There are serious and long-term effects of air pollution on children, thus the Royal College of Physicians of Edinburgh, Air Pollution Working Group has evaluated whether air quality was being sufficiently monitored around Scottish city schools. We undertook a web-based study of school placement and air quality monitors. Data, including location, from the automatic monitors were available on the Scottish Government's air quality webpages and on the UK Government site. These data (for both nitrogen dioxide (NO2) and particulate matter) were supplemented by the non-automatic NO2 diffusion tube locations, the geographical locations of which were found on the relevant local council websites. 340 primary schools and 95 secondary schools were mapped between the five city council regions. Using the council maps of schools and maps of monitors, we plotted the positions of the schools and monitors on a single map, and distances between schools and monitors were calculated using Google Earth measurement tools. 37% of primary schools and 36% of secondary schools are more than 1000 m away from any form of air pollution monitors and for both school types nearly two-thirds are further than 500 m away from monitors. Four out of five cities have no secondary schools within 50 m of air pollution monitors and greater than 97% of all schools are further than 50 m away from any form of air quality monitoring. The mean distance between the primary schools and air quality monitors is 1051 m and for secondary schools 997 m. We have shown that very few schools are near enough to an air quality monitor to provide accurate local readings. The air safety of our school children at school in five Scottish cities, many of which are on busy city streets, is unknown.
Medical tourism, particularly for cosmetic and bariatric procedures, has become increasingly common. This presents significant challenges when patients return to their home country with post-operative infections requiring management. Treatment guidelines for surgical site infections (SSIs) are typically based on local antimicrobial susceptibility patterns, which may not be appropriate when surgery was performed abroad, in countries with potentially differing antimicrobial resistance profiles and healthcare practices. To review the demographics, risk factors, surgical management, microbial aetiology and treatment of SSI in patients presenting to hospitals in Ireland after undergoing cosmetic or bariatric surgery abroad. This prospective, multi-centre observational study was conducted across four tertiary referral plastic surgery centres in the Republic of Ireland. Ethical approval was obtained at each participating hospital site, and a standardised data collection proforma ensured consistency in reporting. SSIs were classified as per the Centres for Disease Control and Prevention (CDC) criteria. Eligible participants were adults presenting in the Republic of Ireland with infections after undergoing cosmetic or bariatric procedures abroad. Practising plastic surgeons were also surveyed on various aspects of this patient cohort to gain further insight and to complement findings from our study. Of the 37 patients included in the study, 34 underwent cosmetic procedures whilst 3 underwent bariatric procedures. 21 (57%) underwent procedures in Turkey, with abdominoplasty being the most common cosmetic procedure (n=17, 46%). The majority (n=34, 92%) had procedures classified as 'clean' surgeries. Significant positive microbiological cultures were identified in 22 (59%) patients, with Gram-negative organisms isolated in 15 of these cases (68%). In 17 cases (77%), the isolates were resistant to antimicrobials recommended by local empiric treatment guidelines. Length of hospital stay ranged from 1 to 107 days. SSIs following medical tourism may present challenges to local healthcare systems and involve a wide range of causative pathogens, meaning existing local empiric treatment guidelines are often inappropriate for this patient cohort. Public information campaigns, strengthening surveillance to enable accurate recording of emerging trends and complications, and updating empiric treatment guidelines for this patient cohort are all essential to optimise patient outcomes.
