JRSM Open最新文献

Objectives: This qualitative study captured the perspectives of patients and healthcare professionals to better understand COVID-19 vaccine decision-making among South Asians in London.

Design: In-depth semi-structured telephone and virtual interviews were conducted using convenience and purposive sampling to explore narratives about COVID-19 decision-making processes, pandemic experiences, and perceptions of living through a period of unprecedented uncertainty and turbulence.

Setting: UK.

Participants: 12 London-based individuals including patients, clinicians, and a medical receptionist.

Main outcome measures: Respondents were categorised as either COVID-19 vaccine compliant or non-compliant based on their vaccination status.

Results: The variation and dynamic nature of the vaccination trajectories described in this study suggest that the decision to vaccinate or not against COVID-19 comprises a fluid, continually evolving process shaped by personal experiences and ongoing risk assessments. This study examines the possibility that some individuals form an 'epistemic community of uncertainty,' influenced by the pervasive 'infodemic' surrounding COVID-19 vaccines, which has created substantial ambiguity about truth and trust, reminiscent of the Rashōmon effect. Developing a nuanced understanding of this effect in the context of the COVID-19 era is a critical step towards addressing such ambiguity and fostering deeper critical thinking about vaccine decision-making.

Conclusions: This research highlights the need for more flexible and innovative strategies to navigate the complex factors influencing decision-making. Furthermore, the study advocates for a more refined and discerning personalised approach to engagement, which is vital for improving scientific and health literacy within society and overcoming common barriers to making informed and autonomous choices.

Objective: To map the global research on the impact of plastic-based health products and their packaging across the product lifecycle in order to inform equitable, sustainable governance for the role of plastics in health products.

Design: A scoping review of primary research and systematic reviews examining plastic-related outcomes in the context of health products or packaging using a systematic search of the MEDLINE, EMBASE, SCOPUS, GEOBASE and Compendex databases November 2024 with no date or language restrictions.

Setting: Studies spanning global and disciplinary contexts.

Participants: Primary research or systematic reviews that examined plastic-related outcomes in the context of health products or packaging.

Main outcome measures: We descriptively analyzed characteristics and outcomes of the included articles according to the product lifecycle stage.

Results: We screened 14,695 articles and included 572 articles published between 1960-2024. Only 8% (45/572) of articles studied more than one lifecycle stage. The evidence is otherwise siloed by focus, setting, and discipline: articles focused on clinical use and storage outcomes (266/572, 46.5%), were conducted primarily in high income countries (230/266, 86.5%) and within biomedical disciplines (207/266, 86.5%); articles focused on end-of-life outcomes (n=257/572, 44.9%) were conducted more frequently in middle-income countries (158/257, 61.7%), and within engineering and environmental sciences (208/257, 80.9%). We documented a multi-decade interest in plasticizer leaching from plastic devices and packaging.

Conclusions: A research agenda that is lifecycle oriented, prevention focused, and precautionary will produce robust, actionable evidence to support treaty decision-making and implementation. We conclude with recommendations for research priorities that include interventions to reduce the use of plastics in healthcare, to measure the health and environmental impacts of the chemicals in plastics, and identification and assessment of safe, toxics-free, sustainable alternatives.

Objective: High Intensity Users (HIUs) of Urgent and Emergency Care (UEC) services account for disproportionately high numbers of Emergency Department (ED) attendances, ambulance journeys and non-elective admissions. This review aimed to assess the quality and completeness of evidence for understanding the characteristics of HIUs, how best to identify and differentiate them, the effectiveness of services to support them, and to identify areas for further research.

Design: Scoping review of UK-based peer-reviewed literature.

Setting: Four databases (January 2010 to October 2025) - additional grey literature identified through hand searching and Google searches.

Participants: Twenty-eight published articles (19 peer-reviewed papers, 9 grey literature).

Main outcome measures: HIU definitions, descriptions, effectiveness of care, characteristics of successful programmes and interventions.

Results: HIUs are generally defined by the frequency of UEC use rather than diagnosis or need, despite being highly heterogeneous. The national model of care adopted in England relies largely on individual Case Managers supporting small numbers of HIUs. Although most published evaluations report reductions in ED attendances and admissions, and positive impacts on individual well-being, they are generally small, uncontrolled, and short-term with poorly defined interventions and minimal evidence that they reduce overall demand on UEC services.

Conclusions: Further research is needed to better characterise HIUs, drivers of their behaviour and risk factors to determine which HIUs benefit from which interventions. Services need to operate at scale using near-real time data, be integrated with health as well as social care services, and use standardised, granular definitions of HIUs to guide appropriate interventions.

Objectives: The aim of this study is to investigate potential inter-continental mental health differences in journalists covering climate-related events.

Design: Descriptive, cross sectional.

Setting: Internet-based study.

Participants: Journalists recruited from the Oxford Climate Journalist Network: 268 of 561 (48.6%) journalists from 89 countries completed the study.

Main outcome measures: Questions related to physical threat and loss secondary to climate change. Symptoms of anxiety (Generalized Anxiety Disorder-7-item scale [GAD-7]), depression (Patient Health Questionnaire-9 [PHQ-9]), posttraumatic stress disorder (PCL-5) and Moral Injury (Toronto Moral Injury Scale for Journalists [TMIS-J]).

