BMJ Open最新文献

Introduction: The interfaces between the fields of communication, education and health have been indicated by international institutions such as the WHO and the European Centre for Disease Prevention and Control. However, hegemonic scientific practices supersede dialogue between the three fields, isolating their practices. This fragmenting tendency is observed in scientific literature, which has created gaps in the dialogue and articulation between communication, education and health. Although health promotion requires both communicative and educational practices, the epistemological, historical, political, cultural and socioeconomic aspects have also engendered tensions between the fields. Communication is often seen as a mere instrument for other practices, rather than a phenomenon that (re)produces meanings and power dynamics. In opposing the reductionist and instrumentalising perspectives of knowledge fields, the primary objective of the scoping review is to map the scientific evidence on the interfaces between communication and education in health to indicate a conceptual framework that articulates communication and education practices within the context of health.

Methods and analysis: A transdisciplinary team developed this protocol based on the 2024 Joanna Briggs Institute Manual for Evidence Synthesis. The procedures required to conduct the review were guided by the frameworks proposed by Arksey and O'Malley, Levac et al and Peters et al. The study eligibility criteria were established based on the Problem, Concept and Context outlined in the research questions. Primary and secondary studies will be retrieved from nine sources, covering both conventional and grey literature. These sources include Embase, ERIC, LILACS, PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science, the Brazilian Digital Library of Theses and Dissertations, and the Networked Digital Library of Theses and Dissertations. A categorised form will be used for data collection and subsequent analysis. The reporting of the review findings will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Ethics and dissemination: The nature of the research and the use of secondary data sources do not require informed consent forms or approval from ethics committees in Brazil. The scientific findings from the review will be disseminated through peer-reviewed journals, academic conferences and other scientific communication channels.

Study registration: The protocol was registered on the Open Science Framework (OSF) and is available at https://doi.org/10.17605/OSF.IO/Z3CX7.

Introduction: Target trial emulation (TTE) has emerged as a methodological framework to strengthen causal inference from observational health data when randomised controlled trials are infeasible. The credibility of TTE studies depends not only on rigorous design and transparent reporting, but also on their relevance and acceptability to patients and the public. Patient and public involvement and engagement (PPIE) has been shown to enhance the relevance, transparency and impact of health research by shaping research priorities, informing study design and ensuring outcomes reflect patient perspectives. However, the extent to which PPIE has been incorporated into TTE studies remains unclear. This scoping review aims to systematically map the use and reporting of PPIE in published TTE studies.

Methods and analysis: This review will follow the Joanna Briggs Institute methodology for scoping reviews and will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews checklist. We will search MEDLINE (Ovid) and Embase (Ovid) from January 2011 to present, limited to English-language publications. Eligible studies will be studies that self-identify as using the TTE framework and report empirical analyses of health outcomes using observational or trial data. We will exclude protocols, methodological or simulation-only studies, preprints, conference abstracts and grey literature. Three reviewers will independently screen titles and abstracts, and then full texts, with disagreements resolved by discussion or adjudication. Data extraction will include study characteristics and PPIE information guided by the Guidance for Reporting Involvement of Patients and the Public 2-Short Form checklist. Findings will be summarised using descriptive statistics, tables, figures and narrative synthesis.

Ethics and dissemination: Ethics approval is not required, as this review will use publicly available data. Results will be disseminated through a peer-reviewed publication and presented at conferences.

Introduction: In all countries, some population groups experience barriers to accessing eye health services, contributing to health inequities. Outreach is a common strategy used to deliver healthcare services to populations experiencing inequities. This scoping review aims to summarise the nature and extent of the existing literature describing outreach as a service delivery model to improve access to eye health services, particularly among populations experiencing inequities.

Methods and analysis: An information specialist will search academic databases (Medline, Embase and Global Health) without language restrictions to find peer-reviewed articles describing outreach eye health services, published in any country between 1 January 2010 and the search date. Grey literature sources will also be searched. In Covidence, two reviewers will independently screen titles and abstracts and subsequently relevant full texts against the inclusion criteria. Data extraction will also be performed independently by two reviewers in Covidence. This scoping review will summarise the characteristics of the included outreach eye health services, including the type of eye health service delivered, personnel involved, mode of transport, source of funding and whether the service targeted any specific PROGRESS-Plus group (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus). We will present our findings quantitatively using diagrams, tables and graphs.

