Efficacy and outcomes of a highland prehospital trauma response team.

BACKGROUND AND AIMS: The Scottish Highlands face unique prehospital care challenges due to population dispersity, mountainous terrain, seasonal weather, and higher trauma burden compared to the nearest Major Trauma Centres (MTCs) as highlighted by the Scottish Trauma Audit Group (STAG). Primary road/air transfer from scene to nearest designated MTC averages 1-5 hours, making prompt and informed utilisation of prehospital and in-hospital resources within the Highlands critical - comparative to other UK metropolitan regions where the trauma population majority lay within 20-45 minute transfer windows. This paper reviews the Highland pre-hospital immediate care and trauma (PICT) Team's trauma response through a retrospective review of PICT patient report forms (PRFs). METHODS AND RESULTS: The analysis highlighted increased trauma response by the team in the nature of attended callouts and interventions utilised. Improving trends of patient outcomes, increased advanced analgesia and medico-surgical intervention utilisation, and relative increase of road traffic collision attendance and trauma-specific calls were noted. CONCLUSION: Results highlight the Scottish Highlands' trauma burden and PICT's added value; with increased trauma response and improving outcomes. Despite the rate and ratio of major trauma not reducing PICT Team utilisation has, potentially led to fewer patients over narrower geography at later stages in emergency calls accessing the enhanced care doctor and advanced physician team than was achieved previously.

Alcohol free? An analysis of UK and Scottish Government obesity policies' engagement with alcohol 1999-2023.

BACKGROUND AND AIMS: Alcoholic beverages can be highly calorific yet remain largely absent from obesity policy debates. This article seeks to identify how Scottish and English obesity policies have engaged with the issue of alcohol consumption since devolution. METHODS: Obesity policy documents for England and Scotland from 1999 to 2023 were thematically analysed to identify their engagement with alcohol consumption. A stakeholder analysis was undertaken to identify key public health actors and commercial sector policy actors in the debate regarding the inclusion of alcohol in obesity policy. Their engagement with the issue of alcohol as an obesity policy issue was assessed through thematic analysis of consultation responses, along with documents, press releases, reports and other statements on policy (e.g. blog posts) available on stakeholder websites. RESULTS: While alcohol was recognised as a risk factor for obesity within obesity policy documents, no specific measures to address this issue were identified until a consultation on mandatory calorie labelling on alcoholic beverages was proposed in 2020. Engagement with alcohol in the policy documents was mainly limited to voluntary and self-regulatory measures favoured by industry actors who portrayed themselves as a key part of the policy solution. They used the policy focus on childhood obesity as a pretext to exclude alcoholic drink from fiscal and labelling measures. Public health NGOs, by contrast, argued that obesity measures such as mandatory calorie labelling and other obesity policies should be extended to alcoholic beverages. CONCLUSION: There is an insufficient engagement with alcohol as an obesity policy issue within policy documents and an over-reliance on voluntary and industry-partnership approaches. Alcoholic beverages and reduced alcohol products are excluded from beverage taxes and labelling requirements in ways which are hard to justify. As with other areas of public health policy, this represents an industry-favoured policy agenda, opposed by health NGOs. Further research is needed to understand the influence of these actors on the engagement of obesity policy with alcohol.

GIS-ODE: linking dynamic population models with GIS to predict pathogen vector abundance across a country under climate change scenarios.

Mechanistic mathematical models such as ordinary differential equations (ODEs) have a long history for their use in describing population dynamics and determining estimates of key parameters that summarize the potential growth or decline of a population over time. More recently, geographic information systems (GIS) have become important tools to provide a visual representation of statistically determined parameters and environmental features over space. Here, we combine these tools to form a 'GIS-ODE' approach to generate spatiotemporal maps predicting how projected changes in thermal climate may affect population densities and, uniquely, population dynamics of Ixodes ricinus, an important tick vector of several human pathogens. Assuming habitat and host densities are not greatly affected by climate warming, the GIS-ODE model predicted that, even under the lowest projected temperature increase, I. ricinus nymph densities could increase by 26-99% in Scotland, depending on the habitat and climate of the location. Our GIS-ODE model provides the vector-borne disease research community with a framework option to produce predictive, spatially explicit risk maps based on a mechanistic understanding of vector and vector-borne disease transmission dynamics.