Robust evidence for most licensed Crohn's disease therapies is lacking for perianal fistula outcomes due to a lack of dedicated clinical trials. This study aimed to use a Bayesian framework to determine the efficacy of medical therapies for perianal fistulizing Crohn's disease (PFCD). A formal prior elicitation exercise was conducted by a group of 11 gastroenterologists and 5 statisticians. Consensus priors were developed leveraging both existing published data and clinical expertise, to determine one-year fistula remission rates for medical treatments with 5 different mechanisms of action (anti-TNF, anti-integrin, anti-IL-12/23, anti-IL-23, and JAK inhibitor). Consensus priors on efficacy of each treatment were determined relative to an elicited consensus prior for placebo control. Consensus priors were obtained for the likelihood of fistula remission at 1 year. The prior mean, together with a 90% prior credible interval, of the one-year fistula remission rate was 0.22 (0.05, 0.46) for placebo, 0.58 (0.09, 0.96) for intravenous infliximab, 0.39 (0.06, 0.82) for adalimumab, 0.53 (0.09, 0.93) for subcutaneous infliximab, 0.24 (0.03, 0.60) for intravenous vedolizumab, 0.44 (0.05, 0.90) for upadacitinib, 0.34 (0.04, 0.77) for ustekinumab, and 0.36 (0.04, 0.82) for anti-IL-23 specific agents. Oral upadacitinib and subcutaneous infliximab demonstrated the highest probability for efficacy, alongside intravenous infliximab. We have conducted the first Bayesian prior elicitation exercise in inflammatory bowel disease. The generated priors could be used to enhance the design and analysis of clinical trials in PFCD by improving estimation of treatment efficacy, minimizing sample sizes, and potentially reducing the need for placebo control arms.
No-reflow is a serious complication of PPCI in STEMI. Systemic inflammation plays a role, but simple prognostic tools are needed. The Scottish Inflammatory Prognostic Score (SIPS), combining neutrophil count and serum albumin, shows promise in other areas but hasn't been tested for no-reflow. The present study aimed to investigate the association between admission SIPS and angiographic no-reflow in STEMI patients undergoing PPCI. One thousand eighteen consecutive STEMI patients undergoing PPCI between 2020 and 2025 were analysed. SIPS was calculated on admission. No-reflow was defined as post-procedural thrombolysis in myocardial infarction (TIMI) flow <3 without mechanical obstruction. Associations were assessed using chi-square, receiver operating characteristic (ROC) analysis, and multivariate logistic regression. No-reflow occurred in 132 patients (13.0%), increasing with SIPS: 10.2% (low), 15.9% (moderate), 16.5% (high; P = .022). SIPS had modest discriminative ability (area under Curve [AUC] = 0.563, P = .019), similar to neutrophil count. Diabetes was independently linked to no-reflow (OR 1.30, P = .032); SIPS categories were not. Higher admission SIPS was associated with increased no-reflow risk in a graded pattern but did not emerge as an independent predictor after multivariable adjustment. DM was the sole independent predictor identified.
Primary liver cancer (PLC) remains a significant global health challenge with rising incidence rates and poor prognosis. While Scotland has historically faced high disease burdens, recent data indicate that PLC incidence has transitioned from a period of rapid growth to a stabilised plateau since 2014. PLC risk factors are influenced by regional disparities driven by socio-economic deprivation. This study aims to analyse the trends in PLC incidence in Scotland by cancer networks from 2000 to 2023. PLC patients, defined as ICD-10 C22 topographic code, were extracted from the Scottish Cancer Registry between 2000 and 2023. There are three cancer networks in Scotland: North of Scotland (NoS), Southeast of Scotland (SEoS) and West of Scotland (WoS). The European age-standardised incidence rate was annually calculated. Joinpoint regression analysis identified the turning points in incidence trends by cancer networks. The distribution of age and sex were evaluated using Chi-squared tests. A total of 11,933 PLC cases in Scotland were recorded between 2000 and 2023. WoS accounted for the largest proportion of cases (48.9 %), followed by SEoS (26.8 %) and NoS (24.3 %). An epidemiological shift experienced in the mid-2010s: incidence rates increased from 2000 before plateauing in 2013 for SEoS, 2014 for WoS and Scotland, and 2015 for NoS. WoS exhibited a distinct demographic profile, characterised by higher proportions of male (68.2 %) and higher proportions of patients under age 70 (43.8 %) compared to the national average (p < 0.05). PLC incidence by cancer networks transitioned from a period of rapid growth to a stabilised plateau in the mid-2010s. WoS is characterised by the highest incidence rates and more males, a younger age profile compared to other networks. The high burden in WoS underscores a need for region-specific strategies in Scotland.
