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Journal articleBaker Y, Warnapala M, Wasan D, et al., 2026, , BMC Primary Care, Vol: 27, ISSN: 2731-4553
BackgroundVaping among youth has emerged as a significant public health concern. Primary care professionals are uniquely positioned to address this issue, but their practices, perceptions, and preparedness remain poorly understood.ObjectivesThis systematic review aimed to explore how primary care professionals manage e-cigarette use among youth, focusing on three key areas: perceptions, screening practices, and counselling strategies.DesignThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure rigour and transparency.Data sourcesFor studies published from January 2000 to December 2024, a comprehensive search was conducted across Embase, Ovid MEDLINE, Global Health, and Scopus.Eligibility criteriaStudies focusing on youth (aged 15–24), addressing e-cigarette use within primary care settings, and published in English were included. Exclusion criteria encompassed non-human studies, dual users, and articles without full text.Data extraction and synthesisFrom an initial pool of 896 publications, 14 studies met the inclusion criteria and were analysed. Data extraction followed a structured process, identifying themes related to perceptions, knowledge, screening, and counselling.ResultsClinicians’ perceptions of e-cigarettes seem to affect their likelihood of discussing usage with patients, while gaps in knowledge and inconsistent screening practices remain common obstacles. Screening rates for e-cigarettes were remarkably lower than those for traditional cigarette products. Counselling practices varied considerably, while strategies such as motivational interviewing and personalised counselling were described, overall practice remained inconsistent. Thus, highlighting missed opportunities for early intervention and the need for more structured and standardised clinical approaches.ConclusionPrimary care professionals play a crucial role in addressing vaping among youth, but gaps in knowledge, in
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Journal articleWignadasan W, Fontalis A, Alsheddi A, et al., 2026, , Journal of Robotic Surgery, Vol: 20, ISSN: 1863-2483
Robotic-arm assisted total knee arthroplasty (RO TKA) has been developed to improve surgical precision and reproducibility compared with conventional techniques. However, the economic implications of adopting robotic technology remain uncertain, particularly within publicly funded healthcare systems. This study aimed to evaluate the in-hospital costs and health-related quality of life outcomes associated with RO TKA compared with conventional TKA (CO TKA) using a cost-utility framework within a UK National Health Service (NHS) institution. A propensity-matched cohort cost-utility analysis was performed including 200 patients undergoing primary TKA for end-stage osteoarthritis at a single high-volume tertiary centre. 100 patients underwent RO TKA and 100 underwent CO TKA, matched 1:1 for age, sex and American Society of Anesthesiologists (ASA) grade. Direct in-hospital costs were obtained using a micro-costing approach. Health-related quality of life was measured using the EQ-5D-3 L preoperatively and at one year postoperatively to estimate quality-adjusted life years (QALYs). The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. Mean total in-hospital costs were higher for RO TKA compared with CO TKA (£6,517 vs. £6,204), representing an incremental cost of £313 per patient. Patients undergoing RO TKA demonstrated a significantly shorter length of stay (2.3 vs. 3.1 days; p = 0.008) and lower ward (p = 0.029) and drug and pharmacy (p = 0.041) costs. One-year postoperative EQ-5D-3 L scores were higher in the RO TKA cohort (0.82 vs. 0.75; p < 0.001), resulting in a greater mean QALY gain (0.192 vs. 0.140). The incremental QALY gain of 0.052 produced an ICER of £6,019 per QALY gained, well below the National Institute for Health and Care Excellence (NICE) willingness-to-pay thresho
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ReportShah N, Doliente S, Hallett J, et al., 2026,
Fine Chemicals Sector 2025. Sectoral systems of innovation and the UK’s competitiveness
, Publisher: ԹϺExecutive SummaryWe are extremely grateful to Lord DavidSainsbury and the Gatsby Charitable Foundationfor generously supporting this sectoral studyof the fine chemicals industry. It is a sector withsignificant contributions to the UK’s economy(both directly and by underpinning other sectors)but is facing multiple challenges within andoutside the UK. As such, it deserves a closerinspection of its status and the developmentof potential interventions. We aimed to providea diagnosis of the industry by looking at itslandscape, productivity, skills requirements,technology, innovation, business, and regulatoryenvironment. We coupled these with deep diveswith UK chemical industry organisations tosupport our findings. Based on these analysesand stakeholder engagements, we developedour high-level conclusions, recommendations tostakeholders, and areas of further detailed study.Our key conclusions so far are the following:• The global fine chemicals industry is a thriving andgrowing industry marked by a competitive market,wherein the major players dominate at 40% to 45%.Most of the fine chemicals businesses are involvedin manufacturing (80% of the market). Having R&Dcapabilities, manufacturing expertise & efficiency,supply chain management, global presence reach,and regulatory compliance are crucial competitiveadvantages in the global landscape.