Childhood obesity, defined as an age-adjusted and sex-adjusted body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) in the 95th percentile or higher, accordi...

When people consult their GP they often arrive with a clearly defined medical problem—a pain, a lump, breathlessness, a rash—and what they’re asking for is a diagnosis, treatment, and, if necessary, a referral. However, the solution to a problem isn’t always obvious or simple: a patient may present with back pain and insomnia, but further discussion may reveal relationship problems, stresses at work

I recently went on a country walk with two medical friends, and for some reason we started to talk about 360 degree feedback, sometimes called multisource feedback. This is an exercise that virtually all doctors have to do in one context or another, requesting comments from colleagues on our performance, teamwork, and so on. To be honest, the three of us had little positive to say about it. Maybe some

Finn and colleagues make several excellent points.1 Four year graduate entry courses are a useful model; generally these have been successful in reducing the course from five years. This has been done partly by making the course more intense, by …

England’s suicide prevention strategy still needs to be backed by sufficient resources, writes Ella Fuller A year has passed since the publication of a new national suicide prevention strategy for England.1 In that time, the political landscape has shifted and we now have a new government in place, but national data on deaths by suicide are still showing worrying trends. As outlined in last year’s

The World Health Organisation says that air pollution contributes to seven to eight million premature deaths a year, but only one person, Ella Kissi-Debrah, has ever had air pollution on their death certificate. She has it on her death certificate because of a long struggle led by her mother, Rosamund Kissi-Debrah, supported by doctors and lawyers. On Saturday 7 September, International Day of Clean

“… a range of collective failures in leadership” (page 3) “… a clear lack of accountability and due process.” (page 4) “[T]here is a pervasive lack of trust and confidence in the College’s governance.” (page 4) “The Council is not operating effectively.” (page 4) “When the evidence did not … match the apparent pre-conceived views of those behind the survey [of members], it led to the results being

I agree with Finn and colleagues that the four year undergraduate medical degree will only hinder accessibility for those from disadvantaged socioeconomic backgrounds.1 A shorter degree would result in more intense hours of study, preventing …

The Cass review of the care of children and adolescents with gender dysphoria was a wake up call.1 Having commissioned several peer reviewed, systematic reviews of evidence, paediatrician Hilary Cass’s team drew on four years’ comprehensive engagement with service users, parents, clinicians, researchers, and advocacy groups, finding that most children’s gender dysphoria in historical cohorts resolves

Finn and colleagues highlight the potential unintended consequences of shortened medical degrees—particularly regarding access to medicine, degree attrition rates, and reduced global recognition of the UK medical degree.1 Of particular concern is “paradoxically rising unemployment.” Increasing medical student and foundation year doctor cohorts, without concomitant increases in senior posts, will exacerbate

Lightning is responsible for over a third of deaths by natural disasters in India. And it disproportionately affects the poorest people, write Majid Alam and Rishabh Jain On the morning of 6 July, 48 year old Leela Devi went to harvest moong beans near her house in Bihar, northeast India. She was struck unconscious by a powerful thunderbolt and despite being rushed by relatives to the nearby government

Reducing the prevalence of obesity requires multifaceted intervention, and system-wide modelling would support a move away from current piecemeal policy making towards an equitable and cost effective strategy, argue Joanna McLaughlin and colleagues Despite longstanding government rhetoric of a commitment to tackling obesity, UK policies have not provided an adequate and coherent response. A 2021 analysis

BACKGROUND Insulin efsitora alfa (efsitora) is a new basal insulin designed for once-weekly administration. Data on safety and efficacy have been limited to small, phase 1 or phase 2 trials. METHODS We conducted a 52-week, phase 3, parallel-design, open-label, treat-to-target trial involving adults with type 2 diabetes who had not previously received insulin. Participants were randomly assigned in

BACKGROUND Long-term oxygen supplementation for at least 15 hours per day prolongs survival among patients with severe hypoxemia. On the basis of a nonrandomized comparison, long-term oxygen therapy has been recommended to be used for 24 hours per day, a more burdensome regimen. METHODS To test the hypothesis that long-term oxygen therapy used for 24 hours per day does not result in a lower risk of

Analysis of data related to the Ukraine famine of 1932–1933 shows that in utero exposure to famine increases the risk of adult type 2 diabetes by more than twofold.

The pandemic’s origins, the lab leak theory, and the blame game have been in the headlines again. Despite another war of words, we aren’t any closer to a definitive answer as to where the novel coronavirus came from. Mun-Keat Looi asks why “Simply preposterous,” said Anthony Fauci, responding in a US congressional hearing to one more in a long line of allegations that he had caused the covid-19 pandemic

Industry influence still threatens the integrity of healthcare and harms patients “To influence physicians from the bottom up” reads an internal company document published in the late 1990s from the drug manufacturer Parke-Davis.1 This memo, outlining the company’s business strategies for a section of its market, became public through litigation around off-label drug promotion. Among the company’s

Consultant radiologist Jumana Hussain talks to Erin Dean about maintaining her identity and culture while working as a doctor From an early age Jumana Hussain was told, “It doesn’t matter what background you’re from, it doesn’t matter who you are or that you’re a woman, you’re going to go and succeed.” Hussain, who works for Everlight Radiology providing radiology reporting, says that teachers have

BACKGROUND Depemokimab is an ultra-long-acting biologic therapy with enhanced binding affinity for interleukin-5 that may enable effective 6-month dosing intervals. METHODS In these phase 3A, randomized, placebo-controlled replicate trials, we evaluated the efficacy and safety of depemokimab in patients with severe asthma and an eosinophilic phenotype characterized by a high eosinophil count (≥300

ImportanceCatastrophic facial injury with globe loss remains a formidable clinical problem with no previous reports of reconstruction by whole eye or combined whole eye and facial transplant.ObjectiveTo develop a microsurgical strategy for combined whole eye and facial transplant and describe the clinical findings during the first year following transplant.Design, Setting, and ParticipantA 46-year-old

This Viewpoint discusses the findings of a recent National Academies of Sciences, Engineering, and Medicine report suggesting that current health care delivery and accountability structures perpetuate, rather than reduce, health inequities and details several changes needed to address these structural problems.

