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Understanding preferences for behaviour change support as part of the NHS Health Check: a qualitative study with adults from underserved minoritised ethnic communities. 作为国民保健服务健康检查的一部分,了解对行为改变支持的偏好:一项对来自服务不足的少数民族社区的成年人的定性研究。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-14 DOI: 10.1136/bmjopen-2025-111413
Sophie Griffiths, Yvonne K Bartlett, David P French, Brian McMillan

Introduction: NHS Health Checks (NHSHCs) provide individuals with cardiovascular disease (CVD) risk scores alongside advice and signposting to behaviour change support. A particular problem is that the support people receive is often poorly delivered, absent or not tailored to the needs of people in deprived communities, which risks exacerbating health inequalities. Improving this support is critical if NHSHCs are to achieve their goals of prevention and equity.

Objectives: To explore needs and preferences for behaviour change support among adults in deprived areas, using a digital prototype presenting CVD risk information and signposting to services.

Design: A longitudinal qualitative study involving focus groups and semi-structured follow-up interviews.

Participants and setting: Adults from minoritised ethnic groups eligible for NHSHCs, recruited online and through a community centre, with both methods targeting high-deprivation areas.

Method: Participants were first shown the digital prototype in focus groups to generate discussion. Follow-up interviews captured more in-depth reflections on needs for behaviour change support. Data were analysed using reflexive thematic analysis.

Results: We conducted four focus groups and 20 follow-up interviews with 23 adults, predominantly of South Asian ethnicity living in areas of high deprivation. We developed three themes: (1) Trusted information to counter confusion and misinformation; (2) Support that makes change feel possible and meaningful, through culturally and personally relevant advice that addresses unhelpful beliefs about risk reduction and behaviour change and (3) Ensuring access to inclusive, socially connected environments that feel supportive and conducive to action.

Conclusions: For minoritised ethnic adults in deprived areas, NHSHC support should build on everyday practices and foster positive perceptions of services. Alongside service-level changes, policy action is needed to remove structural barriers (eg, cost, safety) that limit people's ability to act on advice. Such changes could enhance the programme's contribution to reducing inequalities in CVD prevention.

简介:NHS健康检查(NHSHCs)为个人提供心血管疾病(CVD)风险评分以及行为改变支持的建议和路标。一个特别的问题是,人们得到的支助往往提供得很差,缺乏或没有针对贫困社区人民的需要,这有可能加剧保健不平等。如果国家卫生健康服务中心要实现其预防和公平的目标,改善这种支持至关重要。目的:探索贫困地区成年人对行为改变支持的需求和偏好,使用呈现心血管疾病风险信息和服务指示的数字原型。设计:涉及焦点小组和半结构化随访访谈的纵向定性研究。参与者和环境:来自有资格获得国家卫生健康保障中心的少数民族的成年人,通过在线和社区中心招募,两种方法都针对高度贫困地区。方法:首先在焦点小组中向参与者展示数字原型,以引发讨论。后续访谈更深入地反映了对行为改变支持的需求。数据分析采用反身性主题分析。结果:我们对23名成年人进行了四个焦点小组和20次随访访谈,主要是生活在高度贫困地区的南亚种族。我们开发了三个主题:(1)可信信息,以对抗混乱和错误信息;(2)通过与文化和个人相关的建议,解决有关减少风险和改变行为的无益信念,使变化感觉可能和有意义的支持;(3)确保获得包容性的、社会联系的环境,让人们感到支持和有利于行动。结论:对于贫困地区的少数民族成年人,国家卫生健康服务中心的支持应建立在日常实践的基础上,并培养对服务的积极看法。除了服务水平的变化,还需要采取政策行动来消除限制人们根据建议采取行动能力的结构性障碍(例如,成本、安全)。这种改变可以加强该方案对减少心血管疾病预防方面的不平等的贡献。
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引用次数: 0
Neurofilament light chain as a potential biomarker of perioperative neurocognitive disorders: a systematic review and meta-analysis. 神经丝轻链作为围手术期神经认知障碍的潜在生物标志物:系统回顾和荟萃分析。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-14 DOI: 10.1136/bmjopen-2025-102444
Feng Chen, Zhuo-Xi Wu, Qin Chen, Du-Kun Zuo, Xin-Ming Ye, Hong Li

Objectives: Although neurofilament light chain (NfL) is used as a biomarker of neurodegenerative decline, its application in surgery- and anaesthesia-induced acute cognitive dysfunction remains uncertain. We aimed to synthesise existing evidence to evaluate the potential of NfL as a biomarker for perioperative neurocognitive disorder (PND).

Design: Systematic review and meta-analysis.

Data sources: PubMed, EMBASE, MEDLINE, the Cochrane Library and the Cochrane Central Register of Clinical Trials were systematically searched up to March 2024.

Eligibility criteria: Observational studies-including cohort, case-control and cross-sectional designs-were included if they reported cerebrospinal fluid (CSF) or blood NfL levels in individuals with and without PND.

Data extraction and synthesis: Three independent reviewers assessed each article. Quality scoring was conducted, and the extracted data were analysed using STATA. Risk of bias was evaluated using the Newcastle-Ottawa Scale. Meta-analytical model selection was guided by the I2 statistic, with I2≤40% indicating low heterogeneity and the use of a fixed-effect model; random-effects models were used when this threshold was exceeded.

