BMJ Open最新文献

{"title":"Assessing HIV treatment literacy among men living with HIV in Mozambique: a mixed-methods study to identify insights, gaps and impact from the 'Somos Iguais' campaign.","authors":"Mercy Murire, Montague Hermann, Marcos Chissano, Micaela Rodrigrues, Yolanda Chongo, Nina Hasen, Paul Bouanchaud","doi":"10.1136/bmjopen-2023-083040","DOIUrl":"10.1136/bmjopen-2023-083040","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to understand antiretroviral therapy (ART) adherence norms and beliefs among men living with HIV (MLHIV) in Mozambique, gauge the impact of misconceptions and harmful beliefs, evaluate perceived HIV service quality and assess the effectiveness of a behaviour change campaign (Somos Iguais), particularly among men aged 25-34 years.</p><p><strong>Design: </strong>A mixed-methods, cross-sectional study using quantitative and qualitative approaches.</p><p><strong>Setting: </strong>In Mozambique, over two million individuals live with HIV. This study was conducted in Maputo, Nampula and Sofala provinces.</p><p><strong>Participants: </strong>The study comprised 10 focus group discussions with MLHIV aged 18-35 years and 58 indepth interviews with MLHIV aged 15-35 years across diverse subpopulations. A quantitative cross-sectional survey was completed by 1934 MLHIV aged 25-34 years.</p><p><strong>Intervention: </strong>Population Services International developed a behaviour change campaign in 2020 aimed at reaching men age 25-34, who often remain undiagnosed or not virally suppressed.</p><p><strong>Outcome measure: </strong>The study explores key aspects of HIV-related norms, behaviours and beliefs among people living with HIV, including high-risk subpopulations. These key aspects include misinformation, service quality gaps, perceived treatment benefits and the impact of the Somos Iguais campaign.</p><p><strong>Results: </strong>Significantly more MLHIV who were on ART believed that HIV treatment reduces the risk of transmission compared with those who were not on ART (33% and 10%, respectively; p<0.001). Few, however, understood that undetectable viral loads prevent transmission. This lack of understanding is associated with self-stigma and diminished motivation to stay on ART. More than half (54%) of the survey participants agreed that people who are suspected of having HIV lose respect in their community. Surprisingly, our findings did not suggest that provider stigma hampers ART adherence; instead, concerns centred around clinic privacy while obtaining ART. Many MLHIV received HIV education only after diagnosis at the clinic, highlighting a significant community knowledge gap that intensified stigma and hampered treatment. The Somos Iguais behaviour change campaign resonated well with men already on ART, but less so with those not on treatment.</p><p><strong>Conclusion: </strong>While the study highlights a positive trend in HIV treatment literacy among MLHIV, it showed persistent stigmatising attitudes in the wider community. Investments to enhance knowledge and counter misconceptions about HIV treatment, especially among men not reached by the Somos Iguais campaign, are essential in expanding and sustaining the number of MLHIV virally suppressed on ART. Safeguarding patient confidentiality in clinics is imperative to encourage and sustain ART adherence.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e083040"},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132128","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":"The effect of dietary micronutrient intake on abdominal aortic calcification: a study protocol for systematic review and meta-analysis.","authors":"Etsay Weldekidan Tsegay, Nigus Alemu Hailu, Meresa Berwo Mengesha, Zenawi Hagos Gufue","doi":"10.1136/bmjopen-2024-096551","DOIUrl":"10.1136/bmjopen-2024-096551","url":null,"abstract":"<p><strong>Introduction: </strong>Healthy dietary choices have an important role in preventing chronic diseases such as cardiovascular disease (CVD). Increasing evidence suggests micronutrient intake (essential minerals and vitamins) is associated with abdominal aortic calcification (AAC), which is an advanced marker of CVD. However, the existing reports seem inconsistent. Some studies reported micronutrients are associated with a lower risk of AAC, while others have reported an increased risk. Therefore, this systematic review and meta-analysis sought to summarise the available evidence on the association of dietary micronutrient intake on AAC.