BMJ Open最新文献

{"title":"Tobacco-related toxicant exposure among people with and without experience of psychosis: findings from the US Population Assessment of Tobacco and Health study.","authors":"Eve Taylor, Ann McNeill, Harry Tattan-Birch, Tim Marczylo, Katherine East, Deborah Robson","doi":"10.1136/bmjopen-2025-101066","DOIUrl":"10.1136/bmjopen-2025-101066","url":null,"abstract":"<p><strong>Objective: </strong>Smoking and vaping are especially prevalent among people with experience of psychosis (EoP), potentially increasing their toxicant exposure. Switching from tobacco smoking to vaping e-cigarettes reduces exposure to tobacco-related toxicants and likely associated diseases. We compared levels of nicotine and tobacco-related toxicant exposure among people with versus without EoP.</p><p><strong>Design: </strong>Cross-sectional study, secondary data analysis of Wave 5 (2018) of the Population Assessment of Tobacco and Health Study.</p><p><strong>Setting: </strong>Data collection took place in the USA at the home of participants.</p><p><strong>Participants: </strong>Data were from 5750 adults (aged >18 years) with and without EoP who smoked, vaped, did both or did neither. EoP was defined as ever being told by a health professional that you have schizophrenia, schizoaffective disorder, psychosis, a psychotic illness or psychotic episode.</p><p><strong>Primary outcome: </strong>Levels of urinary toxicants: nicotine metabolites, metals, volatile organic compounds (VOCs) and tobacco-specific nitrosamines (TSNAs) among people with and without EoP. Analyses were adjusted for demographics, cannabis use and past 30-day smoking/vaping status, and were repeated after stratifying by smoking /vaping status.</p><p><strong>Results: </strong>Of the 5750 participants, 6.3% (n=361) reported EoP, and 93.7% reported no EoP. Levels of nicotine and TSNA metabolites, cadmium, uranium and some VOCs were significantly higher among participants with EoP compared with those without. However, when smoking, vaping and cannabis use were taken into account, the associations of EoP with nicotine and TSNA metabolites, and most of the VOCs, were attenuated and no longer significant.</p><p><strong>Conclusion: </strong>Participants with EoP are exposed to more nicotine and tobacco-related toxicants than those without EoP, likely largely due to the high prevalence of smoking, vaping and cannabis use among this population.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e101066"},"PeriodicalIF":2.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273778","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":"Evaluating practices in the management of youth nicotine vaping in hospital-based child and youth mental health and addictions settings in Canada: protocol for a mixed-methods study.","authors":"Aaya Mahdi, Laila Alfadhli, Nicholas Chadi, Selene Etches, Martha J Ignaszewski, Balpreet Panesar, Amy Porath, Poppy Desclouds, Sofia Constantakis, Zainab Samaan, Simon Hatcher, Melissa Brouwers, Tea Rosic","doi":"10.1136/bmjopen-2025-109023","DOIUrl":"10.1136/bmjopen-2025-109023","url":null,"abstract":"<p><strong>Introduction: </strong>Nicotine vaping is common among children and youth, and even more so among those with mental health concerns. Identifying and managing nicotine vaping in child and youth mental health treatment settings is key to addressing this modifiable risk factor for poorer physical and mental health in young people. Recommendations exist for screening, assessment and treatment of youth vaping; however, it remains unclear whether current practices in child and youth mental health programmes align with recommended standards.</p><p><strong>Methods and analysis: </strong>An explanatory sequential mixed methods design with three stages will be employed. In the first stage, a cross-sectional survey will be distributed to all eligible Canadian hospitals to identify practices in assessment and treatment of nicotine vaping within their child and youth mental health and addictions programmes. This survey will also assess barriers and facilitators for the uptake of the 2021 Canadian Paediatric Society recommendations on management of youth vaping. Semi-structured focus groups and interviews will be conducted in stage two, with clinicians, managers, youth and caregivers. Qualitative data will be analysed using a reflexive thematic approach. In stage three, findings and proposed behaviour change interventions will be reviewed at a knowledge mobilisation meeting with the goal of developing a national knowledge mobilisation plan to improve assessment and treatment of youth vaping in hospital-based mental health and addictions programmes.</p><p><strong>Ethics and dissemination: </strong>This study has received ethics approval from the Research Ethics Board at the Children's Hospital of Eastern Ontario (Protocol #25/19X). Participants will provide informed consent prior to participating. Results will be published in peer-reviewed journals and presented at scientific conferences. Summaries will be provided to the funders of the study and to participating hospitals.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e109023"},"PeriodicalIF":2.