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Worldwide prevalence of anxiety in transgender persons:Systematic review with meta-analysis
No full textObjective: This systematic review and meta-analysis estimate the global pooled prevalence of anxiety among transgender individuals. Methods: A comprehensive search was conducted in Scopus, Web of Science, Embase, EBSCOhost, VHL, PsycINFO, and PubMed. Observational studies reporting anxiety prevalence in transgender people were included. Meta-analytical methods were applied using a random-effects model to compute pooled prevalence estimates. Heterogeneity, publication bias, and subgroup analyses were assessed. Results: A total of 71 studies, comprising 73,565 transgender individuals from 23 countries, were included. The global pooled prevalence of anxiety was 43% (95% CI: 38–48%), with higher rates among non-binary individuals (59%) compared to transmasculine (44%) and transfeminine (37%) identities. Significant variability was observed across geographic regions, age groups, ethnicity/race of the samples, and assessment methods. Non-probabilistic sampling and self-reported measures were associated with higher prevalence estimates. Conclusion: Transgender individuals experience a disproportionately high prevalence of anxiety, with notable disparities by gender identity and region. Findings emphasize the need for targeted mental health interventions and inclusive healthcare policies. Standardized methodologies and broader geographical and ethnical representation in future research are essential to enhance global understanding and inform policy development.</p
Advancing Work-Related Musculoskeletal Pain Science in the Journal of Occupational Rehabilitation:Time to fully Adopt Biopsychosocial Approaches?
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Validation in China of the Quality Maternal and Newborn Care Framework index
No full textProblem: Despite progress in maternal and newborn health, China still lacks a validated and multidimensional tool to monitor care quality and guide improvements.Background: The Quality Maternal and Newborn Care Framework index (QMNCFi) is a novel but comprehensive and globally developed tool for assessing maternity care quality from the service user’s perspective, offering huge potential for assessing care quality in China.Aim: This study aimed to validate the Chinese version of the QMNCFi and report initial findings from economically diverse settings.Methods: An online survey was conducted in five hospitals in five provinces in China among women between 6 weeks to 1 year postpartum. Construct validity was assessed using confirmatory factor analysis. Reliability was evaluated through internal consistency and test–retest reliability. Inferential statistics were used to analyze score differences across sub-groups.Findings: 547 mothers completed the survey. Confirmatory factor analysis indicated that the construct of the Chinese version aligned with the original version. The Cronbach’s α for the survey’s 13 sections ranged from 0.629 to 0.975, and the Intraclass Correlation Coefficient of test-retest ranged from 0.620 to 0.926. There is a modest correlation between regional economic level and QMNCFi scores at all time periods (p < 0.05). Pregnancy sub-index scores were slightly higher among women in rural areas compared to urban areas (p < 0.05).Conclusion: The Chinese version of the QMNCFi is feasible to obtain service user perceptions of the quality of care at scale in China
Alienation and/or Anomie in Pharmacists:A Systematic Review and Narrative Synthesis of the International Literature
No full textBackgroundFlourishing and belonging are key concepts for the wellbeing of staff and the success of a profession. Alienation and anomie are distinct types of psycho-social ills which inhibit flourishing and belonging. A better understanding of these may offer hope in preventing many negative work endpoints, including burnout and intention to leave.ObjectivesTo systematically review and narratively synthesise alienation and/or anomie in pharmacists across the globe, reviewing all types of methodological designs, published in peer-reviewed journals.MethodsWe identified published peer-reviewed research through searching eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science – Core Collection, Scopus, and Google Scholar) and extensive hand/citation searching. Two independent reviewers identified and critiqued eligible studies, extracted data, and synthesised the findings. The synthesis evaluated the focuses, causes, associated