Trends (2014-2018) in the healthiness of packaged food purchases of Australian consumers before and after the introduction of voluntary Health Star Rating nutrition labels.

OBJECTIVE: To evaluate the trends in the healthiness of packaged food purchases of Australian consumers before and after the introduction of the Health Star Rating (HSR) nutrition labels. DESIGN: Panel data analysis and difference-in-differences analysis. SETTING: The Australian Government endorsed HSR nutrition labels for voluntary implementation on packaged foods in June 2014. We analyse the packaged food purchases of households across all major supermarkets before (January 2014 to June 2014) and after (June 2014 - Dec 2018) the introduction of HSR. PARTICIPANTS: 6284 members of a panel of households across Australia reporting their grocery purchases to a market research company (Nielsen Homescan Panel). RESULTS: The healthiness of household food purchases exhibited a U-shaped trend - decreasing from 2014 to 2017, and then increasing from 2018, corresponding to the time when a higher proportion of products were HSR-labelled. Households that purchased a higher proportion of HSR-labelled products had healthier household purchases overall. Further, the healthiness of households' category-specific food purchases was positively associated with the proportion of HSR labelled products in categories where HSR was adopted, relative to control categories where HSR was not adopted. CONCLUSIONS: In Australia, once a substantial number of packaged food products adopted the voluntary HSR summary indicator, we observed an increasing trend in the healthiness of household food purchases. Widespread adoption of a nutrition summary indicator, such as HSR, on packaged food is likely to be beneficial for population health.

Transforming practice chains through ideological objects: How plant-based meats impact consumers' everyday food practices.

This research investigates the impact of the introduction of plant-based meats (PBMs) on consumers' food practices. Based on the results of 21 in-depth interviews with consumers who use PBMs, this research uses practice theory to explore how the adoption of PBMs affects linked food practices and the meanings associated with these practices. We find that consumers adopt PBMs due to either a desire for meaning coherence or for practicality. Subsequently there are social and embodied ripple consequences associated with this adoption, with consumers revising their social food practices, reconfiguring their understandings of health, and re-orienting their relationship to their body. Our findings extend the research on practice theory by examining how the adoption of a new category of ideological objects shapes other linked consumption practices. Practically, our findings provide important insights for dietary, marketing and health practitioners to understand the overall impact of PBM adoption on consumers' dietary patterns and practices, and their perception about health and body.

Colour correct: the interactive effects of food label nutrition colouring schemes and food category healthiness on health perceptions.

OBJECTIVE: The purpose of the present study was to examine the effects of food label nutrition colouring schemes in interaction with food category healthiness on consumers' perceptions of food healthiness. Three streams of colour theory (colour attention, colour association and colour approach-avoidance) in interaction with heuristic processing theory provide consonant predictions and explanations for the underlying psychological processes. DESIGN: A 2 (food category healthiness: healthy v. unhealthy)×3 (food label nutrient colouring schemes: healthy=green, unhealthy=red (HGUR) v. healthy=red, unhealthy=green (HRUG) v. no colour (control)) between-subjects design was used. SETTING: The research setting was a randomised-controlled experiment using varying formats of food packages and nutritional information colouring. SUBJECTS: Respondents (n 196) sourced from a national consumer panel, USA. RESULTS: The findings suggest that, for healthy foods, the nutritional colouring schemes reduced perceived healthiness, irrespective of which nutrients were coloured red or green (healthinesscontrol=4·86; healthinessHGUR=4·10; healthinessHRUG=3·70). In contrast, for unhealthy foods, there was no significant difference in perceptions of food healthiness when comparing different colouring schemes against the control. CONCLUSIONS: The results make an important qualification to the common belief that colour coding can enhance the correct interpretation of nutrition information and suggest that this incentive may not necessarily support healthier food choices in all situations.

National income and macro-economic correlates of the double burden of malnutrition: an ecological study of adult populations in 188 countries over 42 years.

