BMJ Open最新文献

{"title":"Basic ENT training for enhanced healthcare worker knowledge, attitudes and practices in a resource-limited setting: a pre-post and post-post cross-sectional study.","authors":"Lufunda Lukama, Colleen Aldous, Sinoya Mbewe, Charles Michelo, Chester Kalinda","doi":"10.1136/bmjopen-2024-086684","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-086684","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnostic errors in ear, nose and throat (ENT) diseases are prevalent among healthcare workers (HCWs) in resource-limited settings, yet comprehensive data that describe HCW knowledge, attitudes and practices (KAP) regarding ENT disease management remains scarce. Further, the impact of basic ENT training on HCW KAP in such settings is largely undetermined.</p><p><strong>Objective: </strong>We assessed HCW KAP before and after basic training in ENT disease management.</p><p><strong>Methods: </strong>This questionnaire-based pre-post-test cross-sectional survey employed HCW training in public hospitals in a resource-limited setting. We conducted a 2-day training, preceded by a pretraining survey, followed by immediate and 5-month post-training assessments using a prevalidated questionnaire. 416 HCWs participated and were selected through probability-proportionate-to-size random sampling. Wilcoxon matched-pairs signed-rank and Kruskal-Wallis tests were used to assess pre-post training KAP variations.</p><p><strong>Results: </strong>At baseline, the median (IQR) percentage knowledge scores for HCWs in general ENT, ear, sinonasal and head and neck disease management were 60 (40), 55 (18), 58.3 (25) and 56 (22.6), respectively. Only 33.8% (133/394) of HCWs had access to an otoscope, 25.5% (101/396) to a headlight and 12.1% (48/397) to a nasal speculum. While 99.2% (390/393) of HCWs considered ENT important, 57.8% (226/391) of them lacked the confidence to correctly diagnose and manage most ENT conditions. At the immediate post-training assessment, HCWs' median knowledge scores increased by 20%, 18%, 25% and 33% for general ENT, ear, sinonasal and head and neck disease management, respectively (p<0.001). Further, the proportions of HCWs consistently performing otoscopy and using ENT guidelines increased from 15.1% (43/284) and 13.8% (48/282) to 35.5 (44/124) and 23.9% (27/113) 5 months post-training.</p><p><strong>Conclusions: </strong>This study underscores the critical need for continuous medical education (CME) to address knowledge gaps and improve HCW attitudes and practices. The findings provide valuable insights for policymakers aiming to enhance ENT healthcare delivery in resource-limited settings.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e086684"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885014","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":"PREVENTion and treatment of incontinence-associated dermatitis through a codesigned manual (PREVENT-IAD): a study protocol for a feasibility cluster randomised controlled trial with a nested process evaluation.","authors":"Sue Woodward, Tanya Graham, Sangeeta Sooriah, Dimitri Beeckman, Chris Chatterton, Mandy Fader, Francesca Fiorentino, Joanne M Fitzpatrick, Ruth Harris, Jan Kottner, Christine Norton, Peter Worsley","doi":"10.1136/bmjopen-2024-092338","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-092338","url":null,"abstract":"<p><strong>Introduction: </strong>Incontinence is commonly experienced by adults who receive care support in a residential facility or in their own home. These individuals are at risk of developing incontinence-associated dermatitis (IAD), which is caused by prolonged and repeated exposure of the skin to urine or faeces. An IAD manual was developed providing an evidence-based clinical algorithm and an e-learning training programme for the prevention and treatment of IAD. The aim of the study is to establish the feasibility of conducting a definitive trial to examine the clinical and cost-effectiveness of the IAD manual. The objectives are to assess recruitment and attrition rates, acceptability of the IAD manual and intervention fidelity.</p><p><strong>Methods and analysis: </strong>A feasibility cluster randomised controlled trial will be conducted in residential nursing homes and in the homes of people receiving formal care support in London and Hampshire, England. A total of six clusters including n=248 participants who are incontinent of urine, or faeces will be included. At each intervention site, care staff will be trained to implement the IAD manual over a 6-month period. Quantitative outcomes include IAD incidence and severity, IAD-related pain, satisfaction with care and mental health. A qualitative evaluation of care staff and care receivers' experiences of participation will be conducted. Rates and proportions of each feasibility outcome will be described informing the sample size estimation for a definitive cluster randomised controlled trial. A thematic analysis of the qualitative data will be guided by a logic model detailing potential factors impacting on both the study methodology and adoption of the IAD manual into routine care.</p><p><strong>Ethics and dissemination: </strong>The study received the approval of the Queens Square Ethics Committee Health Research Authority 23/LO/036, (Project ID 296167). Results will be disseminated through peer-reviewed open-access journals and international conferences TRIAL REGISTRATION NUMBER: ISRCTN70866724.