</p><p><strong>Methods and analysis: </strong>A comprehensive systematic search of the PubMed/MEDLINE, EMBASE, Web of Science and Google Scholar databases from their inception up to September 1, 2024, will be conducted. All clinical studies that report eligible exposure/s (dietary micronutrient intake) and outcome/s (presence/severity of AAC) will be included, and this systematic review and meta-analysis protocol will be reported following the revised Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. The risk of bias for observational studies will be assessed using the Newcastle-Ottawa Scale and publication bias will be evaluated through visual inspection of funnel plots and the Egger's and Begg's regression tests. The Der Simonian and Laird random-effects model meta-analysis will be calculated to provide pooled results, and the weighted risk ratio with their 95% confidence intervals will be presented.</p><p><strong>Ethics and dissemination: </strong>The results will be disseminated through publishing in a peer-reviewed journal and public presentations at relevant local, national and international conferences, workshops and symposiums. Ethical approval is not required as this is a systematic review of publicly available data.<b>PROSPERO registration number</b>CRD42024575902.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e096551"},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131826","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":"Efficacy of sensorimotor training combined with core strength training for low back pain in adult idiopathic scoliosis: a study protocol for a randomized controlled trial.","authors":"Xiangyue Zhou, Xin Li, Nan Chen, Zhengquan Chen, Hong Yu, Juping Liang, Qimeng Fan, Xiaoqing Zhu, Tongtong Zhang, Xuan Zhou, Qing Du","doi":"10.1136/bmjopen-2024-091476","DOIUrl":"10.1136/bmjopen-2024-091476","url":null,"abstract":"<p><strong>Introduction: </strong>Sensorimotor training (SoMT) is a gradual balance training technique employed to treat various chronic musculoskeletal pain. Core strength training (CST) is one of the most commonly used interventions for managing low back pain (LBP). This randomied controlled trial protocol aims to determine whether the combination of SoMT and CST can significantly reduce LBP, and improve scoliosis-related outcomes and overall functional status in adult idiopathic scoliosis (AdIS) patients.</p><p><strong>Methods and analysis: </strong>A total of 300 AdIS patients will be recruited from the outpatient clinic and randomly assigned to one of three groups: CST group, SoMT group or the combined therapy group, using stratified block randomization based on the severity of scoliosis curve. All groups will receive the intervention three times a week for 12 weeks. Sessions will be conducted in the hospital, and no home programme will be provided. Adherence and attendance will be monitored and recorded. The CST group will receive CST therapy, while the SoMT group will receive SoMT therapy, which consists of three progressive phases: static, dynamic and functional. Participants will progress to the next phase on achieving pelvic stability in the current phase. The combined therapy group will receive both CST and SoMT. Assessors and statisticians will remain blinded to participant allocation throughout the study. Assessments will be performed at baseline and at the endpoint, 12 weeks after the initiation of the intervention. The primary outcome will be the self-reported pain level, measured using the visual analogue scale. Secondary outcomes will include pain-related disability (by the Oswestry Disability Index and the Roland-Morris Disability Questionnaire), spinal morphology indicators (including Cobb angle, the angle of trunk rotation and the Sagittal Index), postural control ability (by the Tetrax IBSTM), proprioceptive sensitivity (by the repositioning error test) and health-related quality of life (by the 36-Item Short Form Health Survey). Statistical analysis will adhere to the intention-to-treat principle and will be complemented by per-protocol analysis. To compare the effects of SoMT versus CST and combined therapy versus SoMT on both primary and secondary outcomes, a linear mixed-effects model or generalised linear mixed model will be applied.</p><p><strong>Ethics and dissemination: </strong>The current study received ethical approval from the Xinhua Hospital Ethics Committee Affiliated to Shanghai Jiao Tong University School of Medicine (XHEC-C-2024-080-3). Written informed consent will be obtained from all participants. Any interim analysis and full results will be published in an international peer-reviewed journal.</p><p><strong>Trial registration number: </strong>This protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2400085370).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e091476"},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132182","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":"Current applications of indocyanine green fluorescence angiography in trauma patients and its potential impact: a systematic review.","authors":"Eline Anna Breuking, Emma J de Fraiture, David D Krijgh, Karlijn van Wessem, Ivar Gjm de Bruin, Falco Hietbrink, Jetske Ruiterkamp","doi":"10.1136/bmjopen-2025-099755","DOIUrl":"10.1136/bmjopen-2025-099755","url":null,"abstract":"<p><strong>Objectives: </strong>Tissue viability assessment is one of the main challenges in trauma surgery. Vitality assessment using indocyanine green fluorescence angiography (ICG-FA) may improve surgical decision-making. This systematic review gives an overview of current applications of ICG-FA in surgical treatment of traumatic injury and its effects on the incidence of postoperative complications and intraoperative decision-making.