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  • BMJ  (10)
  • 1
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    Association between maternal pregestational glucose level and adverse pregnancy outcomes: a population-based retrospective cohort study
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 9 ( 2021-09), p. e048530-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 9 ( 2021-09), p. e048530-
    Abstract: To investigate the association between maternal pregestational blood glucose level and adverse pregnancy outcomes. Design Retrospective cohort study. Setting This study was conducted in the Chongqing Municipality of China between April 2010 and December 2016. Participants A total of 60 222 women (60 360 pregnancies) from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project and had pregnancy outcomes were included. Primary outcome measures Adverse pregnancy outcomes included spontaneous abortion, induced abortion or labour due to medical reasons, stillbirth, preterm birth (PTB), macrosomia, large for gestational age, low birth weight (LBW) and small for gestational age. Results Of the 60 360 pregnancies, rates of hypoglycaemic, normoglycaemia, impaired fasting glycaemia (IFG) and diabetic hyperglycaemic before conception were 5.06%, 89.30%, 4.59% and 1.05%, respectively. Compared with women with normoglycaemia, women with pregestational glucose at the diabetic level (≥7.0 mmol/L) might have a higher rate of macrosomia (6.18% vs 4.16%), whereas pregestational IFG seemed to be associated with reduced risks of many adverse outcomes, including spontaneous abortion, induced abortion due to medical reasons, PTB and LBW. After adjusting for potential confounders, pregestational diabetic hyperglycaemic was remained to be significantly associated with an increased risk of macrosomia (adjusted risk ratio 1.49, 95% CI 1.07 to 2.09). Abnormal maternal glucose levels before pregnancy (either hypoglycaemic or hyperglycaemic) seemed to have no significant negative effect on spontaneous abortion or induced abortion due to medical reasons. Conclusion Although without overt diabetes mellitus, women with once diabetic fasting glucose level during their preconception examinations could be associated with an increased risk for macrosomia. Uniform guidelines are needed for maternal blood glucose management during pre-pregnancy care to improve pregnancy outcomes.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-048530
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 2
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    Research on the influencing factors of fatigue and professional identity among CDC workers in China: an online cross-sectional study
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 4 ( 2022-04), p. e058762-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 4 ( 2022-04), p. e058762-
    Abstract: This study aimed to investigate the status quo and the influencing factors of fatigue and professional identity among the Centers for Disease Control and Prevention (CDC) workers in China during the pandemic. Design A cross-sectional design. Setting CDC workers employed by the Liaoning CDC system were enrolled (administrative staffs were excluded). Participants 1020 CDC workers. Primary outcome measures Fatigue scores and professional identity scores. Secondary outcome measures Postcompetency scores, respect scores, occupational stress scores, resilience scores and self-efficacy scores. Results The average scores of fatigue and professional identity were 8.23, 38.88, respectively. Factors including perceived public respect ( β =−0.129, p 〈 0.01), resilience ( β =−0.104, p 〈 0.05) and self-efficacy ( β =−0.22, p 〈 0.01) were negatively associated with fatigue. Educational background (bachelor vs junior college or below) ( β =0.105, p 〈 0.01), (master or above vs junior college or below) ( β =0.092, p 〈 0.05), workplace (county vs district) ( β =0.067, p 〈 0.05), (city vs district) ( β =0.085, p 〈 0.05), fighting the COVID-19 on the front line ( β =0.059, p 〈 0.05) and occupational stress ( β =0.166, p 〈 0.01) were positively correlated with fatigue. Educational background (bachelor vs junior college or below) ( β =−0.097, p 〈 0.01), (master or above vs junior college or below) ( β =−0.114, p 〈 0.01), workplace (city vs district) ( β =−0.114, p 〈 0.01), fighting the COVID-19 on the front line ( β =−0.047, p 〈 0.05) and occupational stress ( β =−0.105, p 〈 0.01) were negatively associated with professional identity. Factors including postcompetency ( β =0.362, p 〈 0.01), perceived public respect (general vs low) ( β =0.219, p 〈 0.01), (high vs low) ( β =0.288, p 〈 0.01), resilience ( β =0.097, p 〈 0.05) and self-efficacy ( β =0.113, p 〈 0.01) were positively connected with professional identity. Conclusion The fatigue among the CDC workers was at a higher level. The level of professional identity was high, and administrators should take measures to alleviate fatigue and maintain professional identity. In addition, methods aiming to attenuate occupational stress, and improve resilience and self-efficacy should be immediately put into action.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-058762
