BMJ Open最新文献

{"title":"Risk prediction models for delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis.","authors":"Juan Li, Lumei Huang, Zhifeng Gu","doi":"10.1136/bmjopen-2025-099350","DOIUrl":"10.1136/bmjopen-2025-099350","url":null,"abstract":"<p><strong>Objectives: </strong>Although several risk prediction models for delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD) have been developed, their suitability for clinical application and future studies remains uncertain. This study aimed to systematically review published studies on risk prediction models for DGE after PD.</p><p><strong>Design: </strong>A systematic review and meta-analysis.</p><p><strong>Data sources: </strong>Chinese databases (such as China National Knowledge Infrastructure, VIP, SinoMed and Wanfang), PubMed, Web of Science, Cochrane Library, Embase and Scopus were searched from their inception to May 2025 to identify studies describing DGE prediction models.</p><p><strong>Eligibility criteria: </strong>All observational studies that developed DGE prediction models for post-pancreatectomy patients were included. Eligible models were required to incorporate at least two predictive variables. Studies were excluded if they were unpublished, not available in English or Chinese or lacked sufficient methodological details regarding study design, model development or statistical analysis.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently screened eligible studies and extracted relevant data. The risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool. A random-effects meta-analysis was conducted to estimate the pooled area under the curve (AUC). Heterogeneity among studies was evaluated using the I² statistic and Cochran's Q test, and publication bias was assessed through Egger's regression test and funnel plot symmetry. Additionally, to evaluate the robustness of the findings, leave-one-out sensitivity analyses were conducted.</p><p><strong>Results: </strong>This systematic review included 12 studies (n=24 453), with reported incidences of DGE after PD ranging from 11.7% to 37.9%. Most studies had a high overall bias risk, primarily due to retrospective designs and inadequate model validation. Pooled analysis showed moderate predictive accuracy (AUC=0.728, 95% CI 0.678 to 0.778) with moderate heterogeneity (I² = 32.6%). No significant publication bias was detected (Egger's p=0.12), and sensitivity analyses supported the robustness of the findings (AUC=0.70-0.77).</p><p><strong>Conclusions: </strong>Current risk prediction models for DGE after PD remain in the preliminary stages of development and generally exhibit a high risk of bias. Future efforts should focus on developing models with strong prediction performance, low bias risk and convenience for clinical application.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e099350"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term effects of a virtual, community-based, task-oriented group exercise programme incorporating a healthcare-community partnership compared to a waitlist control on increasing everyday function among adults with mobility limitations: protocol for the TIME™ at Home randomised controlled trial.","authors":"Nancy Margaret Salbach, C Allyson Jones, Ruth Barclay, Heidi Sveistrup, Lisa Sheehy, Mark T Bayley, Elizabeth L Inness, Jean Michelle Legasto-Mulvale, Renato Barbosa Dos Santos, Joyce Fung, Rahim Moineddin, Robert W Teasell, Margot Catizzone, Nina Hovanec, Jill I Cameron, Sarah Munce, Jennifer O'Neil, Susan B Jaglal, Gayatri Aravind, Tai-Te Su, Heather M Hanson","doi":"10.1136/bmjopen-2025-102694","DOIUrl":"10.1136/bmjopen-2025-102694","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;While group, task-oriented, community-based exercise programs (CBEPs) delivered in-person can increase exercise and social participation in people with mobility limitations, challenges with transportation, cost and human resources, threaten sustainability. A virtual delivery model may help overcome challenges with accessing and delivering in-person CBEPs. The study objective is to estimate the short-term effect of an 8-week, virtual, group, task-oriented CBEP called TIME™ (Together in Movement and Exercise) at Home compared with a waitlist control on improving everyday function in community-dwelling adults with mobility limitations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;A randomised controlled trial incorporating a type 1 effectiveness-implementation hybrid design is being conducted in four Canadian metropolitan centres. We aim to stratify 200 adults with self-reported mobility limitations by site, participation