ImportanceScabies, bedbug, and body lice infestations are caused by organisms that live on or in the skin, on clothing, or in the environment and commonly cause pruritus and rash. In 2021, approximately 622 million incident cases of scabies occurred globally. Data on bedbug infestations are limited. Body lice prevalence ranges from 4.1% to 35% among persons experiencing homelessness worldwide.ObservationsScabies

Food additives that are “generally recognized as safe” — a determination that can be made by manufacturers — aren’t required to be approved by the FDA. This system could pose a threat to public health.

The optimum number of units of blood and the associated number of blood donors required to meet a given population's needs remain undetermined globally. Typically, a whole blood donation rate of ten donations per 1000 population, at a minimum, is necessary to meet a country's blood needs. This rate is attributed to a WHO recommendation that 1% of a given country's population should donate blood to

BACKGROUND Leber congenital amaurosis 1 (LCA1), caused by mutations in GUCY2D, is a rare inherited retinal disease that typically causes blindness in early childhood. The aim of this study was to evaluate the safety and preliminary efficacy of ascending doses of ATSN-101, a subretinal AAV5 gene therapy for LCA1. METHODS 15 patients with genetically confirmed biallelic mutations in GUCY2D were included

arising from M. Ferrell et al. Nature Medicine https://doi.org/10.1038/s41591-023-02793-8 (2024) Ferrell et al.1 recently reported associations between serum levels of the terminal niacin metabolites N1-methyl-2-pyridone-5-carboxamide (2PY) and N1-methyl-4-pyridone-3-carboxamide (4PY) with an increased 3-year incident risk of major adverse cardiovascular events. The association of 4PY with cardiovascular

replying to J. R. Guyton & W. E. Boden Nature Medicine https://doi.org/10.1038/s41591-024-03220-2 (2024) replying to S. Schreiber et al. Nature Medicine https://doi.org/10.1038/s41591-024-03219-9 (2024)

Diversity, equity and inclusion (DEI) has become a political lightning rod in the USA, with its laudable mission increasingly misinterpreted as a blunt discriminatory tool. Although such critique has been ongoing for decades, it has intensified in academic medicine in recent months, from the resignation of Johns Hopkins’ chief diversity officer over an email on privilege, to efforts within the American

arising from M. Ferrell et al. Nature Medicine https://doi.org/10.1038/s41591-023-02793-8 (2024) Ferrell et al.1 report a surprisingly strong association between terminal metabolites of niacin and major adverse cardiovascular events (MACE), amounting to roughly a doubling of MACE risk in the 4th quartile of circulating levels of the 4PY (N1-methyl-4-pyridone-3-carboxamide) metabolite. The results presented

Multimorbidity, the cooccurrence of two or more chronic health conditions within the same individual, is increasingly prevalent worldwide and is associated with decreased health-related quality of life, increased mortality, and greater healthcare utilization1,2. The clinical care of multimorbidity is complex, arising from potential interactions between conditions, treatment regimens and overlapping

Measuring patient related outcomes helps to assess the effects of treatment on patients and can facilitate personalised care, say Ramzi Ajjan and colleagues In most consultations about long term conditions, healthcare professionals tend to focus on patients’ clinical outcomes or targets. Frequently missing from these discussions is how psychologically and physically challenging the day-to-day management

In 2017, one of us wrote in this journal that “it is impossible to achieve a comprehensive understanding of events such as Grenfell Tower without confronting the political determinants of health and challenging the forces that shape them.” 1 Seven years later, the final report of the official inquiry into this tragedy, which killed 72 people, shows the extent to which this argument holds true.2 When

The anthropologist Helen Fisher, who died just a few weeks ago, was well known for her many elegant studies on the pharmacology and neuroanatomy of the three primary emotions associated with mating and reproduction: sexual desire or lust, romantic love, and long term attachment or devotion. Lust, she thought, was mediated in the brain by oestrogens and androgens, romantic love by increases in dopaminergic

Michael Crowe was born in Harrogate, the son of Nora and Squadron Leader (later Air Commodore) Henry Crowe. He was educated at Malsis Hall and Bootham School in York. Following national service in the Royal Navy, he attended Magdalene College, Cambridge, completing his clinical studies at Guy’s Hospital, London. After house jobs in Guildford he embarked on a 44 year career in general practice, …

Hugh Dinwoodie was a GP, an enthusiastic piper, a lifelong climber, and a keen archaeologist. He was born in Derby in 1930, the son of a Scottish doctor practising “down south.” Hugh, the eldest of three siblings, was sent back to Scotland to be educated at Merchiston Castle School, where he was introduced to piping. He later became pipe major …

Henry Gossman was born in Berlin in 1925. His paternal grandmother was Jewish and despite her conversion to Christianity the family endured escalating persecution from the Nazis. His father, a lawyer, escaped to England when it became clear that he would be arrested. Henry’s mother organised Henry’s escape with his younger sister, Ursula, just before the outbreak of the second world war. Henry was