BMJ Open最新文献

Objective: To examine demographic and occupational attributes associated with work-life balance (WLB) satisfaction among physician assistants/associates (PAs) using a national dataset.

Design: This is a cross-sectional study using 2023 national data.

Setting: USA.

Participants: The study included 149 909 board certified PAs who updated, confirmed or verified their profile questions.

Methods: Descriptive and bivariate statistics, followed by multivariate logistic regression, were conducted to identify factors associated with WLB satisfaction among PAs. The primary outcome was a binary variable derived from a 7-point scale assessing PAs' satisfaction with WLB. Responses of 'Somewhat', 'Mostly' and 'Completely' satisfied were coded as 'Satisfied', while 'Neither/Nor', 'Somewhat', 'Mostly' and 'Completely' dissatisfied were coded as 'Not satisfied'. Our analytical sample comprised 86,000 PAs who responded to a question inquiring about their satisfaction with WLB.

Results: Over two-thirds (71.7%) of PAs indicated satisfaction with WLB. The multivariate logistic regression revealed that the types of specialties that PAs practised were among the strongest factors associated with WLB satisfaction. Compared with PAs in primary care, those practising in dermatology (adjusted OR (aOR)=1.83; 95% CI 1.66 to 2.02), general surgery (aOR=1.64; 95% CI 1.48 to 1.83), pain medicine (aOR=1.63; 95% CI 1.41 to 1.89) and hospital medicine (aOR=1.52; 95% CI 1.37 to 1.68) had higher odds of being satisfied with WLB (all p<0.001). Moreover, compared with females, male PAs indicated nearly 25% higher odds of being satisfied with WLB (p<0.001). Lower odds of WLB satisfaction were observed among PAs with any education debt, those seeing more than 40 patients weekly, those working over 40 hours a week, and PAs in their mid- and late-career stages.

Conclusions: Our findings revealed that PAs practising in non-primary care specialties had the highest odds of reporting satisfaction with WLB. Identifying factors strongly associated with PA work-life balance can aid in developing targeted interventions. However, further research is needed to understand the intrinsic and extrinsic factors influencing PAs' WLB.

Objectives: To assess Chinese medical staff's knowledge and attitudes towards insomnia and explore their association with mental health status.

Design: A multicentre cross-sectional survey conducted across hospitals in China using convenience sampling.

Setting: Multiple hospitals across different regions of China; level of care primarily secondary.

Participants: A total of 654 medical staff enrolled from 23 hospitals between April and June 2023, with 420 (64.22%) nurses. Inclusion criteria encompassed hospital staff involved in patient care; exclusion criteria included those on leave or unwilling to participate. Data on sex and ethnicity were collected but not specified in the abstract.

Primary and secondary outcome measures: Primary outcomes included insomnia knowledge and attitudes, assessed by a structured questionnaire. Secondary outcomes encompassed mental health status, measured via the Depression-Anxiety-Stress Scale (DASS)-21 (stress, anxiety and depression). The interactions between these variables were analysed using structural equation modelling (SEM).

Results: Of the participants, 392 (59.94%) reported insomnia symptoms. The median scores for insomnia knowledge and attitudes were 16.0 (range 0-24) and 27.0 (range 7-35), respectively. The median DASS-21 score was 30.0; 189 (28.90%) experienced stress, 400 (61.16%) anxiety and 302 (46.18%) depression. SEM analysis indicated that night shift work (β=-0.101, p=0.024) and job satisfaction (β=-0.258, p<0.001) had direct effects on mental health outcomes.

Conclusions: Medical staff showed limited understanding of insomnia and a high prevalence of stress, anxiety and depression. Targeted education, optimised shift scheduling and accessible mental health support are recommended to promote staff well-being and improve care quality. Nevertheless, the findings should be interpreted with caution because of the cross-sectional design and convenience sampling method.

Objective: To understand how reductions in resource allocation affect food safety services in England.

Design: This longitudinal ecological study analysed secondary observational data.

Setting: England, data at the local authority level.

Participants: Ecological study, without human participants.

Primary and secondary outcome measures: The primary outcome measures were the number of staff, represented by the number of full-time equivalents per capita, number of interventions per establishment, and proportion of hygiene-compliant establishments.