</p><p><strong>Design: </strong>Systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.</p><p><strong>Data sources: </strong>PubMed, EMBASE and MEDLINE were searched through 18 December 2023.</p><p><strong>Eligibility criteria for selecting studies: </strong>Primary research reports regarding indocyanine green (ICG)-fluorescence in patients with traumatic injury were included. Exclusion criteria were use of ICG for treatment of burn wounds, traumatic brain injury or reconstructive surgery, absence of an English or Dutch full-text and non-primary study design.</p><p><strong>Data extraction and synthesis: </strong>Two independent reviewers performed the search and screening process according to standardised methods. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies. Data were presented in text and overview tables.</p><p><strong>Results: </strong>Thirteen studies were included, of which six were case series/reports including three or fewer patients. Within the other seven studies, 301 patients received ICG-guided surgery. ICG was used for perfusion assessment in all studies. Injury types consisted of traumatic extremity and abdominal injury. All studies reported beneficial effects such as necrosis detection, determination of resection/debridement margins and reduction of debridement procedures. ICG could improve intraoperative decision-making and significantly decrease postoperative complications. No included studies reported ICG-related complications or adverse events.</p><p><strong>Conclusion: </strong>The available literature regarding the use of ICG-FA in trauma surgery is limited, and comparability is low. Still, the results are promising and show a large potential of ICG-FA for better and more efficient treatment of trauma patients. Further research with larger samples and comparable conditions is thus necessary and highly recommended.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e099755"},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132176","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":"Barriers in implementing antibiotic stewardship programmes at paediatric units in academic hospitals in Thailand: a qualitative study.","authors":"Suvaporn Anugulruengkitt, Thidarat Jupimai, Prissana Wongharn, Thanyawee Puthanakit","doi":"10.1136/bmjopen-2024-092509","DOIUrl":"10.1136/bmjopen-2024-092509","url":null,"abstract":"<p><strong>Objective: </strong>To explore the barriers that hinder and the facilitators that strengthen the implementation of the antimicrobial stewardship (AMS) programme at paediatric units in academic hospitals in Thailand.</p><p><strong>Design: </strong>A qualitative study using thematic analysis of interviews with healthcare staff.</p><p><strong>Setting: </strong>Five paediatric units in academic hospitals in Thailand.</p><p><strong>Participants: </strong>20 healthcare workers and 10 AMS service providers who actively participated in the AMS programme in the sampled hospitals were included from purposive criterion.</p><p><strong>Primary outcome measures: </strong>Qualitative, interpretive description with semistructured individual interviews were digitally recorded and transcribed. The MAXQDA software was used to facilitate content analysis.</p><p><strong>Results: </strong>In total, 4 themes emerged from the data: (1) organisational hierarchical culture and individual behaviours influence the acceptance and adherence to AMS implementation, (2) changing healthcare workers' mindset to improve stewardship is crucial, (3) effective communication and collaboration among healthcare teams are the key to implementing the AMS programme and (4) dedication to antimicrobial stewardship despite resource limitations is important to improve AMS programme implementation.</p><p><strong>Conclusions: </strong>To implement antimicrobial stewardship in a paediatric setting, there are many issues to overcome. The key barriers to focus were organisational hierarchical culture and perception of healthcare workers. Support from hospital policy and effective communication with contextualised strategies should be considered to improve AMS programme implementation plans.