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 3
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    Association between annual household income and adverse outcomes in patients who had ischaemic stroke
    BMJ ; 2022
    In:  Journal of Epidemiology and Community Health Vol. 76, No. 3 ( 2022-03), p. 293-300
    Details
    In: Journal of Epidemiology and Community Health, BMJ, Vol. 76, No. 3 ( 2022-03), p. 293-300
    Abstract: The association between annual household income and prognosis of ischaemic stroke remains debatable. We aimed to prospectively investigate the relationship between annual household income and prognosis at 3 months after ischaemic stroke. Methods We included 3975 participants from the China Antihypertensive Trial in Acute Ischemic Stroke. All participants were categorised into three groups according to annual household income per capita: 〈 ¥10 000 (Chinese Yuan Renminbi (RMB)), ¥10 000–19 999 and ≥¥20 000. The primary outcome was a composite outcome of death and major disability (modified Rankin Scale score ≥3) at 3 months after stroke onset, and secondary outcomes included major disability, death, and vascular events. A meta-analysis was conducted to incorporate the results of the current study and previous studies on the association of income level with outcomes after stroke. Results Within 3 months after ischaemic stroke, 1002 participants (25.20%) experienced primary outcome (880 major disabilities and 122 deaths). After multivariate adjustment, low annual household income level was associated with increased risk of the primary outcome (OR 1.60; 95% CI: 1.12 to 2.31; P trend =0.034) when two extreme groups were compared. The meta-analysis confirmed the significant association between income level and death or major disability after stroke (pooled relative risk for lowest vs highest income level, 1.31 (95% CI: 1.18 to 1.45)). Conclusions Low annual household income per capita was significantly associated with increased risks of adverse clinical outcomes at 3 months after ischaemic stroke, independently of established risk factors. Further studies from other samples are needed to replicate our findings due to a reason for excluding some patients who had a severe stroke in this study. Trial registration number ClinicalTrials.gov ( http://wwwclinicaltrialsgov ) Registry ( NCT01840072 ).
    Type of Medium: Online Resource
    ISSN: 0143-005X , 1470-2738
    URL: Article
    DOI: 10.1136/jech-2021-216481
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2015405-7
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  • 4
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    Impact of cardiovascular disease and cardiac injury on in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis
    BMJ ; 2020
    In:  Heart Vol. 106, No. 15 ( 2020-08), p. 1142-1147
    Details
    In: Heart, BMJ, Vol. 106, No. 15 ( 2020-08), p. 1142-1147
    Abstract: Coronavirus disease 2019 (COVID-19) has produced a significant health burden worldwide, especially in patients with cardiovascular comorbidities. The aim of this systematic review and meta-analysis was to assess the impact of underlying cardiovascular comorbidities and acute cardiac injury on in-hospital mortality risk. Methods PubMed, Embase and Web of Science were searched for publications that reported the relationship of underlying cardiovascular disease (CVD), hypertension and myocardial injury with in-hospital fatal outcomes in patients with COVID-19. The ORs were extracted and pooled. Subgroup and sensitivity analyses were performed to explore the potential sources of heterogeneity. Results A total of 10 studies were enrolled in this meta-analysis, including eight studies for CVD, seven for hypertension and eight for acute cardiac injury. The presence of CVD and hypertension was associated with higher odds of in-hospital mortality (unadjusted OR 4.85, 95% CI 3.07 to 7.70; I 2 =29%; unadjusted OR 3.67, 95% CI 2.31 to 5.83; I 2 =57%, respectively). Acute cardiac injury was also associated with a higher unadjusted odds of 21.15 (95% CI 10.19 to 43.94; I 2 =71%). Conclusion COVID-19 patients with underlying cardiovascular comorbidities, including CVD and hypertension, may face a greater risk of fatal outcomes. Acute cardiac injury may act as a marker of mortality risk. Given the unadjusted results of our meta-analysis, future research are warranted.
