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Rapid realist review of organisational supports for youth peer support workers. 对青年同伴支持工作者的组织支持的快速现实主义审查。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-02-10 DOI: 10.1136/bmjopen-2025-111837
Julia Hews-Girard, Tanya Halsall, Emma Cullen, Amanda Bellefeuille, Mardi Daley, Charlotte Evans, Vanessa Sandoval, Allison Dunning, Jayden Lee, Brittany Carde, Jennifer Couturier, Manuela Ferrari, Melissa Kimber, Scott B Patten, Srividya Iyer, Gina Dimitropoulos

Objectives: Providing peer support can benefit youth peer support workers (peers)et by supporting self-determination, recovery and resilience to self-stigma. There is a need to clarify the role of the organisation in providing benefits for peers. We aimed to identify the organisational contexts and mechanisms that result in the creation of healthy workplaces for peers.

Design: Rapid realist review guided by the Realist and Meta-Narrative Evidence Syntheses-Evolving Standards guidelines and Pawson's iterative approach.

Data sources: MEDLINE, CINAHL, PsycINFO, ERIC, SocINDEX, Google Scholar and Embase were searched from 1979 to 2025.

Eligibility criteria: We included qualitative and quantitative peer-reviewed studies and grey literature that captured characteristics of organisational practices and employment considerations in youth peer support programmes.

Data extraction and synthesis: Articles were screened independently by multiple reviewers. Inclusion criteria were adjusted to capture literature on organisational practices, and employment considerations for youth peer support programmes. Data were extracted and analysed retroductively to develop Context-Mechanism-Outcome Configurations (CMOCs).

Results: Five employment-related risks to peer well-being were identified: (1) difficulty entering the job market, (2) lack of role clarity, (3) pressure to live up to ideals, (4) retraumatisation and (5) stigma. Six CMOCs were developed; all focused on the creation of equitable employment and supporting peer development and empowerment were developed.

Conclusions: Community-based mental health organisations can facilitate equitable peer employment through strategies that reduce professional stigma, enhance peer resilience and promote professional and personal development. Policy reform that addresses precarious work conditions is needed to support healthy work environments.

目标:提供同伴支持可以通过支持青年同伴支持工作者(同伴)等人的自我决定、恢复和对自我耻辱的适应能力而受益。有必要明确组织在为同事提供福利方面的角色。我们的目标是确定为同事创造健康工作场所的组织背景和机制。设计:由现实主义和元叙事证据综合-不断发展的标准指南和Pawson的迭代方法指导的快速现实主义审查。检索时间:1979 - 2025年,检索时间:MEDLINE, CINAHL, PsycINFO, ERIC, SocINDEX,谷歌Scholar, Embase。资格标准:我们纳入了定性和定量的同行评议研究和灰色文献,这些研究捕获了组织实践的特征和青年同伴支持计划中的就业考虑因素。数据提取和综合:文章由多位审稿人独立筛选。纳入标准进行了调整,以纳入有关组织实践的文献,以及青年同伴支持计划的就业考虑因素。数据被提取并追溯分析,以形成上下文-机制-结果配置(cmoc)。结果:确定了五种与就业相关的同伴幸福感风险:(1)进入就业市场困难,(2)角色不明确,(3)实现理想的压力,(4)再创伤和(5)耻辱。开发了6个cmoc;所有这些都侧重于创造公平就业和支持同伴发展和赋权。结论:以社区为基础的精神卫生组织可以通过减少职业耻辱、增强同伴适应能力和促进专业和个人发展的战略来促进公平的同伴就业。需要进行政策改革,解决不稳定的工作条件问题,以支持健康的工作环境。
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引用次数: 0
Prevalence of asthma and gastro-oesophageal reflux disease, and their association with health-related quality-of-life: a cross-sectional study among a cohort of Sri Lankan adolescents. 哮喘和胃食管反流病的患病率及其与健康相关生活质量的关系:斯里兰卡青少年队列的横断面研究
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-02-10 DOI: 10.1136/bmjopen-2025-104603
Manori Vijaya Kumari, Shashanka Rajapakse, Shuja Mohamed, Niranga Devanarayana, Shaman Rajindrajith, Lakmali Amarasiri

Objective: This study assessed the associations between asthma, gastro-oesophageal reflux disease (GORD) and health-related quality-of-life (HRQoL) among adolescents.

Design: A cross-sectional survey.

Setting: Six randomly selected schools across all five educational zones of the Anuradhapura district in Sri Lanka.

Participants: A total of 1127 adolescents aged 13-14 years were included from six randomly selected schools representing all five educational zones in the Anuradhapura district, Sri Lanka.

Main outcome measures: Prevalence of asthma and GORD, the associations between asthma, GORD and HRQoL among adolescents in Sri Lanka.

Results: This study of 1127 adolescents (44.8% male, mean age 13.66±0.56 years) found that 16.1% (n=181) had current asthma and 17.9% (n=202) exhibited symptoms of GORD. A significant association was observed between current asthma and GORD (OR 2.30, 95% CI 1.59 to 3.31, p=0.0005). Comorbidity of asthma and GORD was observed in 4.8% of participants (n=54). The total HRQoL score was not associated with asthma, GORD or those having both asthma and GORD. However, the presence of GORD was associated with poor emotional functioning (unstandardized regression coefficient ± standard error = -4.7±1.7, p=0.008).

