BMJ Open最新文献

{"title":"Prevalence of autism among adults in Canada: results from a simulation modelling study.","authors":"Erin Collins, Rojiemiahd Edjoc, Amy Farrow, Christoffer Dharma, Stelios Georgiades, Kieran Holmes, Christa Orchard, Siobhan O'Donnell, Sarah Palmeter, Mackenzie Salt, Ahmed Al-Jaishi","doi":"10.1136/bmjopen-2024-089414","DOIUrl":"10.1136/bmjopen-2024-089414","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the prevalence of autism among adults living in Canada.</p><p><strong>Design: </strong>A Monte Carlo simulation modelling approach was employed. Input parameters included adult population estimates and mortality rates; autism population all-cause mortality risk ratios; and autism prevalence estimates derived from child and youth data due to the lack of adult data. This approach was executed through 10 000 simulations, with each iteration generating a distinct data scenario. Prevalence estimates were reported as the mean with the 2.5th and 97.5th percentiles, corresponding to a 95% simulation interval (SI).</p><p><strong>Setting: </strong>Where possible, Canadian data sources were used, including the 2019 Canadian Health Survey on Children and Youth and Statistics Canada mortality rates and population estimates.</p><p><strong>Primary outcome measure: </strong>National prevalence estimates of autistic adults living in private dwellings in Canada, with variations in prevalence by sex at birth and province/territory considered.</p><p><strong>Results: </strong>The findings suggest the prevalence of autism among adults in Canada to be 1.8% (95% SI 1.6%, 2.0%). National prevalence estimates by sex at birth were 0.7% (95% SI 0.6%, 0.9%) for females and 2.9% (95% SI 2.6%, 3.2%) for males. Provincial/territorial estimates ranged from 0.7% in Saskatchewan (95% SI 0.3%, 1.3%) to 3.6% in New Brunswick (95% SI 2.4%, 5.1%).</p><p><strong>Conclusions: </strong>The limited availability of data on autistic adults constrains our ability to fully understand and address their unique needs. In this study, autism prevalence was estimated based on diagnosed cases, which excludes individuals without a formal diagnosis. Additionally, other factors such as data availability and methodological assumptions may influence the modelling of prevalence estimates. As a result, our findings should be interpreted within the context of these limitations. Nevertheless, this study provides a valuable reference point for understanding autism prevalence among adults in Canada.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e089414"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483164","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":"Preventing the transition from acute to chronic low back pain using home-based neuromodulation: protocol for a randomised, controlled study.","authors":"Ariane Y Suhood, Simon Summers, Tasha R Stanton, Daniel Thomson, James McAuley, Aidan Cashin, Luke C Jenkins, Ghufran Alhassani, Keeley R McNally, Amitabh Gupta, Rocco Cavaleri","doi":"10.1136/bmjopen-2024-096126","DOIUrl":"10.1136/bmjopen-2024-096126","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic low back pain (LBP) is among the world's leading causes of disability and declines in quality of life. Despite considerable financial and research investment, current interventions demonstrate only modest success or are associated with deleterious side effects. Furthermore, most treatment efforts are directed towards LBP that has already become chronic, rather than interventions capable of preventing pain chronicity in the first instance. Transcranial direct current stimulation (tDCS), a portable and cost-effective form of non-invasive brain stimulation, presents a potential means of targeting acute pain and preventing the transition to chronic pain. However, this approach has been limited primarily to experimental settings that require intensive appointments and specialist expertise. Thus, this assessor-blinded, participant-blinded, and therapist-blinded, randomised controlled trial aims to explore the effectiveness of home-based tDCS for improving pain and disability in people with acute LBP. This may provide insight into the potential for tDCS to expedite recovery from acute LBP and prevent pain chronicity.