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Introduction: Social determinants of health (SDOH) contribute to differences in health outcomes and exacerbate health disparities. This study characterizes the National Institute on Minority Health and Health Disparities' (NIMHD) portfolio of funded grants in SDOH research, identifies gaps, and provides suggestions for future research., Methods: Using the National Institutes of Health's SDOH Research, Condition, and Disease Categorization, research projects funded from 2019 to 2023 were identified and linked with NIMHD's internal coding system to extract in-depth study characteristics, including sociodemographics of study participants, disease and condition focus, and alignment with strategic priorities. Natural Language Processing methods were used to categorize projects into five Healthy People 2030 SDOH domains., Results: The resulting sample included 675 unique research projects. Most projects included racial and ethnic minority groups (89%), followed by people with lower socioeconomic status (33%), underserved rural communities (16%), and sexual and gender minority groups (13%). Most projects focused on the Etiology of health disparities (61%), followed by Interventions (54%), and Methods and Measurement (39%). Of the Healthy People 2030 domains, Social and Community Context had the greatest representation (61%) whereas Education Access and Quality had the least (6%). Variation in research project characteristics across SDOH domains is also presented., Conclusions: This study documents characteristics of SDOH research funded by NIMHD and explores how they differ across Healthy People 2030 SDOH domains. Findings highlight how study characteristics and foci align with strategic priorities and suggest opportunities for future research., (Published by Elsevier Inc.)

Background: Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. Obesity exacerbates the reproductive complications of PCOS; however, the management of obesity in women with PCOS remains a large unmet clinical need. Observational studies have indicated that bariatric surgery could improve the rates of ovulatory cycles and prospects of fertility; however, the efficacy of surgery on ovulation rates has not yet been compared with behavioural modifications and medical therapy in a randomised trial. The aim of this study was to compare the safety and efficacy of bariatric surgery versus medical care on ovulation rates in women with PCOS, obesity, and oligomenorrhoea or amenorrhoea., Methods: In this multicentre, open-label, randomised controlled trial, 80 women older than 18 years, with a diagnosis of PCOS based on the 2018 international evidence-based guidelines for assessing and managing PCOS, and a BMI of 35 kg/m 2 or higher, were recruited from two specialist obesity management centres and via social media. Participants were randomly assigned at a 1:1 ratio to either vertical sleeve gastrectomy or behavioural interventions and medical therapy using a computer-generated random sequence (PLAN procedure in SAS) by an independent researcher not involved with any other aspect of the clinical trial. The median age of the entire cohort was 31 years and 79% of participants were White. The primary outcome was the number of biochemically confirmed ovulatory events over 52 weeks, and was assessed using weekly serum progesterone measurements. The primary endpoint included the intention-to-treat population and safety analyses were per-protocol population. This study is registered with the ISRCTN registry (ISRCTN16668711)., Findings: Participants were recruited from Feb 20, 2020 to Feb 1, 2021. 40 participants were assigned to each group and there were seven dropouts in the medical group and ten dropouts in the surgical group. The median number of ovulations was 6 (IQR 3·5-10·0) in the surgical group and 2 (0·0-4·0) in the medical group. Women in the surgical group had 2.5 times more spontaneous ovulations compared with the medical group (incidence rate ratio 2·5 [95% CI 1·5-4·2], p<0·0007). There were more complications in the surgical group than the medical group, although without long-term sequelae. There were 24 (66·7%) adverse events in the surgical group and 12 (30·0%) in the medical group. There were no treatment-related deaths., Interpretation: Bariatric surgery was more effective than medical care for the induction of spontaneous ovulation in women with PCOS, obesity, and oligomenorrhoea or amenorrhoea. Bariatric surgery could, therefore, enhance the prospects of spontaneous fertility in this group of women., Funding: The Jon Moulton Charity Trust., Competing Interests: Declaration of interests ADM has received research funding from the Medical Research Council (MRC), National Institute for Health and Care Research (NIHR), Jon Moulton Charitable Foundation, Anabio, Fractyl, Boehringer Ingelheim, Gila, Randox, and Novo Nordisk. ADM has received honoraria for lectures and