BMJ Open最新文献

{"title":"How did the context of COVID-19 affect the implementation and mechanisms of participatory learning and action to address type 2 diabetes? Mixed-methods research in rural Bangladesh.","authors":"Joanna Morrison, Malini Pires, Sarker Ashraf Uddin Ahmed, Carina King, Tasnova Jerin Jeny, Raduan Hossin, Tasmin Nahar, Naveed Ahmed, Sanjit Shaha, Hassan Haghparast-Bidgoli, Abdul Kuddus, Kishwar Azad, Edward Fottrell","doi":"10.1136/bmjopen-2024-089288","DOIUrl":"10.1136/bmjopen-2024-089288","url":null,"abstract":"<p><strong>Objectives: </strong>Research indicates the effectiveness of participatory interventions to address rapid rises in type 2 diabetes in low-income countries. Understanding their transferability to different contexts is a priority. We aimed to analyse how the COVID-19 post-lockdown context and adjustments to a participatory learning and action intervention affected theorised mechanisms of effect in rural Bangladesh and to examine the broader implications of this context and intervention adjustments for developing optimal contexts for participatory interventions.</p><p><strong>Design: </strong>Mixed methods using longitudinal qualitative and quantitative observation data, focus group discussions and interviews with group and community members and project personnel. We used descriptive content analysis, guided by realist evaluation research questions about context, implementation and mechanisms. We used team reflection to enhance the rigour of our analysis.</p><p><strong>Setting: </strong>Cluster-randomised trial in Alfadanga upazila, Faridpur district, in the central region of Bangladesh. The intervention was implemented between January 2020 and December 2022, during the COVID-19 pandemic.</p><p><strong>Participants: </strong>Participatory group members, community members and project personnel (n=32). Structured observations of participatory groups (n=1820) and unstructured observations of groups and their environments (n=15).</p><p><strong>Interventions: </strong>Participatory learning and action community groups of men and women implemented by community-based facilitators.</p><p><strong>Results: </strong>Due to COVID-19, the participatory learning and action (PLA) intervention was not implemented as planned, which had major effects on the time available to develop the intervention with communities. Communities learnt about diabetes and were motivated to address its causes at an individual level, but community action was a more challenging mechanism to trigger. The post-pandemic context made it difficult to build community rapport, and strategies to engage communities through home visits were challenging. Communities' prior negative experience in working together and in working with non-governmental organisations led to low community cohesion and low motivation to address diabetes collectively. This also resulted in expectations that the implementing organisation would implement community actions and incentivise attendance at meetings. This misalignment of expectations further disabled relationship building, and community strategies addressing the social causes of diabetes were largely not enacted.</p><p><strong>Conclusion: </strong>PLA has optimal effects when time is available to build trust and social cohesion. These are contextual elements and mechanisms that need to be activated to enable critical reflection and community action to develop an enabling environment to address type 2 diabetes.</p><p><strong>Trial registration number: </","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e089288"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779068","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":"Knowledge, attitude and practice of patients with ankle injury regarding osteochondral lesions of the talus: a cross-sectional study in Wuxi, China.","authors":"Xueming Chen, Chang She, Xingfei Zhang, Wencheng Wang, Yuxuan Zhang","doi":"10.1136/bmjopen-2024-087402","DOIUrl":"10.1136/bmjopen-2024-087402","url":null,"abstract":"<p><strong>Objective: </strong>To investigate knowledge, attitude and practice (KAP) of patients with ankle injury regarding osteochondral lesions of the talus (OLT).</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>Between March and September 2023, at the Ninth People's Hospital of Wuxi, affiliated with Soochow University.</p><p><strong>Participants: </strong>Among patients with OLT.</p><p><strong>Primary and secondary outcome measures: </strong>KAP scores and associated factors.</p><p><strong>Methods: </strong>Data were collected through a researcher-designed, validated questionnaire with four dimensions (sociodemographic characteristics, knowledge, attitude and practice). Structural equation modelling (SEM) was applied to explore associations among variables.