</p><p><strong>Methods and analysis: </strong>40 individuals with acute LBP (onset <8 weeks prior to enrolment) will be recruited and randomly allocated to a 2-week treatment protocol of either active or sham home-based tDCS. Participants will attend five laboratory sessions (pre-intervention baseline; at intervention completion; 4 weeks, 8 weeks and 12 weeks post-completion of intervention) where measures of pain processing and disability will be collected. Mechanistic factors (potential mediators) of treatment effectiveness, including corticomotor organisation (transcranial magnetic stimulation mapping), somatosensory function, electroencephalography and affective-emotional characteristics, will also be assessed. Daily online questionnaires will be completed by participants during the intervention period to assess pain intensity and to monitor safety, treatment adherence and tolerability. The efficacy of tDCS in improving pain and disability in people with acute LBP will be investigated by analysing within-group and between-group changes in these outcomes over time.</p><p><strong>Ethics and dissemination: </strong>Ethics approval has been granted by the Western Sydney University Human Research Ethics Committee (H16334). Findings will be disseminated through scientific conferences and peer-reviewed journal publication.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e096126"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483165","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":"Evaluation of the outpatient parenteral antimicrobial therapy (OPAT) service in Malaysian public hospitals: a mixed-methods study protocol.","authors":"Audrey Huili Lim, Norazida Ab Rahman, Afra Nahdia Marizan Nor, Nor Arisah Misnan, Peter Seah Keng Tok","doi":"10.1136/bmjopen-2025-100292","DOIUrl":"10.1136/bmjopen-2025-100292","url":null,"abstract":"<p><strong>Introduction: </strong>Outpatient parenteral antimicrobial therapy (OPAT) is an innovative approach to manage infections that require extended courses of intravenous antibiotics by enabling patients to receive treatment in an outpatient setting. In Malaysia, there has yet to be a systematic evaluation of the OPAT service. This study aims to describe the safety, clinical indications and treatment outcomes of the OPAT service in Malaysia, assess patients' satisfaction and experiences and determine the facilitators and barriers associated with the provision of the OPAT service in Malaysia.</p><p><strong>Methods and analysis: </strong>A mixed-methods approach combining qualitative and quantitative methods will be employed for a comprehensive understanding of the provision of the OPAT service in Malaysian public hospitals. The study consists of four distinct parts: systematic review, retrospective cohort analysis of clinical outcomes, patients' satisfaction survey and focus group discussions on providers' experiences. A longitudinal analysis of the clinical outcomes (treatment success/failure, infection cure, adverse events, readmission and mortality) of the OPAT patients' cohort will be conducted using descriptive and conclusive statistics, in addition to rates of patients' satisfaction and evaluation of providers' experiences.</p><p><strong>Ethics and dissemination: </strong>This study is registered in the National Medical Research Register (NMRR ID-24-00941-2C8) and approved by the Medical Research and Ethics Committee, Ministry of Health Malaysia (Ref: 24-00941-2C8). Written informed consent will be obtained from all participants. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e100292"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483162","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":"Prognostic nutritional index in the prediction of adverse cardiac and cerebrovascular events in ST-segment elevation myocardial infarction patients with type 2 diabetes mellitus in Urumqi, China: a retrospective cohort study.","authors":"Bang-Hao Zhao, Teng Yuan, Ling Zhao, Amanguli Ruze, Qiu-Lin Li, An-Xia Deng, Su Hu, Xiao-Ming Gao","doi":"10.1136/bmjopen-2025-099750","DOIUrl":"10.1136/bmjopen-2025-099750","url":null,"abstract":"<p><strong>Objective: </strong>Prognostic nutritional index (PNI) is an index for assessing nutritional and immune status. The aim of this study is to investigate the predictive value of PNI for long-term major adverse cardiac and cerebrovascular events (MACCE) in ST-segment elevation myocardial infarction (STEMI) patients with type 2 diabetes mellitus (T2DM).</p><p><strong>Design, setting and participants: </strong>This retrospective cohort study analysed 1582 STEMI patients with T2DM who underwent percutaneous coronary intervention from January 2015 to June 2023 in Urumqi, China. Patients were followed up for MACCE.</p><p><strong>Primary and secondary outcome measures: </strong>The primary endpoint was new-onset MACCE including all-cause death, non-fatal MI and non-fatal stroke.