Medical Journal News

bmj;388/mar21_10/r565/FAF1faAt the height of the Troubles in the early 1980s Ian Bownes, a young trainee psychiatrist in Northern Ireland, was sent into the notorious H blocks in Belfast’s Maze prison to assess if its paramilitary inmates were mentally fit to go on hunger strikes.It would have been an unsettling experience for anyone to go inside the Maze, which mainly housed republican prisoners. For a young Protestant like Bownes, however, it must have been even tougher. That Bownes did so for many years spoke to his “quiet heroism,” how much his professional opinion was valued, and how fully he was trusted to uphold the confidentiality on which his access depended, says friend and former colleague Harry Kennedy, a professor of forensic psychiatry at the University of Dublin.When Bownes first went into the Maze, republican prisoners were escalating a campaign of protest against the British government. This included demands to reinstate special...

by Yulong Ma, Siyuan Liu, Faqiang Zhang, Xuhui Cong, Bingcheng Zhao, Miao Sun, Huikai Yang, Min Liu, Peng Li, Yuxiang Song, Jiangbei Cao, Yingfu Li, Wei Zhang, Kexuan Liu, Jiaqiang Zhang, Weidong Mi

Background

Perioperative stroke is a serious and potentially fatal complication following non-cardiac surgery. Thus, it is important to identify the risk factors and develop an effective prognostic model to predict the incidence of perioperative stroke following non-cardiac surgery.

Methods and findings

We identified potential risk factors and built a model to predict the incidence of perioperative stroke using logistic regression derived from hospital registry data of adult patients that underwent non-cardiac surgery from 2008 to 2019 at The First Medical Center of Chinese PLA General Hospital. Our model was then validated using the records of two additional hospitals to demonstrate its clinical applicability. In our hospital cohorts, 223,415 patients undergoing non-cardiac surgery were included in this study with 525 (0.23%) patients experiencing a perioperative stroke. Thirty-three indicators including several intraoperative variables had been identified as potential risk factors. After multi-variate analysis and stepwise elimination (P < 0.05), 13 variables including age, American Society of Anesthesiologists (ASA) classification, hypertension, previous stroke, valvular heart disease, preoperative steroid hormones, preoperative β-blockers, preoperative mean arterial pressure, preoperative fibrinogen to albumin ratio, preoperative fasting plasma glucose, emergency surgery, surgery type and surgery length were screened as independent risk factors and incorporated to construct the final prediction model. Areas under the curve were 0.893 (95% confidence interval (CI) [0.879, 0.908]; P < 0.001) and 0.878 (95% CI [0.848, 0.909]; P < 0.001) in the development and internal validation cohorts. In the external validation cohorts derived from two other independent hospitals, the areas under the curve were 0.897 and 0.895. In addition, our model outperformed currently available prediction tools in discriminative power and positive net benefits. To increase the accessibility of our predictive model to doctors and patients evaluating perioperative stroke, we published an online prognostic software platform, 301 Perioperative Stroke Risk Calculator (301PSRC). The main limitations of this study included that we excluded surgical patients with an operation duration of less than one hour and that the construction and external validation of our model were from three independent retrospective databases without validation from prospective databases and non-Chinese databases.

Conclusions

In this work, we identified 13 independent risk factors for perioperative stroke and constructed an effective prediction model with well-supported external validation in Chinese patients undergoing non-cardiac surgery. The model may provide potential intervention targets and help to screen high-risk patients for perioperative stroke prevention.

Great British Energy, a new, publicly owned company created by the government, is to invest £200m to fit solar panels to the roofs of 200 NHS hospitals and 200 schools in England. The aim is to cut costs and carbon and make key areas of the public sector less dependent on the uncertain energy market. The programme is expected to save £400m over the lifetime of the panels (30 years), with savings reinvested in the NHS and education. The NHS spends an estimated £1.4bn a year on energy, a figure that has more than doubled since 2019.The programme is expected to last two years, and the first panels should be on NHS sites and schools by the end of summer 2025. The educational component of the programme will focus on schools in deprived areas, particularly in the north east, north west, and west Midlands.Mark Harber, special adviser on healthcare sustainability...