Conclusion: Asthma and GORD were significantly associated among early adolescents in Sri Lanka. While overall HRQoL did not differ by disease status, the presence of GORD was associated with poorer emotional functioning.

目的:本研究评估青少年哮喘、胃食管反流病(GORD)与健康相关生活质量(HRQoL)之间的关系。设计:横断面调查。背景:斯里兰卡阿努拉德普勒地区五个教育区的六所随机选择的学校。参与者:共有1127名13-14岁的青少年,他们来自斯里兰卡阿努拉德普勒地区五个教育区的六所随机选择的学校。主要结局指标:斯里兰卡青少年哮喘和GORD患病率,哮喘、GORD和HRQoL之间的关系。结果:本研究共纳入1127名青少年(44.8%为男性,平均年龄13.66±0.56岁),发现16.1% (n=181)患有哮喘,17.9% (n=202)表现出GORD症状。当前哮喘与GORD之间存在显著相关性(OR 2.30, 95% CI 1.59 ~ 3.31, p=0.0005)。4.8%的参与者(n=54)存在哮喘和GORD的合并症。HRQoL总评分与哮喘、GORD或同时患有哮喘和GORD的患者无关。然而,GORD的存在与情绪功能不良相关(非标准化回归系数±标准误差= -4.7±1.7,p=0.008)。结论:斯里兰卡早期青少年哮喘和GORD显著相关。虽然总体HRQoL没有因疾病状态而异,但GORD的存在与较差的情绪功能有关。
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引用次数: 0
Feasibility of the MAINTAIN intervention to support independence after a fall for people with dementia: a pilot cluster randomised controlled trial in participants' own homes. 痴呆患者跌倒后支持独立的MAINTAIN干预的可行性:一项在参与者家中进行的试点随机对照试验。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-02-10 DOI: 10.1136/bmjopen-2025-112336
Leanne Greene, James Connors, Claire Hulme, Obioha C Ukoumunne, Robert Barber, Alison Bingham, Simon Conroy, Chris Fox, Carol Duff, Victoria Goodwin, Adam L Gordon, Abigail J Hall, Rowan H Harwood, Thomas Jackson, Rachael Litherland, Sarah Morgan-Trimmer, Steve W Parry, Ashima Sharma, Bethany Whale, Louise Allan

Objectives: To evaluate the feasibility of conducting a full-scale randomised controlled trial to assess the clinical and cost-effectiveness of the MAINTAIN intervention, designed to support recovery and independence following a fall among people living with dementia.

Design: Pilot cluster randomised controlled trial (c-RCT).

Setting: Community-based healthcare services across six UK sites representing primary and secondary care settings.

Participants: 31 participant-carer dyads were recruited. Eligibility criteria included a diagnosis of dementia and a recent fall. Exclusion criteria included severe comorbidity precluding participation. The consent rate was 84%, and retention at follow-up was 81%.

Interventions: The MAINTAIN intervention comprised tailored, home-based therapy sessions delivered by trained professionals, focusing on functional recovery, confidence and re-engagement in daily activities, compared with usual care. The intervention was delivered over 12 weeks with booster sessions up to week 24, with the full trial period lasting 28 weeks.

Primary and secondary outcome measures: Feasibility outcomes included recruitment and retention rates, intervention adherence and data completeness for outcome and economic measures. Exploratory outcomes assessed functional performance and quality of life. Feasibility outcomes were assessed at baseline, 12 weeks and 28 weeks.

Results: Recruitment occurred over an 8-month period (September 2023-April 2024) across six UK sites. Most intervention participants (89%) attended at least 60% of planned sessions. Completion rates for outcome and economic data were high, indicating strong acceptability and feasibility of both the intervention and trial procedures.

Conclusions: The pilot c-RCT demonstrated that recruitment, retention and intervention delivery were feasible and well accepted. Findings support progression to a definitive trial to evaluate the effectiveness and cost-effectiveness of the MAINTAIN intervention.

Trial registration number: ISRCTN16413728 (International Standard Randomised Controlled Trial Number registry).

目的:评估开展一项全面随机对照试验的可行性,以评估维护干预的临床和成本效益,旨在支持痴呆患者跌倒后的康复和独立。设计:先导组随机对照试验(c-RCT)。设置:以社区为基础的医疗保健服务跨越六个英国站点代表初级和二级保健设置。参与者:招募了31对参与者-照顾者。入选标准包括痴呆诊断和近期跌倒。排除标准包括严重合并症。同意率为84%,随访保留率为81%。干预措施:与常规护理相比,maintenance干预包括由训练有素的专业人员提供的量身定制的家庭治疗课程,重点是功能恢复,信心和重新参与日常活动。干预持续了12周,强化治疗持续到第24周,整个试验期持续28周。主要和次要结果测量:可行性结果包括招募率和保留率、干预依从性以及结果和经济测量的数据完整性。探索性结果评估功能表现和生活质量。在基线、12周和28周时评估可行性结果。结果:招募在8个月期间(2023年9月至2024年4月)在英国六个地点进行。大多数干预参与者(89%)至少参加了计划疗程的60%。结果和经济数据的完成率很高,表明干预和试验程序都具有很强的可接受性和可行性。结论:试点c-RCT表明,招募、保留和干预交付是可行的,并且被广泛接受。研究结果支持进行一项明确的试验,以评估维护干预的有效性和成本效益。试验注册号:ISRCTN16413728(国际标准随机对照试验注册号)。
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引用次数: 0
Experiences of healthcare providers, survivors and caregivers with hospital-to-home stroke transitional care in Tanzania: a qualitative study. 医疗保健提供者,幸存者和护理人员的经验,医院到家庭卒中过渡护理在坦桑尼亚:一项定性研究。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-02-10 DOI: 10.1136/bmjopen-2024-098301
Nyagwaswa Athanas Michael, Lilian Teddy Mselle, Costansia Anselim Bureta, Edith Mroso Tarimo, Yingjuan Cao

