Displaying publications 241 - 260 of 262 in total

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  1. Al-Yateem N, Hijazi H, Saifan AR, Ahmad A, Masa'Deh R, Alrimawi I, et al.
    BMJ Open, 2023 Dec 22;13(12):e076326.
    PMID: 38135338 DOI: 10.1136/bmjopen-2023-076326
    OBJECTIVES: To identify language-related communication barriers that expatriate (non-Arabic) healthcare practitioners in the UAE encounter in their daily practice.

    DESIGN: Qualitative study utilising semi-structured in-depth interviews. The interviews were conducted in English language.

    SETTING: Different healthcare facilities across the UAE. These facilities were accessed for data collection over a period of 3 months from January 2023 to March 2023.

    PARTICIPANTS: 14 purposively selected healthcare practitioners.

    INTERVENTION: No specific intervention was implemented; this study primarily aimed at gaining insights through interviews.

    PRIMARY AND SECONDARY OUTCOMES: To understand the implications of language barriers on service quality, patient safety, and healthcare providers' well-being.

    RESULTS: Three main themes emerged from our analysis of participants' narratives: Feeling left alone, Trying to come closer to their patients and Feeling guilty, scared and dissatisfied.

    CONCLUSIONS: Based on the perspectives and experiences of participating healthcare professionals, language barriers have notably influenced the delivery of healthcare services, patient safety and the well-being of both patients and practitioners in the UAE. There is a pressing need, as highlighted by these professionals, for the inclusion of professional interpreters and the provision of training to healthcare providers to enhance effective collaboration with these interpreters.

  2. Joiner A, Blewer AL, Pek PP, Ostbye T, Staton CA, Silvalila M, et al.
    BMJ Open, 2023 Dec 09;13(12):e077378.
    PMID: 38070908 DOI: 10.1136/bmjopen-2023-077378
    OBJECTIVES: Strengthening of emergency care systems, including prehospital systems, can reduce death and disability. We aimed to identify perspectives on barriers and facilitators relating to the development and implementation of a prehospital emergency care system assessment tool (PEC-SET) from prehospital providers representing several South and Southeast (SE) Asian countries.

    DESIGN: We conducted a qualitative study using focus group discussions (FGD) informed by the Consolidated Framework for Implementation Research (CFIR). FGDs were conducted in English, audioconferencing/videoconferencing was recorded, transcribed verbatim and coded using an inductive and deductive approach. Participants suggested specific elements to be measured within three main 'pillars' of disease conditions proposed by the research team of the tool being developed (cardiovascular, trauma and perinatal emergencies).

    SETTING: We explored the perspectives of medical directors in six low-income and middle-income countries (LMICs) in South and SE Asia.

    PARTICIPANTS: A total of 16 participants were interviewed (1 Vietnam, 4 Philippines, 4 Thailand, 5 Malaysia, 1 Indonesia and 1 Pakistan) as a part of 4 focus groups.

    RESULTS: Themes identified within the four CFIR constructs included: (1) Intervention characteristics: importance of developing an contextually specific tool, need for generalisability, trialling in one geographical area or with one pillar before expanding; (2) Inner setting: data transfer barriers, workforce shortages; (3) Outer setting: underdevelopment of EMS nationally; need for further EMS system development prior to implementing a tool and (4) Individual characteristics: lack of buy-in by prehospital personnel. Elements proposed by participants included both process and outcome measures.

    CONCLUSIONS: Through the CFIR framework, we identified several themes which can provide a basis for codeveloping a PEC-SET for LMICs with local stakeholders. This work may inform development of quality improvement tools in LMIC PEC systems.

  3. Vreeman RC, Yiannoutsos CT, Yusoff NKN, Wester CW, Edmonds A, Ofner S, et al.
    BMJ Open, 2023 Mar 13;13(3):e069399.
    PMID: 36914183 DOI: 10.1136/bmjopen-2022-069399
    OBJECTIVES: To assess access children with HIV have to comprehensive HIV care services, to longitudinally evaluate the implementation and scale-up of services, and to use site services and clinical cohort data to explore whether access to these services influences retention in care.

    METHODS: A cross-sectional standardised survey was completed in 2014-2015 by sites providing paediatric HIV care across regions of the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We developed a comprehensiveness score based on the WHO's nine categories of essential services to categorise sites as 'low' (0-5), 'medium', (6-7) or 'high' (8-9). When available, comprehensiveness scores were compared with scores from a 2009 survey. We used patient-level data with site services to investigate the relationship between the comprehensiveness of services and retention.

