Malaria poses a significant threat to public health in tropical regions, with nearly half of the global population at risk. Historically, transmission was common in temperate regions including northwestern Europe, with records indicating that malaria was prevalent in Scotland until the early nineteenth century. While current environmental and epidemiological conditions are unsuitable for transmission, future climate, environmental, and land-use change may alter the receptivity of Scotland to malaria and other mosquito-borne diseases. As a first step to assess the potential for future transmission risk, we aimed to map the distribution of two native Anopheles mosquito species in Scotland that have been implicated in historical malaria transmission and assess the relationship between areas of high contemporary suitability and historical hotspots of transmission. Using data generated from a recent Scotland-wide mosquito surveillance programme and citizen science reporting (2023-2024), we used species distribution models to predict the current distribution of Anopheles claviger and An. plumbeus in Scotland and identify their associations with environmental and land-use variables. Another historical vector, An. maculipennis s.l., was also recorded but with too few observations for reliable modelling. Using georeferenced historical parish hotspots of malaria in Scotland (eighteenth century records), we tested whether predicted contemporary suitability at hotspot locations was higher than expected by chance using comparisons against randomly sampled background locations. Several climatic and physical environmental variables were associated with Anopheles species distribution in Scotland, with altitude and landcover being the most consistent, and temperature and precipitation having variable impact across species. Anopheles were predicted to have widespread distribution across coastal and lowland Scotland, with pockets of habitat suitability extending up to the northeast coast and Shetland islands. Historical hotspots of malaria (parish locations) were consistently associated with higher predicted current suitability for Anopheles species than background locations. Overall, these findings show that potential malaria vectors are still common throughout Scotland and highlight the need for continued monitoring to generate more accurate estimates of predictors, distribution and future disease risk.
Invasive meningococcal disease (IMD) remains a major global health threat. Despite vaccination, meningococcal genetic diversity means disease, including epidemics at various scales, still occurs unpredictably, highlighting the need for real-time genomic surveillance. The COVID-19 pandemic reduced invasive respiratory diseases, but its effect on IMD distribution remains unassessed. We aimed to investigate the effect of the COVID-19 pandemic and consequent social restrictions on genomic and demographic characteristics of IMD in Scotland to inform public health policy. In this retrospective, observational analysis, we used genomic and epidemiological surveillance data of cases of IMD reported in Scotland between July 1, 2009, and April 20, 2026. Genomic data (from whole genome characterisation of culture-confirmed IMD cases) were obtained from the public databases for molecular typing and microbial genome diversity (PubMLST) and demographic data were obtained from the Meningococcal Invasive Disease Augmented Surveillance database. The pre-COVID-19 period was defined as July 1, 2009, to March 23, 2020, the COVID-19 period was March 24, 2020, to March 18, 2022, and the post-COVID-19 period was March 19, 2022, to April 20, 2026. A total of 27 binary outcomes derived from the genomic and demographic variables were prespecified before model fitting. We assessed associations with interrupted time-series analyses to establish changes related to the COVID-19 pandemic. Between July 1, 2009, and April 20, 2026, 1143 IMD cases were reported in Scotland. Of these, 512 (44·8%) were culture-confirmed cases with a corresponding meningococcal genome. High-risk groups (including children aged <1 year, children aged 1-4 years, adolescents and young adults aged 15-24 years, and people aged 65 years or older) were affected across all time periods with no demographic changes associated with the COVID-19 pandemic. Of the 27 genomic and demographic variables analysed, six showed changes in their contribution to IMD between the pre-COVID-19 and COVID-19 periods. During the COVID-19 period, the contributions of genogroup B and MenB-FHbp-preventable status to IMD both increased and the contributions of genogroups W and C, clonal complex 11, and polysaccharide-preventable status all decreased. The COVID-19 pandemic was associated with changes in IMD capsular distribution in Scotland, concomitant with a decline in clonal complex 11. In 2025-26, 4 years after physical restrictions eased, genogroup and lineages returned towards pre-COVID-19 patterns, from a new baseline, expected with a host-associated pathogen causing human disease. Age, sex, and deprivation status did not differ over time, highlighting that ongoing efforts are needed to deploy vaccinations to protect high-risk groups based on data from integrated genomic epidemiological surveillance and cost-effectiveness evaluation. NHS Scotland, Public Health Scotland, Wellcome Trust.