alone or with a partner, and functional mobility level, and randomise them using REDCap software to either TIME™ at Home or a waitlist control group. During TIME™ at Home classes (2 classes/week, 1.5 hours/class), two trained facilitators stream a 1-hour exercise video and facilitate social interaction prevideo and postvideo using Zoom. A registered healthcare professional at each site completes three e-visits to monitor and support implementation. Masked evaluators with physical therapy training evaluate participants and their caregivers at 0, 2 and 5 months using Zoom. The primary outcome is the change in everyday function from 0 to 2 months, measured using the physical scale of the Subjective Index of Physical and Social Outcome. The study is powered to detect an effect size of 0.4, given α=0.05, power=80% and a 15% attrition rate. Secondary outcomes are mobility, well-being, reliance on walking aids, caregiver assistance, caregiver mood, caregiver confidence in care-recipient balance and cost-effectiveness. A multimethod process evaluation is proposed to increase understanding of implementation fidelity, mechanisms of effect and contextual factors influencing the complex intervention. Qualitative data collection immediately postintervention involves interviewing approximately 16 participants and 4 caregivers from the experimental group, and 8 participants and 4 caregivers from the waitlist control group, and all healthcare professionals, and conducting focus groups with all facilitators to explore experiences during the intervention period. A directed content analysis will be undertaken to help explain the quantitative results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;TIME™ at Home has received ethics approval at all sites. Participants provide verbal informed consent. A data safety monitoring board is monitoring adverse events. We will disseminate findings through lay summaries, conference presentations, reports and journal articles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration number: &lt;/strong&gt;NC","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e102694"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brolucizumab efficacy and safety single-arm descriptive trial in patients with persistent diabetic macular edema (BEST study): protocol for a single-centre, open-label, single-arm clinical trial in China.","authors":"Ziyi Huang, Yunyan Hu, Chenxiao Shen, Jing Li, Anyi Liang, Ying Fang, Jiahui Zeng, Huiyi Liao, Chunwen Zheng, Shuyi Ouyang, Yijun Hu, Dan Cao, Honghua Yu","doi":"10.1136/bmjopen-2025-099551","DOIUrl":"10.1136/bmjopen-2025-099551","url":null,"abstract":"<p><strong>Introduction: </strong>Persistent diabetic macular edema (DME) with inadequate responsiveness to conventional inhibitors of vascular endothelial growth factor (VEGF) has caused significant vision loss and substantial treatment burdens. Brolucizumab is a new-generation anti-VEGF agent with better anatomical efficacy and prolonged duration of action. This single-centre, open-label, single-arm design clinical trial aims to evaluate the efficacy and safety of intravitreal brolucizumab 6 mg in Chinese subjects with persistent DME.</p><p><strong>Methods and analysis: </strong>A total of 52 adult subjects with persistent DME will be recruited from Guangdong Provincial People's Hospital. All study eyes will receive three consecutive 6 mg brolucizumab injections at intervals of 6 weeks. Disease activity assessment (DAA) will be arranged at week 18, and if disease activity is detected, subjects will continue with dosing of brolucizumab every 6 weeks (at weeks 18 and 24). Otherwise, the dosing will be adjusted to every 12 weeks (at week 24). The primary endpoints will be the proportion of patients with central subfield thickness (CST) <300 µm and the proportion of patients with ≥5 letters visual improvement at week 28. The secondary endpoints will involve anatomical changes assessed through multimodal imaging techniques containing optical coherence tomography (OCT), OCT angiography (OCTA), ultrawide-field fundus photograph (UWFP), ultrawide-field fluorescein angiography (UWFFA), as well as safety assessment. Additionally, aqueous samples will be collected and cytokine levels will be assessed for exploratory analysis.</p><p><strong>Ethics and dissemination: </strong>This study has been approved by the Ethics Review Committee of Guangdong Provincial People's Hospital (KY2024-319). This study will be conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki and that are consistent with the ICH E6 guidelines for Good Clinical Practice and the applicable regulatory requirements. The study results will be submitted to a peer-reviewed journal and presented at both local and international congresses.