Weight management programmes for obese or overweight children may be effective, but their impact has been hampered by low uptake and completion rates, an evaluation of eight pilot projects across England has suggested.1A report from the Office for Health Improvement and Disparities evaluated eight projects funded through a £4.2m government grant in July 2021, which piloted extended brief interventions (EBIs) and expansion of behavioural weight management services for children aged 2 to 19 and their families.EBIs involve a practitioner discussing a child’s weight and growth with their parent or carer, and can include the use of behaviour change techniques, tailored support, and onward referral to services. Weight management services usually involve 12 week programmes and include diet and physical activity guidance. Their primary aim is weight maintenance and growing into a healthier weight, rather than weight loss.The pilots were funded for a year and took place across several areas in...

The World Health Organization (WHO) has called for an urgent international public health response as tuberculosis (TB) funding cuts threaten to reverse two decades of progress in containing the world’s deadliest infectious disease.The UN health agency said that it was particularly concerned about services in the world’s worst affected nations collapsing, allowing the respiratory disease to spread almost unabated.More than a million people died from TB last year, but that number is expected to rise sharply as public health systems, particularly in Africa, are no longer able to diagnose, treat, and monitor the disease. WHO warned that the situation could quickly deteriorate, as 27 countries faced “crippling breakdowns” in their TB response as funding cuts hit every stage of detection, treatment, and prevention.“The huge gains the world has made against TB over the past 20 years are now at risk as cuts to funding start to disrupt access to services...

A US judge has blocked drastic job cuts to the US Agency for International Development (USAID).On 18 March Judge Theodore Chuang of the US District Court for Maryland ruled that the moves—which effectively shut the agency—had probably violated the US constitution. The case was brought by more than 20 current and former USAID employees and contractors.The fired employees are not back at work but have been placed on paid administrative leave. The judge said the fast shutdown of the agency “deprived the public’s elected representatives in Congress of their constitutional authority to decide whether, when, and how to close down an agency” authorised by Congress.1The cuts were initiated by the Department of Government Efficiency (DOGE) which is headed by billionaire Elon Musk, adviser to President Donald Trump. Around 1600 of USAID’s US employees were fired and most of the rest were placed on administrative leave. USAID had about 13 000...

Liz Calhoun was halfway through her three year emergency physician training when she learnt from a text message that her hospital was closing in three months. She and the other 571 resident physicians at Hahnemann University Hospital in Philadelphia did not know how or where they would finish their training. In the end they didn’t have three months to figure it out: the training programme closed 30 days later.Hahnemann, located in the heart of the city, was a “safety net” hospital, meaning that its staff provided care to patients regardless of their insurance status or ability to pay. At the time of its closure in 2019, Hahnemann made headlines as the model for what can go wrong when a profit driven private equity firm takes over a hospital. In the years since, several other hospitals bought by private equity firms have abruptly closed, leaving their communities’ health, economies, and resident...

New England Journal of Medicine, Ahead of Print.

Traditional solid fuels, such as coal and biomass, continue to be widely used to meet daily cooking energy needs, with particularly widespread consumption persisting in many low-income and middle-income countries (LMICs).1 Incomplete burning of these solid fuels yields various hazardous particles that pollute ambient and indoor air.2 Prolonged indoor exposure to household air pollution (HAP) substantially elevates the risk of developing severe respiratory and cardiovascular diseases, such as lung cancer, chronic obstructive pulmonary disease, and ischaemic heart disease.

Although the burden attributable to HAP has decreased considerably, HAP remains a substantial risk factor, especially in sub-Saharan Africa and south Asia. Our comprehensive estimates of HAP exposure and attributable burden offer a robust and reliable resource for health policy makers and practitioners to precisely target and tailor health interventions. Given the persistent and substantial impact of HAP in many regions and countries, it is imperative to accelerate efforts to transition under-resourced communities to cleaner household energy sources.

by Juan Carlos Salgado, Lilia S. Pedraza, Alejandra Contreras-Manzano, Tania C. Aburto, Lizbeth Tolentino-Mayo, Simon Barquera

Background

In late March 2020, the Mexican government announced an updated norm to include front-of-pack warning labels for packaged foods and non-alcoholic beverages. Warning labels came into effect in October 2020. To avoid displaying warning labels, producers can reformulate their products by reducing the content of calories or critical nutrients targeted by the policy (added sugars, saturated fat, and sodium) or removing non-caloric sweeteners or added caffeine. The objective of this study is to assess changes in the percentage of products above warning-label cutoffs for calories and critical nutrients and changes in the content of calories and critical nutrients associated with warning labels in Mexico.

