BMJ Open最新文献

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.

Objective: To characterise long-term trajectory of recovery in individuals with long covid.

Design: Prospective cohort.

Setting: Single-centre, specialist post-COVID service (London, UK).

Participants: Individuals aged ≥18 years with long covid (hospitalised and non-hospitalised) from April 2020 to March 2024.

Main outcome measures: Routine, prospectively collected data on symptoms, quality of life (including Fatigue Assessment Scale (FAS) and EuroQol 5 Dimensions (EQ-5D), return to work status and healthcare utilisation (investigations, outpatient and emergency attendances). The primary outcome was recovery by self-reported >75% of 'best health' (EQ-5D Visual Analogue Scale) and was assessed using Cox proportional hazards regression models over 4 years. Linked National Health Service England registry data provided secondary care healthcare utilisation and expenditure.

Results: We included 3590 individuals (63.3% female, 73.5% non-hospitalised, median age 50.0 years, 71.9% with ≥2 doses of COVID-19 vaccination), who were followed up for a median of 136 (0-346) days since first assessment and 502 (251-825) days since symptom onset. At first assessment, 33.2% of employed individuals were unable to work. Dominant symptoms were fatigue (78.7%), breathlessness (68.1%) and brain fog (53.5%). 33.4% of individuals recovered to >75% of best health prior to clinic discharge (recovery occurred median 202 (94-468) days from symptom onset). Vaccinated individuals were more likely to recover faster (pre: HR 2.93 (2.00-4.28) and post: HR 1.34 (1.05-1.71) COVID-19 infection), whereas recovery hazard was inversely associated with FAS (HR 0.37 (0.33-0.42)), myalgia (HR 0.59 (0.45-0.76)) and dysautonomic symptoms (HR 0.46 (0.34-0.62)). There was high secondary care healthcare utilisation (both emergency and outpatient care). Annual inpatient and outpatient expenditure was significantly lower in hospitalised individuals while under the service. When compared with the prereferral period, emergency department attendances were reduced in non-hospitalised patients with long covid, but outpatient costs increased.

Conclusions: In the largest long covid cohort from a single specialist post-COVID service to date, only one-third of individuals under follow-up achieved satisfactory recovery. Fatigue severity and COVID-19 vaccination at presentation, even after initial COVID-19 infection, was associated with long covid recovery. Ongoing service provision for this and other post-viral conditions is necessary to support care, progress treatment options and provide capacity for future pandemic preparedness. Research and clinical services should emphasise these factors as the strongest predictors of non-recovery.

Objectives: This study aims to assess travel time, associated costs, challenges and factors influencing healthcare facility choices among persons with cancer in Southern India.

Design: An explanatory sequential mixed methods study.

Setting: The study was conducted in the cancer care outpatient department at a tertiary care centre in Puducherry, Southern India.

Participants: A total of 192 persons with cancer aged 18 to 65 years, diagnosed with breast, lip and oral cavity, cervical, lung or upper gastrointestinal cancers, and attending the cancer care centre between 2023 and 2024, were enrolled in the study through systematic random sampling. Additionally, 10 in-depth interviews were conducted using purposive sampling.

Results: Of the 192 participants, 89 (46.4%) belonged to a lower socioeconomic group, and 178 (92.7%) reported experiencing financial hardship while undergoing cancer treatment. The median travel time to a tertiary care centre was 4.3 hours (IQR: 2.07-7.3), with a median direct non-medical cost of Indian Rupees (INR) 453 (IQR: 200-987). Median expenditures for travel, food and accommodation were INR 200 (IQR: 123-400), INR 360 (IQR: 150-613) and INR 30 (IQR: 20-60), respectively, per single visit. A significant proportion of participants (n=146, 76%) were unaware of nearby cancer treatment centres and relied on peer recommendations when choosing their place of treatment. Key challenges identified included long-distance travel, financial burden due to high food and transportation costs and limited affordability for accommodation.

Conclusion: The study highlights that prolonged travel time and associated costs pose substantial financial strain on cancer-affected families. Enhancing awareness of available healthcare facilities, implementing patient-friendly travel and accommodation support systems and decentralising cancer care services can improve accessibility and mitigate both travel and financial burdens.

Introduction: Transcranial magnetic stimulation (TMS) and upper extremity manipulation training have demonstrated clinical effectiveness in stroke rehabilitation. Post-stroke, the affected cerebral cortex often shows reduced excitability, which can limit the optimal outcomes of conventional manual training. To address this, we developed a new upper limb training method integrating TMS with active sensory training (AST) to enhance the fine motor ability in the upper limbs following stroke, potentially improving overall rehabilitation efficacy. However, the clinical effectiveness of this approach remains unclear. Importantly, we demonstrated the efficacy of the new rehabilitation strategy by using TMS in conjunction with AST in patients experiencing upper limb motor dysfunction after stroke.

