BMJ Open最新文献

Introduction: Life satisfaction is a key indicator of successful ageing and reflects well-being. There is evidence of the association between life satisfaction and health behaviours among older adults. Therefore, this systematic review and meta-analysis protocol seeks to determine the strength and direction of the association between life satisfaction and health behaviours among older adults.

Methods and analysis: This protocol followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search the electronic databases (MEDLINE, APA PsycINFO, Web of Science, CINAHL and Global Health) from inception to date. Only observational studies that described the association between life satisfaction and health behaviours-smoking, alcohol drinking, physical activity, diet/nutrition and sleep-will be included. Two independent reviewers will conduct screening, data extraction and risk of bias assessment of the articles. The risk of bias will be assessed using the Joanna Briggs Institute critical appraisal tools for cohort and analytical cross-sectional studies. Studies will be included in the meta-analysis if they report zero-order associations between life satisfaction and health behaviours; otherwise, a narrative synthesis will be presented.

Ethics and dissemination: This study does not require ethics approval, as it involves analysing secondary data from published studies. The completed review will be published in a peer-reviewed journal and presented at conferences.

Trial registration number: PROSPERO (CRD42023441386).

Introduction: A clinical prediction tool to estimate life expectancy in community-dwelling individuals living with dementia could inform healthcare decision-making and prompt future planning. An existing Ontario-based tool for community-dwelling elderly individuals does not perform well in people living with dementia specifically. This study seeks to develop and validate a clinical prediction tool to estimate survival in community-dwelling individuals living with dementia receiving home care in Ontario, Canada.

Methods and analysis: This will be a population-level retrospective cohort study that will use data in linked healthcare administrative databases at ICES. Specifically, data that are routinely collected from regularly administered assessments for home care will be used. Community-dwelling individuals living with dementia receiving home care at any point between April 2010 and March 2020 will be included (N≈200 000). The model will be developed in the derivation cohort (N≈140 000), which includes individuals with a randomly selected home care assessment between 2010 and 2017. The outcome variable will be survival time from index assessment. The selection of predictor variables will be fully prespecified and literature/expert-informed. The model will be estimated using a Cox proportional hazards model. The model's performance will be assessed in a temporally distinct validation cohort (N≈60 000), which includes individuals with an assessment between 2018 and 2020. Overall performance will be assessed using Nagelkerke's R², discrimination using the concordance statistic and calibration using the calibration curve. Overfitting will be assessed visually and statistically. Model performance will be assessed in the validation cohort and in prespecified subgroups.

Ethics and dissemination: The study received research ethics board approval from the Sunnybrook Health Sciences Centre (SUN-6138). Abstracts of the project will be submitted to academic conferences, and a manuscript thereof will be submitted to a peer-reviewed journal for publication. The model will be disseminated on a publicly accessible website (www.projectbiglife.com).

Trial registration number: NCT06266325 (clinicaltrials.gov).

Obstructive sleep apnoea (OSA) and its associations with lung function.

Background: OSA is highly prevalent and characterised by abnormal respiration during sleep. This large, population-based study aimed to investigate the associations between OSA and lung function in subjects aged 50-64 years.

Method: The population-based Swedish CArdioPulmonary bioimage Study includes information on anthropometry, comorbidities and spirometry. The current analysis included data from three centres (Gothenburg, Umeå and Uppsala) on whole-night respiratory polygraphy as a meta-analysis examining the overall effect size of lung function on sleep apnoea severity, expressed as ß-coefficient after stratifying for sex and adjusting for age, waist circumference and smoking status.

Results: Data from 9016 participants (54% women, age 58±4 years, body mass index 27±4 kg/m² ) with sleep recordings of good quality were included in the final analysis. Forced expiratory volume during 1 s (FEV ₁ ) (ß=-0.10 (95% CI -0.16 to -0.03)), forced vital capacity (FVC) (-0.15 (-0.21 to -0.10)) and diffusion capacity for carbon monoxide (DL_CO ) (-0.08 (-0.10 to -0.05)) were all negatively associated with the oxygen desaturation index (ODI) and also with per cent of registration with nocturnal oxygen saturation <90% FVC (-0.44 (-0.87 to -0.01)), FEV ₁ (-0.86 (-1.36 to -0.36)) and DL _CO (-0.47 (-0.60 to -0.35)). Additionally, a positive association was observed between FEV ₁ (0.13 (0.05 to 0.22)) and DL _CO (0.07 (0.04 to 0.09)) with the mean nocturnal saturation. There was a negative association between DL _CO and apnoea-hypopnoea index, AHI, (ß=-0.04 (95% CI-0.06 to -0.03)), while no associations were found between FEV ₁ or FVC and AHI.