Methods and findings

We used nutritional panel data collected by the Mexican National Institute of Public Health from ≈1,000 top-purchased products, which represented ≥60% of the market share for each of the included food groups according to household purchases in the Nielsen Consumer Panel commercial dataset for Mexico in 2016. Nutritional panel data is available for three periods: 2016−2017, T0 (pre-policy); Jul–Sep 2020, T1 (post-warning-label announcement); and Feb–Apr 2021, T2 (post-warning-label implementation). We assessed changes in T1 versus T0 (potential anticipatory reformulation before the warning-label implementation) and T2 versus T0 (reformulation after the warning-label implementation) by food group using generalized estimating equations for the percentage of products above warning-label cutoffs or containing non-caloric sweeteners or added caffeine, and fixed-effects linear models and quantile regressions for the content of calories and critical nutrients. Included food groups were cereal-based desserts, bread and other cereals, salty snacks, sweetened beverages, solid dairy, liquid dairy, instant food, and candies. At T0, the food group level with the lowest percentage of products with at least one calorie/nutrient content above warning-label cutoffs was instant food (77.8%); at T2, this fell to 52.6%. Based on our statistical models, we found that all food groups showed reductions in at least one type of warning label. The most common reductions in the percentage of products exceeding warning-label cutoffs were for sodium (up to −63.1 percentage points for bread and other cereals; 95% CI: −77.5, −48.6; p-value < 0.001), saturated fat (up to −26.3 percentage points for salty snacks; 95% CI: −35.8, −16.8; p-value < 0.001), and products containing non-caloric sweeteners (up to −29.0 percentage points for solid dairy; 95% CI: −40.7, −17.2; p-value < 0.001). The reductions in products above warning-label cutoffs were coupled with reductions in products’ content of calories and critical nutrients. According to quantile regressions, these reductions mostly occurred at the 50th–75th percentiles. Product reformulation mainly occurred in T2.

Conclusion

Our findings show product reformulation due to reductions in critical nutrients/calories after the warning-label policy implementation, which entails improving the nutritional profile of the packaged food and beverage supply in Mexico.

“During medical school, I came across a professor who introduced me to research—up until that point, I was content with being an excellent clinician, but that was the moment when I realised that I was missing out on making a larger impact on the population at large”, recalls Assistant Professor Aliasgar Esmail, Pulmonologist at the Groote Schuur Hospital and Deputy Head of the Centre for Lung Infection and Immunity at the University of Cape Town (UCT) Lung Institute in South Africa. As one of two recipients of the 2024 Stephen Lawn TB-HIV Research Leadership Prize, Esmail felt “so overwhelmed and humbled” to have received the award.

“I think what I've really wanted to do since I was a teenager was work on HIV and TB, and conditions that affected people who were disproportionately poor and vulnerable. And research was a nice way into that, but—the purpose of what the research was for, that came before the methods, was justice and solidarity, and a conviction that everybody matters. That was really, genuinely important. That's how I ended up in public health”, says Rachael Burke, joint winner of the 2024 Stephen Lawn TB-HIV Research Leadership Prize.

As Justin Trudeau steps down after a decade as leader of Canada's ruling Liberal Party, Canadians face a pivotal moment. Although attention is focused on trade tariffs and souring relations with the USA, there are important health dimensions to Canada's political transition. Trudeau leaves behind a legacy of initiatives, including the Canada Child Benefit, climate change initiatives through the Pan-Canadian Framework, a National Housing Strategy, legalisation of cannabis, the Early Learning and Child Care plan, and the Canadian Dental Care Plan—which has already benefited 1·5 million Canadians—and passed a universal pharmacare plan to institute publicly funded coverage for medications.

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 on oral conditions represents a landmark moment for the community.1 For the first time, a comprehensive analysis of the global, regional, and national burden of oral diseases has been published in The Lancet. Previously confined to dental research journals, this broader platform underscores the increasing significance of oral diseases in global health.

President Subianto's ambitious plan of health checks for all is one of Indonesia's biggest ever health initiatives, but not everyone is convinced it will have the desired effect. Chris McCall reports.

Many Indians are exposed to silica dust, but experts and patients lament the lack of information and health services related to silicosis. Sophie Cousins reports from West Bengal.