In the latest rundown of our top ten most read articles, we highlight new entries to our monthly chart of the most widely read publications in BMJ Open from April 2025. The top ten table below is based on full text views—including downloads of the full article PDFs.
Sexual and reproductive health in rural Pakistan
In the first new entry in the top ten—sitting at the top of the chart—Inayat Ali and colleagues report findings from a cross-sectional study of sexual and reproductive health knowledge, attitudes and practices among male and female adolescents living in rural subdivisions of the Thatta district of Sindh, Pakistan.
The authors report that, among the respondents, there were no significant differences in mean scores for knowledge and attitudes between males and females, although a difference in practice score was identified. In multivariable analysis, participant marital status and father’s occupation were associated with knowledge score; marital status, household income, father’s occupation and mother’s education were associated with attitude score; and marital status and mother’s occupation were associated with practice score.
The study utilised a systematic, multistage sampling technique and had a response rate of 83%; however, the authors report a strong gender imbalance in favour of female respondents, which they indicate is due to the timing of data collection.
Symptom clusters, diagnosis and healthcare experiences in ME/CFS and long COVID
At number two in April’s top ten list, Mansoubi and colleagues report findings from a secondary analysis of UK survey data, investigating symptoms, coexisting conditions and service utilisation among people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or long COVID. The online survey was conducted between May and July, 2023—among 10 458 individuals who responded to the survey, 8804 confirmed that they or a close friend/family member had ME/CFS or long COVID.
The investigators report that ME/CFS and long COVID have overlapping but distinct symptom clusters, suggesting common challenges with respect to management. They also emphasise that their study findings highlight significant delays in diagnosis and low satisfaction with specialist services as key issues to be addressed.
RSVpreF vaccine in pregnancy
At number six in April’s top ten, Alami and colleagues report on the post-marketing safety profile of respiratory syncytial virus (RSV) prefusion F (RSVpreF) vaccine among pregnant individuals. In their analysis of the US Food and Drug Administration’s Vaccine Adverse Event Reporting System (VAERS) database, covering spontaneously reported adverse event data from Sept 1, 2023 to Feb 23, 2024, they identify 77 relevant reports, 42 of which were classified as serious. Among pregnancy-related events, preterm birth was the most frequently reported (27 event reports), most of which were moderate to late. In a disproportionality analysis, reports of preterm birth in conjunction with RSVpreF vaccination were determined to have been observed more frequently than would be statistically expected.
The authors conclude that their findings largely aligned with the safety profile observed in prelicensure studies, but that they do highlight a previously observed safety signal for preterm birth. They recommend active surveillance studies focused on maternal and perinatal outcomes to further investigate this signal and guide future clinical recommendations.
New-onset supraventricular arrhythmia during septic shock
Rounding out the new entries to the top ten, Labbé and colleagues present the study protocol for a randomised controlled trial to compare the efficacy and safety of three management strategies in patients with new-onset supraventricular arrhythmia (NOSVA) during septic shock. The Control Atrial Fibrillation in Septic shock (CAFS) study is being conducted in France and Belgium and will compare risk control (magnesium and control of risk factors for NOSVA), rate control (risk control and low-dose amiodarone) or rhythm control (risk control and cardioversion using high-dose amiodarone with external electrical shock if NOSVA persists) for 7 days. Results are expected by 2026.
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Below are the top ten most-read papers in BMJ Open during April 2025: