In our top 10 most read blog, we highlight the articles from BMJ Open that have been the most widely read in the previous month. The chart below is based on full text views—including downloads of the full article PDFs—from July 2024.

Spotlight remains on COVID-19

July saw seven new entries into the top 10, three of which were focused on COVID-19. One of the articles remaining in the chart from previous months, Naik et al’s trial protocol assessing low-dose naltrexone for post-COVID fatigue syndrome, brings COVID-related papers up to 40% of the top 10.

Among the new entries, Murthy et al’s observational study looked at trends in serious and life-threatening COVID-19 pneumonia as the SARS-CoV-2 pandemic progressed. Using data from 15 US hospitals, they investigated 60-day mortality after hospital admission, taking into consideration patient demographics, medical history, COVID-19 vaccination status, viral variant, symptoms, and routine laboratory test results. They report that, while the observed mortality of patients hospitalised with COVID-19 has decreased substantially over time, COVID-19 remains lethal, although for a decreasing at-risk group of the general population. Notably, the authors report, for those who develop severe and life-threatening COVID-19 pneumonia, a patient admitted early in the pandemic and predicted by the authors’ model to be at high risk of mortality would still be at high risk of mortality if admitted tomorrow.

Meanwhile, Schade Skov et al utilised national health register data from Denmark to investigate stroke risk following SARS-CoV-2 infection in relation to disease severity. Notably, about 83% of the adult Danish population had one or more SARS-CoV-2 PCR tests within the study period, resulting in a large study cohort. The researchers report that SARS-CoV-2 infection was associated with an increased stroke risk and that disease severity seems to be an important factor—those with community-managed SARS-CoV-2 infection had no increased risk of stroke.

Finally, Adegoke et al investigated the impact of the COVID-19 pandemic on infant vaccination trends among rural and urban communities in Ibadan, Nigeria. The authors compared infant vaccination records 1 year before and 1 year after the onset of the pandemic, noting declines in vaccination uptake, timeliness, and completion, with urban communities more strongly affected.

Neurodivergence and chronic fatigue

In the most read of our new entries, at third place in the top 10, Quadt et al analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort to investigate the link between neurodivergent traits in childhood and chronic disabling fatigue in adolescence. The authors report that children with neurodivergent traits (above the screening threshold for autism or attention deficit hyperactivity disorder) at ages 7 and 9 years were around two times as likely to experience chronic disabling fatigue at age 18. A mediation analysis suggests a possible role for inflammation (as assessed via interleukin 6 measured at age 9) in the reported association.

Socioeconomic status and health professional bias

Rounding out the new original research articles in the July top 10, Job et al report the results of their scoping review looking at the impact of health professional bias with respect to socioeconomic status (SES) on clinical decision-making and its effect on care (the work was based on an a priori protocol, also published in BMJ Open). Of 48 primary research studies included in the scoping review, 35 (73%) reported an association between health professional SES bias and decision-making. The reviewers conclude that clinical decision-making is sometimes influenced by non-medical factors for people with low SES, and that “assumptions are made based on implicit bias and stereotyping, which compound or exacerbate health inequalities”.

Below are the top ten most-read papers in BMJ Open during July 2024: