Medical Journal News

Targeted NHS retention schemes have helped to reduce the number of doctors and other staff leaving the health service, NHS England has reported.NHS data show that one in 10 (10.1%) hospital and community healthcare workers left the NHS in the 12 months up to September 2024, nearly 21 300 fewer than in the same period up to September 2022 when one in eight (12.5%) left the health service.12 In the same period, one in seven (13.9%) doctors working in hospital and community services left the NHS, 771 fewer than in the 12 months up to September 2022, when one in six (15.9%) doctors left.NHS England said that the fall in leavers had been aided by a pilot scheme to find new ways to improve retention, which was trialled in 23 trusts from April 2022 and is now being extended to a further 116. An NHS England evaluation of the initiative...

International women’s day falls on 8 March every year. As the outgoing president of the Medical Women’s Federation, I want this year’s celebration to be followed by action. The number of women doctors in the UK has doubled in the past 20 years.1 This is a large but undervalued workforce, so improving their working lives would have the additional benefit of improving health across the population.The key to this change is to talk about sexism and systemic barriers in medicine.23 We must challenge sexist generalisations about individual women doctors while also understanding that some general systemic factors are more likely to limit their careers than those of men. Pregnancy, child rearing, caring for elderly parents, or being overlooked for opportunities and development are factors affecting women doctors at critical phases, preventing career progression.The prevailing model of healthcare—a continuum of symptoms, investigations, diagnosis, treatment, and cure—doesn’t fit our increasingly complex population...

Within hours of being sworn in, President Donald Trump signed an executive order withdrawing the United States from the World Health Organization (WHO).1 On 30 January 2025, just 10 days later, a deadly outbreak of the Sudan strain of the Ebola virus was reported in Kampala, Uganda.2 By 10 February, nine cases of the virus had been confirmed.3 This marks Uganda’s sixth Ebola outbreak since 2000, following the late 2022 outbreak that resulted in 143 infections and 55 deaths.4The US contributes roughly 14% of the WHO’s $6.9bn biennial budget, so its withdrawal would strip WHO of a major funder, leading to budget cuts that will affect both the current response in Uganda and global health efforts broadly.5Historically, WHO has had a crucial role in managing outbreaks in sub-Saharan Africa. In Uganda in 2022, WHO provided essential equipment like testing kits and isolation centres for patients with Ebola, enhancing disease containment...

Last month NHS England published its priorities and operational planning guidance for 2025-26,12 outlining key improvement objectives for the NHS for the first time since Labour took office in 2024. Meanwhile, the government’s 10 year plan for the NHS3 is due to report this spring. Whatever the 10 year plan concludes won’t be enacted immediately. If we’re looking for actions to improve, stabilise, or protect services—and to navigate our way out of our current crisis—this operational plan is our only short term roadmap. But is it helpful?In January, Wes Streeting’s Road to Recovery,4 his first mandate to the NHS as health and social care secretary, emphasised the need to “cut waiting times for elective care,” “improve urgent and emergency care,” “improve access to primary care,” “reduce the amount of time spent in ill health,” “tackle health inequalities,” and “reduce lives lost to the biggest killers—cancer, cardiovascular disease, and suicide.” It...

New England Journal of Medicine, Volume 392, Issue 10, Page 947-957, March 6, 2025.

New England Journal of Medicine, Volume 392, Issue 10, Page 984-994, March 6, 2025.

New England Journal of Medicine, Volume 392, Issue 10, Page 1006-1016, March 6, 2025.

New England Journal of Medicine, Volume 392, Issue 10, Page 1037-1039, March 6, 2025.

New England Journal of Medicine, Volume 392, Issue 10, Page 1035-1037, March 6, 2025.

New England Journal of Medicine, Volume 392, Issue 10, Page 1028-1032, March 6, 2025.

New England Journal of Medicine, Volume 392, Issue 10, Page 1026-1027, March 6, 2025.

New England Journal of Medicine, Volume 392, Issue 10, Page 1018-1024, March 6, 2025.

New England Journal of Medicine, Volume 392, Issue 10, Page 1017-1017, March 6, 2025.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

Hospital consultants have demanded action to tackle the “unacceptable” treatment delays, avoidable harm, and excess deaths resulting from the number of patients being treated in corridors and other inappropriate settings.Doctors at the BMA’s UK consultants annual conference on 4 March said that they were “deeply concerned” by the crisis in emergency care which has resulted in unprecedented crowding in emergency departments and delays in ambulance responses.The conference carried a motion urging the BMA and medical royal colleges to lobby the government to urgently rectify the situation by tackling understaffing and under-resourcing in NHS trusts and social care. The BMA should also work with other unions and colleges to “increase pressure on the government to manage this crisis,” it said.In January1 a report from the Royal College of Nursing highlighted the scale of the problem.Denise Langhor, an emergency medicine consultant from Wirral University Teaching Hospital, who proposed the motion, described the...

Heart attacks and strokes rise exponentially with age and make a major contribution to increasing healthcare costs and lost productivity. In the UK more than 7 million people are living with cardiovascular disease. Around 100 000 people have a heart attack and more than 100 000 people have a stroke every year. Direct healthcare costs relating to cardiovascular disease are estimated at £10bn a year, with a cost of £25bn to the UK economy from lost productivity.1Preventive medication to reduce blood pressure and low density lipoprotein (LDL) cholesterol can have a major effect in avoiding most cases of heart attack and stroke.23 This opportunity has been neglected and should form part of an overall preventive strategy that also includes the avoidance of smoking or being overweight and keeping active. The polypill, which combines blood pressure lowering agents, statins, and anti-platelet agents, and its application in preventing heart attacks and strokes...

Israel is preventing humanitarian aid from entering Gaza following the expiration of the first phase of the ceasefire agreement on Saturday 1 March.No aid trucks were allowed into Gaza on Sunday morning, aid agencies said, contrasting with the thousands that have entered since the ceasefire began on 19 January.Israeli Prime Minister Benjamin Netanyahu said that Hamas “steals the supplies and prevents the people of Gaza from getting them.”1 Hamas denies the accusations.A Hamas spokesperson told BBC News that blocking supplies was “cheap blackmail” and called on mediators—Egypt, Qatar, and the US—to intervene. Qatar’s foreign ministry said it strongly condemned the Israeli blockade, which it described as “a clear violation of the ceasefire agreement and international humanitarian law.” Egypt similarly accused Israel of using starvation as a “weapon.”The UN Office for the Coordination of Humanitarian Affairs (OCHA) estimates that 876 000 Palestinians in Gaza are still experiencing “emergency” levels of food...

by Mary Ellen Gilder, Makoto Saito, Warat Haohankhunnatham, Clare L. Ling, Gornpan Gornsawun, Germana Bancone, Cindy S. Chu, Peter R. Christensen, Mallika Imwong, Prakaykaew Charunwatthana, Nay Win Tun, Aung Myat Min, Verena I. Carrara, Stephane Proux, Nicholas J. White, François Nosten, Rose McGready

Background

Malaria in pregnancy detected by microscopy is associated with maternal anaemia, reduced fetal growth, and preterm birth, but the effects of lower density (i.e., submicroscopic) malaria infections are poorly characterised. This analysis was undertaken to investigate associations between submicroscopic malaria at the first antenatal care (ANC) visit and these adverse pregnancy events on the Thailand–Myanmar border.

Methods

Blood samples taken from refugee and migrant pregnant women presenting for their first ANC visit were analysed retrospectively for malaria using ultrasensitive PCR (uPCR, limit of detection 22 parasites/mL). The relationships between submicroscopic malaria and subsequent microscopically detectable malaria, anaemia, birth weight, and preterm birth were evaluated using inverse probability weighting for stratified random sampling.

Results

First ANC visit samples from 4,352 asymptomatic women (median gestational age 16.5 weeks) attending between October 1st 2012 and December 31st 2015 were analysed. The weighted proportion of women with submicroscopic malaria infection was 4.6% (95% CI 3.9–5.6), comprising 59.8% (49.5–69.4) Plasmodium vivax, 6.5% (4.0–10.5) Plasmodium falciparum, 1.8% (0.9–3.6) mixed, and 31.9% (22.2–43.5) infections which could not be speciated. Submicroscopic parasitaemia at first ANC visit was associated with subsequent microscopically detected malaria (adjusted hazard ratio [HR] 12.9, 95% CI 8.8–18.8, p < 0.001) and lower birth weight (adjusted predicted mean difference −275 g, 95% CI −510 to −40, p = 0.022). There was no association with preterm birth. Submicroscopic P. falciparum mono-infection (adjusted HR 2.8, 95% CI 1.2–6.6, p = 0.023) and coinfection with P. falciparum and P. vivax (adjusted HR 10.3, 95% CI 2.6–40.4, p = 0.001) was associated with increased risk of maternal anaemia, but submicroscopic P. vivax mono-infection was not. That uPCR was conducted for only a part of the cohort due to cost constraints is a limitation.

Conclusions

In low transmission settings, uPCR identifies substantially more malaria infections at antenatal screening than conventional diagnostic methods. On the Thailand–Myanmar border, submicroscopic malaria at first antenatal consultation was associated with higher risks of microscopically diagnosed malaria later in pregnancy, anaemia, and reduced birth weight.

Widespread fears over the meaning of the Trump administration’s January foreign aid freeze gave way to shock and despair this week as the US government permanently cancelled funding for nearly 10 000 projects supporting health and development around the world.Some 5800 of the United States Agency for International Development’s 6200 multiyear awards will be elimination, representing $54bn of aid spending. At the Department of State, 4100 of 9100 grants were eliminated, worth $4.4bn.Global progress against HIV/AIDS, malaria, tuberculosis, and polio is likely to reverse, aid providers said, at a time when new treatments and vaccines had brought renewed hope of progress. The President’s Emergency Plan for AIDS Relief, the flagship US programme to combat HIV/AIDS, and the less well known President’s Malaria Initiative were not spared and many “lifesaving care” projects that were offered temporary waivers in January found themselves permanently cut off. The cuts amount to 90% of the...