Results: Within-group analyses showed significant postoperative increases in blood NfL levels in both the postoperative delirium (POD) group (standardised mean difference (SMD) = 0.49; 95% CI 0.34 to 0.64) and the no-POD group (SMD=0.67, 95% CI 0.53 to 0.81). Between-group comparisons revealed significantly higher preoperative CSF NfL levels in the POD group (SMD=0.27, 95% CI 0.07 to 0.47). Both preoperative and postoperative blood NfL levels were also significantly elevated in the POD group (SMD=0.53, 95% CI 0.40 to 0.66, and SMD=0.58, 95% CI 0.43 to 0.73, respectively).

Conclusions: This meta-analysis suggests that NfL may be a potential biomarker for POD. Further research is needed to clarify the association between CSF and blood NfL levels and other forms of PND.

Prospero registration number: CRD42024516907.

目的:虽然神经丝轻链(NfL)被用作神经退行性衰退的生物标志物,但其在手术和麻醉诱导的急性认知功能障碍中的应用仍不确定。我们的目的是综合现有证据来评估NfL作为围手术期神经认知障碍(PND)生物标志物的潜力。设计:系统回顾和荟萃分析。数据来源:PubMed, EMBASE, MEDLINE, Cochrane Library和Cochrane Central Register of Clinical Trials系统检索至2024年3月。入选标准:观察性研究——包括队列、病例对照和横断面设计——如果报告了PND患者和非PND患者脑脊液(CSF)或血液NfL水平,则纳入。数据提取和综合:三名独立审稿人评估每篇文章。进行质量评分,提取的数据使用STATA进行分析。偏倚风险采用纽卡斯尔-渥太华量表进行评估。meta分析模型选择以I2统计量为指导,I2≤40%表示异质性较低,采用固定效应模型;当超过这个阈值时,使用随机效应模型。结果:组内分析显示,术后谵妄(POD)组和术后谵妄(POD)组的血NfL水平均显著升高(标准化平均差(SMD) = 0.49;95% CI 0.34 ~ 0.64)和无pod组(SMD=0.67, 95% CI 0.53 ~ 0.81)。组间比较显示,POD组术前脑脊液NfL水平显著升高(SMD=0.27, 95% CI 0.07 ~ 0.47)。POD组术前和术后血NfL水平均显著升高(SMD=0.53, 95% CI 0.40 ~ 0.66, SMD=0.58, 95% CI 0.43 ~ 0.73)。结论:这项荟萃分析表明,NfL可能是POD的潜在生物标志物。需要进一步的研究来阐明CSF和血液NfL水平与其他形式PND之间的关系。普洛斯彼罗注册号:CRD42024516907。
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引用次数: 0
Associations between psychosocial factors and health service utilisation and self-management in older Australian women with type 2 diabetes or pre-diabetes: a cross-sectional study. 澳大利亚老年2型糖尿病或糖尿病前期妇女心理社会因素与保健服务利用和自我管理之间的关系:一项横断面研究
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-14 DOI: 10.1136/bmjopen-2025-103794
Shanshan Lin, Wenbo Peng, Md Sazedur Rahman, David Sibbritt

Objectives: Diabetes is highly prevalent in older women worldwide. This study explores the associations of psychosocial factors with both health service utilisation and self-management in older women aged 68 to 73 years with type 2 diabetes (T2D) or pre-diabetes.

Design and setting: This cross-sectional study used data from the Australian Longitudinal Study on Women's Health (ALSWH), which is a national population-based cohort study that has collected information on factors related to women's health and well-being over 20 years.

Participants: Women aged 68-73, born between 1946 and 1951, participated in ALSWH and self-reported their diagnosis of T2D or pre-diabetes.

Outcome measures: Resilience, dispositional optimism and perceived control were the measures of psychosocial factors. The associations between these factors and diabetes self-management behaviours, healthcare visits and preventive service use were examined by numerous regression models.

Results: There were 939 women aged 68-73 years with T2D or pre-diabetes. Women with T2D who exhibited higher dispositional optimism had significantly higher odds of participating in moderate/vigorous physical activity (OR: 1.06), visiting a dentist (OR: 1.07) and a lower rate of general practitioner (GP) visits (rate ratio (RR): 0.99). Women with T2D with greater resilience were likely to have a lower rate of consulting with mental health professionals (RR: 0.63) and higher odds of blood sugar level checks (OR: 1.68). The rate of GP visits within a year decreased by 16% for women with pre-diabetes who had a higher resilience score (RR: 0.84), and women with pre-diabetes with greater resilience had a 13% lower rate of visits to a nurse (RR: 0.87).

Conclusions: Psychosocial aspects of diabetes care may be important for supporting the physical and mental well-being of older women with T2D or pre-diabetes. Healthcare providers may consider whether integrating assessments of resilience and optimism into routine diabetes management might help identify older women who could benefit from targeted psychosocial support.