Objective: To explore experiences of healthcare providers, stroke survivors and caregivers on stroke transitional care delivery at a tertiary hospital in Tanzania.

Design: A qualitative descriptive design with a phenomenological approach was used. Colaizzi's thematic analysis was conducted using Dedoose software to identify significant information that describes the transitional care experiences of the study participants.

Setting: This study was conducted in the internal medicine and outpatient departments of a tertiary hospital in Tanzania.

Participants: 15 triads of healthcare providers, stroke survivors and caregivers were purposively recruited to participate in semi-structured in-depth interviews between June and September 2024.

Results: The analysis identified four themes: communication and exchange of information, involvement of patients and caregivers in transitional care, coordination of transitional care and experiences with changing care setting. Effective communication and information exchange among healthcare providers, survivors and caregivers ensured that survivors and their caregivers were well informed about the care process, clinical condition, prognosis and transitional care needs. A collaborative care approach enabled survivors and caregivers to actively participate in care, decision-making and discharge planning during hospital-to-home transition. Coordination of care was equally important during hospital-to-home transition as it provided survivors with home-care instructions and opportunities for follow-up care. However, miscommunication among the healthcare team, insufficient information exchange, inadequate discharge planning, poor social support and lack of care coordination prevented smooth hospital-to-home transition leading to a crisis at home.

Conclusions: The experiences of healthcare providers, patients and caregivers during stroke transitional care in Tanzania highlight achievements and key areas for improvement. Hospital-to-home transition is often characterised by uncertainty and emotional strain, emphasising the need for effective communication, involving patients and caregivers in care, as well as coordinating transitional care to address medical and psychosocial needs of survivors and their caregivers during and after discharge.

目的:探讨坦桑尼亚某三级医院医疗服务提供者、脑卒中幸存者和护理人员在脑卒中过渡护理服务中的经验。设计:采用现象学方法进行定性描述设计。Colaizzi的专题分析使用Dedoose软件进行,以确定描述研究参与者过渡护理经历的重要信息。环境:本研究在坦桑尼亚一家三级医院的内科和门诊部进行。参与者:在2024年6月至9月期间,有目的地招募了15名医疗服务提供者、中风幸存者和护理人员参加半结构化的深度访谈。结果:分析确定了四个主题:沟通和信息交流、患者和护理人员在过渡护理中的参与、过渡护理的协调以及改变护理环境的经验。医疗保健提供者、幸存者和照顾者之间的有效沟通和信息交流确保了幸存者及其照顾者充分了解护理过程、临床状况、预后和过渡性护理需求。协作护理方法使幸存者和护理人员能够在从医院到家庭的过渡期间积极参与护理、决策和出院计划。在从医院到家庭的过渡期间,护理协调同样重要,因为它为幸存者提供了家庭护理指导和后续护理的机会。然而,保健团队之间的沟通不畅、信息交流不足、出院计划不充分、社会支持不足以及缺乏护理协调,阻碍了从医院到家庭的顺利过渡,从而导致家庭危机。结论:卫生保健提供者、患者和护理人员在坦桑尼亚卒中过渡护理期间的经验突出了成就和需要改进的关键领域。从医院到家庭的过渡往往具有不确定性和情绪紧张的特点,强调需要进行有效的沟通,使患者和护理人员参与护理,并协调过渡护理,以解决幸存者及其护理人员在出院期间和出院后的医疗和社会心理需求。
{"title":"Experiences of healthcare providers, survivors and caregivers with hospital-to-home stroke transitional care in Tanzania: a qualitative study.","authors":"Nyagwaswa Athanas Michael, Lilian Teddy Mselle, Costansia Anselim Bureta, Edith Mroso Tarimo, Yingjuan Cao","doi":"10.1136/bmjopen-2024-098301","DOIUrl":"10.1136/bmjopen-2024-098301","url":null,"abstract":"<p><strong>Objective: </strong>To explore experiences of healthcare providers, stroke survivors and caregivers on stroke transitional care delivery at a tertiary hospital in Tanzania.</p><p><strong>Design: </strong>A qualitative descriptive design with a phenomenological approach was used. Colaizzi's thematic analysis was conducted using Dedoose software to identify significant information that describes the transitional care experiences of the study participants.</p><p><strong>Setting: </strong>This study was conducted in the internal medicine and outpatient departments of a tertiary hospital in Tanzania.</p><p><strong>Participants: </strong>15 triads of healthcare providers, stroke survivors and caregivers were purposively recruited to participate in semi-structured in-depth interviews between June and September 2024.</p><p><strong>Results: </strong>The analysis identified four themes: communication and exchange of information, involvement of patients and caregivers in transitional care, coordination of transitional care and experiences with changing care setting. Effective communication and information exchange among healthcare providers, survivors and caregivers ensured that survivors and their caregivers were well informed about the care process, clinical condition, prognosis and transitional care needs. A collaborative care approach enabled survivors and caregivers to actively participate in care, decision-making and discharge planning during hospital-to-home transition. Coordination of care was equally important during hospital-to-home transition as it provided survivors with home-care instructions and opportunities for follow-up care. However, miscommunication among the healthcare team, insufficient information exchange, inadequate discharge planning, poor social support and lack of care coordination prevented smooth hospital-to-home transition leading to a crisis at home.</p><p><strong>Conclusions: </strong>The experiences of healthcare providers, patients and caregivers during stroke transitional care in Tanzania highlight achievements and key areas for improvement. Hospital-to-home transition is often characterised by uncertainty and emotional strain, emphasising the need for effective communication, involving patients and caregivers in care, as well as coordinating transitional care to address medical and psychosocial needs of survivors and their caregivers during and after discharge.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 2","pages":"e098301"},"PeriodicalIF":2.3,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Oral fluoroquinolone use and the risk of aortic and mitral valve regurgitation: a nationwide cohort study. 口服氟喹诺酮类药物与主动脉瓣和二尖瓣反流的风险:一项全国性队列研究
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-02-10 DOI: 10.1136/bmjopen-2024-096783
Olof Nibell, Jonas Björk, Malin Inghammar

