Medical Journal News

General practice leaders in Wales have voted unanimously to reject the Welsh government’s GP contract offer for 2024-25.The BMA’s ​General Practitioners Committee Wales said the government’s general medical services contract offer for the current financial year “fails to provide a credible and sustainable future” for general practice.GPs in Wales will now vote on whether to accept or reject the contract in a referendum that will open later this month.Gareth Oelmann, chair of the committee, said, “The decision to disregard the serious concerns and valuable contribution of general practice in Wales is beyond insulting, it is dangerous, leaving more surgeries and their patients in peril. We are concerned that this offer will leave more practices with no option but to close. GPs are being denied the resources they need to deliver vital services to the population.”The BMA said it was not yet able to disclose any details on the offer, and...

The BMA has entered into a formal dispute with University Hospitals Birmingham NHS Foundation Trust (UHB) over its plans to cut overtime rates for doctors.The trust told doctors last week that it would no longer pay enhanced rates for work carried out outside contracted hours and would instead pay basic salary rates. The BMA said it has since given UHB “several opportunities to reverse that decision and avoid patient care being impacted by the trusts’ failure to pay their doctors fairly for extra shifts” but that the trust has “chosen not to respond.”The BMA accused the trust of contravening a national agreement the association made with the Department of Health and Social Care earlier this year when settling industrial disputes, which included an agreement that rates for extra contractual work would be negotiated at a local level rather than imposed by trusts on doctors.As a result, the BMA has now...

Africa is undergoing rapid urbanisation while facing growing climate vulnerabilities and a rising burden of non-communicable diseases. With global urban growth expected to be greatest in Africa and Asia,1 addressing the interlinked issues of health, climate, land use, and pollution is crucial for sustainable development. By 2030, the number of African cities with over half a million people is estimated to increase by 80%,2 putting pressure on housing, transport, and energy sectors.The transport sector is important for development and economic progress, influencing environmental (noise and air pollution, green and blue spaces), economic (employment, household income), and social (education, social network) factors. It can facilitate access to livelihoods, education, and social connectedness but has historically been associated with negative impacts on health and climate.Positive changes are emerging across the African region towards healthier and low carbon transport systems, with increasing emphasis on safe non-motorised travel such as walking and cycling, alongside...

What you need to knowChild maltreatment may present with subtle features, and a history of abuse or neglect is not typically providedPerform a full skin and intraoral examination in pre-mobile infants, consider occult injury screening, and use age- and situation-appropriate questions to help identify maltreatmentIf child sexual abuse is suspected, limit the number of physical assessments to minimise trauma to the child and contact the local sexual assault (referral) centre in a timely mannerGiven the potential for legal proceedings, ensure documentation is clear and objective, using quotations, drawings, and photographs when indicatedChild abuse and neglect, collectively known as maltreatment, is common, and most healthcare providers who care for children will encounter some form of maltreatment in their practice.1 Common presentations include physical abuse, sexual abuse and commercial sexual exploitation of children, and neglect.In this article, we make recommendations for frontline healthcare providers on identifying child maltreatment and making evidence based...

Even for the most experienced healthcare providers, recognising and evaluating suspected child maltreatment or exploitation is challenging. The pressure to make the correct diagnosis is extremely high. Failing to recognise maltreatment can result in the child experiencing severe harm or even death. Conversely, incorrect diagnoses of accidental injuries as abusive or misinterpretations of poverty as neglect may burden care givers and lead to subsequent mistrust in healthcare providers.1 Unwarranted investigations and subsequent referral to child welfare (social) services affect marginalised populations disproportionately, including children of black, Hispanic, and Aboriginal ethnicity, and visible minorities.23Two education articles in The BMJ offer healthcare providers guidance to better identify child abuse and neglect and recognise young people experiencing criminal and sexual exploitation.45 They summarise the growing evidence base that should inform consistent, effective practice. Schwartz et al discuss screening using clinical decision rules such as the TEN-4-FACESp, which identifies region, age, and patterns of...

When Ike Anya was working his way through medical training in Nigeria his grandmother reassured him, “Everything worthwhile is achieved small by small.”Some 30 years later, Anya chose that saying as the title of his memoir.“You become a doctor ‘small by small.’ This Nigerian expression is also a lovely way of paying tribute to my grandmother,” says Anya, a consultant in public health medicine who works as a locum and is based in London.In his memoir, Anya recalls the achievements and failures of his student days and his first demanding year as a house officer while living in 1990s Nigeria during a time of political unrest, social change, and a worsening economy.Of the process of creating his memoir he says, “You have to be incredibly honest in your writing. I felt there would be no interest in a memoir that only paints a good picture.” You also have to be...