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12516965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273803","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":"Musculoskeletal disorders among spousal caregivers of individuals with chronic motor disabilities: a cross-sectional study in Tunisia.","authors":"Ikram Haddada, Ameni Ameur, Soumaya El Arem, Aymen Hadj Salah, Aymen Fekih, Meriem Kacem, Issam Khalifa, Noura Belhadj, Mouna Sghir, Wassia Kessomtini","doi":"10.1136/bmjopen-2025-101509","DOIUrl":"10.1136/bmjopen-2025-101509","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the prevalence and identify the independent factors associated with musculoskeletal disorders (MSDs) among spousal caregivers of individuals with chronic motor disabilities.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>The sole tertiary-level Physical Medicine and Rehabilitation Department serving its region in Tunisia.</p><p><strong>Participants: </strong>A consecutive sample of 142 spousal caregivers (response rate 85%) was recruited between January and June 2024. Inclusion criteria were being the primary spouse caregiver for an individual with a chronic motor disability (>6 months). Exclusion criteria included caregivers with pre-existing chronic musculoskeletal or rheumatic diseases or an inability to complete the questionnaire.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome was the prevalence of MSDs, assessed by the Nordic Musculoskeletal Questionnaire.Secondary outcomes included pain intensity (visual analogue scale (VAS)) and the identification of factors independently associated with MSDs. Associated factors (eg, caregiver burden by Zarit Burden Scale, fatigue by Checklist Individual Strength) were analysed using multivariate logistic regression.</p><p><strong>Results: </strong>The prevalence of at least one MSD was 72.5% (103/142). Chronic low back pain (LBP) was the most common MSD (54.2%). Among affected caregivers, the mean pain intensity was 56.9±18.2 mm on the VAS, with 28.2% reporting severe pain (VAS≥70 mm). Multivariate regression analysis identified four independent predictors of MSDs: providing care for≥8 hours per day (adjusted OR (AOR)=10.06, 95% CI 1.24 to 81.38), a high caregiver burden (AOR=4.15, 95% CI 1.07 to 16.06), severe caregiver fatigue (AOR=3.10, 95% CI 1.24 to 7.72) and caring for an obese partner (AOR=3.07, 95% CI 1.00 to 9.40).</p><p><strong>Conclusions: </strong>The high prevalence of MSDs, particularly chronic LBP, among spousal caregivers highlights the significant physical strain associated with this role. The strong association with prolonged daily caregiving, high burden and fatigue identifies key modifiable risk factors. These findings suggest that the health of spousal caregivers is often overlooked, which could impact their long-term well-being and the quality of care they provide. Implementing targeted support interventions, such as ergonomic training and respite care, should be considered.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e101509"},"PeriodicalIF":2.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12516967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273812","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 smartphone screen time and fast food intake among adolescents: a cross-sectional survey.","authors":"Dan Bi Kim, Soo Yong Kim, Il Yun, Eun-Cheol Park, Suk-Yong Jang","doi":"10.1136/bmjopen-2024-085825","DOIUrl":"10.1136/bmjopen-2024-085825","url":null,"abstract":"<p><strong>Objective: </strong>Despite growing concerns regarding the impact of smartphone use on adolescents' lifestyle, there is a notable lack of studies utilising national data to explore how smartphone use influences eating habits in this age group. We aimed to investigate the association between smartphone screen time and fast food intake using representative data from Korean adolescents.</p><p><strong>Design: </strong>Cross-sectional survey.</p><p><strong>Setting: </strong>This cross-sectional analysis used data from the 2017 Korean Youth Risk Behavior Web-based Survey (KYRBS). We used Poisson regression to directly estimate prevalence ratios (PRs) rather than using logistic regression as odds ratios (ORs) tend to overestimate PRs when the outcome is common. Smartphone screen time was categorised into four groups based on the daily time spent using smartphones: <2 hours/day, 2-3 hours/day, 4-5 hours/day and ≥6 hours/day. Fast food intake was assessed based on the weekly intake frequency of pizza, hamburgers, fried chicken and carbonated beverages (infrequent consumption: ≤2 times/week; frequent consumption: ≥3 times/week).</p><p><strong>Participants: </strong>Data from 39 753 individuals were included.</p><p><strong>Primary outcome measures: </strong>The primary outcome was the frequency of fast food intake, assessed via a self-reported survey that asked: \"In the past 7 days, how often did you eat fast food such as pizza, hamburgers, fried chicken, or drink carbonated beverages?\". Participants were categorised into two groups based on their median intake: infrequent (≤2 times/week) and frequent (≥3 times/week).