St Ann's Hospital

BackgroundFood Is Medicine interventions show promise for improving cardiovascular health outcomes, particularly for addressing disparities affecting Black and Hispanic populations. However, their development often lacks community co‐creation. Human‐centered design approaches can enhance the acceptability and feasibility of interventions through co‐design processes. We aimed to co‐design the THRIVE program (Adaptive Personalized Dietitian Coaching and Messaging With Produce Prescriptions to Improve Healthy Dietary Behaviors) among Black and Hispanic adults with hypertension living in healthy food priority areas in Maryland.MethodsUsing social cognitive theory and the human‐centered design double‐diamond framework, 3 iterative co‐design sessions were conducted. The first session included an orientation/listening (virtual), followed by 2 in‐person prototyping and process mapping sessions. Participants included community residents with hypertension, health care providers, local food system representatives, and community organization leaders. Data collection included detailed session notes, post‐session surveys, prototypes, and documentation of visual outputs. Content analysis identified key implementation themes.ResultsThirty‐six community stakeholders (29 female, 6 male, 17 English‐speaking, 18 Spanish‐speaking/bilingual) participated. Three primary themes emerged: (1) health care system integration, emphasizing personalized dietitian support with cultural competency; (2) food access and education, highlighting flexible produce prescription programs with practical nutrition education; and (3) community empowerment, emphasizing peer support networks. Process evaluation demonstrated high engagement, with 100% reporting valued contributions and 92% recommending similar approaches for future cardiovascular interventions.ConclusionsHuman‐centered design effectively guided community engagement in the development of a contextually tailored Food Is Medicine intervention. Integrating human‐centered design with implementation science creates more effective, equitable, and sustainable health interventions for addressing complex health challenges.

This review paper explores the synergistic effects of obesity, hypertension (HTN), and hyperlipidemia on cardiovascular health by integrating pathophysiological and clinical perspectives. Obesity, characterized by excessive body fat, HTN, defined by elevated blood pressure, and hyperlipidemia, indicated by high blood lipid levels, are globally prevalent conditions that significantly increase the risk of cardiovascular diseases (CVDs). The interplay between these conditions exacerbates cardiovascular risk through mechanisms such as chronic inflammation, insulin resistance, endothelial dysfunction, arterial stiffness, and atherogenesis. This review synthesizes epidemiological evidence and highlights the prevalence and co-occurrence of these conditions, with an emphasis on their combined impact on cardiovascular health. The literature search encompassed various databases, and data extraction included key study characteristics and outcomes. The findings underscore the importance of integrated management strategies, involving lifestyle interventions, pharmacological treatments, and regular monitoring, to mitigate the heightened cardiovascular risk posed by these conditions. In addition, the various public health implications are addressed, advocating for community-based interventions and policy changes. Future research directions may include exploring novel therapeutic approaches, personalized medicine strategies, and longitudinal studies to enhance the understanding and management of the synergistic effects of obesity, HTN, and hyperlipidemia on cardiovascular health.

Evidence of protection from childhood Bacillus Calmette-Guerin (BCG) against tuberculosis (TB) in adulthood, when most transmission occurs, is important for TB control and resource allocation. We conducted a population-based case-control study of protection by BCG given to children aged 12-13 years against tuberculosis occurring 10-29 years later. We recruited UK-born White subjects with tuberculosis and randomly sampled White community controls. Hazard ratios and 95% confidence intervals (CIs) were estimated using case-cohort Cox regression, adjusting for potential confounding factors, including socio-economic status, smoking, drug use, prison and homelessness. Vaccine effectiveness (VE = 1 - hazard ratio) was assessed at successive intervals more than 10 years following vaccination. We obtained 677 cases and 1170 controls after a 65% response rate in both groups. Confounding by deprivation, education and lifestyle factors was slight 10-20 years after vaccination, and more evident after 20 years. VE 10-15 years after vaccination was 51% (95% CI 21, 69%) and 57% (CI 33, 72%) at 15-20 years. Subsequently, BCG protection appeared to wane; 20-25 years VE = 25% (CI -14%, 51%) and 25-29 years VE = 1% (CI -84%, 47%). Based on multiple imputation of missing data (in 17% subjects), VE estimated in the same intervals after vaccination were similar [56% (CI 33, 72%), 57% (CI 36, 71%), 25% (-10, 48%), 21% (-39, 55%)]. School-aged BCG vaccination offered moderate protection against tuberculosis for at least 20 years, which is longer than previously thought. This has implications for assessing the cost-effectiveness of BCG vaccination and when evaluating new TB vaccines.

Atypical presentations of genital herpes simplex virus have been described in HIV. We report two cases with hypertrophic presentations which were effectively treated with imiquimod, one of which is the first reported case occurring in a patient with HIV-2.

A learning zone article broadened Andrew Clark’s understanding of prevention and treatment

This study aims to explore perceptions of eating disorder service strengths and to develop a clearer picture of improvements clinicians would like to see occur in the services they lead. A survey designed by the Royal College of Psychiatrists' Section of Eating Disorders was completed by 83 lead clinicians in both public and private sector services in the UK and Eire. Content analysis was performed, and common themes were identified. Five main strengths of a service were identified as follows: quality of treatment (n = 36), staff skills (n = 21), continuity of care (n = 15), family involvement (n = 12) and accessibility and availability (n = 11). These themes also arose when clinicians evaluated areas they wished to develop and improve. Service providers' views were congruent with each other, NICE guidelines and quality standards as proposed by the Royal College. Although clinicians feel that their service fulfils many practice guidelines, there remains areas in which adherence is felt to be lacking.

Mentalization is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful based on intentional mental states (e.g., desires, needs, feelings, beliefs, and reasons). This process is disrupted in individuals with comorbid antisocial (ASPD) and borderline personality disorder (BPD), who tend to misinterpret others' motives. Antisocial characteristics stabilize mentalizing by rigidifying relationships within prementalistic ways of functioning. However, loss of flexibility makes the person vulnerable to sudden collapse when the schematic representation is challenged. This exposes feelings of humiliation, which can only be avoided by violence and control of the other person. The common path to violence is via a momentary inhibition of the capacity for mentalization. In this article, the authors outline their current understanding of mentalizing and its relation to antisocial characteristics and violence. This is illustrated by a clinical account of mentalization-based treatment adapted for antisocial personality disorder. Treatment combines group and individual therapy. The focus is on helping patients maintain mentalizing about their own mental states when their personal integrity is challenged. A patient with ASPD does not have mental pain associated with another's state of mind; thus, to generate conflict in ASPD by thinking about the victim will typically be ineffective in inducing behavior change.

Aims and MethodWe surveyed educational supervisors and trainees in Wessex about their experience of the first 6 months of using workplace-based assessments (WPBAs), to see whether they needed further support in using them and, if so, in which areas. An anonymous questionnaire was sent to all trainees and educational supervisors in Wessex.ResultsOverall, 63% of trainees and 61% of educational supervisors responded; 22% of supervisors had not received training in WPBA and 61% of trainees identified barriers to completing it. Non-medical staff were rarely approached for assessments.Clinical ImplicationsThere is a need for further training of supervisors, a more user-friendly IT system and expansion of the role of non-medical staff as assessors.