Successful acquisition of language and literacy skills is essential to child development and is associated with positive socioeconomic and well-being outcomes later in life. Research into communication skills has primarily focused on early development and childhood. This is particularly the case for studies of genetic variation in reading and language skills, which rarely include older adults; the largest genome-wide association study to date includes participants only up to 26 years of age. We argue that reading-related traits remain stable across the adult lifespan and that including older adults offers a way to increase statistical power for gene discovery. Here, we describe newly available reading, spelling and oral-language-related measures in the Generation Scotland: Scottish Family Health Study (GS:SFHS). Phenotypic data in GS:SFHS were extended to include quantitative measures of reading, spelling and language-related measures as well as self-reported neurodevelopmental and psychiatric conditions. Participants also reported frequency of book reading in both childhood and adulthood. Multiple regression analyses were conducted to examine associations between reading-related measures and age and characterise their stability across the adult lifespan. Reading-related data were collected for N=1595 GS:SFHS participants aged 29.5-76.9 years. Regression analyses indicated that reading and spelling performance were stable across the adult lifespan. In contrast, negative curvilinear effects of age2 were observed with phonological verbal-memory, auditory short-term memory and working memory, indicating decreasing performance with increasing age. These data provide a novel resource for investigating reading, spelling and language skills in adults. The opportunity to link these measures with the existing and future biomarker, cognitive and health record data within GS:SFHS offers a deeply phenotyped dataset with substantial potential for replication studies, meta-analyses and future genetic discovery.
Research and practice around dance for promoting health and well-being are rapidly expanding, especially dance for chronic neurological conditions. Yet, research has primarily focused on assessing individual-level therapeutic outcomes, providing limited insight into broader stakeholder voices and community-level health impacts. In response, a longitudinal qualitative interview study was conducted to explore stakeholder perspectives on the community impact of a collaborative, community-centred dance for multiple sclerosis (MS) initiative in a rural Scottish island community. Repeated semi-structured interviews were undertaken with 19 participants, recruited purposively across three fieldwork visits. Participants included organizational partners, dance practitioners, musicians, volunteers, and dancers with MS. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Three themes were developed: (i) amplifying specialist community dance capacity, supporting individual practitioners and the island's wider dance industry; (ii) promoting social capital and inclusion among the diverse local stakeholders involved, especially those living with MS; and (iii) providing a holistic well-being resource for participant dancers with MS, affording regular opportunities for physical, joyful, and meaningful activity through dance. By adopting a broader health promotion perspective, findings show that community-centred dance for health initiatives can generate a range of impacts in rural contexts both among and beyond the primary target participant group (i.e. people with MS), supporting capacity, inclusion, and well-being. Given the breadth of community impacts reported, findings also highlight the importance of maintaining such changes locally, suggesting the need for further consideration around organizational planning, support, and investment in the long-term sustainability of dance for health in rural contexts.
To investigate the association between pre-existing mental illness and out-of-hospital cardiac arrest (OHCA) survival. We performed a nationwide retrospective cohort study using Scottish Ambulance Service OHCA data linked to unscheduled care and death data in Scotland. We identified adults 18 years or older with non-traumatic OHCA between 2011 and 2022 and defined pre-existing mental illness as a record of mental illness within an unscheduled acute hospital admission or a record of unscheduled psychiatric hospital admission prior to OHCA. We used logistic regression models to obtain crude and adjusted odds ratios (ORs) for the association between mental illness and OHCA 30-day survival and conducted subgroup analyses based on patient and event characteristics, including age, sex, initial heart rhythm and bystander cardiopulmonary resuscitation. We included 30,523 patients with OHCA, of whom 12.8% had a pre-existing mental illness. Those with pre-existing mental illness had a higher prevalence of physical comorbidities, lower rates of initial shockable heart rhythm and significantly lower odds of 30-day survival compared to those without mental illness, after adjusting for age (OR 0.22, 95% confidence interval 0.18-0.26). This association persisted after adjusting the model for sex, year of arrest, comorbidities and deprivation, and was consistent across the different subgroups analysed. Compared to people without pre-existing mental illness, those with pre-existing mental illness have lower odds of OHCA survival even after accounting for patient and event characteristics. Further research should investigate factors that may be responsible for this association and inform interventions to address disparities.
