BMJ Open最新文献

Objectives: To compare aetiology, microbiological isolates and antibiotic susceptibilities of endophthalmitis between children and adults.

Design: Retrospective observational study.

Participants: Patients admitted to Zhongshan Ophthalmic Center between January 2013 and December 2019 with clinically diagnosed endophthalmitis were included.

Outcome measures: The aetiology, microbiological isolates and antibiotic susceptibilities of endophthalmitis were analysed.

Results: Of 1803 patients, 430 (23.8%) were aged ≤16 years. In both children and adults, the main aetiology was trauma (85.6% vs 64.7%, p<0.05). Streptococcus species (spp.) (28.8%) were most prevalent in paediatric post-traumatic endophthalmitis; whereas, coagulase-negative staphylococci (36.9%) were dominant in adults. In postoperative endophthalmitis, all children had bacterial infections, while fungal infections accounted for 12.5% in adults. In endogenous endophthalmitis caused by fungi, Candida was most prevalent in adults (26.9%); whereas, all causative fungi involved filamentous fungi in children. Isolated bacteria in children presented a higher susceptibility in 7 of 11 antibiotics compared with those in adults. Levofloxacin had the highest susceptibility rate in children (97.9%), and ofloxacin had the highest susceptibility rate in adults (90.6%).

Conclusion: The main aetiology was trauma, with a higher proportion in children than in adults. The microbial profile of paediatric endophthalmitis was different from those of adults. Susceptibilities of causative bacteria to most antibiotics were higher in children than in adults.

Objective: This study assessed the trends and patterns of antimicrobial consumption (AMC) from 2020 to 2021, 2021-2022 and 2022-2023 at the Benjamin Mkapa Zonal Referral Hospital (BMH) in Dodoma, Tanzania.

Design: A retrospective cross-sectional study was conducted to collect AMC data for three financial years with respective denominators. The data were computed using the AMC Tool 2019 v1.9.0 and defined daily dose per 1000 inhabitants per day (DID).

Setting: The BMH, Dodoma, Tanzania.

Participants: This study surveyed quantities of antimicrobials procured at the BMH. It did not have any human participants.

Outcome measures: AMC was quantified in DID. The comparisons were made based on the DID of all surveyed antimicrobials, taking into account oral and parenteral administration and based on pharmacological classes. Further, DIDs were presented based on the 2023 WHO Access (A), Watch (W) and Reserve (R) (AWaRe) classification.

Results: In 29 assessed antimicrobials, the DIDs for 2020-2021, 2021-2022 and 2022-2023 were 3.0852, 3.5892 and 3.9213, respectively. The average DID per year was 3.5319, with a mean of 2.4207±1.9765 DID per year. The topmost consumed antimicrobials over the 3 years (doxycycline, azithromycin, amoxicillin/beta-lactamase inhibitors, ampicillin/cloxacillin, amoxicillin/flucloxacillin, ceftriaxone, nitrofurantoin and clarithromycin) account over 90% of consumption. The most highly consumed therapeutic classes were beta-lactam antibacterial penicillins (34.71%), macrolides, lincosamides, streptogramins and others (25.75%), followed by tetracycline (23.88%). The AWaRe categorisation and antimicrobials not recommended (ANR) distribution were as follows: Access-51.61%, Watch-31.96%, Reserve-0.00%, and ANR-16.43%, respectively.

Conclusion: For every 1000 patients attending the BMH per day, our study found 2.4207±1.9765 DIDs of an antimicrobial were consumed. The most consumed antimicrobials include doxycycline, azithromycin, amoxicillin/beta-lactamase inhibitor, ceftriaxone and metronidazole. To combat antimicrobial resistance effectively, it is imperative to institute a hospital policy for antimicrobial stewardship that prioritises the utilisation of a hospital formulary and antibiograms for the procurement of antimicrobials at the BMH.

Objective: To describe temporal trends in the incidence and disability-adjusted life years (DALYs) of rheumatoid arthritis (RA) across sociodemographic index (SDI) quintiles and sexes from 1990 to 2019.

