The art of endurance:implementation of lifestyle interventions in mental healthcare

BACKGROUND: An increasing number of studies in people with mental illness have demonstrated the efficacy of lifestyle interventions for both mental and physical health. However, implementing and sustaining such interventions in routine mental healthcare is challenging.&lt;br/&gt; AIM: To describe implementation barriers and facilitators of various lifestyle interventions in routine mental healthcare.&lt;br/&gt; METHOD: In this paper we summarise the results of three recent doctoral theses and provide recommendations for routine mental healthcare.&lt;br/&gt; RESULTS: Enabling factors and barriers for successful implementation appeared to be universal across various settings and patient populations. Mental healthcare professionals and patients appreciated and supported the lifestyle interventions. A lack of priority, recognition and support on the organisational level were reported as barriers in all the studies. Addressing various lifestyle behaviours simultaneously (e.g. physical activity and diet), personalised to the patients' abilities and preferences, and setting measurable and attainable goals, were important for success. Moreover, involving qualified professionals (e.g. exercise professionals and dietitians with expertise in mental healthcare) and ensuring cooperation between patients and healthcare professionals and disciplines within and outside mental healthcare appeared crucial.&lt;br/&gt; CONCLUSION: Successful implementation of lifestyle interventions in mental healthcare requires changes in culture and behaviour, a long-term strategy and endurance.</p

Removal of bacterial plant pathogens in columns filled with quartz and natural sediments under anoxic and oxygenated conditions

Irrigation with surface water carrying plant pathogens poses a risk for agriculture. Managed aquifer recharge enhances fresh water availability while simultaneously it may reduce the risk of plant diseases by removal of pathogens during aquifer passage. We compared the transport of three plant pathogenic bacteria with Escherichia coli WR1 as reference strain in saturated laboratory column experiments filled with quartz sand, or sandy aquifer sediments. E. coli showed the highest removal, followed by Pectobacterium carotovorum, Dickeya solani and Ralstonia solanacearum. Bacterial and non-reactive tracer breakthrough curves were fitted with Hydrus-1D and compared with colloid filtration theory (CFT). Bacterial attachment to fine and medium aquifer sand under anoxic conditions was highest with attachment rates of max. katt1 = 765 day-1 and 355 day-1, respectively. Attachment was the least to quartz sand under oxic conditions (katt1 = 61 day-1). In CFT, sticking efficiencies were higher in aquifer than in quartz sand but there was no differentiation between fine and medium aquifer sand. Overall removal ranged between < 6.8 log10 m−1 in quartz and up to 40 log10 m−1 in fine aquifer sand. Oxygenation of the anoxic aquifer sediments for two weeks with oxic influent water decreased the removal. The results highlight the potential of natural sand filtration to sufficiently remove plant pathogenic bacteria during aquifer storage

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

De kunst van de lange adem: implemen-tatie van leefstijlinterventies in de ggz

BACKGROUND: An increasing number of studies in people with mental illness have demonstrated the efficacy of lifestyle interventions for both mental and physical health. However, implementing and sustaining such interventions in routine mental healthcare is challenging. AIM: To describe implementation barriers and facilitators of various lifestyle interventions in routine mental healthcare. METHOD: In this paper we summarise the results of three recent doctoral theses and provide recommendations for routine mental healthcare. RESULTS: Enabling factors and barriers for successful implementation appeared to be universal across various settings and patient populations. Mental healthcare professionals and patients appreciated and supported the lifestyle interventions. A lack of priority, recognition and support on the organisational level were reported as barriers in all the studies. Addressing various lifestyle behaviours simultaneously (e.g. physical activity and diet), personalised to the patients' abilities and preferences, and setting measurable and attainable goals, were important for success. Moreover, involving qualified professionals (e.g. exercise professionals and dietitians with expertise in mental healthcare) and ensuring cooperation between patients and healthcare professionals and disciplines within and outside mental healthcare appeared crucial. CONCLUSION: Successful implementation of lifestyle interventions in mental healthcare requires changes in culture and behaviour, a long-term strategy and endurance

Prevention of well clogging during aquifer storage of turbid tile drainage water rich in dissolved organic carbon and nutrients

Well clogging was studied at an aquifer storage transfer and recovery (ASTR) site used to secure freshwater supply for a flower bulb farm. Tile drainage water (TDW) was collected from a 10-ha parcel, stored in a sandy brackish coastal aquifer via well injection in wet periods, and reused during dry periods. This ASTR application has been susceptible to clogging, as the TDW composition largely exceeded most clogging mitigation guidelines. TDW pretreatment by sand filtration did not cause substantial clogging at a smaller ASR site (2 ha) at the same farm. In the current (10 ha) system, sand filtration was substituted by 40-μm disc filters to lower costs (by 10,000–30,000 Euro) and reduce space (by 50–100 m2). This measure treated TDW insufficiently and injection wells rapidly clogged. Chemical, biological, and physical clogging occurred, as observed from elemental, organic carbon, 16S rRNA, and grain-size distribution analyses of the clogging material. Physical clogging by particles was the main cause, based on the strong relation between injected turbidity load and normalized well injectivity. Periodical backflushing of injection wells improved operation, although the disc filters clogged when the turbidity increased (up to 165 NTU) during a severe rainfall event (44 mm in 3 days). Automated periodical backflushing, together with regulating the maximum turbidity (&lt;20 NTU) of the TDW, protected ASTR operation, but reduced the injected TDW volume by ~20–25%. The studied clogging-prevention measures collectively are only viable as an alternative for sand filtration when the injected volume remains sufficient to secure the farmer’s needs for irrigation.</p

Removal of bacterial plant pathogens in columns filled with quartz and natural sediments under anoxic and oxygenated conditions.

Irrigation with surface water carrying plant pathogens poses a risk for agriculture. Managed aquifer recharge enhances fresh water availability while simultaneously it may reduce the risk of plant diseases by removal of pathogens during aquifer passage. We compared the transport of three plant pathogenic bacteria with Escherichia coli WR1 as reference strain in saturated laboratory column experiments filled with quartz sand, or sandy aquifer sediments. E. coli showed the highest removal, followed by Pectobacterium carotovorum, Dickeya solani and Ralstonia solanacearum. Bacterial and non-reactive tracer breakthrough curves were fitted with Hydrus-1D and compared with colloid filtration theory (CFT). Bacterial attachment to fine and medium aquifer sand under anoxic conditions was highest with attachment rates of max. katt1 = 765 day-1 and 355 day-1, respectively. Attachment was the least to quartz sand under oxic conditions (katt1 = 61 day-1). In CFT, sticking efficiencies were higher in aquifer than in quartz sand but there was no differentiation between fine and medium aquifer sand. Overall removal ranged between < 6.8 log10 m-1 in quartz and up to 40 log10 m-1 in fine aquifer sand. Oxygenation of the anoxic aquifer sediments for two weeks with oxic influent water decreased the removal. The results highlight the potential of natural sand filtration to sufficiently remove plant pathogenic bacteria during aquifer storage