BMJ Open最新文献

Objectives: To evaluate the criterion validity and test-retest reliability of the Chinese version International Physical Activity Questionnaire-Short Form (cIPAQ-SF) for assessing sedentary behaviour and physical activity (PA) in overweight and obese Chinese adults, using activPAL as the reference.

Methods: A cross-sectional study was conducted at a Clinical Nutrition Clinic in China. Participants completed the cIPAQ-SF before and after wearing an activPAL for 7 consecutive days. Criterion validity was assessed using Pearson's/Spearman's correlation coefficients and Bland-Altman plots for sitting time (hours/day), moderate, vigorous and moderate-to-vigorous PA (MVPA) (min/week). Sensitivity and specificity evaluated the IPAQ-SF's accuracy in identifying those not engaging in any PA and those not meeting the PA recommendation (MVPA ≥150 min/week). Test-retest reliability was assessed using intraclass correlation (ICC).

Results: Among 80 participants (age 33.9±7.3 years; body mass index 29.1±4.5 kg/m²), the IPAQ-SF demonstrated moderate criterion validity for sitting time (r=0.577 on weekdays, r=0.444 on weekends) and MVPA (ρ=0.451) compared with activPAL. It underestimated sitting time by 3.5 hours/day on weekdays and 2.9 hours/day on weekends. The cIPAQ-SF showed moderate-to-high sensitivity for correctly identifying individuals who were not engaging in any PA (53.6%-85.7%) or not meeting PA recommendations (93.8%), but its specificity was low to moderate (47.8%-73.7%) for PA engagement and meeting guidelines (55.2%). Test-retest reliability was moderate for sitting time (ICC=0.549-0.614) and poor to moderate for PA levels (ICC=0.453-0.592).

Conclusion: The IPAQ-SF demonstrates moderate validity and reliability in assessing sedentary behaviour and insufficient PA among overweight and obese Chinese adults. It can be used to identify physically inactive individuals for targeted interventions and monitor changes in sedentary behaviour.

Objective: Socioeconomic inequalities significantly impact access to healthcare services for individuals with type 2 diabetes mellitus (T2DM). This study investigates these inequalities in Iran, focusing on factors such as asset, sex, urban-rural residence, age, education, employment status, and marital status.

Design: Cross-sectional study.

Setting: This study used data from the national 'Diabetes Care (DiaCare)' study, a population-based survey conducted from 2018 to 2020 in Iran.

Methods: Socioeconomic status (SES) was assessed using Principal Component Analysis (PCA) based on assets. Socioeconomic inequalities in access to physicians, pharmacies and laboratories were measured using the Concentration Index (CI) and Erreygers Corrected Concentration Index (ECI). Decomposition analysis was performed using a probit regression model to assess the contributions of various factors to the observed inequalities.

Results: Among 13 315 patients with T2DM, 5.8% lacked access to physicians, 6.8% to pharmacies and 8.7% to laboratories. The CI was positive and statistically significant for access to physicians (0.0614), pharmacies (0.0787) and laboratories (0.0875), indicating better access concentrated among higher SES individuals. Urban residents had the largest positive marginal effects on access to physicians (0.032), pharmacies (0.078) and laboratories (0.053), with percentage contributions of 13.21%, 23.23% and 17.39%, respectively. Higher asset quintiles showed substantial contributions to inequalities, with the highest quintile contributing 10.5% to physician access inequality, 9.68% to pharmacy access and 9.16% to laboratory access. Education level also positively impacted access, with high school education contributing 0.64% and college education 0.52% to access inequalities. Sex differences showed a negative marginal effect for women, indicating slightly lower access.

Conclusion: Socioeconomic factors, particularly asset, residence and education, significantly impact access to healthcare services for patients with T2DM in Iran. Policies should focus on reducing barriers to healthcare access, especially for lower SES and rural populations.

Objectives: To assess the state of the research literature addressing what is known about the quality of continence care from the perspective of older adults in long-term care or in receipt of home care.