The United Kingdom (UK) does not have an evidence-based policy on circumcision for non-medical reasons. The aim of this systematic review is to address the question "Is non-therapeutic male circumcision (NTMC) a beneficial public health intervention for the UK?". A PRISMA-compliant, PROSPERO-registered, systematic review was conducted involving PubMed, EMBASE, SCOPUS and Cochrane databases searches for male circumcision articles to January 2024. Those rated high-quality by the Scottish Intercollegiate Grading Network (SIGN) system were included in results. Searches retrieved 183 articles rated as high-quality and relevant to the objectives. These showed early circumcision provided immediate and lifetime medical benefits by protecting against urinary tract infections, penile dermatological inflammation, phimosis, inferior penile hygiene, candida, sexually transmitted infections (STIs) such as human papillomavirus, genital herpes virus type-2, human immunodeficiency virus, and penile and prostate cancers. NTMC had no long-term adverse effect on sexual function or pleasure. Female partners were at lower STI and cervical cancer risk. A risk-benefit analysis for the UK found benefits of early circumcision exceeded procedural risks by over 200 to one, and that as many as half of uncircumcised males may be affected during their lifetime from an adverse medical condition attributable to foreskin retention. Costs for treatment of these exceeds procedural costs for early NTMC. A recent systematic review found NTMC of male minors is legal and supported by ethical arguments as well as the United Nations Convention of the Rights of the Child which emphasizes the right to health. Routine provision of accurate, evidence-based information on risks and benefits should assist parents in making an informed decision about circumcision should they have a boy. Cost coverage is warranted. In summary, the medical evidence supports early circumcision as a public health recommendation in the UK.
The folded ear phenotype of Scottish Fold cats is associated with an autosomal dominant TRPV4 variant (c.1024G>T) linked to osteochondrodysplasia. Although genetic testing has been implemented to guide breeding, empirical evidence of its impact on allele frequency remains limited, and crossbreed investigations are lacking. Here, we evaluated longitudinal changes in TRPV4 c.1024G>T allele frequencies in Scottish Folds and surveyed the variant in 8610 cats from 14 breeds in Japan. Overall, between 2017 and 2024, the proportion of homozygous cats significantly declined (from 14.2% to 1.9%, p < 0.001), whereas the frequency of heterozygous cats remained stable (39.3% vs. 51.5%, p > 0.74). The variant was identified primarily in Scottish Folds but was also detected in American Curls, Norwegian Forest Cats, Munchkins, and Minuets. Taken together, our results highlight that integrating TRPV4 c.1024G>T genotyping into breeding programs can effectively reduce the prevalence of this hereditary disorder, and they warrant the expansion of genetic testing to additional breeds.
Bisphosphonates and teriparatide are used in the management of osteoporosis and reduction of fracture risk. However, their effects on fracture healing have been subject to debate, with concerns that the antiresorptive action of these drugs might impair bone remodelling and delay union. This systematic review and meta-analysis aimed to assess the effects of anti-osteoporotic medication on fracture union, clinical outcomes, complications, and patient-reported outcome measures for acute fractures in adults. We searched MEDLINE (1946 to Sept 24, 2025), Embase (1974 to Sept 26, 2025), Cochrane Library (1946 to Sept 26, 2025), Web of Science (1900 to Sept 26, 2025), and Scopus (2000 to Sept 26, 2025) for randomised controlled trials involving patients aged 18 years or older who had sustained a fracture and had commenced on or were continuing anti-osteoporotic medicine. The included studies compared at least one form of anti-osteoporotic medication with another anti-osteoporotic medication or a placebo. Outcomes that were common to the studies included rates of non-union and delayed union of fractures, complications, overall time to fracture union, and visual analogue