Methods: Data on RA incidence and DALYs with a 95% uncertainty interval from 1990 to 2019 were extracted from the Global Burden of Disease 2019. Subsequently, trends across SDI quintiles and sexes from 1990 to 2019 were determined using joinpoint regression and age-period-cohort analyses.

Results: A significant upward trend in the global age-standardised incidence rate (ASIR) of RA was observed for both sexes from 1990 to 2019 (average annual per cent change (AAPC): 0.214, 95% CI 0.179 to 0.249, p<0.001). Specifically, the ASIR of RA for both sexes demonstrated a significant increasing trend at all SDI levels, with the highest AAPC observed in the low SDI regions. A non-significant increasing trend in the global age-standardised DALYs rate (ASDR) of RA was observed for both sexes from 1990 to 2019 (AAPC: 0.017, 95% CI -0.051 to 0.085, p=0.621). Varying trends in ASDR were observed for both sexes and across SDI quintiles. Additionally, diverse age-period-cohort patterns in incidence and DALYs were observed across SDI quintiles and sexes.

Conclusion: The significant heterogeneity observed in the temporal trends of the incidence and DALYs of RA across SDI quintiles and sexes suggests potential disparities in the prevention, management and treatment of RA. Therefore, establishment of practical and customised healthcare initiatives for specific populations across SDI quintiles and sexes and allocation of supplementary health resources to high-risk populations are crucial for effective management of RA.

Objectives: The objective of this study is to examine the association between relationship satisfaction and blood pressure (BP) in a low-income setting and to screen for gender moderation in this context. Research conducted in high-income settings suggests that relationship satisfaction is associated with better physical and mental health outcomes.

Design: A cross-sectional study design was employed, using both questionnaire and physical measurement data. Multiple linear regression models were calculated for systolic and diastolic BP and adjusted for age, gender, demographics/socioeconomics and other health-related variables. Gender moderation was tested using interaction terms in multivariable analyses.

Setting: A household survey was conducted in 2018 in rural northwestern Burkina Faso.

Participants: Final analysis included 2114 participants aged over 40 who were not pregnant, reported being in a partnership and had valid BP readings.

Main outcome measures: Systolic and diastolic BP levels.

Results: A significant positive association existed between relationship satisfaction (Couples Satisfaction Index-4 score) and systolic BP (B=0.23, 95% CI (0.02 to 0.45), p=0.03) when controlling for demographics/socioeconomics. Nevertheless, this relationship lost statistical significance when additional adjustments were made for health-related variables (B=0.21, 95% CI (-0.01 to 0.42), p=0.06). There was no significant association of relationship satisfaction and diastolic BP and no evidence of gender moderation.

Conclusion: In contrast to many higher-income settings, we found a positive association between relationship satisfaction and systolic BP in very low-income rural Burkina Faso. Our results add to the evidence regarding the contextual nature of the association between relationship satisfaction and health, as high relationship satisfaction may not act as a health promotor in this socioeconomic context.

Introduction: Emotion dysregulation is a transdiagnostic characteristic that affects many people with many psychopathological problems. Two mechanisms that have been frequently associated with emotional regulation are immersion and distancing. Focusing is a task that combines these two mechanisms of emotion regulation through the phase of creating a working distance and subsequently the phase of reassigning meaning. However, the benefit of its use in Portuguese population without a moderate to severe symptomatology for promoting mental health remains unclear.

Methods and analysis: Participants aged between 18 and 65 years who wish to improve their awareness and understanding of their emotions will be recruited and then, randomised into two groups: the intervention group (IG) and the control group (CG; delayed intervention). The IG will have access to two focusing sessions and the CG will only have access to the intervention 4 weeks later. Both groups will be evaluated at five different times. Primary outcomes include positive and negative affect, attitudes towards focusing (emotions and bodily sensations), the ability to perform focusing and emotion regulation. Secondary outcomes include mental health and psychological well-being, depression and anxiety symptoms and self-esteem.

Ethics and dissemination: Our study has been approved by the Council of Ethics and Deontology of the University of Maia. Findings will be disseminated via manuscripts, presentations and the lead author's thesis.

