Warning labels for sugar-sweetened beverages and fruit juice: evaluation of 27 different labels on health effects, sugar content, energy and exercise equivalency.

OBJECTIVES: Front-of-pack warning labels may reduce consumption of sugar-sweetened beverages, potentially mitigating negative health outcomes. Comparisons between different warning label types to inform future research and policy directions are lacking. This study compared 27 warning labels across six message types for their potential to reduce sugar-sweetened beverage consumption. DESIGN AND METHODS: A national sample of regular soda (n = 2578) and juice (n = 1048) consumers aged 14-60 years participated in an online survey. Participants evaluated randomly allocated labels; one from each of six warning label sets (health-graphic, sugar-pictogram, sugar-text, exercise equivalents, health-text, energy information) on four measures of perceived effectiveness (PE: overall effectiveness, discourage from drinking, emotional response, persuasive potential). Participants could also provide open comments. A general linear model compared differences in mean scores across label sets for each measure of PE. RESULTS: PE ratings differed significantly between label sets. Labels clearly quantifying sugar content (sugar-teaspoons) received consistently high PE ratings, whereas 'high in sugar' labels did not. Health-graphic labels were rated highly across all PE measures except persuasive potential. Exercise labels only rated highly on persuasive potential. Health-text results were mixed, and energy labels were consistently low. CONCLUSIONS: Simple, factual labels were easily interpreted and perceived as most effective. Labels quantifying sugar content were consistently high performers and should be advanced into policy to help decrease overconsumption of sugar-sweetened beverages.

"You can't just eat 16 teaspoons of sugar so why would you drink 16 teaspoons' worth of sugar?": a qualitative study of young adults' reactions to sugary drink warning labels.

BACKGROUND: Several jurisdictions have introduced nutrient warning front of pack (FoP) labels in an effort to curb consumption of ultra-processed foods and beverages high in free sugars (sugars added to foods and beverages, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates). This study aimed to explore consumer understanding and perceptions of FoP warning labels that convey different nutritional and health information messages regarding the consumption of sugary drinks. METHODS: Sixteen focus groups were held with 4-8 young adults per group (aged 18-24; n = 105 participants in total) stratified by education level, location (rural centres, large cities) and gender (males, females) to ensure diversity. Labels shown to participants during group discussions included text warning labels of health effects, exercise equivalents, calorie/kilojoule information and sugar content as a "high in" label and as teaspoons (text and pictograms). Thematic analysis was undertaken. RESULTS: Four themes were identified related to participants' perceived effectiveness of labels: the extent to which labels were perceived to be useful, relevant and credible; the extent to which a label elicited shock or disgust (perceived aversiveness); the extent to which the label message was resistant to self-exemption; and participants' perceived potential of the label to reduce purchasing and consumption behaviour. Across all four themes, labels communicating the number of teaspoons of sugar in a sugary drink (whether by text or pictogram) were perceived as the most impactful, resistant to self-exemption and to have the greatest potential to reduce consumption, with enhanced reactions to the pictogram label. Labels depicting health effects, exercise equivalents, calorie/kilojoule information or a general 'high in sugar' warning were perceived by consumers to be less effective in one or more themes. CONCLUSIONS: Labels conveying the amount of sugar in a beverage in teaspoons were perceived as highly factual, relatable and interpretable, and as having the greatest potential to impact consumption attitudes and intentions. Further quantitative studies are required to compare the potential effectiveness of the teaspoons of sugar labels in reducing purchasing and consumption behaviour than other alternative warning labels, such as health effects or "high in" sugar labels.

Support following total laryngectomy: Exploring the concept from different perspectives.

Adjustment after total laryngectomy is complex, and the resultant support needs are extensive. Current practice is often guided by health-related quality of life measures. While useful, many of these tools were developed without considering the perspectives of people who have experienced the surgery. To improve understanding of the support needs after total laryngectomy, multiple viewpoints were examined, for example individuals with a laryngectomy (IWL), significant others (SO) and health professionals (HP). A qualitative study explored the perspectives of 28 individuals (IWL-seven men and five women, nine SO and seven HP). Data were collected through in-depth, semi-structured interviews and analysed using constructivist grounded theory and symbolic interactionism. The data suggested that the construct "being supported to develop competence and resilience" is a multidimensional and nonlinear phenomenon underpinned by the interactive processes "perceiving influencing factors," "building trusting relationships" and "sharing and balancing the care." The findings highlight the significant contribution the care triad (i.e., IWL, SO and HP) plays and the factors influencing care, safety and dignity for IWL. Furthermore, support is optimised when all stakeholders are competent with the care. In turn, reduced competence increases the burden for one or all in the triad.