</p><p><strong>Trial registration number: </strong>NCT06498050.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e099551"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of antibiotic prescribing for respiratory tract infection on future consultations in primary care: a systematic review and meta-analysis.","authors":"Ibrahim Adamu, Amanda Lambert, Safiyya Bello, Fatima Aminu Abdulmalik, Tom Marshall","doi":"10.1136/bmjopen-2025-099357","DOIUrl":"10.1136/bmjopen-2025-099357","url":null,"abstract":"<p><strong>Objectives: </strong>Prescribing antibiotics may reinforce patients' beliefs that antibiotics are needed and increase future consultations for similar symptoms. This review determines the effect of antibiotic prescribing for respiratory infections in primary care on future reattendance.</p><p><strong>Design: </strong>A systematic review and meta-analysis of randomised controlled trials (RCTs) and cohort studies and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Participants were adults or children presenting with respiratory infection in primary care.</p><p><strong>Data sources: </strong>MEDLINE (Ovid), PubMed, Embase, the Cochrane Central Register of Controlled Trials, clinical trial registries and grey literature sources were searched from inception until 6 February 2024.</p><p><strong>Eligibility criteria: </strong>Eligible studies included open-label RCTs or cohort studies of antibiotics compared with no antibiotics in adults or children with respiratory infections. The outcome of interest was reattendance at least 28 days after the initial consultation.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently screened, selected, assessed the quality and extracted data. Separate meta-analyses were presented for RCT and cohort studies and a combined meta-analysis of all studies.</p><p><strong>Results: </strong>We identified 2128 records and reviewed 48 full texts, of which five met the inclusion criteria. These reported three RCTs (1207 randomised to antibiotics, 672 controls) and three cohort studies (209 138 exposed to antibiotics, 46 469 controls). In the meta-analysis of RCTs, relative risk (RR) of reattendance with antibiotics was 1.10 (95% CI: 0.99 to 1.23), and in cohort studies, RR was 1.21 (95% CI: 0.94 to 1.49). An important limitation is that most studies were in UK primary care.</p><p><strong>Conclusion: </strong>Evidence suggests prescribing antibiotics for acute respiratory tract infections in primary care probably modestly increases future reattendance for similar conditions. Reducing antibiotic prescribing may help decrease demand for primary care.</p><p><strong>Prospero registration number: </strong>CRD42023470731.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e099357"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling non-communicable diseases among pregnant women in a lower-middle-income country and the feto-maternal outcomes: a descriptive cross-sectional study.","authors":"Anne Thushara Matthias, Probhodana Ranaweera, Hiruni Abeysinghe, R Prathapan, Shanilka Marious, Madura Jayawardena, Rasika Herath, Rukshan Cleophas Fernandopulle, Ajith Fernando, Dhammike Silva, Shameera Ruwan Chamara, Shamini Prathapan","doi":"10.1136/bmjopen-2024-098178","DOIUrl":"10.1136/bmjopen-2024-098178","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine the prevalence of non-communicable diseases (NCDs) among pregnant women in Sri Lanka and examine the association between NCDs and maternal and fetal outcomes.</p><p><strong>Design: </strong>A hospital-based, descriptive cross-sectional study.</p><p><strong>Setting: </strong>The study was conducted in three tertiary care hospitals in the Western Province and one intermediate obstetrics care facility in the Southern Province of Sri Lanka, encompassing diverse, multiethnic populations, over 3 months.</p><p><strong>Participants: </strong>Data from 1350 pregnant women were collected from discharged bed head tickets of the postnatal obstetric wards using a standardised checklist.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcomes were the prevalence of NCDs. Secondary outcomes included associations between maternal NCDs and adverse fetal outcomes such as preterm births and neonatal complications.