BMJ Open最新文献

{"title":"PlacEntal Acute atherosis RefLecting Subclinical systemic atherosclerosis in women up to 20 years after pre-eclampsia (PEARLS): research protocol for a cohort study.","authors":"Gwyneth Jansen, Robert-Jan Alers, Emma Bnj Janssen, Laura M Jorissen, Eri Morina-Shijaku, Carmen Severens-Rijvers, Arnoud van 't Hof, J van Drongelen, Ralph R Scholten, Salwan Al-Nasiry, Droima Stevens, Wessel Ganzevoort, Sanne Gordijn, Jérôme Cornette, Casper Mihl, Bas Kietelaer, Chahinda Ghossein-Doha, Marc Ea Spaanderman","doi":"10.1136/bmjopen-2025-100542","DOIUrl":"10.1136/bmjopen-2025-100542","url":null,"abstract":"<p><strong>Introduction: </strong>Despite being a leading cause of female morbidity and mortality, female-specific cardiovascular disease (CVD) is understudied, underdiagnosed and undertreated. Pregnancy complications involving the placenta, including pre-eclampsia, pregnancy-induced hypertension and foetal growth restriction, are thought to reflect global maternal vascular derangements that indicate a twofold to eightfold increased risk of future CVD. This calls for a better understanding of female cardiovascular pathophysiology to allow development of targeted screening and prevention strategies.Acute atherosis is a placental vascular lesion, which histologically resembles systemic atherosclerosis. The PlacEntal Acute atherosis RefLecting Subclinical atherosclerosis study investigates the association between placental acute atherosis lesions and subclinical systemic atherosclerosis up to 20 years postpartum.This study will improve our understanding of the relationship between pregnancy complications and CVD to identify potential prevention targets and treatments. In addition, it could determine whether the placenta can improve identification of young women at high risk of CVD. These women could benefit from risk-reducing interventions.</p><p><strong>Methods and analysis: </strong>This longitudinal prospective cohort study will include women who are either currently pregnant or from a historical cohort. Both groups will have placental histopathology and a single postpartum CVD assessment. The CVD assessment will include medical history taking, blood tests, electrocardiography and echocardiography. Additionally, coronary CT angiography focusing on the presence of atherosclerotic plaques and calcium score will be carried out.The currently pregnant women will either have a pre-eclamptic pregnancy (pre-eclamptic group) or an uncomplicated normotensive pregnancy (uncomplicated group), and their placenta will be collected prospectively. The single CVD assessment will be carried out 6-36 months postpartum.Women from the historical cohort had a pre-eclamptic pregnancy 10-20 years ago. Placental tissue is available for reanalysis. The single CVD assessment will take place immediately and corresponds with 10-20 years postpartum.Exclusion criteria are contraindications to diagnostic assessment necessities: iodinated contrast, beta-blockers or glyceryl trinitrate. Women with uncomplicated pregnancies will be excluded if they have a pre-existing auto-immune condition, chronic hypertension or diabetes mellitus. In the pre-eclamptic group, there are no additional exclusion criteria.</p><p><strong>Ethics and dissemination: </strong>Ethical approval was granted by the Medical Ethics Committee in Maastricht University Medical Centre+ (NL52556.068.15/METC152019). Participants will give written informed consent. Results will be shared in peer-reviewed journals and conference presentations.</p><p><strong>Trial registration number: </strong>NCT05500989; ClinicalTrial","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e100542"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141456","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":"Challenges and opportunities in engaging health development partners in district health planning in Uganda: an exploratory qualitative study.","authors":"Khamisi Musanje, Evelyne B Nywacho, Rachel Faith Mirembe, Joyce Nansamba, Grace Cherotich Ruto","doi":"10.1136/bmjopen-2024-093035","DOIUrl":"10.1136/bmjopen-2024-093035","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore the challenges and opportunities in engaging health development partners in planning healthcare services at a sub-national level in Uganda.</p><p><strong>Design: </strong>An exploratory qualitative study involving selected health development partner organisations and district local governments.