BMJ Open最新文献

{"title":"Optimisation of services to prevent dental caries for school-aged children in China: a discrete choice experiment.","authors":"Lidan Wang, Zhu Chen, Sixuan Chen, Xinyu Jin, Lu Hu, Jiacheng Jiang, Hong Yu, Jianguang Xu, Wenhua Xu","doi":"10.1136/bmjopen-2024-084776","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-084776","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study is to analyse the preferences of guardians of school-aged children for children's caries prevention services (CPS) and their willingness to pay (WTP) for different levels of attributes.</p><p><strong>Design: </strong>Four key attributes were identified through a literature review and expert consultations: preventive service time, preventive effectiveness, distance (driving time to service institution) and service cost (out-of-pocket for CPS). A D-efficient design was used to create a discrete choice experiment questionnaire, and data were collected via face-to-face interviews.</p><p><strong>Setting: </strong>Data collection was conducted between July 2021 and January 2022 in Anhui, China.</p><p><strong>Participants: </strong>Guardians (785) of children aged 3-12 years participated.</p><p><strong>Main outcome measures: </strong>A mixed-logit model was used to estimate preferences and WTP for different attribute levels, and the preference heterogeneity was assessed using a latent class logit model.</p><p><strong>Results: </strong>Preventive effectiveness was the most important attribute, followed by service cost, preventive service time and distance. Guardians preferred CPS with over 90% preventive effectiveness, a distance of 10-25 min, services offered during vacations and lower service cost. Guardians were willing to pay 409 Chinese yuan (CNY) for higher effectiveness, 84 CNY for shorter distances and 87 CNY for services offered during vacation. Guardians with a college education or higher and females prioritise preventive effectiveness, while guardians who had children with a caries history and who had children with better oral health status preferred CPS during vacation.</p><p><strong>Conclusions: </strong>All four attributes influenced guardians' preferences for CPS, with preventive effectiveness being the most important. Guardians were willing to pay extra money for better CPS, and preferences varied according to individual characteristics. These findings provide a reference for policy-makers to provide personalised, demand-based CPS.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e084776"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885112","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":"Readability of online and offline written health information: a protocol of a systematic review of systematic reviews.","authors":"Tsuyoshi Okuhara, Emi Furukawa, Hiroko Okada, Takahiro Kiuchi","doi":"10.1136/bmjopen-2023-079756","DOIUrl":"https://doi.org/10.1136/bmjopen-2023-079756","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare organisations should create and disseminate readable information to citizens and patients to reduce the level of health literacy required for individuals. Several systematic reviews have reported overviews of the readability of written health information for each subject area. This systematic review of systematic reviews will synthesise evidence from existing systematic reviews to provide an overview of studies that assessed readability in diverse areas and identify gaps to be filled in future research and practice to improve the readability of health information.</p><p><strong>Methods and analysis: </strong>The following databases will be searched: PubMed, MEDLINE, CINAHL, PsycINFO, Web of Science Core Collection, Scopus, Cochrane Database of Systematic Reviews, and Google Scholar. The reference lists of the eligible studies will be searched to identify additional studies. The eligible literature will be systematic reviews of published empirical studies that quantitatively assessed the readability of health information for patients and/or citizens. Two independent reviewers will screen the titles, abstracts and full texts of all identified literature. A lead researcher will extract the data, and a second reviewer will check the results. Discrepancies will be resolved through discussion, and a third reviewer will be involved if necessary. Data, such as the characteristics of the systematic review, characteristics of the reviewed literature in the systematic review, subject area, material characteristics, definition(s) of readability, readability assessment methods, main results and quality assessment, will be extracted. The findings will be synthesised in a numerical summary and a descriptive and narrative review.</p><p><strong>Ethics and dissemination: </strong>This review does not involve any ethical concerns. The results and implications of this systematic review will be disseminated at conferences and in peer-reviewed journals.