BMJ Open最新文献

{"title":"Barriers, facilitators and solutions to equitable career progression for disabled doctors: an integrative review.","authors":"Megan E L Brown, Bryan Burford, Gillian Vance","doi":"10.1136/bmjopen-2025-106639","DOIUrl":"10.1136/bmjopen-2025-106639","url":null,"abstract":"<p><strong>Objectives: </strong>Disabled resident doctors face persistent structural, cultural and institutional barriers to career progression. This integrative review synthesises empirical and grey literature to identify the challenges disabled doctors encounter, the practices that support their careers and the potential solutions applicable to healthcare, in particular National Health Service (NHS), settings.</p><p><strong>Design: </strong>Integrative literature review using a content analysis approach to data analysis. Included sources were published in English and examined disabled doctors' career progression or included disabled doctors as a separate subgroup. Opinion pieces without empirical grounding and articles not available in full text were excluded.</p><p><strong>Setting: </strong>International postgraduate medical education, with consideration for transferability and applicability to the UK NHS.</p><p><strong>Participants: </strong>Focused on the experiences and careers of disabled resident doctors, at any stage of their career, prior to completion of training.</p><p><strong>Results: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity guidelines, 53 sources were included and analysed. Structural ableism, inaccessible systems and stigma around disclosure were consistently identified as barriers to career progression. Facilitators included mentorship, affirming supervisory relationships and identity-affirming networks. Promising practices included universal design approaches, anticipatory rather than reactive approaches to making adjustments and integration of disability equity into organisational governance. However, most initiatives remain unevaluated, and UK-specific evidence is limited.</p><p><strong>Conclusions: </strong>While awareness of barriers is growing, evidence-based solutions remain underdeveloped and unevenly implemented. To build a sustainable and representative medical workforce, workforce policy and planning must not only remove barriers to progression for disabled doctors, but also embed disability inclusion into the structures and cultures that shape medical career paths.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e106639"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224949","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":"Impacts of Global School Feeding Programmes on Children's Health and Wellbeing Outcomes: A Scoping Review.","authors":"Amy Locke, M James, Hope Jones, Rachel Davies, Francesca Williams, Sinead Brophy","doi":"10.1136/bmjopen-2024-093244","DOIUrl":"10.1136/bmjopen-2024-093244","url":null,"abstract":"<p><strong>Objectives: </strong>School feeding programmes (SFPs) are widely implemented to address child poverty, food insecurity and malnutrition, yet evidence on their influence on children's health outcomes is limited. With ongoing debate around universal versus targeted provision, this scoping review aims to map global literature on SFPs, identify which health and well-being outcomes are reported, and explore how these outcomes vary by programme type (targeted vs universal).</p><p><strong>Design: </strong>Scoping review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was pre-registered on the Open Science Framework.</p><p><strong>Data sources: </strong>Four electronic databases-Medline, PubMed, Web of Science and Google Scholar-were searched in December 2023 and July 2025. Reference lists of included papers were also screened.</p><p><strong>Eligibility criteria: </strong>Included studies examined the impact of SFPs on physical, emotional, psychological and social health outcomes in children aged 5-16. Only English-language studies published between 2009 and 2025 were included.</p><p><strong>Data extraction and synthesis: </strong>Data were extracted using a structured template and reviewed by multiple authors. Due to the heterogeneity in study designs and reported outcomes, a narrative synthesis approach was used to group findings thematically, following established guidance for narrative synthesis in systematic reviews.</p><p><strong>Results: </strong>A total of 44 papers were included in the final review, spanning 13 countries and published between 2009 and 2025. SFPs were associated with healthier weight status, improved dietary intake, better social engagement and reductions in stigma. Targeted programmes addressed food insecurity but were more often linked to stigma and poorer mental health outcomes.</p><p><strong>Conclusions: </strong>Universal SFP were effective at improving children's health outcomes such as healthy weight, improved behaviour and social support. Overall, both targeted and universal SFP positively impact children's health outcomes and address health disparities.