Ethics and dissemination: Ethics approval was not sought, as this scoping review will use only publicly available reports. The results of this review will be disseminated through publication in a peer-reviewed journal and will be presented at eye health conferences. It will offer valuable insights for eye health providers, health and social service providers and policymakers who are interested in improving access to eye health services for populations experiencing inequities. This scoping review will inform a project in New Zealand which aims to develop outreach eye health services to populations experiencing inequities, such as unhoused people and refugees.

Registration: This protocol was registered on the Open Science Framework on 11 November 2025 (https://osf.io/vyz32).

Objective: To describe work participation (WP) and receiving disability benefit (DB) in persons with chronic gastrointestinal disorders (CGID); to describe associations between the six dimensions of positive health (PH) and WP and DB, respectively; and to assess whether the type of CGID is associated with WP and receiving DB.

Design: Cross-sectional and observational questionnaire study.

Setting: Maastricht University Medical Centre+ (tertiary care hospital), including regional, supra-regional and national referrals.

Participants: 441 patients of working age (18-66 years) with CGID who visited the outpatient department of the Gastroenterology-Hepatology Clinic between March 2019 and June 2021 (mean±SD age: 45.0±14.7 years, 68.5% women).

Primary/secondary outcome measures: Associations of PH dimensions and WP and receiving DB, respectively; association of type of CGID and WP, and receiving DB. The main independent variables (PH dimensions) were bodily functions, mental well-being, meaningfulness, quality of life (QoL), participation and daily functioning.

Results: Among 441 working-age patients, 49% worked; 20% received DB (40% of non-workers). All PH dimensions related significantly to WP and DB (bivariate level). After adjusting for demographics and CGID type, better general health (dimension QoL) (OR 1.018; 95% CI 1.001 to 1.035, p=0.040) and daily functioning dimension (OR 1.030; 95% CI 1.013 to 1.047, p<0.001) related to higher WP. In the fully adjusted model, daily functioning showed the strongest association with receiving DB. Each one-point increase in Short Form-36 physical functioning was associated with a 2% lower likelihood of receiving DB (OR 0.975; 95% CI 0.959 to 0.992; p=0.004).

Conclusions: Of the 441 working-age patients with CGID, only 49% worked; most non-workers did not receive DB. Of the PH dimensions, daily functioning appears most directly related to WP and receiving DB; CGID type had minimal impact.

Objective: Healthcare quality improvement increasingly relies on patient experience data, yet traditional survey modes face declining response rates and rising costs. Mobile web surveys have emerged as a promising alternative for improving response rates. The primary aim of this study was to investigate the effectiveness of mobile web surveys in improving response rates in South Korea's Patient Experience Assessment. We also aimed to assess the impact of a mixed-mode approach integrating mobile web and follow-up telephone surveys across different demographic groups.

Design: A randomised experimental design was employed to compare response rates as well as contact and cooperation rates among survey modes. A total of 4800 patients from four general hospitals were randomly allocated to telephone, mobile web or mixed-mode survey, with 1600 patients per mode. Each mode allowed five contact attempts through calls or mobile survey links. The mixed-mode survey included follow-up calls for mobile non-respondents.

Setting: The survey was conducted between October and November 2022 among patients discharged from four general hospitals in South Korea.

Participants: A total of 4800 patients aged 19 years or older who were hospitalised for more than 1 day and discharged within 2-56 days from four general hospitals were included in this study. Exclusion criteria included patients in day clinics, palliative care, paediatrics and neuropsychiatry, as well as those without personal information consent forms during hospital admission.

Primary and secondary outcome measures: The primary outcome measure was the response rate for each survey mode. Secondary outcome measures included the contact rate and the cooperation rate.

Results: The mobile web survey yielded an overall higher response rate (32.5%) than the telephone survey (22.4%), with the mixed-mode survey achieving the highest response rate (39.3%). Decomposing response rates revealed that while contact rates were comparable for both telephone and mobile web surveys, the cooperation rate was considerably higher for the mobile web survey (73.2%) compared with the telephone survey (52.2%). Substantial gender-age subgroup differences were found.

Conclusions: Adopting mobile web surveys for patient experience assessments, which aligns with the public's preference for information and communication technologies, could significantly improve response rates in patient experience surveys.

Trial registration number: KCT0011374 (post-results).

Objective: This study aimed to understand hospital doctors' priorities (target use cases and aetiologies) for the development of a new rapid diagnostic test for patients with fever.

Design: A cross-sectional online survey.

Setting: Europe-wide.

Participants: Secondary and tertiary care doctors involved in patient assessment and diagnosis across Europe.

Intervention: Online survey from April to September 2024.