</p><p><strong>Setting: </strong>A study was conducted in Northern Uganda, specifically in 12 districts that comprise the Lango and Acholi sub-regions. The study area has many health development partners compared with the other regions in the country.</p><p><strong>Participants: </strong>A total of 18 participants were enrolled in the study. To be considered for inclusion, a participant had to be working for a district local government in Northern Uganda and involved in planning health services or working for a development partner supporting health services in the region. Most of the participants were men aged between 41 and 50 years.</p><p><strong>Outcome measures: </strong>Factors that affect the involvement of health development partners in planning health services at sub-national levels and opportunities that can facilitate involvement.</p><p><strong>Results: </strong>The findings show that health development partners serve as a source of information and data, guide the planning and supervision of services, conduct community mobilisation and support infrastructure development. However, differing planning cycles, corruption, power dynamics and budget constraints affect their participation in district health planning. Continuous engagement, even outside budget periods, with respect to the terms agreed upon in the memoranda of understanding (MOU), equitable treatment of all partners and transparency from all parties emerged as opportunities to improve involvement.</p><p><strong>Conclusion: </strong>The involvement and importance of health development partners in planning district-level health services cannot be overstated. Therefore, addressing the challenges that hinder joint planning through a focus on open communication, mutual respect and adherence to the terms of the MOU can improve working relationships.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e093035"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141355","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":"Household food security and its influence on psychological well-being: a cross-sectional study among adults in slums in Bangladesh.","authors":"A B M Nahid Hasan, Mst Ishrat Jahan Luky, Fahmida Rashid, Most Mahfuja Khanam, Jamal Hossain, Mst Rokshana Rabeya, Azaz Bin Sharif","doi":"10.1136/bmjopen-2024-091640","DOIUrl":"10.1136/bmjopen-2024-091640","url":null,"abstract":"<p><strong>Background: </strong>Rapid urbanisation and the dense population of Bangladesh foster the growth of slum settlements, where poverty and food insecurity are magnified by economic instability and inflationary pressures, adversely affecting psychological health.</p><p><strong>Objectives: </strong>This study aimed to assess household food security and its influence on psychological well-being among adults living in urban slums of Bangladesh.</p><p><strong>Methods: </strong>A cross-sectional study using convenient sampling was conducted among 300 adults in slums in Dhaka, Bangladesh, using a semistructured questionnaire to collect data on sociodemographics, food security and mental health status. Multivariable logistic regression analyses were conducted to observe the influence of food insecurity on mental health status, controlling for other covariates.</p><p><strong>Results: </strong>The majority of the participants experienced food insecurity, with 38.0% expressing severe food insecurity. High levels of psychological distress were observed, including stress (54.7%), anxiety (63.3%) and depression (73.3%). Older adults (aOR 4.5, 95% CI 1.3 to 15.5) and females (aOR 4.1, 95% CI 2.0 to 8.4) had higher odds of experiencing anxiety. Single individuals were more prone to experience depression, while homemakers exhibited elevated levels of both depression and anxiety. Furthermore, moderate to severe food insecurity was significantly associated with higher odds of depression (aOR 2.8, 95% CI 1.2 to 6.7) and anxiety (aOR 8.2, 95% CI 3.3 to 20.3) compared with no or mild food insecurity.</p><p><strong>Conclusions: </strong>This study highlights the pervasive influence of household food insecurity on urban slum dwellers' psychological well-being. Addressing vulnerabilities tied to age, marital status and occupation is crucial for alleviating mental health burdens.