Assessing real world vaccine effectiveness: A review of Scotland's approach to monitoring human papillomavirus (HPV) vaccine impact on HPV infection and cervical disease.

High-risk human papillomavirus (HPV) infections can progress to cervical cancer which is the fourth most common cancer in women globally. In Scotland, the incidence of cervical cancer has a strong socioeconomic deprivation gradient disproportionately affecting women from more deprived areas. An HPV vaccination programme was initiated in Scotland in 2008 targeting girls aged 12-13 years with a catch-up campaign running for the first three years for girls aged up to 18 years. The programme has evolved over the last 16 years with changes in the type of vaccine, dosing schedules and the extension of the programme to boys and gay, bisexual and other men who have sex with men. Vaccine uptake in Scotland has historically been high but has gradually decreased over time and disparities exist in women from more deprived areas of Scotland. The ability to link national immunisation and screening databases in Scotland has allowed direct monitoring of the impact of the HPV vaccine on virological and histological outcomes. Analyses of this linked data have demonstrated real-world evidence of high vaccine effectiveness against HPV infection, cervical disease, and cervical cancer with evidence of herd immunity in unvaccinated women. Continued monitoring is crucial to assess the duration of protection, the impact of vaccine and dosing schedules changes and the emergence of potential type replacement. With the World Health Organisation's aim to eliminate cervical cancer as a public health problem by the next century addressing the inequalities in cervical cancer incidence will be crucial. This will require targeted interventions for women most at risk of cervical cancer to ensure elimination is achieved timely for all women in Scotland.

Should We Defund the National Health Service?

Despite record investment in Scotland's National Health Service, ever-increasing numbers of people remain in hospital despite being clinically fit for discharge. This paper curiously explores two of the whole-system problems ensuring discharges are delayed and argues that greater investment in, and contractual changes to, social care commissioning is required to support more people to live their best lives in their own homes. A more creative perspective is required to ensure better outcomes for the population.

Awareness of radiation risks by medical students & referrers requesting radiological examinations in the North of Scotland: an audit.

INTRODUCTION: Radiological imaging has played an important role in diagnostic medicine for over a century, though it is known to contribute to dermatological conditions, cataracts, and cancer. The associated risk of harm has led to the introduction of protective regulations around the world. Present-day NHS clinicians are increasingly requesting and relying on diagnostic imaging. Knowledge surrounding the radiation doses of common radiological investigations and the associated risks is imperative, and on a global level has been found to be inadequate. Consequently, there is a need for the formal inclusion of teaching within training programmes. AIMS/OBJECTIVES: This prospective audit aims to establish the knowledge of radiation doses and risks of common radiological investigations of both medical students and referrers within four NHS Health Boards based in the North of Scotland. It also seeks to establish prior teaching and the preference for further educational interventions. AUDIT STANDARD: Referrers should have adequate knowledge of radiation doses and the risks associated with common radiological investigations. AUDIT TARGET: The standard should be achieved by 90% of referrers. METHODS: A 19-question online survey was devised to include subjective and objective questions on ionising radiation awareness, education preference, and respondent demographics, based on RCR (Royal College of Radiologists) audit criteria and previous studies. Data collection was conducted between the 22/02/23 to the 22/03/2023 and the questionnaire was distributed to senior medical students and radiological referrers of different grades within NHS Grampian, NHS Highland, NHS Shetland, and NHS Orkney. A descriptive analysis of the data was undertaken using Microsoft Excel Version 16.71. RESULTS: Two hundred eight questionnaires were completed. 22.11% (n = 46) of the sample population had received no prior teaching on the topic of ionising radiation. Over half of the respondents (51.92%, n = 108) rated the importance of radiation risks as either important or extremely important, with 69.71% (n = 145) of participants rating their perceived knowledge as limited or average. Most correctly identified that a CT scan (n = 203), PET-CT scan (n = 199) and a chest x-ray (n = 196) exposed patients to ionising radiation. A small proportion of the participants incorrectly thought that an MRI scan (n = 21) and an ultrasound scan (n = 2) involved ionising radiation. The results obtained failed to meet the RCR audit target, which states that 90% of doctors should be aware of common radiological doses. It was observed that only 17.79% (n = 37) of survey respondents scored over 50% in the knowledge assessment, with the median knowledge score of the whole cohort being 2.5 out of 9 (27.78%). Respondents who had prior teaching on the topic performed better those who had no prior teaching, with average scores of 3.19 (35.44%) and 2.04 (22.67%) respectively. Senior clinicians performed better when compared to junior clinicians and medical students. CONCLUSION & FUTURE RECOMMENDATIONS: This audit found that the knowledge of radiation risks within the North of Scotland in the selected sample population was insufficient across all levels of the clinical team. Further, continuous education around the topic and future audit opportunities may help to optimise knowledge and training.