Feasibility of a novel participatory multi-sector continuous improvement approach to enhance food security in remote Indigenous Australian communities.

BACKGROUND: Food insecurity underlies and compounds many of the development issues faced by remote Indigenous communities in Australia. Multi-sector approaches offer promise to improve food security. We assessed the feasibility of a novel multi-sector approach to enhance community food security in remote Indigenous Australia. METHOD: A longitudinal comparative multi-site case study, the Good Food Systems Good Food for All Project, was conducted (2009-2013) with four Aboriginal communities. Continuous improvement meetings were held in each community. Data from project documents and store sales were used to assess feasibility according to engagement, uptake and sustainability of action, and impact on community diet, as well as identifying conditions facilitating or hindering these. RESULTS: Engagement was established where: the community perceived a need for the approach; where trust was developed between the community and facilitators; where there was community stability; and where flexibility was applied in the timing of meetings. The approach enabled stakeholders in each community to collectively appraise the community food system and plan action. Actions that could be directly implemented within available resources resulted from developing collaborative capacity. Actions requiring advocacy, multi-sectoral involvement, commitment or further resources were less frequently used. Positive shifts in community diet were associated with key areas where actions were implemented. CONCLUSION: A multi-sector participatory approach seeking continuous improvement engaged committed Aboriginal and non-Aboriginal stakeholders and was shown to have potential to shift community diet. Provision of clear mechanisms to link this approach with higher level policy and decision-making structures, clarity of roles and responsibilities, and processes to prioritise and communicate actions across sectors should further strengthen capacity for food security improvement. Integrating this approach enabling local decision-making into community governance structures with adequate resourcing is an imperative.

An exploration of the value of social interaction in a boys' group for adolescents with muscular dystrophy.

BACKGROUND/AIM: Engagement in peer-based social activities is a normal and important aspect of adolescence. Adolescent boys with muscular dystrophy typically lack opportunities for participation in peer-based recreation and socialization activities. 'MD Mafia' is a group which aims to reduce social isolation and offer social and recreational opportunities for adolescent boys with muscular dystrophy. This research is a qualitative exploration of the value of 'MD Mafia' and seeks to answer the question: "what does the experience of participating in 'MD Mafia', a group for adolescent boys with muscular dystrophy, mean to the boys and their parents?". METHODS: This research sought the views of the boys who participate in MD Mafia and their parents. The sample included seven boys and four mothers. Data collection methods included creative group activities, specifically chosen to match the participants' age, interests and skills, and online data collection. The theoretical perspective of symbolic interactionism guided the theoretical analysis of the data. RESULTS: Analysis of the data provided a description of the meaning and value of 'MD Mafia' from the participants' perspective. MD Mafia has a strong collective identity, which reflects ideals of masculinity and common interests. The group provides much valued opportunity for socialization in a safe and familiar environment, but parents also felt that MD Mafia could offer greater opportunities for skill development by increasing the challenge level of the activities and social environment. The theoretical analysis provides insight into the value of social interactions between participants in a group which has had positive implications for the boys as individuals and for MD Mafia as a group. CONCLUSIONS: The research supports a group model of service delivery for boys with muscular dystrophy and has implications for the development of the group into the future.

Cost and affordability of healthy food in rural South Australia.

INTRODUCTION: As in many other countries, Australian consumers have recently had to accommodate increases in costs of basic food, and during the financial year 2007-2008 overall food prices rose by nearly 4%. Food costs are mediating factors in food choice, especially for low-income groups, where food security is often tenuous. There are reports that rural populations may have higher levels of food insecurity, although the evidence is often contradictory. METHODS: To assess cost and affordability of food in rural areas this study used the Healthy Food Basket (HFB) methodology, which has been applied in a number of settings. The HFBs were costed at supermarkets and stores in different locations with different degrees of rurality. RESULTS: Compared with metropolitan areas, healthy food is more expensive in rural areas; costs are even higher in more remote areas. The overall affordability of HFB in rural areas was not significantly different from metro areas. The main difference concerned low socio-economic status (SES) groups, where the proportion of household income spent on the HFB was three times that of higher SES groups. CONCLUSIONS: The unaffordability of healthy food, or 'food stress' in low SES groups is a concern, especially when this group carries the greatest burden of diet-related disease. Findings suggest that there is a need to consider both rurality and SES when developing policy responses to decrease the cost and increase the affordability of healthy foods in rural and remote areas.

Food security and sustainability: Are we selling ourselves short?