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e091640"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141378","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":"Mediation effect of body mass index on the association between glycated albumin and 10-year atherosclerotic cardiovascular disease risk in Hunan residents of China: a retrospective cross-sectional study.","authors":"Xi Zeng, Yangliuzi Hu, Shujuan Xiao, Ni-Ni Chen, Yang Zhou, Miyang Luo","doi":"10.1136/bmjopen-2024-092714","DOIUrl":"10.1136/bmjopen-2024-092714","url":null,"abstract":"<p><strong>Objectives: </strong>Glycated albumin (GA) and body mass index (BMI) are associated with the risk of atherosclerotic cardiovascular disease (ASCVD). However, the role of BMI in the association between GA and 10-year ASCVD risk is still not fully understood.</p><p><strong>Design: </strong>A retrospective cross-sectional study.</p><p><strong>Setting: </strong>In this retrospective cross-sectional study, 4646 healthy subjects who received a full health examination at the Health Management Medical Center, Third Xiangya Hospital of Central South University, from 1 January 2022 to 30 December 2023 were initially identified. According to the exclusion criteria, 2107 participants were included in the final analysis.</p><p><strong>Participants: </strong>The inclusion criteria for this study included (a) age is ≥18 years old and (b) subjects were long-term residents of Hunan province.</p><p><strong>Primary and secondary outcome measures: </strong>The 10-year ASCVD risk was evaluated via the China-PAR equation. The link between GA and 10-year ASCVD risk was examined through a multivariable logistic regression model, and the dose-response relationship was demonstrated using the restricted cubic spline. The potential mediation effect of BMI on this association was explored, and the differences in this mediation effect across age and metabolic-associated fatty liver disease (MAFLD) subgroups were analysed.</p><p><strong>Results: </strong>Elevated GA levels were positively linked to an intensified 10-year ASCVD risk (OR=1.160, 95% CI 1.055 to 1.276). Additionally, BMI was negatively linked to GA and 10-year ASCVD risk. BMI mediated 13.9% of the connection between GA and 10-year ASCVD risk. Specifically, the mediating effect of BMI remained significant in the 40-60-year age subgroup and non-MAFLD subgroup, with mediation ratios of 43.7% and 8.5%, respectively.</p><p><strong>Conclusions: </strong>GA is a key predictor of 10-year ASCVD risk, and BMI partially mediates this relationship in healthy populations. Therefore, targeted weight management is recommended to reduce the adverse effect of GA on 10-year ASCVD risk in different populations.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e092714"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141401","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":"Enhancing the quality and safety of central venous catheter insertion using projection mapping: a prospective observational simulation study with eye-tracking glasses.","authors":"Atsushi Miyazaki, Arisa Fujii, Daisuke Kuwabara, Kazuhiro Minoguchi, Hiromasa Kawakami, Kyota Nakamura, Keiko Tsuchiya, Takeru Abe, Kazue Nakajima, Hitoshi Sato, Takahisa Goto","doi":"10.1136/bmjopen-2024-095803","DOIUrl":"10.1136/bmjopen-2024-095803","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to evaluate the effect of projection mapping (PM) on the quality and safety of central venous catheter (CVC) insertion under real-time ultrasound guidance.</p><p><strong>Design: </strong>Prospective, observational, simulation study.</p><p><strong>Setting: </strong>This study was conducted at the Yokohama City University Medical Center (Yokohama, Japan). Volunteer residents were enrolled over 12 months from January to December 2023.</p><p><strong>Participants and methods: </strong>12 rotating residents (postgraduation year (PGY) 1 and 2) and eight anaesthesia residents (PGY 3-5) placed the CVC in the internal jugular vein in a simulator under the real-time ultrasound guidance using the short-axis out-of-plane approach. The ultrasound image was provided either just caudad to the puncture site using the PM method or on the monitor of the ultrasound machine (conventional method) placed next to the simulator's right shoulder. Each resident performed four punctures alternating between the PM and conventional methods, and the first method for each resident was chosen randomly. Eye-tracking analysis was also used to evaluate differences in gaze behaviour.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome was the procedure time defined as the time from the application of the ultrasound probe on the puncture field until successful puncture of the vein. The secondary outcomes were incidence of complications and eye-tracking analysis data.