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e092338"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885114","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":"Spatiotemporal distribution characteristics and impact factors of hepatitis C in Chongqing, China, 2014-2020.","authors":"Saijuan Chen, Qiuting Wang, Yunyi An, Ying Chen, Hua Liu, Weijie Tan, Xinyun Zhou, Dianguo Xing, Yan Zhang","doi":"10.1136/bmjopen-2023-077935","DOIUrl":"https://doi.org/10.1136/bmjopen-2023-077935","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore the spatial and temporal distribution of hepatitis C and its influencing factors in Chongqing, providing a scientific basis for the relevant departments to formulate targeted preventive measures for the high prevalence of hepatitis C in the region and population.</p><p><strong>Design: </strong>We collected data on hepatitis C cases in Chongqing (located in the southwest of China) from 2014 to 2020, and analysed the spatiotemporal heterogeneity of hepatitis C incidence in different populations and identified factors that might influence the incidence of hepatitis C by constructing a Bayesian spatiotemporal model.</p><p><strong>Settings: </strong>The study subjects included clinically diagnosed cases and confirmed cases of hepatitis C with current address in Chongqing and onset date between 1 January 2014 and 31 December 2020.</p><p><strong>Participants: </strong>The study used aggregated data, including 33 900 clinically diagnosed cases and confirmed cases of hepatitis C.</p><p><strong>Results: </strong>From 2014 to 2020, the high-risk areas of hepatitis C were primarily concentrated in the main and new urban areas of Chongqing. In contrast, the low-risk areas were mainly found in southeast and northeast Chongqing. There was also an increasing trend in the risk of incidence in the low-risk areas. Analysis of different populations revealed that men aged 45-59 years had a higher risk of developing hepatitis C in the main urban area compared with other age groups. Additionally, the risk for this population group showed an increasing trend in the southeast and northeast of Chongqing as well as the main urban area. Among women, the rising trend of hepatitis C risk was stronger for those aged 30-44 years in southeast Chongqing and for those aged 45-59 years in northeast Chongqing compared with other age groups. The analysis of influencing factors found that gross domestic product per capita, population density and the proportion of tertiary industry were associated with an increased risk of hepatitis C.</p><p><strong>Conclusions: </strong>High-risk areas for hepatitis C virus were mainly located in the main and new urban areas of Chongqing, where the male prime-age population was the focus of prevention and treatment. In the future, the relevant authorities should concentrate on high-risk areas and at the same time strengthen screening and serological surveys for hepatitis C in low-risk areas and various populations, and raise public awareness of prevention, so as to reduce the incidence of hepatitis C.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e077935"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885124","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":"Use of complementary and alternative medicine among females with polycystic ovary syndrome in Jordan: a cross-sectional study.","authors":"Oriana Awwad, Mais Saleh, Sana Bardaweel, Ali Alsamydai, Fatma U Afifi, Amal Akour, Renad Abu Tarboosh, Manar Hamdan, Asma Sa'd Basha","doi":"10.1136/bmjopen-2024-088945","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-088945","url":null,"abstract":"<p><strong>Background and objectives: </strong>Polycystic ovary syndrome (PCOS) is a prevalent female reproductive and metabolic disorder. Among patients with chronic conditions, an increasing number have approached complementary and alternative medicine (CAM) to cope with their disease. This study aimed to assess the use of CAM among females with PCOS in Jordan.</p><p><strong>Design, settings and participants: </strong>A cross-sectional study was conducted at one of the largest tertiary centres in Jordan. Adult females with PCOS were interviewed using a data collection tool.</p><p><strong>Outcome measures: </strong>CAM use and the factors associated with its use.</p><p><strong>Results: </strong>A total of 402 women participated in the study, the median-IQR age was 25 (31-21) years. Common PCOS signs/symptoms included menses irregularity (81.8%), fatigue (71.6%) and hyperandrogenism (77.6%). Among all participants, 63.2% used CAM with the most common being herbs (60.4%). The primary sources of information were family and friends (46.1%).Longer duration since diagnosis, having more PCOS signs/symptoms and a higher level of education were factors significantly associated with CAM use (<i>β</i>=1.257, 95% CI=1.018 to 2.552, p=0.034; <i>β</i>=1.146, 95% CI=1.052 to 1.250, p=0.002 and <i>β</i>=1.584, 95% CI=1.054 to 2.379, p=0.027, respectively). Of all the CAM users, 57.5% reported an amelioration in PCOS symptoms; this was significantly associated with the long-term use of CAM (<i>β</i>=12.759, 95% CI=6.789 to 23.976, p<0.001). Just a few participants (9.4%) reported side effects.