when their children reached 9 and 11 years of age.

A high paternal factor 1 score was associated with 21% and 19% lower odds of a higher SDQ score at the ages of 9 and 11, respectively. Similarly, a high paternal factor 3 score was associated with 28% lower odds of a higher SDQ score at both time points.

After taking account of potentially influential factors, such as age at fatherhood, educational attainment and household income, hours worked, and sex of the child, every unit increase in factor 1 scores was associated with 15% lower odds of behavioural problems at the age of 9 and 12% lower odds at the age of 11, compared with kids of the same age, sex, and family background.

Similarly, every unit increase in factor 3 scores was associated with 12% lower odds at the age of 9, and 10% lower odds at the age of 11.

This is an observational study so no firm conclusions can be drawn about cause and effect, and as the researchers note, the study dates back 25 years, since when parenting styles may have changed, so the findings may therefore not be widely generalisable.

But they write: “The findings of this research study suggest that it is psychological and emotional aspects of paternal involvement in a child’s infancy that are most powerful in influencing later child behaviour, and not the amount of time that fathers are engaged in childcare or domestic tasks in the household.”

London 2012 Olympics inspired many local kids to get more involved in sport

22 Nov, 16 | by Emma Gray

But levels of physical fitness significantly worsened

The London 2012 Olympic Games inspired many local children to get more involved in sport, reveal the results of a before and after study, published in the online journal BMJ Open.

But this inspiration did not translate into improved physical fitness, levels of which declined significantly in the aftermath of the event, the findings indicate.

When Britain was awarded host status for the Olympic Games in London 2012 in 2005, this was based on a bid which promised to “inspire a generation” and “create a legacy of sport and healthy living,” despite there being no evidence of any such outcome from previous events of this kind, say the researchers.

The Active People Survey showed an initial increase of around half a million adults participating in a weekly 30 minute session of sporting activities between April 2012 and April 2013.

But the data indicate that since then, the number of 16-25 year olds doing this has fallen, a trend that has continued, say the researchers.

To find out if London 2012 was associated with increased levels of physical activity, physical fitness and changes in body mass index (BMI), the researchers carried out a before and after study among pupils at six schools within a 50 km radius of the Olympic park in East London.

Some 733 children between the ages of 10 and 16 were assessed in 2008-9, up to 3+years before London 2012, and 931 from the same schools in 2013-14, up to 18 months afterwards.

At both time points they were quizzed about how much inspiration they took from the Games, and how much physical activity they did. Their cardiorespiratory fitness was assessed in a 20 metre shuttle run by peak V02—a measure of oxygen uptake that is linked to the capacity to perform sustained exercise.

Over half (53%) of the children said London 2012 had inspired them to try new sports/ activities.

Children who continued to take part in sports/activities in the 18 months after London 2012 were more active and fitter than those who didn’t. And average BMI was also lower among the girls.

Compared with those who said they weren’t inspired by the Olympics, peak V02 was higher among those who continued to participate in sports/activities 18 months after London 2012.

This 45% of the sample was also more physically active than those who said they were not inspired, or had been only briefly inspired, by London 2012.

But peak V02 was significantly lower after London 2012 than it had been before among all the children. This is a cause for concern as low levels of cardiorespiratory fitness in childhood are associated with a heightened risk of metabolic disorders in adulthood, say the researchers.

This is an observational study so no firm conclusions can be drawn about cause and effect. Furthermore, the researchers caution that they cannot discount the possibility that the children who had been inspired by the Olympics might already have been fitter and more active, or that other factors might have offset any fitness benefits arising from London 2012.

And the true scale of the legacy may never be known due to the lack of any appropriate measures to monitor changes associated with events like London 2012, they point out.

“High levels of inspiration to participate in new activities reported following London 2012 and positive associations with fitness are encouraging…[But] these associations must be interpreted in the context of the significant declines in fitness shown by our repeated cross-sectional comparison,” they write.

“The cost of hosting future mega-events cannot be justified based on the assumption that they will automatically produce health related benefits,” they add.

Eyes on Diabetes – World Diabetes Day 2016

14 Nov, 16 | by Hemali Bedi


World Diabetes Day (WDD) is celebrated by millionwdd-logo-date-ens of people around the world on November 14th each year. [1] Led by the IDF, WDD is a global campaign that aims to raise awareness of diabetes and promote efforts to tackle the condition as a global health priority. [2]

The International Diabetes Federation (IDF) estimate that 415 million adults were living with diabetes in 2015, with this number set to rise to around 642 million by 2040. [3] This is equivalent to one in 10 adults. [3]

Diabetes is the leading cause of cardiovascular disease, blindness and kidney failure in many countries around the world, but some of these complications, such as blindness, can be prevented with early detection and treatment. [3]

This year, the theme of WDD is “eyes on diabetes.” [2] Key messages of the campaign are:

  • Screening for type 2 diabetes is essential for managing the condition and reducing the risk of complications.
  • Screening for diabetes complications is a vital for the management of both types of diabetes. [2]

Highlighted articles from BMJ Open for World Diabetes Day 2016 include:



  1. World diabetes day 2016. Diabetes UK., accessed 8 November 2016
  2. World diabetes day. IDF., accessed 31 October 2016
  3. World diabetes day 2016. IDF. accessed, 31 October 2016

Top 10 Most Read: The Male-Female Gap in Alcohol Use, requests for genital cosmetic surgery and opposition to standardised tobacco packaging in the UK.