Objective: This study aims to investigate whether oral fluoroquinolone use is associated with an increased risk of aortic and mitral valve regurgitation.

Design: A nationwide cohort study based on linked healthcare register data encompassing patient characteristics, prescription data and cases of aortic and mitral valve regurgitation.

Setting: Sweden, 2006-2018.

Participants: Study participants were adults aged 18-75 years. 794 588 courses of fluoroquinolones (88% ciprofloxacin) propensity score-matched (1:1) to an equal number of courses of penicillin V.

Main outcome measures: Aortic or mitral valve regurgitation leading to ED visit, hospitalisation or death. Cox regression was used to estimate HRs for the first incident of valve regurgitation within 120 days of treatment initiation. Subgroup and supplementary analyses included sex, age, first episode, surgery or death only, 356-day follow-up and analysis using amoxicillin as comparator drug.

Results: There were 29 (incidence rate 0.5 per 1000 person-years) cases in the fluoroquinolone group compared with 43 (0.7 per 1000 person-years) cases in the penicillin V group during the main (1-30 days) follow-up period; corresponding to a HR 0.70 (95% CI 0.43 to 1.11). Analyses of subsequent time periods yielded results consistent with the main period: HR 1.06 (0.63-1.78) for days 31-60 and 0.90 (0.59-1.36) days 61-120. No significant differences were found in any of the subgroup- or supplementary analyses. The absolute risk difference was -17 (95% CI -33 to 6) cases of valve regurgitation per 1 000 000 courses of fluoroquinolones.

Conclusion: In a nationwide cohort study, there was no statistical support for an increase in the risk of mitral or aortic valve regurgitation associated with oral fluoroquinolone use.

目的:本研究旨在探讨口服氟喹诺酮类药物是否与主动脉瓣和二尖瓣反流风险增加有关。设计:一项全国性队列研究,基于相关的医疗保健登记数据,包括患者特征、处方数据和主动脉瓣和二尖瓣反流病例。背景:瑞典,2006-2018。研究对象:研究对象为18-75岁的成年人。794 588个疗程的氟喹诺酮类药物(88%环丙沙星)倾向评分与相同疗程的青霉素v相匹配(1:1)。主要结局指标:主动脉瓣或二尖瓣反流导致急诊科就诊、住院或死亡。使用Cox回归来估计治疗开始后120天内第一次瓣膜返流事件的hr。亚组和补充分析包括性别、年龄、首次发作、仅手术或死亡、356天随访和以阿莫西林作为比较药物的分析。结果:主要随访期(1 ~ 30 d)氟喹诺酮组29例(发病率0.5 / 1000人年),青霉素V组43例(发病率0.7 / 1000人年);相对危险度为0.70 (95% CI 0.43 ~ 1.11)。后续时间段的分析结果与主要时间段一致:31-60天的HR为1.06(0.63-1.78),61-120天的HR为0.90(0.59-1.36)。在任何亚组或补充分析中均未发现显著差异。氟喹诺酮类药物每100万疗程发生瓣膜返流的绝对风险差为-17例(95% CI -33 ~ 6)。结论:在一项全国性队列研究中,没有统计学证据支持口服氟喹诺酮类药物会增加二尖瓣或主动脉瓣反流的风险。
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引用次数: 0
Advancing Strategies to Optimise the PerIopeRativE Management of PostOperative Nausea and Vomiting (ASPIRE-PONV) study: rationale and design for a sequential, repeated crossover trial. 优化术后恶心呕吐围手术期管理的推进策略(ASPIRE-PONV)研究:一项连续、重复交叉试验的基本原理和设计
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-02-10 DOI: 10.1136/bmjopen-2025-113842
Ellen G Stallings, Jonathan P Wanderer, Mark Balavage, Christopher Patrick Henson, Leslie Fowler, Svetlana Eden, Matthew S Shotwell, Calvin Gruss, Kelsey R Neuhafen, Brian J Gelfand, Miklos D Kertai