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e079756"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885121","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":"Theory-based behaviour modification of Asian adults with type-2 diabetes mellitus after participating in a novel telemonitoring system: a qualitative research study.","authors":"Ngiap Chuan Tan, Pei Pei Gong, Cia Sin Lee, Shawn Kuan Liang Goh, Seng Bin Ang, Gerald Choon Huat Koh","doi":"10.1136/bmjopen-2023-080830","DOIUrl":"https://doi.org/10.1136/bmjopen-2023-080830","url":null,"abstract":"<p><strong>Objective: </strong>Telemonitoring (TM) remotely monitors individuals' health. Awareness of personal clinical data has resulted in improved glycaemic control in adults with type-2 diabetes mellitus (T2DM). However, its effects on their health-seeking behaviour remain unclear. This study aims to explore and understand the effects of a multicomponent TM system on self-efficacy in adults with T2DM.</p><p><strong>Design: </strong>A qualitative study using semistructured interviews.</p><p><strong>Setting: </strong>A public primary care clinic which is located at an estate in north-eastern Singapore with a population of about 300 000 multiethnic Asian residents.</p><p><strong>Participants: </strong>21 participants who completed 6 months of TM intervention which included immediate feedback on glucose and blood pressure readings, educational videos on exercise and nutrition, and personalised support with TM nurse when clinical parameters met high glucose or blood pressure thresholds.</p><p><strong>Results: </strong>The health belief model was used to explain the participants' behaviour change, including (1) immediate feedback from TM clinical parameters (blood pressure and glucose), raised their awareness of their health status and disease control to motivate behaviour change; (2) notification of higher glucose through TM allowed patients to reflect on their recent food consumption and nudged them to select healthier food options; (3) App teleeducation improved health literacy and supported lifestyle changes; (4) cues for action through personalised engagement with TM nurse and via automated reminders and (5) the TM system enhanced self-efficacy by modifying their multifaceted self-care behaviours.</p><p><strong>Conclusion: </strong>TM heightened understanding among adults with T2DM of their potential for health complications and increased awareness of the benefits of proper diabetes management. It also helped lower the barriers to self-management and further enhanced their self-efficacy in self-care. The system and care team provided users with cues for health which was perceived to lead to adapting their lifestyle in order to achieve better health outcomes.</p><p><strong>Clinical trials registration number: </strong>NCT04306770.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e080830"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885131","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":"Assessing the knowledge, attitudes and practices of healthcare staff and students regarding disposal of unwantead medications: a systematic review.","authors":"Janeme Lam, Dayana El Nsouli, E Lyn Lee, Tawfiq Alqeisi, Ros Kane, Ian McGonagle, Despina Laparidou, David Nelson, Keivan Armani","doi":"10.1136/bmjopen-2024-093636","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-093636","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We sought to review studies that examine healthcare professionals' and students' knowledge, attitudes and practices (KAP) regarding medication disposal. We also explore recommendations and barriers related to appropriate medication disposal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A systematic review was conducted that adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;MEDLINE, Embase, CINAHL, Web of Science, PsycINFO and Google Scholar were searched up to 23 February 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study eligibility criteria and setting: &lt;/strong&gt;Qualitative, quantitative and mixed-method primary research studies. There was no limitation on the publication date, geographical locations or the study settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Pharmacists, doctors, nurses and students from these respective professional groups in any country.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Primary outcome measures: &lt;/strong&gt;The levels of healthcare staff and students' KAPs about disposal of unwanted medications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Date extraction and synthesis: &lt;/strong&gt;Data extraction was conducted by four of the researchers independently. The study details were categorised into three main domains, that is, KAP using the KAP model. Other relevant information was also extracted, and synthesised in overall themes, such as challenges and recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-seven studies from 18 countries (Asia n=21, the USA n=7, Africa n=5, EU n=2, South America n=2) were included. 