Addressing the overuse of hospital emergency departments in the Portuguese NHS: a new paradigm.

The escalating trend of inappropriate visits to Emergency Departments (ED) has led to significant concerns, including resource misallocation, compromised patient care, and an increased burden on healthcare workers. Portugal faces a notable challenge, reporting one of the highest ED visit rates, with an annual average of approximately 6 million ED visits from 2013 to 2023. In response, the "Call First, Save Lives" pilot project was launched by the Portuguese NHS Executive Board, in 2023, at the Local Health Unit (LHU) of Póvoa de Varzim/Vila do Conde.

Do Child-Turcotte-Pugh and nutritional assessments predict survival in cirrhosis: A longitudinal study.

Background: Cirrhotic patients face heightened energy demands, leading to rapid glycogen depletion, protein degradation, oxidative stress, and inflammation, which drive disease progression and complications. These disruptions cause cellular damage and parenchymal changes, resulting in vascular alterations, portal hypertension, and liver dysfunction, significantly affecting patient prognosis.

Aim: To analyze the association between Child-Turcotte-Pugh (CTP) scores and different nutritional indicators with survival in a 15-year follow-up cohort.

The sociolinguistic foundations of language modeling.

In this article, we introduce a sociolinguistic perspective on language modeling. We claim that language models in general are inherently modeling , and we consider how this insight can inform the development and deployment of language models. We begin by presenting a technical definition of the concept of a variety of language as developed in sociolinguistics.

Experiences and overall impact reported by people living with obesity: results from a multinational study.

Objectives: To explore the impact of obesity on clinical outcomes, health-related quality of life, emotional well-being, and work productivity in people/patients with obesity across six countries by body mass index and the presence of complications.

Methods: Adelphi Real World Obesity Disease Specific Programme™ captured data related to physicians and their consulting people/patients with obesity on a weight management program or anti-obesity medication in Brazil, Canada, China, Japan, Kingdom of Saudi Arabia, and the United Arab Emirates from April to December 2022. Physicians reported data for up to eight qualifying people/patients with obesity.

Understanding trends in osteoporosis drug prescribing: implications for reducing futile biomedical research.

Introduction: Osteoporosis is a significant geriatric condition, considering its impact on fracture-related morbidity and mortality, particularly among older women. The interplay of clinical evidence, diagnostic tools availability, and broader societal attitudes toward aging and treatment efficacy affect medical attitude and prescribing behaviors. Using the example of osteoporosis in France and England, the study aims to unravel the intricacies of medical decision-making in geriatric care, offering insights into the evolving landscape of healthcare policy and practice, which in turn can help reduce futile biomedical research.

Cleft Lip and Palate Research in the United Kingdom: Advances in Clinical Psychological Knowledge and Future Directions.

In 2012, the James Lind Alliance (JLA) worked with individuals with cleft lip and/or palate (CL/P), their families and clinicians to identify priority areas for future research. This article reviews progress conducted in the United Kingdom in the 3 JLA priorities most closely related to Clinical Psychology. It then builds upon the original priorities to identify 4 future directions, based on contemporary literature and in-depth discussions between clinical and research experts.

The Public Mental Health Framework: thinking about law as preventive medicine.

Health, mental health, and well-being are not 'natural' but are shaped by social and environmental factors. This article aims to reorient the development of all laws and policies to do more to prevent mental ill-health and promote well-being as a core function of the contemporary state. It introduces a new conceptual and empirical model, the Public Mental Health Framework, based on three areas of research: (i) the social determinants of health and mental health, which include social structures and daily living conditions (such as poverty, inequality, education, employment, discrimination, adverse childhood experiences, and crime); (ii) health and human rights; and (iii) the intermediate social model of disability.

Evaluating the impact, implementation experience and political economy of primary care networks in Kenya: protocol for a mixed methods study.

Background: Primary care networks (PCNs) are increasingly being adopted in low- and middle-income countries (LMICs) to improve the delivery of primary health care (PHC). Kenya has identified PCNs as a key reform to strengthen PHC delivery and has passed a law to guide its implementation. PCNs were piloted in two counties in Kenya in 2020 and implemented nationally in October 2023.

Childhood body size, adulthood adiposity, underlying mechanisms, and risk of incident hypertension: a prospective cohort study of 180,527 participants.

Background: Mechanisms underlying the association of life-course adiposity with incident hypertension in adulthood have not been comprehensively investigated. In this study, we aimed to investigate the potential biochemical and metabolomic mechanisms underlying the association between adiposity and incident hypertension.

Methods: A total of 180,527 participants from the UK Biobank aged 37 to 73 years were included.

New job, new habits? A multilevel interrupted time series analysis of changes in diet, physical activity and sleep among young adults starting work for the first time.

Background: The workplace is an important determinant of health that people are exposed to for the first-time during adolescence or early adulthood. This study investigates how diet, physical activity, and sleep change as people aged 16-30 years transition into work and whether this varies for different individuals and job types.

Methods: Multilevel linear regression models assessed changes in fruit and vegetable intake, sleep duration, and physical activity among 3,302 UK Household Longitudinal Study (UKHLS) participants aged 16-30 years, who started work for the first time between 2015 and 2023.

Exploring variation in the six-month review for stroke survivors: a national survey of current practice in England.

Background: The Six-Month Review (6MR) was introduced in the United Kingdom to provide a holistic, systematic review of the ongoing needs faced by stroke survivors. However, a theoretical underpinning regarding how it should work is lacking, potentially leading to wide variation in service provision. This study aimed to understand the current degree of variation in 6MR delivery across England and explore the potential driving factors.