</p><p><strong>Conclusion: </strong>A variety of CAM approaches were reported by the study population; herbs were the most widely used and accepted by the patients. Considering the primary source of information and the potential interactions of herbal medicine with the standard PCOS treatment, efforts are needed by healthcare providers to better understand the use of CAM among their patients with PCOS.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e088945"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885137","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":"Efficacy of opioid combination versus single opioid for adult cancer pain: a protocol for systematic review and meta-analysis.","authors":"Chi Hoon Maeng, David Hui, Ji-Yeon Kang, Soo Young Kim, Jung Hye Kwon","doi":"10.1136/bmjopen-2024-084829","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-084829","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pain is one of the most common and serious symptoms of cancer. Despite the limitations of dose titration using only one type of opioid, the effects of opioid combinations are poorly understood.</p><p><strong>Methods and analysis: </strong>This study will be conducted in accordance with the Cochrane Handbook of Systematic Reviews of Interventions 6.3. We will search the Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science databases from their inception to June 2023. This review will consider all clinical trials involving patients aged ≥18 years who received opioids for chronic cancer pain. Two reviewers will independently screen and select relevant studies. The intervention will be a combination of opioids, including both strong and weak, to control cancer pain. The comparator will be set as a single opioid, with or without a placebo. For randomised controlled trials, version 2 of the Cochrane tool will be used to assess the risk of bias. For non-randomised studies, the risk of bias will be assessed using a tool for assessing the Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I). The primary outcome will be pain response; if a quantitative synthesis is not appropriate, a synthesis without a meta-analysis will be undertaken. The quality of evidence for each primary outcome will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation guidelines.</p><p><strong>Ethics and dissemination: </strong>Ethical approval was not required for this systematic review and meta-analysis. The findings will be disseminated through peer-reviewed (open-access) journal publications and conference presentations. Given the widespread use of opioid-based cancer pain management in clinical practice, this study is expected to generate significant interest among physicians, many of whom are likely to review and consider the findings in the context of their clinical decision-making.</p><p><strong>Prospero registration number: </strong>PROSPERO CRD42023427299.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e084829"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885105","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":"Interventions to enhance the core competencies of clinical nursing preceptors: a protocol for a systematic review.","authors":"Ke Liu, Shuyi Wang, Xirongguli Halili, Qirong Chen, Minhui Liu","doi":"10.1136/bmjopen-2024-088939","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-088939","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical nursing preceptors (CNPs) teach nursing skills to students in real medical scenarios and develop their professionalism. The adequacy of CNPs' teaching competencies affects the effectiveness of student learning, so it is crucial to seek the best evidence for teaching competency interventions. This report describes a protocol for a systematic review to identify and analyse interventions to enhance the teaching competencies of CNPs. The aims of this systematic review are to (1) summarise the characteristics, quality, effectiveness and limitations of existing intervention programmes that support or train CNPs in teaching competencies; and (2) identify knowledge gaps related to teaching competencies interventions for CNPs, thereby supporting future research on constructing and improving preceptor intervention programmes.</p><p><strong>Methods and analysis: </strong>This protocol follows Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols 2015 checklist. We will report this systematic review following the updated PRISMA 2020 checklist. Between 1 May 2024 and 30 May 2024, we will search PubMed, Web of Science, CINAHL, MEDLINE, EMBASE and ProQuest (Health & Medical Collection). The intervention studies that focus on enhancing and supporting the core competencies of CNPs will be included. The two researchers will conduct the study screening, data extraction and quality appraisal independently. Disagreements will be addressed by discussion or the involvement of a third researcher. We will evaluate the quality of the included studies using the modified Educational Interventions Critical Appraisal Tool. Furthermore, we will label the training programme levels using Kirkpatrick's Four Levels of Training Evaluation Model.</p><p><strong>Ethics and dissemination: </strong>Ethical approval is not applicable to this study. We will share the findings from the study at national and/or international conferences and in a peer-reviewed journal in the field of nurse education.