Motivators and mechanisms for an international rural health collaboration.

Collaborations are critical to address rural health challenges. We evaluated a new international collaboration between institutions in Georgia, the United States (US), and Scotland, United Kingdom (UK), to address rural health issues and to understand the barriers and facilitators to effective international collaboration efforts. A qualitative approach was used through in-depth interviews and focus groups with educators, researchers, and healthcare providers in the US and Scotland who were involved in the CONVERGE international rural health collaboration. Transcriptions were imported into the NVivo qualitative software program. A reflexive thematic analysis was employed to identify key themes from the collected data. Twelve interviews and two focus groups were conducted virtually with 17 participants. Two primary domains were identified from the thematic analysis: (1) motivators that increase engagement in international collaboration, and (2) mechanisms for, and barriers to, the continuity needed to create meaningful change. Six themes emerged related to commonality of issues, prospect of sharing knowledge, need of sustained funding and institutional support, and selection of human resources. Participants of CONVERGE were more likely to engage when they had a space to share ways to address challenging issues and integrate knowledge and practice. They were motivated by their desire for growth and the institutions they serve and emphasized that infrastructure support is vital for sustainable collaborations.

Interfacing legitimacy - health and social care integration in Scotland.

As people, particularly those ageing and living with disabilities, struggle with how care is enacted, integrated care has gained policy purchase in the United Kingdom. Despite integration's apparent popularity, its contribution to improved care for people has been questioned, exposing uncertainties about its associated benefits. Nonetheless, over decades a remarkably consistent approach to integrated care has advanced partnerships between the NHS and local government. Accordingly, in 2014 the Scottish Government mandated Health and Social Care Integration (HSCI) via the Scottish Public Bodies (Joint Working) (Scotland) Act. Emerging from an interorganisational ethnography of the implementation of a Health and Social Care Partnership in 2016, in a place I call 'Kintra', I interrogated what happened when NHS Kintra and Kintra Council endeavoured to implement HSCI according to the precepts of 'the Act'. Immersed in the everyday arrangements in the spaces of governance, I attended to how these policy actors worked to both (re)configure and held things together behind care frontiers, and away from the bodywork of direct care. I charted their efforts to comply with regulations, plan, and build governance apparatuses through documents. In following documents, I show the ways in which HSCI was materialised through documentation. I reveal how, in the mundane mattering of document manufacturing, possibilities for (re)forming the carescape emerged. I deploy a posthuman practice stance to show not only the way in which 'papery' partnerships between the NHS and local government 'enact' care, but also how they make worlds through a sociomaterial politics of anticipation.

Diversity of Orbiniella (Orbiniidae, Annelida) in the North Atlantic and the Arctic.

In this work, the diversity of the genus Orbiniella in the Nordic Seas and the North Atlantic waters south of Iceland is studied based on the analyses of molecular markers (mitochondrial COI, 16S rDNA and nuclear ITS2) and morphological characters. Our results showed the presence of at least five genetic lineages in the studied material which could also be morphologically identified by their segmental annulation patterns, the number and the shape of acicular spines, and the length and the shape of pygidial lobes. The species name Orbiniellapetersenae is assigned to one of the lineages restricting its geographical and vertical distribution to the deep-sea areas north of Iceland and Jan Mayen, and three lineages are described as new species (i.e., Orbiniellagriegi Meca & Budaeva, sp. nov., Orbiniellamayhemi Meca & Budaeva, sp. nov., and Orbiniellaparapari Meca & Budaeva, sp. nov.) elevating the number of known species in the genus to 25. Three deep-sea species of Orbiniella in our study are reported only north of the Greenland-Iceland-Scotland Ridge, one deep-sea species found south of the ridge. A single shallow-water species is distributed along the ridge and on the Norwegian shelf.

