Predicting Accelerometer-Assessed Estimates of Adolescents' Multidimensional Physical Activity: A Self-Determination Theory Approach.

Based on the tenets in self-determination theory, a dual-process model of motivational processes was tested to predict accelerometer-assessed estimates of adolescents' light physical activity (LPA), moderate to vigorous physical activity (MVPA), and sedentary time. Here, we hypothesized that (a) perceptions of psychological need support for exercise would be positively associated with LPA and MVPA and negatively associated with sedentary time via exercise-related psychological need satisfaction and autonomous exercise motivation and (b) perceptions of psychological need thwarting for exercise would be negatively associated with LPA and MVPA and positively associated with sedentary time via exercise-related psychological need frustration and controlled exercise motivation. Adolescents (N = 338; 234 female) age 11-15 years (M = 12.75, SD = .90) wore an ActiGraph accelerometer for 8 days and completed questionnaires pertaining to the self-determination-theory variables. Results showed psychological need support to indirectly and positively predict LPA and MVPA via psychological need satisfaction and autonomous exercise motivation. Although directly predictive of need frustration and indirectly predictive of controlled motivation and amotivation, the hypothesized effects from psychological need thwarting to the behavioral outcomes were nonsignificant. The current findings highlight the important role that need-supportive environments play in facilitating autonomous exercise motivation and behavior by being conducive to exercise-related psychological need satisfaction.

Perioperative Malnutrition.

CASE SUMMARY: A 61-year-old man presented with penetrating Crohn's ileocolitis and neoterminal ileal fibrostenotic stricture. He developed an anastomotic leak after a redo ileocolic resection and now has a chronic low-output enterocutaneous fistula. He was transferred from an outside institution for further management and is currently without Crohn's disease (CD)-related medical therapy. The fistula output is 25 to 50 mL/day of GI contents. His weight dropped by 25 pounds in 6 months after surgery with a current BMI of 19.1, albumin of 2.0 g/dL, and hemoglobin of 9.7 g/dL. During a 3-month period, he was optimized for surgery with local wound care, initiation of infliximab, and nutritional support with exclusive enteral nutrition (EEN). He gained 9 pounds (BMI 20.4). Albumin improved to 3.4 g/dL and hemoglobin to 12.1 g/dL. He underwent a successful open takedown of the enterocutaneous fistula with ileocolic anastomosis.

Far From Home: The Role of Travel Distance and Care Fragmentation in Surgical Outcomes for Inflammatory Bowel Disease.

Background: Fragmented care for inflammatory bowel disease (IBD) is known to correlate negatively with outcomes, but it is unclear which aspects of care fragmentation are relevant and potentially modifiable. Furthermore, there is little data on the relationship between travel distance and the benefits of integrated care models. Hypothesizing care coordination in the preoperative period may have a significant impact on surgical outcomes, we explored associations between integrated care, travel distance, and surgical outcomes. Methods: A single-center retrospective cohort study of patients undergoing index abdominal surgery was done to compare the rate of surgical complications with and without long travel distance and nonintegrated preoperative care. Multivariable logistic regression was used to identify factors independently associated with complications. Results: One hundred and fifty-seven patients were included. Complications were more common among patients with travel distance >75 miles (47.6% vs 27.4%, P = .012). Integrated preoperative care was not significant on bivariate (P = .381) or multivariable analysis but had a stronger association among patients with travel distance <75 miles (20.9% integrated vs 36.7%, P = .138). After adjustment, new ileostomy, open surgical approach, and distance >75 miles were independently associated with complications. Conclusions: Patients with longer travel distances to the hospital were twice as likely to have a surgical complication after adjusting for other risk factors. Without significant accommodations for remote patients, potential benefits of an integrated model for IBD care may be limited to patients who live close to the medical center. Future efforts addressing continuity of care should consider tactics to mitigate the impact of travel distance on outcomes.

Perioperative Nutritional Considerations in Colon and Rectal Surgery.