    Type of Medium: Online Resource
    ISSN: 1355-6037 , 1468-201X
    URL: Article
    DOI: 10.1136/heartjnl-2020-317062
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2378689-9
    detail.hit.zdb_id: 1475501-4
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  • 5
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    Mediating role of emotional labour strategy in the association between patient/visitor incivility and nurses’ fatigue: a cross-sectional study
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 11 ( 2022-11), p. e059146-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 11 ( 2022-11), p. e059146-
    Abstract: Fatigue is a common problem among nurses, and patient/visitor incivility is thought to lead to nurses’ fatigue. However, the mechanism by which patient/visitor incivility leads to nurses’ fatigue has not been well studied. The aim of this study is to examine whether the association between patient/visitor incivility and fatigue among Chinese nurses is mediated by emotional labour strategy. Design A cross-sectional study. Methods In November 2019, a stratified cluster sample of 1207 nurses from two hospitals in China was used to collect data on fatigue, patient/visitor incivility and emotional labour strategy through online questionnaires. Emotional labour strategy has three dimensions: surface acting (SA), deep acting and natural acting. Complete responses were provided by 1036 (85.8%) participants. Student’s t-test, one-way analysis of variance, Pearson correlation analysis and the PROCESS procedure (A modeling macro installed in SPSS to analyse mediation.) were adopted to analyse the data. Results Patient/visitor incivility and SA were positively related to fatigue (p 〈 0.01), while natural acting was negatively related to fatigue (p 〈 0.01). SA played as a mediator in the association between patient/visitor incivility and nurses’ fatigue (95% CI 0.047 to 0.113, p 〈 0.05). Conclusion Patient/visitor incivility could contribute to Chinese nurses' fatigue. When nurses were exposed to patient/visitor incivility, they were more likely to use the SA emotional labour strategy, which would lead to fatigue. Nursing administrators should be aware of the seriousness of nurses’ fatigue.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-059146
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 6
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    Effectiveness of virtual reality technology in symptom management of end-of-life patients: protocol of a systematic review and meta-analysis
    BMJ ; 2023
    In:  BMJ Open Vol. 13, No. 2 ( 2023-02), p. e068532-
    Details
    In: BMJ Open, BMJ, Vol. 13, No. 2 ( 2023-02), p. e068532-
    Abstract: With the worsening of population ageing globally, the number of the elderly with chronic and incurable diseases such as malignant tumours is gradually increasing, and the need for palliative care is growing. As a primary task in the end-of-life phase, symptom management is an essential aspect of palliative care, which aims to alleviate distressing symptoms of terminally ill patients and improve their quality of life. Virtual reality (VR) technology, which allows the creation of simulated environments in which a three-dimensional experience is generated, has been increasingly used in palliative care for symptom management. Therefore, we aim to conduct a systematic review to investigate the effects of VR-based interventions on end-of-life patients. Methods and analysis This protocol for conducting a systematic review and meta-analysis will be prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. We will conduct a series of searches from inception to 31 July 2022 in the following databases: PubMed, Embase, Web of Science, the Cochrane Library, JBI, EBSCO, CNKI, Wanfang and SinoMed. The key concepts of ‘virtual reality’ and ‘end-of-life’ will be combined in each database using both free-text terms and controlled vocabulary terms (eg, MeSH/Emtree terms), if available. Two independent reviewers will use raw data to explore the effectiveness of VR for symptom management in end-of-life patients. The Cochrane Risk-of-Bias tool will be used to assess the risk of bias of included studies. Disagreements will be resolved by a third independent reviewer to reach a consensus. For the included articles, Review Manager software will be used for data synthesis and I 2 statistics will be used to measure the heterogeneity. Subgroup analyses and sensitivity analyses will be used to identify the source of heterogeneity. Ethics and dissemination As this is a protocol for a systematic review and meta-analysis, patients will not be included in this study. For this reason, ethical approval is not required. In order to disseminate the research findings, the results and conclusions of this review will be submitted to a worldwide journal. PROSPERO registration number CRD42022344679.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2022-068532