Identifying households with children who have complex needs: a segmentation model for integrated care systems.

Background: Adversity in childhood is increasing in the United Kingdom. Complex health and social problems affecting children cluster in families where adults also have high need, but services are rarely aligned to support the whole family. Household level segmentation can help identify households most needing integrated support.

Decision-making regarding place of end-of-life care for children with life-limiting and life-threatening conditions: a systematic integrative review.

Background: Due to medical advancements the number of children living with life-limiting and life-threatening conditions is rising, meaning more children and their families will require palliative and end-of-life care in the future. While 'home' is often the preferred place of end-of-life care, the evidence around best practice for decision-making about place of end-of-life care remains inadequate.

Aim: To synthesise evidence on the factors influencing decision-making regarding place of end-of-life care for children with life-limiting and life-threatening conditions.

The obesity paradox in osteoporosis risk among older adults is mostly driven by women: a population-based prospective study.

Objectives: The obesity paradox is common among older adults at risk for various diseases. Although this paradox has also been observed in the association between obesity and osteoporosis, the available evidence remains controversial. This study aimed to investigate the association between obesity and OP risk in an older population.

Preserved ratio impaired spirometry, airflow obstruction, and their trajectories in relationship to chronic kidney disease: a prospective cohort study.

Spirometry findings, such as restrictive spirometry and airflow obstruction, are associated with renal outcomes. Effects of spirometry findings such as preserved ratio impaired spirometry (PRISm) and its trajectories on renal outcomes are unclear. This study aimed to investigate the impact of baseline and trajectories of spirometry findings on future chronic kidney disease (CKD) events.

NIRS-BIDS: Brain Imaging Data Structure Extended to Near-Infrared Spectroscopy.

Functional near-infrared spectroscopy (fNIRS) is an increasingly popular neuroimaging technique that measures cortical hemodynamic activity in a non-invasive and portable fashion. Although the fNIRS community has been successful in disseminating open-source processing tools and a standard file format (SNIRF), reproducible research and sharing of fNIRS data amongst researchers has been hindered by a lack of standards and clarity over how study data should be organized and stored. This problem is not new in neuroimaging, and it became evident years ago with the proliferation of publicly available neuroimaging datasets.

Patients with neurological or psychiatric complications of COVID-19 have worse long-term functional outcomes: COVID-CNS-A multicentre case-control study.

It is established that patients hospitalised with COVID-19 often have ongoing morbidity affecting activity of daily living (ADL), employment, and mental health. However, little is known about the relative outcomes in patients with COVID-19 neurological or psychiatric complications. We conducted a UK multicentre case-control study of patients hospitalised with COVID-19 (controls) and those who developed COVID-19 associated acute neurological or psychiatric complications (cases).

Phosphorylation-dependent WRN-RPA interaction promotes recovery of stalled forks at secondary DNA structure.

The WRN protein is vital for managing perturbed replication forks. Replication Protein A strongly enhances WRN helicase activity in specific in vitro assays. However, the in vivo significance of RPA binding to WRN has largely remained unexplored.

Splicing accuracy varies across human introns, tissues, age and disease.

Alternative splicing impacts most multi-exonic human genes. Inaccuracies during this process may have an important role in ageing and disease. Here, we investigate splicing accuracy using RNA-sequencing data from >14k control samples and 40 human body sites, focusing on split reads partially mapping to known transcripts in annotation.

Patterns, timing and predictors of recurrence following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: an international multicentre retrospective cohort study.

Background: Most patients undergoing pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) develop recurrence. No previous studies have investigated predictors of local-only recurrence following PD for PDAC. Our study aimed to determine timing, pattern and predictors of any-site and local-only recurrence following PD for PDAC.

The Soundtrack of a Clinic Day.

There is a hum and drum to the clinical day, sounds and rhythms that pervade physician and patient's soundscape. We hear but we do not listen. The soundtrack of the daily grind is experienced as an audio blanket of white noise.

Do final-year medical students in Scotland have the knowledge and confidence to deliver the physical activity guidelines? A cross-sectional online survey to evaluate changes over a decade.

Objectives: This study assessed knowledge of physical activity (PA) guidelines and confidence to deliver PA advice, across current final-year medical students in Scotland. This follows a 2013 survey finding that this cohort lacked this knowledge and confidence; thus, authors recommended improvements to undergraduate medical PA education and re-evaluation of these measures thereafter.

Design: A cross-sectional online survey.

Exploring the Use of Smartwatches and Activity Trackers for Health-Related Purposes for Children Aged 5 to 11 years: Systematic Review.

Background:  Digital health interventions targeting behavior change are promising in adults and adolescents; however, less attention has been given to younger children. The proliferation of wearables, such as smartwatches and activity trackers, that support the collection of and reflection on personal health data highlights an opportunity to consider novel approaches to supporting health in young children (aged 5-11 y).

Objective:  This review aims to investigate how smartwatches and activity trackers have been used across child health interventions (for children aged 5-11 y) for different health areas, specifically to identify the population characteristics of those being targeted, describe the characteristics of the devices being used, and report the feasibility and acceptability of these devices for health-related applications with children.

How to: share and reuse data - challenges and solutions from PrIMAVeRa project.

Background: Data sharing accelerates scientific progress and improves evidence quality. Even though journals and funding institutions require investigators to share data, only a small part of studies made their data publicly available upon publication. The procedures necessary to share retrospective data for re-use in secondary data analysis projects can be cumbersome.