</p><p><strong>Results: </strong>A total of 537 valid (valid rate: 78.85%) questionnaires were obtained from the responders who were aged 27.18±11.01 years, with 151 (28.12) males. The mean KAP scores were 17.28±4.84 (possible range: 0-28), 29.44±4.21 (possible range: 9-45) and 18.01±5.39 (possible range: 6-30), respectively. SEM revealed that employment (employed vs unemployed, β=1.33, p=0.002), had medical insurance (β=1.19, p=0.019) and with a history of ankle sprains (β=1.08, p=0.009) exhibited positive direct effects, while whether with cartilage injury of the talus (no vs yes, β=-0.73, p=0.001) had negative direct effect on knowledge. Additionally, knowledge (β=0.08, p=0.032) showed positive direct effects, while gender (males vs females, β=-1.81, p<0.001) showed negative direct effects on attitude. Furthermore, knowledge (β=0.38, p<0.001), attitude (β=0.18, p<0.001), had medical insurance (β=1.05, p=0.045) and had recovered from an ankle injury (β=1.38, p=0.025) exhibited positive direct effects on practice.</p><p><strong>Conclusion: </strong>Patients with ankle injury had inadequate knowledge, negative attitude and inactive practice toward OLT. Gender, job, medical insurance, cartilage injury of the talus, history of ankle sprains and recovery from ankle injury influenced their KAP.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e087402"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779089","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":"Spiritual care for prevention of psychological disorders in critically ill patients: study protocol of a feasibility randomised controlled pilot trial.","authors":"Paula Repetto, Carolina Ruiz, Verónica Rojas, Patricia Olivares, Jan Bakker, Leyla Alegria","doi":"10.1136/bmjopen-2024-084914","DOIUrl":"10.1136/bmjopen-2024-084914","url":null,"abstract":"<p><strong>Introduction: </strong>A significant number of critically ill patients who survive their illness will experience new sequelae or a worsening of their baseline health status following their discharge from the hospital. These consequences may be physical, cognitive and/or psychological and have been labelled postintensive care syndrome (PICS). Prior research has demonstrated that spiritual care aligned with a specific creed during hospitalisation in the intensive care unit (ICU), as part of a comprehensive care plan, may be an effective strategy for preventing psychological sequelae in surviving critically ill patients. However, there is a gap in clinical literature regarding the effectiveness of generalist spiritual care in preventing psychological sequelae associated with PICS. This pilot study aims to explore the feasibility of implementing a generalist spiritual care strategy in the ICU and to evaluate its preliminary effectiveness in preventing anxiety and depression symptoms and post-traumatic stress disorder in critically ill patients.</p><p><strong>Methods and analysis: </strong>This is a single-site, feasibility randomised controlled pilot trial of a generalist spiritual care intervention compared with the current standard of care. A total of 30 adults who are critically ill and have undergone invasive mechanical ventilation for a minimum of 72 hours without alterations in consciousness will be randomly assigned to either the spiritual care group or the usual care group at a ratio of 1:1. The primary outcome will be the feasibility and acceptability of the spiritual care strategy in critically ill patients. Secondary aims include evaluating the differences in anxiety and depression symptoms and post-traumatic stress disorder between the spiritual care group and the usual care control group at 3 months after ICU discharge. Subjects will be followed up until 3 months post-ICU discharge.</p><p><strong>Ethics and dissemination: </strong>The Ethics Committee for Medical Sciences of Pontificia Universidad Católica de Chile (#220111005) and the Ethics Committee of Servicio de Salud Metropolitano Sur Oriente approved the study. Pontificia Universidad Católica de Chile funded the study (project number 105699/DPCC2021). The findings will be widely disseminated through peer-reviewed publications, academic conferences, local community-based presentations, partner organisations and the Chilean Intensive Care Society.</p><p><strong>Trial registration number: </strong>NCT06048783.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e084914"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779141","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":"Insights into the provision of physical therapy services at public sector hospitals in Pakistan: an exploratory qualitative study.","authors":"Quratul Ain Muhammad Hanif, Nousheen Akber Pradhan, Waqas Hameed, Beenish Zafar, Bakhtawar M Hanif Khowaja","doi":"10.1136/bmjopen-2024-084854","DOIUrl":"10.1136/bmjopen-2024-084854","url":null,"abstract":"<p><strong>Objectives: </strong>Although physical therapy services are a part of the Essential Package of Health Services in Pakistan, they do not receive their due importance. This qualitative study aimed to explore the in-depth insights regarding the factors that influence the provision of physical therapy services in public sector hospitals of Karachi, Pakistan using the WHO's health systems framework.