Design: Scoping review of the literature according to the Joanna Briggs Institute method, reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Participant: older adults (>65 years of age), either in receipt of home health or social care services or older adult residents of long-term care (nursing homes). Concept: older adult perspectives on quality of continence care (access, care to meet needs, continuity, goals, expectations, delivery, experiences, personalised care, partnerships in care, well-being and social support). Context: older adults in long-term care or in receipt of home care.

Results: We identified 14 articles from the academic literature. Sources originated from the USA (7), Australia (4), Canada (2) and 1 from Italy. Long-term care residents were the focus of 12 of the articles. Older adults reported limited access and information regarding continence care and services and variable abilities of care staff to deliver care. Older adults wanted to be actively involved in decisions about their care, preserve their autonomy and independence and wanted care to enhance their well-being.

Conclusions: Studies examining the perspectives of older adults regarding the quality of their continence care are few. Older adults value person-centredness, expert advice regarding their condition, allowing preservation of self-determination and independence where possible. Older people value meaningful relationships with empathetic care providers. There remains a need for education of care providers in continence care and for policies and practices to support continence in a dignity-preserving framework.

Registration: Open Science Framework (https://osf.io/bprq9/).

Introduction: Concha-type microtia, classified as a milder form of microtia under Nagata's classification, is characterised by the presence of more normal ear subunits compared with other types. The non-expanded auricular reconstruction using autologous rib cartilage is a standard procedure treating conchal microtia, and this operation typically comprises two stages. To maximise the utilisation of native auricular cartilage, the lower half of a patient's ear is preserved as residual ear, which should be connected to the rib cartilage scaffold in this operation. However, it remains unclear whether this connection should be performed in the first-stage or second-stage surgery. Current literature lacks sufficient evidence to determine the safer and more effective approach. Thus, we plan to conduct this randomised controlled trial to formally compare the safety and efficacy of first-stage versus second-stage connection, hypothesising that second-stage connection may be a better choice since it may reduce skin cutting, operative risk and improve recovery.

Methods and analysis: This is a single-centre, randomised controlled trial comparing two surgical treatments. Based on sample size calculations, a total of 78 eligible patients will be randomised with a 1:1 allocation. The control group will be treated with connecting the residual ear with the framework in stage 1, while the experimental group will be treated with connecting the residual ear with the framework in stage 2.The safety of the surgery will be evaluated based on the grade-A healing rate and the incidence of complications (infection, haematoma, flap or skin necrosis and cartilage scaffold exposure). Efficacy of the surgery will be assessed using the Patient and Observer Scar Assessment Scale (POSAS) and Glasgow Benefit Inventory (GBI) scores. Patients will be scheduled for follow-up 3-6 months after each surgery. Descriptive analyses will be performed to summarise baseline demographics. The incidence of grade-A healing and complications will be analysed using the χ² test. GBI and POSAS scores of the two groups will be analysed using independent-samples t test. A p value <0.05 will be considered statistically significant.

Ethics and dissemination: This study was approved by the Ethics Committee of Sichuan Provincial People's Hospital (no. 2025-256-1) on 9 April 2025, and conformed to the Declaration of Helsinki. At the time of manuscript submission, patient recruitment began in April 2025 and is expected to continue until January 2027. Surgical procedures and follow-up will continue until February 2028. Trial results will be published in peer-reviewed journals and will be disseminated to the media and the public.

Trial registration number: NCT06763991.

Introduction: Persistent postsurgical pain (PPSP) affects up to 15% of patients after major surgery, impairing physical function, quality of life and increasing risk for long-term opioid use. Current PPSP prediction models rely on static or retrospective data and fail to incorporate dynamic perioperative factors. The Personalised Prediction of Persistent Postsurgical Pain (P5) study aims to develop individualised, multimodal prediction models by integrating preoperative behavioural, psychophysical and neurocognitive assessments and high-frequency symptom monitoring.