Conclusion: In OSA, lower lung function is more distinctly associated with the nocturnal hypoxic burden than AHI. Potential lung function impairment should be investigated in OSA patients with a high ODI relative to AHI.

Introduction: Childhood-onset obesity poses significant health risks, including early-onset type 2 diabetes, cardiovascular disease, and reduced quality of life. Hospital-based non-pharmacological obesity care can reduce childhood obesity, but 25% of children do not respond. Therefore, this study investigates the effect of the glucagon-like peptide-1 receptor agonist, semaglutide, as an add-on to hospital-based obesity care in youth who still have obesity following hospital-based obesity care as children. Furthermore, biomedical and psychosocial factors linked to treatment response will be investigated, alongside an exercise-based strategy to prevent weight regain and maintain a healthy body composition after semaglutide treatment.

Methods and analysis: This is an investigator-initiated, randomised, placebo-controlled, double-blind trial. We will enrol expectedly 180-270 young adults aged 18-28 years based on their previous response to a paediatric obesity management programme and their current body mass index (BMI). Participants are categorised into four groups: low treatment response (BMI SD score (SDS) reduction <0.10; BMI ≥30 kg/m²); medium treatment response (BMI SDS reduction >0.25; BMI ≥30 kg/m²); high treatment response (BMI SDS reduction >0.50; BMI <30 kg/m²) and a population-based reference group with normal weight development in childhood. Participants with BMI ≥30 kg/m² are randomised 2:1 to subcutaneous injections of semaglutide 2.4 mg/week or placebo as an add-on to hospital-based obesity care for 68 weeks. The primary outcome is the change in BMI from randomisation to the end of treatment with semaglutide compared with placebo. Secondary endpoints are changes in weight and body composition.

Ethics and dissemination: The trial has been approved by the Danish Medicines Agency and the Ethical Committee of the Capital Region of Denmark (H-20039422). The trial will be conducted in accordance with the Declaration of Helsinki and follow the guidelines for Good Clinical Practice. Results will be presented at international scientific conferences and published in peer-reviewed scientific journals.

Trial registration number: EudraCT 2019-002274-31.

Objectives: Primary health workers are crucial to the healthcare system, yet China experiences a notable shortage driven by high turnover rates. This study aimed to investigate the prevalence and determinants of turnover intention among primary health workers.

Design: Cross-sectional study.

Setting: Primary healthcare facilities across 21 cities in Guangdong province, China.

Participants: Online questionnaires (SurveyStar, Changsha Ranxing Science and Technology) were administered to 16 573 primary health workers in September and October 2022.

Primary and secondary outcome measures: Variables measured included demographics, work-related factors, job satisfaction, emotional exhaustion and turnover intention. Comparisons of turnover intention were made across different categorical groups, and hierarchical regression analysis was used to pinpoint influencing factors.

Results: The average turnover intention score among participants was 10.49±2.93. Notable positive correlations included those with male gender, single marital status, leadership positions and roles as public health physicians. Emotional exhaustion correlated positively (β=0.108), while job satisfaction showed a significant negative correlation (β=-0.154). Other negative influential factors were observed with tenure lengths of 6-10 years, 11-15 years and ≥16 years, as well as with senior professional titles, lower salary levels and perceptions of fair compensation.

Conclusions: Turnover intention is notably prevalent among primary healthcare workers, with emotional exhaustion and job satisfaction identified as primary determinants. Salary, payment justice in compensation and tenure also significantly influence turnover intention. Based on the above analysis, a series of intervention measures can be expectedly unveiled to reduce the turnover intention of primary health workers and maintained the steady development of basic medical resources.

Objectives: To assess the prevalence and severity of paruresis ('shy bladder syndrome') in a population of university staff and students and to determine if there was any relationship between demographics, self-esteem, presence of social anxiety disorders and negative toilet experiences and paruresis.

Design: We undertook an anonymised cross-sectional online survey using Microsoft Forms. We invited participants aged 18 and over to complete the survey which included demographic information; any pre-existing medically or self-diagnosed anxiety-related conditions; Shy Bladder Scale (SBS); Rosenberg Self-Esteem Scale (RSES) and questions about using school toilets in their younger life. We defined 'mild' and 'severe' paruresis based on total SBS cut-off scores of greater than or equal to 31 and greater than or equal to 40. We calculated prevalence of paruresis, and explored differences in self-esteem, school toilet experience and social anxiety disorders between individuals with and without paruresis. Multivariable logistic regression was used to determine which variables had any influence on having a 'mild' and 'severe' paruresis diagnosis.