</p><p><strong>Design: </strong>Exploratory qualitative study.</p><p><strong>Setting and participants: </strong>Three public sector hospitals located in Karachi, Pakistan were selected for this study. In-depth interviews were conducted with a total of 12 physical therapists working in the outpatient departments of the selected hospitals.</p><p><strong>Results: </strong>Findings were categorised into six major themes within the health systems framework, shedding light on various factors influencing the quality of care provided to the patients. These encompass issues such as inappropriate facility infrastructure, limited staff availability and competency, challenges with equipment adequacy and functionality, insufficient financial support, low staff incentivisation and the absence of a regulatory council.</p><p><strong>Conclusion: </strong>The findings exhibited that the physical therapy services are constrained by various factors at the public sector hospitals in Pakistan. Improvement is recommended at various levels to increase the adequate staffing, financial support, provide the necessary equipment and ensure its functionality. The development of the regulatory council for physical therapy services is the need of the time to address the above solutions.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e084854"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779085","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":"Acupuncture for substance use disorders: a protocol of systematic review and meta-analysis of randomised controlled trials.","authors":"Chao-Ren Tan, Meng Qiao, Jin Chang, Shu-Min Chen, Yingying Wang","doi":"10.1136/bmjopen-2024-095435","DOIUrl":"10.1136/bmjopen-2024-095435","url":null,"abstract":"<p><strong>Introduction: </strong>Substance use disorders (SUDs) are common and highly disabling, causing serious long-term harm to people's health. Despite the existence of evidence-based interventions for treating SUDs, many individuals remain symptomatic regardless of treatment, and relapse is common. Acupuncture has been examined for the treatment of SUDs, but available evidence is mixed. This comprehensive systematic review and meta-analysis aims to provide updated evidence which will include both English and Chinese studies to investigate the effectiveness and safety of different types of acupuncture for the treatment of alcohol, tobacco and illicit drug use disorders.</p><p><strong>Methods and analysis: </strong>This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta Analysis Protocols. A thorough search for relevant studies in multiple electronic databases (PubMed, Embase, PsycINFO, Cochrane Library, China National Knowledge Infrastructure, VIP, Wan-fang and China Biomedical Database) and clinical trial registries will be conducted. Population-Intervention-Comparator-Outcomes-Study design criteria will be adopted for study inclusion. Only randomised controlled trials analysing the efficacy and safety of acupuncture for SUDs will be included. Two reviewers will independently conduct the study selection, data extraction and quality assessment, and disagreements will be solved by a third senior reviewer or by contacting study authors. Frequency and quantity of substance use, abstinence rate, withdrawal symptoms, treatment drop-out and relapse rates are primary outcomes. Functional status, health-related quality of life and adverse events are secondary outcomes. The risk of bias and quality of evidence will be assessed by the revised Cochrane risk-of-bias tool for randomised trials and guidelines of the Grading of Recommendations Assessment, Development and Evaluation working group, respectively. When sufficient data is available, subgroup analyses will be performed to further compare the differences in the primary and secondary outcomes based on the type of substance use, acupuncture, co-intervention status, comparison group, measurement tools, length of follow-up, risk of bias of included studies and countries of studies conducted.</p><p><strong>Ethics and dissemination: </strong>No private information is used in the entire process of the systematic review. Therefore, ethical approval is not required. Findings of the proposed systematic review will be published in a peer-reviewed journal and/or disseminated through conference presentations.</p><p><strong>Protocol registration number: </strong>The protocol has been archived in the Prospero repository (PROSPERO 2024 CRD42024566389).