Methods and analysis: P5 is a prospective, single-centre cohort study enrolling 2500 adults aged 18-75 undergoing major surgery at a tertiary academic hospital. Participants complete baseline surveys, cognitive testing and quantitative sensory testing preoperatively. Ecological momentary assessments (EMAs) are collected via smartphone three times per day through 30 days postoperatively, capturing pain, mood, catastrophising and medication use. Participants are assessed on postoperative day 1 and complete online surveys at 3 and 6 months, evaluating pain persistence, interference, neuropathic symptoms and related outcomes. Clinical and perioperative data are extracted from the electronic health record. The primary outcome is PPSP at 3 months. Predictive models will be developed using supervised machine learning and dynamic structural equation modelling to extract latent features from EMA data. Model performance will be assessed using area under the receiver operating characteristic curve, area under the precision-recall curve and SHapley Additive exPlanations for interpretability.

Ethics and dissemination: This study has received ethics approval from the Washington University School of Medicine Institutional Review Board #202101123. Informed consent is required. Results will be submitted for publication in peer-reviewed journals and presented at research conferences.

Trial registration number: NCT04864275.

Objectives: To explore prescribers' awareness of medicine-related challenges of older people (≥65 years) with sensory impairment (hearing, visual or dual impaired) and identify the influences on prescribing behaviours for these patient populations.

Design: Semistructured interviews were completed online.

Setting: Primary care-based prescribers in the UK.

Participants: Independent prescribers working in primary care. Participants were recruited through professional networks and organisations, social media and using snowballing. Purposive sampling was used to ensure variation in roles, practice/organisational settings and geographical location.

Results: 15 prescribers participated, including general practitioners (n=6), pharmacists (n=5), nurses (n=3) and one optometrist. Many demonstrated limited awareness of sensory impairment and suggested that outdated patient records contribute to it being easy to overlook. Prescribers underestimated sensory impairment prevalence, with one predicting that only a small proportion of older patients had hearing loss. Formal training on prescribing for older people with sensory impairment was minimal, and most relied on experiential learning. Prescribers employed strategies to support safe prescribing, such as simplifying regimens and selecting lower-risk medications. The prescribers also reported a lack of evidence-based guidelines or resources tailored to these patient populations.

Conclusions: Prescribers currently receive minimal training to support their prescribing practices for older people with sensory impairment. Given the increasing prevalence of age-related sensory impairment, evidence-based resources and training are needed to support prescribing for these patient populations.

Objectives: People with disabilities are underrepresented in clinical trials, which impacts generalisability and ethical integrity of results. Despite international mandates to diversify participants, there is a lack of guidance on how to make trials disability-inclusive. This scoping review identifies and synthesises guidance, practices and recommendations supporting the inclusion of people with disabilities in clinical trials.

Design: We conducted a scoping review following the Arksey and O'Malley framework and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews.

Data sources: Medline (OVID) and Public Affairs Information System Index (October 2024) searches identified peer-reviewed articles. Grey literature was identified through targeted advanced Google searches and website reviews (February-March 2025). Google Scholar was searched to identify recently published documents between March and April 2025.

Eligibility criteria for selecting studies: Documents with guidance or policies related to inclusion of people with disabilities in clinical trials published in English from 2019 to 2025 were included.

Data extraction and synthesis: Two independent reviewers screened titles, abstracts and full texts and extracted data, with adjudication by a third reviewer.

Results: A total of 69 documents met inclusion criteria. Thematic synthesis identified eight recommendation domains: (1) inclusive and universal trial design, (2) accessible recruitment, (3) inclusive data collection, (4) equitable data analysis, (5) accessible reporting and dissemination, (6) ethical oversight and institutional review board inclusion, (7) supported and accessible consent processes and (8) the inclusion of people with disabilities as researchers and stakeholders. Themes cutting across all domains included guidance emphasising universal design, anti-ableist frameworks, supported decision-making, flexible protocols and engagement with disability communities.

