Abdominal aortic aneurysm (AAA) is less common in women than in men; however, when present, women appear to follow a more aggressive disease course, rupturing at smaller diameters and experiencing worse operative outcomes. The United Kingdom provides a unique environment in which to evaluate sex-specific outcomes, as national screening invitations are extended to men only and National Institute for Health and Care Excellence guidance applies a uniform 5.5 cm threshold for elective repair irrespective of sex. A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. MEDLINE, EMBASE, and the Cochrane Library were searched to September 2025. Eligible studies reported sex-stratified outcomes for AAA in the United Kingdom. Gray literature was included through review of the National Vascular Registry, National Health Service AAA Screening Program reports, and National Institute for Health and Care Excellence guidance. Where sex-stratified numerators and denominators were available, crude odds ratios (ORs) were calculated and pooled using Der Simonian-Laird random-effects models. A separate adjusted-effects meta-analysis was performed using the generic inverse-variance method for studies reporting multivariable-adjusted ORs (adjORs). Five peer-reviewed studies met inclusion, supported by national reports. Women had significantly higher perioperative mortality after elective endovascular repair (pooled OR 1.61, 95% confidence interval [CI] 1.31-1.97) and elective open repair (pooled OR 1.37, 95% CI 1.16-1.63). After ruptured repair, mortality was similar between sexes following endovascular aneurysm repair (EVAR) (pooled OR 1.11, 95% CI 0.89-1.39), but higher in women after open surgery (pooled OR 1.53, 95% CI 1.24-1.89), although with substantial heterogeneity. Adjusted-effects synthesis confirmed higher mortality for women after elective EVAR (summary adjOR ≈1.55, 95% CI 1.25-1.80) and open repair (adjOR 1.39, 95% CI 1.25-1.56). Women were less likely to undergo surgery following rupture, more likely to be readmitted after elective EVAR, had longer hospital stays, and higher long-term aortic-related mortality. Women with AAA in the United Kingdom remain disadvantaged at every stage of care: they are less likely to be screened, rupture at smaller diameters, less often selected for repair, and when treated, face higher perioperative and long-term mortality. These disparities reflect a combination of anatomical and biomechanical differences, together with systemic factors. Current UK policy, based on male-only screening and a sex-neutral 5.5 cm threshold, does not reflect this reality. Sex-specific thresholds for repair, targeted female screening, and the development of devices optimized for female anatomy are needed to address inequity.

Nirsevimab, a long-acting monoclonal antibody against respiratory syncytial virus (RSV), was recently introduced in Catalonia (Spain, 2023-2024 season onwards) and Italy (2024-2025 season). The United Kingdom (UK) instead introduced maternal RSV vaccination (RSVpreF) in the 2024-2025 season. Our aim was to analyse emergency department (ED) attendances and admissions to hospital following RSVpreF and nirsevimab introduction, with hospitals in Iceland and Romania, where no intervention was introduced, used as comparators. Multi-national retrospective analysis of ED attendances and admissions for all diagnoses, respiratory diagnoses excluding bronchiolitis, and bronchiolitis from all hospitals in Catalonia (Spain), four UK hospitals (Bristol, Edinburgh, Glasgow, and Leicester), and one hospital in Italy (Rome), Romania (Bucharest), and Iceland (Reykjavík) from April 2018 to March 2025. Bronchiolitis diagnoses in the 2024-2025 season were compared to previous pre-intervention seasons (2018-2023, excluding the 2020-2021 COVID-19 year) by applying a generalised linear model in Poisson regression to obtain risk ratios (RR) and 95% confidence intervals (95% CI). In the 2024-2025 season, in Catalonia, there was a reduction in the RR for bronchiolitis ED attendances and admissions in infants of age <6 months (RR 0.45; 95% CI 0.43-0.47 and RR 0.40; 95% CI 0.37-0.43, respectively). This was not seen in Rome, where the RR for ED attendances with bronchiolitis in infants of age <6 months was 1.09 (95% CI 0.92-1.30) and the RR for admissions was 1.12 (95% CI 0.83-1.52). In the UK, for infants of age <6 months with bronchiolitis, there was a significant but modest reduction in 1 out of 4 hospitals for ED attendances (Leicester; RR 0.91, 95% CI 0.85-0.97) and in 2 out of 4 hospitals for admissions (Leicester; RR 0.80, 95% CI 0.69-0.94 and Edinburgh; RR 0.85, 95% CI 0.76-0.95). In Catalonia, there was a sustained reduction in bronchiolitis ED attendances and admissions for infants in the 2024-2025 season. However, no substantial reduction in bronchiolitis ED attendances or admissions was observed in Rome or the UK. These differences are likely to relate to the reduced uptake of RSV prevention products in these settings compared to Catalonia. None.