</p><p><strong>Results: </strong>This study ultimately included 1582 patients for analysis with a median follow-up period of 48 months (IQR: 24-84 months) and 282 patients (17.8%) developed MACCE. Of them, 138 (8.7%), 84 (5.3%) and 60 (3.8%) patients developed all-cause death, a non-fatal MI and a non-fatal stroke, respectively. Incidences of MACCE and all-cause death conversely correlated with PNI. Kaplan-Meier curves showed a significant difference in all components of MACCE between PNI quartiles (p<0.001). The multivariate Cox regression analysis revealed that PNI was an independent predictor of MACCE (adjusted HR 0.95, 95% CI 0.93 to 0.97, p<0.001) and all-cause death (adjusted HR 0.93, 95% CI 0.90 to 0.97, p<0.001). The optimal PNI cut-off for predicting MACCE and all-cause death was 45.10 and 45.09, respectively. Moreover, the addition of PNI to the traditional prognostic model for MACCE improved the C-statistic value (p<0.001).</p><p><strong>Conclusions: </strong>PNI, a simple and easily obtainable index, was independently associated with MACCE and all-cause death in this study. Lower PNI levels were significantly linked to an increased risk of long-term MACCE, especially in male, elderly patients and those with higher glycosylated haemoglobin and low- density lipoprotein cholesterol levels.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e099750"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483167","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":"Beyond the puff: qualitative insights into smoking behaviours and societal perceptions among university students in India.","authors":"Seemadevi Thangeswaran, Naganandini Sampath, Kumar Gaurav Chhabra, Pankaj Chaudhary, Avishek Singh, Shweta Dangi","doi":"10.1136/bmjopen-2025-101172","DOIUrl":"10.1136/bmjopen-2025-101172","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of the study was to understand the smoking behaviour of adults and how societal perceptions influence the smoking behaviour of university students.</p><p><strong>Design: </strong>Qualitative study.</p><p><strong>Setting: </strong>National Institute of Medical Sciences university, India.</p><p><strong>Participants: </strong>20 face-to-face interviews were carried out among university students who were in the age group of 19-30 years using a combination of purposive sampling, followed by snowball sampling methods.</p><p><strong>Results: </strong>Qualitative responses revealed that stress, cravings for cigarettes and mealtimes were key triggers for smoking behaviour. Many participants felt guilty about their smoking and often became irritated by advice from non-smoking friends. All participants had experienced negative health effects, including physical and sensory issues, as well as other adverse experiences. Students expressed a dislike for judgemental attitudes from society. They respected elders and found it difficult to smoke in front of them. Rather than being blamed for their smoking, they preferred supportive assistance to help them quit.</p><p><strong>Conclusions: </strong>The study highlights the importance of understanding college students' smoking behaviour, as it greatly influences their smoking habits. Cessation efforts should target this group and emphasise the negative experiences associated with smoking. Additionally, students recommend creating a non-judgemental and supportive environment to aid in quitting, rather than a judgemental and blaming society.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e101172"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483156","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":"Are client and provider preferences for HIV care coordination programme features concordant? Discrete choice experiments in Ryan White part A-funded New York City care coordination programmes.","authors":"Rebecca Zimba, Chunki Fong, Madellena Conte, Honoria Guarino, Tigran Avoundjian, Jennifer Carmona, Grace Herndon, Gina Gambone, Mary Kathryn Irvine, Denis Nash","doi":"10.1136/bmjopen-2024-097918","DOIUrl":"10.1136/bmjopen-2024-097918","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The New York City (NYC) HIV Care Coordination Programme (CCP) is designed to help people with HIV (PWH) overcome barriers to care and treatment engagement. We assessed preferences for CCP components among programme enrollees ('clients') and providers. Our objective is to compare client and provider preferences, which were previously analysed separately.