目的:糖尿病在全球老年妇女中非常普遍。本研究探讨了68至73岁老年2型糖尿病(T2D)或糖尿病前期妇女的社会心理因素与卫生服务利用和自我管理的关系。设计和背景:这项横断面研究使用了澳大利亚妇女健康纵向研究(ALSWH)的数据,这是一项以全国人口为基础的队列研究,收集了20多年来与妇女健康和福祉相关因素的信息。参与者:年龄在68-73岁之间的女性,出生于1946年至1951年之间,参加了ALSWH,并自我报告了他们的T2D或前驱糖尿病诊断。结果测量:心理复原力、性格乐观和知觉控制是心理社会因素的测量。这些因素与糖尿病自我管理行为、医疗保健访问和预防服务使用之间的关联通过许多回归模型进行了检验。结果:939名女性,年龄68 ~ 73岁,伴有t2dm或糖尿病前期。表现出较高性格乐观的T2D女性参加中度/剧烈体育活动(OR: 1.06)、看牙医(OR: 1.07)的几率显著较高,看全科医生(GP)的几率显著较低(RR: 0.99)。患有T2D的女性更有韧性,她们咨询心理健康专家的比例更低(RR: 0.63),血糖水平检查的几率更高(OR: 1.68)。适应力评分较高的糖尿病前期妇女一年内去看全科医生的比率降低了16% (RR: 0.84),适应力较高的糖尿病前期妇女去看护士的比率降低了13% (RR: 0.87)。结论:糖尿病护理的社会心理方面可能对支持患有糖尿病前期或糖尿病的老年妇女的身心健康很重要。医疗保健提供者可以考虑将恢复力和乐观评估纳入常规糖尿病管理是否有助于确定可以从有针对性的社会心理支持中受益的老年妇女。
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引用次数: 0
Protocol for the development of the WHO gestational weight gain charts. 世卫组织妊娠期体重增加图表制定方案。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-14 DOI: 10.1136/bmjopen-2025-101973
Thais Rangel Bousquet Carrilho, Olufemi Taiwo Oladapo, Jennifer A Hutcheon, Giovanna Gatica-Domínguez, Kathleen M Rasmussen, Monica C Flores-Urrutia, Richard Kumapley, Ӧzge Tunçalp, Dang Bahya-Batinda, Amel A Fayed, Annick Bogaerts, Aris T Papageorghiou, Cinthya Muñoz-Manrique, Dayana Rodrigues Farias, Eric Ohuma, Harshpal Sachdev, Hayfaa A Wahabi, Helena J Teede, Kari Johansson, Lisa M Bodnar, Molin Wang, Nandita Perumal, S M Tafsir Hasan, Suzanne Phelan, Elaine Borghi, Gilberto Kac

Introduction: Gestational weight gain (GWG) is an important indicator of maternal nutrition to be monitored during pregnancy. However, there is no evidence-based tool that can be used to monitor it across all geographic locations and pre-pregnancy body mass index (BMI) categories. The WHO is undertaking a project to develop GWG charts by pre-pregnancy BMI category, and to identify GWG ranges associated with the lowest risks of adverse maternal and infant outcomes. This protocol describes all the steps that will be used to accomplish the development of these GWG charts.

Methods and analysis: This project will involve the analysis of individual participant data (researcher-collected or administrative). To identify eligible datasets with GWG data, a literature review will be conducted and a global call for data will be launched by the WHO. Eligible individual datasets obtained from multiple sources will be harmonised into a pooled database. The database will undergo steps of cleaning, data quality assessment and application of individual-level inclusion criteria. Heterogeneity of maternal weight and GWG will be assessed to verify the possibility of combining datasets from multiple sources and regions into a single database. Generalized Additive Models for Location, Scale and Shape will be applied for the construction of the centile curves. Diagnostic measures, internal and external validation procedures will also be performed.

Ethics and dissemination: This project will include an analysis of existing study de-identified data. To be included in the pooled database, each included study should have received ethics approvals from relevant committees. Manuscripts will be submitted to open-access journals and a WHO document will be published, including the GWG charts and cut-offs for application in antenatal care.

妊娠期体重增加(GWG)是妊娠期孕产妇营养监测的重要指标。然而,目前还没有一种基于证据的工具可用于监测所有地理位置和孕前体重指数(BMI)类别。世卫组织正在开展一个项目,按孕前BMI类别编制GWG图表,并确定与孕产妇和婴儿不良结局最低风险相关的GWG范围。该协议描述了用于完成这些GWG图开发的所有步骤。方法和分析:本项目将涉及个人参与者数据的分析(研究人员收集或管理)。为了确定具有GWG数据的合格数据集,世卫组织将进行文献综述,并发起全球数据征集。从多个来源获得的符合条件的个人数据集将协调成一个池数据库。该数据库将经历清理、数据质量评估和适用个人一级列入标准的步骤。将评估产妇体重和GWG的异质性,以验证将来自多个来源和地区的数据集合并到一个数据库中的可能性。位置、尺度和形状的广义加性模型将用于百分位曲线的构建。诊断措施、内部和外部验证程序也将执行。伦理与传播:本项目将包括对现有研究去识别数据的分析。要纳入合并数据库,每个纳入的研究都应获得相关委员会的伦理批准。手稿将提交给开放获取期刊,并将发表一份世卫组织文件,包括GWG图表和用于产前保健的截止日期。
{"title":"Protocol for the development of the WHO gestational weight gain charts.","authors":"Thais Rangel Bousquet Carrilho, Olufemi Taiwo Oladapo, Jennifer A Hutcheon, Giovanna Gatica-Domínguez, Kathleen M Rasmussen, Monica C Flores-Urrutia, Richard Kumapley, Ӧzge Tunçalp, Dang Bahya-Batinda, Amel A Fayed, Annick Bogaerts, Aris T Papageorghiou, Cinthya Muñoz-Manrique, Dayana Rodrigues Farias, Eric Ohuma, Harshpal Sachdev, Hayfaa A Wahabi, Helena J Teede, Kari Johansson, Lisa M Bodnar, Molin Wang, Nandita Perumal, S M Tafsir Hasan, Suzanne Phelan, Elaine Borghi, Gilberto Kac","doi":"10.1136/bmjopen-2025-101973","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-101973","url":null,"abstract":"<p><strong>Introduction: </strong>Gestational weight gain (GWG) is an important indicator of maternal nutrition to be monitored during pregnancy. However, there is no evidence-based tool that can be used to monitor it across all geographic locations and pre-pregnancy body mass index (BMI) categories. The WHO is undertaking a project to develop GWG charts by pre-pregnancy BMI category, and to identify GWG ranges associated with the lowest risks of adverse maternal and infant outcomes. This protocol describes all the steps that will be used to accomplish the development of these GWG charts.</p><p><strong>Methods and analysis: </strong>This project will involve the analysis of individual participant data (researcher-collected or administrative). To identify eligible datasets with GWG data, a literature review will be conducted and a global call for data will be launched by the WHO. Eligible individual datasets obtained from multiple sources will be harmonised into a pooled database. The database will undergo steps of cleaning, data quality assessment and application of individual-level inclusion criteria. Heterogeneity of maternal weight and GWG will be assessed to verify the possibility of combining datasets from multiple sources and regions into a single database. Generalized Additive Models for Location, Scale and Shape will be applied for the construction of the centile curves. Diagnostic measures, internal and external validation procedures will also be performed.</p><p><strong>Ethics and dissemination: </strong>This project will include an analysis of existing study de-identified data. To be included in the pooled database, each included study should have received ethics approvals from relevant committees. Manuscripts will be submitted to open-access journals and a WHO document will be published, including the GWG charts and cut-offs for application in antenatal care.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 1","pages":"e101973"},"PeriodicalIF":2.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984422","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
Testing a mobile peer support intervention for persons with serious mental illness (DigiPer) in community mental health services: a feasibility study protocol. 在社区精神卫生服务中测试对严重精神疾病患者的流动同伴支持干预措施(DigiPer):可行性研究协议。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-14 DOI: 10.1136/bmjopen-2025-111869
Bo Wang, Ingunn Mundal, Karen Fortuna, Cecilie Katrine Utheim Grønvik, Trude Fløystad Eines, Miroslav Muzny, Jorunn Nærland Skjærpe, Marianne Storm