Malnutrition is common in surgical patients and is associated with substantially increased morbidity and mortality. Dedicated assessment of nutritional status is advised by major nutrition and surgical societies. Assessment may utilize comprehensive and validated nutritional assessment tools or targeted history, physical examination with accompanying serologic markers to identify nutritional risk preoperatively. Emergent surgery in malnourished patients should proceed as the clinical situation dictates with consideration of ostomy or primary anastomosis with proximal fecal diversion to mitigate postoperative infectious complications. Nonemergent surgery should be delayed to facilitate nutritional optimization via oral nutritional supplementation preferably and total parenteral nutrition if necessary for at least 7 to 14 days. Exclusive enteral nutrition may be considered to optimize nutritional status and inflammation in patients with Crohn's disease. Immunonutrition use in the preoperative setting is not supported by evidence. Perioperative and postoperative immunonutrition may be of benefit but requires dedicated study in the contemporary era. Close attention to preoperative nutritional status and optimization represents a critical opportunity to improve outcomes in patients undergoing colorectal surgery.

What's up with everyone?': The effectiveness of a digital media mental health literacy campaign for young people.

BACKGROUND: In 2021, the Arts and Humanities Research Council commissioned a mass-media mental health campaign called "What's up With Everyone?" Here, innovative co-created messages were professionally storied and animated by an internationally recognized production company and focused on improving mental health literacy in five core areas: competition, social media, perfectionism, loneliness and isolation, and independence. AIMS: This study examines the impact of the "What's up With Everyone?" campaign on young people's mental health awareness. METHODS: Seventy-one (19 males, 51 females, M age = 19.20 years, SD = 1.66, range = 17-22) young people completed a one-sample, pre-post experiment to measure changes in knowledge, attitudes, confidence, and stigma of mental health struggles, as well as help-seeking for mental ill-health before and following exposure to animations. RESULTS: Paired and one-sample t-tests revealed that knowledge, attitudes, confidence, and willingness to seek support improved at post-test. There were also significant reductions in the stigma towards depression following the animations. CONCLUSIONS: Continued long-term investment in campaigns such as "What's up With Everyone?" seems warranted given the impact on mental health awareness, help-seeking, and stigma.

Young People's Trust in Cocreated Web-Based Resources to Promote Mental Health Literacy: Focus Group Study.

BACKGROUND: There is a pressing need to create resources to promote mental health literacy among young people. Digital media is one of the methods that can be used to successfully promote mental health literacy. Although digital mental health resources are generally favorably perceived by young people, one of the essential factors in whether they choose to use these interventions is trust. OBJECTIVE: The objective of this study was to explore young people's trust-related concerns about and recommendations for the cocreated mental health website "What's Up With Everyone" by using TrustScapes. Our aim was to use the findings to improve the trustworthiness of the website and to inform future creators of web-based mental health resources. METHODS: In total, 30 young people (mean age 19, SD 1.509; range 17-21 years) participated in TrustScapes focus groups. Thematic analysis was carried out to analyze both the TrustScapes worksheets and audio transcripts. RESULTS: Qualitative analysis revealed that the mental health website contains elements perceived to be both trustworthy and untrustworthy by young people. The relatable and high-quality design, which was achieved by cocreating the website with a team of design professionals and young people, was considered to increase trust. Creators' credibility also positively affected trust, but the logos and other information about the creators were recommended to be more salient for users. Suggestions were made to update the privacy policy and cookie settings and include communication functions on the platform to improve the trustworthiness of the website. CONCLUSIONS: Factors perceived to be trustworthy included the website's relatable, high-quality design and creators' credibility, whereas those perceived to be untrustworthy included the privacy policy and cookie settings. The findings highlighted the significance of collaborating with end users and industrial partners and the importance of making the trust-enabling factors salient for users. We hope that these findings will inform future creators of web-based mental health resources to make these resources as trustworthy and effective as possible.

Ammonia emissions from agriculture and their contribution to fine particulate matter: A review of implications for human health.

