BMJ Open - BMJ Journals

Resisting recommended treatment for #prostate #cancer: a qualitative analysis of the lived experience of possible overdiagnosis | BMJ Open
▻https://bmjopen.bmj.com/content/9/5/e026960
▻https://bmjopen.bmj.com

Men’s accounts revealed profound consequences of both prostate cancer diagnosis and resisting medical advice for treatment, with effects on their psychological well-being, family, employment circumstances, identity and life choices. Some of these men were tested for prostate-specific antigen without their knowledge or informed consent. The men felt uninformed about their management options and unsupported through treatment decision making. This often led them to develop a sense of disillusionment and distrust towards the medical profession and conventional medicine. The findings show how some men who were told they would soon die without treatment (a prognosis which ultimately did not eventuate) reconciled issues of overdiagnosis and potential overtreatment with their own diagnosis and situation over the ensuing 1 to 20+ years.

Students with lower A Levels from poorly performing schools do just as well on medical degrees - News and events, The University of York
▻https://www.york.ac.uk/news-and-events/news/2018/research/students-with-lower-a-levels-do-just-as-well

Particulièrement intéressant en ces temps de #sélection en #France,

The research also found that students from poorly performing schools who match the top A Level grades achieved by pupils from the best performing schools, go on to do better during a medical degree.

The authors of the research are now calling for medical school entry criteria to be relaxed for all pupils applying from low-performing schools.

L’étude du BMJ
▻http://bmjopen.bmj.com/content/8/5/e020291

#études

Effects of health and social care spending constraints on mortality in England: a time trend analysis | BMJ Open
▻http://bmjopen.bmj.com/content/7/11/e017722

#austérité #santé #mortalité #Angleterre

Objective Since 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates.

Methods We collected data on health and social care resources and finances for England from 2001 to 2014. Time trend analyses were conducted to compare the actual mortality rates in 2011–2014 with the counterfactual rates expected based on trends before spending constraints. Fixed-effects regression analyses were conducted using annual data on PES and PEH with mortality as the outcome, with further adjustments for macroeconomic factors and resources. Analyses were stratified by age group, place of death and lower-tier local authority (n=325). Mortality rates to 2020 were projected based on recent trends.

Results Spending constraints between 2010 and 2014 were associated with an estimated 45 368 (95% CI 34 530 to 56 206) higher than expected number of deaths compared with pre-2010 trends. Deaths in those aged ≥60 and in care homes accounted for the majority. PES was more strongly linked with care home and home mortality than PEH, with each £10 per capita decline in real PES associated with an increase of 5.10 (3.65–6.54) (p<0.001) care home deaths per 100 000. These associations persisted in lag analyses and after adjustment for macroeconomic factors. Furthermore, we found that changes in real PES per capita may be linked to mortality mostly via changes in nurse numbers. Projections to 2020 based on 2009-2014 trend was cumulatively linked to an estimated 152 141 (95% CI 134 597 and 169 685) additional deaths.

Conclusions Spending constraints, especially PES, are associated with a substantial mortality gap. We suggest that spending should be targeted on improving care delivered in care homes and at home; and maintaining or increasing nurse numbers.

Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study | BMJ Open
▻http://bmjopen.bmj.com/content/6/3/e009892

2015

Results Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods (21.1% of calories) was eightfold higher than in processed foods (2.4%) and fivefold higher than in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7%). Both in unadjusted and adjusted models, each increase of 5 percentage points in proportional energy intake from ultra-processed foods increased the proportional energy intake from added sugars by 1 percentage point. Consumption of added sugars increased linearly across quintiles of ultra-processed food consumption: from 7.5% of total energy in the lowest quintile to 19.5% in the highest. A total of 82.1% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars, compared with 26.4% in the lowest.

Food classification according to processing
▻http://bmjopen.bmj.com/content/bmjopen/suppl/2015/12/25/bmjopen-2015-009892.DC1/bmjopen-2015-009892supp-new.pdf

#nutrition #agro_industrie #santé #Etats-Unis

What has happened to suicides during the Greek economic crisis? Findings from an ecological study of suicides and their determinants (2003–2012) — Rachiotis et al. 5 (3) — BMJ Open
▻http://bmjopen.bmj.com/content/5/3/e007295.abstract

Results The mean suicide rate overall rose by 35% between 2010 and 2012, from 3.37 to 4.56/100 000 population. The suicide mortality rate for men increased from 5.75 (2003–2010) to 7.43/100 000 (2011–2012; p<0.01). Among women, the suicide rate also rose, albeit less markedly, from 1.17 to 1.55 (p=0.03). When differentiated by age group, suicide mortality increased among both sexes in the age groups 20–59 and >60 years. We found that each additional percentage point of unemployment was associated with a 0.19/100 000 population rise in suicides (95% CI 0.11 to 0.26) among working age men.

Conclusions We found a clear increase in suicides among persons of working age, coinciding with austerity measures. These findings corroborate concerns that increased suicide risk in Greece is a health hazard associated with austerity measures.

#suicides #grèce #austérité #santé