BMJ Open最新文献

{"title":"Communication challenges and experiences between parents and providers in South Korean paediatric emergency departments: a qualitative study to define AI-assisted communication agents.","authors":"Sejin Heo, Sohyeong Jeong, Hansol Paeng, Suyoung Yoo, Meong Hi Son","doi":"10.1136/bmjopen-2024-094748","DOIUrl":"10.1136/bmjopen-2024-094748","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore communication challenges between parents and healthcare providers in paediatric emergency departments (EDs) and to define the roles and functions of an artificial intelligence (AI)-assisted communication agent that could bridge existing gaps.</p><p><strong>Design: </strong>A qualitative study using in-depth interviews and affinity diagram methodology to analyse interview data.</p><p><strong>Setting: </strong>A tertiary paediatric ED in South Korea.</p><p><strong>Participants: </strong>11 parents of paediatric patients and 11 ED staff members (physicians, nurses and security personnel).</p><p><strong>Primary and secondary outcome measures: </strong>The study examined parent-provider communication difficulties, emotional responses and situational factors contributing to miscommunication and increased workload for ED staff.</p><p><strong>Results: </strong>The study identified key emotional factors-fear, anger and sadness-that negatively affect communication between parents and ED staff. Parents experienced frustration due to uncertainty, insufficient information and difficulty navigating the ED process. ED staff faced challenges in managing anxious or demanding parents, resulting in increased workload and communication breakdowns.</p><p><strong>Conclusions: </strong>An AI-assisted communication agent could help mitigate these challenges by providing timely information, managing non-medical inquiries and supporting both parents and ED staff at critical stages of the ED visit. Implementing such technology has the potential to improve communication and enhance overall patient care in paediatric emergency settings.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e094748"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal dynamics of pulse wave velocity in the days after acute ischaemic stroke: prospective cohort study.","authors":"Kurt Moelgg, Anel Karisik, Benjamin Dejakum, Silvia Felicetti, Christian Boehme, Lukas Mayer-Suess, Thomas Toell, Michael Knoflach, Stefan Kiechl, Raimund Pechlaner","doi":"10.1136/bmjopen-2024-089304","DOIUrl":"10.1136/bmjopen-2024-089304","url":null,"abstract":"<p><strong>Objectives: </strong>Arterial stiffness as assessed by pulse wave velocity (PWV) improves the prediction of first-ever and recurring stroke and of stroke outcomes when measured in the days after stroke. Here, we investigated the longitudinal dynamics of PWV in the days after acute ischaemic stroke.</p><p><strong>Design: </strong>Monocentric, prospective cohort study nested within a clinical trial registry with repeated measurement assessment of PWV.</p><p><strong>Setting: </strong>Comprehensive middle European stroke centre.</p><p><strong>Participants: </strong>20 men and women that suffered stroke from November 2022 through August 2023.</p><p><strong>Primary and secondary outcome measures: </strong>Change in carotid-femoral PWV was investigated by recording PWV four times between 1.2 and 9.9 days after stroke using a Vicorder device. Haemodynamic and patient-, stroke- and care-related variables were investigated as potential modifiers of PWV trajectories.</p><p><strong>Results: </strong>Twenty patients aged 61.3±16.9 years (14 males) were included. There was a daily decline in PWV of -0.19 m/s (95% CI: -0.29 to -0.09; p<0.001) until approximately 8 days after stroke, corresponding to a total relative decline of -15.5% (95% CI: -22.3 to -8.1; p<0.001). Whereas higher anxiety predicted 0.11 m/s (95% CI: 0.01 to 0.20; p=0.044) slower daily decline, decline was not significantly related to baseline PWV, blood pressures, stroke severity or location, or functional status (all p>0.05). Rank-order correlation between the earliest and latest PWV measurements was 0.87 (95% CI: 0.69 to 0.95; p<0.001).</p><p><strong>Conclusions: </strong>A marked decline in PWV during the first week after acute ischaemic stroke should be accounted for when interpreting PWV after recent stroke.</p><p><strong>Trial registration number: </strong>The STROKE-CARD Registry was registered at ClinicalTrials.gov (NCT04582825).