86.5% (n=32) investigated participants' knowledge of medication disposal. Although there was a good level of awareness about the environmental impacts, there were significant gaps in knowledge regarding correct disposal methods, available services, guidelines and training. Thirty studies explored participants' attitudes towards medication disposal. There was a generally positive attitude towards the need for environmentally safe disposal practices. Thirty-five studies evaluated participants' practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, the majority of the participants did not follow the practice guidelines, especially outside healthcare settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussions and conclusions: &lt;/strong&gt;Although healthcare staff and students have fair knowledge and positive attitudes towards medicine disposal, their actual practices are lacking. One significant challenge identified is the limited awareness about proper disposal methods coupled with a lack of established services or guidelines. Even in cases where take-back programmes are available, they often face issues with accessibility. To tackle these challenges, it is suggested that governmental bodies should establish and enforce clear policies on medication disposal while also expanding educational initiatives to increase understanding among professionals and","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e093636"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142884990","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":"Cluster randomised controlled trial of double-dose azithromycin mass drug administration, facial cleanliness and fly control measures for trachoma control in Oromia, Ethiopia: the stronger SAFE trial protocol.","authors":"Anna R Last, Oumer Shafi Abdurahman, Katie Greenland, Ailie Robinson, Claire Collin, Alexandra Czerniewska, Edao Sinba Etu, Bart Versteeg, Robert Butcher, Meseret Guye, Demitu Legesse, Kedir Temam Nuri, Gemeda Shuka, Munira Haji Mohammed Yousuf, Gaddisa Dheressa, Gebeyehu Dumessa, Melesse Akalu, Mesfin Tadesse, Dereje Adugna Kumsa, Fikre Seife Gebretsadik, Aida Abashawl, Esmael Habtamu, Virginia Sarah, Wondu Alemayehu, Anthony Solomon, Helen Anne Weiss, James G Logan, David Macleod, Matthew J Burton","doi":"10.1136/bmjopen-2024-084478","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-084478","url":null,"abstract":"<p><strong>Introduction: </strong>Trachoma is caused by the bacterium <i>Chlamydia trachomatis</i> (<i>Ct</i>). The WHO recommends the SAFE strategy for trachoma elimination: Surgery for trichiasis, Antibiotics, Facial cleanliness and Environmental improvement. Multiple rounds of SAFE implementation have proven insufficient to eliminate trachoma in Ethiopia, where over 50% of the global trachoma burden remains. More effective antibiotic treatment schedules and transmission-suppressing approaches are needed. The aim of stronger SAFE is to evaluate the impact of a novel package of interventions to strengthen the A, F and E of SAFE on the prevalence of ocular <i>Ct</i> and trachoma in Oromia, Ethiopia.</p><p><strong>Methods and analysis: </strong>68 clusters were randomised in a 1:1:1:1 ratio to one of (1) standard A/standard F&E (standard SAFE), (2) standard A/enhanced F&E, (3) enhanced A/standard F&E or (4) enhanced A/enhanced F&E (stronger SAFE). Enhanced A includes two height-based doses of oral azithromycin (equivalent to 20 mg/kg) given as single doses 2 weeks apart, as mass drug administration, annually. Enhanced F&E includes fly control measures (permethrin-treated headwear and odour-baited traps) and face-washing hygiene behaviour change implemented at household level in selected communities. The interventions will be implemented and reinforced over 3 years.The primary outcome is the prevalence of ocular <i>Ct</i> by quantitative PCR in children aged 1-9 years at 36 months. A key secondary outcome is the prevalence of active (inflammatory) trachoma in the same children, assessed by validated trachoma graders and conjunctival photography. Laboratory technicians and photo-graders are masked to treatment allocation. Other important secondary analyses include process evaluations, assessment of behaviour change, fly indicators, adherence and coverage of interventions and a cost analysis.</p><p><strong>Ethics and dissemination: </strong>Study protocols have been approved by the National Research Ethics Review Committee of the Ethiopian Ministry of Science and Higher Education and the London School of Hygiene & Tropical Medicine Ethics Committee. An independent data safety and monitoring board oversees the trial. Results will be disseminated through peer-reviewed publications, presentations and reports.