Introduction: Persons with serious mental illness (SMI) often have coexisting medical conditions and experience a significantly reduced life expectancy compared with the general population. Peer support is considered an effective care approach for this population, and with rapid technological advancements, digital peer support, such as the DigiPer mobile application, can be a feasible self-management tool for persons with SMI. The study aims to assess the feasibility of DigiPer for persons with SMI in the Norwegian community mental health service settings.

Methods and analysis: This feasibility study will incorporate both qualitative and quantitative methods. The study consists of three phases: (1) simulation-based training among peer support workers using qualitative individual interviews; (2) pre-post study of DigiPer among peer support workers and service users using quantitative questionnaires and (3) process evaluation for peer support workers and service users using qualitative individual interviews. Peer support workers (n=5) and service users with SMI (n=15) will be recruited to evaluate the feasibility of DigiPer.

Ethics and dissemination: Ethics approval was granted from the Regional Committee for Medical Research Ethics (reference no. 853041), along with an assessment of processing of personal data by the Norwegian Agency for Shared Services in Education and Research (reference no. 810990). Findings will be disseminated through peer-reviewed publications and presentations at relevant national and international scientific conferences.

患有严重精神疾病(SMI)的人通常有共存的医疗条件,与一般人群相比,他们的预期寿命明显缩短。同伴支持被认为是这一人群的有效护理方法,随着技术的快速进步,数字同伴支持,如DigiPer移动应用程序,可以成为重度精神障碍患者可行的自我管理工具。该研究旨在评估挪威社区精神卫生服务机构中重度精神障碍患者使用DigiPer的可行性。方法和分析:本可行性研究将采用定性和定量方法。本研究分为三个阶段:(1)采用定性个人访谈对同伴支持工作者进行模拟培训;(2)采用定量问卷对同伴支持工作者和服务使用者使用DigiPer进行前后研究;(3)采用定性个人访谈对同伴支持工作者和服务使用者进行过程评价。将招募同伴支持工作者(n=5)和重度精神障碍的服务使用者(n=15)来评估DigiPer的可行性。伦理和传播:医学研究伦理区域委员会批准了伦理批准(参考号:853041),以及挪威教育和研究共享服务机构对个人数据处理的评估(参考编号:853041)。810990)。研究结果将通过同行评议的出版物和在有关的国家和国际科学会议上的报告加以传播。
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引用次数: 0
Predictors of healthcare seeking for tuberculosis symptoms in the private healthcare facilities: findings from a cross-sectional population-based survey in Tamil Nadu. 在私立医疗机构寻求结核病症状的预测因素:来自泰米尔纳德邦基于人口的横断面调查的结果。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-14 DOI: 10.1136/bmjopen-2025-098806
Prathiksha Giridharan, Stephen Arangba, Karikalan Nagarajan, Asha Frederick, Kannan Thiruvengadam, Sriram Selvaraju

Objectives: To identify the factors influencing the choice of private healthcare facilities among individuals experiencing tuberculosis (TB) symptoms.

Design: Cross-sectional study.

Setting: The data for this study were obtained from a cross-sectional population-based TB prevalence survey conducted in 33 districts of Tamil Nadu, a state in southern India, between February 2021 to July 2022.

Participants: 130 932 individuals, 15 years and above, residents of the selected cluster for the past 1 month, were included. Hospitalised patients, sick/morbid individuals and the institutional population were excluded.