Prevalence, demographic, socio-economic, and lifestyle factors associated with cigarette, e-cigarette, and dual use: evidence from the 2017-2021 Scottish Health Survey.

Understanding the correlation between demographic, socio-economic, and lifestyle factors with e-cigarette use, cigarette smoking, and dual use is essential for targeted public health interventions. This study examines the prevalence of these behaviors in Scotland and identifies the associated factors. We conducted a repeated cross-sectional analysis of the Scottish Health Survey data from 2017 to 2021, leveraging data from 12,644 participants aged 16 and older: 2271 cigarette smokers, 687 e-cigarette users, 428 dual users, and 9258 never users. Weighted prevalences were calculated by age group, sex, and survey year, followed by weighted multinomial logistic regression to explore associated factors. The overall prevalences were 72.0% (95% CI 70.9-73.1) for never users, 18.9% (95% CI 17.9-19.9) for cigarette smokers, 5.5% (95% CI 5.0-6.1) for e-cigarette users, and 3.6% (95% CI 3.2-4.0) for dual users. From 2017 to 2021, cigarette smoking declined from 21.7% (95% CI 19.6-23.9) to 13.1% (95% CI 11.5-15.0), e-cigarette use from 6.5% (95% CI 5.4-7.8) to 4.8% (95% CI 3.6-6.4), and dual use from 3.7% (95% CI 2.9-4.6) to 2.7% (95% CI 1.9-3.7). Age was a critical factor, with the 25-34 age group more likely to use e-cigarettes (p = 0.007) and the 35-44 age group more likely to engage in dual use (p = 0.006) compared to the 16-24 age group. Males had higher odds of e-cigarette use than females (p = 0.031). White individuals had higher odds of using e-cigarettes (p = 0.023) and being dual users (p = 0.017) compared to non-whites. Previously married individuals had higher odds of dual use than singles (p = 0.031). Larger household sizes were linked to reduced odds of all three behaviors (p = 0.001). Rural residents were less likely to use e-cigarettes compared to urban residents (p = 0.025). Higher education correlated with lower odds of all three behaviors (p = 0.001). Manual occupation increased the likelihood of dual use (p = 0.042). Lower income and higher deprivation significantly increased the odds of all three behaviors (p < 0.001). Excessive alcohol consumption was associated with increased odds of the three behaviors (p < 0.001). Poor sleep quality correlated with increased odds of dual use (p = 0.002) and cigarette smoking (p < 0.001). Adherence to physical activity guidelines was associated with reduced odds of all three behaviors (cigarette smoking p < 0.001, e-cigarette use p = 0.031, dual use p = 0.016). In conclusion, this study showed a decline in the prevalence of cigarette smoking, e-cigarette use, and dual usage from 2017 to 2021 in Scotland. Significant associations with demographic, socio-economic, and lifestyle factors highlight the need for targeted public health interventions.

Investigating local trawl fishing as a source of plastic beach litter.

This paper uses a particle tracking model to simulate the distribution of fishing-related marine-sourced plastic litter from demersal trawling activities along the Atlantic coast of Scotland. The modelled fishing litter dispersed widely across the region, with ∼50% of the particles beaching along the northwestern Scottish coast after a year-long simulation. The model was tuned using observations of beached litter loadings along the same coastline to estimate the annual input, by mass, of small (<1 kg) plastic litter. Model results suggest that between 107 g and 280 g of small fishing-related litter enters the ocean per hour of fishing, resulting in an estimated 234 t to 614 t of small fishing-related litter entering the ocean annually on the Scottish west coast. These results suggest that fishing on the Atlantic coast of Scotland may be a significant source of marine plastic. However, more modelled and observational data are required to reduce uncertainty.

Postpartum haemorrhage and risk of cardiovascular disease in later life: A population-based record linkage cohort study.