</p><p><strong>Trial registration number: </strong>ISRCTN40760473.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e084478"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885078","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":"Transforming Households with Refraction and Innovative Financial Technology (THRIFT): study protocol for a randomised controlled trial of vision interventions and online banking among the elderly in Kurigram.","authors":"Sharmin Akter Shitol, Ishrat Binte Aftab, Prabhath Piyasena, Lynne Lohfeld, Sridevi Rayasam, Nagamani Challa, Payal Sangani, Lovemore Nyasha Sigwadhi, H M Masudur Rahman, Rohit C Khanna, Ving Fai Chan, Mrittika Barua, Sonia Pant, Achyuta Adhvaryu, Anant Nyshadham, Malabika Sarker, Asha Latha Mettla, Enam Haque, Greame MacKenzie, Sadiq Alam, Ella Gudwin, Mike Clarke, Abu Shonchoy, Atonu Rabbani, Nathan Congdon","doi":"10.1136/bmjopen-2024-085083","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-085083","url":null,"abstract":"<p><strong>Introduction: </strong>Presbyopia, difficulty in seeing close-ups, affects a billion people globally. Mobile financial services (MFS) have been mandated since January 2021 for Bangladesh government social safety net payments, including old age allowance (OAA) and widow allowance (WA). We report the protocol for the Transforming Households with Refraction and Innovative Financial Technology randomised trial assessing the impact on the use of online banking of providing presbyopic safety net beneficiaries with reading glasses, and brief smartphone and mobile banking app training.</p><p><strong>Methods and analyses: </strong>Eligible participants (n=484) are OAA (men aged 65-70 years; women aged 62-70) or WA recipients (women aged 48-60) with presbyopia as their only vision problem, passing a smartphone-based test of numeracy, cognition and dexterity, and not currently owning a smartphone or independently using MFS. All participants receive smartphones loaded with a mobile banking app and a transaction-tracking app and are randomised 1:1 to receive immediate free near-vision glasses and half-day training for smartphone and banking app use (intervention), or glasses and training 12 months later (control). The primary outcome is the mean quarterly number of mobile bank transactions over the 12-month follow-up period, comparing study groups, with and without adjustment. Secondary outcomes include food security, healthcare access and social connectedness.</p><p><strong>Ethics and dissemination: </strong>The protocol was approved by ethics committees at Queen's University Belfast (reference #MHLS22_69) and BRAC James P Grant School of Public Health (reference #IRB-21 August'22-028). The trial is conducted in accordance with the Declaration of Helsinki and national regulations in Bangladesh, and results will be published in open-access, peer-reviewed journals.</p><p><strong>Trial registration number: </strong>NCT05510687; ClinicalTrials.gov.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e085083"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885133","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":"Understanding cervical cancer prevention in Africa: a qualitative systematic review of the role of men.","authors":"Nancy Innocentia Ebu Enyan, Aigli Raouna, Michelle King-Okoye, Sebastian Ken-Amoah, Patrick Kafui Akakpo, Lawrence Doi, Dorcas Obiri-Yeboah","doi":"10.1136/bmjopen-2023-080416","DOIUrl":"https://doi.org/10.1136/bmjopen-2023-080416","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer (CC) is a preventable noncommunicable disease if detected early through screening for precancers and appropriately managed. The causal link with high-risk human papillomavirus infection is established, making elimination possible through the WHO multipronged 90:70:90 strategy. However, practical CC elimination efforts need to address issues within the sociocultural context that can facilitate or hinder prevention strategies. In this regard, the role of men in promoting reproductive health, especially in Africa, cannot be overemphasised.</p><p><strong>Objective: </strong>This systematic review examined the extent of involvement of men in CC prevention in Africa and its impact on the WHO CC elimination strategy.</p><p><strong>Methods: </strong>A comprehensive search for relevant literature was conducted from 2008 to 2023 in the following electronic databases: Embase, Medline, Global Health, APA PsycINFO, Scopus, Web of Science, CINAHL Plus and the WHO website. Eligible studies explored the views of n=592 men. Screening of abstracts and titles, data extraction and quality assessment were performed in duplicate. A narrative synthesis was performed, as developed by the Economic and Social Research Council Methods Programme, to synthesise the qualitative data.