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;We used a discrete choice experiment to assess preferences for four CCP features ('attributes'): Help with Adherence to Antiretroviral Therapy (ART), Help with Primary Care Appointments, Help with Issues other than Primary Care and Where Programme Visits Happen. Each of these attributes had 3-4 variants ('levels'). In the original surveys, levels within Where Programme Visits Happen varied by participant type (client vs provider). We recoded the levels by visit location (VL) or by travel time (TT) to make them comparable and report results from both approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;25 Ryan White Part A-funded NYC CCPs participated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;152 providers and 181 clients completed the survey.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Primary and secondary outcome measures: &lt;/strong&gt;Preferences were quantified using the relative importance of the attributes and utility of the levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From January 2020 to March 2021, 152 providers and 181 clients completed the survey. Most of the providers (52%) were &lt;40 years, while most of the clients (60.2%) were ≥50 years. Almost half of the providers identified as Hispanic, whereas two-thirds of the clients (66.9%) identified as Black non-Hispanic. Most of the providers and clients identified as women (68.4% and 55.3%, respectively). In both the VL and TT analyses, clients were most influenced by Help with Adherence to ART (relative importance (RI) 30.5%, 95% CI 28.5% to 32.4% and 29.4%, 95% CI 27.5% to 31.4%, respectively), preferring medication reminders via phone or text, and Where Programme Visits Happen (RI 26.8%, 95% CI 25% to 28.6% and 32%, 95% CI 30.1% to 33.8%, respectively), preferring visits via phone or video chat. In the VL analysis, providers were most influenced by Help with Issues other than Primary Care (RI 26.9%, 95% CI 25.3% to 28.6%), valuing connections to specialty medical care, and by Help with Adherence to ART (RI 25.5%, 95% CI 23.5% to 27.5%), valuing directly observed therapy most highly. In the TT analysis, providers were most influenced by Where Programme Visits Happen (RI 28.2%, 95% CI 26.6% to 29.9%), preferring longer travel times, and Help with Issues other than Primary Care (RI 24.5%, 9%% CI 22.9% to 26.1%), again preferring connections to specialty medical care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Client and provider preferences clearly diverged regarding CCP service intensity: in the aggregate, clients tended to prefer lower-intensity services, whereas providers endorsed higher-intensity services. These results highlight th","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e097918"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483142","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":"Randomised trial of home sleep apnoea testing compared to in-lab polysomnography for the evaluation of obstructive sleep apnoea in children: rationale and study protocol.","authors":"Yaelis D Roman Rosado, Mahalakshmi Somayaji, Darko Stefanovski, Eberechukwu A Uwah, Michelle Ward, Ignacio E Tapia, Anjalee Galion, Lourdes M DelRosso, Sally L Davidson Ward, Christopher M Cielo","doi":"10.1136/bmjopen-2025-103315","DOIUrl":"10.1136/bmjopen-2025-103315","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnoea (OSA) affects 1-5% of the paediatric population, including 55-90% of children with Down syndrome (DS), and has been associated with negative effects on neurocognitive development, cardiovascular health, immune development and quality of life. In-lab attended polysomnography (PSG) is currently the gold standard for the diagnosis of OSA in children, but it poses challenges due to the burden on families and limited testing facilities. Home sleep apnoea testing (HSAT), an unattended sleep test done at home, is an accepted alternative for adults but lacks sufficient evidence to be used clinically for the evaluation of OSA in children. HSAT may be especially beneficial for children with DS or others with sensory issues or those who struggle with sleeping in a laboratory setting overnight.</p><p><strong>Methods and analysis: </strong>This single-centre trial compares HSAT to PSG for the diagnosis of OSA in children, including those with DS. The trial will enrol 317 children 5-12 years old, including approximately 100 with DS. The primary outcome is the diagnostic accuracy of HSAT compared with PSG for OSA evaluated through ROC. Secondary outcomes include the agreement between HSAT and PSG for therapeutic decision-making and comparison of preference and acceptability of HSAT versus PSG. This trial seeks to evaluate HSAT as an alternative diagnostic tool for paediatric OSA, potentially expanding testing options for clinicians and families.