Medical Journal News

New England Journal of Medicine, Volume 391, Issue 18, Page 1735-1741, November 7, 2024.

New England Journal of Medicine, Volume 391, Issue 18, Page 1734-1734, November 7, 2024.

New England Journal of Medicine, Volume 391, Issue 18, Page 1721-1733, November 7, 2024.

New England Journal of Medicine, Volume 391, Issue 18, November 7, 2024.

New England Journal of Medicine, Ahead of Print.

Plans to ban smoking outside schools and hospitals in England have been broadly welcomed, but experts and charities say there is still an urgent need for investment in NHS stop smoking services.The main focus of the updated Tobacco and Vapes Bill, laid before Parliament on 5 November, is to make it illegal to sell tobacco products to anyone born on or after 1 January 2009, with the aim of creating the first smokefree generation.1 The bill completed committee stage in the last parliament. The new bill goes further than the last one by giving the government powers to extend the indoor smoking ban to specific outdoor spaces, with children’s playgrounds, areas outside schools, and hospitals all being considered, subject to consultation.However, the government has dropped plans to outlaw smoking outside pubs and restaurants, after an outcry from the hospitality industry.The new bill will also ban advertising and sponsorship of vapes...

Two additional cases of clade Ib mpox have been detected in household contacts of the first UK case,1 bringing the total number of confirmed cases to three, health officials have reported.The two patients are being treated at Guy’s and St Thomas’ NHS Foundation Trust in London, the UK Health Security Agency said. Officials said the risk to the UK population remained low and that contacts of all three cases were being followed up and being offered testing and vaccination as required.Clade Ib mpox differs from clade II mpox that has been present at low levels in the UK since 2022, largely among gay, bisexual, and other men who have sex with men. Clade Ib mpox is more dangerous than clade II, as human-to-human transmission can occur through sexual and non-sexual contact, including among children.2In August 2024 the World Health Organisation declared mpox a public health emergency after clade Ib mpox...

by Peter MacPherson, Helen R. Stagg, Alvaro Schwalb, Hazel Henderson, Alice E. Taylor, Rachael M. Burke, Hannah M. Rickman, Cecily Miller, Rein M. G. J. Houben, Peter J. Dodd, Elizabeth L. Corbett

Background

Community active case finding (ACF) for tuberculosis was widely implemented in Europe and North America between 1940 and 1970, when incidence was comparable to many present-day high-burden countries. Using an interrupted time series analysis, we analysed the effect of the 1957 Glasgow mass chest X-ray campaign to inform contemporary approaches to screening.

Methods and findings

Case notifications for 1950 to 1963 were extracted from public health records and linked to demographic data. We fitted Bayesian multilevel regression models to estimate annual relative case notification rates (CNRs) during and after a mass screening intervention implemented over 5 weeks in 1957 compared to the counterfactual scenario where the intervention had not occurred. We additionally estimated case detection ratios and incidence. From 11 March 1957 to 12 April 1957, 714,915 people (622,349 of 819,301 [76.0%] resident adults ≥15 years) were screened with miniature chest X-ray; 2,369 (0.4%) were diagnosed with tuberculosis. Pre-intervention (1950 to 1956), pulmonary CNRs were declining at 2.3% per year from a CNR of 222/100,000 in 1950. With the intervention in 1957, there was a doubling in the pulmonary CNR (RR: 1.95, 95% uncertainty interval [UI] [1.81, 2.11]) and 35% decline in the year after (RR: 0.65, 95% UI [0.59, 0.71]). Post-intervention (1958 to 1963) annual rates of decline (5.4% per year) were greater (RR: 0.77, 95% UI [0.69, 0.85]), and there were an estimated 4,599 (95% UI [3,641, 5,683]) pulmonary case notifications averted due to the intervention. Effects were consistent across all city wards and notifications declined in young children (0 to 5 years) with the intervention. Limitations include the lack of data in historical reports on microbiological testing for tuberculosis, and uncertainty in contributory effects of other contemporaneous interventions including slum clearances, introduction of BCG vaccination programmes, and the ending of postwar food rationing.

Conclusions

A single, rapid round of mass screening with chest X-ray (probably the largest ever conducted) likely resulted in a major and sustained reduction in tuberculosis case notifications. Synthesis of evidence from other historical tuberculosis screening programmes is needed to confirm findings from Glasgow and to provide insights into ongoing efforts to successfully implement ACF interventions in today’s high tuberculosis burden countries and with new screening tools and technologies.

Three people were sentenced in relation to drug charges on 25 October after an international police investigation found that the Londoners had conspired to import unregulated drugs from India into the UK and then repackaged them for internal and overseas distribution.Officers from the City of London Police seized over 730 kg of drugs during the operation, including more than one million individual tablets. Drugs identified in the haul included pharmaceutical grade opioids, such as tramadol and tapentadol, and anti-anxiety medications and sedatives such as zopiclone, etizolam, alprazolam, nitrazepam, zolpidem, and pregabalin.In total, police recovered nine class C category substances (zolpidem, zopiclone, nitrazepam, tramadol, etizolam, pregabalin, flubromazolam, bromazolam, and alprazolam), one class B (cannabis resin), and one class A (tapentadol).International police agencies have been collaborating on the investigation since October 2020, when US Customs and Border agents operating at New York’s JFK airport found illicit pharmaceuticals in numerous shipments tracked to...