8 Nov, 16 | by Ed Sucksmith


October sees six new entries make it into our top ten most read articles. In at number 2 is a systematic review investigating birth cohort changes in male-to-female ratios in indicators of alcohol use and related harms. The authors concluded that the male–female gap in alcohol use was closing over time, with women now drinking almost as much as men. At number 3 is a survey of GPs’ knowledge, attitudes and practice regarding female genital cosmetic surgery in Australia. The study found high rates of women contacting their GP about genital normality concerns, with those requesting female genital cosmetic surgery frequently having a suspected or diagnosed psychological problem.

Other new entries include a documentary analysis of opponents to standardised packaging in the UK by Dr Jenny Hatchard and colleagues from the University of Bath and Aston University. The authors found that opposition to standardised packaging was primarily undertaken by third parties with financial relationships to major tobacco manufacturers, whilst a lack of transparency regarding these links created a misleading impression of diverse and widespread opposition.

Ravnskov et al.’s systematic review on the associations between low-density-lipoprotein cholesterol and mortality remains in first place for a fifth month in a row.


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 Slade et al. Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression
3 Simonis et al. Female genital cosmetic surgery: a cross-sectional survey exploring knowledge, attitude and practice of general practitioners
4 Fenton et al. Systematic review of the association between dietary acid load, alkaline water and cancer
5 Power et al. Multimethod study of a large-scale programme to improve patient safety using a harm-free care approach
6 Nazar et al. New transfer of care initiative of electronic referral from hospital to community pharmacy in England: a formative service evaluation
7 Hatchard et al. Standardised tobacco packaging: a health policy case study of corporate conflict expansion and adaptation
8 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
9 Dean et al. Community-based Rehabilitation Training after stroke: protocol of a pilot randomised controlled trial (ReTrain)
10 Johnson et al. Early real-world evidence of persistence on oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a cohort study in UK primary care

‘Worried well’ may be boosting their risk of heart disease

3 Nov, 16 | by Emma Gray

Potential consequences of health anxiety underlines need to treat it, say researchers

People who needlessly worry that they have, or will develop, serious illness—popularly referred to as ‘the worried well’—may be boosting their risk of developing heart disease, suggests research published in the online journal BMJ Open.

Anxiety is a known risk factor for heart disease. And health anxiety, which describes persistent preoccupation with having or acquiring a serious illness, and seeking prompt medical advice, on the basis of misattributed bodily symptoms in the absence of any physical disease, seems to be no exception, say the researchers.

And as such, it needs to be taken seriously and treated properly, they suggest.

They base their findings on 7052 participants of the Norwegian Hordaland Health Study (HUSK), a long term collaborative research project between the National Health Screening Service, the University of Bergen, and local health services.

The participants, all of whom were born between 1953 and 1957, filled in two questionnaires about their health, lifestyle, and educational attainment. And they had a physical check-up, consisting of blood tests, weight, height, and blood pressure measurements, taken between 1997 and 1999.

Levels of health anxiety were assessed using a validated scale (Whiteley Index), comprising 14 items scored from 1-5. Those (710) whose total score amounted to 31 or more were in the top 10% of the sample and considered to have health anxiety.

The heart health of all the participants was subsequently tracked using national data on hospital treatment episodes and death certification up to the end of 2009.

Anyone who received treatment for, or whose death was linked to, coronary artery disease occurring within a year of entering the study, was excluded, on the grounds that they might already have been ill.

In all, 234 (3.3%) of the entire sample had an ischaemic event—a heart attack or bout of acute angina—during the monitoring period, with the average time to the first incident just over 7 years.

But the proportion of those succumbing to heart disease was twice as high (just over 6%) among those who displayed health anxiety as it was among those who didn’t (3%).

While established risk factors for heart disease explained part of the association found, health anxiety was still linked to a heightened risk, after taking account of other potentially influential factors.

Those with health anxiety at the start of the study were 73% more likely to develop heart disease than those who weren’t in this state of mind, the analysis showed. And the higher the Whiteley Index score, the greater was the risk of developing heart disease.

This is an observational study, so no firm conclusions can be drawn about cause and effect, added to which the researchers admit that health anxiety often exists alongside other mental health issues, such as general anxiety and depression, making it hard to differentiate.

But the findings back current thinking on the potentially harmful effects of anxiety on health, they say.

“[Our research] further indicates that characteristic behaviour among persons with health anxiety, such as monitoring and frequent check-ups of symptoms, does not reduce the risk of [coronary heart disease] events,” they write.

If anything, putting the body on a permanent state of high alert may have the opposite effect, they suggest.

“These findings illustrate the dilemma for clinicians between reassuring the patient that current physical symptoms of anxiety do not represent heart disease, contrasted against the emerging knowledge on how anxiety, over time, may be causally associated with increased risk of [coronary artery disease],” they conclude.

The findings “underline the importance of proper diagnosis and treatment of health anxiety,” they add.