</p><p><strong>Results: </strong>Out of the 1961 studies identified through the electronic database search, 16 met all inclusion criteria. This review revealed varying levels of awareness of CC among men; while some had little to no knowledge, others demonstrated a comprehensive understanding. Gaps in knowledge and perception of CC were evident across studies. Both individual and systemic challenges shaped the perspectives of men on screening as a preventive measure, resulting in a range of attitudes and concerns regarding human papillomavirus vaccination. Though male participation in CC prevention was generally low, it was noted that males were willing to play an active role in CC screening and vaccination by supporting the process. Men believed that aggressive education and awareness creation among men were required.</p><p><strong>Conclusions: </strong>This review highlights the need for targeted interventions to improve awareness, knowledge and perception of CC among men. Such efforts are essential to help men recognise their crucial role in supporting CC elimination within the African context.</p><p><strong>Prospero registration number: </strong>The review protocol was registered on 26 June 2023 in PROSPERO with registration number CRD42023437100.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e080416"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885135","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":"Childhood early oral ageing syndrome: prevalence and association with possible aetiological factors and consequences for the vertical dimension of occlusion: protocol for a cross-sectional study.","authors":"Sandra Gouveia Spinola, Ana Paula Taboada Sobral, Amanda Rafaelly Honório Mandetta, Thais Gimenez, Marcela Letícia Leal Gonçalves, Paulo Vinícius Soares, Elaine Marcilio Santos, José Carlos Pettorossi Imparato, Anna Carolina Ratto Tempestini Horliana, Raquel Agnelli Mesquita-Ferrari, Lara Jansiski Motta, Kristianne Porta Santos Fernandes, Sandra Kalil Bussadori","doi":"10.1136/bmjopen-2024-090085","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-090085","url":null,"abstract":"<p><strong>Introduction: </strong>Childhood early oral ageing syndrome (CEOAS) is a condition involving oral abnormalities resulting from systemic diseases of different origins that are related to the current lifestyle of the paediatric population. Enamel defects associated with intrinsic and extrinsic factors promote the early loss of tooth structure at an accelerated pace, with negative impacts on function, aesthetics and quality of life. The aim of the study is to identify the prevalence of early tooth wear in childhood and its severity using the CEOAS index, which is a tool for the diagnosis of the condition and for epidemiological surveys, involving the investigation of abnormalities of the oral cavity in the paediatric population and possible factors associated with the severity of the condition.</p><p><strong>Methods and analysis: </strong>Children aged 3-6 years will be recruited from the paediatric clinic of Universidade Nove de Julho. Children with amelogenesis imperfecta, dentinogenesis imperfecta and genetic syndromes, as well as those undergoing orthodontic treatment will be excluded. A questionnaire will be administered addressing general health, sleep quality, dietary habits, oral hygiene habits and parafunctional habits. Clinical examinations will then be performed using the novel CEOAS index to assess tooth wear (scores 0-3) and determine the occurrence of enamel defects (scores I-III). The vertical dimension of occlusion (VDO) will also be measured. The CEOAS scores will be computed for the deciduous dentition and analysed statistically, with the significance level set at 5% (p<0.05).</p><p><strong>Ethics and dissemination: </strong>This protocol has been approved by the institutional review board of Universidade Nove de Julho (process number: 6.713.724. Approved on 20 March 2024). The results will be submitted to international peer-reviewed journals and presented at international conferences.</p><p><strong>Trial registration number: </strong>www.</p><p><strong>Clinicaltrials: </strong>gov, NCT06381414. Registered 23 April 2024.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e090085"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885075","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":"Duration, course and caregiver burden of croup in children: two observational cohorts.","authors":"Candice Leigh Bjornson, Alberto Nettel-Aguirre, Janielee Williamson, David W Johnson","doi":"10.1136/bmjopen-2023-080102","DOIUrl":"https://doi.org/10.1136/bmjopen-2023-080102","url":null,"abstract":"<p><strong>Objectives: </strong>Although croup is a common respiratory illness, there is little published regarding symptom course. We aimed to assess symptom progression and caregiver burden, and whether age, sex or season and initial severity of disease are associated with symptom duration.