pain scores. χ2, τ2, and I2 tests were conducted to evaluate heterogeneity. For I2 values of 50% or more, subgroup analysis was considered; if subgroup analysis was not feasible, random-effects modelling was used. For I2 values less than 50%, fixed-effect modelling was used. Risk ratios (RRs) and mean difference were calculated with 95% CIs. Standardised mean difference was used if there was substantial heterogeneity between outcome measures. This review is registered with PROSPERO (CRD42021230018). We identified 28 trials reporting on 5085 patients (3513 [69·1%] women and 1090 [21·4%] men; sex was not reported for 482 [9·5%] patients) for inclusion in the systematic review, of which 12 trials were suitable for meta-analysis. From pooled meta-analyses, no statistically significant differences were found between groups receiving bisphosphonate versus control for time to union (standardised mean difference 0·39, 95% CI -0·65 to 1·42; Z=0·73; p=0·47), delayed union (RR 1·24, 95% CI 0·82 to 1·89; Z=1·01; p=0·31), or non-union rates (0·71, 0·14 to 3·72; Z=0·40; p=0·69). Pooled analysis showed a significant reduction in time to union with use of teriparatide compared with a control (mean difference -3·03, 95% CI -3·61 to -2·45; Z=10·32; p<0·0001). There were no significant differences between delayed union rates (RR 0·72, 95% CI 0·18 to 2·84; Z=0·48; p=0·63) and Radiological Union Score for Hip scores (mean difference 0·58, 95% CI -0·46 to 1·62; Z=1·10; p=0·27) for patients receiving teriparatide versus control. On the basis of these analyses, bisphosphonate therapy did not appear to affect the time to or rate of fracture healing. Teriparatide does not appear to delay healing and might reduce the time to union for osteoporotic fractures, although further prospective evidence is needed. Heterogeneous reporting and variation in drug agents and doses used limited the comparison of other variables. Standardised reporting in this area is recommended. None.
We aimed to evaluate the direct and indirect costs of anterior cruciate ligament (ACL) injuries and assess their effects on career trajectories, market value, and potential associations with the age of the head coach at the time of injury in European professional football. A retrospective Transfermarkt.com cohort study was conducted on 211 professional male footballers who underwent ACL reconstruction. Primary outcomes related to demographics, career outcomes, market value, and coaching profiles were analysed. Data were analysed using SPSS 30, employing analysis of variance, Mann-Whitney U tests, Wilcoxon signed-rank tests, and independent-samples t-tests. Post-hoc power analysis (G Power) confirmed statistical power > 0.99 for the primary outcome. The mean recovery period was 256.6 days (standard deviation [SD]: 91.9; median: 241; interquartile range [IQR]: 102; range: 109-674). ACL injuries were associated with a mean market value depreciation of approximately 2.5% (Value Drop Ratio [VDR]: 1.0; SD: 0.1; 95% confidence interval [CI]: 1.0159-1.033). Age was significantly associated with financial loss (F = 6.2, p < 0.001; Cohen's f = 0.332); players ≥ 30 years showed a 5.5% decline compared to 0.9% for those aged ≤ 22 years. Post-injury, 16.0% transitioned to a lower-tier league and 7.3% to a higher-tier league. Players who transitioned to lower tiers had shorter mean recovery durations (221.6 vs. 264.1 days; p = 0.011). In an exploratory analysis (n = 38 coaches), teams coached by managers < 40 years had lower ACL injury rates among newly transferred players (p = 0.004). After Bonferroni correction (p < 0.007), only Scottish and Dutch subgroup findings remained significant. ACL injuries in professional male footballers impose a substantial economic burden on clubs through market value depreciation, prolonged recovery and continued salary obligations. Older player age is the strongest determinant of financial impact, while a meaningful proportion of injured players transition to lower-tier leagues, with shorter recovery paradoxically associated with downward career mobility. These findings suggest that ACL injury constitutes a multidimensional risk encompassing medical, financial and career consequences. Level III, retrospective cohort study.