Introduction: This project, in adult surgical patients, will evaluate whether the creation of a customised checklist, driven by a clinical decision support tool, is able to improve anaesthesia providers' adherence to consensus guidelines and standardised practice recommendations for the prevention of postoperative nausea and vomiting (PONV).

Methods and analysis: The intervention will be evaluated using a sequential, repeated crossover design at the institutional level, with designated washout, control and intervention periods. The surgical case will serve as the unit of analysis. The primary outcome is adherence to appropriate PONV prophylaxis administration guidelines. Secondary outcomes include the incidence of PONV and length of stay in the postanaesthesia care unit (PACU).

Ethics and dissemination: This protocol and statistical analysis plan provide an outline of the study design, primary and secondary end points and analytic approach. The Advancing Strategies to Optimise the PerIopeRativE Management of PostOperative Nausea and Vomiting trial has received approval from the Vanderbilt University Institutional Review Board (IRB: 250773). The results will be disseminated through peer-reviewed publications and presentations at national conferences. Findings from this trial will inform best practices for timely antiemetic prophylaxis, with the goal of reducing PONV incidence and shortening PACU stay.

Trial registration number: NCT07152249.

本项目在成人手术患者中,将评估由临床决策支持工具驱动的定制检查表的创建是否能够提高麻醉提供者对预防术后恶心和呕吐(PONV)的共识指南和标准化实践建议的依从性。方法与分析:干预措施将在机构层面采用连续、重复交叉设计进行评估,并指定洗脱期、对照期和干预期。手术病例将作为分析单元。主要结果是遵守适当的PONV预防给药指南。次要结局包括PONV的发生率和在麻醉后护理单位(PACU)的停留时间。伦理和传播:该方案和统计分析计划提供了研究设计、主要和次要终点和分析方法的大纲。优化术后恶心和呕吐围手术期管理的推进策略试验已获得范德比尔特大学机构审查委员会(IRB: 250773)的批准。研究结果将通过同行评议的出版物和在国家会议上的发言加以传播。该试验的结果将为及时止吐预防提供最佳实践,目标是减少PONV发生率和缩短PACU住院时间。试验注册号:NCT07152249。
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引用次数: 0
Circadian patterns of patient symptoms in a tertiary university emergency department: a single-centre retrospective analysis. 某高等大学急诊科患者症状的昼夜节律模式:单中心回顾性分析。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-02-10 DOI: 10.1136/bmjopen-2025-101295
Katalin Fusz, András Deák, Péter Závodi, Bence Jónás, Vilmos Dávid Szilber, Peter Laszlo Kanizsai

Objectives: To evaluate emergency patient care from a chronophysiological perspective, examining circadian variations in symptom presentations and physiological parameters.Single-centre retrospective analysis.

Design: SETTING: Department of Emergency Medicine, Clinical Centre, University of Pécs, Hungary (August 2022 to August 2023).

Participants: Patient data including symptom categories, time of presentation (divided into eight 3-hour intervals), sex and age were collected. A total of 32 977 patient records were analysed. Symptoms were classified using the International Classification of Diseases, 10th Revision. For hypertension, random proportionally stratified sampling was performed (n=120).

Primary and secondary outcome measures: Primary outcomes were the circadian distribution of emergency presentations across 14 symptom categories and their variation by time of day, age and sex. Secondary outcomes included diurnal variation in hypertension-related cases, examining blood pressure, pulse rate, triage time and medication use.

Results: Cardiovascular cases peaked between 09:00 and 12:00 (p<0.001), toxicological emergencies between 18:00 and 21:00 (p<0.001) and endocrine-metabolic cases between 12:00 and 15:00 (p<0.001). In hypertensive patients, the lowest systolic pressure occurred between 12:00 and 15:00 (p=0.037). More patients presented on weekdays than weekends (p=0.013).

Conclusions: Symptom presentations in emergency care follow distinct circadian patterns, highlighting the influence of biological rhythms on clinical demand. Recognition of these temporal trends may support more effective ED scheduling and resource allocation.