Main outcome measures: Importance of developing a new test on a scale of 1-10 for up to 19 'use cases' (types of febrile presentations in specific demographic groups): use case scores and ranks and differences across subgroups of respondents, with free text to capture additional suggestions; respondents' preferences (multiple choice) regarding which aetiologies should be included in a new test.

Results: 265 respondents from 30 European countries (out of 270 starting the survey) were included in the analysis. Top priorities included febrile immunocompromised patients and fever without a focus for both paediatric and adult use cases, and 1-3 months old febrile infants. Rankings were similar across clinician subgroups despite some differences in average scores. 92% (243/263), 95% CI 89% to 95%, of respondents would find a 'generic' test for bacterial aetiology useful, even if it does not differentiate between Gram-positive and Gram-negative aetiologies. 54% (63/116), 95% CI 45% to 63%, of respondents would find a 'generic' test for inflammatory aetiology useful when seeking to diagnose children for whom Kawasaki's disease (KD) is on the differential, even in the absence of any KD-specific test, 83% (96/116), 95% CI 75% to 89%, would find such a 'generic' test useful if they could use it alongside a KD test when desired.

Conclusion: Clinicians prioritise the most vulnerable patients (because of age or comorbidities) and unclear presentations (fever without a focus) for the development of a new fever diagnostic test. Even relatively simple (eg, bacterial, inflammatory) tests could provide added value to most clinicians.

Introduction: Outcomes for degenerative cervical myelopathy (DCM) patients are limited by delayed and missed diagnoses, driven in part by poor professional awareness. Despite DCM being the most common cause of adult spinal cord injury, it remains under-recognised and undertaught in clinical education. Lessons from other common pathology like stroke and acute myocardial infarction highlight the potential of education to improve early diagnosis. This study will develop a professional education strategy to improve early DCM diagnosis. It will define key audiences and identify an effective delivery method, laying the groundwork for a sustained, targeted intervention.

Methods and analysis: The study aims to define who needs to know about DCM, what they need to know and how they can learn it. This will be carried out in three phases: phase 1-who and what: to establish the target population and to define core competencies for the educational intervention; phase 2-how: to create and review the educational intervention; phase 3-evaluation: to test whether the framework is an improvement to existing strategies.

Ethics and dissemination: Ethical approval is in place from the University of Cambridge (HBREC.2024.24). Results from the study will be disseminated through scientific publication, conference presentation, blog posts and podcasts.

Prospero registration number: CRD42023461838.

Purpose: Adverse pregnancy and perinatal outcomes (APPOs), including pre-term birth, pre-eclampsia and gestational diabetes, can result in maternal and neonatal morbidity and mortality, parental anxiety and increased healthcare costs. A better understanding of the causes of APPOs is essential to inform lifestyle and pharmaceutical interventions for their prevention and management. Given the difficulty of undertaking randomised controlled trials in pregnant women, triangulating evidence from across methods with different sources of bias may improve causal inference for APPOs. The purpose of the Mendelian randomisation in pregnancy (MR-PREG) collaboration is to support such triangulation using genetic (eg, Mendelian randomisation (MR)) and non-genetic (eg, partner negative controls) approaches to investigate the causal effects of maternal exposures on a comprehensive set of APPOs.

Participants: The MR-PREG collaboration includes individual participant data from three birth cohorts (two from the UK and one from Norway) and UK Biobank, as well as summary data from FinnGen and publicly available genome-wide association studies (GWAS). Data have been harmonised across studies and currently include information on up to 35 APPOs in up to 707 797 women.

Findings to date: The main aims of MR-PREG are to strengthen the evidence base for (1) prevention, by advancing understanding of maternal lifestyle factors on APPOs, (2) the role of pre-conceptional health, by improving understanding of the effect of maternal pre-existing conditions on APPOs, and (3) treatments, by evaluating the efficacy and safety of existing medications used for pre-existing conditions, and by identifying and testing novel or repurposed therapies for APPOs. To date, our published work has mainly addressed aims 1 and 3. Examples include triangulation of evidence from MR, conventional multivariable regression and paternal negative control, showing that higher maternal body mass index increases the risk of multiple APPOs, as well as the identification of maternal circulating metabolites and proteins that may influence birth weight.

Future plans: Future priorities include increasing diversity within the MR-PREG collaboration by expanding representation of participants from non-European ancestries. We are also integrating molecular data, including circulating protein levels and placental transcriptomics, to better characterise the molecular mechanisms underlying APPOs. Additionally, we are using whole-exome and whole-genome sequencing to identify novel causal genes and to inform the prioritisation of candidate therapeutic targets for APPOs.