The aim of the study is to describe the use of immune checkpoint inhibitors (ICIs) for the treatment of cancer in Scotland. The retrospective observational cohort study included patients aged 18 years or older who commenced treatment with an ICI in Scotland between 1 January 2018 and 31 December 2024. The National Systemic Anti-Cancer Therapy (SACT) dataset was used to identify patients and obtain details on ICI treatments and patient characteristics. Additional data sources providing information on comorbidities were linked deterministically via a unique patient identifier. All analyses were descriptive. In total, 10 394 patients in Scotland initiated their first ICI treatment between 2018 and 2024; the number of patients initiating ICIs increased substantially year-on-year, from 764 patients in 2018 to 2233 patients in 2024. The most commonly prescribed ICI was pembrolizumab (56.8%, n = 5908), followed by nivolumab (16.4%, n = 1700) and atezolizumab (11.3%, n = 1170); treatment was most commonly initiated for lung and chest cancers (44.1%, n = 4585), skin cancer (18.8%, n = 1955) and urological cancers (14.8%, n = 1539). While the majority of patients (66.6%, n = 6923) initiated ICI monotherapy, combination therapies-most commonly ICI with chemotherapy (18.4%, n = 1910)-were also used. Overall, 6.6% of patients (n = 681) were on treatment for more than 2 years. With the continuous addition of new ICIs, alongside the ever-expanding list of approved indications for their use, the observed increase in ICI use is expected to continue. This increasing use of ICIs may pose challenges to health services-for instance, an increase in immune-related adverse effects-with potential implications for clinical practice and future research.
Over 200 safer drug consumption facilities have been implemented globally, as an effective intervention to prevent drug-related harms. There are many possible service designs of the facility and currently the optimum design is unclear in the Scottish context. This study investigates people who use drugs (PWUD)' preferences for the features of safer drug consumption facility to provide useful information in guiding planning for improved service in Scotland. Preferences were elicited using a discrete choice experiment. Each choice set presented 2 different hypothetical safer drug consumption facilities and an opt-out option. The hypothetical facilities were defined by 6 attributes: location, staffing, space allocation, ancillary service, opening times, and travel time. A mixed logit model was used to assess the relative importance of defined attributes among 77 PWUD in Dundee, Edinburgh, and Glasgow. Participants had a strong preference for a safer drug consumption facility that involves peer workers (Coeff: 0.953, p<0.001), provides inhalation space (Coeff: 0.668, p<0.05), provides drug checking service (Coeff: 0.677, p<0.001), and is open 24 hours a day (Coeff: 0.373, p<0.05) compared to one without peer workers, no inhalation space, no drug checking service, and with daytime-only opening hours. A longer travel time was associated with a lower preference to use a safer drug consumption facility (Coeff: -0.011, p<0.001). There was no evidence of preferences regarding location or overnight opening time (p>0.05). This is the first discrete choice experiment to quantify the preference of PWUD regarding different design features for a hypothetical safer drug consumption facility. The findings can be used to guide the design of safer drug consumption facility in Scotland, while providing evidence base for the wider context.