    RESULTS: Survey data from 174 IeDEA sites in 32 countries were analysed. Of the WHO essential services, sites were most likely to offer antiretroviral therapy (ART) provision and counselling (n=173; 99%), co-trimoxazole prophylaxis (168; 97%), prevention of perinatal transmission services (167; 96%), outreach for patient engagement and follow-up (166; 95%), CD4 cell count testing (126; 88%), tuberculosis screening (151; 87%) and select immunisation services (126; 72%). Sites were less likely to offer nutrition/food support (97; 56%), viral load testing (99; 69%) and HIV counselling and testing (69; 40%). 10% of sites rated 'low', 59% 'medium' and 31% 'high' in the comprehensiveness score. The mean comprehensiveness of services score increased significantly from 5.6 in 2009 to 7.3 in 2014 (p<0.001; n=30). Patient-level analysis of lost to follow-up after ART initiation estimated the hazard was highest in sites rated 'low' and lowest in sites rated 'high'.

    CONCLUSION: This global assessment suggests the potential care impact of scaling-up and sustaining comprehensive paediatric HIV services. Meeting recommendations for comprehensive HIV services should remain a global priority.

  4. Samsudin EZ, Yaacob SS, Xin Wee C, Mat Ruzlin AN, Azzani M, Jamil AT, et al.
    BMJ Open, 2023 Nov 15;13(11):e072801.
    PMID: 37967999 DOI: 10.1136/bmjopen-2023-072801
    BACKGROUND: Cyberbullying is a growing public health concern with clear, negative impacts on the mental, physical and social health of targeted victims. Previous research on cyberbullying has largely focused on examining its occurrence among children and adolescents. The present study aims to examine the prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in Selangor, Malaysia.

    METHODS: A cross-sectional study was conducted in a locality within Selangor, sampling a total of 1449 young adults. The Cyberbullying and Online Aggression Survey was used to measure cyberbullying victimisation. The Family APGAR scale, General Health Questionnaire, Pittsburgh Sleep Quality Index and single-item measures were used to assess family dysfunction, psychological distress and health behaviour, respectively.

    RESULTS: The 1-month prevalence of cyberbullying victimisation among young adults was 2.4%. The most common cyberbullying act experienced was mean or hurtful comments about participants online (51.7%), whereas the most common online environment for cyberbullying to occur was social media (45.8%). Male participants (adjusted OR (AOR)=3.60, 95% CI=1.58 to 8.23) had at least three times the odds of being cyberbullied compared with female participants. Meanwhile, participants with higher levels of psychological distress had increased probability of being cyberbullied compared with their peers (AOR=1.13, 95% CI=1.05 to 1.21).

    CONCLUSIONS: As evident from this study, cyberbullying victimisation prevails among young adults and is significantly related to gender and psychological distress. Given its devastating effects on targeted victims, a multipronged and collaborative approach is warranted to reduce incidences of cyberbullying and safeguard the health and well-being of young adults.

  5. Mubarak N, Zahid T, Rana FR, Ijaz UE, Shabbir A, Manzoor M, et al.
    BMJ Open, 2023 Nov 21;13(11):e079507.
    PMID: 37989383 DOI: 10.1136/bmjopen-2023-079507
    INTRODUCTION: Countries are grappling with a rapidly worsening upsurge in the opioid-related overdose deaths, misuse and abuse. There is a dearth of data in Pakistan regarding the practices and competencies of pharmacists in handling opioid-related issues.

    STUDY DESIGN: A cross-sectional study, conducted across Punjab, Pakistan.

    METHOD: The study deployed a validated survey to evaluate the competencies and practices of the community and hospital pharmacists.

    RESULTS: 504 community pharmacists and 279 hospital pharmacists participated in the survey with an overall response rate of 85.5%. Almost half of the respondents 'never' or 'sometimes' made clinical notes in a journal or dispensing software to monitor ongoing opioid use. Generally, pharmacists were reluctant to collaborate with physicians or notify police regarding the abuse/misuse of opioids. Hospital pharmacists achieved significantly higher mean competency scores than chain and independent community pharmacists (p<0.05). In competency evaluation, three priority areas emerged that require additional training, that is, 'opioid overdose management', 'opioid use monitoring' and 'therapeutic uses of opioids'.

    CONCLUSION: Both community and hospital pharmacists hold significant positions and potential to contribute meaningfully to the mitigation of harms and risks associated with opioids. Nevertheless, this study underscores notable deficiencies in the competence of pharmacists, whether in hospital or community settings in Punjab, concerning various aspects related to the dispensing and utilisation of opioids. It also highlights the pressing need for the development of strategies aimed at improving several practice areas including the documentation, the quality of patient counselling, the effectiveness of reporting mechanisms for opioid abuse and the stringent enforcement of regulatory policies to curtail opioid misuse. Thus, to mitigate the opioid epidemic in Pakistan, it is imperative to institute opioid stewardship initiatives aimed at rectifying the competency and procedural deficiencies within the pharmacist workforce.