Setting: We distributed the survey to all staff and students via their university email address as well as promoting the survey on university social media sites.

Results: We received responses from 356 individuals. Most participants (237, 66.6%) were within the 18-30 year age category and most (277, 77.8%) were white. There were 221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders. The prevalence of 'mild' paruresis was 25.8% and of 'severe' paruresis 14.9% in this sample. 73.0% indicated that they had at least one medically or self-diagnosed anxiety disorder. There was a statistically significant difference in the total SBS score between individuals with and without an existing anxiety disorder (8 vs 19, <0.001). The adjusted odds of 'mild' paruresis were higher for men than women (OR 3.39; 95% CI 1.90 to 6.06), lower for those with a lower RSES score (OR 0.90; 95% CI 0.85 to 0.96), lower for those for a lower school toilet experience score (OR 0.88; 95% CI 0.78 to 0.99) and higher for those with at least one anxiety disorder (OR 3.164; 95% CI 1.52 to 6.59). The adjusted odds of 'severe' paruresis were higher for men than women (OR 2.60; 95% CI 1.32 to 5.12), lower for those with a lower RSES score (OR 0.90; CI 0.84 to 0.97) and higher for those with at least one anxiety disorder (OR 2.99 (1.18-7.56)).

Conclusion: Large organisations should consider measures to help manage anxiety and improve toilet experiences. These could include resources and signposting to manage anxiety disorders and single-occupancy toilets and toilets in quiet areas to limit anxiety associated with shy bladder syndrome.

This work grew from an interest in understanding how private data are used for health system governance in low-income and middle-income countries (LMICs).

Objective: We conducted a scoping review to understand how the public sector collects routine data from the private health sector and uses it for governance purposes. The private health sector was defined to include both formal and informal, for-profit or non-profit, actors delivering healthcare services.

Findings: We identified 4014 individual English language studies published between 2010 and 2021. We reviewed titles and abstracts of all, with 50% reviewed by two authors to ensure a common application of inclusion criteria. 89 studies were selected for review in full; following this, 26 articles were included in the final selection as they directly report on the use of routine private sector data for governance in LMICs. Only English language studies were included, limiting the scope of possible conclusions.

Results: Data were most commonly collected by the Ministry of Health or a subministerial office, with extraction from District Health Information System 2 specifically cited for three studies. 16 studies collected data on infrastructure and distribution, 15 on service delivery, 12 on health financing, 7 on pharmaceuticals and other consumables, 4 on health workforce, 4 on quality of care and 4 on epidemic surveillance.

Conclusion: The studies identified provide examples of the public sector's capacity to collect and use data routinely collected from the private sector to perform essential governance functions. The paucity of studies identified is an indication that more attention is needed to ensure that this key area of health system governance is undertaken and that lessons learnt are shared. This review provides insights to understanding private sector health data collection and use for governance in LMICs, and for guiding activities to assess and improve this according to country context and capacity.

Objectives: This study aims to investigate the satisfaction levels of inpatients and identify the determinants of inpatient satisfaction and hospital recommendations.

Design: A cross-sectional study was conducted in 2022.

Setting: A tertiary general hospital in Sichuan Province, China.

Participants: 271 inpatients were randomly selected and studied.

Primary and secondary outcome measures: A tailored questionnaire was developed to measure inpatient satisfaction and hospital recommendation. T-test and analysis of variance were employed to compare the differences in inpatients' demographic characteristics across five satisfaction domains. Multivariate binary logistic regression was performed to identify determinants associated with inpatient satisfaction and hospital recommendation.

Results: The mean inpatient satisfaction score was 4.27 and the mean hospital recommendation score was 3.96. Inpatients showed the highest satisfaction with the physician care domain and the lowest satisfaction with the hospital environment domain. Statistically significant differences were observed in inpatient demographic characteristics among specific satisfaction domains. Older inpatients, those with Urban Employees and Residents Medical Insurance, from the internal medicine department, and inpatients from the hospital's older region reported the highest levels of satisfaction. Multivariate binary logistic regression revealed that the nursing care domain was the strongest positive predictor of both inpatient overall satisfaction and hospital recommendation. Additionally, the medical procedure and hospital environment domains were strong positive predictors for hospital recommendation and inpatient overall satisfaction respectively. The hospital region domain was a strong negative predictor for inpatient overall satisfaction.

