BMJ Open最新文献

Introduction/objective: Previous research on socioeconomic factors influencing health outcomes has often centred on the urban-rural divide, overlooking the nuanced variations within these categories. This study enhances our understanding by moving beyond traditional comparisons to examine the specific impacts of multiple deprivations on self-rated health across traditional authority areas, rural formal areas, urban informal areas and urban formal areas. By doing so, it captures the unique challenges and health implications associated with varying deprivation levels within these diverse contexts.

Methods: We first constructed the Provincial Index of Multiple Deprivation for each selected region using Wave 5 data from the National Income Dynamics Study, enabling an assessment of the health impacts of multiple deprivations across South Africa. During the estimation of the ordered probit model, collinearity issues emerged. To address this, we applied Principal Component Analysis (PCA) to create independent components which were then incorporated into the model. Self-reported health (SRH) was used as the dependent variable, allowing us to gain valuable insights into the relationship between health and multiple deprivation within these four contexts.

Results: The study uncovers significant disparities in deprivations, with the most deprived areas being rural formal areas and traditional authorities' areas and the least deprived being the urban formal areas. The PCA variables in the ordered probit model suggest that traditional and rural formal areas soften the effect of multiple deprivations on SRH relative to urban areas. In contrast, informal urban areas enhance the negative effect of multiple deprivation SRH relative to urban formal areas.

Conclusion/recommendations: The interaction between multiple deprivation variables and the specific areas examined in this study reveals varying impacts on health. Greater attention should be given to finer geographical characteristics in residential contexts to ensure that interventions are tailored effectively to the specific needs of each area. This focus is particularly important, as the local context may significantly impact health-a fundamental component of life and well-being.

Objectives: To identify what changes in the prescribing of isotretinoin have occurred since funded prescriber access was widened in 2009 from 'dermatologist only' prescribing to include 'general practitioners (GPs) and nurse practitioners working within their scope of practice'.

Design: Evaluation of isotretinoin dispensing data from 2008 to 2023 using the national annual prescribing data obtained from the New Zealand Pharmaceutical National Collection database.

Setting: All New Zealand citizens prescribed and dispensed funded isotretinoin for acne from 2008 to 2023 were included.

Main outcome measures: The prescribing data were analysed to identify the total number of prescriptions per year by prescribing clinician type, patient ethnicity and deprivation levels.

Results: In 2008, nearly 100% (26 897) of dispensed prescriptions were written by a dermatologist, while in 2023, 79% (39 432) were written by primary care clinicians. Annual isotretinoin prescriptions increased by 87%, from 26 897 (2008) to 50 613 (2023). Prescriptions for Māori increased from 1750 in 2008 to 4374 in 2023, with similar increases for other ethnic minorities.

Conclusion: Expanding the prescriber cohort has resulted in a substantial increase in prescriptions, with primary care now issuing the majority of isotretinoin prescriptions. These data demonstrate that the GP workforce can absorb and manage the additional acne workload from the increasing population. Enhanced access for patients suggests an unmet need. An absolute number of prescriptions have risen faster for Māori and Asian patients than for Europeans. Pacific people were generally lower than Europeans. This suggests the longstanding ethnic disparity in access to isotretinoin is partially reduced.Many countries have restrictions on patient access to isotretinoin, similar to New Zealand in 2008. This is the first study demonstrating that, given appropriate postgraduate education and support, the isotretinoin risk-benefit profile may be enhanced to safely deliver high-quality, timely, equitable patient access to isotretinoin in primary care.

Objective: To examine the prevalence rate of social anxiety disorder (SAD) among university students in Jordan after the COVID-19 pandemic and its associated predictors.

Design: A cross-sectional online survey study that was conducted in Jordan between January and December 2023.

Setting: Universities in Jordan.

Participants: Healthy university students from any specialty currently enrolled at a Jordanian university.

Primary outcome measure: The prevalence rate of SAD, which was assessed using the Social Phobia Inventory.

Results: A total of 851 university students participated in this study. More than half of them (65%) were women. The mean age of the study participants was 21.9 (2.7) years. The majority of them (70.6%) were studying medical fields. The median number of times the study participants got infected with COVID-19 was 1.0 (IQR: 0.0-2.0). The median number of viewing hours spent on social networking sites was 4.0 (IQR: 3.0-6.0). The median SAD score was 19 (IQR: 10-32) out of 68, which represents 27.9% of the maximum attainable score. Up to 45.4% of the study participants were susceptible to SAD, with 12.5% of the study participants reporting severe to very severe SAD symptoms. Students older than 21.9 years were 32% less likely to report SAD symptoms compared with younger students (p<0.01).

Conclusion: Jordanian universities students are increasingly likely to report SAD symptoms. The data show how important it is for universities to recognise and deal with this mental health issue. Focused treatments and support networks could help students with social anxiety problems to deal with them.