OBJECTIVE: To investigate the association between postpartum haemorrhage (PPH) and subsequent cardiovascular disease. DESIGN: Population-based retrospective cohort study, using record linkage between Aberdeen Maternity and Neonatal Databank (AMND) and Scottish healthcare data sets. SETTING: Grampian region, Scotland. POPULATION: A cohort of 70 904 women who gave birth after 24 weeks of gestation in the period 1986-2016. METHODS: We used extended Cox regression models to investigate the association between having had one or more occurrences of PPH in any (first or subsequent) births (exposure) and subsequent cardiovascular disease, adjusted for sociodemographic, medical, and pregnancy and birth-related factors. MAIN OUTCOME MEASURES: Cardiovascular disease identified from the prescription of selected cardiovascular medications, hospital discharge records or death from cardiovascular disease. RESULTS: In our cohort of 70 904 women (with 124 795 birth records), 25 177 women (36%) had at least one PPH. Compared with not having a PPH, having at least one PPH was associated with an increased risk of developing cardiovascular disease, as defined above, in the first year after birth (adjusted hazard ratio, aHR 1.96; 95% confidence interval, 95% CI 1.51-2.53; p < 0.001). The association was attenuated over time, but strong evidence of increased risk remained at 2-5 years (aHR 1.19, 95% CI 1.11-1.30, P < 0.001) and at 6-15 years after giving birth (aHR 1.17, 95% CI 1.05-1.30, p = 0.005). CONCLUSIONS: Compared with women who have never had a PPH, women who have had at least one episode of PPH are twice as likely to develop cardiovascular disease in the first year after birth, and some increased risk persists for up to 15 years.

Antidepressant and antipsychotic prescribing in patients with type 2 diabetes in Scotland: A time-trend analysis from 2004 to 2021.

AIMS: Prescribing of antidepressant and antipsychotic drugs in general populations has increased in the United Kingdom, but prescribing trends in people with type 2 diabetes (T2D) have not previously been investigated. The aim of this study was to describe time trends in annual prevalence of antidepressant and antipsychotic drug prescribing in adult patients with T2D. METHODS: We conducted repeated annual cross-sectional analysesof a population-based diabetes registry with 99% coverage, derived from primary and secondary care data in Scotland, from 2004 to 2021. For each cross-sectional calendar year time period, we calculated the prevalence of antidepressant and antipsychotic drug prescribing, overall and by sociodemographic characteristics and drug subtype. RESULTS: The number of patients with a T2D diagnosis in Scotland increased from 161 915 in 2004 to 309 288 in 2021. Prevalence of antidepressant and antipsychotic prescribing in patients with T2D increased markedly between 2004 and 2021 (from 20.0 per 100 person-years to 33.3 per 100 person-years and from 2.8 per 100 person-years to 4.7 per 100 person-years, respectively). We observed this pattern for all drug subtypes except for first-generation antipsychotics, prescribing of which remained largely stable. The degree of increase, as well as the overall prevalence of prescribing, differed by age, sex, socioeconomic status and subtype of drug class. CONCLUSIONS: There has been a marked increase in the prevalence of antidepressant and antipsychotic prescribing in patients with T2D in Scotland. Further research should identify the reasons for this increase, including indication for use and the extent to which this reflects increases in incident prescribing rather than increased duration.

How do we conduct a national transfusion related lookback program?

BACKGROUND: Lookback investigations are conducted by blood services when a risk of transmission of infection from a donor to a recipient has been identified. They involve tracing transfusion recipients and offering them testing for the relevant infectious agent. Results are relayed to the recipient to provide reassurance that there has been no transmission or to ensure appropriate treatment and care if required, and blood services are able to learn lessons from the planning, delivery, and outcomes of the investigation. A national lookback exercise was conducted in Scotland following the introduction of a test to identify occult hepatitis B infection, as recommended by the UK Advisory Committee for the Safety of Blood, Tissues and Organs (SaBTO) in 2021. METHODS AND MATERIALS: This paper outlines the development and delivery of a national lookback program. It discusses the logistical, economic, ethical, regulatory, and scientific issues that were considered during the planning and delivery of the lookback exercise. RESULTS: Development and delivery of a national lookback required robust governance, engagement of all relevant stakeholders and a shared understanding of aims, effective communication, systems, resources, limitations, and project management. Outcomes included a high testing uptake, low levels of reported anxiety, and a comprehensive data set. CONCLUSION: Key aspects for delivery of a successful large-scale lookback program include a patient-centered approach, clear and accessible communication, and whole-systems multiagency collaboration. Major challenges include stakeholder engagement and capacity.

