April saw four papers enter into BMJ Open’s top 10 most read articles. The journal’s most read paper in April reviewed the safety of morphine use in acute coronary syndrome. The authors found an association between morphine and increased risk of in-hospital mortality and major adverse cardiovascular events, but this was based on studies with a high risk of bias. Higher quality of evidence was found for the finding that morphine decreases the antiplatelet effect of P2Y12 inhibitors in the first hours of acute coronary syndrome. In at 8th position is a study quantifying sex ratios at birth and the demographic correlates of skewed sex ratios at birth in Nepal. Analysis of data from a randomised controlled trial and the 2011 Nepal Demographic and Health Survey uncovered evidence for a skewed sex ratio of deliveries in six large public hospitals, which the authors attributed to sex-selective abortion. Lastly, at number 10 is a study from the UK’s Great Ormond Street Institute of Child Health in London, investigating the associations between different forms of child maltreatment and mid-adult cardiometabolic markers. Using data from the 1958 British birth cohort, the authors found all forms of child maltreatment were associated with at least one adverse cardiometabolic outcome (adiposity, blood lipids and/or HbA1c) in mid-adulthood; consistent associations were found for neglect and physical abuse in relation to adiposity.

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