• Being the birthplace of fine chemicals, the UK’s industryhas been well-established with highly diversifiedproducts. The UK’s fine chemicals sector interlinks itsown bulk (or commodity) chemicals industry to variousend-use sectors within the country and internationally.Our estimates show that fine chemicals contribute 40%of the GDP value of chemical manufacturing (£11bn to£12bn), which is commonly reported.• The UK’s broad chemicals industry (bulk + fine), whilesignificant, has struggled with consistent productivitygrowth since the global financial crisis. The industry’sin
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Journal articleWang J, Almeida-Magana R, Dinneen E, et al., 2026, , European Urology Open Science, Vol: 92, Pages: 55-63, ISSN: 2666-1691
BackgroundRobotic radical prostatectomy (RARP) is a standard first-line curative treatment for localised prostate cancer but carries risks of erectile dysfunction and urinary incontinence. The NeuroSAFE technique provides pathological assessment to optimise nerve-sparing whilst avoiding positive surgical margins.ObjectiveThis study evaluated the cost-effectiveness of NeuroSAFE-guided RARP compared with standard RARP.Design, setting and participantsA within-trial economic evaluation with a 12-month time horizon was conducted alongside NeuroSAFE-PROOF, a single-blinded, multi-centre, randomised controlled trial. Participants were patients with a diagnosis of non-metastatic prostate cancer deemed suitable to undergo RARP, good erectile function without medical erectile function assistance, and no previous prostate cancer treatment. No age limits were applied.InterventionThe intervention is the NeuroSAFE-guided RARP.Outcome measurements and statistical analysisCosts were assessed from NHS and societal perspectives using patient-level data. Quality-adjusted life years (QALYs) were measured using EQ-5D-5L. Incremental cost-effectiveness ratios (ICERs) and net monetary benefits were estimated. Uncertainty was captured via bootstrapping, missing data were addressed through multiple imputation, and Monte Carlo simulations were undertaken to assess robustness.Results and limitationsAmong 407 randomised patients (NeuroSAFE: 204; standard RARP: 203), NeuroSAFE increased mean total cost (by £827 and £1,000 from NHS and societal perspectives, respectively) and QALYs (by 0.03). ICERs were £26,195/QALY (NHS) and £31,666/QALY (societal). Cost-effectiveness probabilities were 53% and 56% (NHS) and 48% and 56% (societal) at the lower and upper UK willingness-to-pay thresholds. Limitations include substantial uncertainty around estimates, missing data, and potential recall bias from retrospectively collected data. Findings reflect short-term, within-trial estima
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Journal articleBonci E-A, Di Micco R, Marotti L, et al., 2026, , Breast, Vol: 89
BACKGROUND: Cross-country disparities in access to guideline-recommended early breast cancer care persist across Europe. PORTRAIT is a clinician-reported, cross-sectional access study mapping availability and state reimbursement of key services across the early breast cancer pathway. METHODS: A 49-item survey covering diagnostics, pathology and genomics, systemic therapy, surgery, radiotherapy, and supportive care was emailed from June to September 2024 to multidisciplinary teams at one expert breast centre in 42 European countries. Respondents provided a consensus perspective on service availability and reimbursement. Descriptive proportions with full, partial, or no access were calculated. RESULTS: Thirty-nine countries responded (93%). Core diagnostics were widely available, but gaps persisted: MRI-guided biopsy was absent in 29% of countries and vacuum-assisted biopsy was fully reimbursed in 66%. Genomic assays were unavailable in 14% and not fully reimbursed in 35%. Public funding gaps were reported for PARP inhibitors (33%) and CDK4/6 inhibitors (26%). Immediate implant-based reconstruction and biological meshes lacked reimbursement in 21% and 33%, respectively. Despite broad availability of hypofractionated radiotherapy, 38% of countries still used per-fraction reimbursement. Psycho-oncology was limited in 35%, fertility preservation in 46%, and patient-reported outcome measures absent in 43%. CONCLUSION: Basic services are nearly universal, but gaps persist in advanced imaging, molecular testing, targeted therapies, radiotherapy reimbursement, reconstructive/oncoplastic surgery, and survivorship care. PORTRAIT identifies practical targets for policy audit, reimbursement alignment, and resource stewardship. Findings reflect clinician perspectives from expert centres, potentially representing best specialist care rather than average national care, and are not population-representative estimates or direct measures of patient outcomes.