Results: A £1 decrease in food safety expenditure per capita was associated with a 2% (-3.3 to -0.7) decrease in staffing levels and a 1.6% (-3.2 to -0.1) decrease in the number of interventions achieved per establishment. A one-unit reduction in staff was associated with a 42.2% (-80.5 to -11.9) decrease in the number of interventions achieved. No evidence of an association was found between expenditure or staff levels and the proportion of compliant establishments.

Conclusions: Spending reductions negatively affected the capacity of food safety teams to provide key services. Reductions in food safety expenditure significantly affected food hygiene staff levels and service provision. This finding raises concerns about the capacity of food safety teams to operate and the potential for increased public risk of gastrointestinal infections.

Objectives: To compare primary care for depression among patients detected in the first 21 months of the SARS-CoV-2 pandemic to patients detected pre-pandemic, and examine whether depression care was associated with patient characteristics.

Design: Retrospective pre-post study using de-identified data from electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN).

Setting: Primary care clinics enrolled in CPCSSN from 1 January 2018 to 31 December 2021.

Population: Patients with a valid CPCSSN case definition of depression detected between 01 January 2018 and 31 December 2021 were included in the cohort and categorised by detection date (pre-pandemic or during Canadian pandemic waves).

Outcome measures: Primary care encounters, psychotropic prescriptions and selective serotonin reuptake inhibitor (SSRI) prescriptions were observed at 3 and 12 months post-detection. Multivariable regression evaluated associations between patients' depression detection timing and depression care, adjusting for age, sex, rurality, neighbourhood deprivation quintile, province, number of observable comorbidities and pre-detection psychotropic use.

Results: 91 453 patients with depression were identified, of whom 53% were detected pre-pandemic. Patients detected during the pandemic were younger and less comorbid than those detected pre-pandemic. Proportions of patients with any encounter, psychotropic prescriptions and SSRI prescriptions were higher for patients detected during every pandemic wave compared with patients detected pre-pandemic. The adjusted incidence rate ratios (aIRRs) of number of encounters (aIRR=1.15; 95% CI 1.13 to 1.17), psychotropics (aIRR=1.11, 95% CI 1.09 to 1.13) and SSRIs prescribed (aIRR=1.12; 95% CI 1.10 to 1.15) within 3 months of detection were higher among patients detected during the first pandemic wave compared with those detected pre-pandemic. Socio-demographic characteristics had weaker associations with outcomes compared with timing of detection. Results were similar within 12 months of detection.

Conclusion: Overall, primary care for depression was maintained during the pandemic despite challenging circumstances. Increases in paediatric encounter rates and increased prescribing in younger adults warrant further investigation to understand the factors driving these patterns.

Trial registration number: ClinicalTrials.gov NCT05813652.

Introduction: Pre-exposure prophylaxis (PrEP) use among cisgender female sex workers (FSWs), a population at disproportionately high HIV acquisition risk in Uganda, remains suboptimal. Uptake and continued use are constrained by barriers, such as limited clinical hours, long distances to access facility-based PrEP services, and high mobility among FSWs. Community pharmacies may offer a more accessible PrEP delivery model due to extended operating hours and convenient locations. This study aims to evaluate the accessibility and capacity of pharmacies in Kampala, Uganda, to serve as potential sites for PrEP delivery.

Methods and analysis: We will conduct a concurrent mixed-methods study combining geospatial mapping, structured surveys, a discrete choice experiment (DCE), and in-depth interviews (IDIs). First, the study will compare the reach and accessibility of PrEP services through community pharmacies versus public healthcare facilities. To highlight PrEP service reach, we will use geospatial analysis to map pharmacies, PrEP clinics, FSW hotspots (i.e., areas where sex is exchanged), and HIV incidence. We will also calculate a PrEP facility needs ratio (number of PrEP facilities/HIV incidence) for each of Kampala's administrative divisions and estimate travel distance and time to access PrEP services using cost-distance analysis. Perceived accessibility of PrEP services will be assessed through FSW surveys (n=50) and IDIs (n=20-30), guided by Levesque's framework. Then, we will evaluate pharmacy capacity via surveys (n=274) and IDIs (n=20-30), exploring infrastructure, resources, and staff perspectives, informed by the Consolidated Framework for Implementation Research. Additionally, a DCE will be embedded in the pharmacy survey to elicit staff preferences for delivery approaches and analysed using mixed logit models. Finally, we will integrate quantitative and qualitative findings to provide a broad assessment of whether pharmacies are suitable venues for PrEP delivery to FSWs in Kampala. Enrolment will begin by April 2026 for FSWs and July 2026 for pharmacy staff.

