To meet the UK's greenhouse gas (GHG) emissions targets, the Climate Change Committee (CCC) recommended to reduce current meat and dairy intake by 20% by 2030. In this study, we modelled the impact of potential dietary changes on GHG emissions and water use with the selected scenarios based on the trend of food purchase and meat and dairy reduction policy. We show that implementing fiscal measures and facilitating innovations in production of meat alternatives would accelerate existing positive trends, help the UK reach the CCC 2030 target of 20% meat and dairy reduction and increase fruit and vegetable intake.

We used 2001–2019 data from the Family Food module of the Living Costs and Food Survey (LCF), an annual UK survey of about 5,000 representative households recording quantities of all food and drink purchases, to model four 2030 dietary scenarios: Business as usual (BAU); two fiscal policy scenarios (‘fiscal 10%’ and ‘fiscal 20%’), combining either a 10% meat and dairy tax and a 10% fruit and vegetable subsidy, or a 20% tax and 20% subsidy on the same foods; and an ‘innovation scenario’ substituting traditionally-produced meat and dairy with plant-based analogues and animal proteins produced in laboratories. Compared to 2019 levels, we forecasted reductions in the range of 5–30% for meat and 8–32% for dairy across scenarios. Meat reductions could be up to 21.5% (fiscal20%) and 30.4% (innovation). For all scenarios we forecasted an increase in fruit and vegetables intake in the range of 3–13.5%; with the fiscal 20% scenario showing highest increases (13.5%). GHG emissions and water use reductions were highest for the innovation scenario (−19.8%, −16.2%) followed by fiscal 20% (−15.8%, −9.2%) fiscal 10% (−12.1%, 5.9%) and BAU (−8.3%, −2.6%) scenarios. Compared to average households, low-income households had similar patterns of change, but both past and predicted purchase of meat, fruit and vegetables and environmental footprints were lower.

Meat and dairy-reduction policies would help meet net zero targets and improve population health in the UK.

To examine socioeconomic disparities in use of electroconvulsive therapy (ECT) among homeless or unstably housed (HUH) veterans with mental illness.

National data from medical records in years 2000 to 2019 on 4 to 6 million veterans with mental illness, including 140 000 to 370 000 homeless veterans served annually from the U.S. Department of Veterans Affairs (VA) healthcare system, were analyzed to examine ECT utilization and changes in utilization over time.

ECT utilization was higher among HUH veterans (58–104 per 1000) than domiciled veterans with mental illness (9–15 per 1000) across years with a trend toward increasing use of ECT use among HUH veterans over time. Among HUH and domiciled veterans who received ECT, veterans received an average of 5 to 9 sessions of ECT. There were great regional differences in rates of ECT utilization among HUH and domiciled veterans with the highest overall rates of ECT use at VA facilities in the Northeast and Northwest regions of the country.

ECT is commonly and safely used in HUH veterans in a comprehensive healthcare system, but geographic and local factors may impede access to ECT for veterans who may benefit from this treatment. Efforts should be made to reduce barriers to ECT in the HUH population.

The German health technology assessment (HTA) rejected additional benefit of alectinib for second line (2L) ALK+ NSCLC, citing possible biases from missing ECOG performance status data and unmeasured confounding in real-world evidence (RWE) for 2L ceritinib that was submitted as a comparator to the single arm alectinib trial. Alectinib was approved in the US and therefore US post-launch RWE can be used to evaluate this HTA decision.

We compared the real-world effectiveness of alectinib with ceritinib in 2L post-crizotinib ALK+ NSCLC using the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database. Using quantitative bias analysis (QBA), we estimated the strength of (i) unmeasured confounding and (ii) deviation from missing-at-random (MAR) assumptions needed to nullify any overall survival (OS) benefit.

Alectinib had significantly longer median OS than ceritinib in complete case analysis. The estimated effect size (Hazard Ratio: 0.55) was robust to risk ratios of unmeasured confounder-outcome and confounder-exposure associations of <2.4.

Based on tipping point analysis, missing baseline ECOG performance status for ceritinib-treated patients (49% missing) would need to be more than 3.4-times worse than expected under MAR to nullify the OS benefit observed for alectinib.

Only implausible levels of bias reversed our conclusions. These methods could provide a framework to explore uncertainty and aid decision-making for HTAs to enable patient access to innovative therapies.

Nonsuicidal self-injury (NSSI) is prevalent among adolescents and research is needed to clarify the mechanisms which contribute to the behavior. Here, the authors relate behavioral neurocognitive measures of impulsivity and compulsivity to repetitive and sporadic NSSI in a community sample of adolescents.