factors, and/or consequences of alienation and/or anomie and aligned these to six deductive themes from alienation theory: care; values; meaning; recognition; autonomy; and shared responsibility.ResultsSearches identified 886 papers, with 47 included in the final results. From the synthesis, ten key causes of alienation and/or anomie were identified; 1) Changing Professional Identity, 2) Reimbursement Models & Corporatisation, 3) Focus on Medicines Rather than People, 4) Misunderstanding & Deprofessionalisation, 5) Environments & Culture, 6) Suboptimal Societal Mandate, 7) Roles Misaligned with Aspirations, 8) Systematic Underutilisation, 9) Lack of Professional Agency, and 10) Value Conflict. From the evidence, there was high confidence that inhibitions of care, values, recognition, and/or autonomy (four of the six deductive themes) were associated with alienation and/or anomie.ConclusionAlienation and/or anomie are present across many countries and regions. This paper helps us understand the aetiology of this complex psycho-social syndrome, a necessary first step in creating an inclusive profession where all pharmacists can flourish. Future research needs to trial new interventions targeted at correcting this professional malady
Novel biomarkers in bone pathophysiology:Establishing reference intervals and biological variations estimates for serum leptin, sclerostin, lipocalin-2, osteoprotegerin, resistin and Dickkopf-related protein-1 from the European biological variation study (EuBIVAS) populations
No full textA range of biomarkers of bone metabolism are thought to mediate adipose tissue-bone crosstalk and fulfil a homeostatic role. While considered clinically relevant, their utility and application appears limited by lack of data characterising biological variability and reference intervals rather than by analytical issues. We have therefore studied the biological variation (BV) of these biomarkers. Concentrations of Dikkopf-related protein 1, leptin, osteoprotegerin, sclerostin, lipocalin2 (Lcn2) and resistin were measured by Luminex assays in serum samples from the EuBIVAS study. Samples were taken once per week, over 10 consecutive weeks, from 91 subjects in cohorts from 5 European countries. Estimates of analytical variation (CVA), within-subject (CVI) and between-subject (CVG) BV were calculated and analytical imprecision (CVAPS) and analytical bias (BAPS) specifications, index of individuality (II), reference change values (RCV) for increase and decrease and the number of samples required to estimate the homeostatic set points (NHSPs) were derived. Mean concentrations differed between males and females for leptin, osteoprotegerin, and sclerostin, and for osteoprotegerin and sclerostin between females in fertile and menopausal ages. No male-to-female differences were observed in CVI estimates. Index of individuality was below 0.6, for all measurands. Determination of reference intervals (RI) limits indicated that all, with the exception Lcn2, described data which were non-gaussian distributed and that only leptin differed between sexes. Availability of high-quality biological variation enables objective assessment of the bone metabolism biomarker results which may enhance their clinical utility. The data indicates that they exhibit significant individuality.</p
Estimating incidence rates of primary infection and reinfection with hepatitis C virus among people who inject drugs in Scotland:a model-based analysis of repeated cross-sectional survey data
No full textBACKGROUND: Reducing the incidence of hepatitis C virus (HCV) infection is a World Health Organization (WHO) elimination goal, but approaches to estimate this from population-level survey data are lacking. We modelled HCV incidence among people who inject drugs (PWID) surveyed over time, to provide evidence on whether Scotland has reached the WHO elimination target of ≤2 per 100 person-years in this population.METHODS: A statistical model was fitted using HCV infection data from five sweeps (2013-14, 2015-16, 2017-18, 2019-20, and 2022-23) of a national bio-behavioural survey, involving 11,651 PWID recruited at sites providing injecting equipment. Per-sweep incidence rates of primary chronic HCV infection, reinfection, and combined primary and reinfection ('total infection') were inferred within a Bayesian framework. Incidence rates relate to the number of new infections per 100 person-years for the population at risk of (primary, reinfection and total) infection.FINDINGS: In 2022-23, the model-estimated total, re-infection and primary infection incidence