Atmospheric ammonia (NH3) released from agriculture is contributing significantly to acidification and atmospheric NH3 may have on human health is much less readily available. The potential direct impact of NH3 on the health of the general public is under-represented in scientific literature, though there have been several studies which indicate that NH3 has a direct effect on the respiratory health of those who handle livestock. These health impacts can include a reduced lung function, irritation to the throat and eyes, and increased coughing and phlegm expulsion. More recent studies have indicated that agricultural NH3 may directly influence the early on-set of asthma in young children. In addition to the potential direct impact of ammonia, it is also a substantial contributor to the fine particulate matter (PM2.5) fraction (namely the US and Europe); where it accounts for the formation of 30% and 50% of all PM2.5 respectively. PM2.5 has the ability to penetrate deep into the lungs and cause long term illnesses such as Chronic Obstructive Pulmonary Disease (COPD) and lung cancer. Hence, PM2.5 causes economic losses which equate to billions of dollars (US) to the global economy annually. Both premature deaths associated with the health impacts from PM2.5 and economic losses could be mitigated with a reduction in NH3 emissions resulting from agriculture. As agriculture contributes to more than 81% of all global NH3 emissions, it is imperative that food production does not come at a cost to the world's ability to breathe; where reductions in NH3 emissions can be easier to achieve than other associated pollutants.

Selective type & screen for elective colectomy based on a transfusion risk score may generate substantial cost savings.

BACKGROUND: Preoperative type and screen are currently recommended for all patients undergoing colectomy. We aimed to identify risk factors for transfusion and define a low-risk cohort of patients undergoing colectomy in whom type and screen may be safely avoided. METHODS: We identified all patients undergoing elective colectomy in the National Surgical Quality Improvement Project-Targeted Colectomy files from 2012 to 2016. Patients transfused preoperatively and those undergoing other concurrent major abdominal procedures were excluded. We compared patients who received blood transfusion on the day of surgery to those who did not. Half of the cohort was randomly selected for development of a points-based model predicting blood transfusion on the day of surgery. This model was then validated using the remaining patients. RESULTS: Of 61,964 patients undergoing colectomy, 3128 (5%) patients were transfused with 1290 (2.1%) occurring on the day of surgery. Preoperative anemia was the strongest predictor of blood transfusion on the day of surgery. Among patients with hematocrit > 35%, day of surgery transfusion risk was 0.8%; 99% of patients with hematocrit > 35% had a score 20 or less. Selective type and screen for patients with score ≤ 20 or hematocrit > 35% would avoid type and screen in 91% and 81% of patients, respectively. CONCLUSION: Transfusion following elective colectomy is rare and can be accurately predicted by preoperative patient characteristics. Selective type and screen based on these parameters have the potential to prevent operative delays and lower cost.

What's Up With Everyone? A qualitative study on young people's perceptions of cocreated online animations to promote mental health literacy.

INTRODUCTION: Adolescence and young adulthood are especially critical times to learn about mental health, given that 75% of mental health issues are developed by the age of 24. Animations have great potential to effectively deliver mental health information to young people. A series of five short animated films to promote mental health literacy were created with and for young people in partnership with the multi-award-winning independent animation studio, Aardman Animations. The aim of this study was to explore young people's perceptions of the cocreated animated films. METHODS: Seven Youth Juries were conducted to capture young people's opinions and recommendations about the content related to mental health literacy and presentation style of the cocreated animated films. Thematic analysis was used to analyse the audio transcripts. RESULTS: Many participants reported a view that the animated films had the potential to promote mental health literacy, especially for understanding mental health and reducing stigma. Some recommendations were provided to improve the films, such as including subtitles and having a better transition to the companion website. CONCLUSION: Cocreated animations have great potential to promote the mental health literacy of young people. We hope that the findings from the present study will inform future media development to make them as effective as possible. PATIENT OR PUBLIC CONTRIBUTION: Young people were actively involved in the development, production, implementation and evaluation (up to the time before data analysis) of the animated films.

Fever After Colectomy in the Enhanced Recovery Era: Incidence and Risk Factors for Pathologic Source.