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e095435"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779176","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":"Patient decision aids for hip and knee arthroplasty decision-making: a scoping review protocol.","authors":"Ouyao Chen, Jianlin Ji, Chengxi Zeng, Hanlin Yang, Qunfeng Lu","doi":"10.1136/bmjopen-2024-089305","DOIUrl":"10.1136/bmjopen-2024-089305","url":null,"abstract":"<p><strong>Introduction: </strong>Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective methods carried out widely in patients with end-stage hip and knee osteoarthritis (OA). Despite the trend towards shared decision-making in surgical decisions, patients often struggle to fully participate due to a lack of informational support. Patient decision aids (PtDAs) which provide evidence-based sources of health information can address this issue and facilitate shared decision-making. However, most existing studies and systematic reviews focus on the effects of PtDAs in the decision-making process for THA and TKA, with little attention given to a comprehensive scoping review of the range and scope of research in this area. Therefore, this review aims to assess the state of the literature on PtDAs for THA and TKA, describe the features of PtDAs for patients with OA who are considering primary elective THA or TKA and identify the questions in the implementation of decision-making.</p><p><strong>Methods and analysis: </strong>This scoping review will be conducted according to the framework recommended by Arksey and O'Malley. The search will be limited to articles written in English and Chinese, while the publication date restriction is from 'inception' to 'February 2025'. Studies on PtDAs for patients with OA considering primary elective THA and TKA will be considered for inclusion. Five electronic databases will be searched (CINAHL, Pubmed, Embase, PsycINFO and Web of Science). Studies for inclusion will be selected independently by two review authors. Data will be extracted using a predefined data extraction form. Findings will be presented in tabular form. A narrative description of the evidence will complement the tabulated results.</p><p><strong>Ethics and dissemination: </strong>This scoping review does not require ethical approval, as it will involve a secondary analysis of existing literature. Findings will be published in a peer-reviewed journal.</p><p><strong>Registration details: </strong>Open Science Framework (https://doi.org/10.17605/OSF.IO/9JCG3).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e089305"},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779194","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":"Locating the built environment within existing empirical models of climate change and mental health: protocol for a global systematic scoping review.","authors":"Marlee Bower, Lauren M Scott, Scarlett Smout, Amarina Donohoe-Bales, Lexine A Stapinski, Gareth Bryant, Edward Jegasothy, Ross Bailie, Shamila Haddad, Arianna Brambilla, Amanda Howard, Jo McClellan, Jon Swain, Laura McGrath, Maree Teesson, Emma L Barrett, Lyrian Daniel","doi":"10.1136/bmjopen-2024-093222","DOIUrl":"10.1136/bmjopen-2024-093222","url":null,"abstract":"<p><strong>Introduction: </strong>Where a person lives, the characteristics of their housing and neighbourhood environment influence their exposure to climate-related hazards and vulnerability to associated mental health impacts. This suggests that the built environment may be a promising focus for integrated policy responses to climate change and public mental health challenges. However, few empirical studies have focused on the role of the built environment as an important mediator of climate-attributable mental health burden. The proposed scoping review seeks to identify and synthesise existing conceptual models and frameworks linking climate change to mental health via built environment pathways. We aim to provide a preliminary overview of the housing and neighbourhood pathways through which climate change may impact mental health, which will inform future empirical work in this emerging area of research.</p><p><strong>Methods and analysis: </strong>A systematic scoping review of the global peer-reviewed and grey literature will be conducted in accordance with Arksey and O'Malley's methodological framework and Joanna Briggs Institute recommendations. Included articles must present a conceptual model or framework incorporating relevant built environment pathways through which climate change may impact mental health and well-being. Relevant models and frameworks will be identified through systematic searches (for English-language reports) of Medline, PsycINFO, Embase, Scopus, Web of Science and grey literature databases. Two reviewers will independently screen the article titles, abstracts and full texts, with conflicts resolved by a third reviewer. Data extraction will occur using a predefined template. The presentation of findings will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, including a narrative synthesis of the role of housing and neighbourhood factors in the relationship between climate change and mental health, as identified from the existing literature. The review will lay essential foundations for future empirical research and place-based policy responses to the mental health consequences of a changing climate.