  6. Er YT, Chan YM, Mohd Shariff Z, Abdul Hamid H, Mat Daud Z', Yong HY
    BMJ Open, 2023 Nov 20;13(11):e075937.
    PMID: 37989361 DOI: 10.1136/bmjopen-2023-075937
    INTRODUCTION: Nutrition education is the cornerstone to maintain optimal pregnancy outcomes including gestational weight gain (GWG). Nevertheless, default for appointments is common and often lead to suboptimal achievement of GWG, accompanied with unfavourable maternal and child health outcomes. While mobile health (mHealth) usage is increasing and helps minimising barriers to clinic appointments among pregnant mothers, its effectiveness on health outcomes has been inconclusive. Therefore, this study aimed to address the gap between current knowledge and clinical care, by exploring the effectiveness of mHealth on GWG as the primary outcome, hoping to serve as a fundamental work to achieve optimal health outcomes with the improvement of secondary outcomes such as physical activity, psychosocial well-being, dietary intake, quality of life and sleep quality among pregnant mothers.

    METHODS AND ANALYSIS: A total of 294 eligible participants will be recruited and allocated into 3 groups comprising of mHealth intervention alone, mHealth intervention integrated with personal medical nutrition therapy and a control group. Pretested structured questionnaires are used to obtain the respondents' personal information, anthropometry data, prenatal knowledge, physical activity, psychosocial well-being, dietary intake, quality of life, sleep quality and GWG. There will be at least three time points of data collection, with all participants recruited during their first or second trimester will be followed up prospectively (after 3 months or/and after 6 months) until delivery. Generalised linear mixed models will be used to compare the mean changes of outcome measures over the entire study period between the three groups.

    ETHICS AND DISSEMINATION: Ethical approvals were obtained from the ethics committee of human subjects research of Universiti Putra Malaysia (JKEUPM-2022-072) and medical research & ethics committee, Ministry of Health Malaysia: NMRR ID-22-00622-EPU(IIR). The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research.

    TRIAL REGISTRATION NUMBER: Clinicaltrial.gov ID: NCT05377151.

  7. Zhang B, Deng H, Ren J, Legrand FD, Ahmad Yusof H, Zhang R, et al.
    BMJ Open, 2024 Jun 26;14(6):e080315.
    PMID: 38926142 DOI: 10.1136/bmjopen-2023-080315
    BACKGROUND: The prevalence of major depressive disorder (MDD) is on the rise globally, and the use of antidepressant medications for its treatment does not usually result in full remission. However, the combination of physical exercise and psychotherapy for the treatment of MDD increase the rate of full remission among patients. This three-armed, parallel-group, double-blinded randomised controlled trial (RCT) aims to assess and compare the effects between the combination of exergame and acceptance and commitment therapy (e-ACT) programme, ACT only and treatment-as-usual (TAU) control groups on the severity of depression and anxiety symptoms, the degree of experiential avoidance and quality of life (QoL) and the serum levels of depression biomarkers (such as brain-derived neurotrophic factor, C-reactive protein and vascular endothelial growth factor) among patients with MDD across three time points.

    METHODS AND ANALYSIS: This RCT will recruit 126 patients with MDD who will be randomised using stratified permuted block randomisation into three groups, which are the combined e-ACT programme, ACT-only and TAU control groups in a 1:1:1 allocation ratio. The participants in the e-ACT and ACT-only intervention groups will undergo once a week intervention sessions for 8 weeks. Assessments will be carried out through three time points, such as the pre-intervention assessment (t0), assessment immediately after completion of the intervention at 8 weeks (t1) and assessment at 24 weeks after completion of the intervention (t2). During each assessment, the primary outcome to be assessed includes the severity of depression symptoms, while the secondary outcomes to be assessed are the severity of anxiety symptoms, experiential avoidance, QoL and depression biomarkers.

    ETHICS AND DISSEMINATION: Approval of this study was obtained from the Human Research Ethics Committee of Universiti Sains Malaysia (USM/JEPeM/PP/23050420). The findings of the study will be published in academic peer-reviewed journals.

    TRIAL REGISTRATION NUMBER: NCT05812001 (ClinicalTrials.gov). Registered on 12 April 2023.

  8. Dhaliwal JS, Mohamad Yusra MAM, Muharram SH, Akkawi ME, Hussain Z, Rahman H, et al.
    BMJ Open, 2022 Feb 28;12(2):e049867.
    PMID: 35228275 DOI: 10.1136/bmjopen-2021-049867
    INTRODUCTION: Antimicrobial resistance (AMR) is one of the critical medical issues of the 21st century. Medical professionals are the primary prescribers of antimicrobials; their undergraduate education of antimicrobial stewardship (AMS) is considered one of the fundamental approaches in combating the issue of AMR. This education level provides a platform to bridge any gaps in their knowledge and competency in AMS. This study aims to develop an educational resource on microbes, hygiene and prudent antimicrobial use for the undergraduate medical programme. The guideline produced will then be assimilated into the existing curriculum which will help to improve the quality of education which in turn will improve rationale as the use of antimicrobials in the future.

