The healthcare system accounts for 4 percent of United Kingdom (UK) greenhouse gas (GHG) emissions annually. In response to climate change, the National Health Service (NHS) is calling for less carbon-intensive care practices through prevention. Respiratory Syncytial Virus (RSV), a leading cause of infant hospitalization, currently has no widespread immunization program in the UK. This study estimates the impact on GHG emissions generated within the care pathway from an immunization against RSV in all infants in the UK with nirsevimab, a new monoclonal antibody used in prophylaxis.

A novel approach was applied, mapping care pathway emissions from immunization and avoiding RSV-related primary and secondary care burden. Avoided healthcare resources were estimated using a published health economic model for nirsevimab versus standard of care (SoC), which is characterized as receiving palivizumab or having no immunization intervention, assuming different universal immunization scenarios. NHS England GHG emission factors were applied to each health outcome to measure the GHG emissions associated with a nirsevimab versus SoC strategy.

Compared with SoC, a universal immunization program using nirsevimab leads to avoided GHG emissions, amounting to ~22 kilotons of CO2 equivalents per year, with immunizing all UK infants at birth leading to the greatest reduction. About 40 percent of avoided emissions were from reductions in inpatient hospitalizations.

This study shows how prevention can deliver benefits to people, NHS system capacity, and the environment. However, avoided patient care pathway emissions must be considered alongside drug lifecycle emissions, which are not included here.

Non-suicidal self-injury (NSSI) often emerges during adolescence and young adulthood. A prior open-label pilot study suggested that N-acetylcysteine (NAC) may reduce NSSI frequency in young individuals.

This study investigated potential NSSI-related biological markers for NAC in young adults with a history of NSSI using a placebo-controlled, randomised clinical trial of two NAC dosage regimens.

Forty-three individuals (assigned female at birth) aged 16–24 years and with a history of NSSI were randomly assigned to either low-dose NAC (3600 mg/day), high-dose NAC (5400 mg/day) or placebo treatment for 4 weeks. Participants underwent blood draws, magnetic resonance imaging with spectroscopy and clinical assessments before and after treatment. Primary outcomes included brain glutathione (GSH), blood reduced to oxidised GSH ratio and brain glutamate. Secondary outcomes included antioxidant protein levels, brain gamma-aminobutyric acid concentrations, functional connectivity (between amygdala and insula) and clinical outcomes. Pharmacokinetics, tolerability and correlations among measures were also explored.

For 39 participants who completed study assessments at follow-up, weekly NSSI and depression symptoms improved similarly across both treatment and placebo groups, with no significant group differences in primary or secondary outcomes at follow-up. Some significant correlations emerged.

The study did not support the proposed biological signatures of NAC in young adults with NSSI, although exploratory findings suggested potential biological correlates of clinical improvement. Further research is necessary to explore neurobiologically based treatments for young adults with NSSI.

Atherosclerosis is the leading cause of vascular disease worldwide, and traditionally it has been considered a disease of older individuals. However, this atherosclerotic process begins early in childhood, and when exposed to critically high levels of atherogenic risk factors, coronary artery disease may develop even during childhood. There are very few reports of coronary artery disease in young children, and most are linked to Kawasaki disease and congenital coronary abnormalities. Involvement of the mitral valve due to hypercholesterolaemia is rare and under-reported.

We did a retrospective audit of all children (age <14 years) who underwent coronary angiogram between January 2005 and July 2024 in our tertiary care hospital. Only those children with atherosclerotic coronary artery disease were included.

We studied four paediatric cases of atherosclerotic coronary artery disease with concomitant valvular involvement despite ongoing lipid-lowering therapy. We highlight the mechanisms of valvular involvement and the challenges to the diagnosis and treatment of familial hypercholesterolaemia.

These cases highlight the cardiovascular changes associated with this “malignant” atherosclerosis and emphasise the need for early recognition and prompt initiation of aggressive lipid-lowering therapy at diagnosis.

Discharge is a pivotal transition of care moment; however, discharge antibiotic stewardship efforts have historically been limited. Our institution has a mandatory indication field for inpatient antibiotic orders. Using the last-ordered inpatient antibiotic indication (“Last Inpatient Indication”), we assessed the utility of this field compared to the ICD-10 in inferring clinician intent for discharge antibiotics, to forgo the need for manual chart review to assess antibiotic appropriateness.

We extracted electronic medical record data on adult inpatient encounters in 2023 with ≤2 discharge antibiotics. We reviewed a random subset of 300 encounters to determine if the ICD-10 or Last Inpatient Indication had higher agreement with clinician intent for discharge antibiotics, as determined by chart notes. To facilitate comparison, we created a dictionary classifying ICD-10 indications.

We included 3,414 encounters. The most common discharge antibiotics were amoxicillin/clavulanate (24%) and ciprofloxacin (15%). The most common ICD-10s were non-infectious (48%) and sepsis (18%). In the subset of chart-reviewed encounters, the Last Inpatient Indication agreed with the documented clinician intent for discharge antibiotic more often than the ICD-10 (84% vs 28%). Applying institutional guidelines, we were able to use the Last Inpatient Indication to assess appropriate duration and choice of discharge antibiotics for select infections.

The Last Inpatient Indication outperformed ICD-10s in inferring clinician intent for discharge antibiotics and can be used to efficiently assess antibiotic appropriateness without need for manual chart review. Usefulness of ICD-10s was limited by high percentage of non-infectious and sepsis codes.