presentations from Novo Nordisk, AstraZeneca, Currax Pharmaceuticals, Boehringer Ingelheim, Screen Health, GI Dynamics, Algorithm, Eli Lilly, Ethicon, and Medtronic. ADM and CWlR are shareholders in the Beyond BMI clinic, which provides clinical obesity care. SA was supported by Princess Nourah bint Abdulrahman University Researchers Supporting Project (PNURSP2024R530), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. CWlR reported grants from the Irish Research Council, Science Foundation Ireland, Anabio, and the Health Research Board. CWlR has received honoraria for lectures and presentations from Novo Nordisk, Herbalife, Eli Lilly, Johnson & Johnson, Rhythm Pharmaceuticals, Currax Pharmaceuticals, and Boehringer Ingelheim. CWlR serves on advisory boards of Novo Nordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Altimmune, Irish Life Health, and Boehringer Ingelheim. CWlR plays a leadership role in the Irish Society for Nutrition and Metabolism. CWlR was the Chief Medical Officer and Director of the Medical Device Division of Keyron in 2021—both of these were unremunerated positions. CWlR was a previous investor in Keyron, which developed endoscopically implantable medical devices that mimic the surgical procedures of sleeve gastrectomy and gastric bypass. CWlR does not have any contracts with other companies to put their products into clinical practice. CWlR continues to provide scientific advice to Keyron for no remuneration. AA was supported by the NIHR Clinician Scientist Award and MRC project grant. AA has received consulting fees from Myovant Sciences and honoraria for a lecture from Merck. AA serves on the public engagement committee of the Society for Endocrinology. FS has received a grant from the Deutsche Forschungsgemeinschaft (2027/5–1). BL, AD, and PT received a grant from the Jon Moulton Charitable Foundation. GKD has received research grants from the NIHR, Novo Nordisk, and Diabetes Digital Media, as well as payment or honoraria for lectures and presentations from Novo Nordisk, Rhythm Pharmaceuticals, Eli Lilly, Ethicon, and Medtronic. GKD is a co-founder and shareholder in the Heracles Project clinic, which provides clinical care for men's health. GKD plays a leadership role in The Association for the Study of Obesity and is a member of the Society for Endocrinology–British Endocrine Society. RM has received a grant from the Waterloo Foundation, as well as payment and support from Roche Diagnostics and the Androgen Excess and Polycystic Ovary Syndrome Society. HR has received a grant from the Jon Moulton Charitable Foundation, as well as payment or honoraria from Novo Nordisk and support from Ipsen. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Congenital hyperinsulinism (CHI) is a condition characterised by severe and recurrent hypoglycaemia in infants and young children caused by inappropriate insulin over-secretion. CHI is of heterogeneous aetiology with a significant genetic component and is often unresponsive to standard medical therapy options. The treatment of CHI can be multifaceted and complex, requiring multidisciplinary input. It is important to manage hypoglycaemia in CHI promptly as the risk of long-term neurodisability arising from neuroglycopaenia is high. The UK CHI consensus on the practice and management of CHI was developed to optimise and harmonise clinical management of patients in centres specialising in CHI as well as in non-specialist centres engaged in collaborative, networked models of care. Using current best practice and a consensus approach, it provides guidance and practical advice in the domains of diagnosis, clinical assessment and treatment to mitigate hypoglycaemia risk and improve long term outcomes for health and well-being., Competing Interests: IB has received honoraria for advisory opinion from Merck and Diurnal Pharmaceuticals. He is the UK CI for clinical trials funded by Zealand Pharmaceuticals and has received grant funding from Merck, Diurnal and Crinetics Pharmaceuticals. IB is the Chair of the BSPED-NIHR Clinical Studies Group and the Chair of the ESPE Communications Committee. He is a co-opted member of the NICE Head Injury Update Committee. IB has advisory roles with several patient organisations including the Pituitary Foundation, Living with CAH, CHC and CHI. MGS has received funding/speaker honorium from Novo Nordisk, Sandoz, Pfizer and received honorarium for consultancies/advisory boards from Novo Nordisk, Pfizer and Merck. RK has received grant funding and honoraria for advisory opinion from Merck. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Shaikh, Lucas-Herald, Dastamani, Salomon Estebanez, Senniappan, Abid, Ahmad, Alexander, Avatapalle, Awan, Blair, Boyle, Chesover, Cochrane, Craigie, Cunjamalay, Dearman, De Coppi, Erlandson-Parry, Flanagan, Gilbert, Gilligan, Hall, Houghton, Kapoor, McDevitt, Mohamed, Morgan, Nicholson, Nikiforovski, O'Shea, Shah, Wilson, Worth, Worthington and Banerjee.)