INTRODUCTION: Postoperative fever following elective colectomy is common and often results in comprehensive laboratory and radiographic testing. We hypothesized that risk factors for febrile complications may be identified with data available at the time of initial fever episode and that a significant proportion of patients exists in which additional testing is of minimal utility. METHODS: We performed a retrospective case-control study of patients undergoing elective colorectal resection at a single institution between 2015 and 2020 with postoperative fever ≥38.0°C. Febrile patients with a clinically significant fever source requiring a change in management were compared to patients with fever that resolved spontaneously. An additive risk score from 0 to 3 was generated from selected characteristics with P-value <0.001. Multivariable logistic regression was used to model the odds of infection with the risk score entered as a binary variable (0-1 versus 2-3 risk factors). RESULTS: Of 1036 elective colectomy patients, 143 (13.8%) had postoperative fever ≥38.0°C. Among the febrile patients, 27 had a positive evaluation (18.9%). Active smoking status (P = 0.018), time from surgery to fever, fever ≥38.5°C, other vital sign changes, and documented localizing signs/symptoms (all, P < 0.001) were associated with an identifiable source of fever. On multivariable regression, the presence of 2-3 risk factors and fever onset after postoperative day 1 were associated with a positive fever evaluation. CONCLUSIONS: Few patients with fever after colectomy required a change in clinical management. Those without multiple risk factors elicited from an interval history and physical exam are unlikely to benefit from additional testing.

Surgical Outcomes Improvement and Health Inequity in a Regional Quality Collaborative.

BACKGROUND: Surgical quality improvement initiatives may impact sociodemographic groups differentially. The objective of this analysis was to assess the trajectory of surgical morbidity by race and age over time within a Regional Collaborative Quality Initiative. STUDY DESIGN: Adults undergoing eligible general surgery procedures in South Carolina Surgical Quality Collaborative hospitals were analyzed for the presence of at least 1 of 22 morbidities between August 2015 and February 2020. Surgery-level multivariable logistic regression assessed the racial differences in morbidity over time, stratified by age group (18 to 64 years, 65 years and older), and adjusting for potential patient- and surgical-level confounders. RESULTS: A total of 30,761 general surgery cases were analyzed, of which 28.4% were performed in Black patients. Mean morbidity rates were higher for Black patients than non-Black patients (8.5% vs 6.0%, p < 0.0001). After controlling for race and other confounders, a significant decrease in monthly mean morbidity through time was observed in each age group (odds ratio [95% CI]: age 18 to 64 years, 0.986 [0.981 to 0.990]; age 65 years and older, 0.991 [0.986 to 0.995]). Comparing morbidity rates from the first 4 months of the collaborative to the last 4 months reveals older Black patients had an absolute decrease in morbidity of 6.2% compared with 3.6% for older non-Black patients. Younger Black patients had an absolute decrease in morbidity of 4.7% compared with a 3.0% decrease for younger non-Black patients. CONCLUSIONS: Black patients had higher morbidity rates than non-Black patients even when controlling for confounders. The reasons for these disparities are not apparent. Morbidity improved over time in all patients with older Black patients seeing a larger absolute decrease in morbidity.

Young people's perceptions of their parents' expectations and criticism are increasing over time: Implications for perfectionism.

Recent evidence demonstrates rising self-oriented, other-oriented, and socially prescribed perfectionism among young people from the United States, United Kingdom, and Canada (Curran & Hill, 2019). One reason why perfectionism is increasing may be that rising competitiveness and individualism are requiring parents to engage in anxious, overly involved, and/or overly controlling forms of parenting. Yet, data to support this claim are limited and contested. In two meta-analyses, we expanded upon and tested this claim by examining whether excessive parental expectations and harsh parental criticism are correlated with perfectionism (Study 1) and whether these perceived practices are changing over time among American, Canadian, and British college students (Study 2). In Study 1, meta-analyses found small-to-moderate positive mean weighted effects of parental expectations and parental criticism on self-oriented and other-oriented perfectionism, and large positive mean weighted effects of parental expectations and parental criticism on socially prescribed perfectionism. In Study 2, using cross-temporal meta-analysis, we found that mean levels of parental expectations and parental criticism had linearly increased between 1989 and 2019 among college students. With rising competitiveness, individualism, economic inequality, and pressure to excel at school and college as the societal background, increases in parental expectations and parental criticism offer the most plausible explanation for rising perfectionism to date. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Athlete Burnout Symptoms Are Increasing: A Cross-Temporal Meta-Analysis of Average Levels From 1997 to 2019.