BACKGROUNDCommunity-acquired pneumonia by Mycoplasma pneumoniae is often complicated by co-infections with other respiratory pathogens.AIMWe describe through a sentinel respiratory surveillance system in Scotland, M. pneumoniae infection occurrence in patients presenting to general practitioners with acute respiratory infection (ARI) (October 2022-May 2025) and the co-detection frequency of other respiratory pathogens.METHODSUpper respiratory tract swabs from a representative community sample of 65,798 ARI patients were laboratory-tested for 10 respiratory pathogens, including M. pneumoniae. Positivity for M. pneumoniae was monitored over time. Single or multiple joint pathogen detections were assessed and stratified by demographic characteristics. Proportions hospitalised within 14 days after their M. pneumoniae positive test were determined.RESULTSOf 65,798 patients (40,158 female, 25,534 male, 106 sex unknown; median age: 35 years, interquartile range (IQR): 17-59), 3,031 (4.6%) were M. pneumoniae positive (1,686 female, 1,340 male, five sex unknown; median age: 18 years, IQR: 9-39). Positivity was elevated in October 2023-October 2024, particularly in 5-14-year-olds, and peaked at 47.7% (31/65) in week 1, 2024. Among M. pneumoniae cases viably tested for all pathogens, 26.0% (728/2,799) had co-detections of another pathogen, with rates in 0-4-year-olds (61.3%; 122/199) and 5-14-year-olds (31.3%, 321/1,024) reflecting those reported elsewhere in hospitalised paediatric cases. Co-detections involving rhinovirus (47.5%; 346/728) predominated, otherwise varying by pathogen and age. Of 3,031 M. pneumoniae cases, 1.8% (n = 55) were admitted.CONCLUSIONSentinel surveillance of respiratory pathogens in the community was helpful to characterise an M. pneumoniae epidemic, revealing frequent respiratory-pathogen co-detections in ≤ 14-year-olds, as prior reported in hospitalised M. pneumoniae paediatric cases.
Described as the 'cause célèbre' of North Sea oil developments, this article focuses on the unexpected alliance provoked by a proposal for a concrete platform construction yard at Drumbuie, Wester Ross, on the Scottish northwest coast. This land was owned inalienably by the National Trust for Scotland, which teamed up with a local action group to argue against the development proposals primarily on the basis of perceived damage to the social fabric of the community. Previous descriptions of the Drumbuie Inquiry have been fleeting and have missed the centrality of the social to the objectors, assuming it to be a straightforward 'environmentalist' case. This article details the arguments against the development and the consequences this had on larger Scottish planning issues, such as creating the first National Planning Guidelines. It also discusses how the 'environment' as a concept was used during the inquiry, arguing that this lacked conceptual coherence other than being used as a synonym for 'amenity'.
Previous analysis of the Scottish Cancer Patient Experience Survey showed that rural-dwelling cancer patients experience greater travel burden and fewer opportunities to participate in research, while reporting similar overall care experience. However, urban-rural classification captures only one dimension of geography and does not directly reflect how cancer services are organized, accessed or delivered across regional systems. This study aimed to explore whether cancer patient experience in Scotland varies across regional and service-system geographies, and whether these patterns provide policy-relevant information beyond urban-rural classification alone. We conducted an exploratory descriptive analysis of publicly available aggregated SCPES 2024 data, comparing patient experience responses across NHS Board of residence, NHS Board of treatment, regional cancer network and deprivation quintile. We interpreted these patterns alongside previously reported urban-rural variation. We examined deprivation gradients using SIMD (Scottish Index of Multiple Deprivation) quintiles. Chi-square tests and Cramér's V assessed both presence and magnitude of variation across key domains of the cancer care pathway. Associations between experience and geography differed across organizational levels. Early diagnosis showed little variation, while reported treatment receipt, particularly radiotherapy, varied substantially by NHS Board and persisted at cancer network level. Travel burden and reported distance to services showed the strongest geographic effects. Deprivation gradients were present but generally modest compared with regional variation. Findings suggest geography in cancer patient experience is multi-layered. Urban-rural classification remains important, but analysis by NHS Board, treatment location and cancer network may reveal additional service-system variation relevant to cancer policy, access and planning. Geographic variation in cancer patient experience should be evaluated not only by urban-rural classification or deprivation, but also by NHS Board, treatment location and cancer network. This may help identify service-system variation relevant to treatment access, travel burden and cancer service planning.
