JRSM Open最新文献

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.

Objectives: Ethnic minority and migrant healthcare workers (HCWs) constitute 24% of the UK's National Health Service. Migration status, often overlooked in Human Resources records, is associated with their placement within the Agenda for Change (AfC) pay bands. Therefore, we analysed the association between ethnicity, migration status, and AfC pay bands using data from the UK-REACH cohort study.

Design: Cross-sectional study.

Setting: UK-REACH cohort using baseline data collected via online questionnaires across various healthcare settings.

Participants: Healthcare workers from a broad range of professional roles across the UK, recruited between December 2020 and February 2021.

Main outcome measures: We used multivariable generalised ordered logistic regression models to examine the associations between ethnicity, migration status and AfC pay bands, adjusting for sex, education level, job role, and years qualified.

Results: We found that Overseas-born ethnic minority HCWs were less likely to be in higher AfC pay bands compared to their White UK-born counterparts. Specifically, Asian Overseas-born and Black Overseas-born HCWs reported significantly lower odds of being in higher pay bands compared to White UK-born workers.

Conclusions: Overseas-born HCWs from ethnic minorities resided in lower paid roles than White UK HCWs. Our study is the first to highlight a link between migration status and the AfC pay band and to explore interactions between ethnicity and migration within this context. Our data highlights the need for policymakers to incorporate migration status into NHS-wide electronic records to address career progression and pay inequities.

Spontaneous pneumothorax is a rare complication of lung cancer. In this report, we present a case of a patient with recurrent pneumothorax undergoing routine bullectomy and pleurodesis and lung adenocarcinoma is diagnosed incidentally. The prognosis for patients with untreated lung cancer has always been unfavourable with a median survival time of only 10 to 14 months, even for early-stage disease. Once the diagnosis is established, an effective treatment should be instituted without delay. Spontaneous pneumothorax is a rare manifestation of lung cancer and the relative risk for developing lung cancer should be considered with the patients with recurrent spontaneous pneumothorax.

Objectives: This study aims to quantitatively assess the baseline level of self-perceived cultural competency preparedness and skillfulness among medical and health professions students from 21 universities around the world utilizing a previously validated and standardized testing tool.

Design: Cross-sectional study.

Setting: The International Collaboration and Exchange Program (ICEP), a global exchange initiative for junior medical and health professions students spanning 21 universities across four continents.

Participants: A total of 753 students from the 2021 and 2022 ICEP cohorts.

Main outcome measures: Students self-evaluated their cultural competency skills on a 5-point Likert-type scale encompassing different areas of competency. Multiple linear regression was performed to identify contributors to cultural competency levels.

Results: Upon rating how skillful they are at interacting with culturally diverse patients, North American students reported the highest scores with a mean of 3.22, while Australian students showed the lowest score of 2.82. When analyzing students' stages of study, those in clinical years of medical schools scored the highest at 3.29. Significant variations were observed in the cultural competency self-rating scores among students based on their respective regions (p < .005) and program types/stages (p < .05). Notably, students in their clinical years of school consistently rated themselves higher compared to their preclinical counterparts (p < .05). Furthermore, students from Europe displayed elevated self-ratings compared to the other regions (p < .005).

Conclusions: Though these participants represent a highly motivated subgroup of students, potentially limiting result generalizability, the findings emphasize that regional differences exist. Given the multifaceted nature of cultural competency, the results suggest that factors such as educational stage, age, and region may influence students' perceived competency levels.