BMJ Open最新文献

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.