Background Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed. Objective This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension. Methods We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure. Results The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: –2.8 mmHg, 95% CI –1.8 to 7.4; P=.23) and diastolic (mean difference: –3.6 mmHg, 95% CI –0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals. Conclusions A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. Trial Registration ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472

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Benign intracranial hypertension (BIH) is a condition which is strongly associated with weight gain. A well-known potential adverse effect of anti-psychotic treatment, especially the atypical group, is weight gain. Our case describes the use of risperidone in a young obese lady who gained significant weight after commencing the antipsychotic and later developed headache and blurred vision. Withdrawing the offending drug (causing reduction in her weight) in addition to acetazolamide drastically improved her symptoms within a month. Our case highlights that, obese patients started on antipsychotic medication, who develop headache, should be considered for investigation of BIH.

Background International medical graduates (IMGs) contribute significantly towards the NHS care provision. No standardised clinical orientation programme (COP) for IMGs new to the NHS exists. Objective Our objective was to describe recruitment and retention strategies for junior doctors (JDs) in general medicine and develop a framework to anticipate outcomes of these interventions using the realist evaluation methodology. Methods We performed quality improvement interventions of recruitment and COP for new entrant IMGs in our organisation employed between December 2017 and April 2019. Results Twenty-three IMGs were recruited, 96% successfully completed the COP with a mean contract duration of 13±5 months.

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The continuous technological advancement has provided innovative and attractive electronic devices that led individuals to spend longer times in front of screens. Longer periods of screen time have been linked to poor dietary habits including higher consumption of sugar, low nutritional quality foods like french fries, refined grain products, snacks and desserts, lower intakes of fiber, vegetables, fruits, and whole grains. Objective: To compare the association between screen time and eating habits among the students of 11 to 25 years. Methodology: A cross-sectional study was conducted to evaluate eating habits and screen time of 150 students from different schools, colleges and universities of Lahore. Participants were selected through non-probability convenient sampling. Data were collected using a self- constructed questionnaire. In exclusion criteria, students off the selected age group, having no screen time and non-cooperative individuals were excluded. SPSS version 25.0 was used for data analysis. Results: Total participants of study were 150. Few of them were obese (8%) and more were overweight (26%). Some of them were spending 3-5 hours on screen (23%) while more were spending greater than 7 hours (32%). Mostly skipped breakfast (54%), delayed meals (45%), ate above planned limit (57%). Majority consumed fried food (56%) and sweets (44%) while using electronic gadgets. Conclusions: High prevalence of screen time had negatively affected student’s eating patterns. Students with longer screen time usually consumed fast food, junk food, sugary desserts, salty snacks and caffeinated beverages as snacks.