</p><p><strong>Results: </strong>Among the participants, 68.5% (n=926) had one or more NCDs, with anaemia (37.9%), obesity (18.1%), gestational diabetes mellitus (14.9%) and hypertensive disorders (13.6%) being the most prevalent. Women with NCDs were at significantly higher odds of adverse fetal outcomes, including preterm birth (OR=2.3, 95% CI: 1.5 to 3.4), neonatal sepsis (OR=2.5, 95% CI: 1.5 to 4.04) and hypoglycaemia (OR=3.5, 95% CI: 1.2 to 10.0). Maternal complications, including postpartum haemorrhage (3.3%) and placental abruption (0.7%), were also more frequent in this group.</p><p><strong>Conclusions: </strong>NCDs are highly prevalent among pregnant women in Sri Lanka and are significantly associated with adverse maternal and fetal outcomes. Enhanced screening and management strategies during antenatal care are essential to mitigate risks and improve health outcomes, aligning with global efforts to reduce maternal and neonatal morbidity and mortality.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e098178"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of QT interval prolongation in patients receiving bedaquiline for drug-resistant tuberculosis in Sub-Saharan Africa: a protocol for systematic review and meta-analysis.","authors":"Morrish Okello-Obol, Ivaan Pitua, James Nelson Okema, Doris Ekwem, Felix Bongomin, Ronald Olum","doi":"10.1136/bmjopen-2024-096709","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-096709","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberculosis (TB) remains a major public health challenge in Sub-Saharan Africa, exacerbated by the high prevalence of drug-resistant TB (DR-TB) and its strong association with HIV. Bedaquiline (BDQ), approved by the WHO in 2013, offers a promising treatment for DR-TB, including multidrug-resistant TB (MDR-TB) and extensively DR-TB (XDR-TB). However, BDQ has been associated with QT interval prolongation, a condition that can lead to serious cardiac arrhythmias such as torsades de pointes. This systematic review and meta-analysis aims to quantify the incidence of QT interval prolongation in patients receiving BDQ for DR-TB in Sub-Saharan Africa and identify predictors of this adverse effect.</p><p><strong>Methods and analysis: </strong>We will conduct a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science and African Journals Online using medical subject headings and keywords related to 'BDQ', 'DR-TB', 'QT interval prolongation' and 'Sub-Saharan Africa'. Eligible studies will include randomised controlled trials, cohort studies, case-control studies and observational studies conducted in Sub-Saharan Africa. Study titles and abstracts will be initially screened, and full texts will be retrieved and reviewed against eligibility criteria. Relevant data will be extracted from the selected articles and assessed for risk of bias. The primary outcome will be the pooled incidence of QT interval prolongation. Data will be synthesised using a random-effects model meta-analysis if significant heterogeneity is present; otherwise, a fixed-effects model will be applied.</p><p><strong>Ethics and dissemination: </strong>This study will use published data, requiring no ethical approval. Findings will be disseminated through peer-reviewed publications and conference presentations to inform clinical guidelines and DR-TB treatment policies in Sub-Saharan Africa.</p><p><strong>Prospero registration number: </strong>CRD42024560368.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e096709"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Instruments for measuring fatigue in patients with brain tumours: protocol for a COSMIN--based systematic review.","authors":"Zefeng Xiao, Yan Luo, Zhouning Li, Liwei Wang, Shuji Li, Zhou Zhou, Tuanbiao Nie, Wenjing Hong, Shuyi Wang, Rui Wang","doi":"10.1136/bmjopen-2024-098711","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-098711","url":null,"abstract":"<p><strong>Introduction: </strong>Cancer-related fatigue occurs at high rates and can harm patients' quality of life and even reduce survival, especially in patients with brain tumours. Many measures have been developed to assess this condition, but there have been no systematic reviews evaluating the metrological properties of these tools, and it is difficult to determine the measures with optimal properties and the conditions under which they should be applied. Therefore, we need to collect existing evidence and choose the most reasonable instrument. Our aim is to identify all instruments used to measure fatigue in patients with brain tumours and identify gaps in them by assessing measurement properties and methodological quality.