With the increasing prevalence of mental health difficulties in sport, athletes may be at greater risk of burnout than ever before. In the present study, we tested this possibility by examining whether average athlete burnout levels have changed over the past 2 decades, from 1997 to 2019. A literature search returned 91 studies (N = 21,012) and 396 effect sizes. Findings from cross-temporal meta-analysis suggested that burnout symptoms have increased over the past 2 decades. Specifically, we found that athletes' mean levels of reduced sense of athletic accomplishment and sport devaluation have increased. As burnout symptoms are now typically higher among athletes than in the past, we can expect more athletes to be prone to the negative effects of burnout. Sport is therefore in urgent need of prevention and intervention strategies to stop and reverse this trend.

Abdominal Surgical Procedures in Adult Patients With Cystic Fibrosis: What Are the Risks?

BACKGROUND: With advances in medical care, patients with cystic fibrosis are more commonly living into adulthood, yet there are limited data describing the need for GI surgery and its outcomes in adult cystic fibrosis patients. OBJECTIVE: We aim to use a national administrative database to evaluate trends in abdominal GI surgery and associated postoperative outcomes among adult cystic fibrosis patients. DESIGN: This was a national retrospective cohort study. SETTING: A national all-payor administrative database from 2000 to 2014 was used. PATIENTS: Patients included adults (age ≥18 years) with cystic fibrosis undergoing abdominal GI surgery. MAIN OUTCOME MEASURES: The primary outcome was trend over time in number of surgical admissions. Secondary outcomes included morbidity and mortality by procedure type. RESULTS: We identified 3075 admissions for abdominal surgery, of which 28% were elective. Major GI surgical procedures increased over the study period ( p < 0.01), whereas appendectomy and cholecystectomy did not demonstrate a clear trend ( p = 0.90). The most common procedure performed was cholecystectomy ( n = 1280; 42%). The most common major surgery was segmental colectomy ( n = 535; 18%). Obstruction was the most common surgical indication ( n = 780; 26%). For major surgery, in-hospital mortality was 6%, morbidity was 37%, and mean length of stay was 15.9 days (SE 1.2). LIMITATIONS: The study is limited by a lack of granular physiological and clinical data within the administrative data source. CONCLUSIONS: Major surgical admissions for adult patients with cystic fibrosis are increasing, with the majority being nonelective. Major surgery is associated with significant morbidity, mortality, and prolonged length of hospital stay. These findings may inform perioperative risk for adult patients with cystic fibrosis in need of GI surgery. See Video Abstract at http://links.lww.com/DCR/B850 . PROCEDIMIENTOS QUIRRGICOS ABDOMINALES EN PACIENTES ADULTOS CON FIBROSIS QUSTICA CULES SON LOS RIESGOS: ANTECEDENTES:Con los avances en la medicina, los pacientes con fibrosis quística viven más comúnmente hasta la edad adulta, pero hay datos escasos que describan la necesidad de cirugía gastrointestinal y sus resultados en pacientes adultos con fibrosis quística.OBJETIVO:Nuestro objetivo es utilizar una base de datos administrativa nacional para evaluar las tendencias en la cirugía gastrointestinal abdominal y los resultados posoperatorios asociados entre los pacientes adultos con fibrosis quística.DISEÑO:Estudio de cohorte retrospectivo nacional.AJUSTE:Base de datos administrativa nacional de todas las instituciones pagadoras desde 2000 a 2014.PACIENTES:Todos los pacientes adultos (edad> 18) con fibrosis quística sometidos a cirugía gastrointestinal abdominal.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la tendencia a lo largo del tiempo en el número de ingresos quirúrgicos. Los resultados secundarios incluyeron morbilidad y mortalidad por tipo de procedimiento.RESULTADOS:Identificamos 3.075 ingresos por cirugía abdominal de los cuales el 28% fueron electivos. Los procedimientos quirúrgicos gastrointestinales mayores aumentaron durante el período de estudio (p <0,01) mientras que la apendicectomía y la colecistectomía no demostraron una tendencia clara (p = 0,90). El procedimiento realizado con mayor frecuencia fue la colecistectomía (n = 1.280; 42%). La cirugía mayor más común fue la colectomía segmentaria (n = 535; 18%). La obstrucción fue la indicación quirúrgica más común (n = 780; 26%). Para la cirugía mayor, la mortalidad hospitalaria fue del 6%, la morbilidad del 37% y la estadía media de 15,9 días (EE 1,2).LIMITACIONES:El estudio está limitado por la falta de datos clínicos y fisiológicos granulares dentro de la fuente de datos administrativos.CONCLUSIONES:Los ingresos quirúrgicos mayores de pacientes adultos con fibrosis quística están aumentando y la mayoría no son electivos. La cirugía mayor se asocia con una morbilidad y mortalidad significativas y una estancia hospitalaria prolongada. Estos hallazgos pueden informar el riesgo perioperatorio para pacientes adultos con fibrosis quística que necesitan cirugía gastrointestinal. Consulte Video Resumen en http://links.lww.com/DCR/B850 . (Traducción-Dr. Felipe Bellolio ).