Recurrent urinary tract infection (rUTI) is common, debilitating, and associated with substantial negative impact on quality of life. Despite this, rUTI healthcare is often experienced as fragmented, dismissive, and poorly aligned with patient needs. Applying behavioural science theory to systematically identify modifiable intervention targets offers a promising but unexplored approach to improving rUTI care. To explore patient experiences of rUTI healthcare in the United Kingdom, identify barriers to and facilitators of quality care, and generate theory-informed targets for behaviour-change intervention and service improvement. Qualitative interview study using reflexive thematic analysis, followed by deductive mapping of themes to the Theoretical Domains Framework (TDF), Behaviour Change Technique Taxonomy (BCTT), and Behaviour Change Intervention Ontology (BCIO). Semi-structured one-to-one interviews with 26 adults living with rUTI in the United Kingdom, with the interview schedule informed by the TDF. Four barrier themes revealed systematic challenges: 'Struggling with the System,' 'Unheard Voices,' 'Shouldering Blame' and 'Forced to Become an Expert.' Together, these captured how diagnostic limitations, fragmented services, clinical dismissal, and individualised blame compel people living with rUTI into self-advocacy experienced as exhausting. Four facilitator themes demonstrated that quality care is achievable: 'Feeling Validated,' 'Partners in the Puzzle,' 'Continuity and Connection' and 'Expanding the Toolkit.' All 14 TDF domains were implicated, most frequently 'social influences,' 'beliefs about consequences,' 'environmental context and resources' and 'knowledge,' indicating improvement requires both system restructuring and interpersonal skill development. Mapping to the BCTT and BCIO identified specific intervention techniques targeting these domains. People living with rUTI face structural and relational challenges in healthcare that compound illness burden. When individuals feel believed, involved, and supported, rUTI healthcare experiences are transformed. By integrating reflexive thematic analysis with behavioural theory, this study demonstrates that improving rUTI care requires attention to both system-level factors such as diagnostic flexibility, service continuity, and treatment options, alongside relational factors, particularly validation and shared decision-making. These findings provide a theoretically grounded foundation for intervention development, with broader relevance for chronic conditions characterised by diagnostic uncertainty.

Child sexual exploitation and abuse (CSEA) is prevalent worldwide. Yet, knowledge about potential perpetrators in the community is constrained by reliance on justice-involved and clinical samples, which limits external validity and obscures undetected behaviour. This study estimates population-level prevalence, demographic correlates, and co-endorsement patterns of men's self-reported sexual feelings, interests, and behaviours towards children. We analyse an anonymous online survey of 4,918 adult men quota-matched and weighted to national populations in Australia, the United Kingdom, and the United States. In pooled analyses, 8.0% reported sexual feelings towards children, 7.4% would likely have sexual contact with a child if undetected, 5.5% to 5.7% would watch child sexual abuse material or a webcam show, and 2.4% to 4.7% reporting engagement in online or contact offending. Prevalence estimates were consistently higher in the United States than in Australia and the United Kingdom. Age distributions generally showed peaks in early adulthood with subsequent decline, alongside later-life upticks for selected outcomes. Sociodemographic indicators linked to trust or access (higher income, being partnered, employment, university education, children in the household, and working with children) were consistently associated with multiple outcomes, with the largest effect sizes for men who live or work with children. Overlap analyses and a nodewise LASSO-based Ising network indicated coherent clusters (online behaviours, contact behaviour, and interest) with strong within-cluster and bridging connections. Findings support tiered prevention that distinguishes interest from behaviour, age-responsive strategies, and strengthened safeguards for child-contact roles, while providing cross-national baselines to inform surveillance, resource allocation, and targeted intervention.