Methods and analysis: This single-centre, single-blind, sham stimulation, randomised controlled clinical trial investigated the efficacy of AST combined with TMS in patients with stroke and upper limb motor dysfunction post-stroke (1-24 months post-onset) at Brunnstrom stages III-V. Upper limb motor function was evaluated before and 2 weeks after the intervention. The primary outcome was the Action Research Arm Test result, and the secondary indicators included results on the Fugl-Meyer Assessment Upper Extremity Scale, Modified Barthel Index, Semmes-Weinstein Monofilament, Erasmus MC revised Nottingham Sensory Assessment Scale, Embodied Sense of Self Scale (stroke version), functional near-infrared spectroscopy and neuroelectrophysiology. Between-group differences were analysed using independent t-tests, and within-group differences were examined with paired t-tests, with statistical significance set at p<0.05.

Ethics and dissemination: This study was approved by the Ethics Committee of the Second Rehabilitation Hospital of Shanghai for ethical application (Approval number: 2024-34-01). Written informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed journals and presentations at local and international conferences.

Trial registration number: ChiCTR2500097067.

Introduction: Published clinical trials offer valuable insights into the clinical research landscape in Portuguese-speaking African countries (PSAC)-Angola, Cabo Verde, Guinea-Bissau, São Tomé and Príncipe and Mozambique. The objective of this comprehensive scoping review is to systematically map and analyse randomised clinical trials (RCTs) evaluating pharmacological interventions conducted in PSAC from 1995 to 2024, in order to identify research trends, targeted diseases, geographic distribution and evidence gaps to better understand the development and evolution of clinical trials in the region. This is the first comprehensive scoping review to examine the clinical trials landscape in PSAC.

Methods and analysis: This scoping review adheres to the Joanna Briggs Institute methodology for scoping reviews, which builds on the Arksey and O'Malley methodological framework (refined by Levac et al) and will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A dual-search strategy will be used, consulting 4 electronic databases (MEDLINE, EMBASE, African Index Medicus, Cochrane Central Register of Clinical Trials) and 3 clinical trials registries platforms (Clinicaltrials.gov, International Clinical Trials Registry Platform, Pan African Clinical Trials Registry). Eligible studies will include RCTs conducted in at least one of the PSAC. Extracted data will include trial characteristics, targeted diseases, phases and designs, funding and ethical compliance. Risk of bias (RoB) will be assessed using the Cochrane RoB tool V.2.0 to evaluate the quality of the evidence included in the scoping review. Conclusions will be drawn upon the comparison between countries and their scope of clinical research, together with comparison with countries from other geographies, considering disease profiles.

Ethics and dissemination: Ethical approval is not required. Results will be disseminated through a peer-reviewed publication, conference presentation and in plain language in social media, both in Portuguese and in English.

Prospero registration number: This protocol is registered in the Open Science Framework https://osf.io/5nhc9.

Objectives: Women experiencing infertility employed various coping strategies to overcome the diverse stressors encountered. These coping strategies had their peculiar consequences or outcomes. This study aimed to explore the outcomes deduced from the coping strategies employed by women with infertility.

Design: The study employed a qualitative descriptive research design to gain an in-depth understanding of the outcomes of coping strategies used by women with infertility. In-depth interviews were conducted using a semi-structured interview guide.

Settings and participants: The study was carried out at a private fertility and specialist hospital within the Kumasi Metropolitan Assembly, where 15 women diagnosed with primary infertility were interviewed for 45 min to 1 hour each. With all participants completing the study, interviews were audiotaped with consent, transcribed verbatim and analysed using content analysis.

Results: The findings revealed that women with infertility used various coping strategies to mitigate the psychosocial stressors encountered. The coping strategies employed had a varying impact on the well-being of women with infertility, from long-term (physical health, mental health and life satisfaction) to short-term (composure and reduced state anxiety) coping outcomes. The result of the coping strategy employed had a varying impact on the well-being of women with infertility.

Conclusion: Women with infertility shared how they experienced good physical health, mental health and life satisfaction after employing adaptive coping strategies like seeking social support. They also shared how they exercised composure and had reduced state anxiety after using some maladaptive coping strategies, such as self-control and avoidance.

Objectives: To explore maternity care providers' attitudes toward regional centralisation of vaginal breech birth (VBB) care and gather their recommendations for maintaining clinical proficiency.

Design: Exploratory qualitative study using semi-structured interviews and thematic analysis.

Participants: 10 hospital-based maternity care professionals (nine obstetricians and one clinical midwife), purposively sampled to represent experience and institutional diversity.