</p><p><strong>Results: </strong>Among 39 753 adolescents, 19 273 reported frequent fast food intake (10 162 (51.9%) boys, 9111 (45.1%) girls), while 20 480 reported infrequent intake (9409 (48.1%) boys, 11 071 (54.9%) girls). The probabilities that adolescents who used smartphones for 6 hours daily would have frequent fast food intake were 1.29 times (95% CI: 1.28 to 1.30) among boys, and 1.43 times (95% CI: 1.42 to 1.44) higher among girls, compared with adolescents who used smartphones for 2 hours daily.</p><p><strong>Conclusion: </strong>The association between prolonged smartphone screen time and frequent fast food intake in adolescents suggests the need for targeted interventions addressing digital media use to promote healthier eating behaviors.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e085825"},"PeriodicalIF":2.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273823","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":"PLAN-psoriasis: protocol for a randomised controlled feasibility trial comparing patient-led 'as-needed' treatment and therapeutic drug monitoring-guided treatment to continuous treatment for adults with clear or almost clear skin on risankizumab monotherapy for psoriasis.","authors":"Weiyu Ye, Kingsley Powell, Niamh Dooley, Charlotte M Thomas, Bola Coker, Helen McAteer, Jessica Ruoheng Wei, Wei Ren Tan, David Baudry, Tejus Dasandi, Jade Pizzato, Tracey H Sach, John Gregory, Zijing Yang, Andrew E Pink, Richard T Woolf, Richard B Warren, John Weinman, Jonathan N Barker, Sarah Chapman, Joseph F Standing, Sam Norton, Catherine H Smith, Satveer K Mahil","doi":"10.1136/bmjopen-2025-106635","DOIUrl":"https://doi.org/10.1136/bmjopen-2025-106635","url":null,"abstract":"<p><strong>Introduction: </strong>Targeted biologic therapies have transformed outcomes for individuals with psoriasis, a common immune-mediated inflammatory skin disease. The widespread use of these highly effective treatments has led to a growing number of individuals with clear or nearly clear skin remaining on continuous, long-term treatment. Personalised strategies to minimise drug exposure may sustain long-term disease control while reducing treatment burden, associated risks and healthcare costs. This study aims to evaluate the feasibility of a definitive pragmatic effectiveness trial of two personalised dose minimisation strategies compared with continuous treatment (standard care) in adults with well-controlled psoriasis receiving the exemplar biologic risankizumab.</p><p><strong>Methods and analysis: </strong>This is a multicentre, assessor-blind, parallel group, open-label randomised controlled feasibility trial in the UK, evaluating two personalised biologic dose minimisation strategies for psoriasis. 90 adults with both physician-assessed and patient-assessed clear or nearly clear skin on risankizumab monotherapy for ≥12 months will be randomised in a 1:1:1 ratio to (1) patient-led 'as-needed' treatment, where risankizumab is administered at the first sign of self-assessed psoriasis recurrence, (2) therapeutic drug monitoring-guided treatment, with personalised dosing intervals determined using a pharmacokinetic model or (3) continuous treatment as per standard care, for 12 months. Participants will be invited to submit self-reported outcomes and self-taken photographs every 3 months using a bespoke remote monitoring system (mySkin app) and will attend an in-person assessment at 12 months. They may also request additional patient-initiated follow-up appointments during the trial if needed. The primary outcome is the practicality and acceptability of the two personalised biologic dose minimisation strategies, assessed as a composite measure including recruitment and retention rates, adherence to the assigned strategies and acceptability to both patients and clinicians. The feasibility of collecting healthcare cost and resource utilisation data will also be evaluated to inform a future cost-effectiveness analysis. A nested qualitative study, involving semistructured interviews with patients and clinicians, will explore perspectives on the personalised biologic dose minimisation strategies. These findings will inform the design of a future definitive trial.</p><p><strong>Ethics and dissemination: </strong>This study received ethical approval from the Seasonal Research Ethics Committee (reference 24/LO/0089). Results will be disseminated through scientific conferences, peer-reviewed publications and patient/public engagement events. Lay summaries and infographics will be codeveloped with patient partners to ensure the findings are accessible for the wider public.</p><p><strong>Trial registration number: </strong>ISRCTN17922845.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e106635"},"PeriodicalIF":2.