Assessing public health training in Southeast Asia and the United Kingdom: A comparison of competency development for delivering the Essential Public Health Functions.

Mobile technologies have become key tools to promote physical activity and reduce sedentary behavior among office workers. While workplaces serve as ideal settings for implementing such interventions, bibliometric analyses of the growing literature evaluating their effectiveness remain limited. The aim of this bibliometric analysis was to examine trends in research productivity and impact of m-health within workplace-related literature. Six databases including Web of Science, Scopus, Ovid Medline, Cochrane Central, Cumulative Index of Nursing and Allied Health Library, and Embase were searched for the studies that have explored the m-health interventions to promote physical activity and reduce sedentary behavior among office workers on February 12, 2024. The studies were downloaded as BibTex files and analyzed for productivity, citation impact, and intellectual structure (conceptual and social structural) using Biblioshiny, Bibliometrix software. In total, 113 studies were identified with 10% of studies published in JMIR mHealth and uHealth and BMC Public Health. Mair JL, 2022 was found to be a significant contributor to the evidence. Australia, the United Kingdom, and the United States continue to dominate the contributions. M-health, obesity, physical activity, and validity were among the most frequently used terms, whereas digital health, development, and adherence remain underrepresented in the literature. Research on m-health to promote physical activity and reduce sedentary behavior among office workers is growing, predominantly in high-income countries. However, interdisciplinary collaboration and studies integrating behavioral science, primary care, digital development, and end-user acceptability remain limited and are urgently needed.

Smokers quitting successfully with the help of e-cigarettes often continue vaping. It is not known whether this promotes or prevents relapse back to smoking. This study aimed to determine whether use of e-cigarettes after successful smoking cessation affects the probability of relapse later on. Secondary analysis of a randomised controlled trial where participants received combination nicotine replacement therapy (NRT) or e-cigarettes to compare relapse rates in the two study arms and in abstainers who did and did not use e-cigarettes. Four stop-smoking services in the United Kingdom. 886 smokers (median age 41, smoking on average 15 cigarettes per day, 48% female) seeking help with stopping smoking. Main outcome was relapse to smoking by 12 months in participants who were abstinent at 4 weeks or at 6months. Relapse was defined as abstinence at 4weeks but not at one year or abstinence at 6months but not at one year. Abstinence from smoking was defined as no smoking over the past 7days. E-cigarette use was defined as using e-cigarettes at the time of abstinence on at least one day per week. Abstainers in the e-cigarette arm were less likely to relapse than abstainers in the NRT arm [relative risk (RR) =0.78, 95% confidence interval (CI) = 0.64-0.96 for relapse between 4weeks and 1year; RR =0.71, 95% CI = 0.55-0.93 for relapse between 6months and 1year). Relapse rates over both time periods were also lower in abstainers who used e-cigarettes compared with abstainers who did not use e-cigarettes (RR =0.79, 95% CI = 0.65-0.97 and RR =0.75, 95% CI = 0.57-0.98, respectively). Use of e-cigarettes after stopping smoking is associated with a reduced risk of relapse.