What you need to knowHealthcare providers have an important role in recognising criminal and sexual exploitation and escalating concerns to prevent harm to young peopleUsing the HEADSSS model can help structure conversations with young peopleRaise concerns through appropriate local safeguarding channels to access specially trained professionals and organisations who can provide supportJames is a 16 year old boy who lives in a residential (children’s) home. Over the past two months, he has regularly gone missing, returning with new clothes and a new smartphone and laptop. He has been dropped off by different cars late at night. His reluctance to offer explanations for his absences and new possessions raised concerns among care workers.He presents to the emergency department with an arm injury and is found to have a fracture. He seems withdrawn and provides only limited details about how the injury occurred. He is in a rush to leave and hesitant...

The route to the US presidency this election season was a wild ride, marked by a relatively last minute change of candidates on the Democratic side, from incumbent president Joe Biden to his deputy Kamala Harris, and disinformation, misdirection, and odd statements by former president—now president elect—Donald Trump, the Republican candidate.Three weeks before voting day, Drew Altman, chief executive of the health policy research foundation KFF, wrote that this was not a “healthcare election.”1 Indeed, throughout the months long campaigning the only health topic that made it into the top tier for the presidential candidates was reproductive rights. Beyond that, the high price of prescription drugs and the limits of the health insurance system got occasional mentions. The candidates made some promises about reform of Medicare, the healthcare insurance scheme for over 65s and disabled people. And only the Democrats talked about Medicaid, the major scheme for people on low...

20 years ago, the Ministerial Summit on Health Research1 in Mexico led to a World Health Assembly Resolution in 20052 challenging WHO, its member states, and other stakeholders to promote health research globally, especially in low-income and middle-income countries (LMICs). The Resolution highlighted a lack of transparency of clinical trials, poor use of evidence in policy making, and neglect of health systems research as three key barriers for which priority actions were urgently needed.

New England Journal of Medicine, Volume 391, Issue 19, Page 1837-1837, November 14, 2024.

New England Journal of Medicine, Volume 391, Issue 19, Page 1770-1771, November 14, 2024.

New England Journal of Medicine, Volume 391, Issue 19, Page 1761-1763, November 14, 2024.

New England Journal of Medicine, Volume 391, Issue 19, Page 1768-1769, November 14, 2024.

New England Journal of Medicine, Volume 391, Issue 19, Page 1765-1767, November 14, 2024.

New England Journal of Medicine, Volume 391, Issue 19, Page 1763-1765, November 14, 2024.

Over 14 years of Conservative Government in the UK—characterised by policies of austerity and deep cuts to public services—healthy life expectancy dropped, mental health worsened, and public satisfaction with the National Health Service (NHS) fell from 70% in 2010 to 24% in 2023. In September, 2024, 7·7 million people were on the waiting list for hospital treatment (>10% of the population), up from just over 2 million in 2010. UK spending on health stands at 21% below the median of 14 EU countries.

Mpox and its causative pathogen, monkeypox virus, represent a growing international public health concern following a global outbreak of monkeypox virus clade II in 2022–231 and regional outbreaks of monkeypox virus clade I centred in DR Congo beginning in late 2023.2 Epidemiological analysis of monkeypox virus, including genomic epidemiology, is crucial to understanding the expansion of the virus within and outside its historically endemic range due to increased spillover from a zoonotic host, increased human-to-human transmission, or both, and any changes in virulence.

Dr Sivakumar was a successful Consultant Psychiatrist in Maidstone, UK. He had emigrated from Sri Lanka in 1977 and was, in his words, “one of the lucky ones”. Why lucky? Because, having received a “decent English education” in his home country, Dr Sivakumar's journey through medicine as a South Asian doctor in the UK was “comfortable”. This outcome had not necessarily been his expectation. He arrived from Sri Lanka armed with letters attesting to his excellent English language skills. He did not need them.

Revolutionary new HIV drugs are being made available in 120 low-income countries, but many important populations are being left out. Sophie Cousins reports.

A contested election with allegations of vote rigging could be damaging to health NGOs in the country. Sharmila Devi reports.