Caloric Sweetened Beverage Taxes: The Good Food/Bad Food Trap

Beverage Taxes, Obesity Prevention, Public Health Strategies, Agricultural and Food Policy, Food Security and Poverty, Health Economics and Policy, H, H2, H25,

Report of ESCOP Subcommittee on Domestic and International Markets and Policy

International Relations/Trade,

App Assisted Depression Self-Management in Integrated Primary Care: A Pilot Study Exploring Patient and Provider Experiences

The integrated primary care (IPC) setting is currently the de facto institution for accessing mental healthcare among underserved populations. However, many barriers exist for these populations when seeking regular and adequate mental healthcare, including provider availability and transportation challenges. This study piloted the incorporation of mindLAMP, a mHealth app, into IPC treatment to offer a low-resource intervention designed to improve and expand access to mental healthcare for underserved patients between face-to-face visits. This study gathered data from a sample of both behavioral health providers and patients (N = 6) in IPC settings to pilot the use of the mindLAMP app among traditionally underserved patients with depression. The Patient Activation Measure and Patient Health Questionnaire were used to assess patient outcomes in addition to conducting a directed content analysis on qualitative data obtained with interviews of both patients and providers. Results from the mixed methods study design indicate that implementing this digital intervention in the IPC setting is feasible and positively experienced by both patients and providers. Perceived positive outcomes were reported by both patients and providers after incorporating the mHealth app into their mental healthcare. However, both patients and providers discussed barriers to mHealth app use that need to be addressed in order to accommodate more widespread use. Further, constraints and barriers at the provider, patient, and healthcare system levels were discussed and need to be examined further to increase the implementation of this multilevel digital intervention

Short-term responses of native bees to livestock and implications for managing ecosystem services in grasslands

Rangelands are significant providers of ecosystem services in agroecosystems world‐wide. Yet few studies have investigated how different intensities of livestock grazing impact one important provider of these ecosystem services—native bees. We conducted the first large‐scale manipulative study on the effect of a gradient of livestock grazing intensities on native bees in 16 40‐ha pastures in the Pacific Northwest Bunchgrass Prairie. Each pasture was exposed to one of four cattle stocking rates for two years and grazing intensity was quantified by measuring utilization. We measured soil and vegetation characteristics related to floral and nesting resources as well as several metrics of the bee community. Increased grazing intensity significantly reduced vegetation structure, soil stability, and herbaceous litter and significantly increased soil compaction and bare ground. Native bees responded with changes in abundance, richness, diversity, and community composition. Responses varied with taxa and time of season. Bumble bees were sensitive to grazing intensity early in the season, showing reduced abundance, diversity, and/or richness with increased intensity, potentially because of altered foraging behavior. In contrast, sweat bees appeared unaffected by grazing. These results show that native bee taxa vary in their sensitivity to livestock grazing practices and suggest that grazing may potentially be a useful tool for managing pollination services in mosaic agroecosystems that include rangelands

Pseudotumoural soft tissue lesions of the foot and ankle: a pictorial review

In the foot and ankle region, benign neoplasms and pseudotumoural soft tissue lesions are significantly more frequent than malignant tumours. The pseudotumoural lesions constitute a heterogeneous group, with highly varied aetiology and histopathology. This article reviews the imaging features of the most common pseudotumours of the soft tissues in the foot and ankle. Although the imaging characteristics of several of the lesions discussed are non-specific, combining them with lesion location and clinical features allows the radiologist to suggest a specific diagnosis in most cases

Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Background Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. Methods We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. Results 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. Conclusions In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care

Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Background: Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. Methods: We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (<135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration >10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. Results: 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was >3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. Conclusions: In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care