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e088939"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885108","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":"Designing a multicomponent intervention to support caregivers of persons with dementia in primary care in Spain: a qualitative study of family and professional carers.","authors":"Claudia Curto Romeu, Gerard Mora López, Ester Gavaldà Espelta, Núria Brunet Reverté, Alessandra Queiroga Gonçalves, Constanza Jacques-Aviñó, Maria Del Mar Lleixà Fortuño, Maria Ferre Ferrate, Carina Aguilar Martín, Macarena Pozo Ariza, Carme Ferre Grau","doi":"10.1136/bmjopen-2024-091599","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-091599","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to explore experiences of family and professional caregivers of persons with dementia in order to design a tailored community-based support programme.</p><p><strong>Design: </strong>A two-stage study was deployed. First, qualitative research draws on three focus groups. Two of these comprised family caregivers and the third was made up of care provision professionals. Thematic content analysis was conducted by interpretative description for applied practice. Second, an experience-based codesign methodology was applied to design a tailored support programme in accordance with carers' demands and contextual realities.</p><p><strong>Setting and study period: </strong>Rural region in Catalonia, at northeast of Spain. March-June 2019.</p><p><strong>Participants: </strong>We interviewed 12 family caregivers and 8 primary care providers.</p><p><strong>Results: </strong>10 main themes were identified: caregivers' feelings, repercussions of caregiving in caregivers' lives, education about dementia and caring skills, education about time management and self-care, caregivers' needs to receive more information and training, improved patients' follow-up and social assistance and more psychologic support. Finally, three themes related to caregivers' demands: social services resources, multidisciplinary approach programmes and support from other caregivers. From these results, a multicomponent, professionally led community-based intervention was designed. The main components were the following: education and caring skills, professional psychological support, and social and community resources.</p><p><strong>Conclusion: </strong>This study allowed the design of a multicomponent support intervention for family caregivers of persons with dementia aimed at reducing their burden and improving their quality of life in ways consistent with their actual needs and the available local resources.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e091599"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885080","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 maternal systemic lupus erythematosus and infant infection: a population-based cohort study in Sweden.","authors":"Sofie A M Gernaat, Julia F Simard, Maria Altman, Elisabet Svenungsson, Elizabeth V Arkema","doi":"10.1136/bmjopen-2024-090555","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-090555","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of the study are to investigate infection risk in offspring born to women with systemic lupus erythematosus (SLE) compared with offspring born to women without SLE and examine the mediating role of preterm birth.</p><p><strong>Design: </strong>This is a register-based cohort study.</p><p><strong>Setting: </strong>Liveborn singletons born in Sweden, 2006-2021, were included in the study.</p><p><strong>Participants: </strong>1248 infants born to mothers with SLE (≥2 International Classification of Diseases-coded visits in the National Patient Register (NPR) and Medical Birth Register, with ≥1 visit before pregnancy) and 34 886 infants born to women without SLE from the general population were included.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome was any visit for infection in the NPR or anti-infectives in the Prescribed Drug Register. The secondary outcome was hospitalised infection. Infection risks within 72 hours, within 1 month and within 1 year were estimated.</p><p><strong>Results: </strong>SLE offspring had a higher risk of infection in the first 72 hours compared with non-SLE (2.1% vs 1.2%; risk ratios (RR) (95% CI) 1.62 (1.09 to 2.42)), the first month (5.2% vs 4.5%; RR 1.12 (0.88 to 1.43)) and first year of life (38.2% vs 37.2%; RR 1.09 (1.01 to 1.17)). The hospitalised infection risk for SLE offspring was similar to that of non-SLE (5.8% vs 5.5%, first year of life). The percentage of the total effect of maternal SLE on infant infection mediated through preterm birth was 86% for infection in the first 72 hours and 27% in the first year of life.</p><p><strong>Conclusions: </strong>The risk of infection in SLE offspring is most increased in the first 3 days after birth, and a proportion of this association can be explained by preterm birth. To prevent early neonatal infections, maternal SLE could be considered as a risk factor before allowing early discharge from postnatal care.