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Empowering children and young people (CYP) to actively participate in research development is essential to ensure impactful outcomes. Meaningful involvement helps researchers to pose relevant questions, design acceptable methodologies, and disseminate findings effectively. However, the inclusion of CYP in research, particularly in paediatric intensive care (PIC), is rarely reported. This is partly due to the challenging PIC environment, and most patient and public involvement and engagement activities (PPIE) focus only on the parents' experience and perspective. The Intensive-Share group was established in Scotland in 2022 to facilitate PPIE activity in PIC research. The group includes family members with a range of lived experiences with the youngest member aged 7 years. They meet regularly to contribute to various aspects of research including research design, study materials and procedures, and public engagement. This article describes the co-production approach adopted in the 'What is data?' Project, which was co-created with researchers based on an idea from the Intensive-Share group. The project aimed to co-develop a short-animated video to explain healthcare data research to CYP in an engaging and accessible format. CYP meaningfully participated in all stages of the project and were integral to its success. Initial evaluations indicated the animation was well-received by families and they self-reported improved understanding of and willingness to participate in research. Co-production with CYP can be resource-intensive and challenging, but this project demonstrated it was feasible and incredibly valuable. Meaningful and authentic involvement challenged the research teams assumptions on inclusive language and the nature and level of involvement CYP preferred. Adopting a broader approach to PPIE in PIC research to include paediatric patients and siblings, perhaps on a national level, could facilitate similar initiatives in research communication and co-production. The open-source animated video is available as a resource to the wider research community to aid communication about paediatric healthcare data research. Actively involving children and young people (CYP) in research development is essential for research to have an impact. CYP can help ensure communication about research is understandable, engaging and addresses what is important to them. However, there are very few reports of involving CYP in developing research information, particularly in paediatric intensive care (PIC). Most examples focus on parents, not on the valuable perspectives of paediatric patients and their siblings. To address this, the Intensive-Share group was established in Scotland in 2022. The group includes families with a range of experiences of PIC. Members meet regularly to contribute to various aspects of research development including project questions, the way projects are carried out (methodology), and sharing research findings with the public. This article shares experiences from the ‘What is data?’ Project which was created through a partnership between researchers and the Intensive-Share group. The project took a co-production approach to develop a short-animated video to help CYP understand how healthcare data is used for research. CYP had important roles in all stages of the project, particularly in ensuring the language in the animation was accessible and relevant. The animation was well-received by families and they reported it improved their understanding of healthcare data research. The project underscores the value of involving CYP in research communication, not just parents, and research teams would benefit from resources to support such initiatives. The animation is an open-source resource to aid researchers communicating with families about healthcare data research.
This commentary argues for the systematic integration of brain health into menopause care and policy in the United Kingdom (UK). Using Scotland as a strategically bounded case study, it examines persistent knowledge gaps among women and primary care professionals and their implications for equitable menopause care. Menopause involves significant neuroendocrine changes that affect brain metabolism, structure, and cognition, contributing to women's disproportionate Alzheimer's disease risk. Although hormone replacement therapy may alleviate neurological and cognitive symptoms - and may offer neuroprotective benefits when initiated early - clinical uncertainty, stigma, and inconsistent guidance continue to delay recognition, support, and treatment. These gaps translate into avoidable cognitive decline, reduced quality of life, and marked inequities in access to menopause care. Targeted primary care training, coherent public communication, and UK-specific investment in evidence-based menopause services are urgently required. This programme of research is situated within Scotland as a strategically bounded, devolved health system, allowing for a focused examination of how brain health is addressed within menopause policy and practice. By embedding brain health within Scotland's Women's Health Plan, the findings will inform future comparative and UK-wide research and contribute to the development of equitable, person-centred, and brain-health informed menopause care across the lifespan.
Granular creep is the slow, sub-yield movement of constituents in a granular packing due to the disordered nature of its grain-scale interactions. Despite the ubiquity of creep in disordered materials, it is still not understood how to best predict the creep-to-failure regime based on the forces and interactions among constituents. To address this gap, we perform experiments to explore creep and failure in quasi-two-dimensional piles of photoelastic disks, allowing the quantification of both grain movements and grain-scale contact force networks. Through controlled external disturbances, we investigate the emergence and evolution of grain rearrangements, force networks, and voids to illuminate signatures of creep and failure. Surprisingly, the force chain structure remains dynamic even in the absence of observable particle motion. We find that shifts in force chains indicate larger, avalanche-scale disruptions. We connect these force signatures with the geometry of the voids in the pile. Overall, our experiments and analyses deepen our mechanical and geometric understanding of the creep-to-failure transition in granular systems.