Results: Of 143 005 eligible individuals, 130 932 (91.6%) participated. Among them, 9540 individuals were found to have at least one TB symptom. Of these symptomatic individuals, 2678 sought healthcare, with 62.7% in the public facilities and 37.3% in private facilities. Factors associated with seeking care in the private healthcare facilities included working in organised sector (aOR: 1.3; 95% CI 1.0 to 1.7; p<0.05), being a housewife (aOR: 1.3; 95% CI 1.0 to 1.7; p<0.05), having symptom of expectoration (aOR: 1.3; 95% CI 1.1 to 1.6; p<0.05) and fatigue (aOR: 1.5; 95% CI 1.2 to 1.9; p<0.05).Conversely, individual with symptom of weight loss (aOR: 0.4; 95% CI 00.3 to 00.6; p<0.05), loss of appetite (aOR: 0.8; 95% CI 0.6 to 0.9; p<0.05), chest pain (aOR: 0.6; 95% CI 0.5 to 0.7; p<0.05), history of past TB care (aOR: 0.4; 95% CI 0.3 to 0.5; p<0.05), age >25 years (aOR: 0.6; 95% CI 0.4 to 0.9; p<0.05), living in a rural area (aOR: 0.7; 95% CI 0.6 to 0.8; p<0.05) and living below the poverty line (aOR: 0.7; 95% CI 0.6 to 0.9; p<0.05) were less likely to seek care in the private healthcare facilities.

Conclusion: The study highlights the distinct factors that could affect healthcare seeking for TB symptoms in the public and private healthcare settings for TB and the need for tailored interventions and customised healthcare policies to address such gaps and distinctions in care seeking.

目的:确定在经历结核病(TB)症状的个体中影响选择私立医疗机构的因素。设计:横断面研究。背景:本研究的数据来自2021年2月至2022年7月期间在印度南部泰米尔纳德邦33个地区进行的基于人口的横断面结核病患病率调查。研究对象:选取过去1个月内所属组别15岁及以上的居民130932人。住院病人、患病/病态个人和机构人口被排除在外。结果:在143,005名符合条件的个体中,有130,932名(91.6%)参与了研究。其中9540人至少有一种结核症状。在这些有症状的个体中,2678人寻求医疗保健,其中62.7%在公共设施,37.3%在私人设施。与在私营医疗机构求医相关的因素包括:在有组织部门工作(aOR: 1.3; 95% CI 1.0至1.7;p25年(aOR: 0.6; 95% CI 0.4至0.9);结论:该研究强调了可能影响在公立和私立结核病医疗机构中因结核病症状求医的不同因素,以及需要量身定制的干预措施和定制的医疗政策,以解决求医方面的差距和差异。
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引用次数: 0
Does CMR improve aetiological sub-phenotyping beyond echocardiography in patients with elevated LV filling pressure? A prospective registry study (PREFER-CMR). 在左室充盈压升高的患者中,CMR是否能改善超声心动图之外的病因学亚表型?前瞻性注册研究(PREFER-CMR)。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-14 DOI: 10.1136/bmjopen-2025-102836
Aradhai Bana, Rui Li, Zia Mehmood, Craig Rogers, Ciaran Grafton-Clarke, Tiya Bali, David Hall, Mustapha Jamil, Liandra Ramachenderam, Uwais Dudhiya, Hilmar Spohr, Victoria Underwood, Rebekah Girling, Bahman Kasmai, Sunil Nair, Gareth Matthews, Pankaj Garg

Objectives: To evaluate the incremental diagnostic value and sub-phenotyping capability of Cardiovascular Magnetic Resonance (CMR) compared with Transthoracic Echocardiography (TTE) in patients with elevated left ventricular filling pressure (LVFP).

Design: Prospective registry study. [Results from ClinicalTrials.gov ID NCT05114785] SETTING: A single NHS hospital in the UK.

Main outcome measures: The primary outcome was the rate of diagnostic discordance between TTE and CMR. Secondary outcomes included the characterisation of specific pathologies identified by CMR where TTE was normal, non-diagnostic or provided a non-specific diagnosis.

Results: CMR demonstrated diagnostic discordance with TTE in 74% (n=194) of cases. In patients with a normal TTE (n=54), CMR identified heart failure with preserved ejection fraction (HFpEF) in 46% (n=25) and ischaemic heart disease (IHD) in 19% (n=10). For non-diagnostic TTE cases (n=15), CMR detected HFpEF in 53.3% (n=8) and IHD in 26.7% (n=4). Among those with non-specific left ventricular hypertrophy on TTE (n=47), CMR revealed HFpEF in 45% (n=21) and hypertrophic cardiomyopathy in 34% (n=16).

Conclusions: CMR markedly improves diagnostic precision and sub-phenotyping in patients with elevated LVFP, identifying key conditions like HFpEF, IHD and specific cardiomyopathies that TTE frequently misses. These findings highlight CMR's critical role as a complementary imaging tool for refining diagnoses and informing management strategies in cardiovascular conditions.