Results: More African and Asian journalists felt physically threatened than journalists in Europe (p < .001 and p = .002, respectively). More journalists in Africa had lost a family member to climate change than journalists in the Americas (p = .009), and Asia and Europe (p < .001 for both). More journalists in Africa, Asia, and the Americas had lost a friend to climate change compared to journalists in Europe (p < .001, p = .003, and p = .001, respectively). There were higher PTSD-intrusion scores in African and Asian than European journalists (p = .001 and p < .001, respectively) and higher PTSD-avoidance scores in African and Asian than European journalists (p = .014 and p = .001, respectively. African and Asian journalists were less likely to receive psychotherapy than European journalists (p < .001 for both).

Conclusions: Given the enduring challenges posed by climate change, addressing these inequalities in journalists' care should not be delayed any further.

Objective: The scientific evidence indicates little or no difference in the effectiveness or cost of using of metered-dose inhalers (MDIs) versus nebulisation to treat acute asthma in the emergency department (ED). However, the use of MDIs raises questions of environmental impact. Our objective was to compare the ecological footprint of salbutamol administered by MDI versus nebulisation.

Design: Life cycle assessment in which we inventoried and quantified the resources extracted and pollutants emitted by each therapeutic option, from the manufacturing of medication and equipment to their disposal by incineration.

Setting: EDs of the CHU de Québec-Université Laval (Canada).

Participants: Not applicable.

Main outcome measures: Each item of life cycle inventory data was translated into CO₂-equivalent emissions (CO₂eq) using the IPCC2021/GWP100 method. Results were estimated for the administration of one and three treatments of 800 µg of salbutamol by MDI and 5 mg by nebulisation (standard doses for adults and children ≥ 24 kg).

Results: One and three ED-administered treatments with salbutamol emit respectively 1.9 and 4.0 kg of CO₂eq via MDI versus 0.9 and 1.0 kg via nebulisation, which corresponds to 5.5 and 11.6 km and to 2.7 and 2.8 km travelled in a subcompact car. Each series of eight inhalations from an MDI releases 1.1 kg of CO₂eq due to emission of the hydrofluoroalkane propellant.

Conclusions: Considering the absence or minimal difference in clinical effectiveness, this study suggests that nebulisation may be a more eco-efficient administration route than MDIs in the emergency treatment of asthma.Trail registration: N/A.

Objectives: To evaluate the incidence, management, and outcomes of Acute Respiratory Distress Syndrome (ARDS) in Sub-Saharan Africa (SSA), and to identify challenges related to healthcare infrastructure and resource availability.

Design: Systematic review of published studies on ARDS in SSA.

Setting: Studies conducted across hospitals and intensive care units in 11 countries within Sub-Saharan Africa between 2000 and 2024.

Participants: Adult patients diagnosed with ARDS.

Main outcome measures: Prevalence of ARDS, patient demographics, management strategies, availability of critical care resources, and mortality rates.

Results: Thirteen studies met the inclusion criteria. ARDS prevalence varied widely, ranging from 2.4% to 100%. The Kigali modification of the Berlin criteria was most frequently applied, reflecting limited access to chest radiography and arterial blood gas analysis. Pneumonia, sepsis, and trauma were the predominant causes, with infectious diseases such as HIV, tuberculosis, and malaria contributing substantially. Access to invasive mechanical ventilation and other critical care resources was limited. Reported mortality rates ranged from 22% to 77%.

Conclusions: ARDS represents a major but under-recognised cause of morbidity and mortality in SSA. Resource limitations, including inadequate diagnostic capacity and restricted access to mechanical ventilation, likely contribute to poor outcomes. Efforts to strengthen critical care infrastructure, provide targeted training, and adapt diagnostic criteria for low-resource environments are urgently needed. Further research should explore regional variations and context-appropriate interventions to improve ARDS care across SSA.

Intra-ocular corticosteroids have the potential to cause adrenal insufficiency when used long term. Patients and clinicians should be counselled on the risks of long-term steroid use and consider appropriate monitoring.

We aim to highlight the diagnostic challenges in differentiating Behcet's syndrome from Crohn's disease, in patients presenting with overlapping clinical features, highlighting the importance of comprehensive clinical evaluation for appropriate management and prognostication.

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Objective: A cause of death is a specific disease or injury which directly led to the death whereas a mode of death which is a mechanism such as respiratory failure, cardiac arrest or cardiac failure but does not provide the cause of death. We sought to establish the scale of use of cardiovascular mode and other non-specific codes as causes of death.

Design: We extracted the mortality statistics recorded between 2013 and 2021 and then selected cardiovascular codes.

Setting: The Office for National Statistics mortality data.

Participants: Deceased individuals from England and Wales.

Main outcome measures: Cause of death.

Results: Of 4,852,897 deaths, 836,741 (17.2%) had cardiovascular codes. Of these, 103,160 (12.3%) were labelled as modes and 35,784 (4.3%) were non-specific causes. Modes increased from 5862 in 2013 to 14,641 in 2021. Modes included 56,291 (6.7%) as arrhythmia and 46,787 (5.6%) as heart failure. Non-specific included 12,192 (1.46%) myocardial degeneration and 6573 (0.79%) cardiomegaly. Non-specific cardiomyopathies included other cardiomyopathies (207) and cardiomyopathy, unspecified (2984).

Conclusions: Modes of death are being used in a notable proportion of medical certificates and this is increasing which is worrying and does not provide the underlying cause of the death. It is important that a cause of death is given so that underlying heritable cardiac conditions, such as channelopathy or cardiomyopathy, are identified. This enables referral of blood relatives for cardiological screening and intervention. ICD-11 will help address some of the non-specific causes of death with the inclusion of codes for sudden arrhythmic death syndrome and arrhythmogenic cardiomyopathy. Autopsy is essential to establish a cause of death where only a mode of death can be given without clarification of a causative disease.