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e093244"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224980","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":"Sources, topics and acquisition routes and timing of health information acquired by women and their partners in the perinatal and postpartum periods: a scoping review protocol.","authors":"Yuriko Tadokoro, Nozomi Sonoda, Kaori Takahata","doi":"10.1136/bmjopen-2024-096812","DOIUrl":"10.1136/bmjopen-2024-096812","url":null,"abstract":"<p><p><b>Introduction</b>During the perinatal and postpartum periods, appropriate health information is crucial for women and their partners. Although previous studies and reviews have identified various sources of health information, these studies have neither sufficiently clarified the relationships between the sources and topics of health information and the acquisition of health information nor included women's partners as participants. Thus, this scoping review protocol aims to map and synthesise evidence on the acquisition of health information by women and their partners during the perinatal and postpartum periods and clarify the relationships between the sources and topics of health information and the acquisition of health information. We aim to generate thorough knowledge of relationships and patterns from the answers to our research questions as follows: (1) What are the relationships between the sources and topics of health information that women and their partners acquire during the perinatal and postpartum periods? (2) What are the patterns of acquisition of health information by women and their partners? (3) What are the patterns of acquisition routes and timing of health information by women and their partners?</p><p><strong>Methods and analysis: </strong>This scoping review will be conducted in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis for scoping reviews. We will search PubMed, CINAHL, Embase and Ichushi (Japanese electronic database) for relevant articles. The search in Google will be for grey literature. We will include sources of evidence that were investigated after 2020 and written in English and Japanese. Article screening will be conducted by two independent reviewers and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping review flow diagram. Results will be presented on tables and described narratively.</p><p><strong>Ethics and dissemination: </strong>This scoping review covers only secondary data that are publicly available and therefore does not require ethical review approval. The results will be disseminated in a peer-reviewed journal and presented in a conference.</p><p><strong>Trial registration number: </strong>UMIN000056170.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e096812"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224991","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":"Prospective, multicentre trial on preoperative biliary drainage by endoscopic ultrasound-guided hepaticogastrostomy for resectable/borderline resectable pancreatic cancer with biliary obstruction: the PROLOGUE study - a study protocol.","authors":"Shin Yagi, Susumu Hijioka, Yoshikuni Nagashio, Shota Harai, Daiki Agarie, Daiki Yamashige, Kohei Okamoto, Souma Fukuda, Masaru Kuwada, Yasuhiro Komori, Yusuke Kurita, Sho Hasegawa, Kensuke Kubota, Yusuke Ishida, Jun Ushio, Kotaro Takeshita, Kohei Yoshino, Hirotoshi Ishiwatari, Takuji Okusaka","doi":"10.1136/bmjopen-2025-106543","DOIUrl":"10.1136/bmjopen-2025-106543","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative biliary drainage (PBD) is often required for patients with pancreatic cancer accompanied by biliary obstruction to ensure the safe administration of neoadjuvant chemotherapy or to manage cholangitis and jaundice. Although endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for PBD, it carries a significant risk of post-ERCP pancreatitis. Endoscopic ultrasound-guided biliary drainage (EUS-BD), particularly via hepaticogastrostomy (EUS-HGS), offers a promising alternative that avoids papillary manipulation. However, the clinical utility of EUS-BD as primary drainage for PBD remains unclear due to a lack of prospective studies. This multicentre prospective trial aims to evaluate the safety and efficacy of EUS-HGS as primary drainage for PBD in patients with resectable or borderline resectable pancreatic cancer.</p><p><strong>Methods and analysis: </strong>This multicentre prospective study involves seven institutions in Japan. Eligible patients will undergo EUS-HGS using a 7Fr plastic stent. The primary endpoint is clinical success, defined by improvements in bilirubin or liver enzyme levels within 14 days postprocedure. Secondary endpoints include technical success rate, adverse event incidence, stent patency and surgical outcomes. A total of 30 patients will be enrolled, considering an expected clinical success rate of 90% and a 10% dropout allowance.</p><p><strong>Ethics and dissemination: </strong>This study has been approved by the National Cancer Center Institutional Review Board (Research No. 2024-084). The results of this study will be reported at an international conference and published in an international peer-reviewed journal.</p><p><strong>Trial registration number: </strong>UMIN ID: 000055173.