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e089304"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction for 'Effects of a web application based on multimedia animations to support therapeutic exercise for rotator cuffrelated shoulder pain: protocol for an open-label randomised controlled trial'.","authors":"","doi":"10.1136/bmjopen-2024-085381corr1","DOIUrl":"10.1136/bmjopen-2024-085381corr1","url":null,"abstract":"","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e085381corr1"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updating global estimates of pathogen-attributable diarrhoeal disease burden: a methodology and integrated protocol for a broad-scope systematic review of a syndrome with diverse infectious aetiologies.","authors":"Josh M Colston, Thomas G Flynn, Andrea H Denton, Francesca Schiaffino, Shannon E Majowicz, Brecht Devleesschauwer, Carlotta Di Bari, Yuki Minato, Margaret N Kosek","doi":"10.1136/bmjopen-2024-093018","DOIUrl":"10.1136/bmjopen-2024-093018","url":null,"abstract":"<p><strong>Introduction: </strong>Sustaining declines in global infectious disease burden will increasingly require efforts targeted to specific aetiological agents and common transmission pathways, particularly in this era of global change and human interconnectivity accelerating transmission and emergence of infectious pathogens. Systematic reviews and meta-analyses can be an effective and resource-efficient method for synthesising evidence regarding disease epidemiology for a wide range of pathogens and are the evidence source used by initiatives like the Planetary Child Health and Enterics Observatory (Plan-EO) and the WHO to determine the aetiology-specific epidemiology of diarrhoeal disease. Therefore, we developed this integrated systematic review methodology and protocol that aims to compile a database of published prevalence estimates for 17 diarrhoea-causing pathogens as inputs for disease burden estimation.</p><p><strong>Methods and analysis: </strong>We will seek estimates of the prevalence of each endemic enteric pathogen estimated from published population-based studies that diagnosed their presence in stool samples from both asymptomatic subjects and those experiencing diarrhoea. The pathogens include the enteric viruses adenovirus, astrovirus, norovirus, rotavirus and sapovirus, the bacteria <i>Campylobacter</i>, <i>Shigella</i>, <i>Salmonella enterica</i>, <i>Vibrio cholerae</i> and the <i>Escherichia coli (E. coli)</i> pathotypes enteroaggregative <i>E. coli</i>, enteropathogenic <i>E. coli</i>, enterotoxigenic <i>E. coli</i> and Shiga-toxin-producing <i>E. coli</i> and the intestinal protozoa <i>Cryptosporidium</i>, <i>Cyclospora</i>, <i>Entamoeba histolytica</i> and <i>Giardia</i>. Meta-analytical methods for analyses of the resulting database (including risk of bias analysis) will be published alongside their findings.</p><p><strong>Ethics and dissemination: </strong>This systematic review is exempt from ethics approval because the work is carried out on published documents. The database that results from this review will be made available as a supplementary file of the resulting published manuscript. It will also be made available for download from the Plan-EO website, where updated versions will be posted on a quarterly basis.</p><p><strong>Prospero registration number: </strong>CRD42023427998.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e093018"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International consensus-based core outcome set for airway management clinical trials and observational studies: the Airway Terminology and Outcome Measures (ATOM) protocol.","authors":"Jan Hansel, Alexander Fuchs, Gillian Radcliffe, Andreas Sotiriou, Kate Rivett, Vera Bohnenblust, Rosanna Grimes, Markus Fally, Robert Greif, Tim M Cook, Kariem El Boghdadly","doi":"10.1136/bmjopen-2024-096886","DOIUrl":"10.1136/bmjopen-2024-096886","url":null,"abstract":"<p><strong>Introduction: </strong>Airway management describes a range of commonly performed procedures undertaken to enable invasive respiratory support for patients. Studies of airway management interventions report heterogeneous outcomes, impeding evidence synthesis and translation of findings into clinical practice. A core outcome set is a consensus-based standardised minimum collection of outcomes to be reported in a given area of healthcare. The Airway Terminology and Outcome Measures project aims to define a core outcome set and select outcome measurement instruments for future airway management research.</p><p><strong>Methods and analysis: </strong>Following a systematic literature search, we generated a list of candidate outcomes by extracting outcomes and their measurement instruments from a random sample of included studies until saturation was reached and no new outcomes emerged. The search resulted in a long list of 64 outcomes for inclusion in the consensus building stage. Key stakeholders, including patients, clinicians and researchers, will be invited to participate in a multiround modified Delphi process and a panel meeting to finalise the core outcome set and agree to their measurement instruments.</p><p><strong>Ethics and dissemination: </strong>The study was approved by the Health Research Authority and the London - Fulham Research Ethics Committee (24/LO/0544). All participants will provide informed consent. Study findings will be presented as conference proceedings and published in peer-reviewed medical journals.</p><p><strong>Estimated start of this study: </strong>20 November 2024 REGISTRATION NUMBER: COMET 3146.