Objectives: Creating age-friendly cities (AFCs) is essential for supporting older adults' well-being. The WHO's 2007 guide outlines key features of AFCs, including social inclusion. Despite increasing numbers of AFC programmes, diverse experiences of ageing are often overlooked. This scoping review explores innovative programmes implemented by AFCs to enhance social inclusion for older adults.

Design: A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Data sources: Systematic searches were conducted between December 2023 and January 2024 across relevant databases (Ovid Medline, OVID Embase, OVID PsycINFO, CINAHL, Web of Science, Cochrane Library and Scopus) and the grey literature.

Eligibility criteria for selecting studies: Selection criteria included English language publications describing evaluated age-friendly, social inclusion programmes for older adults.

Data extraction and synthesis: Data extraction followed Gonyea and Hudson's (2015) framework assessing programmes on population, environment and/or sector inclusion levels. Inductive analysis identified and evaluated aspects of social inclusion.

Results: We identified 20 peer-reviewed publications and 18 grey literature sources. Most programmes (peer review, n=19, 95.0%; grey, n=18, 100.0%) addressed population inclusion, incorporated environment (peer review, n=10, 50.0%; grey, n=15, 83.3%) and/or sector inclusion (peer review, n=7, 35.0%; grey, n=15, 83.3%). Key outcomes included an improved sense of belonging, increased engagement with community resources and activities, enhanced digital literacy and connectivity, and a reduction in feelings of loneliness and isolation. A notable gap was the absence of studies focused on Indigenous populations.

Conclusion: We highlight that programmes addressing population, environment and sectoral inclusion may improve the well-being of older adults in urban settings. Our findings will inform AFC practices and policies by deepening our understanding of how social inclusion can be improved for older adults, including those from under-represented groups, ensuring an equitable approach to enhancing quality of life.

Background: Caregivers of people with motor neuron disease (MND) face more negative consequences of caregiving than other terminal illnesses. The impact of this caregiver burden can negatively influence bereavement outcomes.

Objectives: This study aims to explore the support needs of caregivers of people with MND, the types of bereavement services they use, or the reasons for not using bereavement services, and understanding the opportunities and barriers to accessing bereavement services.

Design: The design of the study was a qualitative interview study using thematic analysis following the method of Braun and Clarke (2006).

Setting and participants: Twenty bereaved caregivers of people with MND were purposively sampled. Participants were recruited through the Lancashire and South Cumbria MND Care and Research Centre.

Results: Thematic analysis revealed four overarching themes: (1) type of support accessed, (2) the importance of people who understand, (3) barriers to accessing support, and (4) being (un)prepared for death and afterwards.

Conclusions: Caregivers of people with MND require people who understand their unique needs to support them, alongside professional support, to prepare them for the death of their loved one and beyond. Barriers to accessing support included the need for in-person support, insufficient financial support or signposting to relevant services and being unprepared for death and bereavement.

Objectives: During the COVID-19 pandemic, designated rehabilitation centres were established in the province of Québec, where strict sociosanitary measures such as isolation and mandatory personal protection equipment requirements were followed. This study aimed to describe the impact of the pandemic on rehabilitation care indicators for poststroke users with (COV+) and without (COV-) COVID-19 infection in designated rehabilitation centres compared with those admitted in the previous year (pre-COV).

Method: A retrospective analysis of 292 medical files was performed in 3 rehabilitation centres. Demographic characteristics were collected, as well as indicators routinely collected in acute care and rehabilitation such as length of stay (LOS), the Functional Independence Measure and a number of physical/occupational therapy (PT/OT) sessions. Non-parametric statistical tests were used to compare variables among the three groups.

Results: COV+ users were older than COV- and pre-COV ones (p<0.01) and were more disabled on admission to a rehabilitation centre (p<0.01). They also exhibited longer LOS in acute care prior to rehabilitation (p<0.001) and were more often rehospitalised (p<0.002) during the course of their stay in the rehabilitation centre. Despite longer rehabilitation stays (p<0.001) and more PT/OT sessions, COV+ users remained more disabled at discharge (p<0.002). COV- users showed rehabilitation care indicators resembling the ones of pre-COV despite spending less time in rehabilitation.

Conclusions: Patients who had a stroke infected with COVID-19 exhibited greater vulnerability on admission to rehabilitation. They required more care and services during their rehabilitation period. However, this additional support did not enable them to achieve the same level of recovery as COV- and pre-COV users. This underscores the added impact of the disease on already impaired patients and highlights the specific needs of COV+ users undergoing rehabilitation.

Background: Garment workers are at high risk of musculoskeletal disorders (MSDs) due to repetitive physical tasks, long working hours and varying workstations. As there is no existing epidemiological overview of MSDs among garment workers, this systematic review aimed to evaluate the global evidence on prevalence of MSDs in this population.

Methods: A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus and Web of Science electronic databases were searched to identify studies published in English up to November 2022. Random-effects meta-analysis was used to estimate pooled prevalence.