Research on technology-facilitated child sex offenders outside of forensic and clinical samples is scarce but necessary to inform prevention, early intervention, and investigation. This article describes and compares the demographic characteristics and internet use habits of technology-facilitated child sex offenders sourced from three quota-based samples comparable to the Australian (n = 1,945), U.S. (n = 1,473), and U.K. (n = 1,506) adult male population. The odds (99% CI) of technology-facilitated child sex offending, relative to non-offenders, were calculated for demographic factors (e.g. age, sexual orientation, and number of children in household), hours per day spent online, frequency of engagement in common online behaviours (e.g. sending emails, online messaging, and private video chatting), use of social media platforms (e.g. Facebook, Twitter, and Snapchat), online pornography viewership, and use of privacy software (e.g. The Onion Router [TOR], Telegram, and Element). Logistic regression analysis adjusted for age, educational attainment, household income, and residential location were conducted separately for each sample, with effect sizes formally compared between countries. The study identified significantly higher rates of technology-facilitated offending against children in the United States (10.9%) compared to Australia (7.5%) and United Kingdom (7.0%). Online offenders were between 2 and 3.7 times more likely to work with children and, depending on the jurisdiction, were significantly more likely to be employed, married/living with a partner, have a bachelor's degree or higher, and live with a child. Across all jurisdictions, technology-facilitated offenders were significantly more sexually active online, including paying for sexual services and content, visiting romance and dating websites, and viewing violent or animal pornography. The article considers the implications of these findings for prevention, early intervention, and more effective detection of technology-facilitated offending, including the role of internet regulation and the financial sector in online child protection.

Towards farm-level net-zero greenhouse gas emissions: Contributions of climate mitigation actions - A study of four European crop and dairy farms.

Multimorbidity and suicidality among military veterans: a scoping review.

Social psychology has long claimed neutrality in its explanations of collective behaviour, yet its foundational theories of crowds have repeatedly been co-produced with institutions of authority and mobilized in the reactionary governance of social order. This article challenges the discipline's familiar origin myth-centred on benign laboratory demonstrations of social influence-by re-situating crowd psychology as one of social psychology's earliest and most politically consequential points of emergence. From nineteenth-century crowd theory, through mid-twentieth-century de-individuation research, to contemporary public-order doctrine, assumptions about the inherent irrationality and danger of collective action have been repeatedly reformulated in scientific form, their persistence reflecting institutional and ideological fit rather than explanatory adequacy. Against this background, the article repositions the Social Identity Approach and the Elaborated Social Identity Model (ESIM) not merely as theoretical corrections, but as a reorientation of how psychological knowledge is produced, authorized and used. Drawing on ethnographic participatory action research and sustained engagement with policing institutions in the United Kingdom, Europe, and the United States, it conceptualizes collective behaviour as interactional and normatively organized, with policing practices constitutive of crowd dynamics rather than external to them. The article argues that co-production is not a methodological innovation but a historically persistent condition of social psychology and that the ESIM represents a distinctive attempt to govern this condition reflexively by redirecting psychological knowledge towards legitimacy, restraint and the facilitation of democratic rights. The broader implication is that social psychology cannot plausibly claim political neutrality: its concepts travel into institutions and practices, shaping how collective action is anticipated, governed and policed.

Effective myocardial protection during cardiac surgery is essential, yet the differential metabolic stress of the left (LV) and right ventricles (RV) to ischemia-reperfusion remains poorly characterized. This predefined substudy of a multicenter randomized trial conducted in the United Kingdom (ISRCTN33084113) evaluated remote ischemic preconditioning in patients undergoing coronary artery bypass grafting (CABG) or aortic valve replacement (AVR). Paired LV and RV biopsies were obtained before ischemia and after reperfusion. High-performance liquid chromatography was used to quantify metabolite concentrations and calculate markers of energetics. Cross-clamp time and postoperative troponin levels were recorded. Eighty-nine patients were included (CABG: n=49; AVR: n=40). Following ischemia-reperfusion, LV exhibited greater decline in metabolites than the RV. In CABG, this included larger sustained fall in ATP (-0.90 vs -0.13μmol/mg, p=0.0032) and glutamate (-4.22 vs -1.33μmol/mg, p=0.0009), alongside ADP (-0.53 vs -0.20μmol/mg, p=0.0196), GTP (-0.04 vs -0.01μmol/mg, p=0.0160), and B-NAD (-0.15 vs -0.04μmol/mg, p=0.0137). Computed energy charge decreased significantly in both ventricles (LV: p=0.0002; RV: p=0.010), but remained stable in AVR. ATP/AMP and ATP/ADP ratios declined more in the LV, suggesting impaired energy buffering. There was no significant correlation between cross-clamp time and changes in energy charge in either the LV or RV. Troponin release correlated with ischemic time in CABG, but EC decline did not. The LV shows greater depletion of myocardial metabolites than the RV following ischemia-reperfusion, particularly in CABG patients. These findings support ventricle-specific strategies to optimize myocardial protection.