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e106543"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224879","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":"Health systems' adaptations to climate change: an umbrella review of global evidence protocol.","authors":"Katarzyna Dubas-Jakóbczyk, Nsikakabasi Samuel George, Costase Ndayishimiye","doi":"10.1136/bmjopen-2025-105492","DOIUrl":"10.1136/bmjopen-2025-105492","url":null,"abstract":"<p><strong>Introduction: </strong>Health systems' (HS) adaptations to climate change (CC) cover two major, and interrelated dimensions: (1) Environmental sustainability-actions aimed at limiting the negative impact of HS on the environment (eg, by reducing greenhouse gas emissions) and (2) Climate resilience-adaptations focused on improving HS' ability to cope with the impact of CC (eg, by improving HS preparedness to climate-induced natural disasters). Within both dimensions, a diversity of actions, at different HS levels, can take place. The general objective is to provide health policy makers with a comprehensive evidence-based set of recommendations on the scope and effectiveness of HS adaptations to CC.</p><p><strong>Methods and analysis: </strong>An umbrella review will be conducted. Systematic reviews will be included if: (1) They focus on HS adaptations to CC (including both environmental sustainability and climate resilience strategies/actions), (2) Were published since 2015 and (3) Report a quality appraisal of included studies. Five databases were searched: (1) MEDLINE via PubMed, (2) Scopus, (3) Web of science core collection, (4) ProQuest Central and (5) The Cochrane Database of Systematic Reviews. Two reviewers will independently assess studies' eligibility, conduct quality appraisal and perform data extraction. Data will be synthesised using both quantitative and qualitative methods. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses will guide the reporting of results.</p><p><strong>Ethics and dissemination: </strong>Ethical approval is not required, as this study involves the collection and analysis of secondary data only. The results will be submitted for publication in a peer-reviewed journal and disseminated via dedicated research channels and social media platforms.</p><p><strong>Prospero registration number: </strong>CRD420251052647.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e105492"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225035","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":"Turnover intentions, job satisfaction and social support among employees of social organisations caring for the elderly in China: a cross-sectional study.","authors":"Jiajie Zhao, Fuqin Xu, Sanyuan Hao, Guoqing Liu, Shuo Ding, Xin Zheng, Lanlan Zhao, Benjamin Otsen, Ziwen Xu, Shufan Yang, Zhongliang Bai, Ren Chen","doi":"10.1136/bmjopen-2025-104422","DOIUrl":"10.1136/bmjopen-2025-104422","url":null,"abstract":"<p><strong>Objectives: </strong>The retention of a critical mass of human resources is currently an urgent priority for China's older adults' care sector. This study investigated the relationship between social support and turnover intention among employees in older adults caring social organisations (SOs) and focused on studying the mediating role of job satisfaction.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Older adults caring for SOs in Anhui, Chongqing and Shanghai, China.</p><p><strong>Participants: </strong>A hybrid sampling method was applied to this study, which encompassed multistage stratified sampling and targeted sampling. Questionnaires were administered to 1433 employees of SOs caring for the elderly from November 2019 to August 2023.</p><p><strong>Primary and secondary outcome measures: </strong>A generalised linear model was employed to examine factors associated with turnover intention. Spearman correlation analysis was used to investigate the relationships between key variables. Finally, the mediating effects among the study variables were examined using structural equation modelling.</p><p><strong>Results: </strong>The overall median scores (IQR) for employees' turnover intention and social support were 10.00 (6.00) and 72.00 (14.00), respectively. The total effect on turnover intention comprised the direct effect of social support on turnover intention (<i>β</i> =-0.165, SE =0.040, 95% CI =-0.243 to -0.087) and the indirect effect of social support on turnover intention through job satisfaction (<i>β</i> =-0.079, SE =0.016, 95% CI =-0.111 to -0.049).</p><p><strong>Conclusions: </strong>The study elucidated the indirect influence of social support on turnover intention among employees in older adults caring SOs, mediated by job satisfaction.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e104422"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225063","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":"E-Prem checklist-driven strategy to improve outcomes in extremely preterm and low birth weight infants: a quasi-experimental study at a national referral hospital in Indonesia.","authors":"Putri Maharani Tristanita Marsubrin, Kanya Lalitya Jayanimitta Sugiyarto, Jessica Sylvania Oswari, Dian Anggur Yulianti, Rinawati Rohsiswatmo, Rosalina Dewi Roeslani, R Adhi Teguh Perma Iskandar, Distyayu Sukarja, Muhamad Azharry Rully Sjahrullah, Ahmad Kautsar, Tejasvi Chaudhari","doi":"10.1136/bmjopen-2025-102714","DOIUrl":"10.1136/bmjopen-2025-102714","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to assess how implementing a checklist for managing extremely preterm or extremely low birth weight infants can reduce mortality rates and morbidities.</p><p><strong>Design: </strong>A quasi-experimental, before-and-after study.</p><p><strong>Setting: </strong>Neonatal intensive care unit at Dr. Cipto Mangunkusumo National General Hospital, a national referral hospital in Indonesia.