Trial registration number: ISRCTN16974329.

Introduction: Premature birth is the leading cause of neonatal mortality. Cervical length shortening during pregnancy serves as the gold standard for predicting preterm birth. Although several interventions have been applied to reduce the incidence of preterm birth in short cervix pregnant women, the optimal intervention in clinical practice remains controversial. The aim of this study is to conduct a network meta-analysis to explore the optimal intervention for preventing preterm birth among pregnant women with a short cervix.

Methods and analysis: We will search electronic information databases including PubMed, Embase Ovid, Cochrane Library Ovid, Wanfang Data, China Science and Technology Journal Database(VIP) and clinical trial registry websites (US Clinical Trials Registry and China Clinical Trials Registry) until 1 January 2024. Randomised controlled trials (RCTs) comparing two or more interventions to prevent preterm birth in short cervix pregnant women will be included. The primary outcomes are preterm birth rate at <37 weeks and the composite neonatal adverse outcome, secondary outcomes include spontaneous preterm birth rate at <37 weeks, preterm birth rate at <34 weeks, spontaneous preterm birth rate at <34 weeks, week of gestation, birth weight of the newborn, perinatal mortality and neonatal admission rate. Risk of bias 2.0 (ROB 2.0） will be used to assess the risk of bias in the RCT, and the Confidence in Network Meta-Analysis software will be used to assess the certainty of the generated evidence. The network meta-analysis will be conducted using the gemtc package in R 4.2.2. Two investigators independently performed article screening, data extraction and quality assessment. In addition, subgroup analyses and sensitivity analyses will be used to assess the robustness of the findings.

Ethics and dissemination: Ethical considerations will not be required. Results will be published in a peer-review journal.

Prospero registration number: CRD42022315200.

Introduction: In Sweden and the UK, there is a high prevalence of risky drinking, a pattern of drinking associated with adverse consequences. Drinking motives are a proximal predictor of risky drinking and subsequent consequences, suggesting it may be an apt intervention target. Currently, there is a lack of evidence regarding the applicability of motives for intervention efforts. The current study aims to test if motives-based materials are effective in impacting plans for future drinking and reactivity to alcohol-related cues. A secondary aim is to assess individuals' perceptions of risky drinking as outlined by health authorities. The results of the study will inform the design of a motives-based digital alcohol intervention.

Methods and analysis: The study is a three-arm, parallel group, randomised controlled trial. Vignettes will be used to present health information, framed in terms of gains from limiting drinking and losses from excess drinking. Control vignettes will present general health information framed in terms of gains or losses. Proxies for behaviour (intentions and self-efficacy) will be assessed with questionnaire items. A Stroop task will be used to assess reactivity to alcohol cues, and an open-ended item will be used to record perceptions of risky drinking. Outcomes will be contrasted with regression models and estimated using Bayesian inference, while qualitative data will be analysed using thematic analysis within a framework analysis.

Ethics and dissemination: Ethical approval for the study was waived by the Swedish Ethical Review Authority on 16 December 2023 based on participants being anonymous (Dnr. 2023-06474-01). The results of the study will be disseminated in an academic journal and research conferences while also informing the design of a national digital alcohol intervention.

Trial registration number: ISRCTN12456514.

Introduction: In critically ill patients, individualised strategies for red blood cell transfusion (RBCT) are lacking. The objective of this study is to demonstrate the potential advantages of employing an individualised transfusion strategy compared with a restrictive approach, in unselected intensive care unit (ICU) patients.

Methods: This will be a randomised, multicentre, international trial. Two open-label parallel groups will be compared with an allocation ratio of 1:1. The trial is designed to investigate the superiority of the individualised intervention group compared with the standard intervention group. The study will be performed in three mixed, academic ICUs located in two different countries. In the individualised group, prescription of RCBT is restricted to patients who present haemoglobin (Hb) ≤9.0 g/dL and oxygen extraction ratio (O₂ER) ≥ 30%, for a minimum Hb value of ≤6.0 g/dL. In the control group, prescription of RBCT is guided by thresholds proposed by recent guidelines, regardless of O₂ER values.