</p><p><strong>Ethics and dissemination: </strong>This study has been approved by the Institutional Review Board at Children's Hospital of Philadelphia (#21-0 19 533). Informed consent will be obtained from all participants, and no identifiable data will be reported.</p><p><strong>Trial registration number: </strong>NCT05382754.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e103315"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483168","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 emerging economic evidence and methods used to evaluate clinical registries: a systematic scoping review protocol.","authors":"Kalpa Pisavadia, Ned Hartfiel, Limssy Varghese, Anne Krayer, Gemma Hobson, Rebecca Masters, Rob Poole, Catherine Robinson, Rhiannon Tudor Edwards, Emily Bebbington","doi":"10.1136/bmjopen-2025-100644","DOIUrl":"10.1136/bmjopen-2025-100644","url":null,"abstract":"<p><strong>Introduction: </strong>A clinical registry is a systematically collected database of health-specific information about a patient population. Clinical registries can be used for a variety of purposes including surveillance, monitoring of outcomes and patient care. The establishment and maintenance of clinical registries come with a significant cost. This scoping review aims to identify the methods used to economically evaluate clinical registries including their costs and benefits.</p><p><strong>Methods: </strong>This systematic scoping review protocol has been developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The final review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The electronic databases Medline, Embase, Cochrane Library and The Cumulative Index to Allied Health Literature(CINAHL) database will be searched. Relevant national organisation websites will be searched to identify empirical studies within grey literature. The inclusion criteria include studies that economically evaluate clinical registries and are published in the English language from inception to February 2025. Two reviewers will independently screen 100% of titles and abstracts and full texts of studies for inclusion. Data will be extracted from eligible studies prior to being assessed for quality using a multi-tool approach.</p><p><strong>Ethics and dissemination: </strong>The findings of this review will be published in an international peer-reviewed journal. They are likely to be of interest to custodians of existing clinical registries and to those wishing to establish or evaluate clinical registries.<b>Keywords</b>Clinical registries, economic evaluation, costs, cost-effectiveness, health economics, registry based studies.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e100644"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483171","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":"Treatment outcomes, medication adherence and predictors among patients with epilepsy in Mekelle City Hospitals, Ethiopia: a multicentre observational cross-sectional study.","authors":"Gebremicheal Gebreyohanns Kahsay, Kidu Gidey, Alemseged Beyene Berha","doi":"10.1136/bmjopen-2024-097067","DOIUrl":"10.1136/bmjopen-2024-097067","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess treatment outcome, medication adherence and predictors among epilepsy patients at three low-resource setting hospitals in Mekelle City, Northern Ethiopia.</p><p><strong>Design: </strong>A multicentre hospital-based observational cross-sectional study was conducted.</p><p><strong>Setting: </strong>The study was conducted in three resource-limited tertiary care hospitals in Mekelle City, Northern Ethiopia: Ayder Comprehensive Specialized Hospital, Mekelle General Hospital and Quiha General Hospital.</p><p><strong>Participants: </strong>A total of 351 patients with epilepsy receiving regular follow-up care at adult neurology outpatient clinics in three low-resource setting hospitals were included in the study.</p><p><strong>Main outcome measures: </strong>The study assessed adherence to antiepileptic drugs (AEDs), treatment outcomes and identified independent predictors of these outcomes.</p><p><strong>Results: </strong>A total of 351 study participants were included in the final analysis, with a mean (±SD) age of 37.98±14.27 years. More than one-third (39%) had poorly controlled seizures. Living in urban areas (adjusted odds ratio (AOR)= 3.36, 95% CI 1.1 to 10.4, p=0.037), being government-employed (AOR = 4.0, 95% CI 1.1 to 14.5, p=0.035) and being a student (AOR = 4.0, 95% CI 1.1 to 14.5, p=0.035) were associated with good seizure control. Half of the participants (177, 50.6 %) were non-adherent to their medications. Being a farmer (AOR = 4.2, 95% CI 1.5 to 11.3, p=0.005), a housewife (AOR = 4.9, 95% CI 1.4 to 17.2, p=0.012), absence of seizure-triggering factors (AOR = 3.7, 95% CI 2.34 to 6.06, p<0.001), absence of comorbidities (AOR 1.8, 95% CI 1.11 to 11.28, p=0.008) and good seizure control (AOR= 2.38, 95% CI 1.55 to 3.71, p<0.001) were predictors of adherence to AED treatment.