This article examines how 'framing' is used to resist a proposal to remove rugby tackling from UK schools. It focuses on rugby tackling for UK school children, which is often a compulsory part of many schools' curricula. Specifically, we explore the importance of framing in how the problem is described in various academic publications, how ideas about risk are articulated and how advocates themselves are represented. We show how the corporate interests of rugby governing bodies can become entangled with distortions about injury prevention. These distortions (or framing practices) include omitting arguments, conflating arguments, changing the argument, misrepresenting advocacy positions and skewing advocate identities. Next, the article demonstrates how a combination of recent advocacy, political interventions, research and cultural shifts appears to be changing perceptions about the risks associated with rugby tackling for children in school settings. In conclusion, we argue that while framing can be a useful strategy for policy advocates, there is value in paying attention to how framing is used by different stakeholder groups., Competing Interests: Competing interests: The authors were signatories of an open letter which recommended the removal of tackling and harmful aspects from school rugby in the UK. JB, KP and JP are members of the Acquired Brain Injury Research Network. AJW and KP are affiliated with the Concussion Legacy Foundation UK. AJW has previously received funding from the European Union Erasmus programme. He is co-founder of the Concussion Legacy Foundation UK and is co-director of Concussion Legacy Project. He is currently employed as the Head of Brain Health at the Professional Footballers’ Association., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The skin barrier is important in the pathogenesis of atopic dermatitis and stratum corneum lipids have a critical role. Skin surface lipids have been largely overlooked but also contribute to barrier function. An untargeted approach was used to compare the skin surface lipids from atopic and non-atopic West Highland White terrier dogs (WHWT)., Objectives: The primary hypothesis was that a difference in the lipidome would exist. The secondary hypothesis was that affected and unaffected skin lipids would differ., Animals and Methods: This prospective, cross-sectional, case-controlled study included thirty-nine privately owned WHWTs. Dogs were assigned to one of four disease status groups based on strict criteria. Samples for lipid analysis were collected from the skin surface of unaffected and affected sites. Lipid analysis was by untargeted liquid chromatography/mass spectrometry and utilised lipid identification software packages. Principle component analysis (PCA) and partial least-squares discriminant analysis (sPLS-DA) statistical methods analysed the association between the relative lipid abundance and disease status and affected and unaffected skin., Results: Samples for lipid analysis found 421 lipid soluble features of which ten lipids were positively identified. Statistical analysis could not distinguish between non-atopic and atopic dogs but did reveal a statistically significant difference in the lipid profiles from affected and non-affected skin irrespective of disease status., Conclusions: A large array of unidentified lipids from the skin surface were found with a difference between affected and unaffected skin unrelated to disease status. Investigation into the lipidome of the skin surface is an emerging area of research with clinical and therapeutic applications.

Objective: Menstrual cycle-related conditions, such as dysmenorrhea and heavy bleeding, are common amongst those under 25 years. Despite having significant impact on work, education, and social activities, most do not seek medical advice, preferring to self-manage their symptoms. We aimed to determine if access to a web-based resource was a feasible and acceptable method for improving menstrual health literacy and encouraging health seeking behavior., Methods: People were eligible to participate if they were currently living in Australia, aged 14-25 years, and had menstruated for at least 12 months. Access to the resource, comprising evidence-based information on the menstrual cycle, the Period ImPact and Pain Assessment (PIPPA) tool, and guidance on self-management options, was provided for three menstrual cycles., Results: Seventy-five participants with a mean age of 20.4 years were enrolled with 56 (75%) providing pre and post measures. Recruitment rate and retention rates met pre-specified criteria for feasibility. Eighty five percent of the participants reported the web-based resource was easy to use, and 90% reported they found the information provided 'very helpful'. Just under half (48%) reported the resource changed what they thought was a 'normal' period. Forty-three percent visited their doctor regarding their menstrual symptoms during the study period, with 84% indicating that they made the appointment due to the resource; over half (56%) who visited their doctor received a referral to a gynecologist., Conclusion: Access to a web-based resource on menstrual health literacy was found to be acceptable and feasible to young people and may encourage health-seeking behavior., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Obesity is becoming increasingly prevalent in paediatric populations worldwide. In addition to increasing prevalence, the severity of obesity is also continuing to rise. Taken together, these findings demonstrate a worrying trend and highlight one of the most significant challenges to public health. Childhood obesity affects multiple organs in the body and is associated with both significant morbidity and ultimately premature mortality. The prevalence of complications associated with obesity, including dyslipidaemia, hypertension, fatty liver disease and psychosocial complications are becoming increasingly prevalent within the paediatric populations. Treatment guidelines currently focus on intervention with lifestyle and behavioural modifications, with pharmacotherapy and surgery reserved for patients who are refractory to such treatment. Research into adult obesity has established pharmacological novel therapies, which have been approved and established in clinical practice; however, the research and implementation of such therapies in paediatric populations have been lagging behind. Despite the relative lack of widespread research in comparison to the adult population, newer therapies are being trialled, which should allow a greater availability of treatment options for childhood obesity in the future. This review summarizes the current evidence for the management of obesity in terms of medical and surgical options. Both future therapeutic agents and those which cause weight loss but have an alternative indication are also included and discussed as part of the review. The review summarizes the most recent research for each intervention and demonstrates the potential efficacy and limitations of each treatment option., (© 2021 John Wiley & Sons Ltd.)