Outcomes After Prolonged ICU Stays in Postoperative Cardiac Surgery Patients.

Background: Prolonged postoperative intensive care unit (ICU) stays are common after cardiac surgery and are associated with poor outcomes. There are few studies evaluating how risk factors associated with mortality may change during prolonged ICU stays or how mortality may vary with length of stay. We evaluated operative and long-term mortality in post-cardiac surgery patients after prolonged ICU stays at 7, 14, 21, and 28 days and factors associated with mortality. Methods: We included University of Michigan Medical Center cardiac surgery patients with ≥ 7 postoperative days in the ICU. We determined factors associated with hospital mortality at 7, 14, 21, and 28 days of ICU stay using logistic regression, and among hospital survivors, we determined the factors associated with long-term mortality using Cox regression. Results: Of 8309 ICU admissions from cardiac surgery, 1174 (14%) had ICU stays > 7 days. Operative mortality was 11%, 18%, 22%, and 35% for the 7-, 14-, 21-, and 28-day groups, respectively. Mechanical ventilation on the day of assessment was associated with increased odds ratios of operative mortality in all models. Of the 1049 (89%) hospital survivors, 420 (40%) died by late follow-up. Median (IQR) Cox model survival was 10.7 (0.7) years. Longer ICU stays, postoperative pneumonia, and elevated discharge blood urea nitrogen were associated with increased hazard of dying; whereas higher discharge platelet count and cardiac transplant were protective. Conclusions: Both operative and late mortality increased as the duration of a ICU stay increased after cardiac surgery.

Towards Equitable Surgical Management of Inflammatory Bowel Disease: A Systematic Review of Disparities in Surgery for Inflammatory Bowel Disease.

