Medical Journal News

AbstractObjectiveTo prospectively assess the effect of endometriosis and uterine fibroids on the long term risk of premature mortality (younger than 70 years).DesignProspective cohort studySettingThe Nurses’ Health Study II, United States (1989-2019).Participants110 091 women aged 25-42 years in 1989 without a history of hysterectomy before endometriosis or fibroids diagnosis, cardiovascular diseases, or cancer.Main outcome measuresHazard ratios (estimated by Cox proportional hazards models) for total and cause specific premature mortality according to laparoscopically confirmed endometriosis or ultrasound or hysterectomy confirmed uterine fibroids reported in biennial questionnaires.Results4356 premature deaths were recorded during 2 994 354 person years of follow-up (27.2 years per person), including 1459 from cancer, 304 from cardiovascular diseases, and 90 from respiratory diseases. The crude incidence of all cause premature mortality for women with and without laparoscopically confirmed endometriosis was 2.01 and 1.40 per 1000 person years, respectively. In age adjusted models, laparoscopically confirmed endometriosis was associated with a hazard ratio of 1.19 (95% confidence interval 1.09 to 1.30) for premature death; these models were strengthened after also adjusting for potential confounders including behavioral factors (1.31, 1.20 to 1.44). Cause specific mortality analyses showed that the association was largely driven by mortality from senility and ill-defined diseases (1.80, 1.19 to 2.73), non-malignant respiratory diseases (1.95, 1.11 to 3.41), diseases of the nervous system and sense organs (2.50, 1.40 to 4.44), and malignant neoplasm of gynecological organs (2.76, 1.79 to 4.26). Ultrasound or hysterectomy confirmed uterine fibroids were not associated with all cause premature mortality (1.03, 0.95 to 1.11), but were associated with a greater risk of mortality from malignant neoplasm of gynecological organs (2.32, 1.59 to 3.40) in cause specific mortality analyses. The risk of mortality caused by cardiovascular and respiratory diseases varied according to joint categories of endometriosis and uterine fibroids, with an increased risk of all cause premature mortality among women reporting both endometriosis and uterine fibroids.ConclusionWomen with a history of endometriosis and uterine fibroids might have an increased long term risk of premature mortality extending beyond their reproductive lifespan. These conditions were also associated with an increased risk of death due to gynecological cancers. Endometriosis was associated with a greater risk of non-cancer mortality. These findings highlight the importance for primary care providers to consider these gynecological disorders in their assessment of women's health.

High monthly turnover rates of nurses and senior doctors are associated with more deaths among patients admitted as emergencies to NHS hospitals in England, an observational study published in The BMJ has found.1Researchers from Cambridge University Hospitals Foundation Trust and the universities of Surrey and Aberdeen looked at the yearly records of 236 000 nurses, 41 800 senior doctors, and 8.1 million patients admitted to hospital in England from April 2010 to March 2019.After adjusting for patient age, sex, and pre-existing conditions, they found that a one standard deviation increase in monthly turnover of nurses at a single trust (equivalent to around 20 nurses quitting) was associated with 35 additional deaths per 100 000 admissions in any given month (0.035 (95% confidence interval 0.024 to 0.045)).Among senior doctors—defined as consultants and specialist, associate specialist, and specialty doctors—a one standard deviation increase was equivalent to about seven doctors quitting and was...

AbstractObjectiveTo investigate the association between monthly turnover rates of hospital nurses and senior doctors and patient health outcomes (mortality and unplanned hospital readmissions).DesignRetrospective longitudinal study.SettingAll 148 NHS acute trusts in England (1 April 2010 to 30 March 2019), excluding specialist and community NHS hospital trusts.ParticipantsYearly records on 236 000 nurses, 41 800 senior doctors (specialist, associate specialist and specialty doctors, and consultants), and 8.1 million patients admitted to hospital.Main outcome measuresThe panel data regression analysis used nine years of monthly observations from administrative datasets at healthcare worker and patient levels. Associations using linear and unconditional quantile regressions were estimated, including controls for seasonality and NHS hospital trust. Four hospital quality indicators (risk adjusted by patient age, sex, and Charlson index comorbidities) were used and measured at a monthly frequency on a percentage scale: mortality risk within 30 days from all cause, emergency, or elective admission to hospital, and risk of unplanned emergency readmission within 30 days from discharge after elective hospital treatment.ResultsA 1 standard deviation (SD) increase in turnover rate for nurses was associated with 0.035 (95% confidence interval 0.024 to 0.045) and 0.052 (0.037 to 0.067) percentage point increases in risks of all cause and emergency admission mortality, respectively, at 30 days. The corresponding values for senior doctors were 0.014 (0.005 to 0.024) and 0.019 (0.006 to 0.033) percentage point increases. Higher nurse turnover rate was associated with higher mortality risk at 30 days in surgical (P<0.01) and general medicine (P<0.01) specialties, as well as mortality for patients admitted to hospital with infectious and parasitic diseases (international classification of diseases, 10th revision; P<0.05) and injury, poisoning, and consequences of external causes (P<0.01). Higher turnover rates for senior doctors were associated with higher mortality risk at 30 days for patients admitted to hospital with infectious and parasitic diseases (P<0.05), mental and behavioural disorders (P<0.05), and diseases of the respiratory system (P<0.05). Turnover rates for hospital nurses and senior doctors were not statistically significantly associated with risk adjusted hospital mortality and unplanned emergency readmissions for elective patients.ConclusionsLower turnover rates for nurses and senior doctors at hospital level were associated with better health outcomes for patients with emergency hospital admissions.Study registrationIntegrated Research Application System project ID 271302.

by Amanda Paust, Claus Vestergaard, Susan M. Smith, Karina Friis, Stine Schramm, Flemming Bro, Anna Mygind, Nynne Bech Utoft, James Larkin, Anders Prior

Background

Potentially inappropriate medication (PIM) is associated with negative health outcomes and can serve as an indicator of treatment quality. Previous studies have identified social inequality in treatment but often relied on narrow understandings of social position or failed to account for mediation by differential disease risk among social groups. Understanding how social position influences PIM exposure is crucial for improving the targeting of treatment quality and addressing health disparities. This study investigates the association between social position and PIM, considering the mediation effect of long-term conditions.