Ethics and dissemination: This trial is approved by the Comitato Etico Area Vasta Centro della Regione Emilia-Romagna (protocol number 350/2023/Sper/AOUFe/PRBCT, date of approval 18/05/2023) and ethic boards at all participating sites. Our results will be published and shared with relevant organisations and healthcare professionals.

Trial registration number: Clinicaltrials.gov NCT06102590.

Objective: To generate evidence about changes in the research and development (R&D) investment of Chinese chemical pharmaceutical companies before and after the implementation of the national pooled procurement, to respond to the concerns that significant price reductions might negatively affect R&D investment, and to facilitate the evidence-based decision-making for improvement of the national pooled procurement.

Methods: This retrospective study employed the fixed-effects models with robust SEs to analyse the changes in R&D investment intensities of 76 A-share listed Chinese chemical pharmaceutical companies before and after the procurement implementation in 2019. The analyses were based on a panel data set between 2013 and 2022. Subgroup analyses were conducted to account for the heterogeneity of the target companies. The bootstrap hypothesis test method was employed to assess potential variations across the different subgroups.

Results: Following the procurement implementation, the R&D investment intensity (RDI) of the target companies increased by 1.9% (p<0.05) compared with the RDI before the procurement implementation. Successful bidders exhibited a higher RDI of 2.2% (p<0.01) compared with that of the other suppliers. The RDI of companies engaged in traditional Chinese medicine (TCM) production was found to be 2.4% lower (p<0.01) than that of companies not involved in TCM production. Similarly, the companies engaged in the production of active pharmaceutical ingredients (APIs) had a 1.6% lower (p<0.01) RDI than those not involved in API production.

Conclusions: This study found that the enthusiasm of Chinese chemical medicines companies towards investing in R&D following the medicines regulatory reforms was not suppressed when the pilot pooled procurement was expanded and continued. The overall level of RDI following the pilot was higher than that before the pilot during the entire observation period. The enhanced investment in R&D has been a distinctive feature of Chinese chemical pharmaceutical companies that position themselves with more substantial market competitiveness.

Objectives: To investigate the use of maintenance immunosuppressive treatments following liver transplantation and to compare their risk-benefit profiles in clinical practice.

Design: Retrospective multicentrer cohort study.

Setting: Four Italian regions (Lombardy, Veneto, Lazio, Sardinia).

Methods: Data were integrated from the national transplant information system and administrative claims data from four Italian regions. All adults who underwent incident liver transplantation between 2009 and 2019 were identified and categorised into two groups: cirrhosis or hepatocellular carcinoma (HCC). The trend of immunosuppressive treatment over years was analysed, and their effectiveness/safety profiles were compared using multivariate Cox models (HR; 95% CI).

Main outcome measures: Mortality, transplant reject/graft failure, incidence of severe infections, cancer, diabetes, major adverse cardiovascular events and lipid-modifying agents use.

Results: The study comprised 750 subjects in the cirrhosis cohort and 1159 in the HCC cohort. Over the study years, there was a decline in the use of cyclosporine-CsA, while combination therapy involving tacrolimus with other drugs increased compared with monotherapy. Overall, tacrolimus monotherapy use was slightly over 40% in both groups, followed by tacrolimus+mycophenolate (39.5%-cirrhosis; 30.6%-HCC) and tacrolimus+molecular target of rapamycin inhibitors (mTORi) (8.5%-cirrhosis; 13.3%-HCC). No significant differences emerged in risk-benefit profile of different tacrolimus-based therapies, except for a higher risk of mortality in cirrhosis subjects under tacrolimus monotherapy compared with tacrolimus+mycophenolate (HR: 2.07; 1.17 to 3.65).

Conclusions: The study highlights a shift over time in postliver transplant therapeutic patterns, favouring the use of tacrolimus in combination with mycophenolate or mTORi, rather than monotherapy. Moreover, a potential association between tacrolimus monotherapy and increased mortality in the cirrhosis cohort was identified. Further research is warranted to investigate these findings more deeply and to optimise treatment strategies for liver transplant recipients.