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Journal articleThichumpa W, Rawson T, Hauck K, et al., 2026,
A mixed-methods study of community dog management and rabies awareness in Thailand
, One Health, ISSN: 2352-7714Rabies elimination requires coordinated interventions across the human-animal-environment interface, yet sustained progress is often hindered by systemic gaps between dog population management, community engagement, and governance. This study investigated community perceptions and challenges related to rabies prevention and control across high-endemic areas in Thailand. Using a mixed‑methods design, secondary provincial quantitative data were integrated with qualitative thematic analysis from 57 stakeholders in high endemic areas, including public health officials, policymakers, NGOs, animal‑welfare liaisons, and community members. The findings indicated standard rabies awareness, 98.2% of participants demonstrated good preventive practices, recognized post-exposure prophylaxis (PEP) as essential, and 68.4% possessed good knowledge. Although most supported dog sterilization (59.6%) and vaccination (63.2%), only 19.3% perceived existing control campaigns as effective. Main challenges included constrained operational resources (57.9%) and limited local government budgets (40.4%). Free‑roaming community dogs were prevalent, with 54.4% of participants identifying abandonment as the primary driver of population growth. Informal feeding networks provided localized care for community dogs. While public willingness to fund management was relatively low (33.3% willing to pay; 19.3% supporting co-payment), reflecting an expectation of local authority crucial for achieving sustainable rabies elimination. responsibility. Qualitatively, unclear boundaries between public health mandates and animal welfare legal frameworks added complexity to rabies outbreak response and sometimes introduced institutional challenges among local government and non-governmental sectors. Nevertheless, stakeholders strongly supported sustained sterilization and intersectoral collaboration. Addressing policy-practice gaps, stabilizing financing, and integrating community social dynamics into formal One
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Journal articleAlagiyawana A, Verdun Z, Pathirana A, et al., 2026,
Community-based health promotion for non-communicable disease prevention in Sri Lanka: protocol for the Happy Village Plus cluster randomized trial
, NIHR Open Research, ISSN: 2633-4402Background: Non-communicable diseases (NCDs) drive major mortality, morbidity, and economic loss in low- and middle-income countries. In Sri Lanka, NCDs account for over 80% of premature deaths, with cardiovascular disease, cancer, and diabetes being the leading causes.Methods: This protocol describes a cluster randomized trial of Happy Village Plus, a community-based NCD prevention program that builds on the ongoing Happy Village initiative launched in 2017. The intervention uses a multilevel package of individual, group, community, and policy-oriented strategies tailored to local needs. It applies an adaptive implementation structure that is refined through community feedback and is supported by mediation and advocacy to link communities with stakeholders. The core components include health education, behaviorally informed approaches, and skills development targeting key risk factors, diet quality, physical inactivity, tobacco use, and alcohol use. Preparatory activities included volunteer training, stakeholder engagement, and community mobilization.Discussion: The evaluation comprised two components. The quantitative trial assessed behavioral outcomes, fruit and vegetable intake, sugar-sweetened beverage consumption, overall diet quality, cigarette use, physical inactivity, cardiometabolic outcomes, blood pressure, blood cholesterol, fasting blood glucose, body mass index, and waist circumference. A qualitative process evaluation examines implementation and context, including norms, perceptions, social network development, acceptability, feasibility, barriers, and facilitators. This trial will generate robust evidence on the effectiveness and implementation of an adaptive village-level health promotion model for NCD prevention in Sri Lanka, with relevance for scalable and equitable approaches in similar settings.Trial Registration: The clinical trial registration number is SLCTR/2023/005 (19-03-2023).