BACKGROUND: Existing evidence for disparities in inflammatory bowel disease is fragmented and heterogenous. Underlying mechanisms for differences in outcomes based on race and socioeconomic status remain undefined. We performed a systematic review of the literature to examine disparities in surgery for inflammatory bowel disease in the United States. METHODS: Electronic databases were searched from 2000 through June 11, 2021, to identify studies addressing disparities in surgical treatment for adults with inflammatory bowel disease. Eligible English-language publications comparing the use or outcomes of surgery by racial/ethnic, socioeconomic, geographic, and/or institutional factors were included. Studies were grouped according to whether outcomes of surgery were reported or surgery itself was the relevant end point (utilization). Quality was assessed using the Newcastle-Ottawa Scale for observational studies. RESULTS: Forty-five studies were included. Twenty-four reported surgical outcomes and 21addressed utilization. Race/ethnicity was considered in 96% of studies, socioeconomic status in 44%, geographic factors in 27%, and hospital/surgeon factors in 22%. Although study populations and end points were heterogeneous, Black and Hispanic patients were less likely to undergo abdominal surgery when hospitalized; they were more likely to have a complication when they did have surgery. Differences based on race were correlated with socioeconomic factors but frequently remained significant after adjustments for insurance and baseline health. CONCLUSIONS: Surgical disparities based on sociologic and structural factors reflect unidentified differences in multidisciplinary disease management. A broad, multidimensional approach to disparities research with more granular and diverse data sources is needed to improve health care quality and equity for inflammatory bowel disease.

Existing evidence for disparities in inflammatory bowel disease management is fragmented. In reviewing the surgical literature, differences in outcomes by race and socioeconomic status reveal opportunities for improving equity while highlighting continued knowledge gaps in understanding disparities.

Digital video interventions and mental health literacy among young people: a scoping review.

BACKGROUND: Mental health literacy is important as it relates to understanding mental illness, increasing help-seeking efficacy, and reducing mental illness-related stigma. One method to improve the mental health literacy of young people is a digital video intervention. AIMS: A scoping review was conducted to map existing research in the area of digital video interventions for mental health literacy among young people. METHODS: The scoping review was conducted following the PRISMA-ScR checklist. All results were screened based on our inclusion criteria. RESULTS: Seventeen studies were selected for analysis. In most studies (n = 14), a digital video was the only intervention whereas three studies took a multi-intervention approach. Only two of the digital video interventions were co-created with people with mental illness or university students. All studies showed positive results in favor of digital video interventions in at least one component of mental health literacy or compared to one of the comparison conditions. CONCLUSIONS: Digital video interventions represent effective tools for enhancing mental health literacy. However, there is a need for active involvement of end-users in co-creation and to attend to the production quality so that the digital video intervention is as relevant, informed, and effective as possible.

The simulated environmental impact of incorporating white clover into pasture-based dairy production systems.

White clover (WC) offers an alternative source of nitrogen (N) for pasture-based systems. Substituting energy- and carbon-intensive synthetic N fertilizers with N derived from biological fixation by WC has been highlighted as a promising environmental mitigation strategy through the omission of emissions, pollutants, and energy usage during the production and application of synthetic fertilizer. Therefore, the objective was to investigate the effect of the inclusion of WC in perennial ryegrass (PRG) swards on the environmental impact of pasture-based dairy systems. Cradle-to-farm gate life cycle assessment of 3 pasture-based dairy systems were conducted: (1) a PRG-WC sward receiving 150 kg of N/ha per year (CL150), (2) a PRG-WC sward receiving 250 kg of N/ha per year (CL250), and (3) a PRG-only sward receiving 250 kg of N/ha per year (GR250). A dairy environmental model was updated with country-specific N excretion equations and recently developed N2O, NH3, and NO3- emission factors. The environmental impact categories assessed were global warming potential, nonrenewable energy, acidification potential, and eutrophication potential (marine and freshwater). Impact categories were expressed using 2 functional units: per hectare and per metric tonne of fat- and protein-corrected milk. The GR250 system had the lowest milk production and highest global warming potential, nonrenewable energy, and acidification potential per tonne of fat- and protein-corrected milk for all systems. The CL250 system produced the most milk and had the highest environmental impact across all categories when expressed on an area basis. It also had the highest marine eutrophication potential for both functional units. The impact category freshwater eutrophication potential did not differ across the 3 systems. The CL150 system had the lowest environmental impact across all categories and functional units. This life cycle assessment study demonstrates that the substitution of synthetic N fertilizer with atmospheric N fixed by WC has potential to reduce the environmental impact of intensive pasture-based dairy systems in temperate regions, not only through improvement in animal performance but also through the reduction in total emissions and pollutants contributing to the environmental indicators assessed.