    METHODS AND ANALYSIS: A three-step approach consensus approach will be adopted for this study for the development of a validated medical curriculum guideline on AMR. A preliminary curriculum for the programme will be drafted from reviews of published literature including syllabi as well as national and international guidelines. A total of 26 potential sources were found to be relevant, and selected for this study. Subsequently, the drafted curriculum will be subjected for validation via online surveys by various infectious disease experts. Finally, a Delphi technique will be employed to obtain consensus on heterogeneous findings to the revised curriculum. The quantitative and qualitative responses will be analysed and discussed among the panel of researchers.

    ETHICS AND DISSEMINATION: This study protocol has been approved by the Institute of Health Sciences Research Ethics Committee of Universiti Brunei Darussalam (Reference: UBD/PAPRSBIHSREC/2020/124). Informed consent declaration will be collected prior to data collections as indication of agreement of participation in the study. Results will be made available to medical educators and also researchers on AMR and stewardship. The results also will be disseminated at feedback sessions to officers at Ministry of Health and Ministry of Education, Brunei Darussalam.

  9. Ahmad Fuad MH, Samsudin EZ, Yasin SM, Ismail N, Mohamad M, Muzaini K, et al.
    BMJ Open, 2024 Aug 13;14(8):e079877.
    PMID: 39142678 DOI: 10.1136/bmjopen-2023-079877
    OBJECTIVES: Occupational skin diseases (OSDs) pose significant risks to the health and well-being of restaurant workers. However, there is presently limited evidence on the burden and determinants of OSDs among this occupational group. This research aims to estimate the prevalence and associated factors of suspected OSDs among restaurant workers in Peninsular Malaysia.

    DESIGN: A secondary data analysis of the 2023 Registry of Occupational Disease Screening (RODS) was performed. The RODS survey tool, which included the Nordic Occupational Skin Questionnaire, a symptoms checklist and items on work-relatedness, was used to screen for OSDs. Logistic regression analyses were performed to identify associated factors.

    SETTING AND PARTICIPANTS: Restaurant workers (n=300) registered in RODS from February 2023 to April 2023, aged 18 years and above and working in restaurants across Selangor, Melaka and Pahang for more than 1 year, were included in the study, whereas workers who had pre-existing skin diseases were excluded.

    RESULTS: The prevalence of suspected OSDs among study participants was 12.3%. Higher odds of suspected OSDs among study participants were observed among those exposed to wet work (adjusted OR (AOR) 22.74, 95% CI 9.63 to 53.68) and moderate to high job stress levels (AOR 4.33, 95% CI 1.80 to 10.43).

    CONCLUSIONS: These findings suggest that OSDs are a significant occupational health problem among restaurant workers. Interventions targeting job content and wet work may be vital in reducing OSDs among this group of workers.

  10. Zhao Z, Gao Y, Sui W, Zhang Z, Feng L, Wang Z, et al.
    BMJ Open, 2024 Aug 17;14(8):e081485.
    PMID: 39153776 DOI: 10.1136/bmjopen-2023-081485
    OBJECTIVES: To seek a triple combination of biomarkers for early diagnosis of chronic kidney disease-mineral and bone metabolic disorder and to explore the diagnostic efficacy of β2-microglobulin, parathyroid hormone and blood urea nitrogen in chronic kidney disease-mineral and bone metabolic disorder.

    PARTICIPANTS: We collected medical records of 864 patients with chronic kidney disease (without direct contact with patients) and divided them into two groups based on the renal bone disease manifestations of all patients.

    PRIMARY AND SECONDARY OUTCOME MEASURES: There were 148 and 716 subjects in the Chronic kidney disease-mineral and bone metabolic disorder and the control groups, respectively. The aggregated data included basic information and various clinical laboratory indicators, such as blood lipid profile, antibody and electrolyte levels, along with renal function-related indicators.

    RESULTS: It was observed that most renal osteopathy occurs in the later stages of chronic kidney disease. In the comparison of two clinical laboratory indicators, 16 factors were selected for curve analysis and compared. We discovered that factors with high diagnostic values were β2-microglobulin, parathyroid hormone and blood urea nitrogen.

    CONCLUSIONS: The triple combination of β2-microglobulin+parathyroid hormone+blood urea nitrogen indicators can play the crucial role of a sensitive indicator for the early diagnosis of chronic kidney disease-mineral and bone metabolic disorder and in preventing or delaying the progress of chronic kidney disease-mineral and bone metabolic disorder.

  11. Fahrni ML, Saman KM, Alkhoshaiban AS, Naimat F, Ramzan F, Isa KAM
    BMJ Open, 2022 Sep 19;12(9):e057868.
    PMID: 36123061 DOI: 10.1136/bmjopen-2021-057868
    OBJECTIVE: To categorise patient-reported outcome measures (PROMs) into their propensity to detect intentional and/or unintentional non-adherence to medication, and synthesise their psychometric properties.

    DESIGN: Systematic review and regression analysis.

    ELIGIBILITY: Medication adherence levels studied at primary, secondary and tertiary care settings. Self-reported measures with scoring methods were included. Studies without proxy measures were excluded.