Aging clocks estimate biological age (BA) using different measures. One novel way to measure it is to use AnthropoAge and S-AnthropoAge, which use sex-dependent body composition measures to predict 10 year all-cause mortality. Studies have found an association between physical activity and BA in different populations. Our objective was to determine the association between physical activity and BA using S-AnthropoAge in a Mexican population of older adults. This is a secondary analysis of the Mexican Health and Aging Study. We implemented a simplified version of AnthropoAge (S-AnthropoAge), which is a metric designed to estimate BA based on anthropometric parameters, including body mass index (BMI) and waist-to-height ratio. We evaluated the association between accelerated aging and physical activity using adjusted linear regression models. Those who exercised frequently had, on average, 0.449 fewer years of BA (approximately five months) than those who did not (95% CI: -0.661 to -0.231). The presence of comorbidities showed a gradient-effect relationship with BA, compared to self-reported illness. On average, those with two or more illnesses had higher accelerated aging of 0.542 years. Among the variables associated, being the caregiver for a child or children under 15 years old was also significantly associated with accelerated aging, compared to those who were not caregivers, after adjusting for other relevant variables CONCLUSIONS: Our study provides further evidence that regular physical activity influences the acceleration of BA, as captured by S-AnthropoAge. However, additional research is needed to fully understand the potential mediating effect of this association.
Major depressive disorder (MDD) is heterogeneous in clinical presentation and treatment response. The COORDINATE-MDD consortium identified two magnetic resonance imaging (MRI)-derived neuroanatomical profiles: dimension 1 (D1), with relatively preserved gray and white matter, and dimension 2 (D2), showing widespread reductions aligned with immunometabolic profile. Profiles were associated with distinct responses to selective serotonin reuptake inhibitor (SSRI) antidepressant and placebo (PLA). In this study, we examined electrophysiological correlates of the neuroanatomical profiles and their relationship to treatment outcome. Baseline resting-state, eyes-closed electroencephalography (EEG) was acquired from 237 medication-free participants with MDD who were in a current depressive episode (155 women; mean age [SD] = 37.47 [13.36] years) from CAN-BIND (Canadian Biomarker Integration Network in Depression) (SSRI) and EMBARC (Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care) (SSRI or PLA). EEG features included spectral power, frontal alpha asymmetry (FAA), multiscale sample entropy, and intersite phase clustering. Effects of profile (D1 and D2) and clinical outcome (responder, nonresponder; defined as ≥50% symptom improvement) were examined with age, sex, and site as covariates. No significant electrophysiological differences were observed after covariate adjustment. However, among participants who subsequently responded to treatment, D1 showed greater baseline alpha power in frontal and central regions and lower relative delta posteriorly compared with D2. In PLA-treated responders, D2 showed spectral slowing, elevated low-frequency power, reduced gamma, and coarse-scale entropy compared with D1. Baseline FAA was lower in responders than nonresponders, independent of the neuroanatomical profile. EEG differences between MRI-defined neuroanatomical profiles emerged in relation to clinical outcome. D1 was associated with electrophysiological patterns consistent with flexible, globally regulated cortical dynamics in SSRI responders, whereas D2 showed a distinct pattern in PLA responders, indicating partially separable neural mechanisms underlying pharmacological and PLA treatment effects. Depression is a common condition, but people differ in their symptoms, underlying biology, and response to treatment. This makes it difficult to predict which treatments will be most effective for each individual. Previous research from the COORDINATE-MDD consortium identified two brain-based groups of individuals with depression using MRI scans. One group showed relatively preserved brain structure and better response to antidepressant medication, whereas the other showed more widespread structural changes and similar improvement with medication or placebo, suggesting different underlying mechanisms. In this study, we examined whether these groups also differ in brain activity measured using electroencephalography before treatment. No clear differences were seen across all participants. However, among those who later improved, distinct patterns emerged: one group showed more organized and adaptable brain activity patterns and greater response to medication, whereas the other showed slower activity and reduced complexity linked to placebo response. These findings suggest that different biological mechanisms underlie treatment response, supporting more personalized approaches to care.