    Language: English
    Publisher: BMJ
    Publication Date: 2023
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  • 7
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    Mediating effect of health consciousness in the relationship of lifestyle and suboptimal health status: a cross-sectional study involving Chinese urban residents
    BMJ ; 2020
    In:  BMJ Open Vol. 10, No. 10 ( 2020-10), p. e039701-
    Details
    In: BMJ Open, BMJ, Vol. 10, No. 10 ( 2020-10), p. e039701-
    Abstract: Suboptimal health status (SHS), a third state between good health and disease, can easily develop into chronic diseases, and can be influenced by lifestyle and health consciousness. No study has surveyed the intermediation of health consciousness on the relationship between lifestyle and SHS. This study aimed to analyse the association of lifestyle and SHS, and intermediation of health consciousness in Chinese urban residents. Design A cross-sectional face-to-face survey using a four-stage stratified sampling method. Participants We investigated 5803 Chinese urban residents aged 18 years and over. We measured SHS using the Sub-Health Measurement Scale V1.0. We adopted a structural equation model to analyse relationships among lifestyle, health consciousness and SHS. We applied a bootstrapping method to estimate the mediation effect of health consciousness. Results Lifestyle had stronger indirect associations with physical ( β −0.185, 95% CI −0.228 to −0.149), mental ( β −0.224, 95% CI −0.265 to −0.186) and social SHS ( β −0.216, 95% CI −0.257 to −0.179) via health consciousness than direct associations of physical ( β −0.144, 95% CI −0.209 to −0.081), mental ( β −0.146, 95% CI −0.201 to −0.094) and social SHS ( β −0.130, 95% CI −0.181 to −0.077). Health consciousness has a strong direct association with physical ( β 0.360, 95% CI 0.295 to 0.427), mental ( β 0.452, 95% CI 0.392 to 0.510) and social SHS ( β 0.434, 95% CI 0.376 to 0.490). Ratio of mediating effect of health consciousness to direct effect of lifestyle with physical, mental and social SHS was 1.28, 1.53 and 1.66, respectively. Conclusions Health consciousness was more important in preventing physical, mental and social SHS than lifestyle. Therefore, it might be useful in changing unhealthy lifestyle and reducing the influence of poor lifestyle on physical, mental and social SHS.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-039701
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2599832-8
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  • 8
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    Do underlying cardiovascular diseases have any impact on hospitalised patients with COVID-19?
    BMJ ; 2020
    In:  Heart Vol. 106, No. 15 ( 2020-08), p. 1148-1153
    Details
    In: Heart, BMJ, Vol. 106, No. 15 ( 2020-08), p. 1148-1153
    Abstract: An outbreak of the highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has sickened thousands of people in China. The purpose of this study was to explore the early clinical characteristics of COVID-19 patients with cardiovascular disease (CVD). Methods This is a retrospective analysis of patients with COVID-19 from a single centre. All patients underwent real-time reverse transcription PCR for SARS-CoV-2 on admission. Demographic and clinical factors and laboratory data were reviewed and collected to evaluate for significant associations. Results The study included 541 patients with COVID-19. A total of 144 (26.6%) patients had a history of CVD. The mortality of patients with CVD reached 22.2%, which was higher than that of the overall population of this study (9.8%). Patients with CVD were also more likely to develop liver function abnormality, elevated blood creatinine and lactic dehydrogenase (p 〈 0.05). Symptoms of sputum production were more common in patients with CVD (p=0.026). Lymphocytes, haemoglobin and albumin below the normal range were pervasive in the CVD group (p 〈 0.05). The proportion of critically ill patients in the CVD group (27.8%) was significantly higher than that in the non-CVD group (8.8%). Multivariable logistic regression analysis revealed that CVD (OR: 2.735 (95% CI 1.495 to 5.003), p=0.001) was associated with critical COVID-19 condition, while patients with coronary heart disease were less likely to reach recovery standards (OR: 0.331 (95% CI 0.125 to 0.880), p=0.027). Conclusions Considering the high prevalence of CVD, a thorough CVD assessment at diagnosis and early intervention are recommended in COVID-19 patients with CVD. Patients with CVD are more vulnerable to deterioration.