While FOXC1 single-nucleotide variants and deletions are well-established causes of Axenfeld-Rieger syndrome, few FOXC1 duplications have been reported. This study investigated families with duplications encompassing the FOXC1 gene to refine the associated phenotypic spectrum and contribution to glaucoma. To investigate the prevalence and phenotype of FOXC1 duplications in 2 large glaucoma registries. This retrospective observational genetic cohort study included participants recruited from the Australian & New Zealand Registry of Advanced Glaucoma (ANZRAG) and the Massachusetts Eye and Ear (MEE) cohort from 2008 through 2025. Participants with glaucoma, and available relatives, underwent genomic testing to identify duplications encompassing FOXC1 using exome sequencing and genotyping arrays (ANZRAG) or whole-genome sequencing (MEE). Data analyses were conducted from 2022 through 2025. Prevalence of FOXC1 duplications, age at glaucoma onset, and phenotype, including ocular and systemic features. Twenty individuals from 10 families (50% female and 50% male; 70% self-described as broadly European [Australian/British, British, English/German, English/Polish, European, or Scottish], 25% as Asian [Chinese or Filipino], and 5% as Latin American [Salvadoran]) were identified with FOXC1 duplications. All genetically tested individuals were diagnosed with glaucoma, demonstrating high penetrance. Seventeen individuals were referred with juvenile open-angle glaucoma (JOAG), 1 with primary open-angle glaucoma, 1 with primary congenital glaucoma, and 1 with anterior segment dysgenesis. The diagnosis of 4 individuals from 1 family with ectropion uveae was revised to anterior segment dysgenesis. Systemic features were reported for 2 participants (10.5%), including subtle dental findings and mild facial dysmorphism. Duplications encompassing FOXC1 were among the most common monogenic contributors to JOAG. In the ANZRAG group, they accounted for 13.5% (95% CI, 6.7%-25.3%) of JOAG probands with a genetic diagnosis, second to MYOC (53.8%; 95% CI, 40.5%-66.7%). In the MEE group, FOXC1 duplications accounted for 9.5% (95% CI, 2.7%-28.9%) of JOAG probands with a genetic diagnosis. These findings suggest FOXC1 duplications are an underrecognized, highly penetrant, but variably expressive, genetic variation associated with JOAG. Findings for the relatively modest number of individuals in the retrospective study were associated with wide confidence intervals. This limitation is often inherent to studies of JOAG, a rare condition for which individual genetic variants account for only a subset of cases. Despite this, the findings highlight the genetic heterogeneity of JOAG and support the potential importance of considering routine genetic copy-number variant analysis for individuals with JOAG.
Dementia is common among people living in care homes, but many residents lack a diagnosis. Quantifying the prevalence of dementia in care homes is therefore challenging. Using routinely collected data, from care homes, healthcare and administrative data sources offer a potential way to address this, but the utility of these data has not been evaluated in this population. To describe the dementia status of care home residents across multiple national datasets and describe the overlaps and conflicts between sources. A retrospective cohort study was undertaken using national care home data from the Scottish Care Home Census. Records for individuals in the cohort were obtained from healthcare (community prescribing, general hospital and psychiatric hospital inpatient diagnoses) and administrative data (death records). These were further categorised for their dementia diagnosis information, including specific dementia subtypes. A cohort of 63,308 adults living in 1,231 care homes in Scotland between 01/04/2012-31/03/2016 was created. They were 66.8% female and 86.6% died by follow-up, May 2020. Care home data identified 36,275 (57.3%) with dementia. In total, 14,269 (22.5%) had a prior prescription for a dementia medication, 13,920 (22.0%) had a general hospital discharge diagnosis of dementia, 2,750 (4.3%) had a psychiatric hospital discharge diagnosis of dementia and 31,825 (50.3%) had dementia recorded on their death certificate. We found 30.2% of the cohort had no dementia data in any national data sources and 25.3% had dementia data in all three sources and 5.1% only had dementia included in death data. This study demonstrates the feasibility and utility of linking care home, healthcare and administrative data to better understand dementia in the population living in care homes. The contributions made by different data sources are of interest to those creating population-level datasets to understand dementia epidemiology across the population for researchers, clinicians and policymakers.