Stakeholder engagement is increasingly required in global health research, yet its implementation often remains underexamined, particularly in low- and middle-income countries. Drawing on literature and experience from a multinational respiratory research programme, this viewpoint highlights how structural constraints, ethical ambiguity, power dynamics, and socio-cultural factors can undermine meaningful engagement. Without reflexive, adequately resourced, and institutionally supported approaches, stakeholder engagement risks becoming symbolic rather than transformative. Funders and institutions must therefore invest in flexible, long-term, and context-sensitive engagement models that genuinely reflect and respond to the communities global health research seeks to serve.
In facultatively sexual species, which reproduce both sexually and clonally, sexual reproduction is often triggered by stress. There exists an extensive theoretical literature to explain this pattern, broadly relying on the fact that the benefits of sexual reproduction are highest when an organism is maladapted to its environment. However, in unicellular eukaryotes a single round of sexual reproduction is often followed by a dormant phase, with clonal reproduction resuming under the restoration of resource-rich conditions to which the organism appears already adapted. In this paper we review the typical life cycles of four model eukaryotic organisms; the green alga Chlamydomonas reinhardtii, the fission yeast Schizosaccharomyces pombe, the budding yeast Saccharomyces cerevisiae and the amoebozoa Dictyostelium discoideum. We also review existing theory as it pertains to these life histories, paying particular attention to the conception of gametes, which are here often morphologically indistinguishable from vegetative cells. In this context we use mathematical models to illustrate how dormancy, syngamy and meiosis could each independently be selected for in response to a particular form of stress, namely resource limitation, under which the opportunity costs of sexual reproduction are minimized (rather than the benefits being maximized). We conclude by addressing open questions.
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Childhood overweight and obesity are prevalent in Chile and globally. Health care responses typically emphasise biomedical and risk-focused approaches, with limited attention to children's own perspectives. This study explored how children clinically classified as overweight or obese understand health, growth and weight within health contexts. Participants were recruited from primary care clinics in two municipalities in Santiago, Chile. Semi-structured online interviews were conducted with 18 children aged 10-12 years during COVID-19 restrictions, incorporating visual tools such as body silhouettes and body mapping to facilitate discussion. Data were analysed using reflexive thematic analysis. Three major themes were identified: Translating Fatness: everyday words and the softening of body labels; Body shapes, shame, and the making of 'unhealthy' bodies; and Making Sense of Measurement: Receiving, Interpreting and Negotiating Medical Labels. The study highlights that children actively interpret and negotiate weight-related messages, drawing on emotional, social, and cultural frames rather than biomedical ones. Clinical encounters can heighten body awareness and stigma. Clinical practice should prioritise non-stigmatising communication, value children's perspectives, and adopt approaches that support wellbeing during growth and identity development.
Hyperuricemia-elevated serum uric acid (SUA)-is the pathogenic driver of gout and is recognized as a systemic condition associated with cardiometabolic risk, including cardiovascular disease and type 2 diabetes, although causality remains debated. Its global prevalence has risen substantially over decades, paralleling the growing epidemic of obesity and increasing life expectancy. This narrative review examines the relationship between adiposity and hyperuricemia and summarises the knowledge about the impact of weight-loss interventions on SUA levels and gout risk. Epidemiological evidence supports a bidirectional relationship between adiposity and hyperuricemia, although Mendelian randomisation studies suggest that excess adiposity is likely a cause rather than consequence of elevated SUA. Multiple mechanisms may underlie this association, including insulin resistance, reduced renal urate excretion, visceral adiposity, and dietary factors. Weight reduction is now recommended as a cornerstone of hyperuricemia and gout management in individuals with overweight or obesity. Lifestyle and dietary interventions are associated with modest reductions in SUA and gout risk. Bariatric surgery achieves substantial and sustained weight loss, leading to significant long-term reductions of SUA and gout incidence, despite a transient postoperative SUA increase. Recently, pharmacological weight-loss therapies (i.e. glucagon-like peptide-1 receptor agonists and tirzepatide) demonstrated meaningful reductions in SUA levels, potentially largely mediated by weight loss. Integrating obesity management into hyperuricemia care represents a key strategy to reduce gout incidence and flares. Further research evaluating emerging anti-obesity therapies impact on hyperuricemia-specific outcomes would be useful, perhaps particularly in people experiencing ongoing flares despite other therapies and with obesity.