目的:从时间生理学的角度评估急诊病人的护理,检查症状表现和生理参数的昼夜变化。单中心回顾性分析。设计:地点:匈牙利passics大学临床中心急诊医学系(2022年8月至2023年8月)。参与者:收集患者资料,包括症状类别、出现时间(分为8个3小时间隔)、性别和年龄。共分析了32 977例病例。根据《国际疾病分类》第十版对症状进行分类。对于高血压,随机按比例分层抽样(n=120)。主要和次要结局指标:主要结局是14种症状类别中急诊表现的昼夜分布及其随时间、年龄和性别的变化。次要结局包括高血压相关病例的日变化、检查血压、脉搏率、分诊时间和药物使用。结论:急诊患者的症状表现具有明显的昼夜节律模式,突出了生物节律对临床需求的影响。认识到这些时间趋势可以支持更有效的ED调度和资源分配。
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引用次数: 0
Social support and its associated factors among people on drug-resistant tuberculosis treatment in three selected hospitals in Ethiopia: a cross-sectional study design. 埃塞俄比亚选定的三家医院中接受耐药结核病治疗的患者的社会支持及其相关因素:一项横断面研究设计。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-02-10 DOI: 10.1136/bmjopen-2024-097011
Tsehay Dabi Bedada, Bira Bejiga, Dinka Fikadu Gemtesa, Gadissa Gutema, Sisay Abebe, Habteyes Tola

Objective: Social support is an important factor for psychosocial well-being and motivation to follow the treatment strictly in people with drug-resistant tuberculosis (DR-TB). Thus, this study aimed to determine the availability of social support and its association factors in people with DR-TB in selected hospitals in Ethiopia.

Design: A cross-sectional study was conducted in Addis Ababa (at Saint Peter and ALERT hospitals) and Bishoftu Hospital in Ethiopia. The study involved 130 people with DR-TB from January to May 2023.

Participants: All adult people on DR-TB treatment for at least 2 months were enrolled consecutively from the registration book. A structured questionnaire was used to collect data. Data were entered to Open Data Kit and analysed with SPSS V.22. Descriptive statistics were used to describe the characteristics of the participants. A linear regression model was used to assess factors associated with social support.

Main outcome: Availability of social support from different sources.

Results: The overall proportion of availability of social support obtained from different sources was 97.7% with 95% CI of (93.1% to 99.5%). Sex (β=0.61, 95% CI (0.28 to 0.94); p<0.001), marital status (β=0.59, 95% CI (0.26 to 0.93); p=0.001) and patient self-stigma score (β=0.60, 95% CI (0.42 to 0.78); p<0.001) were significantly associated with social support score.

Conclusions: A considerable proportion of people with DR-TB were obtaining social support from different sources. Interventions targeted female sex, single marital status and perceived social stigma are required to enhance social support conditions in people with DR-TB.

目的:社会支持是耐药结核病(DR-TB)患者心理健康和严格遵循治疗的重要因素。因此,本研究旨在确定埃塞俄比亚选定医院耐药结核病患者的社会支持可得性及其相关因素。设计:在埃塞俄比亚的亚的斯亚贝巴(圣彼得和阿勒特医院)和Bishoftu医院进行了一项横断面研究。这项研究从2023年1月到5月对130名耐药结核病患者进行了研究。参与者:所有接受耐药结核病治疗至少2个月的成年人从登记簿中连续入组。采用结构化问卷收集数据。数据输入Open Data Kit,用SPSS V.22进行分析。描述性统计用于描述参与者的特征。采用线性回归模型评估与社会支持相关的因素。主要结果:获得不同来源的社会支持。结果:从不同来源获得社会支持的总体比例为97.7%,95% CI为(93.1% ~ 99.5%)。性别(β=0.61, 95% CI (0.28 ~ 0.94);结论:相当比例的耐药结核病患者获得了不同来源的社会支持。为改善耐药结核病患者的社会支持条件,需要针对女性性别、单身婚姻状况和感知到的社会污名采取干预措施。
{"title":"Social support and its associated factors among people on drug-resistant tuberculosis treatment in three selected hospitals in Ethiopia: a cross-sectional study design.","authors":"Tsehay Dabi Bedada, Bira Bejiga, Dinka Fikadu Gemtesa, Gadissa Gutema, Sisay Abebe, Habteyes Tola","doi":"10.1136/bmjopen-2024-097011","DOIUrl":"10.1136/bmjopen-2024-097011","url":null,"abstract":"<p><strong>Objective: </strong>Social support is an important factor for psychosocial well-being and motivation to follow the treatment strictly in people with drug-resistant tuberculosis (DR-TB). Thus, this study aimed to determine the availability of social support and its association factors in people with DR-TB in selected hospitals in Ethiopia.</p><p><strong>Design: </strong>A cross-sectional study was conducted in Addis Ababa (at Saint Peter and ALERT hospitals) and Bishoftu Hospital in Ethiopia. The study involved 130 people with DR-TB from January to May 2023.</p><p><strong>Participants: </strong>All adult people on DR-TB treatment for at least 2 months were enrolled consecutively from the registration book. A structured questionnaire was used to collect data. Data were entered to Open Data Kit and analysed with SPSS V.22. Descriptive statistics were used to describe the characteristics of the participants. A linear regression model was used to assess factors associated with social support.</p><p><strong>Main outcome: </strong>Availability of social support from different sources.</p><p><strong>Results: </strong>The overall proportion of availability of social support obtained from different sources was 97.7% with 95% CI of (93.1% to 99.5%). Sex (β=0.61, 95% CI (0.28 to 0.94); p<0.001), marital status (β=0.59, 95% CI (0.26 to 0.93); p=0.001) and patient self-stigma score (β=0.60, 95% CI (0.42 to 0.78); p<0.001) were significantly associated with social support score.</p><p><strong>Conclusions: </strong>A considerable proportion of people with DR-TB were obtaining social support from different sources. Interventions targeted female sex, single marital status and perceived social stigma are required to enhance social support conditions in people with DR-TB.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 2","pages":"e097011"},"PeriodicalIF":2.3,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative effectiveness of weight loss interventions on blood pressure in obese patients with hypertension: a protocol for a systematic review and network meta-analysis. 减肥干预对肥胖高血压患者血压的比较效果:一项系统评价和网络荟萃分析方案。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-02-10 DOI: 10.1136/bmjopen-2025-105785
Eunyoung Noh, Inhu Bae, Jiyoon Won, Donggeun Han, Changyoung Park, Hyangsook Lee

