Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Understanding and researching wellbeing: Its usage in different disciplines and potential for health research and health promotion

Objectives: To report the findings of a literature review of the concept of wellbeing and consider its operational and heuristic potential within a range of disciplines. Design: A literature review to examine the philosophical roots of wellbeing and the contributions of the main disciplines uncovered by the review; economics, psychology, health studies, sociology, anthropology and biomedicine. Setting: 'Wellbeing' is a concept of increasing interest to those working in health promotion, social and public health medicine and medical sociology. Despite its popularity, wellbeing lacks a clear conceptual base and there is little consensus about how it may be identified, measured and achieved. Method: Although conducted rigorously this was more of a scoping exercise than a systematic review. The reviewer was given a fairly broad exploratory brief including qualitative and quantitative dimensions. The search was restricted to articles in the English Language between the years 1980-2001. Results: Most disciplines tended to be biased towards one or two aspects of the three major aspects of physical, social and psychological Wellbeing, with the main exception of child wellbeing studies. Those working in economics made a significant contribution to understanding conceptual elements of wellbeing. The fields of psychology and biomedicine were more concerned with negative than positive affect. There was a particular lack of consensus and research around social wellbeing. Conclusion: Although wellbeing may indeed be extremely useful as a unifying concept for all those involved in health improvement or health research,at present it is being used unreflectively, thus potentially masking differences

Too many bodies? The return and disavowal of the population question

During the 1960s and early 1970s population growth was regarded as an urgent environmental issue. Since then the topic has fallen into abeyance. Despite continuing demographic expansion and anxieties about a range of socio-ecological problems – from the stresses of high-density urban living to climate change, water, energy and food insecurity and loss of biodiversity – there is currently scant consideration of the benefits of population stabilisation or decline. Indeed, the problematisation of population numbers is widely disavowed or regarded with profound suspicion. Why have we become so reluctant to ask whether we are too many or to countenance policies that might discourage further growth? I identify five discourses – population-shaming, population-scepticism, population-declinism, population-decomposing and population-fatalism – that foreclose public debate and subject them to critical analysis. I end by eliciting signs of a hesitant revival of the population question alongside the enduring potency of silencing discourses