    DATA SOURCES: Using detailed searches with key concepts including questionnaires, reliability and validity, and restricted to English, MEDLINE, EMBASE, CINAHL, International Pharmaceutical Abstracts, and Cochrane Library were searched until 01 March 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA-2020) checklist was used.

    DATA ANALYSIS: Risk of bias was assessed via COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN-2018) guidelines. Narrative synthesis aided by graphical figures and statistical analyses.

    OUTCOME MEASURES: Process domains [behaviour (e.g., self-efficacy), barrier (e.g., impaired dexterity) or belief (e.g., perception)], and overall outcome domains of either intentional (I), unintentional (UI), or mixed non-adherence.

    RESULTS: Paper summarises evidence from 59 studies of PROMs, validated among patients aged 18-88 years in America, the United Kingdom, Europe, Middle East, and Australasia. PROMs detected outcome domains: intentional non-adherence, n=44 (I=491 criterion items), mixed intentionality, n=13 (I=79/UI=50), and unintentional, n=2 (UI=5). Process domains detected include belief (383 criterion items), barrier (192) and behaviour (165). Criterion validity assessment used proxy measures (biomarkers, e-monitors), and scoring was ordinal, dichotomised, or used Visual Analogue Scale. Heterogeneity was revealed across psychometric properties (consistency, construct, reliability, discrimination ability). Intentionality correlated positively with negative beliefs (r(57)=0.88) and barriers (r(57)=0.59). For every belief or barrier criterion-item, PROMs' aptitude to detect intentional non-adherence increased by β=0.79 and β=0.34 units, respectively (R2=0.94). Primary care versus specialised care predicted intentional non-adherence (OR 1.9; CI 1.01 to 2.66).

    CONCLUSIONS: Ten PROMs had adequate psychometric properties. Of the ten, eight PROMs were able to detect total, and two PROMs were able to detect partial intentionality to medication default. Fortification of patients' knowledge and illness perception, as opposed to daily reminders alone, is most imperative at primary care levels.

  12. Kundu S, Shaw S, Khan J, Chattopadhyay A, Baptista EA, Paswan B
    BMJ Open, 2023 Jan 19;13(1):e070419.
    PMID: 36657753 DOI: 10.1136/bmjopen-2022-070419
    OBJECTIVES: The study explores the awareness and e-cigarette use by demographic and socio-economic characteristics of selected 14 Global Adult Tobacco Survey (GATS) countries.

    DESIGN: Cross-sectional.

    SETTING: 14 countries.

    PARTICIPANTS: Surveyed population ≥15 years selected through multi-stage cluster sampling.

    PRIMARY AND SECONDARY OUTCOME MEASURES: We selected 14 countries from 6 different WHO regions where GATS was conducted in different years during 2011-2017.

    RESULTS: Awareness and usage of e-cigarette were highest in Greece and lowest in India. Females were less aware of e-cigarette across ages. The gender gap in awareness is wide in Greece post 50 years of age, while the gap is distinct in early ages in Kazakhstan and Qatar. The gender difference in use of e-cigarette was negligible in most of the countries except among the younger cohorts of Russia, Philippines Malaysia and Indonesia. Relatively higher prevalence of e-cigarette smoking among females in the older adult age was observed in some of the Asian countries like India. Multivariate analysis indicates that those who were younger, male, residing in urban areas, current tobacco smokers were more likely to use e-cigarette than their counterparts. Though prevalence of e-cigarette use increased with wealth and education, such pattern is not strong and consistent. Promotional advertisement plays important role in higher use of e-cigaratte. The predicted national prevalence of e-ciragette use was highest in Malaysia .

    CONCLUSIONS: E-cigarette use is more among urban adults, current smokers, males and in countries with promotional advertisement of e-cigarette. Area specific interventions are needed to understand the nature of e-cigarette use. Russia, Ukraine, Costa Rica and Mexico need better understanding to explore whether e-cigaratte use is an indulgence to new mode of addiction, as youth being highly likely to adopt this practice.

  13. Che Jamaludin FI, Abdullah MRTL, Endut MNAA, Saifuddeen SM, Hamimi KA, Harun S
    BMJ Open, 2025 Jan 06;15(1):e082263.
    PMID: 39762112 DOI: 10.1136/bmjopen-2023-082263
    INTRODUCTION: In an increasingly diverse healthcare landscape, addressing the specific needs of Muslim patients has become paramount. The absence of comprehensive frameworks for Shariah-compliant healthcare services often poses challenges for healthcare professionals striving to provide care that aligns with Islamic values.

    OBJECTIVE: The objective of this study was to develop a comprehensive framework for Shariah-compliant healthcare services, ensuring alignment with Islamic practices in healthcare.

    METHODS, SETTING, PARTICIPANTS: This consensus study employed a key input approach using the fuzzy Delphi method (FDM) and interpretive structural modelling. Conducted in Malaysia, the study involved 10 experts from various regions across the country. These experts were selected based on clear criteria that included professionals with experience in Islamic and/or healthcare, while those lacking relevant expertise were excluded.