    Type of Medium: Online Resource
    ISSN: 1355-6037 , 1468-201X
    URL: Article
    DOI: 10.1136/heartjnl-2020-316909
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2378689-9
    detail.hit.zdb_id: 1475501-4
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  • 9
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    AR-A014418 regulates intronic polyadenylation and transcription of PD-L1 through inhibiting CDK12 and CDK13 in tumor cells
    BMJ ; 2023
    In:  Journal for ImmunoTherapy of Cancer Vol. 11, No. 5 ( 2023-05), p. e006483-
    Details
    In: Journal for ImmunoTherapy of Cancer, BMJ, Vol. 11, No. 5 ( 2023-05), p. e006483-
    Abstract: Immune checkpoint molecules, especially programmed death 1 (PD-1) and its ligand, programmed death ligand 1 (PD-L1), protect tumor cells from T cell-mediated killing. Immune checkpoint inhibitors, designed to restore the antitumor immunosurveillance, have exhibited significant clinical benefits for patients with certain cancer types. Nevertheless, the relatively low response rate and acquisition of resistance greatly limit their clinical applications. A deeper understanding of the regulatory mechanisms of PD-L1 protein expression and activity will help to develop more effective therapeutic strategies. Methods The effects of AR-A014418 and THZ531 on PD-L1 expression were detected by western blot, reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and flow cytometry. In vitro kinase assays with recombinant proteins were performed to confirm that AR-A014418 functioned as a CDK12 and CDK13 dual inhibitor. The roles of CDK12 and CDK13 in intronic polyadenylation (IPA) and transcription of PD-L1 were determined via RNA interference or protein overexpression. T-cell cytotoxicity assays were used to validate the activation of antitumor immunity by AR-A014418 and THZ531. Results AR-A014418 inhibits CDK12 to enhance the IPA, and inhibits CDK13 to repress the transcription of PD-L1. IPA generates a secreted PD-L1 isoform (PD-L1-v4). The extent of IPA was not enough to reduce full-length PD-L1 expression obviously. Only the superposition of enhancing IPA and repressing transcription (dual inhibition of CDK12 and CDK13) dramatically suppresses full-length PD-L1 induction by interferon-γ. AR-A014418 and THZ531 could potentiate T-cell cytotoxicity against tumor cells. Conclusions Our work identifies a new regulatory pathway for PD-L1 expression and discovers CDK12 and CDK13 as promising drug targets for immune modulation and combined therapeutic strategies.
    Type of Medium: Online Resource
    ISSN: 2051-1426
    URL: Article
    DOI: 10.1136/jitc-2022-006483
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2719863-7
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  • 10
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    Vascular protection and regenerative effects of intranasal DL-3-N-butylphthalide treatment after ischaemic stroke in mice
    BMJ ; 2021
    In:  Stroke and Vascular Neurology Vol. 6, No. 1 ( 2021-03), p. 74-79
    Details
    In: Stroke and Vascular Neurology, BMJ, Vol. 6, No. 1 ( 2021-03), p. 74-79
    Abstract: To investigate the effects of DL-3-N-butylphthalide (NBP) via intranasal delivery after ischaemic stroke in mice. Methods C57BL/6 mice were divided into three groups: sham, stroke with vehicle and stroke with NBP treatment. Ischaemic stroke was induced by permanent ligation of right middle cerebral artery with 7 min common carotid artery occlusion. NBP (100 mg/kg) or vehicle was intranasally administered at 1 hour after stroke and repeated once a day until sacrifice. Bromodeoxyuridine (BrdU) (50 mg/kg/day) was given from the third day until sacrifice. Sensorimotor function was tested during 1–21 days after stroke. Local cerebral blood flow in the ischaemic and peri-infarct regions was measured using laser Doppler flowmetry before, during and 3 days after ischaemia. Expressions of vascular endothelial growth factor (VEGF) and endothelial nitric oxide synthase as well as regenerative marker BrdU in the peri-infarct region were analysed by western blotting and immunohistochemical methods. Results Compared with the vehicle group, NBP treatment significantly increased the VEGF expression in the poststroke brain. Stroke mice that received NBP showed significantly less vascular damage after stroke and more new neurons and blood vessels in the peri-infarct region at 21 days after stroke. In the adhesive removal test, the sensorimotor function of stroke mice treated with NBP performed significantly better at 1, 3 and 7 days after stroke compared with vehicle controls. Conclusion Daily intranasal NBP treatment provides protective and neurogenic/angiogenic effects in the poststroke brain, accompanied with functional improvements after a focal ischaemic stroke in mice.
    Type of Medium: Online Resource
    ISSN: 2059-8688 , 2059-8696
    URL: Article
    DOI: 10.1136/svn-2020-000364
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2847692-X
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