目的:评价心血管磁共振(CMR)与经胸超声心动图(TTE)对左心室充盈压力(LVFP)升高患者的增量诊断价值和亚表型能力。设计:前瞻性登记研究。[来自ClinicalTrials.gov ID NCT05114785的结果]设置:英国一家NHS医院。主要结局指标:主要结局是TTE和CMR诊断不一致性的比率。次要结果包括CMR确定的特定病理特征,其中TTE正常,非诊断性或提供非特异性诊断。结果:74% (n=194)的CMR与TTE诊断不一致。在TTE正常的患者(n=54)中,CMR发现46% (n=25)的心力衰竭伴有保留射血分数(HFpEF), 19% (n=10)的缺血性心脏病(IHD)。在非诊断性TTE病例(n=15)中,CMR检出HFpEF的占53.3% (n=8), IHD的占26.7% (n=4)。在TTE非特异性左心室肥厚的患者中(n=47), CMR显示HFpEF的占45% (n=21),肥厚性心肌病的占34% (n=16)。结论:CMR显著提高了LVFP升高患者的诊断精度和亚表型,识别了TTE经常遗漏的关键条件,如HFpEF、IHD和特定心肌病。这些发现强调了CMR作为完善心血管疾病诊断和告知管理策略的补充成像工具的关键作用。
{"title":"Does CMR improve aetiological sub-phenotyping beyond echocardiography in patients with elevated LV filling pressure? A prospective registry study (PREFER-CMR).","authors":"Aradhai Bana, Rui Li, Zia Mehmood, Craig Rogers, Ciaran Grafton-Clarke, Tiya Bali, David Hall, Mustapha Jamil, Liandra Ramachenderam, Uwais Dudhiya, Hilmar Spohr, Victoria Underwood, Rebekah Girling, Bahman Kasmai, Sunil Nair, Gareth Matthews, Pankaj Garg","doi":"10.1136/bmjopen-2025-102836","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-102836","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the incremental diagnostic value and sub-phenotyping capability of Cardiovascular Magnetic Resonance (CMR) compared with Transthoracic Echocardiography (TTE) in patients with elevated left ventricular filling pressure (LVFP).</p><p><strong>Design: </strong>Prospective registry study. [Results from ClinicalTrials.gov ID NCT05114785] SETTING: A single NHS hospital in the UK.</p><p><strong>Main outcome measures: </strong>The primary outcome was the rate of diagnostic discordance between TTE and CMR. Secondary outcomes included the characterisation of specific pathologies identified by CMR where TTE was normal, non-diagnostic or provided a non-specific diagnosis.</p><p><strong>Results: </strong>CMR demonstrated diagnostic discordance with TTE in 74% (n=194) of cases. In patients with a normal TTE (n=54), CMR identified heart failure with preserved ejection fraction (HFpEF) in 46% (n=25) and ischaemic heart disease (IHD) in 19% (n=10). For non-diagnostic TTE cases (n=15), CMR detected HFpEF in 53.3% (n=8) and IHD in 26.7% (n=4). Among those with non-specific left ventricular hypertrophy on TTE (n=47), CMR revealed HFpEF in 45% (n=21) and hypertrophic cardiomyopathy in 34% (n=16).</p><p><strong>Conclusions: </strong>CMR markedly improves diagnostic precision and sub-phenotyping in patients with elevated LVFP, identifying key conditions like HFpEF, IHD and specific cardiomyopathies that TTE frequently misses. These findings highlight CMR's critical role as a complementary imaging tool for refining diagnoses and informing management strategies in cardiovascular conditions.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 1","pages":"e102836"},"PeriodicalIF":2.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984372","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
Breast and cervical cancer care in Ghana: a qualitative exploratory study of stakeholder perspectives on National Health Insurance Scheme coverage. 加纳的乳腺癌和宫颈癌护理:利益相关者对国家健康保险计划覆盖面的看法的定性探索性研究。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-14 DOI: 10.1136/bmjopen-2025-098784
Ivy Amankwah, Michael Gone, Abubakari Jaliu, Mathieu Morand, Richmond Owusu

Background: Breast and cervical cancers are among the most commonly diagnosed cancers in Ghana and impose substantial financial burden on households. Although diagnosis and treatment for these cancers are included in the National Health Insurance Scheme (NHIS) benefits package, stakeholders report limitations in the scope and implementation of coverage, leading to out-of-pocket payments and potential delays in care.

Objectives: To characterise NHIS coverage for breast and cervical cancer care and to explore challenges affecting implementation from the perspectives of key stakeholders.

Design: Qualitative exploratory study using semi-structured key informant interviews and a focused desk review of national guidelines and NHIS policy documents.

Participants: 12 key informants were purposively sampled based on roles in cancer policy, financing or service delivery.

Results: Although the NHIS officially lists coverage for consultation, diagnosis, radiotherapy and selected chemotherapy medications, participants reported that these benefits are not fully realised in practice. Respondents described persistent out-of-pocket payments for breast and cervical cancer services due to incomplete or delayed reimbursement of screening and diagnostic costs, limited inclusion of costly imaging procedures and the exclusion of some essential and innovative therapies, including immunotherapy. Delayed NHIS reimbursement was cited as a recurrent problem that constrains facility cash flow and contributes to co-payments at the point of care. Stakeholders also highlighted misalignment between NHIS reimbursement tariffs and actual service costs, which discourages some facilities from providing certain listed services and thereby limits patient access.

Conclusion: NHIS coverage for breast and cervical cancer care still contains significant gaps, particularly in preventive services and access to advanced therapies. Policy actions should focus on strengthening preventive coverage (including screening and human papillomavirus vaccination), aligning tariffs with service costs, ensuring timely reimbursements and updating the medicines list through transparent, evidence-informed review processes.