</p><p><strong>Methods and analysis: </strong>This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 checklist. Future systematic review reports will be based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and patient-reported outcome measures (PROMs) and PRISMA 2020 statement guidelines. Five databases (PubMed, CINAHL, PsycARTICLES, Embase and Ovid MEDLINE) will be searched between 1 January 2025 and 31 January 2025 to screen for instruments assessing fatigue in patients with brain tumours. Two researchers will independently complete literature screening, data extraction and literature evaluation, and any differences will be resolved through discussion with the participation of a third researcher. The methodological quality and instrument characteristics of included studies will be assessed according to COSMIN risk of bias guidelines.</p><p><strong>Ethics and dissemination: </strong>Ethical approval is not applicable. We will disseminate the findings from the study at national and/or international conferences and in a peer-reviewed journal in the fields of oncology nursing and/or neurosurgery.</p><p><strong>Prospero registration number: </strong>CRD42024530318.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e098711"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighbourhood deprivation and quality of comprehensive diabetes care: findings from a national retrospective cohort study of US Medicare Advantage enrollees.","authors":"Beau Blass, Hannah Mahoney, Jay B Lusk, Amy G Clark, Leonor Corsino, Bradley G Hammill","doi":"10.1136/bmjopen-2024-092971","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-092971","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the association between neighbourhood socioeconomic deprivation and outcomes reflecting comprehensive diabetes care (CDC).</p><p><strong>Design: </strong>Retrospective cohort study SETTING: US Medicare Advantage (MA) data, 2015-2020.</p><p><strong>Participants: </strong>National sample of MA enrollees with diabetes.</p><p><strong>Outcome measures: </strong>Primary outcomes included six indicators of CDC from the Healthcare Effectiveness Data and Information Set: haemoglobin (Hb) A1c (HbA1c) testing, HbA1c control (<8%), HbA1c poor control (>9%), blood pressure control (<140/90 mm Hg), receipt of eye exams and medical attention for nephropathy.</p><p><strong>Results: </strong>There were 827 227 enrolments included in the final analysis. After adjusting for demographic (age, sex, race/ethnicity and dual eligibility) and regional characteristics (rurality and primary care providers per capita), high neighbourhood deprivation was associated only with worse glycaemic control (for HbA1c>9%, risk ratio (RR) 1.04, 95% CI 1.02 to 1.07). This relationship was significant for white and Asian patients (RR 1.08, 95% CI 1.05 to 1.11 and RR 1.18, 95% CI 1.05 to 1.32, respectively); outcomes for black and Hispanic patients were worse overall but independent of neighbourhood deprivation (RR 1.00, 95% CI 0.96 to 1.05 and RR 0.98, 95% CI 0.94 to 1.03, respectively). In the fully adjusted model, neighbourhood deprivation was not associated with measures that directly reflect access to care, including the occurrence of HbA1c testing and receipt of eye exams (RR 0.99, 95% CI 0.94 to 1.04 and RR 1.03, 95% CI 1.00 to 1.05).</p><p><strong>Conclusions: </strong>An increased risk of poor glycaemic control was observed for patients from areas of high neighbourhood deprivation, independent of individual socioeconomic status. Neighbourhood factors and their intersection with racial and ethnic disparities are important considerations for achieving equity in diabetes care.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e092971"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between e-cigarette use, physical activity and cardiorespiratory fitness: protocol for a systematic review.","authors":"Hayley Thode, Javad Heshmati, Hassan Mir","doi":"10.1136/bmjopen-2025-101489","DOIUrl":"10.1136/bmjopen-2025-101489","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the rise in popularity of e-cigarette smoking or 'vaping', its long-term health consequences are still being investigated. In particular, it is unclear what impact e-cigarette use has on aerobic performance and exercise capacity. This information has important implications both for tobacco smokers as a harm reduction approach, and youth and young adults who are increasingly turning to e-cigarettes recreationally. Thus, this review aims to systematically evaluate the literature surrounding the effects of regular e-cigarette use on markers of cardiorespiratory fitness and physical activity.