</p><p><strong>Ethics and dissemination: </strong>The scoping review will be a secondary analysis of published data, for which ethics approval is not required. The results will be disseminated through a peer-reviewed publication and targeted distribution to stakeholders involved in climate change, built environment and health research and policymaking.</p><p><strong>Study registration: </strong>Open Science Framework: doi.org/10.17605/OSF.IO/XR74C.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e093222"},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779092","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":"Recommendations for strengthening primary healthcare delivery models for chronic disease management in Mendoza: a RAND/UCLA modified Delphi panel.","authors":"Javier Roberti, Agustina Mazzoni, Marina Guglielmino, Andrea Falaschi, Yanina Mazzaresi, Ezequiel Garcia Elorrio","doi":"10.1136/bmjopen-2024-098074","DOIUrl":"10.1136/bmjopen-2024-098074","url":null,"abstract":"<p><strong>Background: </strong>Primary healthcare (PHC) should be the cornerstone of equitable, efficient and high-quality healthcare in low- and middle-income countries. However, numerous challenges undermine its effectiveness in these settings.</p><p><strong>Objective: </strong>To identify recommendations to improve PHC by integrating user preferences and provider capacity to deliver patient-centred and competent care in the Mendoza Province, Argentina.</p><p><strong>Design: </strong>Modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) Delphi method.</p><p><strong>Setting: </strong>Health system of the Province of Mendoza, Argentina.</p><p><strong>Participants: </strong>32 public health experts from Mendoza.</p><p><strong>Interventions: </strong>Proposals were developed from secondary data, the People's Voice Survey, an electronic cohort of people with diabetes, qualitative studies of users' and professionals' experiences and reviews of interventions in primary care.</p><p><strong>Primary outcome: </strong>Experts had to evaluate proposals according to five criteria selected from the evidence to decision framework (impact, resource requirements, acceptability, feasibility and measurability).</p><p><strong>Results: </strong>The 19 final recommendations emphasise policy continuity, evidence-based policy-making and standardisation of healthcare processes. Key areas include optimising healthcare processes, managing appointments for non-communicable diseases and ensuring competency-based training in PHC. Implementing performance-based incentives and improving financial sustainability were also highlighted. Other recommendations focus on the Digital Transformation Act, user participation in healthcare design and skills development for active engagement. Collaborative definitions of quality care, incident reporting systems and performance metrics are critical to improving healthcare quality.</p><p><strong>Conclusion: </strong>This process provided decision-makers with contextualised information for health policy development. These interventions represent a step towards improving PHC, particularly chronic disease management, and provide a foundation for future regional research and health policy.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e098074"},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779200","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":"Seroprevalence and demographic characteristics of SARS-CoV-2-infected residents of Kibera informal settlement during the COVID-19 pandemic in Nairobi, Kenya: a cross-sectional study.","authors":"Jane Y Carter, Samoel Khamadi, Joseph Mwangi, Samuel Muhula, Stephen M Munene, Lucy Kanyara, Joyceline Kinyua, Nancy Lagat, Judy Chege, Robert Oira, Alex Maiyo, Roy Stewart, Maarten Postma, Jelle Stekelenburg, Joachim Osur, Marinus van Hulst","doi":"10.1136/bmjopen-2024-094546","DOIUrl":"10.1136/bmjopen-2024-094546","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the prevalence of SARS-CoV-2 antibodies in the residents of Kibera informal settlement in Nairobi, Kenya, before vaccination became widespread, and explore demographic and health-related risk factors for infection.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>Kibera informal settlement, Nairobi, Kenya.</p><p><strong>Participants: </strong>Residents of Kibera informal settlement between October 2019 and August 2021, age 1 year and above who reported no current symptoms of COVID-19.</p><p><strong>Main outcome measures: </strong>Associations were determined between SARS-CoV-2 positive tests measured with one rapid test and two ELISAs and demographic and health-related factors, using Pearson's χ² test. Crude OR and adjusted OR were calculated to quantify the strength of associations between variables and seropositive status.