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Journal articleGarcía-Díaz R, Marcos MÁT, Serván-Mori E, et al., 2026, , BMC Public Health, ISSN: 1471-2458
BackgroundType 2 diabetes mellitus (T2DM) is a major public health challenge, particularly in low- and middle-income countries. Although much is known about its determinants and costs, less is known about how treatment, behaviour, adiposity, and glycaemic control evolve after diagnosis. We examined post-diagnosis trajectories in these domains among adults living with T2DM in Mexico.MethodsWe used repeated cross-sectional data from ENSANUT 2006, 2012, and 2018 and analysed 9277 adults aged 20 years and older with a prior physician diagnosis of T2DM (mean age 55.7 years, SD 13.1). The main exposure was time since diagnosis. Outcomes included current treatment use, household expenditure on non-recommended foods, body mass index (BMI), overweight, obesity, glycosylated hemoglobin (HbA1c %), and fasting blood glucose in a biomarker subsample. We estimated adjusted post-diagnosis trajectories using pooled models with covariates and fixed effects for age-at-diagnosis-by-sex and municipality, and examined heterogeneity by sex and socioeconomic status (SES).ResultsTreatment uptake was higher at longer durations since diagnosis and remained elevated over time, reaching +24.4 percentage points at 12 or more years (p<0.01) relative to the year-of-diagnosis reference. Household expenditure on non-recommended foods showed little evidence of sustained change. BMI declined gradually, remaining at —2.54 kg/m2 lower in the 12 or more years category (p<0.01), while obesity was 16.9 percentage points lower in the same category (p<0.01); changes in overweight were less regular. Glycaemic control did not improve over time: HbA1c remained elevated at longer durations since diagnosis, reaching +1.01 percentage points in the 12 or more years category (p<0.01), and fasting blood glucose showed a similar qualitative pattern. These trajectories exhibited social disparities. At 12 or more years post-diagnosis, the treatment-use increase relative to the year-of-diagnosis refere
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Journal articleDoohan P, Johnson R, Løchen A, et al., 2026, , Nature Health
<jats:title>Abstract</jats:title> <jats:p>There is scant evidence on the broader societal losses of different pandemics, although this is crucial for evaluating mitigation strategies and quantifying the benefits of pandemic preparedness investments. Here we project the socioeconomic loss of respiratory pandemics, the sum of health, economic and educational losses, under four reactive business- and school-closure strategies, six hypothetical diseases and three country-income groups using epidemiological-economic modelling. The socioeconomic loss varies considerably between pandemics, with means ranging (as percentage of annual gross domestic product) from 2.9% to 439%, 2.3% to 360% and 1.9% to 290% in low- to lower-middle-, upper-middle- and high-income countries, respectively. Stringent closure strategies are more likely to minimize losses for severe diseases, high-income countries and higher life-year valuations. Strategies with reactive school- and business-closures usually outperform those with long-term school-closures, but the latter may be preferable under fiscal or political constraints. These findings provide decision-makers with initial evidence to better prepare for and respond to future pandemics.</jats:p>
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Journal articleDrouvelis M, Qiu Z, 2026, , Oxford Bulletin of Economics and Statistics, ISSN: 0305-9049
<jats:title>ABSTRACT</jats:title> <jats:p>This paper investigates the effects of induced emotions on leading‐by‐example. Using an online sample of more than 1000 participants, we observe behaviour in a one‐shot sequential voluntary contribution mechanism game where leaders and followers are induced to be either happy or angry. Our findings show that angry leaders contribute less than happy leaders. The same effect is observed when considering followers' behaviour. A follow‐up study using the strategy method, where followers make conditional contribution decisions without observing the leader's actual contribution, detects no statistically significant differences between angry and happy followers' conditional contribution schedules. This suggests that the effect of induced emotions on followers' behaviour operates primarily through the leader's behaviour, highlighting the importance of leader emotions in shaping team outcomes. More broadly, our findings highlight the role of emotions as a causal force, suggesting that negative changes in well‐being can bring about adverse effects on team cooperation.</jats:p>
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