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e092509"},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132158","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":"Assessment of health system responsiveness in delivering HIV and AIDS care services at Urban sites of Pakistan - a protocol for cross sectional study.","authors":"Muhammad Bilal, Javeria Mansoor, Syed Faisal Mahmood","doi":"10.1136/bmjopen-2024-097740","DOIUrl":"10.1136/bmjopen-2024-097740","url":null,"abstract":"<p><strong>Introduction: </strong>The capacity of a health system to fulfill the justifiable demands of patients and their caregivers while delivering prompt, courteous and patient-centered treatment is known as health system responsiveness (HSR). HSR can be considered as a measure for the quality of the health system. Keeping aside the clinical aspects of healthcare, it focusses on the health system's capacity to meet the needs of patients in accordance with ethical values and service standards. HSR is comprised of eight major dimensions including autonomy, dignity, confidentiality, timely attention, communication, facility quality, social support network accessibility and provider choice.</p><p><strong>Methods and analysis: </strong>An analytical cross-sectional study will be conducted in three public anti-retroviral therapy (ART) centres of Karachi, Pakistan, and will continue for a period of 12 months using purposive sampling technique. A sample size of 381 individuals is calculated, and patients aged >18 years, on treatment for the past 12 months will be included. Face-to-face interviews will be carried out by trained interviewers after obtaining informed consent in the local language. Descriptive statistics will be presented alongside binary logistic regression analysis.</p><p><strong>Ethics and dissemination: </strong>Written and informed consent will be taken from each participant before enrolment. This study is approved by the ethical review committee at the Aga Khan University Hospital (Ref No: 2024-9960-31694), and official permission has been obtained by the additional district health officer of the local government. We will disseminate the findings to stakeholders at the provincial government, private institutions, local and international conferences and a peer-reviewed journal.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e097740"},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132129","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":"Cost-effectiveness of massed versus spaced trauma-focused treatment as first-line treatment for post-traumatic stress disorder in adults with multiple trauma exposure: protocol for a single-blind non-inferiority randomised controlled trial.","authors":"Bram Kemmere, Ytje T van Pelt, Miriam J J Lommen, Rafaele J C Huntjens, Miranda Olff, Mayaris Zepeda Méndez, Suzy Matthijssen, Leona Hakkaart-van Roijen, Mirjam J Nijdam, Foske Jackie June Ter Heide","doi":"10.1136/bmjopen-2025-102530","DOIUrl":"10.1136/bmjopen-2025-102530","url":null,"abstract":"<p><strong>Introduction: </strong>Post-traumatic stress disorder (PTSD) is a serious disorder that burdens individuals and society. The current standard of first-line treatment for PTSD is spaced trauma-focused treatment (S-TFT), involving weekly sessions. While effective, S-TFT may take relatively long to complete, especially in patients exposed to multiple potentially traumatic events (PTEs). Massed trauma-focused treatment (M-TFT), involving increased session frequency, potentially results in faster symptom reduction and restoration of quality of life, as well as in a reduction of societal costs. However, M-TFT is not recommended as first-line treatment. This paper describes the research protocol of a single-blind, multicentre randomised controlled trial (RCT) aimed at investigating: (1) the clinical and cost-effectiveness of M-TFT versus S-TFT in employed, multiply traumatised patients who seek first-line treatment for PTSD and (2) predictive and moderating factors related to treatment response.</p><p><strong>Methods and analysis: </strong>186 participants are recruited from five centres and will be included if they are ≥18 years old, meet criteria for a Diagnostic and Statistical Manual of Mental Disorders Fifth Edition PTSD diagnosis based on ≥two PTEs, seek treatment for the first time and are employed. Patients with specified comorbid disorders and insufficient Dutch language proficiency are excluded. Participants are randomised to 800 min of either M-TFT or S-TFT. M-TFT consists of two once-weekly preparatory sessions, 10 twice-daily sessions of prolonged exposure, eye movement desensitisation and reprocessing therapy for 2 weeks and two once-weekly closing sessions. S-TFT consists of weekly sessions of one of five evidence-based treatment interventions. Outcomes are assessed at baseline and at 7 weeks, 17 weeks, 6 months and 9 months after baseline. Primary outcomes are clinical effectiveness in terms of PTSD symptom severity and cost-effectiveness based on quality of life measures and societal costs. Data will be analysed with linear mixed models.