背景:乳腺癌和宫颈癌是加纳最常见的癌症,给家庭带来了沉重的经济负担。尽管对这些癌症的诊断和治疗包括在国家健康保险计划(NHIS)的一揽子福利中,但利益攸关方报告说,在覆盖范围和实施方面存在限制,导致自费支付和潜在的护理延误。目的:描述国家健康保险系统对乳腺癌和宫颈癌护理的覆盖范围,并从关键利益相关者的角度探讨影响实施的挑战。设计:定性探索性研究,采用半结构化的关键信息提供者访谈和国家指南和NHIS政策文件的重点案头审查。参与者:根据在癌症政策、融资或服务提供方面的作用,有目的地对12名关键举报人进行抽样。结果:尽管NHIS正式列出了咨询、诊断、放疗和选定化疗药物的覆盖范围,但参与者报告说,这些好处在实践中并未完全实现。答复者表示,由于筛查和诊断费用的报销不完整或延迟,有限地纳入昂贵的成像程序,以及排除一些基本和创新疗法,包括免疫疗法,因此一直在自费支付乳腺癌和宫颈癌服务。国家卫生保健系统的延迟报销被认为是一个经常性问题,它限制了设施的现金流,并有助于医疗点的共同支付。利益相关者还强调了国家卫生健康系统报销费用与实际服务成本之间的不一致,这阻碍了一些机构提供某些列出的服务,从而限制了患者获得服务。结论:国家卫生健康系统对乳腺癌和宫颈癌护理的覆盖仍然存在重大差距,特别是在预防服务和获得先进治疗方面。政策行动应侧重于加强预防性覆盖(包括筛查和人乳头瘤病毒疫苗接种),使关税与服务成本保持一致,确保及时报销,并通过透明的循证审查程序更新药品清单。
{"title":"Breast and cervical cancer care in Ghana: a qualitative exploratory study of stakeholder perspectives on National Health Insurance Scheme coverage.","authors":"Ivy Amankwah, Michael Gone, Abubakari Jaliu, Mathieu Morand, Richmond Owusu","doi":"10.1136/bmjopen-2025-098784","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-098784","url":null,"abstract":"<p><strong>Background: </strong>Breast and cervical cancers are among the most commonly diagnosed cancers in Ghana and impose substantial financial burden on households. Although diagnosis and treatment for these cancers are included in the National Health Insurance Scheme (NHIS) benefits package, stakeholders report limitations in the scope and implementation of coverage, leading to out-of-pocket payments and potential delays in care.</p><p><strong>Objectives: </strong>To characterise NHIS coverage for breast and cervical cancer care and to explore challenges affecting implementation from the perspectives of key stakeholders.</p><p><strong>Design: </strong>Qualitative exploratory study using semi-structured key informant interviews and a focused desk review of national guidelines and NHIS policy documents.</p><p><strong>Participants: </strong>12 key informants were purposively sampled based on roles in cancer policy, financing or service delivery.</p><p><strong>Results: </strong>Although the NHIS officially lists coverage for consultation, diagnosis, radiotherapy and selected chemotherapy medications, participants reported that these benefits are not fully realised in practice. Respondents described persistent out-of-pocket payments for breast and cervical cancer services due to incomplete or delayed reimbursement of screening and diagnostic costs, limited inclusion of costly imaging procedures and the exclusion of some essential and innovative therapies, including immunotherapy. Delayed NHIS reimbursement was cited as a recurrent problem that constrains facility cash flow and contributes to co-payments at the point of care. Stakeholders also highlighted misalignment between NHIS reimbursement tariffs and actual service costs, which discourages some facilities from providing certain listed services and thereby limits patient access.</p><p><strong>Conclusion: </strong>NHIS coverage for breast and cervical cancer care still contains significant gaps, particularly in preventive services and access to advanced therapies. Policy actions should focus on strengthening preventive coverage (including screening and human papillomavirus vaccination), aligning tariffs with service costs, ensuring timely reimbursements and updating the medicines list through transparent, evidence-informed review processes.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"16 1","pages":"e098784"},"PeriodicalIF":2.3,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984384","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
Muslim communities' perspectives and preferences regarding end-of-life symptom management: a systematic review and narrative synthesis. 穆斯林社区关于临终症状管理的观点和偏好:系统回顾和叙事综合。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-14 DOI: 10.1136/bmjopen-2025-108877
Joodi Mourhli, Krzysztof Sosnowski, Isla Kuhn, Ben Bowers

Objectives: To provide a synthesis of the published research evidence on Muslims' perspectives and preferences regarding end-of-life symptom management to inform future practice and research priorities aimed at providing sensitive end-of-life care.

Design: Systematic review and narrative synthesis.

Data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, ASSIA, The Cochrane Library and Global Health were searched from 1 January 1994 to 10 July 2024, alongside reference searches of included papers and hand searches of two journals.

Eligibility criteria: The included papers presented primary research on end-of-life care among Muslims in the British Isles.

Data extraction and synthesis: Data were collected on publication details, study aims, participants, methods and results. Studies were appraised using Gough's weight of evidence framework. An inductive narrative synthesis consisting of three steps was conducted. This involved conducting a preliminary synthesis of findings, exploring relationships between studies and assessing the robustness of the synthesis.

Results: 18 papers were included in the synthesis. Patients prioritised conformity between religion, culture and end-of-life symptom management. Symptom management preferences were also influenced by patients' desire to maintain a sense of control at the end of life. Family-based care is culturally accepted, and indeed expected, to achieve a peaceful death. Healthcare professionals experienced challenges in providing sensitive symptom management given their unfamiliarity with the religious needs of Muslims.

Conclusions: Co-design research methods are essential to better understand care priorities within diverse Muslim communities. Meaningful collaboration among patients, families and healthcare professionals is necessary to identify mutually acceptable and beneficial approaches to promote culturally and religiously sensitive end-of-life symptom management.