    RESULTS: The primary outcome was the identification of pertinent elements for the framework, with final elements measured based on expert consensus achieved through FDM. The panel of experts reached consensus on 10 essential elements that form the backbone of the framework for Shariah-compliant healthcare services. These elements include governance, medical ethics, patient care, human resources and professional development, facilities for Islamic worship (ibadah), spiritual care support, end-of-life care, Islamic environment, medicine and drugs, and affordability and accessibility.

    CONCLUSION: Ultimately, the development of this comprehensive framework is a crucial step in addressing the specific needs and concerns of Muslim patients worldwide. By incorporating the input and consensus of experts from various relevant fields, the resulting framework provides healthcare professionals with a solid foundation to deliver healthcare services that align with Islamic values, ultimately promoting the well-being of Muslim patients in Malaysia and tourists globally.

  14. Karim N, Hod R, Wahab MIA, Ahmad N
    BMJ Open, 2024 May 07;14(5):e079826.
    PMID: 38719294 DOI: 10.1136/bmjopen-2023-079826
    OBJECTIVES: Climate change is a major global issue with significant consequences, including effects on air quality and human well-being. This review investigated the projection of non-communicable diseases (NCDs) attributable to air pollution under different climate change scenarios.

    DESIGN: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. A population-exposure-outcome framework was established. Population referred to the general global population of all ages, the exposure of interest was air pollution and its projection, and the outcome was the occurrence of NCDs attributable to air pollution and burden of disease (BoD) based on the health indices of mortality, morbidity, disability-adjusted life years, years of life lost and years lived with disability.

    DATA SOURCES: The Web of Science, Ovid MEDLINE and EBSCOhost databases were searched for articles published from 2005 to 2023.

    ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The eligible articles were evaluated using the modified scale of a checklist for assessing the quality of ecological studies.

    DATA EXTRACTION AND SYNTHESIS: Two reviewers searched, screened and selected the included studies independently using standardised methods. The risk of bias was assessed using the modified scale of a checklist for ecological studies. The results were summarised based on the projection of the BoD of NCDs attributable to air pollution.

    RESULTS: This review included 11 studies from various countries. Most studies specifically investigated various air pollutants, specifically particulate matter <2.5 µm (PM2.5), nitrogen oxides and ozone. The studies used coupled-air quality and climate modelling approaches, and mainly projected health effects using the concentration-response function model. The NCDs attributable to air pollution included cardiovascular disease (CVD), respiratory disease, stroke, ischaemic heart disease, coronary heart disease and lower respiratory infections. Notably, the BoD of NCDs attributable to air pollution was projected to decrease in a scenario that promotes reduced air pollution, carbon emissions and land use and sustainable socioeconomics. Contrastingly, the BoD of NCDs was projected to increase in a scenario involving increasing population numbers, social deprivation and an ageing population.

    CONCLUSION: The included studies widely reported increased premature mortality, CVD and respiratory disease attributable to PM2.5. Future NCD projection studies should consider emission and population changes in projecting the BoD of NCDs attributable to air pollution in the climate change era.

    PROSPERO REGISTRATION NUMBER: CRD42023435288.

  15. Naserrudin NA, Adhikari B, Culleton R, Hod R, Saffree Jeffree M, Ahmed K, et al.
    BMJ Open, 2024 May 13;14(5):e079963.
    PMID: 38740505 DOI: 10.1136/bmjopen-2023-079963
    INTRODUCTION: Vector borne diseases (VBDs) present significant public health challenges in Southeast Asia (SEA), and the increasing number of cases threatens vulnerable communities. Inadequate vector control and management have been linked to the spread of VBDs. To address these issues, community participation has been proposed as a promising approach to enhance health programmes and control of VBDs. This article outlines a protocol for a scoping review of the published literature on community-participation approaches to control VBDs in the SEA region. The primary research question is 'How does community participation complement the control of VBDs in SEA?' This review aims to provide an overview of various approaches and identify barriers and facilitators to effective implementation.

    METHODS AND ANALYSIS: The research questions will guide the scoping review. In stage 1, peer-reviewed publications from PubMed, Web of Science and Scopus will be searched using predefined search terms related to community-based approaches and VBDs in the SEA region, English, Indonesian and Malay published between 2012 and 2022. In stage 2, the references from relevant articles will be screened for eligibility. In stage 3, eligible articles will be charted in Microsoft Excel to facilitate the review process, and studies will be characterised based on the investigated diseases; this review will also highlight the methodological context of these studies. In stage 4, a thematic analysis will be conducted to derive meaningful findings from the dataset relevant to the research inquiry, followed by writing the results in stage 5. This scoping review aims to be the first to explore community participation in VBD control in the SEA population, providing valuable insights for future research and stakeholders involved in disease control.

    ETHICS AND DISSEMINATION: This scoping review does not require ethical approval because the methodology synthesises information from available articles. This review is planned for dissemination in academic journals, conference presentations and shared with stakeholders as part of knowledge sharing among those involved in VBD control.