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e096886"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alpha-lipoic acid on intermediate disease markers in overweight or obese adults: a systematic review and meta-analysis.","authors":"Yao Luo, Jizhen Zhang, Hongxia Guo","doi":"10.1136/bmjopen-2024-088363","DOIUrl":"10.1136/bmjopen-2024-088363","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the associations between alpha-lipoic acid (ALA) intake and intermediate disease markers in overweight or obese adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data sources: &lt;/strong&gt;PubMed, EMBASE, Medline, APA PsycINFO, SocINDEX, CINAHL, SSRN, SocArXiv, PsyArXiv, medRxiv, and Google Scholar (from inception to October 2024).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;This study included English-language randomised controlled trials (RCTs) on adults (body mass index ≥25 kg/m²) to assess the impact of ALA on intermediate disease markers. Studies lacking outcome data, duplicates or inaccessible full texts were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data extraction and synthesis: &lt;/strong&gt;Paired reviewers independently extracted the data. We used frequentist meta-analysis to summarise the evidence, employing the DerSimonian and Laird estimator to account for heterogeneity across study designs, settings and measurement methods. Heterogeneity was assessed via the I² statistic with CIs and τ² values. The risk of bias was independently assessed by two reviewers according to the Cochrane Handbook, covering domains such as randomisation, blinding and data completeness. Publication bias was assessed using Begg's test, while funnel plots and Egger's test were applied to outcomes with 10 or more studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This meta-analysis included 11 RCTs from an initial screening of 431 studies, encompassing a total of 704 adults. The meta-analysis results revealed no significant associations were detected between ALA supplementation and changes in intermediate disease markers, including triglyceride (TG) (standardised mean difference (SMD): -0.08, 95% CI: -0.24 to 0.09, p=0.36, I²=0.00%, τ²=0.00), total cholesterol (TC) (SMD: 0.08, 95% CI: -0.55 to 0.71, p=0.80, I²=87.50%, τ²=0.52), high-density lipoprotein cholesterol (HDL-C) (SMD: -0.05, 95% CI: -0.22 to 0.11, p=0.52, I²=0.00%, τ²=0.00), low-density lipoprotein cholesterol (LDL-C) (SMD: -0.13, 95% CI: -0.40 to 0.15, p=0.37, I²=0.00%, τ²=0.00), homeostasis model assessment of insulin resistance (HOMA-IR) (SMD: -0.23, 95% CI: -0.60 to 0.15, p=0.23, I²=26.20%, τ²=0.05) and fasting blood glucose (FBS) (SMD: 0.13, 95% CI: -0.16 to 0.41, p=0.39, I²=29.40%, τ²=0.04). According to the Grading of Recommendations Assessment, Development and Evaluation bias assessment approach, eight studies were rated as having low bias (grade A), and three studies were rated as having moderate bias (grade B). Begg's test indicated no evidence of publication bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;No significant associations were detected between ALA intake and intermediate disease markers, including TG, TC, HDL-C, LDL-C, HOMA-IR and FBS levels, in overweight or obese adults. Further research is needed to explore the potential associations of ALA, especially in high-risk populations with metabolic disorders, by employing longer intervention ","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e088363"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of an interpretable risk prediction model for diabetic peripheral neuropathy in type 2 diabetes: a single-centre retrospective cohort study in China.","authors":"Lianhua Liu, Bo Bi, Mei Gui, Linli Zhang, Feng Ju, Xiaodan Wang, Li Cao","doi":"10.1136/bmjopen-2024-092463","DOIUrl":"10.1136/bmjopen-2024-092463","url":null,"abstract":"<p><strong>Objective: </strong>Diabetic peripheral neuropathy (DPN) is a common and serious complication of diabetes, which can lead to foot deformity, ulceration, and even amputation. Early identification is crucial, as more than half of DPN patients are asymptomatic in the early stage. This study aimed to develop and validate multiple risk prediction models for DPN in patients with type 2 diabetes mellitus (T2DM) and to apply the Shapley Additive Explanation (SHAP) method to interpret the best-performing model and identify key risk factors for DPN.</p><p><strong>Design: </strong>A single-centre retrospective cohort study.</p><p><strong>Setting: </strong>The study was conducted at a tertiary teaching hospital in Hainan.</p><p><strong>Participants and methods: </strong>Data were retrospectively collected from the electronic medical records of patients with diabetes admitted between 1 January 2021 and 28 March 2023. After data preprocessing, 73 variables were retained for baseline analysis. Feature selection was performed using univariate analysis combined with recursive feature elimination (RFE). The dataset was split into training and test sets in an 8:2 ratio, with the training set balanced via the Synthetic Minority Over-sampling Technique. Six machine learning algorithms were applied to develop prediction models for DPN. Hyperparameters were optimised using grid search with 10-fold cross-validation. Model performance was assessed using various metrics on the test set, and the SHAP method was used to interpret the best-performing model.