</p><p><strong>Results: </strong>A total of 438 participants were recruited. Most (79.2%) were age 18-50 years; females (64.2%) exceeded males. More than one-third (39.1%) were unemployed; only 7.4% were in formal, full-time employment. Less than one-quarter (22.1%) self-reported any underlying health conditions. Nearly two-thirds (64.2%) reported symptoms compatible with COVID-19 in the previous 16 months; only one (0.23%) had been hospitalised with a reported negative COVID-19 test. 370 (84.5%) participants tested positive in any of the three tests. There was no significant difference in SARS-CoV-2 seropositivity across age, sex, presence of underlying health conditions, on medication or those ever tested for SARS-CoV-2. Multiple logistic regression analysis showed that COVID-19 symptoms in the previous 16 months were the only significant independent predictor of seropositivity (p=0.0085).</p><p><strong>Conclusion: </strong>High SARS-CoV-2 exposure with limited morbidity was found in the residents of Kibera informal settlement. The study confirms other reports of high SARS-CoV-2 exposure with limited morbidity in slum communities. Reasons cited include the high infectious disease burden on the African continent, demographic age structure and underreporting due to limited testing and lack of access to healthcare services; genetic factors may also play a role. These factors require further investigation.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e094546"},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779139","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":"Effectiveness and safety of shortened intensive treatment for children with tuberculous meningitis (SURE): a protocol for a phase 3 randomised controlled trial evaluating 6 months of antituberculosis therapy and 8 weeks of aspirin in Asian and African children with tuberculous meningitis.","authors":"Julie Huynh, Chishala Chabala, Suvasini Sharma, Louise Choo, Varinder Singh, Naveen Sankhyan, Hilda Mujuru, Nhung Nguyen, Tung Huu Trinh, Phuc Huu Phan, Nguyen Viet Nhung, Kafula Lisa Nkole, Titiksha Sirari, Constantine Mutata, Elena Frangou, Anna Griffiths, Eric Wobudeya, Caitlin Muller, Sierra Santana, Evelyne Kestelyn, Lam Van Nguyen, Thanh Nguyen, Dai Tran, James A Seddon, Anna Turkova, Susan Abarca-Salazar, Robin Basu-Roy, Guy E Thwaites, Angela Crook, Suzanne T Anderson, Diana M Gibb","doi":"10.1136/bmjopen-2024-088543","DOIUrl":"10.1136/bmjopen-2024-088543","url":null,"abstract":"<p><strong>Introduction: </strong>Childhood tuberculous meningitis (TBM) is a devastating disease. The long-standing WHO recommendation for treatment is 2 months of intensive phase with isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E), followed by 10 months of isoniazid and rifampicin. In 2022, WHO released a conditional recommendation that 6 months of intensified antituberculosis therapy (ATT) could be used as an alternative for drug-susceptible TBM. However, this has never been evaluated in a randomised clinical trial. Trials evaluating ATT shortening regimens using high-dose rifampicin and drugs with better central nervous system penetration alongside adjuvant anti-inflammatory therapy are needed to improve outcomes.</p><p><strong>Methods and analysis: </strong>The <u>S</u>hortened Intensive Therapy for Children with T<u>u</u>be<u>r</u>culous M<u>e</u>ningitis (SURE) trial is a phase 3, randomised, partially blinded, factorial trial being conducted in Asia (India and Vietnam) and Africa (Uganda, Zambia and Zimbabwe). It is coordinated by the Medical Research Council Clinical Trial Unit at University College London (MRCCTU at UCL). 400 children (aged 29 days to <18 years) with clinically diagnosed TBM will be randomised, using a factorial design, to either a 24-week intensified regimen (isoniazid (20 mg/kg), rifampicin (30 mg/kg), pyrazinamide (40 mg/kg) and levofloxacin (20 mg/kg)) or the standard 48-week ATT regimen and 8 weeks of high-dose aspirin or placebo. The primary outcome for the first randomisation is all-cause mortality, and for the second randomisation is the paediatric modified Rankin Scale (mRS), both at 48 weeks. Nested substudies include pharmacokinetics, pharmacogenetics, pathophysiology, diagnostics and prognostic biomarkers, in-depth neurodevelopmental outcomes, MRI and health economics.</p><p><strong>Ethics and dissemination: </strong>Local ethics committees at all participating study sites and respective regulators approved the SURE protocol. Ethics approval was also obtained from UCL, UK (14935/001). Informed consent from parents/carers and assent from age-appropriate children are required for all participants. Results will be published in international peer-reviewed journals, and appropriate media will be used to summarise results for patients and their families and policymakers.</p><p><strong>Trial registration: </strong>ISRCTN40829906 (registered 13 November 2018).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 4","pages":"e088543"},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779042","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}