Conclusions: Higher satisfaction levels do not necessarily correlate with an increased likelihood of hospital recommendation. Inpatient satisfaction levels vary significantly based on factors such as age, gender, insurance type, hospital clinical department and region. The domains of nursing care and medical procedure are the influencing factors associated with inpatient overall satisfaction. The domains of nursing care, hospital environment and hospital region are the influencing factors of inpatient hospital recommendation.

Objectives: This study aimed to describe (1) differences between subjects with patellofemoral pain (PFP) with and without pain during prolonged sitting (PDPS), (2) minimum knee flexion angle and time to onset/disappearance of PDPS and (3) differences between those with PDPS at smaller/greater flexion angles and with fast/slow onset and disappearance of PDPS.

Design: Patient-reported online questionnaire.

Setting: Private physical therapy clinics in the Netherlands between May 2021 and March 2023.

Participants: 87 participants (61 (70%) females, mean age 22.0 years (IQR 4.0), body mass index 23.1 (4.7)).

Outcome measures: Visual Analogue Scale for worst pain (VAS-W) and sitting pain (VAS-W sitting), the Anterior Knee Pain Scale (AKPS), knee flexion angle to provoke PDPS and time to onset/disappearance of PDPS.

Results: 63 of 87 (72%) participants reported PDPS. Participants with PDPS experienced bilateral symptoms of PFP more frequently (71% vs 46%, p=0.44) and scored 12 points lower on the AKPS (p<0.001). Most participants (85%) reported a minimum knee flexion angle of ≥90°, median time to PDPS onset of 16-20 min and 6-10 min for disappearance. Participants experiencing PDPS at smaller flexion angles exhibited higher VAS-W and VAS-W sitting scores (7.0 (1.0), 6.8 (1.1)) than those at greater flexion angles (5.0 (3.0), for both) (p=0.002, p=0.001). Participants with fast onset of PDPS reported higher VAS-W and VAS-W sitting scores (7.0 (2.0), 6.0 (2.0)) than those with slow onset (5.0 (3.0), 5.0 (4.0)) (p<0.001, p=0.025).

Conclusions: Participants with PDPS reported higher levels of disability than those without. PDPS was typically induced at knee flexion of ≥90°, with delayed onset/disappearance. Higher pain levels were reported by those experiencing PDPS at smaller knee flexion angles or with faster onset. Future research should explore the mechanisms of PDPS and develop targeted interventions to improve long-term outcomes.

Objectives: This study aimed to compare the effectiveness of different wearable intervention strategies in reducing sedentary time (ST) and prolonged sitting (PS) on healthy adults.

Design: A network meta-analysis (NMA).

Data sources: PubMed, Web of Science, SPORTDiscus, ProQuest, Opengrey, Medline and Cochrane Central Register of Controlled Trials were searched up to 1 June 2024.

Eligibility criteria for selecting studies: Randomised controlled trials (RCTs) that examined the effect of wearable device interventions on ST and PS among healthy adults were included.

Data extraction and synthesis: Two independent reviewers used standardised methods to search, screen and code included studies. Bias risks were assessed using Cochrane tools (Risk of Bias 2.0). Data were analysed using a frequentist framework NMA to directly and indirectly compare the effects of the five different intervention strategies (comparators). The results were reported as standardised mean differences (SMDs) with 95% CI and surface under cumulative ranking curve (SUCRA) was used to rank the best interventions. The five comparators were as follows: (1) wearable-only intervention (only using wearable devices for self-monitoring); (2) wearable combined with online intervention (ie, online coaching and social media support); (3) wearable combined with offline intervention (ie, face-to-face seminars and courses); (4) comparison group (ie, traditional, non-wearable interventions); (5) control group (ie, maintaining daily routine, waitlist).

Results: 12 RCTs with a total of 2957 participants were included. Results of NMA showed that the 'wearable+online' has significantly better effects in reducing ST compared with control group, comparison group and 'wearable only', with moderate to large effect sizes (SMD=0.96, 95% CI 0.65 to 1.27; SMD=0.87, 95% CI 0.21 to 1.53; SMD=0.78, 95% CI 0.14 to 1.42, respectively). However, no significant differences were identified between the groups in reducing PS. The SUCRA values were ranked as wearable+online (98.1%), wearable+offline (64.4%,), 'wearable only' (40.5%), comparison group (25.9%) and control group (21.1%) for ST reduction. Similar rankings were observed for PS reduction, with probabilities of 69.9%, 61.1%, 59.7%, 37.1% and 22.1%, respectively.

Conclusions: Wearable+online is the best intervention strategy for reducing ST in healthy adults. Additionally, none of the wearable-based interventions effectively reduced PS in healthy adults, but as there is little research on PS, it should receive more attention in the future. PROSPERO registration number: CRD42021290017.