Scotland and the alternative disposal: Thinking differently?

Since its introduction to Scotland, the system of alternatives to prosecution has grown significantly both in terms of use and in the widening of available alternative measures. Despite this, there has been very little research carried out on alternative measures in Scotland. What will follow is a comparative study of the Scottish system with the system of the Netherlands. Prior to recent changes, the Netherlands’ system operated a model similar to that of Scotland but now operates a significantly more comprehensive range of alternatives to court prosecutions. It is concluded that alternatives to prosecution are imperative in a rounded justice system, but there are areas of development that may be feasible to improve the system in Scotland. In addition, recommendations are made for such improvements to the current system in Scotland and there is identification of areas for further research

Atlantic overturning in decline?

Global ocean circulation is an important factor in climate variability and change. In particular, changes in the strength of the Atlantic meridional overturning circulation (AMOC) have been implicated in ancient climate events, as well as in recent climate anomalies such as the rapid warming of the North Atlantic Ocean in the mid-1990s. A series of moored current meters and temperature sensors deployed in the Atlantic at 26° N known as the RAPID-MOCHA array has been used to monitor the strength of meridional overturning since 2004. The data indicate a decline in this strength over the period 2004–20123. Here, using additional observations and climate model simulations we suggest that this measured decline is not merely a short-term fluctuation, but is part of a substantial reduction in meridional overturning occurring on a decadal timescale

Prevalence of chronic kidney disease in the community in the United Kingdom in OxRen, a population-based cohort study

Background: Chronic kidney disease (CKD) is a largely asymptomatic condition of diminished renal function, which may not be detected until advanced stages without screening. Aim: To establish undiagnosed and overall CKD prevalence using a cross-sectional analysis. Design and Setting: Longitudinal cohort study in UK primary care. Method: Participants aged ≥60 years were invited to attend CKD screening visits to determine whether they had reduced renal function (estimated glomerular filtration rate [eGFR] Results: A total of 3207 participants were recruited and 861 attended the baseline assessment. The CKD cohort consisted of 327 people with existing CKD, 257 people with CKD diagnosed through screening (CKD prevalence of 18.2%, 95% confidence interval [CI] = 16.9 to 19.6), and 277 with borderline/transient decreased renal function. In the CKD cohort, 54.4% were female, mean standard deviation (SD) age was 74.0 (SD 6.9) years, and mean eGFR was 58.0 (SD 18.4) ml/min/1.73 m2. Of the 584 with confirmed CKD, 44.0% were diagnosed through screening. Over half of the CKD cohort (51.9%, 447/861) fell into CKD stages 3–5 at their baseline assessment, giving an overall prevalence of CKD stages 3–5 of 13.9% (95% CI = 12.8 to 15.1). More people had reduced eGFR using the Modification of Diet in Renal Disease (MDRD) equation than with CKD Epidemiology Collaboration (CKD-EPI) equation in the 60–75-year age group and more had reduced eGFR using CKD-EPI in the ≥80-year age group. Conclusion: This study found that around 44.0% of people living with CKD are undiagnosed without screening, and prevalence of CKD stages 1–5 was 18.2% in participants aged >60 years. Follow-up will provide data on annual incidence, rate of CKD progression, determinants of rapid progression, and predictors of cardiovascular events.</p

Five-Year Longitudinal Assessment of the Downstream Impact on Schistosomiasis Transmission following Closure of the Three Gorges Dam

Schistosomiasis, caused by Schistosoma japonicum, is a significant parasitic disease and public health problem in China. How the parasite is transmitted there can be categorized into four distinct modes (modes I–IV) and it is predicted that the Three Gorges Dam, recently completed, will affect the way schistosomiasis is spread in these modes. We monitored transmission for a 5-year period (2002–2006) in eight villages, representative of the three modes (I–III) below the dam across four provinces (Hunan, Jiangxi, Hubei and Anhui) to determine whether there was any immediate impact of the dam on schistosomiasis spread. Human schistosomiasis incidence declined considerably within individual villages and each mode, and the yearly odds ratios (adjusted) for infection risk showed significant downward trends in all three modes over the follow-up period. The decreased human S. japonicum incidence recorded across transmission modes I–III was probably attributable to annual human and bovine praziquantel drug treatment. If an increase in schistosome transmission had occurred as a result of the dam, it would be of negligible size compared with this treatment-induced decline. There had thus been virtually no immediate impact of the TGD on schistosomiasis transmission downstream of the dam over the 5-year surveillance period

Analysis of the UK Government's 10-Year Drugs Strategy - a resource for practitioners and policymakers

In 2021, during a drug-related death crisis in the UK, the Government published its ten-year drugs strategy. This article, written in collaboration with the Faculty of Public Health and the Association of Directors of Public Health, assesses whether this Strategy is evidence-based and consistent with international calls to promote public health approaches to drugs, which put ‘people, health and human rights at the centre’. Elements of the Strategy are welcome, including the promise of significant funding for drug treatment services, the effects of which will depend on how it is utilized by services and local commissioners and whether it is sustained. However, unevidenced and harmful measures to deter drug use by means of punishment continue to be promoted, which will have deleterious impacts on people who use drugs. An effective public health approach to drugs should tackle population-level risk factors, which may predispose to harmful patterns of drug use, including adverse childhood experiences and socioeconomic deprivation, and institute evidence-based measures to mitigate drug-related harm. This would likely be more effective, and just, than the continuation of policies rooted in enforcement. A more dramatic re-orientation of UK drug policy than that offered by the Strategy is overdue.Output Status: Forthcoming/Available Online Additional co-authors: Edward Day, Jason Horsley, Fiona Measham, Maggie Rae, Kevin Fenton, Matthew Hickma

Nonbinary and binary transgender youth: Comparison of mental health, self-harm, suicidality, substance use and victimisation experiences

Background: Little research has compared the mental health and victimisation experiences of nonbinary youth depending on their sex assigned at birth (SAAB), or compared these two groups with binary transgender youth. Aims: To compare mental health, self-harm and suicidality, substance use and victimisation experiences between nonbinary and binary transgender young adults, both male assigned at birth (MAAB) and female assigned at birth (FAAB). Methods: Online survey data from 677 participants from the ‘Youth Chances’ community study of 16 to 25 year-olds in the United Kingdom was analysed, comparing across binary participants (transgender females (n=105) and transgender males (n=210)) and nonbinary participants (MAAB (n=93) and FAAB (n=269)). Results: Female SAAB participants (binary and nonbinary) were more likely to report a current mental health condition and history of self-harm than male SAAB participants (binary and nonbinary). Similarly, female SAAB participants (binary and nonbinary) were more likely to report childhood sexual abuse than male SAAB participants (binary and nonbinary); the reverse pattern was found for lifetime physical assault relating to being LGBTQ. Nonbinary MAAB participants were less likely than the other groups to report past suicide attempts and previous help-seeking for depression / anxiety. Binary participants reported lower life satisfaction than nonbinary participants. For all four groups, mental health problems, self-harm, suicidality, alcohol use and victimisation experiences were generally higher than that of youth in general population studies. Conclusions: These findings highlight the importance of considering both nonbinary versus binary gender identity and sex assigned at birth in relation to mental health problems, self-harm, suicidality and substance use in transgender youth. The roles of sexual abuse, other abuse and discrimination in contributing to increased rates of mental illness and self-harm in nonbinary and binary transgender individuals, particularly those who were assigned female at birth, relative to those assigned male, require investigation