</p><p><strong>Ethics and dissemination: </strong>This study protocol was approved by the Medical Ethics Review Board of the Amsterdam University Medical Center (NL86057.018.24). Participants will provide informed consent before enrolment in the trial. Results will be published in peer-reviewed journals and will be released to clinicians, patient groups and the general community.</p><p><strong>Trial registration number: </strong>This protocol is registered at Overview of Medical Research in the Netherlands (OMON; trial register number 56960) and ClinicalTrials.gov (NCT06700590).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e102530"},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132162","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 matters to patients with multiple sclerosis? Identifying patient-relevant attributes using a ranking exercise with open-ended answers from an online survey in Italy.","authors":"Karin Schölin Bywall, Ulrik Kihlbom, Jennifer Viberg Johansson, Guido Pasquini, Filippo Gerli, Claudia Niccolai, Sara Della Bella, Emilio Portaccio, Matteo Betti, Maria Pia Amato, Sylvia Martin","doi":"10.1136/bmjopen-2024-095552","DOIUrl":"10.1136/bmjopen-2024-095552","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore what intervention specificities or attributes newly diagnosed individuals with multiple sclerosis (MS) find important and to explore possible reasons behind their evaluations.</p><p><strong>Design: </strong>A stepwise approach began with a systematic literature review to identify significant attributes. Patients with MS then assessed these attributes through an online survey, which included a ranking exercise and open-ended questions. Finally, the results were evaluated by the clinical team to select the most relevant factors for personalised care.</p><p><strong>Setting and participants: </strong>From June 2023 to December 2023, all consecutive patients referred to the MS Center of Careggi University Hospital were screened for inclusion. Following recruitment, cognitive and physical assessments were administered at the Don Gnocchi Centre. All participants were interviewed by an experienced neuropsychologist.</p><p><strong>Procedures: </strong>Participants were enrolled in the RELIABLE clinical trial, which included a ranking exercise and open-ended question. In the ranking exercise, patients prioritised levels of treatment attributes: treatment effects, methods of intervention, type of monitoring, monitoring, mode and mental support. The open-ended questions addressed the reasons behind the level rankings.</p><p><strong>Results: </strong>Participants' rankings revealed the most important levels of each attribute. The highest-ranked method of intervention was disease-modifying treatment, which received 164 points. For mental support, individual psychotherapy was deemed most important with 149 points. Preservation of cognitive function, a key treatment effect, received 144 points. Clinical check-ups were the top type of monitoring with 129 points. Lastly, the hybrid mode of monitoring (half remote/half in-person) was ranked with 77 points. Open-ended responses provided insights into the reasons behind these preferences, emphasising the importance of maintaining mobility, cognitive function and emotional well-being. The clinical team evaluated these findings, confirming that the selected attributes were both clinically relevant and aligned with patient priorities. This evaluation process ensured that the treatment specificities chosen for individualised care were comprehensive and reflective of patient needs.</p><p><strong>Conclusions: </strong>By identifying and prioritising key treatment attributes, this research highlights the multifaceted nature of MS management and emphasises the importance of aligning treatment options with patient preferences. Addressing these factors through further quantitative preference assessments is essential for preventative MS care, improving patient outcomes and promoting a more patient-centred approach to treatment.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e095552"},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131849","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":"Prevalence of orthorexia nervosa: a systematic review and meta-analysis protocol.","authors":"Tayla Eckley, Shae E Quirk, Julie A Pasco, Mariel Messer, Lana J Williams","doi":"10.1136/bmjopen-2024-096802","DOIUrl":"10.1136/bmjopen-2024-096802","url":null,"abstract":"<p><strong>Introduction: </strong>Orthorexia nervosa (ON) is a newly recognised condition characterised by an excessive fixation with healthy eating, yet the prevalence of ON is poorly understood. This protocol presents the methodology to undertake a systematic review and meta-analysis on the prevalence of ON in a wide range of populations (including general population and 'high-risk'). To the authors' knowledge, the proposed review will be the first systematic review to critically appraise the quality and quantity of evidence on this topic.