Computerized laboratory tasks (Affective Go/No-Go, Cambridge Gambling Task, and Probabilistic Reversal Task) were used to evaluate cognitive performance. Participants were adolescents aged 15 to 17 with (n = 50) and without (n = 190) NSSI history, sampled from the ROOTS project which recruited adolescents from secondary schools in Cambridgeshire, UK. NSSI was categorized as sporadic (1-3 instances per year) or repetitive (4 or more instances per year). Analyses were carried out in a series of linear and negative binomial regressions, controlling for age, gender, intelligence, and recent depressive symptoms.

Adolescents with lifetime NSSI, and repetitive NSSI specifically, made significantly more perseverative errors on the Probabilistic Reversal Task and exhibited significantly lower quality of decision making on the Cambridge Gambling Task compared to no-NSSI controls. Those with sporadic NSSI did not significantly differ from no-NSSI controls on task performance. NSSI was not associated with behavioral measures of impulsivity.

Repetitive NSSI is associated with increased behavioral compulsivity and disadvantageous decision making, but not with behavioral impulsivity. Future research should continue to investigate how neurocognitive phenotypes contribute to the onset and maintenance of NSSI, and determine whether compulsivity and addictive features of NSSI are potential targets for treatment.

Little is known about the impact of interpersonal betrayal experiences on mental health. Research suggests a link between betrayal and mental contamination (MC) within some forms of obsessive compulsive disorder (OCD). This study represents an initial exploration of that link in clinical samples.

A measure for assessing perceptions of betrayal was developed and evaluated (Study 1) in order to assess the extent of specificity of any association between the impact of betrayal and MC, and to estimate the extent of the impact of betrayal across common psychological disorders (Study 2).

In Study 1, the Perception of Betrayal Scale (POBS) was completed by 217 community participants; an exploratory principal components analysis identified the dimensional structure of the POBS. Study 2 was based on a cross-sectional, between-groups design, with three clinical groups [OCD (n = 23), other anxiety disorders (n = 21) and depression (n = 18)] and a non-clinical control group (n = 21). Three clinical groups (OCD, other anxiety disorders, and depression) and a community group completed a selection of measures via questionnaire.

In Study 1, the POBS was found to have an internal consistency of α = .95, and four factors were identified: preoccupation with betrayal events, belief that betrayal had caused major life change, lack of trust due to betrayal and betrayal leading to traumatic responses. In Study 2, the OCD group scored more highly in terms of maladaptive perceptions of betrayal than the other groups. Regression analysis showed betrayal scores to be a moderate predictor of the experience of MC; the POBS subscales lack of trust due to betrayal and betrayal leading to traumatic responses were found to be significantly associated with MC. Although there was some overlap with bitterness, betrayal better predicted MC.

Findings support the hypothesis of a specific relationship between the construct of betrayal and MC.

Patients with severe mental illness are at increased risk of cardiovascular disease because of lifestyle, co-morbidity and medication effects.

The aim of this audit is to ascertain the regularity of metabolic health checks, CVD risk assessment and adequate lipid modification therapy among patients on antipsychotic medication in 3 rehabilitation wards in county Durham and Darlington.

According to audit standards (based on NICE guidelines-Schizophrenia, Lipid Modification, Maudsley guidelines), All patients should have Blood Pressure, Body Mass Index (BMI), CVD risk assessment using appropriate calculator, Fasting blood glucose and Fasting Lipid profile done at least once a year. Lipid modification therapy has to be offered to those with 10 year CVD risk of 20% or greater. All 31 patients in 3 rehabilitation wards were included. We searched for these readings between 1/09/2010 to 30/08/2010 in patient records.

Of 31 patients, 26(84%) had blood pressure, 29(94%) had BMI and 11(35%) had either fasting blood sugar or HbA1c recorded. CVD risk assessment using calculator was not done in any patients. 19(61%) lipid profile done. Of the 19 patients 16 (84%) had abnormal lipid profile. 9 (26%) patients were on lipid modifying drugs, 6 (19%) patients were on appropriate dose of lipid modifying drugs.

Our audit identified a need for systemic assessment of physical health with emphasis on cardiovascular risk management (lifestyle education, lipid modification therapy) which are critical to minimising risks and preventing long term adverse health consequences.

Non-suicidal self-injury (NSSI) is highly prevalent in adolescents and may be a behavioural marker for emergent mental illnesses.

To determine whether sporadic or recurrent NSSI up to the age of 14 years predicted increased risk of new onset of psychiatric disorder in the subsequent 3 years, independent of psychiatric symptoms and social risk factors.

In total, 945 individuals aged 14 years with no past/present history of mental illness completed a clinical interview and completed a questionnaire about NSSI at the ages of 14 and 17 years.

Recurrent NSSI at baseline predicted total disorders, depression and eating disorders. Sporadic baseline NSSI predicted new onset of anxiety disorders only.

NSSI (especially recurrent NSSI) in the early-adolescent years is a behavioural marker of newly emerging mental illnesses. Professionals should treat both recurrent and sporadic NSSI as important risk factors, and prevention strategies could be targeted at this vulnerable group.

None.