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e090555"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885003","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":"Burden of digestive congenital anomalies among children aged 0-14 years in 204 countries and territories, 1990-2021: results from the Global Burden of Disease Study 2021.","authors":"Xi Luo, Jie Luo, Jinhua Zhao, Jun Du, Deqin Lu, Huajian Gu","doi":"10.1136/bmjopen-2024-093902","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-093902","url":null,"abstract":"<p><strong>Objectives: </strong>We aim to delineate the digestive congenital abnormalities burden in children under 14 years old between 1990 and 2021.</p><p><strong>Design: </strong>We implemented data from the Global Burden of Disease (GBD) 2021 database to evaluate digestive congenital abnormalities burden with different measures in 204 countries and territories from 1990 to 2021. We present precise estimations with 95% uncertainty intervals. In addition, we computed the estimated annual percentage change (EAPC) to examine the temporal patterns of these indicators.</p><p><strong>Setting: </strong>It uses prevalence, deaths and disability-adjusted life years (DALYs) data from the GBD study to analyse this issue.</p><p><strong>Participants: </strong>Patients with digestive congenital abnormalities diagnosis.</p><p><strong>Outcomes: </strong>Total numbers, age-standardised rates (ASRs) of prevalence, mortality and DALYs and their EAPCs were the main outcomes among children aged 0-14 years.</p><p><strong>Results: </strong>In 2021, 2206.79 thousand prevalent cases were reported worldwide, with digestive congenital anomalies accounting for 47.16 thousand deaths and 4324.56 thousand DALYs among children aged 0-14 years. Digestive congenital anomalies prevalence was mitigated by 8.15% between 1990 and 2021, with the global ASR of prevalence declining to 40.09 per 100 000. Digestive congenital anomalies mortality was mitigated by 35.35% between 1990 and 2021, with an ASR of deaths declining to 0.77 per 100 000. The worldwide burden of digestive congenital anomalies decreased by 34.96% in terms of DALYs from 1990 to 2021, with an ASR of 70.44 DALYs per 100 000 population. There was a significant hindrance in the prevalence, particularly among older children. The likelihood of digestive congenital abnormalities peaked during infancy (2-4 years) in all regions.</p><p><strong>Conclusion: </strong>We highlight promising global declines in the digestive congenital anomalies burden among children over the past 32 years. Prevalence, deaths and DALYs associated with these anomalies have shown consistent decreases, although regional variations persist. These findings offer crucial insights for shaping effective prevention and management strategies for paediatric digestive congenital anomalies.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e093902"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885021","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":"Carer strain in post-stroke emotionalism: a cross-sectional analysis.","authors":"Niall Broomfield, Matthew Walters, Robert M West","doi":"10.1136/bmjopen-2024-084079","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-084079","url":null,"abstract":"<p><strong>Objectives: </strong>Post-stroke emotionalism (PSE) is a common, under-researched neurologic symptom of stroke, characterised by frequent crying episodes not under usual social control. Currently, there are no data on carer strain in the context of emotionalism after stroke. We aimed to explore the degree of carer strain in carers of individuals with diagnosed PSE compared with carers of individuals with stroke but no PSE to examine whether carer strain varies with particular characteristics of the cared for individual (patient age, sex, social deprivation, stroke type, functional status, mood status) and to quantify the impact of PSE on carer strain, after accounting for other factors.</p><p><strong>Design: </strong>Cross-sectional observation study.</p><p><strong>Setting: </strong>Nine secondary care stroke units in Scotland, UK.</p><p><strong>Participants: </strong>102 informants of people with stroke.</p><p><strong>Primary and secondary outcome measures: </strong>The Modified Carer Strain Index was completed at 6 months post-stroke as part of the Testing Emotionalism After Recent Stroke (TEARS) longitudinal cohort study between 1 October 2015 and 30 September 2018. Stroke survivor diagnostic status was determined using TEARS-Diagnostic Interview based on published, widely accepted diagnostic criteria of emotionalism.</p><p><strong>Results: </strong>There was little evidence of association between carer strain and sex, age, deprivation level or stroke type of the cared for individual. There was strong evidence that carer strain was associated with both increased functional dependence post-stroke (-0.30 to -0.02, p=0.026) and presence of PSE (0.16 to 1.73, p=0.019).</p><p><strong>Conclusions: </strong>Even after accounting for increased functional dependence, our study data indicates that caring in a PSE context may significantly increase carer strain, comparable to a six-point reduction on the Barthel Index.</p><p><strong>Trial registration number: </strong>NRS Stroke Research Network ID 18980.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e084079"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885090","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}