</p><p><strong>Results: </strong>The time to complete the line placement was significantly shorter for the PM than for the conventional method (median (IQR) 22.5 (15.5-30.6) s vs 30.0 (20.4-95.4) s; p=0.02, Wilcoxon's signed-rank test). The incidence of posterior vessel wall puncture was significantly lower in the PM method (0% vs 25%; p=0.02, McNemar's test). Eye-tracking analysis revealed that the percentage of time spent gazing at the ultrasound image was higher in the PM than in the conventional method (61.6% (55.0-69.2) vs 45.7% (34.1-54.5); p<0.01).</p><p><strong>Conclusions: </strong>The PM method facilitates ultrasound-guided CVC placement while preventing excessive needle advancement in the inexperienced operators. This was accompanied by enhanced fixation of the participants' line-of-sight on the ultrasound image.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e095803"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141450","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":"Support measures and demand among healthcare workers during the COVID-19 pandemic: a survey in high-workload provinces of China, 2023.","authors":"Leji Wen, Jianzhong Zheng, Ni Hu, Weizhuo Xu, Yueting Fang, Sihang Ma, Huifang Xiong, Yicihan Liu, Dongbei Guo, Lei Zhang","doi":"10.1136/bmjopen-2024-088799","DOIUrl":"10.1136/bmjopen-2024-088799","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the demands for support measures of healthcare workers (HCWs) in China's high-workload provinces during the COVID-19 pandemic and identify specific needs to make evidence-based recommendations.</p><p><strong>Design: </strong>Prospective cross-sectional study.</p><p><strong>Setting: </strong>Conducted in three Chinese provinces characterised by their significant healthcare demands during the pandemic.</p><p><strong>Participants: </strong>The study comprised 683 HCWs, including doctors, nurses, resident physicians and hospital administrators. The sample was predominantly female (68.1%), with the majority aged between 25 and 34 years. Participants were recruited through convenience and snowball sampling methods, with a focus on individuals working in high-intensity clinical environments.</p><p><strong>Results: </strong>Hierarchical analysis was performed to assess the layered impact of support measures across different roles and genders. Substantial gender disparity was observed, with female staff reporting significantly reduced access to material support (p<0.001), family counselling (p<0.001) and health management (p<0.05), alongside a generally higher demand for various support types. In contrast, HCWs assigned to COVID-19 units did not exhibit heightened needs for COVID-specific training (p<0.001), material support (p<0.001), stress management (p<0.001), family counselling (p<0.001) or rational shift patterns (p<0.001) compared with those in non-COVID-19-focused roles.</p><p><strong>Conclusion: </strong>The study identifies significant support deficiencies, particularly among female HCWs, and emphasises the necessity for targeted interventions to strengthen healthcare system resilience. Recommendations include prioritising adequate rest, equitable resource allocation and the implementation of gender-oriented policies to ensure workforce sustainability and maintain care quality. Further research should focus on longitudinal support dynamics.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e088799"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141519","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":"Conditioned open-label placebos to facilitate opioid reduction in patients with chronic non-cancer pain: study protocol of a randomised controlled trial.","authors":"Katja Carratta, Kiara Bodonyi, Antje Frey Nascimento, Daniel Friis, Roland von Känel, Lukas Bircher, Helen Koechlin, Michael Bernstein, Konrad Streitberger, Isabelle Arnet, Alfred Josef Roth, Joram Ronel, Elisabeth Olliges, Cosima Locher","doi":"10.1136/bmjopen-2024-098253","DOIUrl":"10.1136/bmjopen-2024-098253","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic non-cancer pain presents a global health problem, with a significant increase in opioid prescriptions over recent decades. However, opioid therapy poses risks of adverse events, overdose and non-medical use. As a result, many patients seek to discontinue or reduce their opioid intake. Strategies for opioid tapering often lack efficacy, prompting the investigation of novel approaches like open-label placebo (OLP), that is, the administration of a placebo with full disclosure that it is a placebo. OLP has shown efficacy in chronic non-cancer pain syndromes and has been suggested as a promising candidate for medication tapering. This study aims to assess whether OLPs can enhance the reduction of daily morphine equivalent dose (MED) in chronic non-cancer pain patients and examines its potential in mitigating opioid withdrawal symptoms.