Conclusion: Disability-inclusive clinical trials are essential to ensure the validity of clinical trial results, uphold ethical responsibilities and advance health equity. While emerging frameworks offer direction on how to include people with disabilities in trials, current implementation remains inconsistent and largely voluntary. Clear, enforceable standards are needed to support governments, ethics boards, institutions and funders in making clinical trials more disability-inclusive.

Objectives: A growing number of national diagnostic reference levels based on clinical indications (NDRL_ci) in CT have been implemented worldwide since the International Commission on Radiological Protection's 2017 recommendation. This study aims to compare NDRL_ci practices, identify influencing factors and propose evidence-based recommendations for NDRL_ci development, based on the literature published between 1996 and 2025.

Design: Systematic review.

Setting: A systematic literature search was conducted in PubMed, Web of Science and Scopus from 1996 to 24 august 2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was followed to report the study selection process in this review. Joanna Briggs Institute's critical appraisal tools were used to evaluate the articles critically.

Participants: Adult patients undergoing CT scans for various clinical indications.

Intervention: Clinical indication-based CT protocols with reported NDRL_ci values as CT dose index volume and dose length product (DLP).

Primary and secondary outcome measures: The primary outcomes were NDRL_ci values reported for various clinical indications. The secondary outcomes were CT technology, protocol parameters and patient characteristics influencing NDRL_ci.

Result: A total of 4146 articles were identified. 410 full texts were examined and 11 studies were included in the systematic review. 25 clinical indications across seven anatomical regions were identified across 11 included studies. The NDRL_ci for urinary stones and cerebrovascular accident had the highest number of references, while flank pain and occlusion had the lowest number. The highest NDRL_ci in DLP was found for total body CT in severe trauma (3830 mGy cm) and the lowest for sinusitis (70 mGy cm).

Conclusion: Several factors contribute to dose discrepancies for the same clinical indications in CT imaging, including kilovolt peak and milliampere-second, scan length, number of phases, patient size, reconstruction algorithm, CT scanner age and specifications, underscoring the need for standardised and optimised CT protocols. This review highlighted several challenges, which emphasise the importance of international organisations to standardise the development of NDRL_ci to improve comparability across countries.

Prospero registration number: CRD42024603574.

Introduction: Tuberculosis (TB) remains a globally concerning infectious disease, and significant challenges persist in attaining the 2030 targets set by the WHO. With the rapid advancements in computer-aided detection (CAD) technology, CAD-assisted Chest X-Ray (CAD-CXR) has been applied in TB patients triaging, but the practical application value of the CAD-CXR system in real-world primary healthcare settings in China for TB prevention and control has not been fully elucidated. This protocol reports a design of a cluster randomised controlled trial (CRCT), which aims to evaluate the effectiveness and clinical pathway of CAD-CXR in enhancing TB diagnostic yield in primary healthcare settings, thereby contributing to global TB elimination strategies.

Methods and analysis: Scheduled for September 2025, this CRCT will recruit 22 townships in Yichang of Hubei Province, China. These townships will be randomly allocated at a 1:1 ratio to either the CAD-CXR system intervention group or the control group. In the intervention group, healthcare providers will use the CAD-CXR analysis system to assist in TB screening, whereas the control group will rely solely on conventional CXR interpretation by radiologists. The primary outcome of the study is the TB diagnostic yield; the secondary outcomes include diagnostic delay duration and the accuracy of the CAD-CXR system. These metrics will be comprehensively evaluated to assess the effectiveness of the CAD-CXR intervention. Findings from this study are anticipated to offer evidence-based recommendations regarding the optimal application scenarios and implementation pathways for CAD-CXR.

Ethics and dissemination: This study was approved by the Ethics Committee of the Peking Union Medical College (CAMS&PUMC-IEC-2025-044). Findings of this study will be disseminated through traditional academic pathways, including peer-reviewed publications and conference presentations.

Trial registration number: NCT06963606.