Results: The search yielded 258 published studies, of which 14 were deemed relevant and were included in this review. The included studies reported prevalence from India (n=3), Bangladesh (n=2), Ethiopia (n=2), Thailand (n=2), Botswana (n=1), Iran (n=1), Sri Lanka (n=1), Cambodia (n=1) and Denmark (n=1) and involved 15 029 garment workers. Most of the included studies (79%) were assessed to be methodologically sound (low risk of bias). The mean age of participants ranged from 24.2 to 40 years. The prevalence of MSDs ranged from 15.5% to 92%. The pooled prevalence of MSDs from nine studies was 65.6% (95% CI 44.5% to 51.9%). Low back pain and neck pain were reported as the common MSDs in the included studies.

Conclusions: The findings highlight the considerable risk of MSDs, especially low back and neck pain, linked to repetitive tasks, extended hours and inconsistent workstations. Given the heavy toll of MSDs on this workforce, targeted interventions and ergonomic improvements are crucial to mitigate the risks and improve garment workers' well-being.

Objective: To investigate the safety, feasibility and acceptability of the Neurofenix platform for upper-limb rehabilitation in acute and subacute stroke.

Design: A feasibility randomised controlled trial with a parallel process evaluation.

Setting: Acute Stroke Unit and participants' homes (London, UK).

Participants: 24 adults (>18 years), acute and subacute poststroke, new unilateral weakness, scoring 9-25 on the Motricity Index (elbow and shoulder), with sufficient cognitive and communicative abilities to participate.

Interventions: Participants randomised to the intervention or control group on a 2:1 ratio. The intervention group (n=16) received usual care plus the Neurofenix platform for 7 weeks. The control group (n=8) received usual care only.

Outcomes: Safety was assessed through adverse events (AEs), pain, spasticity and fatigue. Feasibility was assessed through training and support requirements and intervention fidelity. Acceptability was assessed through a satisfaction questionnaire. Impairment, activity and participation outcomes were also collected at baseline and 7 weeks to assess their suitability for use in a definitive trial.

Randomisation: Computer-generated, allocation sequence concealed by opaque, sealed envelopes.

Blinding: Participants and assessors were not blinded; statistician blinded for data processing and analysis.

Results: 192 stroke survivors were screened for eligibility, and 24 were recruited and randomised. Intervention group: n=16, mean age 66.5 years; median 9.5 days post stroke.

Control group: n=8, mean age 64.6 years; median 17.5 days post stroke. Three participants withdrew before the 7-week assessment, n=21 included in the analysis (intervention group n=15; control group n=6). No significant group differences in fatigue, spasticity, pain scores or total number of AEs. The median (IQR) time to train participants was 98 (64) min over 1-3 sessions. Participants trained with the platform for a median (range) of 11 (1-58) hours, equating to 94 min extra per week. The mean satisfaction score was 34.9 out of 40.

Conclusion: The Neurofenix platform is safe, feasible and well accepted as an adjunct to usual care in acute and subacute stroke rehabilitation. There was a wide range of engagement with the platform in a cohort of stroke survivors which was varied in age and level of impairment. Recruitment, training and support were manageable and completion of data was good, indicating that a future randomised controlled trial would be feasible.

Trial registration number: ISRCTN11440079.

Objectives: To explore the experiences and perspectives of female patients with autoimmune rheumatic diseases (ARDs) regarding sexual and reproductive health, including contraception, family planning, and pregnancy.

Design: Qualitative descriptive study using semi-structured interviews.

Setting: Specialised rheumatology clinic in a tertiary hospital in Monterrey, Mexico.

Participants: 21 female patients aged 18-49 with a confirmed ARD diagnosis who were receiving care at the clinic. Participants were selected using convenience sampling, ensuring diversity in age, disease type and stage, socio-economic and cultural background, sexuality and disability status. All participants completed the study.

Results: Four main themes emerged from the analysis. First, participants expressed confusion and concern about the safety and effectiveness of contraceptive methods in the context of their disease and treatment. Second, many participants shared anxiety about infertility, heredity and the risks of pregnancy associated with their ARDs, leading to uncertainty in pregnancy planning. Third, there was concern about the safety of medications during pregnancy and breastfeeding, indicating a lack of guidance and information from healthcare providers. Lastly, patients often deferred decision-making about contraception and medication to their rheumatologists but recognised the importance of a multidisciplinary care approach for comprehensive sexual and reproductive health management.

Conclusions: The study revealed that women with ARDs experience significant challenges and unmet needs related to sexual and reproductive health, particularly in understanding safe contraception, pregnancy planning and medication use during pregnancy and lactation. These findings emphasise the need for rheumatologists to provide clearer guidance on these issues and collaborate closely with gynaecologists and other specialists to ensure comprehensive, patient-centred care. Enhancing communication and education strategies in rheumatology consultations could address these gaps and improve the sexual and reproductive health outcomes and decision-making processes of women with ARDs.