</p><p><strong>Participant: </strong>86 infants were born at <28 weeks of gestation and/or with birth weight <1000 g. Exclusion criteria were major congenital anomalies incompatible with life. 48 were managed prior to checklist implementation (September 2022-March 2023) and 38 after checklist implementation (April-October 2023).</p><p><strong>Interventions: </strong>Implementation of a modified Canberra Health Services extremely preterm-early management checklist during the initial management of extremely preterm or low birth weight infants, including humidified gas resuscitation, thermal management, early surfactant administration and standardised first-hour care protocols.</p><p><strong>Main outcome measures: </strong>The primary outcome was the mortality rate. Secondary outcomes included comorbidities such as hypothermia, hypoglycaemia, acidosis, intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL) and retinopathy of prematurity (ROP).</p><p><strong>Results: </strong>A total of 86 extremely premature and/or extremely low birth weight infants were enrolled, 48 neonates prior to and 38 neonates after the use of the checklist. Baseline characteristics were comparable between groups (median gestational age 27 weeks in both groups, median birth weight 795 g vs 868.5 g, p=0.09). Mortality at discharge showed a non-significant reduction from 52.1% to 47.4% (p=0.664, 0.91, 95% CI 0.64 to 1.30). Significant reductions were observed in IVH (79.2% to 28.9%, p<0.001) and ROP (56.3 to 15.8%, p<0.001). No significant differences were found in hypothermia, hypoglycaemia, acidosis rates or PVL.</p><p><strong>Conclusions: </strong>Implementation of a systematic checklist was associated with significant reductions in IVH and ROP, though mortality reduction was not statistically significant. These findings suggest potential benefits of structured early care protocols, but the observational design limits causal inference.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e102714"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224869","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":"Determinants of vaccine hesitancy among pregnant women in South-West Nigeria: an explanatory sequential mixed method design.","authors":"Olorunfemi Akinbode Ogundele, Oyinkansola Omoloja, Anne Osimokhua Zibiri, Ayokunle Victor Dinehin, Adeola Oluwaseyi Adewusi, John Nwabueze","doi":"10.1136/bmjopen-2025-101767","DOIUrl":"10.1136/bmjopen-2025-101767","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the prevalence and determinants of vaccine hesitancy among pregnant women in South-West Nigeria.</p><p><strong>Design: </strong>An explanatory sequential mixed-methods study was conducted between January and March 2023. Participants for the quantitative phase were selected using a systematic sampling technique, while those for the qualitative phase were purposively selected. A modified parent attitude about childhood vaccines questionnaire was used for data collection and analysed using IBM SPSS V.25.0. Qualitative data were collected through focus group discussions and analysed using NVivo V.14. Univariable, bivariable and multivariable logistic regression analysis was done. A p<0.05 was considered statistically significant.</p><p><strong>Setting: </strong>A tertiary health facility in South-West Nigeria.</p><p><strong>Participants: </strong>Three hundred and forty-five pregnant women participated in the quantitative phase, while 24 pregnant women were involved in the qualitative phase.</p><p><strong>Results: </strong>The overall prevalence of vaccine hesitancy was 32%. Based on the domains, only 15.4% of the respondents were hesitant due to vaccination behaviour, 38.6% for safety and efficacy, and 49.6% were hesitant due to general attitude and trust for healthcare providers. Maternal age, number of children, religion and occupation showed significant association with vaccine hesitancy. Regarding the predictors of vaccine hesitancy, employed pregnant women (adjusted OR (aOR), 4.33; 95% CI: 1.60 to 9.70) and younger pregnant women (aOR, 2.53; 95% CI: 1.04 to 7.70) had a significantly higher odds of being vaccine-hesitant. The qualitative analyses revealed several major themes that contributed to vaccine hesitancy, including concerns about vaccine safety and efficacy, distrust of healthcare providers and the government, and the spread of misinformation through social networks and peers.</p><p><strong>Conclusion: </strong>A significant proportion of pregnant women in this study were vaccine-hesitant. The major reasons for vaccine hesitancy are concerns about the safety of vaccines and lack of trust for healthcare providers. Policies and programmes should be aimed at improving vaccination behaviour, addressing safety concerns and building trust in vaccination systems.