Using digital technology to reduce drug-related harms: a targeted service users' perspective of the Digital Lifelines Scotland programme.

BACKGROUND: Deaths due to drug overdose are an international issue, causing an estimated 128,000 global deaths in 2019. Scotland has the highest rate of drug-related deaths in Europe, with those in the most deprived areas at greater risk than those in affluent areas. There is a paucity of research on digital solutions, particularly from the perspective of those who use drugs who additionally access harm reduction and homelessness support services. The Digital Lifelines Scotland programme (DLS) provides vulnerable people who use/d drugs with digital devices to connect with services. METHODS: This paper reports on the evaluation of the DLS from the perspective of service users who accessed services for those at risk of drug-related harms. A mixed methods approach was used including an online-survey (n = 19) and semi-structured interviews (n = 21). Survey data were analysed descriptively and interview data through inductive coding, informed by the Technology, People, Organisations and Macroenvironmental factors (TPOM) framework, to investigate the use, access, and availability of devices, and people's experiences and perceptions of them. RESULTS: Most participants lived in social/council housing (63.2%, n = 12), many lived alone (68.4%, n = 13). They were mainly over 40 years old and lived in a city. Participants described a desire for data privacy, knowledge, and education, and placed a nascent social and personal value on digital devices. Participants pointed to the person-centred individuality of the service provision as one of the reasons to routinely engage with services. Service users experienced an increased sense of value and there was a palpable sense of community, connection and belonging developed through the programme, including interaction with services and devices. CONCLUSIONS: This paper presents a unique perspective which documents the experiences of service users on the DLS. Participants illustrated a desire for life improvement and a collective and individual feeling of responsibility towards themselves and digital devices. Digital inclusion has the potential to provide avenues by which service users can safely and constructively access services and society to improve outcomes. This paper provides a foundation to further cultivate the insight of service users on digital solutions in this emerging area.

Red and Red Processed Meat Consumption Behaviors in Scottish Adults.

In 2021, 32% of adult meat consumers in Scotland exceeded the 70 g/d recommended limit of red and red processed meat (RPM) intake. We analyzed RPM consumption behaviors among adults in the Scottish Health Survey (2021) to better understand this consumer group. Consumers were categorized into low, medium, and high consumers, and overall, mean intake was 66 g/d. Males and individuals living in the most deprived areas were most likely to be high consumers (45% compared with 30% for males compared with females, respectively, and 44% compared with 32% for those in the most compared with least deprived areas, respectively). Dinners accounted for the majority of intake among high (55%) and medium (52%) consumers, whereas low consumers distributed intake between lunch (40%) and dinner (48%). Across all groups, consumption was highest on Sundays, and majority of RPM was purchased at supermarkets. Beef dishes and sandwiches were primary contributors among high and medium consumers. These insights can inform the design of effective strategies and policies aligned with meat reduction targets. For instance, strategies focusing on modifying traditional meat-centric dishes and sandwiches could be impactful.

Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the Scottish primary care setting: a population-based segmented interrupted time-series analysis.

BACKGROUND: Inappropriate use of antibiotics is expected to increase during the COVID-19 pandemic, but there are limited data on COVID-19's long-term impact. We assessed the impact of COVID-19 on the quantity and quality of antibiotic use in Scotland. RESEARCH DESIGN AND METHODS: A segmented interrupted time series was applied to monthly dispensed antibiotics using prescription cost analysis data from March/2019 to March/2023. Antibiotic use was quantified using the number of items dispensed/1000 inhabitants (TIDs) and defined daily dose/1000 inhabitants/day (DIDs). The quality of antibiotic use was assessed using key quality indicators including the WHO AWaRe classification, proportion of broad-spectrum and "4C"-antibiotics. RESULTS: Overall, for all antibiotics, there was a non-significant increase in TIDs and DIDs before the first lockdown (March/2020) (ß1), but a decline in the level immediately after the first (ß2) and second lockdowns (ß4) (November/2020), albeit non-significant. However, a significant increase in the time trend after the second lockdown (ß5) for all antibiotic classes was observed. COVID-19 had no negative impact on AWaRe utilisation, with the proportion of all antibiotics from the Access group increasing from 76% in March/2019 to 90% in March/2023. The proportion of "4C" antibiotic reduced significantly after the second lockdown. CONCLUSIONS: Neither the utilisation nor the quality of total antibiotic use appeared to have been significantly affected by COVID-19.