Rates of nonsuicidal self-injury (NSSI) among lesbian, gay, bisexual, transgender, and other sexual or gender minority (LGBTQ+) young adults are high. Research is needed to elucidate potential mechanisms underpinning this elevated risk. In 2021, young adults in the United Kingdom and United States (n=1475, aged 18-30) reported their NSSI history and psychological distress (Kessler Psychological Distress Scale) in an online survey. Participants were cisgender heterosexual (CH; n=1100), cisgender sexual minority (CSM; lesbian, gay, bisexual, asexual) (n=272), or gender minority (GM; transgender, non-binary) (n=103). Rates of lifetime NSSI and psychological distress were significantly higher for GM participants than CSM participants (NSSI: OR=2.68, p<0.001 | Distress: Coef. = 5.22, p<0.001), and significantly higher for CSM participants than CH participants (NSSI: OR=3.39, p<0.001, | Distress: Coef. = 3.08, p<0.001). Cross-sectional mediational models (i.e., associational variable analysis) revealed that psychological distress partially accounted for the relationship between identity group and lifetime NSSI in a stepwise fashion, contributing to higher NSSI in the GM group compared to the CSM group, and higher NSSI in the CSM group compared to the CH group. Findings suggest GM young people are at elevated risk of NSSI and psychological distress relative to both CSM and CH peers, and disparities in distress levels may be a key driver of disparities in NSSI rates. While longitudinal mediation models are needed to verify this mechanism, findings support interventions aimed at reducing psychological distress and NSSI among LGBTQ+ young people.

Understanding the changing burden of head and neck cancers (HNC) is essential to guide public health interventions and inform cancer care strategies. We conducted a cohort study using routinely collected primary care data Clinical Practice Research Datalink (CPRD) GOLD from the United Kingdom. Adults aged ≥ 18 years with ≥ 1 year of prior history were included. We estimated crude and age-standardised incidence rates (IRs) and one-, five-, and ten-year survival from 2000 to 2021, stratified by age and calendar year. Findings from CPRD GOLD were compared with primary care data from CPRD Aurum (England only). There were 12,455 patients with a diagnosis of HNC from CPRD GOLD (69.2 % male; median age 64 years). Crude incidence in GOLD increased from 9.08 (95 % CI: 7.88-10.42) per 100,000 person-years in 2000-15.59 (14.07-17.23) in 2021, with similar trends observed in CPRD Aurum. Age-standardised incidence trends were attenuated overall but remained elevated for oropharyngeal and tongue cancers. Five-year survival improved modestly, from 53.8 % (95 % CI: 51.4-56.3 %) in 2000-2004-58.7 % (56.5-60.9 %) in 2015-2019. Incidence increases for HNC were attenuated after age standardisation, suggesting a contribution of demographic ageing, although elevations persisted for specific subsites. Small improvements in long term survival highlights more research is needed to improve earlier diagnosis which will lead to better patient outcomes.

Perceptions of sexualized deepfake abuse across three nations: An exploration of how victim gender and race shape attitudes towards deepfake abuse in the United States, the United Kingdom, and Australia

Intraoperative and Postoperative Analgesia for Elective Craniotomy: A National Survey of Current Practice in the United Kingdom.