Introduction: High blood pressure (BP) in obese populations poses significant cardiovascular risks, yet the comparative effectiveness of various weight loss interventions on BP remains unclear. This systematic review and network meta-analysis (NMA) aims to assess the comparative effectiveness of weight loss interventions in overweight/obese adults with prehypertension/hypertension on BP change and adverse events (AEs).

Methods and analysis: A systematic review and Bayesian NMA of randomised controlled trials of weight loss interventions in overweight/obese patients with prehypertension/hypertension will be conducted. PubMed, EMBASE and the Cochrane library (CENTRAL) and relevant references will be searched up to June 2025. Primary outcomes are changes in systolic and diastolic BP; secondary outcomes include AEs, body weight reduction (kg) and quality of life. Study selection, data extraction and methodological quality assessment using Cochrane risk of bias (RoB) 2.0 will be performed by independent two authors. A Bayesian NMA will be conducted using BUGSnet, with surface under the cumulative ranking curve to rank interventions. Subgroup analyses will explore heterogeneity by baseline BP severity, intervention duration and comorbidities, and sensitivity analyses will be performed for robustness of the results by RoB and sample size.

Ethics and dissemination: Ethical approval is not required for this systematic review as it will involve analysis of data only from previously published studies. The results will be disseminated through presentations at international conferences and publication in peer-reviewed journals.

Prospero registration number: CRD42022376688.

肥胖人群的高血压(BP)具有显著的心血管风险,但各种减肥干预措施对BP的相对有效性尚不清楚。本系统综述和网络荟萃分析(NMA)旨在评估体重减轻干预对高血压前期超重/肥胖成人血压变化和不良事件(ae)的比较有效性。方法与分析:对超重/肥胖合并高血压前期/高血压患者进行减肥干预的随机对照试验进行系统回顾和贝叶斯NMA分析。PubMed, EMBASE和Cochrane图书馆(CENTRAL)及相关参考文献将检索至2025年6月。主要结局是收缩压和舒张压的变化;次要结局包括ae、体重减轻(kg)和生活质量。研究选择、数据提取和使用Cochrane风险偏倚(RoB) 2.0进行方法学质量评估将由独立的两位作者进行。使用BUGSnet进行贝叶斯NMA,在累积排名曲线下用曲面对干预进行排名。亚组分析将通过基线血压严重程度、干预持续时间和合并症来探索异质性,并通过RoB和样本量对结果的稳健性进行敏感性分析。伦理和传播:本系统评价不需要伦理批准,因为它只涉及分析以前发表的研究的数据。研究结果将通过在国际会议上的演讲和在同行评议的期刊上发表来传播。普洛斯彼罗注册号:CRD42022376688。
{"title":"Comparative effectiveness of weight loss interventions on blood pressure in obese patients with hypertension: a protocol for a systematic review and network meta-analysis.","authors":"Eunyoung Noh, Inhu Bae, Jiyoon Won, Donggeun Han, Changyoung Park, Hyangsook Lee","doi":"10.1136/bmjopen-2025-105785","DOIUrl":"10.1136/bmjopen-2025-105785","url":null,"abstract":"<p><strong>Introduction: </strong>High blood pressure (BP) in obese populations poses significant cardiovascular risks, yet the comparative effectiveness of various weight loss interventions on BP remains unclear. This systematic review and network meta-analysis (NMA) aims to assess the comparative effectiveness of weight loss interventions in overweight/obese adults with prehypertension/hypertension on BP change and adverse events (AEs).</p><p><strong>Methods and analysis: </strong>A systematic review and Bayesian NMA of randomised controlled trials of weight loss interventions in overweight/obese patients with prehypertension/hypertension will be conducted. PubMed, EMBASE and the Cochrane library (CENTRAL) and relevant references will be searched up to June 2025. Primary outcomes are changes in systolic and diastolic BP; secondary outcomes include AEs, body weight reduction (kg) and quality of life. Study selection, data extraction and methodological quality assessment using Cochrane risk of bias (RoB) 2.0 will be performed by independent two authors. A Bayesian NMA will be conducted using BUGSnet, with surface under the cumulative ranking curve to rank interventions. Subgroup analyses will explore heterogeneity by baseline BP severity, intervention duration and comorbidities, and sensitivity analyses will be performed for robustness of the results by RoB and sample size.</p><p><strong>Ethics and dissemination: </strong>Ethical approval is not required for this systematic review as it will involve analysis of data only from previously published studies. The results will be disseminated through presentations at international conferences and publication in peer-reviewed journals.</p><p><strong>Prospero registration number: </strong>CRD42022376688.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 2","pages":"e105785"},"PeriodicalIF":2.3,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Differences in sexual risk behaviours, HIV care utilisation and experiences of stigma between transgender women and cisgender men who have sex with men: findings from integrated biobehavioural surveys in Ukraine 2013-2018. 2013-2018年乌克兰综合生物行为调查结果:跨性别女性和男男性行为的顺性男性在性风险行为、艾滋病毒护理利用和污名化经历方面的差异
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-02-10 DOI: 10.1136/bmjopen-2025-104918
Saher Aijaz, Peter Vickerman, Tetiana Saliuk, Jane Nicholls, David Gillespie, Kerenza Hood, Jack Stone

