The South Eastern Health and Social Care Trust (SEHSCT) is a health organisation in Northern Ireland. Hospitals served by the Trust include Downe Hospital, Lagan Valley Hospital and Ulster Hospital.
BACKGROUND:In most countries, a criminal conviction requires evidence that the individual committed the act and that they had the mental capacity to understand what they were doing and that it was wrong. Youth, as an indicator of brain development, is one factor affecting criminal capacity. Worldwide, this has commonly been managed in part by setting in law an age below which criminal incapacity is presumed, so no prosecution is possible. Considerable variation in the MACR was confirmed across 195 countries. Some countries have no MACR. Otherwise, the MACR ranges from 7 years (some African and South Asian countries) to 18 (some South American countries); many North Asian, European and a few African countries set theirs at 14 which is the most frequently found level, and also the minimum age recommended by the United Nations Convention on the Rights of the Child. Therefore, how do countries set or change their MACR? AIMS:To explore change, efforts to change and impact of change in MACR internationally. METHODS:Between February 1st 2022 and December 31st 2023, members of an international research group (GIRAF-Group of International Researchers in Adolescent Forensics) were asked to complete an emailed questionnaire about changes in the MACR, or efforts to change it, in their country since 2000. Reports were then collated, circulated and discussed within the group. RESULTS:Among the 14 countries responding in detail about the MACR, efforts to raise the MACR had been successful in three, but in nine such efforts had been unsuccessful; in at least two countries pressures were to lower their MACR, but in only one, Denmark, did that happen (from 15 to 14) in the data collection period (though this change was subsequently reversed). Factors most influencing retention of a lower age were exceptional individual cases, which triggered press and political interest in retaining a higher age, and well-evidenced and developed arguments from legal, social and medical or other clinical bodies. CONCLUSIONS AND IMPLICATIONS:The wide differences in the MACR between countries suggest under-use of evidence in deciding it. We need more governmental willingness to bring the MACR at least to the UN-recommended level-but accompanied by research into the impact of this. Efforts targeted exclusively on child and adolescent welfare may have less effect if they also force children through the criminal justice system, with consequent impact on self-identity and sense of citizenship. A low MACR is also likely to be more directly and indirectly costly than a higher one.
Acute Achilles tendon ruptures (AATRs), an extremely prevalent injury amongst adults who remain active, have been treated with surgical intervention for decades. This choice was made due to several decades-old studies demonstrating reduced re-rupture rates as opposed to nonsurgical interventions utilizing casts; however, numerous surgeons and researchers acknowledged potential complications such as wound problems and nerve damage. Functional braces and early weight-bearing now challenge this 'surgical by default' model. An evidence-based, focused review of randomized clinical trials, conventional and network meta-analysis, and large cohorts was conducted for the comparison of operative and nonoperative treatment for AATRs or the evaluation of various rehabilitation approaches. Operative management provides a lower rate of re-rupture in comparison to traditional cast-based nonoperative treatment; however, operative management also results in increased wound complications and sural nerve injuries. Nonoperative management employing functional bracing and early weight-bearing provides re-rupture rates approaching those of operative management, and the long-term functional outcome data are generally comparable. Differences in structural changes continue to exist between the two management groups, with longer tendon length and atrophy of the soleus muscle seen after conservative treatment, although for the majority of patients, the resultant strength and endurance deficits will be minimal. Both treatment options may provide optimal results if implemented through structured rehabilitation pathways. Treatment should be individualized based on the patient's specific factors, injury characteristics, and available resources. The use of current comparative effectiveness research to assist in making decisions regarding treatment with the patient is recommended.
OBJECTIVE:To collate and systematically review the evidence on the impact of substandard housing on early child development in high-income countries. DESIGN:Systematic review. METHODS:Five databases (Medline, Emcare, Web of Science, Scopus and PsycInfo) and relevant grey literature were searched between June and July 2024. Records were screened to include studies which explored the association between substandard housing and cognitive, language, motor, social, emotional and/or behavioural development in children aged 0-8 years living in high-income countries. Studies which only explored lead, radiation or secondhand smoking exposures were excluded. Data were extracted from relevant articles and reported via a narrative synthesis. Risk of bias was assessed using the Risk of Bias in Non-Randomised Studies of Exposures tool. Certainty of findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. All screening, data extraction and 20% of quality assessment were performed independently by a second assessor. RESULTS:6258 records were screened, from which 25 studies were included, representing >2 29 000 children from seven high-income countries. Studies mostly explored home air quality and overcrowding. Moderate certainty evidence was found for associations between mould, damp, condensation, overcrowding, hygiene and safety issues and unclean heating/cooking fuels and poorer early child development. Low certainty evidence was found for an inverse relationship with nitrogen dioxide, particulate matter and xylene levels. Very low certainty evidence was found for associations between limited home resources and poorer child development. ORs ranged from 1.28 to 3.53. All studies had a high or very high risk of bias. Meta-analysis was not possible due to heterogeneity. CONCLUSIONS:Policymakers and professionals working with children in healthcare, social and education settings should be aware that housing conditions may impact child development. Research is needed to further evaluate the impacts of substandard housing on childhood development, but notwithstanding this, our review supports the growing momentum for improving living situations for young children. FUNDING:No specific funding was received for this study. PROTOCOL REGISTRATION:PROSPERO: CRD42024564320.
BackgroundVitamin B12 deficiency can cause anaemia, fatigue, and neurological sequelae. Total B12 assays may not be reflective of tissue B12. Methylmalonic acid (MMA) can assess tissue B12 more accurately. NICE published clinical guidelines on Vitamin B12 deficiency in adults in 2024. They outlined MMA testing in two scenarios: in patients where nitrous oxide use is possible or who have an indeterminate total B12 result (180-350 ng/L) alongside symptoms or signs of B12 deficiency. MMA testing is costly, not readily available, and time consuming, so increased use will have implications.MethodsThis is a Case note review of patients who had MMA requested one year prior to and one year post-NICE NG239 publication. Audit standards followed were NG239 indications for MMA testing.ResultsIn the year after NG239, MMA testing increased by 96% (57 to 112). Whilst only 47% would have meet NG239 testing criteria in the prior group, this increased to 79% in the post group. More were diagnosed with B12 deficiency (16% prior and 21% post), and more commenced on B12 treatment (14% prior and 19% after). Comparing simultaneous total B12 and MMA results suggests an increase in the upper reference interval of the indeterminate range to 375 ng/L could be considered.ConclusionsDemand for MMA testing almost doubled after NG239 was published, though requests appeared much more appropriate. Whilst laboratory costs increased, there may have been savings elsewhere in the system. Further analysis would be required to review the extent of these healthcare savings in practice.