目的:提供关于穆斯林对临终症状管理的观点和偏好的已发表研究证据的综合,以告知未来的实践和研究重点,旨在提供敏感的临终关怀。设计:系统回顾和叙事综合。数据来源:MEDLINE、EMBASE、CINAHL、PsycINFO、Web of Science、ASSIA、The Cochrane Library和Global Health,检索时间为1994年1月1日至2024年7月10日,同时检索了纳入论文的参考文献和两种期刊的手工检索。资格标准:纳入的论文介绍了对不列颠群岛穆斯林临终关怀的初步研究。数据提取与综合:收集有关发表细节、研究目的、参与者、方法和结果的数据。使用Gough的证据权重框架对研究进行评价。本文进行了一个由三个步骤组成的归纳叙事综合。这包括对研究结果进行初步综合,探索研究之间的关系并评估综合的稳健性。结果:共纳入论文18篇。患者优先考虑宗教、文化和临终症状管理之间的一致性。症状管理偏好也受到患者在生命结束时保持控制感的愿望的影响。以家庭为基础的护理在文化上是被接受的,而且确实是被期望的,以实现平静的死亡。医疗保健专业人员在提供敏感症状管理方面遇到了挑战,因为他们不熟悉穆斯林的宗教需求。结论:共同设计研究方法对于更好地了解不同穆斯林社区的护理重点至关重要。有必要在患者、家属和医疗保健专业人员之间进行有意义的合作,以确定相互接受和有益的方法,以促进文化和宗教敏感的临终症状管理。
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引用次数: 0
Nutritional knowledge, attitudes and practices and their determinants among pregnant women attending healthcare centres in southern Tehran. 在德黑兰南部保健中心就诊的孕妇的营养知识、态度和做法及其决定因素。
IF 2.3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2026-01-14 DOI: 10.1136/bmjopen-2025-102117
Golnaz Rajaeieh, Ahad Bakhtiari, Masoomeh Gholami, Fatemeh Ghavidel, Hakimeh Mostafavi, Mitra Zabihi, Efat Mohamadi, Alireza Olyaeemanesh, Amirhossein Takian

Objectives: To assess nutrition-related knowledge, attitudes and practices among pregnant women, and identify socioeconomic and healthcare determinants.

Design: A cross-sectional study on maternal nutrition during pregnancy.

Setting: Pregnant women attending primary healthcare centres in the south of Tehran from December 2022 to March 2024.

Participants: 1535 pregnant women of all ages living in the south of Tehran (both Iranian and non-Iranian).

Measures: Pregnant women were systematically selected from primary healthcare centres. Data were collected via validated questionnaires and electronic health records. Statistical analyses included multivariate logistic regression (adjusted ORs (aORs) with 95% CIs) and generalised linear mixed models.

Results: The findings revealed that a majority of pregnant women (83.3%; 95% CI 81.2% to 85.3%) exhibited low levels of nutritional knowledge (scores below 12), whereas 14% demonstrated moderate knowledge (scores between 12 and 17), and only 2.7% (95% CI 1.9% to 3.8%) possessed high nutritional knowledge (scores above 18). In terms of attitudes, 36.9% of respondents expressed positive views toward nutrition, with higher education significantly associated with positive attitudes (aOR=1.8; 95% CI 1.3 to 2.5, comparing higher vs lower education levels). Dietary variety was consistently reported by 65.4% of participants, while 8.5% lacked dietary variety. Statistically significant associations were observed between educational attainment, socioeconomic status and nutrition-related practices (p<0.05). Women with a university-level education achieved knowledge scores 3.2 times greater (95% CI 2.1 to 4.9) than those with only primary education. Moreover, individuals in the highest wealth quintile demonstrated practices that were 2.1 times superior (95% CI 1.5 to 3.0) to those in the lowest quintile. Nutritional counselling by professionals was positively correlated with improved attitudes (aOR=2.4; 95% CI 1.7 to 3.4).

Conclusion: As a cross-sectional study, these findings highlight substantial gaps in nutrition knowledge among pregnant women in Tehran, with socioeconomic status and education playing crucial roles in shaping dietary behaviours. Improving nutritional education through healthcare interventions is essential for enhancing maternal and fetal health outcomes.

目的:评估孕妇的营养相关知识、态度和做法,并确定社会经济和保健决定因素。设计:一项关于孕期产妇营养的横断面研究。环境:2022年12月至2024年3月期间在德黑兰南部初级保健中心就诊的孕妇。参与者:1535名居住在德黑兰南部的所有年龄段的孕妇(包括伊朗人和非伊朗人)。措施:系统地从初级保健中心挑选孕妇。通过有效的问卷调查和电子健康记录收集数据。统计分析包括多元逻辑回归(调整后的or (aORs) 95% ci)和广义线性混合模型。结果:调查结果显示,大多数孕妇(83.3%;95% CI 81.2%至85.3%)表现出低水平的营养知识(得分低于12),而14%表现出中等知识(得分在12至17之间),只有2.7% (95% CI 1.9%至3.8%)具有高营养知识(得分高于18)。在态度方面,36.9%的受访者对营养持积极态度,高学历与积极态度显著相关(aOR=1.8; 95% CI 1.3至2.5,比较高学历与低学历)。65.4%的参与者一致报告饮食多样性,而8.5%的参与者缺乏饮食多样性。结论:作为一项横断面研究,这些发现突出了德黑兰孕妇在营养知识方面的巨大差距,社会经济地位和教育在塑造饮食行为方面发挥着关键作用。通过保健干预措施改善营养教育对改善孕产妇和胎儿健康结果至关重要。
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引用次数: 0
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