  16. Liu C, Chong MC, Lee WL, Zhang HY, Zhang JH
    BMJ Open, 2024 May 21;14(5):e081840.
    PMID: 38772896 DOI: 10.1136/bmjopen-2023-081840
    OBJECTIVE: Although stroke is prevalent among older people, there is a rising incidence among the younger subpopulations, particularly middle-aged adults. A healthy diet is one of the key modifiable factors to primary prevention of stroke among these subpopulations, yet there is limited understanding of the dietary habits among middle agers who have the risk factor(s) but no occurrence of stroke. This study aims to explore the views on perceptions and the self-management of middle-aged adults at risk of stroke on a healthy diet and to identify the enablers and barriers that could inform the future development of dietary interventions.

    DESIGN: This study used an interpretive descriptive qualitative design, employing semistructured purposive sampling for focus group discussions. Thematic analysis was conducted on the transcribed interviews and field notes, facilitated by NVivo 12.0 Plus software.

    SETTING: Community settings in Zhengzhou City, Henan Province.

    PARTICIPANTS: Middle-aged adults (aged 45-59) were identified as at risk of stroke due to the presence of one or more modifiable risk factors.

    RESULT: A total of seven focus group discussions were audio recorded. Four main themes emerged, which were: (1) cognitive understanding of a healthy diet; (2) dietary practices; (3) knowledge acquisition and (4) barriers to dietary adherence.

    CONCLUSIONS: The middle-aged adults at risk of stroke were generally aware of the risk and attempted to practise healthy eating. The existing educational programmes on following a healthy diet in the prevention of disease need to be made more comprehensible, accessible and equitable, especially for those from socioeconomically disadvantaged communities.

  17. Md Ali NA, El-Ansary D, Abdul Rahman MR, Ahmad S, Royse C, Huat CT, et al.
    BMJ Open, 2023 Jul 14;13(7):e067914.
    PMID: 37451709 DOI: 10.1136/bmjopen-2022-067914
    INTRODUCTION: There is no consistency in current practice pertaining to the prescription and progression of upper limb resistance exercise following cardiac surgery via median sternotomy. The aim of this study is to investigate whether less restrictive sternal precautions with the addition of early-supervised resistance training exercise improves upper limb function and facilitates recovery following median sternotomy.

    METHODS AND ANALYSIS: This is double-blind randomised controlled trial, with parallel group, concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. 240 adult participants who had median sternotomy from eight hospitals in Malaysia will be recruited. Sample size calculations were based on the unsupported upper limb test. All participants will be randomised to receive either standard or early supervised incremental resistance training. The primary outcomes are upper limb function and pain. The secondary outcomes will be functional capacity, multidomain recovery (physical and psychological), length of hospital stay, incidence of respiratory complications and quality of life. Descriptive statistics will be used to summarise data. Data will be analysed using the intention-to-treat principle. The primary hypothesis will be examined by evaluating the change from baseline to the 4-week postoperative time point in the intervention arm compared with the usual care arm. For all tests to be conducted, a p value of <0.05 (two tailed) will be considered statistically significant, and CIs will be reported. The trial is currently recruiting participants.

    ETHICS AND DISSEMINATION: The study was approved by a central ethical committee as well as the local Research Ethics Boards of the participating sites (UKM:JEP-2019-654; Ministry of Health: NMMR-50763; National Heart Centre: IJNREC/501/2021). Approval to start was given prior to the recruitment of participants commencing at any sites. Process evaluation findings will be published in peer-reviewed journals and presented at relevant academic conferences.

    TRIAL REGISTRATION NUMBER: International Standard Randomised Controlled Trials Number (ISRCTN17842822).

  18. Mohd Iqbal HA, Zanudin A, Mohd Nordin NA
    BMJ Open, 2025 Jan 07;15(1):e075912.
    PMID: 39773787 DOI: 10.1136/bmjopen-2023-075912
    INTRODUCTION: Emulating the vast inclusion of advanced technology in everyday practice, the medical world is no exception to its implementation, in particular, virtual reality (VR). Initially, its introduction as a therapy was accompanied by high aspirations and expectations for its growth and potential. Motivation is said to be the most associated benefit; although it is imperative to note that there exists a paucity of research that specifically quantifies its tangible impact on cerebral palsy (CP). There has yet to be a systematic review of the instruments used to precisely measure motivation and examine its association with the benefits of VR for children with cerebral palsy.

    METHODS AND ANALYSIS: This review will evaluate comparative studies that used VR therapy as part of interventions for children with CP. Qualitative studies, single-case studies, systematic reviews, literature reviews and guideline audits will be excluded. This review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-P) guidelines. The methodological protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). The following electronic databases will be used to access related studies published between January 2012 and December 2023: MEDLINE (via EBSCOhost), Web of Science, Scopus, PubMed and Cochrane. The Peer Review of Electronic Search Strategies checklist will be employed to develop database search strategies.