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273835","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":"Evaluating diabetes-specific meal replacements for glycaemic control in overweight and obese patients with T2DM: a protocol for a randomised controlled trial.","authors":"Wan Ain Nadirah Che Wan Mansor, Suzana Shahar, Noorlaili Mohd Tohit, Roslee Rajikan, Munirah Ismail","doi":"10.1136/bmjopen-2025-099562","DOIUrl":"10.1136/bmjopen-2025-099562","url":null,"abstract":"<p><strong>Introduction: </strong>Uncontrolled type 2 diabetes mellitus (T2DM) causes microvascular and macrovascular issues that hike healthcare costs and threaten global health. Previous studies have suggested meal replacement (MR) therapy for T2DM, but there were inconsistencies in the results. Thus, a randomised controlled trial is proposed to determine the efficacy of a diabetes-specific MR product on weight loss, glycaemic control, satiety, quality of life, metabolic gene expression and cost benefit in overweight and obese patients with T2DM.</p><p><strong>Methods and analysis: </strong>164 overweight and obese participants with T2DM will be randomly assigned to either an intervention group (n=82) or a control group (n=82). All participants will receive dietary counselling; however, only the intervention group will receive MR for 12 weeks. Glycaemic control and obesity indicators are the study's main outcomes. Secondary outcomes include cardiovascular disease risk markers, metabolic risk, metabolic gene profile analysis, dietary data, physical activity, satiety level, quality of life and cost analysis. Baseline data will include sociodemographics, anthropometry, blood pressure, diet, physical activity, satiety level, quality of life, blood profile, metabolic gene expression profile and cost-benefit analysis. A follow-up is planned at intervention weeks 6 and 12. Week 6 will assess only anthropometry, blood pressure, diet, physical activity and satiety level. For compliance assessment, intervention group participants will bring their MR container. Week 12 will measure the same baseline parameter, except sociodemographic data. Individuals who consume less than 80% of the MR will be deemed non-compliant. All parameter modifications will be documented and analysed for comparison. All statistical analyses will be conducted using IBM SPSS V.29.0 software, with a significance level of p<0.05. The cost-benefit analysis will be determined using the net present value.</p><p><strong>Ethics and dissemination: </strong>This research protocol was approved by the Ethical Committee of the National University of Malaysia (JEP-2024-695) and registered on International Standard Randomised Controlled Trial Number. Study findings will be disseminated in peer-reviewed journals, conference presentations and social media.</p><p><strong>Trial registration number: </strong>ISRCTN57040303).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e099562"},"PeriodicalIF":2.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273844","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":"What is the access to NHS fertility treatments for women with Mayer-Rokitansky-Küster-Hauser syndrome across England? A freedom of information study.","authors":"Kirsty Milford, Pedro Melo, Mehrunisha Suleman, Naomi Crouch, Isla Mair, Sarah Christine Armstrong","doi":"10.1136/bmjopen-2025-102664","DOIUrl":"10.1136/bmjopen-2025-102664","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The aims of this study were (1) To investigate the availability of NHS funded in vitro fertilisation (IVF) treatment for individuals affected by Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) from all Integrated Care Boards (ICBs) across England and (2) To assess the ethical implications of piecemeal funding for those with MRKH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This was a mixed-methods study containing both quantitative and qualitative data. We filed freedom of information (FOI) act requests on 01/06/2023 for all 42 ICBs across England via secure email.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study focused on England.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;All 42 ICBs across England were contacted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The FOI requests asked for information concerning the provision of funded IVF for uterine factor infertility, and if this included individuals with MRKH. Where assistance was available, we recorded what it comprised along the IVF cycle. If IVF was not offered, we recorded the rationale provided by the ICB.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Responses were received from all 42 ICBs across England. Seven stated that they would fund IVF and cryopreservation of embryos to women with MRKH and other absolute uterine factor infertility diagnoses (NHS Humber and North Yorkshire, NHS Dorset, NHS Devon, NHS Cornwall and Isles of Scilly, NHS Buckinghamshire, Oxford and Berkshire, NHS South Yorkshire and NHS West Yorkshire). However, the number of cycles, the length of cryopreservation and whether they would fund embryo transfer into a surrogate differed between ICBs.Of the remainder, three (NHS Leicester, Leicestershire and Rutland, NHS Greater Manchester and NHS Hampshire and Isle of Wight) described some provision of fertility preservation (cryopreservation of oocytes or embryos) for women with uterine factor infertility, two of whom suggested their policy may include women with MRKH (NHS Greater Manchester and NHS Hampshire and Isle of Wight). Two ICBs (NHS Gloucester and NHS Bedford, Luton and Milton Keynes) explained that individual funding applications would be considered when made by clinicians on the patient's behalf, but no information was provided on how many times requests had been made and granted. The remaining 30 ICBs explained that no part of a surrogacy pregnancy would be funded, owing to concerns around commercial surrogacy, which is illegal in the UK.