BACKGROUND: The double burden of malnutrition (DBM) represents a growing global challenge with adverse health and economic consequences. We aimed to investigate the associative roles of national income (gross domestic product per capita [GDPPC]) and macro-environmental factors on the DBM trends among national adult populations. METHODS: In this ecological study we assembled extensive historical data on GDPPC from the World Bank World Development Indicators database and population-level DBM data of adults (aged ≥18 years) from the WHO Global Health Observatory database in 188 countries over 42 years (1975-2016). In our analysis, a country was considered to have the DBM in a year when adult overweight (BMI ≥25·0 kg/m2) and underweight (BMI <18·5 kg/m2) prevalence was each 10% or more in that year. We used a Type 2 Tobit model to estimate the association of GDPPC and selected macro-environmental factors (globalisation index, adult literacy rate, female share in the labour force, share of agriculture in the national gross domestic product [GDP], prevalence of undernourishment, and percentage of principal display area mandated to be covered by health warnings on cigarette packaging) with DBM in 122 countries. FINDINGS: We find a negative association between GDPPC and the likelihood of a country having the DBM. However, conditional on its presence, DBM level exhibits an inverted-U shaped association with GDPPC. We found an upward shift in DBM levels from 1975 to 2016 across countries at the same level of GDPPC. Among the macro-environmental variables, share of females in the labour force and share of agriculture in the national GDP are negatively associated with DBM presence in a country, whereas the prevalence of undernourishment in the population is positively associated. Further, globalisation index, adult literacy rate, share of females in the labour force, and health warnings on cigarette packaging are negatively associated with DBM levels in countries. INTERPRETATION: DBM level in national adult populations rises with GDPPC until US$11 113 (in 2021 constant dollar terms) and then starts declining. Given their current GDPPC levels, most low-income and middle-income countries are thus unlikely to have a decline in the DBM levels in the near future, ceteris paribus. Those countries will also be expected to experience a higher DBM level at similar levels of national income than were historically experienced by the current high-income countries. Our findings point to a further intensification of the DBM challenge in the near future for the low-income and middle-income countries as they continue to have income growth. FUNDING: None.

A new perspective on the incentive-blood donation relationship: partnership, congruency, and affirmation of competence.

BACKGROUND: The Motivation Crowding-out Theory suggests that incentives undermine intrinsic motivation and thus blood donation behavior. While there is strong evidence showing the negative relationship between monetary incentives and blood donation, findings on the effect of nonmonetary incentives are mixed. Set in a voluntary, nonremunerated environment, this study explores aspects of the nonmonetary incentive-blood donation relationship not captured by the crowding-out hypothesis. STUDY DESIGN AND METHODS: In-depth interviews were conducted to explore donors' attitudes toward nonmonetary incentives currently used or considered by the Australian Red Cross Blood Service (Blood Service). Transcripts were analyzed using an inductive, thematic approach. RESULTS: Of the nonmonetary incentives examined (i.e., health screening tests, branded tokens, paid time off work, recognition of key milestones, and postdonation refreshments), none were found to crowd out intrinsic motivation, although not all were viewed favorably. Donors who viewed branded tokens negatively considered the cost implications for the Blood Service, while donors who responded positively considered the public benefit of tokens in raising the profile of the Blood Service. Other nonmonetary incentives-paid time off work, postdonation refreshments, and health screening tests-were viewed positively because donors perceived them to be congruent to the effort expended in donating blood. Finally, donors expressed a preference for private over public recognition when acknowledging significant contributions. CONCLUSION: When operating in a voluntary, nonremunerated environment, blood services should view donors as supply partners rather than customers, only consider nonmonetary incentives that are congruent with the act of donation, and provide private rather than public recognition of key milestones.

The role of cost and response-efficacy in persuasiveness of health recommendations.

The persuasiveness of a health recommendation, among other things, is a function of the cost of engaging in the recommended behavior--such as money, time, effort, and discomfort--and the response-efficacy, defined as the likelihood that adherence to the recommendation would lead to the desired goal. This research investigates how cost and response-efficacy combine when influencing persuasion. Several theories of health behavior view cost and response-efficacy as having independent effects on persuasion, that is, a weighted additive impact. This research posits, and finds empirical support for the idea that cost and efficacy combine in a multiplicative fashion to influence persuasion, and suggests a structural modification to the traditional models of the relationship between cost, response-efficacy, and persuasion.

Large Retroperitoneal Extraosseous Osteosarcoma Invading into the Spine: a Case Report.

Extraosseous osteogenic sarcoma is a very rare malignant neoplasm. The most common sites are the extremities, thorax, and the abdomen. Retroperitoneal osteosarcomas are rare and very few cases have been reported. They are similar in their biology to high-grade soft tissue sarcomas. R0 resection appears to be the best possible treatment for these tumors but there are no published cases on how to manage them when it involves posterior and intra-spinal regions. We report a 62-year-old male who presented with a backache, and investigations revealed a large retroperitoneal fibrosarcoma invading into the lumbar spine, but was found to be an extra osseous osteosarcoma on final histopathological examination. It is important to emphasize that due to the rarity of soft tissue sarcomas as well as the uniqueness of the multimodal treatment plan for each subtype, soft tissue sarcomas involving the spine are best managed by a multi disciplinary team. Overall, patients with soft tissue sarcomas involving the spine usually present a poor long-term prognosis. Therefore, whenever feasible, "en bloc" resection of such lesions has been shown to play a crucial role in improving the overall and recurrence-free survival rates.