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e101767"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224876","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":"Care accessibility and reasons for non-urgent emergency department visits in South Tyrol (Italy): protocol of the multicentre cross-sectional CARES study.","authors":"Dietmar Ausserhofer, Arian Zaboli, Angelika Mahlknecht, Barbara Plagg, Verena Barbieri, Pasqualina Marino, Giuliano Piccoliori, Adolf Engl, Christian Josef Wiedermann","doi":"10.1136/bmjopen-2024-093688","DOIUrl":"10.1136/bmjopen-2024-093688","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency departments (EDs) suffer from crowding due to patients with low urgency whose treatment is often inappropriate in many cases. Crowding in the ED may indicate inefficiencies in the primary care infrastructure. According to the literature, it is associated with individual and system-related factors, such as younger age, convenience of visiting the ED and a negative perception of care outside the hospital. However, patients' motives driving decision-making for non-urgent visits to the ED in this post-pandemic period require further exploration. Therefore, this study aims to describe the proportion of potentially avoidable, non-urgent ED visits and to explore the associations between socio-demographic and clinical characteristics, patients' motives, and potentially avoidable, non-urgent visits to the ED.</p><p><strong>Methods and analysis: </strong>This multicentre cross-sectional study will be conducted in the ED of seven public hospitals in the South Tyrolean Health Service in the northern Italian Province of Bolzano-Bozen. A consecutive sample of 1000 adult patients (≥18 years) with clinical conditions that are triaged as 'non-urgent' (ie, Manchester Triage System priority level 'blue' or 'green') and consent to participate in the study will be included. Data will be collected in each ED over two full working weeks (24 hours, weekdays and weekends) between 1 September 2024 and 30 November 2024. For each patient, triage nurses and medical doctors will fill out a data collection sheet, including the triage code, diagnosis at discharge and avoidability of the ED visit. Patients will be surveyed using a structured questionnaire with standardised instruments (eg, the Patient Activation Measure and Mental Health Inventory) and self-developed items (eg, motives for ED visits and previous use of community care services). Data analysis will involve descriptive and inferential analyses (ie, χ² tests) to determine group differences. Multivariate multilevel modelling will be applied to explore the associations between individual, system and cultural factors and potentially avoidable, non-urgent visits.</p><p><strong>Ethics and dissemination: </strong>Ethical approval for this study was obtained from the Medical Ethics Committee of the South Tyrolean Health Service (Nr. 41-2024). The results will be published in relevant scientific journals and communicated to the public and relevant institutions through dissemination activities, including press releases and stakeholder meetings. The findings will inform recommendations aimed at refining health policies and optimising access to primary and emergency care services.</p><p><strong>Registration details: </strong>ISRCTN registry (ISRCTN17355506).</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e093688"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224866","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":"Associations between gestational diabetes mellitus and survival without bronchopulmonary dysplasia in very preterm infants: a multicentre cohort study.","authors":"Xiaoping Lei, Juan Du, Siyuan Jiang, Jianguo Zhou, Liyuan Hu, Tiantian Xiao, Yanping Zhu, Wei Shi, Aimin Qian, Ruimiao Bai, Dan Dang, Yujie Han, Shujuan Li, Xinyue Gu, Li-Zhong Du, Mingyan Hei, Shoo K Lee, Wenhao Zhou, Wenbin Dong","doi":"10.1136/bmjopen-2025-101861","DOIUrl":"10.1136/bmjopen-2025-101861","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether gestational diabetes mellitus (GDM) was associated with survival without bronchopulmonary dysplasia (BPD) in very preterm infants (VPIs).</p><p><strong>Design: </strong>Retrospective multicentre cohort study.</p><p><strong>Setting: </strong>A total of 79 neonatal intensive care units across China, January 2019 to December 2021.</p><p><strong>Participants: </strong>A total of 23 752 VPIs (<32 weeks' gestation) or very low birth weight infants (<1500 g), comprising 4452 GDM-exposed and 19 300 unexposed infants.</p><p><strong>Main outcome measures: </strong>The primary outcomes are survival without BPD at 36 weeks' postmenstrual age (PMA) and its components.</p><p><strong>Results: </strong>Infants exposed to GDM were associated with a higher rate of survival without BPD (aOR 1.12, 95% CI 1.04 to 1.21) at 36 weeks PMA and lower mortality (aOR 0.75, 95% CI 0.64 to 0.84) before 36 weeks PMA than unexposed infants. However, no significant association was observed between GDM and BPD at 36 weeks PMA (aOR 0.94, 95% CI 0.87 to 1.02), respiratory distress syndrome, need for advanced resuscitation or mechanical ventilation. After propensity score matching, GDM-exposed VPIs maintained higher survival without BPD (aOR 1.13, 95% CI 1.02 to 1.26) and lower mortality (aOR 0.81, 95% CI 0.68 to 0.97). These associations were strongest in infants born before 28 weeks (aOR 1.32, 95% CI 1.11 to 1.57) and those small for gestational age (aOR 1.41, 95% CI 1.11 to 1.80).</p><p><strong>Conclusions: </strong>GDM was not associated with worsened BPD in VPIs. The positive association with survival and survival without BPD warrants could reflect a selection bias.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 10","pages":"e101861"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224906","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}