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This work has revealed that only a small proportion of ICBs (7/42, 17%) treat women with MRKH like any other woman applying for NHS fertility treatment. The study revealed that decisions by ICBs not to fund IVF treatments based on concerns about commercial surrogacy create significant inequities. It unfairly penalises individuals with MRKH who require surrogacy as part of their fertility treatment. These individuals face a unique set of reproductive challenges, and denying them access to NHS-funded IVF","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e102664"},"PeriodicalIF":2.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257417","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":"Perceived Social Risk Scale: development and validation in relation to social status and depression in the UK.","authors":"Joseph Newton, Jack L Andrews","doi":"10.1136/bmjopen-2024-092107","DOIUrl":"10.1136/bmjopen-2024-092107","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate the Perceived Social Risk Scale (PSRS) for assessing perceptions of socially risky behaviours, and to validate it against existing psychological measures such as perceived social status and depressive symptoms in a UK sample of older adolescents and adults.</p><p><strong>Design: </strong>A cross-sectional study involving exploratory and confirmatory factor analyses.</p><p><strong>Setting: </strong>Participants were recruited from the Cardiff University's Department of Psychology participant pool (students completing studies for course credit) and Prolific Academic (a crowdsourcing platform for research volunteers). Data collection occurred between 17 February and 6 May 2024.</p><p><strong>Participants: </strong>A total of 640 UK participants, including both men and women, aged 18-65.</p><p><strong>Main outcome measures: </strong>We measured the internal consistency of the PSRS, test-retest reliability and validity against measures including rejection sensitivity, perceived social status, depressive symptoms and resistance to peer influence. Moderation analyses examined the role of perceived social status, age and a sense of belonging in the relationship between PSRS scores and depressive symptoms.</p><p><strong>Results: </strong>The PSRS showed excellent internal consistency (<i>α=0.96</i>) and good test-retest reliability (Intraclass Correlation Coefficient (ICC)<i>=0.70</i>). Perceptions of social risks significantly declined with age (<i>r=-0.20, p<0.001</i>) and factor analyses confirmed that the PSRS differentiates among four distinct but related social risk constructs: authenticity and integrity (α=0.91), social assertiveness (α=0.72), reservedness (α=0.83) and social non-conformity (α=0.72). For evidence of convergent validity, higher PSRS scores were associated with increased sensitivity to social rejection (<i>r=0.23, p<0.001),</i> elevated depressive symptoms (<i>r=0.13, p=0.012)</i> and negatively correlated with resistance to peer influence (<i>r=-0.13, p=0.013</i>). Local perceived social status significantly moderated the relationship between PSRS scores and depressive symptoms (<i>β=0.005, SE=0.002, t=2.36, p=0.019</i>). A general sense of belonging did not moderate this relationship.</p><p><strong>Conclusions: </strong>Our results confirm that social risk is not a uniform construct but is instead multidimensional. The PSRS offers a reliable and valid tool for assessing multidimensional social risk-taking, with strong internal consistency and test-retest reliability. The interaction between depression and local perceived social status highlights the importance of perceived status on social risk perception.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e092107"},"PeriodicalIF":2.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12516996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257353","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":"Comparison of efficacy and safety of different types of electrical stimulation for shoulder subluxation after acute stroke: protocol for a systematic review and network meta-analysis of randomised controlled trials.","authors":"Mengfan Kan, Qiang Chen, Yuqin Dan, Linlin Li, Wenkai Li, Linlin Zhang, Yitong Lu, Ziyun Feng","doi":"10.1136/bmjopen-2024-090121","DOIUrl":"https://doi.org/10.1136/bmjopen-2024-090121","url":null,"abstract":"<p><strong>Introduction: </strong>Glenohumeral subluxation (GHS) is a common rehabilitation challenge in the hemiplegic upper limb following stroke, potentially leading to shoulder pain, secondary brachial plexus injury and various other complications. While electrical stimulation therapies, such as electromyography biofeedback, electroacupuncture and neuromuscular electrical stimulation, have shown promise in managing GHS, some controversy remains. Although clinical trials and meta-analyses have confirmed the efficacy of these therapies, healthcare professionals have yet to reach a consensus on which specific therapy is most effective for reducing shoulder subluxation (SS), alleviating pain and improving quality of life. This study will perform a network meta-analysis to compare the relative efficacy of different electrical stimulation therapies for treating GHS in patients following acute stroke.