People in custodial settings are disproportionately affected by, often preventable, oral diseases. Addressing oral health inequities is vital to achieving the United Nations Sustainable Development Goals and Universal Health Coverage by 2030. Obstacles to achieving Universal Health Coverage for oral health in the custodial context include the deficit of oral health professionals in such settings. Innovative workforce models of non-dental professionals are recommended to integrate oral health into routine custodial care. Despite this, no comprehensive review has been undertaken to synthesise the evidence relating to the role of non-dental professionals working in custodial settings in providing oral health promotion. A scoping review, focusing on non-dental professionals working in custodial settings, was conducted from the data of database inception until 3 April 2024 examining oral health knowledge, attitudes and practices; availability of guidelines/recommendations; and oral health-related interventions. We conducted a comprehensive search for indexed and grey literature and initiated a global call for data. Twenty-three sources of evidence from high-income countries (Australia, United Kingdom [UK], United States [USA]) met our inclusion criteria. Guidelines/recommendations defining the role of non-dental professionals in oral health promotion were located (n=15), yet translation into clinical practice may be variable given the few practices located (n=8). Nurses, physicians, and correctional officers were primarily involved in some aspect of oral health education, screening, treatment, and referral, highlighting the importance of interprofessional collaboration. Oral health-related knowledge was limited among nurses (n=1) yet nurses may be receptive to potential training (n=1). Nine interventions focussed on oral health-related prevention and management, including in-service training, resources, officer escort program, motivational interviewing and whole of prison education program, yet only three were evaluated. Correctional professionals reported oral health-related education and training as feasible, acceptable, and improved their knowledge, attitudes, and behaviours. Integrating essential oral health care into routine care among people in custodial settings needs to be prioritised. Championing the workforce reform agenda by strengthening and diversifying the oral health workforce in custodial settings can achieve this. Further research is required to explore innovative models of care involving non-dental professionals working in custodial settings. The protocol was registered with the Open Science Framework (OSF) (DOI 10.17605/OSF.IO/GPY76) before the review was conducted.

Nursing practice in cancer treatment decision making among older adults: A scoping review on behalf of the International Society of Geriatric Oncology Nursing, Allied Health, and Scientists Interest Group.

Informed consent is a legal requirement under The Health and Social Care Act 2008 and a vital part of patient-centred care. Despite national frameworks and guidance, there is significant variability in informed consent implementation across settings. This national service evaluation aimed to assess policies, processes, and principles guiding informed consent for gynaecological radiotherapy across United Kingdom (UK) NHS departments. A survey exploring processes and training, principles, and values was sent to 58 NHS radiotherapy departments. Data were obtained from 38 departments (66 % response rate), representing all UK nations. Ethical approval was obtained. Variation was observed in staff training, use of best-practice guidelines, and content of consent documentation. While 71 % of departments used Royal College of Radiologists (RCR) consent forms, fewer identified professional guidance indicating a potential gap in guideline familiarity. Documentation varied in the number and detail of side-effects described but alignment was observed in core ethical principles. Respondents highlighted structural challenges, notably time and staffing constraints, which limited processes and patient support. This is the first study to provide a national overview of informed consent policies and practices in NHS radiotherapy departments for gynaecological cancers. It identifies inconsistencies in training, documentation, and guideline awareness, but highlights shared professional values. Findings support the need for national guidance, standardised consent materials, and targeted staff education to ensure equitable and fully informed patient decision-making. Informed consent should be treated as an ongoing, patient-centred process that extends beyond the clinician-patient interaction. All staff should be familiar with policies and procedures to support patients' understanding of treatment and long-term impacts. Standardised materials must be tailored to individual needs to facilitate meaningful, patient-centred discussions.

Competencies and leadership attributes for radiographer-led management in clinical practice: A document analysis of job advertisements in the United Kingdom.