CHANGING FOOD PRODUCTION STRATEGIES AMONG GARHWALI RESETTLERS IN THE HIMALAYAS

This article discusses the changing systems of food production among Garhwali resettlers who were forcibly displaced due to the construction of the Tehri Dam in North India. Resettling to a drastically new environment affected their traditional food production strategies and rendered them vulnerable to the vagaries of transition, including the forced adaptation to new cash crop-based farming systems, restricted hunting and fishing areas, and limited access to dairy products. These changes led to an inadequate supply of food and nutrients, especially protein, for these resettlers. Using ethnographic methods, this study illustrates that resettling an agrarian community to a new ecological area significantly changes their food production practices in ways that leave them vulnerable to the potential risk of an impoverished diet.     

Current trends in paediatric and neonatal ventilatory care – a nationwide survey

Aim: To assess daily practices in paediatric and neonatal ventilatory care in Finland. Methods: All neonatal and paediatric intensive care units in Finland were sent a questionnaire on ventilatory strategies and were offered a 3‐month prospective survey. Results: A total of 96% of units returned the questionnaire, and clinicians agreed on most of the principles of lung‐protective ventilation. Seventeen hospitals (94%) joined the prospective survey. On average, 2.3 new ventilation episodes were started daily, and totally 211 episodes were monitored. Pulmonary problems (64%) were the main cause of treatment in neonates and postoperative care (68%) in older children. Synchronized intermittent mandatory ventilation with pressure support was the primary mode in 42% of episodes. Hypocapnia was observed repeatedly in all units. In adult intensive care units, children often received high oxygen fraction, leading to hyperoxia, and they were frequently sedated with propofol, which is not licensed for that purpose. A large proportion of children had only light sedation or no sedation at all. Despite the different strategies and practices, most episodes resulted in a favourable outcome. Conclusion: Most of the principles of lung‐protective ventilation have been well accepted by clinicians. More attention should be paid to achieving normocapnia and normoxia and to the correct use of sedatives, especially in units that only occasionally provide paediatric ventilation.     

Confirmatory versus explorative endpoint analysis: Decision-making on the basis of evidence available from market authorization and early benefit assessment for oncology drugs

The early benefit assessment of pharmaceuticals in Germany and their preceding market authorization pursue different objectives. This is reflected by the inclusion of varying confirmatory endpoints within the evaluation of oncology drugs in early benefit assessment versus market authorization, with both relying on the same evidence. Data from assessments up to July 2015 are used to estimate the impact of explorative in comparison to confirmatory endpoints on market authorization and early benefit assessment by contrasting the benefit-risk ratio of EMA and the benefit-harm balance of the HTA jurisdiction. Agreement between market authorization and early benefit assessment is examined by Cohen’s kappa (k). 21 of 41 assessments were considered in the analysis. Market authorization is more confirmatory than early benefit assessment because it includes a higher proportion of primary endpoints. The latter implies a primary endpoint to be relevant for the benefit-harm balance in only 67% of cases (0.078). Explorative mortality endpoints reached the highest agreement regarding the mutual consideration for the risk-benefit ratio and the benefit-harm balance (0.000). For explorative morbidity endpoints (−0.600), quality of life (−0.600) and side effects (−0.949) no agreement is ascertainable. To warrant a broader confirmatory basis for decisions supported by HTA, closer inter-institutional cooperation of approval authorities and HTA jurisdictions by means of reliable joint advice for manufacturers regarding endpoint definition would be favorable.     

Effectiveness of instrumental reminiscence intervention on improving coping in healthy older adults

Reminiscence is a psychological intervention that uses the recall of past events, feelings, and thoughts to facilitate pleasure, quality of life, and adjustment to present life. The main goal of this study was to investigate the effect of a reminiscence intervention programme on coping strategies. One hundred fifty healthy older adults attended the reminiscence sessions. In order to evaluate the effects of the programme and find out if its effects lasted over time, we used an experimental design with pretest, posttest, and follow‐up assessments, comparing a control group to the intervention group. Repeated‐measures analysis of variance showed significant differences in problem‐solving coping, positive reappraisal, social support seeking, and avoidance coping with the treatment group obtaining higher scores than the control group in all cases. The effects declined after 3 months, but some differences were found in the treatment group obtaining higher scores in problem‐solving coping and positive reappraisal and lower in overt emotional expression. The study suggests that reminiscence therapy contributes to mental health by enhancing coping strategies that can allow the elderly to cope successfully and overcome psychological distress.     

Mycophenolate Fetal Toxicity and Risk Evaluation and Mitigation Strategies

The mycophenolic acid (MPA) preparations are one of the most commonly used immunosuppressants in the United States. However, these agents carry a black box warning regarding their use during pregnancy due to an association with increased risk of miscarriage and congenital defects. To ensure that the benefits of MPA outweigh the risks, the Food and Drug Administration (FDA) required all manufacturers of MPA products to propose risk evaluation and mitigation strategies (REMS). Four years after initially calling for proposals, the FDA approved a single shared REMS system in September 2012. The elements of the MPA REMS include a medication guide and elements to assure safe use (ETASU). The medication guide, which was previously FDA‐approved in 2008, should continue to be distributed to patients, and the ETASU requires physicians to complete training and obtain patient signatures on the “Patient‐Prescriber Acknowledgement Form.” A single, national, voluntary pregnancy registry is available, and pregnant patients should be encouraged to participate. Although the impact of the MPA REMS on clinical practice is not clear, it is a step toward increasing the understanding of fetal risks with MPA products among patients and possibly practitioners.     

False memories in patients with mild cognitive impairment and mild Alzheimer’s disease dementia: Can cognitive strategies help?

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that presents predominantly with impairments in learning and memory. Patients with AD are also susceptible to false memories, a clinically relevant memory distortion where a patient remembers an incorrect memory that they believe to be true. The use of cognitive strategies to improve memory performance among patients with AD by reducing false memories has taken on added importance given the lack of disease-modifying agents for AD. However, existing evidence suggests that cognitive strategies to reduce false memories in patients with AD are of limited effectiveness, although these strategies may be useful at earlier stages of the disease. The purpose of this review is to examine experimental findings of false memories and associated memory processes in patients with mild cognitive impairment due to AD and mild AD dementia. Cognitive strategies to reduce false memories in these patient populations are also reviewed. Approaches to clinically relevant future research are suggested and discussed.