    ETHICS AND DISSEMINATION: This review does not require ethical approval as it uses secondary data. The findings will be published in a scientific journal. We intend to contribute to the expansion of knowledge concerning the motivational implications of VR on children with CP.

    PROSPERO REGISTRATION NUMBER: International Prospective Register of Systematic Reviews (identification number CRD42023401079).

  19. Lam J, El Nsouli D, Lee EL, Alqeisi T, Kane R, McGonagle I, et al.
    BMJ Open, 2024 Dec 23;14(12):e093636.
    PMID: 39719285 DOI: 10.1136/bmjopen-2024-093636
    OBJECTIVES: We sought to review studies that examine healthcare professionals' and students' knowledge, attitudes and practices (KAP) regarding medication disposal. We also explore recommendations and barriers related to appropriate medication disposal.

    DESIGN: A systematic review was conducted that adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

    DATA SOURCES: MEDLINE, Embase, CINAHL, Web of Science, PsycINFO and Google Scholar were searched up to 23 February 2024.

    STUDY ELIGIBILITY CRITERIA AND SETTING: Qualitative, quantitative and mixed-method primary research studies. There was no limitation on the publication date, geographical locations or the study settings.

    PARTICIPANTS: Pharmacists, doctors, nurses and students from these respective professional groups in any country.

    PRIMARY OUTCOME MEASURES: The levels of healthcare staff and students' KAPs about disposal of unwanted medications.

    DATE EXTRACTION AND SYNTHESIS: Data extraction was conducted by four of the researchers independently. The study details were categorised into three main domains, that is, KAP using the KAP model. Other relevant information was also extracted, and synthesised in overall themes, such as challenges and recommendations.

    RESULTS: Thirty-seven studies from 18 countries (Asia n=21, the USA n=7, Africa n=5, EU n=2, South America n=2) were included. 86.5% (n=32) investigated participants' knowledge of medication disposal. Although there was a good level of awareness about the environmental impacts, there were significant gaps in knowledge regarding correct disposal methods, available services, guidelines and training. Thirty studies explored participants' attitudes towards medication disposal. There was a generally positive attitude towards the need for environmentally safe disposal practices. Thirty-five studies evaluated participants' practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, the majority of the participants did not follow the practice guidelines, especially outside healthcare settings.

    DISCUSSIONS AND CONCLUSIONS: Although healthcare staff and students have fair knowledge and positive attitudes towards medicine disposal, their actual practices are lacking. One significant challenge identified is the limited awareness about proper disposal methods coupled with a lack of established services or guidelines. Even in cases where take-back programmes are available, they often face issues with accessibility. To tackle these challenges, it is suggested that governmental bodies should establish and enforce clear policies on medication disposal while also expanding educational initiatives to increase understanding among professionals and students. Furthermore, improving access to take-back programmes is crucial for ensuring safe medication disposal and minimising potential environmental and health hazards.

    PROSPERO REGISTRATION NUMBER: CRD42024503162.

  20. Zhao Y, Tu Y, Chew BH, Gacasan EM
    BMJ Open, 2024 Dec 20;14(12):e083018.
    PMID: 39806599 DOI: 10.1136/bmjopen-2023-083018
    INTRODUCTION: End-of-life care is essential for older adults aged ≥60, particularly those residing in long-term care facilities, such as nursing homes, which are known for their home-like environments compared with hospitals. Due to potential limitations in medical resources, collaboration with external healthcare providers is crucial to ensure comprehensive services within these settings. Previous studies have primarily focused on team-based models for end-of-life care in hospitals and home-based settings. However, there is a lack of sufficient evidence on practices in such facilities, particularly for Chinese older adults. The aim of this scoping review is to map the existing literature and inform the development of an appropriate care framework for end-of-life care in nursing homes. The focus of this article will be on the scope of services, guidelines for decision making, roles within interdisciplinary teams, and the practical feasibility of care provision.

    METHODS AND ANALYSIS: A systematic search will be conducted across nine electronic databases: PubMed, Scopus, EMBASE, Cochrane, PsycINFO, ERIC, CINAHL, China National Knowledge Infrastructure (CNKI), and Wanfang Data. The search will identify literature published in English and Chinese from January 2012 onwards. Articles will be selected based on their relevance to older adults aged ≥60 with disabilities or life-threatening chronic conditions receiving end-of-life care in nursing homes or similar settings. The data extraction process will be guided by the Canadian Hospice Palliative Care Association model (CHPCA) and the Respectful Death model. Qualitative data analysis will be performed using a framework method and thematic analysis, employing both inductive and deductive approaches, with three reviewers participating in the review process.

    ETHICS AND DISSEMINATION: Ethical approval is not required because the data for this review is obtained from selected publicly available articles. The results will be disseminated through publications in peer-reviewed journals and presented at relevant conferences. Furthermore, the findings will be shared with policymakers and healthcare professionals engaged in end-of-life care to inform practice and decision making.

    STUDY REGISTRATION: The review protocol has been registered on osf.io (https://osf.io/3u4mp).

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