</p><p><strong>Methods and analysis: </strong>This study is designed as a randomised, controlled, single-centre trial. Participants will be randomised into either an OLP group or a control group. The study duration will span six to nine weeks, during which all participants will aim to reduce their opioid intake. Both groups will monitor their opioid intake daily using a diary app and will receive feedback on their progress of reducing opioids. Additionally, participants in the OLP group will receive OLP tablets for the entire study period. During the first week, the OLP group will undergo a one week learning phase using a classical conditioning paradigm, where each opioid intake is paired with a placebo. In the subsequent five weeks, the OLP group will enter a dose-extension phase in which only the first opioid intake of the day is paired with a placebo, and additional placebos can be taken as desired. At the end of the study, qualitative interviews will be conducted with the first 15 participants in the OLP group. The primary outcome measure is daily opioid intake. Secondary outcomes include opioid withdrawal symptoms, pain severity, disability, anxiety, depression, opioid beliefs, intervention expectancy and qualitative data. Statistical analyses will include analysis of covariance and regression models.</p><p><strong>Ethics and dissemination: </strong>The ethics committee of the Canton of Zurich, Switzerland, approved the study (SNCTP-nr.: SNCTP000005853/BASEC nr.: 2023-02327).Participants will be compensated with 100 Swiss Francs for their full participation in the study. Participants who will take part in the qualitative interview will be compensated with additional 15 Swiss Francs.</p><p><strong>Trial registration number: </strong>This study is registered at clinicaltrials.gov: NCT06350786.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e098253"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141359","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":"Impact of polycyclic aromatic hydrocarbon exposure on thyroid hormone sensitivity: a cross-sectional study of urinary metabolites in 2356 adults from NHANES.","authors":"Qingqing Yang, Hui Li, Chenchen Wu, Min Li, Weihua Sun, Xiaolei Hu, Zhaoming Shi, Guoxi Jin","doi":"10.1136/bmjopen-2024-098106","DOIUrl":"10.1136/bmjopen-2024-098106","url":null,"abstract":"<p><strong>Objective: </strong>The current study aimed to compare the relationship between polycyclic aromatic hydrocarbons (PAHs) exposure and thyroid hormone (TH) sensitivity markers in individuals with normal thyroid function in the USA population during 2007-2008 and 2009-2012.</p><p><strong>Design: </strong>Observational cross-sectional study.</p><p><strong>Setting: </strong>US population data from 2007 to 2008 and 2009 to 2012.</p><p><strong>Main outcome measures: </strong>Associations between PAH exposure and TH sensitivity were examined, stratified by sex and age, along with dose-response relationships between PAH metabolites and TH sensitivity indices.</p><p><strong>Results: </strong>In women, after adjusting for confounding variables, 1-hydroxynaphthalene was positively associated with thyroid feedback quantile index of FT4 (TFQI_FT4) (β=0.0072, 95% CI 0.0018 to 0.0127, p=0.022), thyrotropin thyroxine resistance index (TT4RI) (β=0.0099, 95% CI 0.0024 to 0.0173, p=0.021) and thyroid-stimulating hormone index (TSHI) (β=0.0107, 95% CI 0.0038 to 0.0176, p=0.012). Among individuals aged 60 years and older, 1-hydroxyphenanthrene was negatively associated with free triiodothyronine/free thyroxine (FT3/FT4) (β = -0.9328, 95% CI -1.5055 to -0.3602, p=0.014). Dose-response analysis revealed no nonlinear relationships between PAH metabolites and TH sensitivity indices in women or individuals aged 60 years and older. Weighted quantile regression analysis demonstrated that OH-PAHs exerted a statistically significant effect (p<0.05) on TH sensitivity indices, including TFQI_FT4, thyroid feedback quantile index of FT3, TT4RI, hyrotropin triiodothyronine resistance index and TSHI.</p><p><strong>Conclusions: </strong>In the US population with normal thyroid function, PAH exposure may interfere with TH sensitivity, with effects varying by population characteristics.