</p><p><strong>Results: </strong>The study included 3343 T2DM inpatients, with a median age of 60 years (IQR 53-69), and 88.6% (2962/3343) had DPN. The RFE method identified 12 key factors for model construction. Among the six models, XGBoost showed the best predictive performance, achieving an area under the curve of 0.960, accuracy of 0.927, precision of 0.969, recall of 0.948, F1-score of 0.958 and a G-mean of 0.850 on the test set. The SHAP analysis highlighted C reactive protein, total bile acids, gamma-glutamyl transpeptidase, age and lipoprotein(a) as the top five predictors of DPN.</p><p><strong>Conclusions: </strong>The machine learning approach successfully established a DPN risk prediction model with excellent performance. The use of the interpretable SHAP method could enhance the model's clinical applicability.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e092463"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions about chronic health conditions, multimorbidity and self-management practices in rural northeast South Africa: findings from a qualitative study.","authors":"Audry Dube, Chodziwadziwa Whiteson Kabudula, Belinda J Njiro, Edward Fottrell, F Xavier Gómez-Olivé, Alisha N Wade, Stephen Tollman, Rochelle Burgess, Nicola Joan Christofides","doi":"10.1136/bmjopen-2024-098219","DOIUrl":"10.1136/bmjopen-2024-098219","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic health conditions are the leading causes of morbidity and mortality worldwide, with a disproportionately high burden in low-income and middle-income countries. The burden arising from these conditions presents immense challenges to countries with dysfunctional public healthcare systems, such as South Africa. This necessitates patients to have a good understanding of the conditions and optimal self-management approaches. We explored patients' understanding of chronic health conditions and self-management practices, including self-monitoring, in the rural South African community of Agincourt in the subdistrict of Bushbuckridge, Mpumalanga Province.</p><p><strong>Methods: </strong>We randomly selected patients receiving routine care for chronic health conditions in primary healthcare facilities who were linked to the Agincourt Health and Demographic Surveillance System to participate in focus group discussions. Six focus groups (three with men and three with women) were conducted, with 17 male and 19 female participants (n=35) living with different chronic health conditions. Data were collected using body mapping exercises and semistructured focus group discussions facilitated by two experienced qualitative research assistants. An inclusive thematic approach was used for analysis.</p><p><strong>Results: </strong>Participants identified most chronic health conditions and their progression. Participants expressed that some consequences of chronic health conditions were unavoidable and some were attributed to medications. Three themes emerged on the management of chronic health conditions: (1) individual-level management, where participants actively changed or managed lifestyle factors associated with the conditions; (2) clinic-level management and support, where participants believed that following instructions from healthcare providers facilitates better management of their condition(s); and (3) prevention and screening, to prevent disease progression and development of complications. Participants also highlighted the role of religion in the control of chronic disease risk factors and traditional treatments for uncommon conditions such as epilepsy. Costs associated with lifestyle changes and equipment to manage and monitor health were highlighted as barriers to self-management of chronic health conditions.</p><p><strong>Conclusions: </strong>Our findings contribute to emerging research on chronic health conditions and self-management approaches. Participants in our study demonstrated a good understanding of various chronic health conditions but lacked knowledge of self-management practices and faced barriers to self-management. There is a need for further studies on self-management of chronic health conditions, including self-monitoring among patients in rural sub-Saharan settings.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e098219"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between serum neurofilament light chain levels and grip strength among US adults: a cross-sectional study using National Health and Nutrition Examination Survey data from 2013 to 2014.","authors":"Diliyaer Dilixiati, Kaisaierjiang Kadier, Bingzhang Qiao, Weijie Zhang, Daniyaer Nuerdebieke, Abudureheman Zebibula, Ying Yang, Mulati Rexiati","doi":"10.1136/bmjopen-2024-084766","DOIUrl":"10.1136/bmjopen-2024-084766","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate the relationship between serum neurofilament light chain (NfL) and grip strength using data from the 2013-2014 US National Health and Nutrition Examination Survey (NHANES).</p><p><strong>Design: </strong>Secondary analysis of cross-sectional, population-based data.</p><p><strong>Setting: </strong>NHANES sample, 2013-2014.</p><p><strong>Participants: </strong>We studied 1925 participants aged 20-75 years.