rates were 3.4 per 100 person-years (95% credible interval (CrI):2.6-4.3), 1.9 (1.3-2.6), and 4.1 (3.0-5.4), respectively. For total new infections, the model-estimated incidence rate decreased by 51% from 7.0 per 100 person-years in 2015-16 to 3.4 in 2022-23 (relating to an absolute decrease of 3.6 per 100 person-years; 95% CrI: 2.0-5.3). Between 2015-16 and 2022-23, model-estimated re-infection and primary infection incidence rates decreased by 78% and 40%, respectively.INTERPRETATION: Over a period when direct-acting antiviral therapy was scaled-up in Scotland, major reductions in the incidence of primary infection, reinfection, and total HCV infection were evident, indicating that the WHO target is within reach, for a relatively high-risk population of PWID.FUNDING: Public Health Scotland (for NESI); NIHR HPRU in Behavioural Science and Evaluation; NIHR Programme Grants for Applied Research programme (reference number RP-PG-0616-20008).</p
The impact of childhood emotional maltreatment on adulthood smoking behaviour:A systematic review and narrative synthesis
Get PDFBackgroundChildhood emotional maltreatment (CEM) has been linked to adulthood smoking behaviour (ASB). However, variability in how these are defined has hindered understanding of their specific relationship.ObjectiveThe aim of this systematic review was to valuate evidence for the association between two different forms of CEM – emotional abuse and emotional neglect – and various types of ASB.Participants and SettingEligible studies included adults aged 18 to 70 who experienced CEM before age 18 and reported any form of tobacco use after age 18. A total of 34 studies (N = 534,104) were included.MethodsA systematic review of studies published between 1997 and 2024 was conducted, and narratively synthesised. This review was registered on PROSPERO (CRD42024572290).ResultsFindings are reported in seven outcome categories, based on different aspects of smoking behaviour. Emotional abuse was most frequently associated with increased smoking outcomes, whereas associations with emotional neglect were mostly non-significant, though the paucity of studies that directly examine neglect limits interpretation, as does variation in study design and operationalisation of key concepts.ConclusionsThese findings indicate that exposure to CEM – particularly emotional abuse – is linked to smoking behaviour in adulthood. Future research should: examine the role of mediating factors; address clarity in conceptualisations of both CEM and ASB; and redress underrepresentation of non-Western populations. This review highlights the need for trauma-informed approaches that account for the long-term impacts of emotional maltreatment on tobacco use
Scottish Consensus Clinical Management Guidelines for Merkel cell cancer
No full textMerkel cell carcinoma (MCC) is a rare but highly aggressive neuroendocrine skin cancer with the highest mortality rate among skin cancers. Approximately 40 new cases are reported annually in Scotland, with a rising incidence. A significant proportion of these cases result in loco-regional recurrence and patient mortality. Historically, few phase 3 randomised controlled trials have been conducted for MCC, and the existing international guidelines are outdated and lack information on the recent advancements in immunotherapy, surgical margins, sentinel lymph node biopsy and post-operative radiotherapy. The 2024 joint guidelines by ESMO-EURA provide comprehensive best practice recommendations; however, there is no UK-specific guideline for the National Health Service (NHS). To address this gap, the Scottish Consensus Clinical Management Guidelines were developed by a multidisciplinary team of experts, including oncologists, surgeons, radiologists, nurse specialists, pathologists, dermatologists and Mohs surgeons from various NHS Scotland health boards. Initial meetings were held in December 2023, followed by further discussions in 2024, including the Scottish Clinical Imaging Network to ratify the use of PET-CT scans for initial imaging. The final draft of the guidelines was approved at the Scottish skin cancer meeting in March 2025 and is accessible within NHS Scotland through local cancer networks. These guidelines recommend initiating MCC treatment within 8 weeks from diagnosis to improve patient outcomes, representing the first UK-based guideline for MCC. The development process and final guideline, aligned with the RIGHT checklist, aimed at enhancing the multidisciplinary management of MCC in the NHS.</p
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