Methods and findings

This cross-sectional study utilized data from the 2017 Danish National Health Survey, including 177,495 individuals aged 18 or older. Data were linked to national registers on individual-level.PIM was defined from the STOPP/START criteria and social position was assessed through indicators of economic, cultural, and social capital (from Bourdieu’s Capital Theory). We analyzed odds ratios (ORs) and prevalence proportion differences (PPDs) for PIM using logistic regression, negative binomial regression, and generalized structural equation modeling. The models were adjusted for age and sex and analyzed separately for indicators of under- (START) and overtreatment (STOPP). The mediation analysis was conducted to separate direct and indirect effects via long-term conditions. Overall, 14.7% of participants were exposed to one or more PIMs, with START PIMs being more prevalent (12.5%) than STOPP PIMs (3.1%). All variables for social position except health education were associated with PIM in a dose-response pattern. Individuals with lower wealth (OR: 1.85 [95% CI 1.77, 1.94]), lower income (OR: 1.78 [95% CI 1.69, 1.87]), and lower education level (OR: 1.66 [95% CI 1.56, 1.76]) exhibited the strongest associations with PIM. Similar associations were observed for immigrants, people with low social support, and people with limited social networks. The association with PIM remained significant for most variables after accounting for mediation by long-term conditions. The disparities were predominantly related to overtreatment and did not relate to the number of PIMs. The study’s main limitation is the risk of reverse causation due to the complex nature of social position and medical treatment.

Conclusions

The findings highlight significant social inequalities in PIM exposure, driven by both economic, cultural, and social capital despite a universal healthcare system. Understanding the social determinants of PIM can inform policies to reduce inappropriate medication use and improve healthcare quality and equity.

In India and Pakistan, schools and many businesses in Delhi and Lahore were closed by official order this week as levels of pollutants on some days rose far beyond the most severe category of the US Air Quality Index (AQI), the most commonly used international scale.The US AQI has six categories, ranging from a “good” score of 0-50 to a “hazardous” score of 301-500. On 19 November the AQI was 22 in Paris, 28 in London, and 38 in New York. On that scale, Delhi reached 1758 at noon on 18 November, its worst day this year. Some monitoring stations in Lahore on 7 November recorded AQI scores above 1900.Countless smaller cities in the region are also under a vast smog cloud, visible both from the ground and from space, that stretches across northern India and southeast Pakistan. The Pakistani city of Multan, which is similarly locked down, reached an...

bmj;387/nov20_8/q2565/FAF1faReutersPolice officers examine the damaged neonatal intensive care unit after 10 newborn babies were killed in a blaze in a hospital in northern India. The fire broke out late last Friday night at the Maharani Laxmi Bai Medical College in Jhansi, in the state of Uttar Pradesh, 450 km south of Delhi. Parents of the 55 babies being treated in the unit had to wait for authorities to carry out DNA testing before discovering whether their children were among the fatalities.Officials told local media that the blaze—believed to have started in a piece of machinery used to enrich the level of oxygen in the atmosphere—spread quickly and suddenly through the ward. An initial inquiry also pointed to lapses in safety protocols, including expired fire extinguishers and non-functioning fire alarms.

A UK coroner has warned of possible future deaths unless providers of unlicensed medicines face stricter requirements to report problems.1Julian Morris, senior coroner for London inner south, delivered the warning after an inquest into the deaths of three babies who died in hospital after consuming contaminated feed. Each baby was one of a set of twins. In each case the babies were receiving total parenteral nutrition (TPN), and Bacillus cereus was recorded as one of the causes of death.Aviva Otte died aged 2 months in January 2014. She had received TPN compounded by the St Thomas’ Hospital pharmacy under an exemption from licensing requirements in section 10 of the Medicines Act 1968. Under the exemption a pharmacist may prepare a limited quantity of a custom made medicine for a specific patient.“There is no requirement for a section 10 exempt entity to report any of its findings to the MHRA [Medicines...

When Labour came to power in July the new health and social care secretary, Wes Streeting, promised a frank report on the current NHS. The report, led by Ara Darzi, pulled no punches about the state of the service and its challenges,12 which led Streeting to say that the NHS was “broken.”3 He also promised a working group to report back next spring on a 10 year plan.4I want the Labour government to succeed in stabilising and improving England’s NHS, and I was glad to see an extra £22.6bn for the NHS promised in the autumn budget.5 However, any welcome for this “plan to have a plan” must be tempered with a healthy “wait and see” scepticism, for several reasons.First, we’ve had NHS long term plans before. Some were transformative—notably, the radical improvement in resource and performance from 2001 to 2010.67 More recent plans didn’t accomplish much of the transformation...