</p><p><strong>Outcome measures and analysis: </strong>We applied a multivariable generalised linear regression model, adjusted for several potential confounders, and restrictive cubic spline models to evaluate the association between serum NfL and grip strength. Subgroup analyses were conducted using stratified multivariable linear regression analysis.</p><p><strong>Results: </strong>We included 1925 participants (average age: 44.8±0.44 years) from the NHANES database. Participants with higher serum NfL levels had a significantly higher prevalence of medical conditions (hypertension, diabetes, cardiovascular disorder, chronic kidney disease (CKD) and cancer) compared with those with lower NfL levels (all p<0.001). After adjusting for confounding factors, there was a negative association between serum NfL and grip strength (β=-2.07; 95% CI -3.47, -0.67; p=0.007). In addition, significant interactions were found between NfL and grip strength stratified by age, physical activity and CKD (p value for interaction=0.002, 0.023 and 0.006). The results of the restricted cubic splines (RCS) analysis showed no evidence against a linear association of serum NfL levels with grip strength. (p for non-linearity=0.334).</p><p><strong>Conclusion: </strong>Our study demonstrates a strong, negative and linear correlation between elevated serum NfL levels and grip strength. Notably, our findings indicate that individuals aged between 60 and 75 years, those with physical inactivity and those with CKD exhibit a more pronounced reduction in grip strength with increasing serum NfL levels.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e084766"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizing the silent vision loss: cost-utility analysis of population-based glaucoma screening in India.","authors":"Neha Purohit, Sandeep Buttan, Parul Chawla Gupta, Ranjan Kumar Choudhury, Kathirvel Soundappan, Atul Kotwal, Shankar Prinja","doi":"10.1136/bmjopen-2024-098113","DOIUrl":"10.1136/bmjopen-2024-098113","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Glaucoma is a major cause of irreversible blindness in India; however, if detected early, its progression can be either prevented or stabilised through appropriate medical or surgical treatment. We aim to evaluate the cost-utility of various models for population-based glaucoma screening at primary health centres in India. We also assess the potential impact of the implementation of a population-based screening programme on overall costs of care for glaucoma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Cost-utility analysis using a mathematical model comprising a decision tree and Markov model was conducted to simulate relevant costs and health outcomes over a lifetime horizon.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Screening services were assumed to be delivered at primary health centres in India.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;A hypothetical cohort of different target population groups in terms of age groups and risk of glaucoma (age group 40-75 years, 50-75 years, 40-75 years age group at high risk of glaucoma, 50-75 years age group at high risk of glaucoma) were included in comparative screening strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;The exclusive intervention scenarios were 12 screening strategies based on different target population groups (age group 40-75 years, 50-75 years, 40-75 years age group at high risk of glaucoma, 50-75 years age group at high risk of glaucoma), screening methods (face-to-face screening and artificial intelligence-supported face-to-face screening) and screening frequencies for 40-75 years aged population (annual vs once every 5 years screening), in comparison to usual care scenario. The usual care scenario (current practice) implied opportunistic diagnosis by the ophthalmologists at higher levels of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Primary and secondary outcomes: &lt;/strong&gt;The primary outcome was the incremental cost-utility ratio for each of the screening strategies in comparison to usual care. The secondary outcomes were per person lifetime costs, lifetime out-of-pocket expenditures, life years and quality-adjusted life-years (QALYs) in all screening scenarios and usual care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Depending on the type of screening strategy, the gain in QALY per person ranged from 0.006 to 0.046 relative to usual care. However, the screening strategies, whether adjusted for specific age groups, patient risk profiles, screening methods or frequency, were not found to be cost-effective. Nonetheless, annual face-to-face screening strategies for individuals aged 40-75 years could become cost-effective in a scenario of strengthened public financing and provisioning, such that at least 67% of those seeking care for confirmatory diagnosis and treatment use government-funded facilities, in conjunction with 60% availability of medications at government hospitals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Enhancing continuity of care following screening through either strengthening of public provisionin","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e098113"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}