Severe Colonic Complications requiring Sub-Total Colectomy in Acute Necrotizing Pancreatitis-A Retrospective Study of 8 Patients.

Colonic involvement in acute pancreatitis is associated with high mortality. Diagnosis of colonic pathology complicating acute pancreatitis is difficult. The treatment of choice is resection of the affected segment. The aim of this study is to evaluate the feasibility of aggressive surgical approach when colonic complication is suspected. Retrospectively, 8 patients with acute necrotizing pancreatitis and colonic complications (2006-2010) were reviewed. Eight patients with acute necrotizing pancreatitis requiring colonic resection were evaluated. Presentation was varied, including rectal bleeding (2), clinical deterioration during severe pancreatitis (4), colonic contrast leak on CT scan (1) and large bowel obstruction (1). Typically, patients with severe acute pancreatitis had colonic pathology obscured and unrecognized initially because of the ongoing, fulminant inflammatory process. All eight patients underwent Sub-total colectomy & ileostomy for suspected imminent or overt ischemia/perforation, based on the outer aspect of the colon. There was one mortality due to severe sepsis and multiorgan dysfunction syndrome. All other patients recovered well and later underwent closure of the stoma. Recognition of large bowel involvement may be difficult because of nonspecific symptoms or be masked by the systemic features of a critical illness. Clinicians should be aware that acute pancreatitis may erode or inflame the large bowel, resulting in lifethreatening colonic necrosis, bleeding or perforation. In our series of eight patients, we observed that mortality can be reduced by this aggressive surgical approach. We recommend a low threshold for colonic resection due to unreliable detection of ischemia or imminent perforation by outside inspection during surgery for acute necrotizing pancreatitis.

Single-incision laparoscopic percutaneous hydatid cystectomy: a novel curative approach for segment 7 hydatid cyst of liver.

Hydatid disease of the liver is one of the common cystic disease of the liver. Chemotherapy as well operative procedures are generally opted for the treatment of hydatid disease of the liver. Apart from open surgical intervention, (PAIR) Percutaneous Aspiration Injection & reaspiration, Laparoscopic hydatid cystectomy is also popularized. We have developed a novel technique for segment 7 liver hydatid cyst as a combination of single incision percutaneous technique with direct visualisation of cystic cavity under sonographic guidance.

Surgical treatment of giant hepatic hemangiomas: technical point of view.

Hepatic hemangiomas are the most common benign tumors of the liver. Surgical treatment can be difficult as a result of the high risk of intraoperative hemorrhage. The present study reviewed clinical features of patients with hepatic hemangioma and surgical techniques used in their treatment. Eight patients with giant hepatic hemangiomas underwent hepatectomies at the Asan Medial Center between January 2006 and March 2009. Patient demographic, clinical, and surgical characteristics and outcomes were reviewed retrospectively. Seven females and one male patient underwent hepatectomies during the study period. The median age was 48.5 years (range, 33 to 58 years). Indications for surgical interventions were abdominal pain (62.5%), an abdominal mass (37.5%), Kasabach-Merritt syndrome (25%), and increased hemangioma size (25%). The hemangiomas were usually multiple (87.5%) and bilobar (75%) and had a median size of 14.5 cm (range, 7 to 29 cm). All patients underwent major hepatic resection with early vascular control using the Glissonean pedicle transection method (GPTM), the liver hanging maneuver (LHM), and preparation for total vascular exclusion (TVE). There was no major morbidity or mortality. The minor morbidity rate was 25 per cent with transfusion rate of 37.5 per cent. Early vascular control using the GPTM, the LHM, and preparation for TVE is essential for safe resection of large hepatic hemangiomas.

Hybrid Single-incision Laparoscopic Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis for Ulcerative Colitis.

Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. We report one of the initial clinical experiences from India for Laparoscopic Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis (RPC IPAA) with this new technique. A SILSTM port was used through the curved intra-umbilical 25-mm incision. A 12-mm port was placed in the right iliac fossa at the ileostomy site. Another 5 mm port was placed in the left iliac fossa at the drain site. 10 mm 0 degree lens was used through the SILS port. Two 5 mm port were placed from the SILS port. Right iliac fossa port was the surgeon's right hand port and left hand port was 5 mm SILS port. Left iliac fossa port and 5 mm SILS port were used by the assistant surgeon for retraction. The specimen was delivered through the umbilical incision by extending the incision for 1.5 cm on either side. Ileal J Pouch was created extracorporeally and then anastomosed to the anal canal with the circular stapler laparoscopically. The diverting loop ileostomy was brought out through the right iliac fossa 12 mm port. The pelvic drain was brought out through the left iliac fossa port. The procedure was completed without any perioperative complications. Operative time was 256 minutes. Postoperative follow-up did not reveal any umbilical wound complication. Till date we have performed 26 Laparoscopic RPC with IPAA and this was the first Single Incision Laparoscopic RPC with IPAA. For experienced laparoscopic colorectal surgeons, single incision laparoscopic colectomy (SILC) is feasible. Single-incision laparoscopic colectomy is a promising alternative method as minimally invasive abdominal surgery for the treatment of patients requiring colectomy.

Is oesophageal manometry a must before laparoscopic fundoplication? Analysis of 46 consecutive patients treated without preoperative manometry.

AIMS: To evaluate retrospectively the outcome of laparoscopic fundoplication in a cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: Forty-six patients with typical symptoms of GERD, from March 2001 to November 2009, were studied. The study was limited to patients with positive findings on upper GI endoscopy done by ourselves and "typical" symptoms (heartburn, regurgitation, and dysphagia) of GERD. Laparoscopic Nissen's fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only 1 patient, who had negative endoscopic findings, underwent a 24-hour pH-monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome and quality of life after surgery. RESULTS: Relief of the primary symptom responsible for surgery was achieved in 85% of patients at a mean follow-up of 28 months. Thirty-nine patients were asymptomatic, 2 had minor gastrointestinal symptoms not requiring medical therapy, 3 patients had gastrointestinal symptoms requiring medical therapy/ Proton Pump Inhibitors and in 2 patients the symptoms worsened after surgery. There were no deaths. Clinically significant complications occurred in 6 patients. Median hospital stay was 3 days, decreasing from 6 in the first 10 patients to 3 in the last 10 patients. CONCLUSIONS: Preoperative oesophageal manometry is not mandatory for laparoscopic fundoplication done in selected patients with typical symptoms of GERD and upper GI endoscopy suggestive of large hiatus hernia.

Retrospective evaluation of patients of gastroesophageal reflux disease treated with laparoscopic Nissen's fundoplication.

AIMS: To evaluate retrospectively the outcome of laparoscopic fundoplication in a cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: Forty-two patients with typical symptoms of GERD, who were operated for laparoscopic Nissen's fundoplication from March 2001 to August 2008, were studied. The study was limited to patients with positive findings on upper gastrointestinal (GI) endoscopy done by us and "typical" symptoms (heartburn, regurgitation, and dysphagia) of GERD. Laparoscopic Nissen's fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only one patient who had negative endoscopic findings underwent a 24-h pH monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome, and quality of life after surgery. RESULTS: Relief of the primary symptom responsible for surgery was achieved in 95.24% of patients at a mean follow-up of 28 months. Thirty-five patients were asymptomatic, two had minor gastrointestinal symptoms not requiring medical therapy, three patients had gastrointestinal symptoms requiring medical therapy/Proton Pump Inhibitors (PPI) and in two patients the symptoms worsened after surgery. There were no deaths. Clinically significant complications occurred in six patients. Median hospital stay was 3 days, decreasing from 6 days in the first 10 patients to 3 days in the last 10 patients. CONCLUSIONS: Laparoscopic Nissen's fundoplication is the choice of operation for clinically symptomatic GERD patients.

Left hepatic vein injury during laparoscopic antireflux surgery for large para-oesophageal hiatus hernia.

Although the advent of laparoscopic fundoplication has increased both patient and physician acceptance of antireflux surgery, it has become apparent that the laparoscopic approach is associated with an increased risk of some complications and as well as the occurrence of new complications specific to this approach. One such complication occurred in our patient who had intra-operative left hepatic vein injury during laparoscopic floppy Nissen fundoplication for large para-oesophageal rolling hernia. With timely conversion to open procedure, the bleeding was controlled and the antireflux and the procedure were completed uneventfully. However, this suggests that even with an experience in advanced laparoscopy surgery, complications can occur. Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic surgery and should help the surgeon avoid complications. The incidence of some of these complications decreases as surgeons gain experience; however, new complications can arise due to the increase in such procedures.