</p><p><strong>Design, setting and participants: </strong>We conducted a secondary analysis of two Canadian prospective cohorts of children 0-16 years old diagnosed with croup; one recruited from a paediatric emergency department (ED) (307 children) between November 1999 and March 2000, and the other from 26 general EDs (1214 children) between September 2002 and April 2006. Baseline data included age, sex, season, corticosteroid treatment and clinical severity score based on the presence or absence of a barky cough, stridor at rest or with agitation and chest wall indrawing (mild, moderate or severe). For both cohorts, the child's primary caregiver was telephoned daily to collect symptom progression and psychosocial data (caregiver stress, lost sleep and work) until the child was symptom-free for over 24 hours.</p><p><strong>Results: </strong>The paediatric and general ED cohorts are reported separately; croup symptoms peaked at initial ED presentation for 96% and 77%, respectively. The longest-lived symptom was a barky cough, resolving by 34 and 47 hours for 50%, and 78 and 119 hours for 90% of children, respectively. Neither sex nor severity at presentation were significantly associated with symptom duration in either cohort. Season of illness was associated in both; age was associated in the general but not the paediatric ED cohort. The primary caregiver lost a mean (SD) of 4.1 (4.9) and 2.8 (4.7) hours of sleep during the illness.</p><p><strong>Conclusions: </strong>Most children with croup presented for care at the peak of symptom severity. Symptoms resolved for half of the children in 1.5-2 days and for 90% in 3-5 days after presentation. Caregivers experienced a significant loss of sleep.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e080102"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885097","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 the role of health literacy among individuals with multimorbidity: a systematic review and meta-analysis.","authors":"Arohi Chauhan, Fernando Gregorio Linares-Jimenez, Girish Chandra Dash, Janine de Zeeuw, Archana Kumawat, Pranab Mahapatra, Andrea F de Winter, Sailesh Mohan, Marjan van den Akker, Sanghamitra Pati","doi":"10.1136/bmjopen-2023-073181","DOIUrl":"https://doi.org/10.1136/bmjopen-2023-073181","url":null,"abstract":"<p><strong>Objective: </strong>To examine existing literature regarding health literacy levels and their association with multimorbidity and the potential underlying mechanisms behind the said association.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>The databases MEDLINE, EMBASE, CINAHL and Science Direct were searched for articles published between 1 January 2000 and 31 October 2023 using a systematic search strategy.</p><p><strong>Eligibility criteria: </strong>Included were all primary studies conducted in people over 18 years old with data on health literacy levels and the presence of multimorbidity. No language restrictions were used.</p><p><strong>Data extraction and synthesis: </strong>Two authors independently extracted data and assessed the bias using the Joanna Briggs Institute critical appraisal tools.</p><p><strong>Results: </strong>We included a total of 39 studies (36 quantitative, two qualitative and one mixed-method), representing 154 337 participants. We found a 32% proportion of limited health literacy among individuals with multimorbidity. Analysis of three articles using the Health Literacy Questionnaire tool (n=31 228) (Pooled OR 2.88 (95% CI 1.92 to 4.31)) and three articles using the Health Literacy Survey Questionnaire-European Union tool (n=35 358) (OR 1.16 (95% CI 1.07 to 1.25)) indicated that people with limited health literacy were likely to have multiple conditions. One of three articles studying underlying mechanisms reported that self-efficacy mediates the association between health literacy and multimorbidity. Additionally, substantial literature identified education and income as the most consistent determinants of health literacy among individuals with multimorbidity. Of the only two articles studying the effectiveness of health literacy-related interventions, both reported an improvement in clinical outcomes after the intervention.</p><p><strong>Conclusions: </strong>Our review demonstrated a consistent association between health literacy and multimorbidity, indicating that people with lower health literacy levels are more likely to have multimorbidity. More evidence is needed regarding the effect of health literacy interventions on multimorbidity.</p><p><strong>Prospero registration number: </strong>CRD42022301369.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"14 12","pages":"e073181"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885136","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}