</p><p><strong>Methods and analysis: </strong>We will systematically search the following databases: PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, Chinese biomedical literature database (SinoMed), Wanfang databases (Wanfang), VIP Journal Integration Platform (VIP) and China National Knowledge Infrastructure (CNKI). Our search will cover the period from the inception of each database until 14 April 2025, and will be restricted to studies published in Chinese or English. The primary outcomes of interest will be the degree of improvement in SS, improvements in quality of life and reductions in pain. We will conduct pairwise meta-analyses using RevMan V.5.3 (The Cochrane Collaboration, Copenhagen, Denmark), and network meta-analyses using ADDIS V.1.16.6 (Drugis, Groningen, The Netherlands) and Stata V.16.0 (StataCorp, College Station, Texas, USA) to compare the relative efficacy of different electrical stimulation therapies. Screening, data extraction, risk of bias assessment and evaluation of the certainty of evidence will all be performed independently by two reviewers to ensure accuracy and reliability. The risk of bias within individual studies will be assessed using the Cochrane Risk of Bias 2 (ROB 2) tool, and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, and Evaluation (GRADE) and Confidence in Network Meta-Analysis (CINeMA) frameworks to ensure transparency and methodological rigour.</p><p><strong>Ethics and dissemination: </strong>Ethical approval is not required for this study. The findings will be submitted to a peer-reviewed journal or conference.</p><p><strong>Prospero registration number: </strong>CRD42024541228.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e090121"},"PeriodicalIF":2.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of abnormal nutritional indices among women aged 15-24 years in 40 low-income and middle-income countries: a multilevel multinomial logistic regression analysis.","authors":"Begetayinoral Kussia Lahole, Beriso Furo Wengoro, Kusse Urmale Mare","doi":"10.1136/bmjopen-2024-091809","DOIUrl":"10.1136/bmjopen-2024-091809","url":null,"abstract":"<p><strong>Background: </strong>Despite global efforts to improve nutrition, young women aged 15-24 years in low-income and middle-income countries (LMICs) face persistent dual burdens of malnutrition, marked by high rates of underweight and emerging issues of overnutrition, such as overweight and obesity. Current research often emphasises individual-level factors, potentially overlooking broader regional influences.</p><p><strong>Objective: </strong>To examine the burden of abnormal nutritional indices among women aged 15-24 years in 40 LMICs using the most recent Demographic and Health Survey conducted between 2015 and 2023.</p><p><strong>Design: </strong>Cross-sectional study design.</p><p><strong>Setting: </strong>40 LMICs.</p><p><strong>Participants: </strong>357 587 young women aged 15-24 years.</p><p><strong>Primary and secondary outcome measures: </strong>A multilevel mixed-effect multinomial analysis was conducted to identify determinants of underweight, overweight and obesity. The adjusted relative risk ratio with 95% CI was used to declare the statistical significance of the association.</p><p><strong>Results: </strong>Our analysis found that among young women aged 15-24 years in LMICs, the pooled prevalence of underweight was 25.7% (95% CI 25.6% to 25.8%), with substantial country-level variation. The highest prevalence was in Timor-Leste (35.4%) and India (31.6%), while Jordan (2.9%) and Zambia (5.5%) had the lowest rates. Overweight and obesity prevalence was 17.7% (95% CI 15.7% to 19.7%), with the highest rates in Jordan (48.9%) and Zambia (40.9%) and the lowest in Timor-Leste (3.9%) and Ethiopia (4.5%). Furthermore, factors such as household wealth, age at marriage, age, education status, access to media, employment status, parity, contraceptive use, toilet facility, region and place of residence were statistically associated with being underweight, overweight and obese.</p><p><strong>Conclusions: </strong>Our study highlights significant variations in nutritional status among young women aged 15-24 years in LMICs, with a notable prevalence of underweight and emerging challenges of overweight and obesity. Country-specific strategies addressing socioeconomic disparities and regional differences are crucial for effective public health interventions to improve nutritional outcomes among this vulnerable population.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e091809"},"PeriodicalIF":2.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12516993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257446","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}