The Impact of Hospital Transfers on Surgical Delay and Associated Postoperative Outcomes for Hip Fracture Patients in Scotland: A Cohort Study.

Background/Objectives: Hip fractures exert a substantial burden on hospital systems. Within Scotland 20% of the population resides rurally, warranting investigation of how this impacts prompt access to surgical care. This study aims to determine whether indirect hospital admission via hospital transfer affects the likelihood of surgical management within 36 h for hip fracture patients. Methods: A retrospective cohort study was performed. This used Scottish Hip Fracture Audit data including patients aged ≥50 split into two propensity matched groups based on their transfer status. Descriptive analysis compared patient characteristics. Regression assessed achieving surgery within 36 h of admission in the unmatched and matched cohorts. Secondary outcomes included time to surgery, mortality, mobilization, returning to residence and length of stay. A sensitivity analysis was undertaken to assess for residual confounding effects. Results: The unmatched analysis included 20,132 patients. Transfer patients were younger (p = 0.007) and less-comorbid (p < 0.001). In the matched population, 711 (63.6%) transfer patients had surgery with 36 h of presentation to hospital, compared to 852 (75.3%) non-transfer patients. Transfer patients had 43% reduced odds of timely surgery (OR (95% CI) 0.57 (0.48 to 0.69); p < 0.001). No disparities emerged in mortality, mobilisation or returning to residence., Transfer patients experienced a significant increase in length of stay in hospital (median (IQR) 16 (8 to 33) vs. 13 (8 to 30); p = 0.024). Conclusions: Hospital transfer is associated with significantly reduced odds of timely surgery, a longer time to surgery and longer length of stay. Development of structured network pathways that minimize delay to transfer are required to potentially optimize outcomes and reduce associated cost.

Who We Test For: Aligning Relational and Public Health Responsibilities in COVID-19 Testing in Scotland.

COVID-19 testing programs in the UK often called on people to test to "protect others." In this article we explore motivations to test and the relationships to "others" involved in an asymptomatic testing program at a Scottish university. We show that participants engaged with testing as a relational technology, through which they navigated multiple overlapping responsibilities to kin, colleagues, flatmates, strangers, and to more diffuse publics. We argue that the success of testing as a technique of governance depends not only on the production of disciplined selves, but also on the program's capacity to align interpersonal and public scales of responsibility.

Blood-based epigenome-wide analyses of chronic low-grade inflammation across diverse population cohorts.

Chronic inflammation is a hallmark of age-related disease states. The effectiveness of inflammatory proteins including C-reactive protein (CRP) in assessing long-term inflammation is hindered by their phasic nature. DNA methylation (DNAm) signatures of CRP may act as more reliable markers of chronic inflammation. We show that inter-individual differences in DNAm capture 50% of the variance in circulating CRP (N = 17,936, Generation Scotland). We develop a series of DNAm predictors of CRP using state-of-the-art algorithms. An elastic-net-regression-based predictor outperformed competing methods and explained 18% of phenotypic variance in the Lothian Birth Cohort of 1936 (LBC1936) cohort, doubling that of existing DNAm predictors. DNAm predictors performed comparably in four additional test cohorts (Avon Longitudinal Study of Parents and Children, Health for Life in Singapore, Southall and Brent Revisited, and LBC1921), including for individuals of diverse genetic ancestry and different age groups. The best-performing predictor surpassed assay-measured CRP and a genetic score in its associations with 26 health outcomes. Our findings forge new avenues for assessing chronic low-grade inflammation in diverse populations.