Setting: 10 hospital maternity units in a metropolitan region of the Netherlands.Key themes describing provider attitudes towards two proposed models of centralised care (mobile breech team, designated referral centre) and alternative strategies.

Results: Three core themes emerged: (1) proficiency-providers valued regular exposure, formal training and peer support, expressing concern that centralisation would reduce overall workforce readiness; (2) organisation-concerns included unequal access, staffing burden, legal risks and inefficiencies in mobile teams and (3) alternatives-participants preferred a regional breech network with shared training, joint video review and expert on-call support.

Conclusions: Maternity care providers opposed full centralisation of VBB, favouring a networked model that distributes expertise and preserves local access. These insights highlight the importance of involving frontline providers in service redesign.

Trial registration number: Not applicable.

Objectives: Age-standardised incidence rates of myocarditis have been widely reported; this metric primarily provides a cross-sectional view of risk based on a fixed standard population and does not capture the effects of population ageing. Lifetime risk represents the probability of developing myocarditis over an individual's lifespan and incorporates both demographic ageing and competing mortality, thereby offering a complementary perspective that reflects the burden experienced in real-world populations. This study aimed to estimate the global lifetime risk of myocarditis.

Design: This was a systematic analysis using publicly available aggregated data from Global Burden of Disease Study 2021.

Setting: The study included 204 countries and territories from 1990 to 2021.

Participants: We used deidentified data from the general population to measure the lifetime risk of developing myocarditis.

Primary and secondary outcome measures: The primary outcome was the estimated lifetime risk of developing myocarditis at the global, regional and national levels. Secondary outcomes included long-term trends in lifetime risk using the average annual percentage change (AAPC), variation in lifetime risk by age and sex, differences across Sociodemographic Index (SDI) levels assessed with concentration indices, and future risk estimated using an Autoregressive Integrated Moving Average (ARIMA) model.

Results: The global lifetime risk of developing myocarditis increased from 1.33% (95% CI 1.32% to 1.33%) in 1990 to 1.50% (95% CI 1.49% to 1.50%) in 2021 (AAPC: 0.388%, 95% CI 0.314% to 0.462%). High and high-middle SDI countries had the greatest risks. In 2021, risk was higher in males (1.59%, 95% CI 1.59% to 1.60%) than in females (1.40%, 95% CI 1.39% to 1.40%). People over 40 years, especially older women, had higher lifetime risks. Forecasts based on the ARIMA model suggest that the risk will continue to rise through 2050.

Conclusions: From 1990 to 2021, the global lifetime risk of developing myocarditis has shown an upward trend. It is crucial to enhance early detection and diagnostic capabilities in primary care settings.

Objectives: To systematically review data-driven modelling studies that evaluated the effectiveness of interventions implemented during the COVID-19 pandemic and to identify which measures were most frequently reported as effective in controlling disease spread.

Design: Systematic review of modelling studies focused on data-driven, model-informed decision-making for COVID-19 interventions.

Data sources: A comprehensive literature search was conducted in PubMed, Web of Science and Embase, covering publications from 1 January 2020 to 16 October 2024.

Eligibility criteria: Studies were included if they: (1) used real-world data; (2) had sufficient sample sizes and (3) assessed at least one intervention with measurable outcomes.Meta-analyses and purely theoretical modelling studies were excluded. Papers were further filtered using a structured screening process to ensure empirical and intervention-based modelling.

Data extraction and synthesis: Data were extracted from eligible studies and categorised according to modelling approaches, data sources, intervention types and reported effectiveness. Descriptive synthesis was performed to summarise modelling trends and intervention performance. Studies were classified into major intervention categories, including tracing, testing and isolation (TTI); physical and social distancing (PSD); vaccination; lockdowns; mask-wearing; home office or stay-at-home (HOSH) and health infrastructure enhancement (HIE).

Results: Out of 2297 studies identified, 126 met inclusion criteria. Compartmental models were the most frequently used approach, primarily relying on case and death counts to assess intervention impact. The most commonly reported effective interventions were TTI, PSD, vaccination, lockdowns, mask-wearing and HOSH. When considering effectiveness relative to study frequency, the top six interventions were TTI, HOSH, mask-wearing, HIE, PSD and lockdowns. The relatively lower representation of vaccination reflects that most included studies were conducted during the early stages of the pandemic, before widespread vaccine rollout and availability of empirical vaccination data.

Conclusions: This review highlights the critical role of data-driven models in guiding COVID-19 response strategies. Evidence supports the combined effectiveness of non-pharmaceutical interventions, robust testing and tracing systems and health infrastructure strengthening. Real-world impact, however, remains dependent on local healthcare capacity, socioeconomic conditions and cultural contexts. Continued research is essential to refine adaptive modelling approaches and strengthen preparedness for future public health emergencies.