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e098106"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141383","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":"Implications derived from the strengths and weaknesses observed in Iran's primary healthcare programmes during the COVID-19 pandemic: a qualitative interview study.","authors":"Reyhane Izadi, Mohammadtaghi Mohammadpour, Moslem Sharifi, Mohsen Khosravi","doi":"10.1136/bmjopen-2024-093310","DOIUrl":"10.1136/bmjopen-2024-093310","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 outbreak at the end of 2019 severely impacted global healthcare systems, especially primary healthcare services. This paper aimed to identify the implications derived from the strengths and weaknesses observed in Iran's primary healthcare (PHC) programmes during the pandemic.</p><p><strong>Methods: </strong>This was a qualitative study conducted in 2021. 13 semistructured interviews were held with Iranian healthcare policymakers and executive managers, selected via snowball sampling, using the World Health Organization's analytical framework. Finally, a thematic analysis was conducted on the interview data.</p><p><strong>Results: </strong>The thematic analysis of the findings yielded five major themes: revision of healthcare financing, redefining education and research in primary healthcare, redefinition of primary healthcare, development of a new model for family medicine, and community engagement.</p><p><strong>Conclusion: </strong>Addressing vertical inequality in Iran's healthcare system was delineated to be crucial. Meanwhile, multiple strategies including enhancing family physicians' knowledge and skills, decentralising decision-making, empowering them and involving communities in healthcare planning were presented to improve PHC and family medicine. Further empirical research is needed.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e093310"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141396","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":"Temporal trends and patient determinants of geographical variation in oral anticoagulant treatment of atrial fibrillation: a Danish nationwide cohort study in 2013-2022.","authors":"Ina Grønkjær Laugesen, Anders Prior, Flemming Bro, Anna Mygind, Erik Lerkevang Grove","doi":"10.1136/bmjopen-2024-098129","DOIUrl":"10.1136/bmjopen-2024-098129","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate temporal trends in the geographical variation in oral anticoagulant (OAC) treatment of patients with atrial fibrillation, to evaluate the extent to which regional differences in patient populations may explain this difference and to explore whether patient predictors of adherence may have a different impact across regions.</p><p><strong>Design: </strong>Register-based cohort study from 1 January 2013 to 31 December 2022.</p><p><strong>Setting: </strong>The study used data from nationwide health registers to explore differences in OAC adherence across the five administrative regions in Denmark.</p><p><strong>Participants: </strong>Patients with atrial fibrillation and a CHA₂DS₂-VASc score ≥2 (n=291 666).</p><p><strong>Outcome: </strong>Population adherence to OAC treatment operationalised as the proportion of days covered (PDC).</p><p><strong>Results: </strong>A continuous rise in overall adherence (PDC) from 53% to 78% was observed during the study period. Concurrently, the predominant treatment shifted from vitamin K antagonists to direct OACs with a preference for rivaroxaban and apixaban. The adherence variation between the highest-performing and lowest-performing regions decreased from 18% in 2013 to 9% in 2022, whereas the relative between-regions rankings remained unchanged. Applying multivariate Poisson models adjusting for patient demographics, health status and socioeconomic factors did not substantially change the inter-regional variations; this suggests that different compositions of patient populations cannot explain these variations. However, the impact of socioeconomic factors and comorbidities among patients was unequal across regions. In regions with the lowest overall adherence, a higher risk of non-adherence was seen among patients having mental health disorders, low income and living alone.</p><p><strong>Conclusions: </strong>The geographical variation in OAC adherence decreased over time as the overall adherence improved. However, substantial variation remained.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e098129"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141531","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}