BMJ Open最新文献

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.