Ethics and dissemination: Ethical approval has been obtained from the Infectious Diseases Institute Research Ethics Committee (IDI-REC-2025-175) and the Uganda National Council for Science and Technology (HS6178ES). Written informed consent will be obtained from all participants. We will disseminate study findings through stakeholder meetings, scientific conferences, and peer-reviewed publications.

Introduction: Leprosy remains a significant public health challenge in many low and middle-income countries, including India. People affected by leprosy face multifaceted challenges: physical, psychological, social and economic. In response, donors support self-help groups (SHGs) to improve health, social integration and economic circumstances for marginalised people, including those with leprosy. This study aims to assess the sustainability of SHGs in India after the withdrawal of donor support by examining whether they remain functional and exploring the key factors, barriers and facilitators that influence their long-term social and economic viability.

Objectives: To examine the functionality of SHGs after withdrawal of donor support, and to explore the factors, barriers and facilitators influencing their long-term social and economic sustainability.

Methods: Using qualitative methods, we conducted semistructured interviews with 40 key informants associated with five SHGs formed under the Self-Help Community Development Project implemented in an endemic state of India and funded by The Leprosy Mission Trust India.

Study design: It was an exploratory qualitative study using interviews with SHG members and key informants, situated within the self-help community-based project.

Results: While some SHGs demonstrated resilience and adaptability, others faced challenges such as internal discord, loss of members to migration and lack of access to government schemes. Thematic analysis revealed key drivers and barriers to sustainability and realising the benefits of SHGs, highlighting variations in leadership, governance, economic performance and social engagement across groups.

Discussion and conclusion: SHGs are often sustained after the funding and managerial donor support have been withdrawn. The findings emphasise the importance of strong leadership, community support and external facilitation in sustaining SHGs and enhancing their impact on marginalised populations. This study contributes to understanding the role of SHGs in addressing the socioeconomic challenges faced by individuals affected by leprosy and offers insights for improving their long-term viability.

Objectives: While health services leaders rely heavily on information gathered via environmental scans (ESs) to guide strategic decision-making, formal guidance on how to conduct these scans is notably absent. The purpose of this study was to determine the level of agreement on essential components of a definition and a methodological framework for ESs. The goals were to (1) advance our working definition to a concept definition for ESs and (2) develop a methodological framework to guide health service researchers conducting ESs.

Design and setting: We used a real-time, modified Delphi survey in a virtual platform setting to seek perspectives on statements related to ESs from individuals who were recruited based on having verifiable experience designing or conducting ESs in health services delivery research. Surveylet, an online software, was used to facilitate asynchronous data collection and to determine the level of agreement on the statements with an a priori threshold of 75% set for agreement on each statement.

Participants: 21 panellists provided opinions on 59 statements related to a proposed ES definition and on 69 statements specific to components of a methodological framework for ESs.

Results: Panellists from four countries participated in the survey representing 2 to ≥11 years of experience with ESs and having completed 1 to ≥7 ESs. Agreement was achieved in 28 of the 59 statements related to the ES definition and for 51 of 69 statements related to a methodological framework.

Conclusions: The agreement on many elements deemed essential for a definition of ES support development of a proposed concept definition of ES in health service delivery research. As well, the agreement on components deemed necessary for a methodological framework will help in future development of such a framework to guide stakeholders in the planning and implementation of ESs. These results provide a starting point for a common understanding of ESs in the field of health services delivery research.

Objectives: This scoping review addresses the underexplored issue of abuse of people with mental illnesses by healthcare professionals. We mapped the existing literature to establish the nature, prevalence, contributing factors and experiences of this abuse.

Design: Scoping review based on the Joanna Briggs Institute framework.

Data sources and study selection: We searched MEDLINE, CINAHL Complete, PsycINFO, ProQuest, Web of Science, Cochrane Central Register of Controlled Trials and Ichushi-Web during the period from 3 July to 22 August 2024. Eligible studies reported abuse of people with mental illnesses by healthcare professionals, with no restrictions on year or language.