Syed Hashim Haider, a 29 year old software engineer in Lahore, not only married out of his family but also out of his Islamic sect. This is unusual in Pakistan, which has one of the highest rates of cousin marriage globally—65%.1But a new generation of Pakistanis is moving away from consanguineous marriages, with families’ increasing awareness of the severe health challenges that have roots in such a match. These include stillbirths, low birthweight, increased mortality, congenital malformations, spinal muscular atrophy, thalassaemia, sensorineural hearing loss, and cystic fibrosis.2Haider’s parents are cousins, but he says that his family had already started a “positive” trend of marrying out of the family when his older brothers chose their own non-familial partners. “Many people get married to their cousins because of undue parental pressure, but I feel privileged that I did not feel any such pressure,” says Haider. He has seen many cousin marriages in...

We respond to a Correspondence by Rasha Khatib and colleagues.1

We are outraged that a prestigious journal such as The Lancet has published a non-peer-reviewed Correspondence1 by Rasha Khatib and colleagues that makes entirely unsubstantiated claims regarding the death toll in Gaza.

A decade ago, 194 member states endorsed WHO's Every Newborn Action Plan (ENAP) to end preventable stillbirths, committing to reach the target of 12 or fewer late-gestation stillbirths (≥28 weeks) in every country by 2030 and to close equity gaps.1 Despite the preventability of most stillbirths through timely access to high-quality antenatal and intrapartum care, millions of babies continue to be stillborn annually, leaving lasting impacts on affected women, families, health-care providers, and wider society.

We are writing regarding the Correspondence by Rasha Khatib and colleagues.1

We agree with Rafael Beyar and Karl Skorecki that every death matters. There have been too many deaths on both sides of this conflict. As physicians trained in clinical medicine and epidemiology, we believe that discussing the challenges of counting them lies within our expertise. We also agree that culpability, responsibility, and accountability matter, but argue that resolving these contested issues does not. Rather, they are a matter for those with the expertise to examine the competing arguments.

Despite the gradual global decline in stillbirths between 1990 and 2021, the overall number of stillbirths remains substantially high. Counting all stillbirths is paramount to progress, as nearly a third—close to 1 million in total—are left uncounted at the 28 weeks or longer threshold. Our findings draw attention to the differential progress in reducing stillbirths, with a high burden concentrated in countries with low development status. Scarce data availability and poor data quality constrain our capacity to precisely account for stillbirths in many locations.

Last week Rachel Reeves, the chancellor of the exchequer, presented a budget designed to help the NHS, providing £22.6bn of extra funding over the next two years.1 Unfortunately, the main way of paying for this welcome increase is to raise employers’ national insurance contributions, a move that risks damaging the service the government claims it wants to save.2This tax has been raised from 13.8% to 15%, and the threshold of earnings at which it kicks in has been reduced from £9100 to £5000. NHS trusts and the rest of the public sector will be sheltered from this tax rise, but GP surgeries, social care providers, and hospices—which are all private businesses with contracts to provide public services—will take the full financial hit.The news has not been well received within general practices, and practice managers up and down the country have been poring over spreadsheets, working out what the rise, which...

NHS England has launched a new campaign emphasising the importance of dialling 999 as soon as stroke symptoms occur, after new data showed that on average people faced a wait of nearly an hour and a half before a call was made.Each year in the UK around 100 000 people have a stroke, and there are 38 000 stroke-related deaths, making it the country’s fourth biggest cause of death.The national Act FAST (face, arms, speech, time) campaign, first launched in 2009, urges people to call 999 immediately if anyone experiences one of the three common symptoms: struggling to smile, struggling to raise an arm, or slurring their words.NHS England’s new public campaign urges people to act quickly, after an analysis of NHS data showed that in 2023-24, among 41 327 patients with a recorded time of stroke symptom onset, the average time between the first sign of symptoms and a...

Gun violence in the US is the leading cause of death among children and teenagers, drives down life expectancy, and cost the economy around $557bn in 2022, says a report from the Commonwealth Fund, a non-profit organisation that researches healthcare issues and promotes improved quality and efficiency in healthcare.1The study used data from the global burden of disease study from the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.Mass shootings in the US get much media attention but represent less than 2% of gun deaths in the US, the report says. Mass shootings are those in which four or more people are shot or killed, excluding the shooter. There were 656 mass shootings in the US in 2023, reports the Gun Violence Archive,2 and at least 385 so far this year.An earlier Commonwealth Fund study showed that in 2019 the US had 10.4 deaths per...