Objectives: To assess whether transgender women who have sex with men (TGWSM) sampled in men who have sex with men (MSM) biobehavioural surveys in Ukraine experience different levels of sexual risk, stigma, HIV prevalence and engagement in the HIV care than cisgender MSM (CMSM).

Design: Analysis of secondary data from three population-level cross-sectional surveys.

Setting: The analysis was conducted on data from three rounds of integrated biobehavioural surveys of MSM in 27 cities of Ukraine from 2013 to 2018.

Participants: Data from n=18 621 MSM with n=18 102 CMSM and n=503 TGWSM.

Primary and secondary outcome measures: The primary outcomes were differences in sexual risk behaviours, HIV testing and treatment uptake, and the secondary outcomes were differences in lifetime experiences of stigma, coercive sex and physical assault (in the 2018 survey only) between CMSM and TGWSM.

Results: Compared with CMSM, TGWSM were more likely to be clients of non-governmental organisations (adjusted OR, aOR: 1.39, 95% CI 1.15 to 1.67), engage in commercial sex (last month; aOR: 1.28, 95% CI 1.01 to 1.61), have group sex (aOR: 1.31, 95% CI 1.06 to 1.61), more long-term sex partners (last month; adjusted incidence rate ratio: 1.14, 95% CI 1.03 to 1.27), history of imprisonment (aOR: 1.51, 95% CI 1.00 to 2.31) and engage in chemsex (last month, aOR: 1.58, 95% CI 1.12 to 2.23). We found no difference in HIV prevalence (5.17% in TGWSM vs 5.43% in CMSM, p=0.065). In 2018, more TGWSM reported lifetime experience of stigma from family and friends (aOR: 3.58, 95% CI 2.54 to 5.04), general social stigma (aOR: 3.13, 95% CI 2.22 to 4.41), anticipated healthcare stigma (aOR: 3.63, 95% CI 2.53 to 5.16), physical assault (aOR: 2.73, 95% CI 1.85 to 4.03) and coercive sex (aOR: 3.01, 95% CI 1.99 to 4.55) than CMSM.

Conclusions: TGWSM in Ukraine may be at increased risk of HIV acquisition compared to CMSM due to many factors including elevated levels of stigma and violence. Services specifically tailored for transgender people are needed to help reduce these high-risk behaviours.

目的:评估乌克兰男同性恋者(MSM)生物行为调查中抽样的跨性别男同性恋者(TGWSM)在性风险、污名、艾滋病毒感染率和参与艾滋病毒护理方面是否与顺性男同性恋者(CMSM)有不同程度的差异。设计:分析来自三个人口水平横断面调查的次要数据。背景:对乌克兰27个城市2013 - 2018年三轮MSM综合生物行为调查数据进行分析。参与者:数据来自n= 18621名MSM, n= 18102名CMSM和n=503名TGWSM。主要和次要结局指标:主要结局指标是性风险行为、艾滋病毒检测和治疗接受方面的差异,次要结局指标是CMSM和TGWSM之间终生耻辱经历、强迫性行为和身体攻击(仅在2018年的调查中)的差异。结果:与CMSM相比,TGWSM更容易被客户的非政府组织(或调整,aOR: 1.39, 95%可信区间1.15到1.67),从事性交易(上个月;优势:1.28,95%可信区间1.01到1.61),性生活集团(优势比:1.31,95%可信区间1.06到1.61),更长期的性伴侣(上个月;调整发病率比:1.14,95%可信区间1.03到1.27),监禁的历史(优势比:1.51,95%可信区间1.00到2.31),从事chemsex(上个月,aOR: 1.58, 95%可信区间1.12到2.23)。我们发现HIV患病率没有差异(TGWSM为5.17%,CMSM为5.43%,p=0.065)。2018年,与CMSM相比,更多的TGWSM报告了来自家人和朋友的耻辱感(aOR: 3.58, 95% CI 2.54至5.04)、一般社会耻辱感(aOR: 3.13, 95% CI 2.22至4.41)、预期的医疗耻辱感(aOR: 3.63, 95% CI 2.53至5.16)、身体攻击(aOR: 2.73, 95% CI 1.85至4.03)和强迫性行为(aOR: 3.01, 95% CI 1.99至4.55)。结论:与CMSM相比,乌克兰TGWSM感染艾滋病毒的风险可能更高,原因包括耻辱和暴力水平升高。需要专门为跨性别者提供服务,以帮助减少这些高危行为。
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引用次数: 0
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