Data extraction and analysis: Two reviewers independently extracted data from the selected articles. The data were synthesised to examine prevalence, associated factors and experiences of people with mental illnesses.

Findings: Of 5793 records, 61 met the inclusion criteria, with 32 from the USA and Japan (16 from each). Abuse types reported across 17 countries included physical, psychological, sexual and economic abuse, neglect and human rights violations. Histories of physical and sexual abuse were frequently reported as possible contributing factors to further abuse. Recommendations for prevention were identified at multiple levels, including individual care, organisational and institutional systems, and broader policy and society.

Conclusions: This review mapped the literature on abuse by healthcare professionals in mental health services and identified critical research gaps, including a lack of methodologically robust studies. Further research is needed to build an evidence base for prevention strategies and to establish institutional safeguards.

Objective: To examine the associations between food-related behaviours and nutrient intake on nutritional status among clients undergoing Community-Based Treatment and Rehabilitation (CBTaR) in Kelantan, Malaysia.

Design: Cross-sectional analytical study.

Setting: Seven CBTaR centres (n=7) across the state of Kelantan, Malaysia.

Participants: A total of 393 adult clients (aged 18 years and above) enrolled in CBTaR programmes between June and December 2022 were selected through stratified random sampling.

Primary and secondary outcome measures: The primary outcome was nutritional status, assessed using body mass index. Secondary outcomes included nutrient intake (macronutrients and micronutrients) and food-related behaviours (emotional eating, external eating, restrained eating and food addiction), measured through Bahasa Malaysia validated questionnaires and 24-hour dietary recalls. All variables were introduced into the structural equation modelling to examine the associations among these variables and their association with nutritional status.

Results: The results revealed that food-related behaviour was significantly associated with the nutrient intake (β=-0.524, p≤0.001). Additionally, the drug use profile significantly determined the food-related behaviour (β=-0.129, p=0.006) and nutritional status (β=-0.134, p=0.007). Nutrient intake was found to be a significant predictor of nutritional status (β=-0.213, p≤0.001). Sociodemographic and drug use profiles were significantly correlated with nutritional outcomes through behavioural and dietary associations. Importance-performance map analysis identified nutrient intake as the most impactful variable, highlighting the need for urgent intervention (R²=0.272).

Conclusions: This study highlights that nutrient intake is a significant predictor associated with food-related behaviours on nutritional status among individuals with substance use disorder. Integrating nutrition counselling and behavioural interventions into CBTaR services may improve recovery and long-term health outcomes.

Objectives: The study aims to evaluate the cost of managing psoriasis and its comorbidities across multiple medical departments and to identify cost determinants based on patient, disease and treatment characteristics. Additionally, it compares the cost of care with reimbursements under the fee-for-service (FFS) system to assess how well they reflect patient-specific care needs.

Design: Seven-step, time-driven activity-based costing (TD-ABC) analysis based on direct observations and interviews to generate patient-level cost estimates over the full cycle of care for participants prospectively enrolled in a clinical trial.

Setting: An integrated practice unit (IPU) at a Belgian University Hospital, centred around the treatment of psoriasis, including the management of associated comorbidities.

Participants: A total of 52 patients meeting the trial's inclusion criteria, enrolled between January 2023 and November 2023, undergoing treatment within the IPU.

Results: The individual cost of care over a 6-month period ranged from €169.78 to €1454.97, highlighting significant variability. Major cost drivers included mental health status and disease severity. Additionally, the presence of one or more comorbidities had a substantial impact on care costs, affecting not only expenses directly related to comorbidity management but often also those associated with dermatological care. Finally, a comparison between the TD-ABC cost variability and reimbursement tariffs variability revealed disparities, indicating that current tariffs do not sufficiently account for patient-specific cost differences.

Conclusions: Healthcare delivery and costing studies often adopt a fragmented approach, limiting cost insights into the full cycle of care for a medical condition. The TD-ABC methodology can address this gap by generating detailed, patient-level cost estimates for both primary illness management and related comorbidities. Our findings underscore the importance of including comorbidity-related costs when discussing a condition's overall economic burden while also revealing significant cost variability among patients with the same disease. Notably, these variations are not sufficiently addressed by the current FFS reimbursement system.

Trial registration number: NCT05480917 (ClinicalTrials.gov).