</p><p><strong>Conclusions: </strong>More than two-thirds of patients with epilepsy experienced poor seizure control. Place of residence, employment status and the number of seizure episodes prior to treatment initiation were identified as significant predictors of treatment outcomes. Approximately half of the study participants were adherent to their medications, with employment status, the presence of seizure-triggering factors, comorbidities and seizure control serving as predictors of medication adherence.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e097067"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483143","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":"Understanding patients' perceptions of chronic illness care, self-management support needs and their relationship with telehealth preferences: a cross-sectional study in Vietnamese primary care.","authors":"Quynh Anh Le Ho Thi, Minh Tam Nguyen, Quoc Huy Nguyen Vu, Quang Tuan Duong, Len Len Che Thi, Mong Tuyen Ngo Thi, Chi Le Van, Anselme Derese, Peter Pype, Wim Peersman, Johan Wens","doi":"10.1136/bmjopen-2024-090734","DOIUrl":"10.1136/bmjopen-2024-090734","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic diseases pose significant challenges to primary care, requiring patient-centred strategies to improve chronic care delivery. As telehealth emerges as a promising tool, this study aims to examine patient experiences with chronic care and their preferences for self-management support (SMS) through telehealth services in primary care settings.</p><p><strong>Design: </strong>A multicentre, cross-sectional survey was conducted (June-August 2022) using the Patient Assessment of Chronic Illness Care (PACIC), the Patient Assessment of Self-Management Tasks (PAST) and a telehealth preferences questionnaire. Linear regression assessed the association between PACIC and PAST scores. Multivariate logistic regression identified factors associated with telehealth preferences, with variables selected according to Andersen's model of healthcare utilisation.</p><p><strong>Settings: </strong>Five diverse primary care settings in Central Vietnam, operating under Family Medicine principles.</p><p><strong>Participants: </strong>290 individuals with hypertension and/or diabetes managed at primary care for at least 6 months.</p><p><strong>Results: </strong>The average PACIC score was 2.52 (SD 0.7); 25.5% rated their care as high quality (PACIC score ≥3). Among PACIC domains, goal-setting and follow-up/coordination domains received the lowest ratings. Participants perceived lifestyle changes as their priority self-management tasks, followed by medical management, communication with providers and coping with disease consequences. Higher PACIC scores were significantly associated with greater engagement across most PAST domains. Live video conferencing and mobile health were the most preferred formats for SMS. Participants strongly preferred remote patient monitoring for medical management (OR 8.8, 95% CI 2.0 to 38.1). Rural residents were more likely to prefer other telehealth modalities (ORs 3.8-4.6), particularly for coping with disease consequences (OR 4.1, 95% CI 1.8 to 9.4) and lifestyle changes (OR 5.8, 95% CI 1.1 to 28.9). Telehealth preferences were associated with factors across Andersen's domains, including education (predisposing), resident area and digital access (enabling), and pill count, disease control, and perceived care quality (need-related).</p><p><strong>Conclusions: </strong>Most elements of the chronic care model remained unmet. Patients' care experiences and self-management priorities aligned with their telehealth preferences, underscoring the need for personalised telehealth strategies to enhance SMS in primary care. Given the cross-sectional design and absence of patient and public involvement, further studies should incorporate these stakeholders and confirm associations in more diverse and underserved populations.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 6","pages":"e090734"},"PeriodicalIF":2.4,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483144","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}