National asthma guidelines (National Institute for Health and Care Excellence or British Thoracic Society/Scottish Intercollegiate Guidelines Network) have recently been updated to recommend anti-inflammatory reliever (AIR) and maintenance and reliever therapy (MART) for patients managed on short-acting beta-2 agonist (SABA) inhalers, due to evidence linking SABA overuse with poor asthma outcomes. This project aimed to identify patients over-relying on SABA inhalers, assess practice compliance with national guidelines, and implement interventions to optimise management. Interventions included asthma reviews, inhaler technique assessment, and initiating AIR/MART therapy where appropriate. A two-cycle retrospective audit was conducted, including adult patients issued ≥2 SABA inhalers in the last 12 months. In the first cycle (October 2024), 94 patients were identified, of which 72 (76.6%) could be contacted and 37 (51.4%) overused their SABA inhaler ≥3 times per week. In the second cycle (September 2025), 35 patients were identified, 23 (65.7%) could be contacted and 18 (78.3%) reported SABA inhaler overuse. Between the two cycles, the number of patients identified as issued ≥2 inhalers over 12 months decreased from 94 to 35 (-62.8%), and SABA inhaler overuse (≥3 times a week) decreased from 37 to 18 (-51.4%). This project demonstrates that identifying SABA inhaler overuse and implementing updated national guidelines can improve asthma control and prescribing in general practice. This model could be replicated across other primary care practices to improve patient outcomes and reduce healthcare system burden.
This narrative review aims to aggregate all reports of nosocomial transmission of rare yeast species, to provide an overview of global trends, causative species, clinical characteristics and preventive measures. A comprehensive literature search of multiple databases was conducted, to identify all reported nosocomial transmission events involving rare yeast species. The five most common yeasts, Candida albicans, Nakaseomyces glabratus, Candida parapsilosis, Candida tropicalis and Pichia kudriavzevii, in addition to Candida auris were excluded. A total of 76 reports were retrieved since 1984, caused by 28 different species. Wickerhamoyces anomalus was the most common agent, followed by Magnusiomyces, Trichosporon and species of the Candida haemulonii complex. Since the early 2000s, a clear increase was noted both in the number of outbreak reports and range of associated species, largely due to improved diagnostics. Most species were resistant to one or multiple antifungals and although environmental sampling was often performed, virtually all efforts yielded negative results. Once noted, strict hand hygiene practices and proper cleaning and disinfection of medical equipment has shown in curbing nosocomial spread. As hospital outbreak events are increasingly reported, accurate species identification and epidemiological surveillance should be in place for rapid detection. An enhanced focus on infection control measures was often sufficient to prevent new cases. Importantly, high-resolution genotyping is needed to confirm clonal transmission, which is often not conducted.
Cigarette smoking is an established cardiovascular risk factor, but the association between electronic cigarette (e-cigarette) use and hypertension remains unclear. We examined this association in a nationally representative adult population in Scotland using pooled cross-sectional data from 22,187 adults aged ≥16 years in the Scottish Health Survey (2017-2022). Participants were classified into five mutually exclusive groups: never users (n = 11,760), former smokers (n = 6,201), current cigarette smoking only (n = 2,747), current e-cigarette use only (n = 907), and current dual use (n = 572). Hypertension was defined as self-reported doctor-diagnosed high blood pressure, excluding pregnancy-related hypertension. Multivariable logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Secondary analyses disaggregated current e-cigarette use only by smoking history, and propensity score matching was performed as a sensitivity analysis. Overall hypertension prevalence was 26.5%, ranging from 19.0% among current exclusive e-cigarette users to 33.5% among former smokers. Compared with never users, current e-cigarette use only was associated with lower odds of hypertension (OR 0.77, 95% CI 0.63-0.93), whereas former smokers had higher odds (OR 1.10, 95% CI 1.02-1.20). No significant associations were observed for current cigarette smoking only (OR 0.94, 95% CI 0.84-1.06) or current dual use (OR 0.95, 95% CI 0.75-1.20). The inverse association for exclusive e-cigarette use was confined to former smokers who had switched to vaping (OR 0.77, 95% CI 0.63-0.94). In propensity score-matched analyses, the inverse association for current exclusive e-cigarette use was attenuated and no longer statistically significant, suggesting that this finding may partly reflect healthy switcher bias and residual confounding rather than a protective effect.