To describe Brazilian parents’ perceptions of non-sugar sweeteners (NSS) in beverages consumed by children and their views for NSS front-of-package labels (FOPL).

A qualitative-driven mixed-methods embedded design was used. Seven focus groups with parents of children explored perceptions of NSS. Qualitative data were coded and analyzed using thematic analysis. Participants also completed a closed-ended survey assessing familiarity with NSS-containing beverages, ability to identify NSS on ingredient labels and perceptions of NSS FOPL. Survey responses were summarised using descriptive statistics.

Public and private schools and early childhood education centres in urban areas of two municipalities in the State of São Paulo, Brazil.

Forty parents of children aged 2–5 and 6–11.

About 35 % of participants reported their children consumed at least one NSS-containing beverage weekly in the past month; 17 % reported daily consumption. Parents expressed a preference for natural products and confusion over the term ‘edulcorantes’ (Portuguese for NSS). They shared concerns about the health effects of both sugar and NSS, particularly for children. NSS were seen as acceptable in specific cases, such as if a child has diabetes. Most parents supported a FOPL like Mexico’s, stating ‘not recommended for children’. In the survey, 85 % of the parents correctly identified beverages with NSS, but 82 % misclassified non-NSS ingredients (e.g. sugar syrup, caramel) as NSS. The Mexico-style FOPL was preferred by 95 % of the parents, who found it helpful and easy to understand.

A FOPL clearly indicating NSS presence, especially one recommending against consumption by children, may help parents make informed choices and reduce children’s intake of NSS-containing beverages.

The Speak Mandarin Campaign (SMC) was launched in Singapore in 1979, promoting Mandarin among the Chinese population. An emerging prevalent narrative blames the SMC in terms of causing Chinese cultural erosion. This article seeks to understand how and why this monolithic discourse has emerged. We do this by tracing Mandarinization as a transnational ideology originating from China’s founding as a republic. We draw on life history interviews with eleven individuals born between 1940 and 1966. Informants recount engagements with the SMC, from alignment to nonchalance, and fear of resistance. Accounts often invoked ‘Lee Kuan Yew’ as a chronotope, representing the sociopolitical circumstances of Singapore in the 1970s–80s. We argue that the current discourse surrounding the SMC might be theorized as a form of collective memory. It emerges from and is sustained by conflating prominent language policies with a perceived sense of the state’s oppression and marginalization of a Chinese-educated class. (Collective memory, collective remembering, Mandarin policy, Speak Mandarin Campaign)

A stepped care approach to treating anxiety and depression is common in mental health services. Low-intensity interventions, typically based on cognitive behavioural principles, are offered first, followed by high-intensity therapy if required. In the English National Health Service Talking Therapies (NHS TT) programme, different types of therapists deliver low- and high-intensity interventions. ‘Stepping up’ therefore involves changing therapist, and often an additional wait, which could both disrupt treatment flow.

In NHS TT, many low-intensity therapists subsequently train at high intensity. Once dual-trained, they typically deliver only high-intensity treatment. With both skillsets, they could theoretically deliver a full stepped care pathway, avoiding potential disruption linked to stepping up.

To explore a blended treatment approach, where dual-trained therapists move between low- and high-intensity flexibly based on patient need.

Ten dual-trained therapists across 4 services treated 43 patients. Patients with clinical complexities more likely to eventually require high-intensity support were selected. Propensity score matching was used to identify matched control groups from a pool of patients who received stepped care. Treatment characteristics and clinical outcomes were compared. Feedback was obtained from patients, therapists and supervisors.

Compared with matched controls, who received low- then high-intensity treatment, blended treatment required four fewer sessions on average, saving a third of therapist time and was completed 121 days sooner. The reliable recovery rate (54.1%) was 9% higher than the stepped care group (44.7%), which is clinically, although not statistically, significant. Blended treatment showed a non-significantly higher reliable deterioration rate. Patient feedback was positive. Therapists and supervisors highlighted advantages alongside practical challenges.

The blended approach showed promise as an efficient and effective method to deliver therapy when clinicians are dual-trained. Larger-scale studies, and consideration of implementation challenges, are needed. However, results suggest that this approach could potentially offer more flexible and seamless care delivery.

Much work has been done on the role of trauma in obsessive–compulsive disorder (OCD), but the relationship between stressful life events (SLEs) and the onset of OCD remains poorly studied. This study aims to summarize the evidence about the association between SLEs and OCD development.

For this systematic review, we searched PubMed, Web of Science, Scopus, and PsycINFO databases for studies published from the database’s inception to December 12, 2024. We included studies investigating the prevalence of SLEs among individuals diagnosed with OCD compared to other psychiatric disorders or healthy controls.

Seven studies met the inclusion criteria and were incorporated. Two studies found that OCD patients suffered more SLEs than healthy controls in the year before the onset of OCD. Two of the included studies showed a higher occurrence of SLEs across the patients’ lifetime before the onset of OCD. Three studies were comparable and, therefore, meta-analyzable. Together, they revealed that SLEs in the year before the onset of OCD were associated with a small yet positive pooled effect size.

Our review suggests that SLEs may be highly represented among people with OCD both in the year preceding the disorder’s onset and throughout their lifetime.