</p><p><strong>Methods: </strong>The protocol has been developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Eligible studies will be identified through a systematic search of electronic databases (eg, Medline Complete, PsycInfo and CINAHL complete via the EBSCOHost platform and Embase). Two reviewers will independently screen and review the full text of records, extract the data and critically appraise the evidence using the Joanna Briggs Institute critical appraisal checklist for prevalence studies. A descriptive synthesis will present the characteristics of the included studies and key findings in text and tables. Where appropriate, meta-analysis will be conducted to determine the proportion of individuals with ON (yes/no) according to population groups of interest (ie, general and 'high-risk' populations) and/or ON tools.</p><p><strong>Ethics and dissemination: </strong>This review will include published data only; thus, ethical permission will not be necessary. Results of this review will be published in a relevant peer-reviewed scientific journal and presented at conferences in related fields.</p><p><strong>Prospero registration number: </strong>CRD42024576557.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e096802"},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131804","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":"Rationale and design of 'discontinuing statins in multimorbid older adults without cardiovascular disease (STREAM)': study protocol of a randomised non-inferiority clinical trial.","authors":"Philipp Stefan Aebi, Luise Adam, Moa Haller, Julia Bianca Bardoczi, Baris Gencer, Fabrice Bonnet, Jürg-Hans Beer, Sebastian Carballo, Mirjam Christ-Crain, Martin Feller, Luca Gabutti, Alan G Haynes, Elisavet Moutzouri, Patricia Orializ Chocano-Bedoya, Stefano Bassetti, Robert Escher, Martin Egger, Rosalinde K E Poortvliet, Philipp Schuetz, Sven Trelle, Maria M Wertli, Dina Zekry, Marie Méan, Drahomir Aujesky, Douglas Bauer, Manuel R Blum, Nicolas Rodondi","doi":"10.1136/bmjopen-2024-093833","DOIUrl":"10.1136/bmjopen-2024-093833","url":null,"abstract":"<p><strong>Introduction: </strong>Statins are among the most widely used drugs. While they are effective for primary and secondary prevention of cardiovascular (CV) disease in middle-aged subjects, their benefits for prevention in older adults (aged ≥70 years) without CV disease are uncertain, particularly for those with multimorbidity. Statin side effects and drug interactions are common in older patients and may negatively impact quality of life. To date, the only randomised controlled trial (RCT) investigating statin discontinuation in older adults has demonstrated no difference in survival but did note a small improvement in quality of life for those who discontinued statins. However, this trial exclusively enrolled patients with a life expectancy <1 year. Therefore, the present RCT aims to assess the safety and potential benefits of statin discontinuation in primary prevention for the ever-growing population of multimorbid older adults.</p><p><strong>Methods and analysis: </strong>This study is a multicentre, randomised, non-inferiority trial conducted in both inpatient and outpatient settings in Switzerland, France and the Netherlands, targeting patients using statins for primary prevention. 1800 participants are randomly assigned 1:1 to either discontinue (intervention arm) or continue (control arm) statin therapy. The primary objective is to compare the primary composite endpoint of major CV events (non-fatal myocardial infarction or non-fatal ischaemic stroke) and all-cause death between the control and intervention groups over a follow-up duration of up to 48 months. We hypothesise that discontinuing statins does not result in shorter event-free survival, with a non-inferiority margin set at 5.2 weeks over a 2-year observation period. Secondary objectives are to compare patient-centred outcomes (health-related quality of life, muscle pain symptoms, falls and sarcopenia) and all-cause death, non-CV death, major CV events and coronary and peripheral artery revascularisation. The study is open-labelled, with blinded outcome adjudication of the primary endpoints.</p><p><strong>Ethics and dissemination: </strong>The trial protocol has received approval from the local ethics committees in Switzerland, France and the Netherlands. Results will be published in a peer-reviewed journal.</p><p><strong>Trial registration number: </strong>Clinicaltrials.gov: NCT05178420; BASEC (Swiss Ethics Commission): 2021-01513; FOPH (Swiss national portal): SNCTP000005172; Netherlands Trial Register: NL83907.058.23; France Trial Register: 22.04747.000158- IDRCB 2022-A02481-42.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 5","pages":"e093833"},"PeriodicalIF":2.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131809","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}