</p><p><strong>Methods and analysis: </strong>This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. A systematic search was undertaken in October 2024, using the defined population, intervention, comparison, outcomes, study time framework to identify all relevant articles. Studies will be eligible if they include individuals who use e-cigarette products, assess regular e-cigarette use as an exposure, compare to a group of non-users and report outcomes related to measures of cardiorespiratory fitness (eg, VO2max, 6 min walk test) or physical activity (eg, sport participation, meeting weekly physical activity guidelines), regardless of study duration. Searched databases will include PubMed/Medline, Cochrane Library and Embase, with no restriction to date or language of publication. Two reviewers will carry out the title and abstract screening, full text review and data extraction. Risk of bias will be assessed using the Newcastle-Ottawa Scale for non-randomised studies and the Cochrane Risk of Bias Tool (v2) for randomised studies. Study heterogeneity will be assessed using the Q and I² statistic tests. Efforts will be made to conduct a meta-analysis if sufficient data and homogeneity are present. Otherwise, a narrative synthesis will be conducted, focusing on common themes, subgroups and sources of variability.</p><p><strong>Ethics and dissemination: </strong>Ethics approval is not required for this review of previously published or presented data. The results of the review will be disseminated via conference presentations and peer-reviewed publication. Moreover, results of this review may inform public health recommendations and identify areas in the field where further research is needed.</p><p><strong>Prospero registration number: </strong>CRD420250589685.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e101489"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring associations between active school environments and children's physical activity, mental health and educational performance in Greater London primary schools: the Health and Activity of Pupils in the Primary Years (HAPPY) study protocol.","authors":"Bina Ram, Nancy Gullett, Amina Benkhelfa, Mark Cunningham, Mansour Taghavi Azar Sharabiani, Esther van Sluijs, Nadia Siddiqui, Melvyn Hillsdon, Carolyn Summerbell, Miranda Pallan, Sonia Saxena","doi":"10.1136/bmjopen-2025-103463","DOIUrl":"10.1136/bmjopen-2025-103463","url":null,"abstract":"<p><strong>Introduction: </strong>School environments that encourage children to be physically active can embed lifelong positive health behaviours and contribute towards reducing health inequalities. The Health and Activity of Pupils in the Primary Years (HAPPY) study aims to: (1) explore the extent to which the WHO criteria for creating active school environments are implemented by primary schools and (2) examine associations between active school environments and children's physical activity, mental health and educational performance.</p><p><strong>Methods and analysis: </strong>The HAPPY study is a quasi-experimental study comprising: (1) a survey of state-funded Greater London primary schools to identify implementation of the WHO's six criteria and (2) a cross-sectional study to examine associations between schools' active environment score (derived from the school survey) and pupils' physical activity, mental health and educational performance. For our cross-sectional study, we will recruit up to 1000 year-three children (aged 7-8 years). Our primary outcome is accelerometer (GENEActiv) assessed physical activity, our secondary outcomes are parent-reported child mental health (Strengths and Difficulties Questionnaire) and teacher-reported educational performance (age-related expectations). Using multilevel mixed-effects regression models, we will examine associations between the active environment score and physical activity. Physical activity will be included as a measure of acceleration and also different intensities (light, moderate, vigorous). We will repeat this analysis to examine associations between the active environment score and mental health and educational performance. We will adjust for school characteristics and area-level deprivation and include pupil characteristics (eg, sex, ethnic group) as covariates. Clustering at the school level will be included as a random effect.</p><p><strong>Ethics and dissemination: </strong>Ethical approval has been obtained from Imperial College Research Ethics Committee (ref: 6800895). Findings will be disseminated through a summary report to all participating schools, peer-reviewed publications, presentations at national and international conferences and National Institute for Health and Care Research policy briefings.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 7","pages":"e103463"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}