Neurotrauma, encompassing traumatic brain injury (TBI) and spinal trauma, remains a significant global cause of mortality and morbidity. Socioeconomic deprivation is associated with higher injury incidence and poorer outcomes, though gradients vary across healthcare systems. This study examines neurotrauma admission disparities across socioeconomic and demographic groups in Scotland over a 6-year period. A national population-based analysis of neurotrauma admissions in Scotland from 2014 to 2020 was conducted using data from Public Health Scotland. Admissions were categorized by sex, age group, injury severity (minor, moderate, major), and socioeconomic status using the Scottish Index of Multiple Deprivation (SIMD), where Quintile 1 represents the most deprived and Quintile 5 the least deprived areas. Year-on-year incidence trends, demographic patterns, and length of stay (LOS) were analyzed. Total neurotrauma admissions increased from 1,098 in 2014 to 2,428 in 2020. A consistent socioeconomic gradient was observed across all injury severities: the most deprived group (SIMD 1) accounted for the highest proportion of admissions annually, while the least deprived (SIMD 5) had the lowest. Males demonstrated higher admission numbers than females across all severity levels. Age-related patterns revealed patients aged <16 years had the highest proportion of head injuries (73.0%), whereas those aged 16-44 and 45-54 had higher proportions of spinal injuries (48.9 and 48.4% respectively). Longer hospital stays were associated with greater deprivation, even after adjusting for age and injury severity. Substantial and persistent socioeconomic gradients exist in neurotrauma admissions across Scotland, with the most deprived communities bearing the greatest burden. These disparities persist despite universal healthcare coverage, suggesting deprivation influences injury exposure, resilience, and recovery pathways. Findings support targeted prevention strategies for high-risk groups and resource allocation informed by area-based deprivation indices to address neurotrauma as both a clinical and public health challenge.
Intelligent Clinical Decision-Making Systems have become a cornerstone of modern healthcare by enabling accurate diagnosis, prognosis and treatment planning through data-driven insights. With the growing availability of heterogeneous healthcare data such as medical images, clinical records, physiological signals and textual reports, multimodal learning has emerged as a powerful paradigm for integrating diverse data sources. This review presents a comprehensive and systematic analysis of multimodal approaches for intelligent clinical decision-making by leveraging machine learning, deep learning, transfer learning and natural language processing techniques. A structured literature search was conducted using IEEE, Elsevier, Wiley Online Library and Springer databases, focusing on peer-reviewed studies published between 2020 and 2025. The selected articles were analysed based on data modalities, learning strategies, healthcare applications, datasets and performance evaluation metrics. This review highlights the effectiveness of multimodal frameworks in addressing key challenges such as class imbalance, disease prediction, patient monitoring and treatment planning. Additionally, it discusses the benefits, open challenges and limitations of existing intelligent clinical decision frameworks, including scalability, interpretability and real-world deployment issues. Finally, the review outlines future research directions emphasizing the integration of Internet of Things-enabled healthcare data, federated learning for privacy preservation and blockchain-based secure data sharing to enhance the reliability and clinical adoption of intelligent decision-making systems.
Objective: There is evidence to show that young children with educational additional support needs (ASN) have poorer oral health and less access to primary care dental services than their peers however, less is known about the oral health and dental service access of young people with ASN as they embark on secondary education. This study investigates the rates of tooth extraction under general anaesthesia and primary care dental attendance in young people with educational ASN attending secondary school in Scotland. Methods: A multi-cohort study of 214,142 young people followed up from age 12 to 16 years in Scotland using data linkage of three routine databases: Pupil Census; Scottish Morbidity Records; and Management Information and Dental Accounting System. Rates of tooth extraction under general anaesthetic in hospital and access to primary care dental services were compared among young people with ASN to those with no recorded ASN. Results: Tooth extraction under general anaesthesia was higher among young people with autism (Adjusted Risk Ratio (aRR) = 2.48; 95% Confidence Interval (CI) = 1.85 to 3.25) and with intellectual disabilities (aRR = 1.76; 95% CI = 1.43 to 2.16) compared to those with no ASN. Regular attendance at primary dental care was less likely for young people with any ASN, particularly among those with intellectual disabilities and social-related ASN. Conclusions: Young people with ASN experience greater inequalities in oral health and dental care, which would also include preventive interventions, than their peers without ASN. Early intervention through national oral health improvement programmes such as Childsmile may help reduce these inequalities.