This paper deals with the question: do some food systems engender a more positive social environment than others, and does this matter? The pressure to generate financial capital from food production is enormous, especially for a country like Australia, and financial imperatives clearly drive choice of food production methods. Many have argued that environmental costs of food production are hardly ever factored into the profitability equation and the notion of sustainable development represents a position where consideration is given to environmental concerns while at the same time maximizing economic returns. While the importance of choice of food system in order to benefit the natural environment has been argued for, another environment - that of the social environment - remains relatively underexplored.

A question of balance: nutrition, health and gastronomy.

Given the higher proportion of manufactured foods now available which meet current dietary recommendations, the food supply in developed countries like Australia could be said to be "healthier". Yet the "health" of the diet is often achieved at the expense of the "health" of the environment since ecological problems created a current food production and distribution methods remain unaddressed. Further, nutritional modifications which produce foods that are low in fat, sugar, salt and high in fibre do not necessarily address the concerns consumers have about the food supply. An emphasis solely on the physical health of populations, through improved diet, is out of keeping with current views on health which recognise the importance of overall well-being. Through the development of the concept of "sustaining gastronomy", consumers, food manufacturers and producers, and food regulators can better address the problems inherent in the food system, including those of an environmental nature.

Radiation dosimetry for indium-111-pentetreotide.

UNLABELLED: We present radiation dose estimates for 111In-pentetreotide. METHODS: Kinetic data were gathered in 10 subjects at two different sites. A compartmental model was used to fit the data, including retention, in three major organs and excretion. RESULTS: The data were consistent for the subjects at both sites. The organ receiving the highest dose was the kidneys (0.52 mGy/MBq); the effective dose equivalent was 0.1 mSv/MBq, and the effective dose was 0.073 mSv/MBq. CONCLUSION: The results of this study provide the basis for evaluation of radiation safety of this drug.

Synthesis, characterization and myocardial uptake of cationic bis(arene)technetium(I) complexes.

A series of bis(arene)technetium(I) complexes has been synthesized from 99mTcO4- in order to study their organ distribution. Syntheses using either ultrasound/Al/AlCl3 or Zn/HCl gave products relatively free from transalkylation. The identity of the complexes was verified by comparison to the 99Tc complexes. Equivalence of the 99Tc and 99mTc complexes was demonstrated by HPLC techniques. Biodistribution studies in rats reveal substantial myocardial uptake for many members of the series, especially those containing benzene rings substituted with about four to six carbon atoms. The myocardial uptake is related to the lipophilicity of the complexes as measured by octanol/buffer partition ratios (OBPR). Optimal ranges of lipophilicity for maximal myocardial uptake occur for OBPR from 2 to 9. Rat and human plasma binding of the complexes increases with lipophilicity after a threshold value is exceeded.

Delayed effects of amphetamine or phencyclidine: interaction of food deprivation, stress and dose.

Tritium-labelled phencyclidine (PCP) hydrochloride (12 mg/kg) was injected SC for six consecutive days into two groups of eight male rats maintained at 85% of their initial free-feeding weights. Eight days after the last injection, electric footshock raised fat levels of PCP 28% over nonshocked controls, and lowered blood levels 18%, but did not alter brain levels of the drug significantly. Thus, application of an acute stressor does result in redistribution of tissue stores of phencyclidine as predicted in the literature; however, the direction of the redistributions was to fat, rather than to brain. To explore the relation of a long-term stressor (one that eliminates adipose tissue as a sink for mobilized PCP), exploratory behavior was evaluated in male rats during six days of food deprivation commencing after six daily injections of PCP HCl (2 or 4 mg/kg, SC). Exploratory behavior of the 4 mg/kg dose group was abruptly altered, compared to saline controls, at six days of food deprivation, when the rats' body weights were about 70% of initial weights and when body fat would be severely reduced or depleted. To assess replicability and generalizability of this phenomenon, PCP HCl (4 or 8 mg/kg, SC) or dextroamphetamine sulfate (3.2 or 6.4 mg/kg, SC) was injected into male rats for six days and food deprivation followed afterward for nine consecutive days, or until similar body weight reductions as in the first experiment were achieved. Again, exploratory behavior was altered in comparison to saline controls in phencyclidine-treated rats (at the 4 mg/kg dose level) when rats reached about 70% of initial weights.(ABSTRACT TRUNCATED AT 250 WORDS)

Food deprivation alters behavioral and plasma corticosterone responses to phencyclidine in rats.

Phencyclidine (PCP) sensitivity of rats, whose body weights were maintained at 70% of free-feeding controls, was compared to drug sensitivity of the controls in terms of unconditioned (exploratory) behavior and plasma corticosterone levels. Low doses of PCP HCl [0 (saline vehicle), 0.3 or 0.9 mg/kg, SC] were given to food-deprived rats and to free-feeding controls 15 minutes before measuring unconditioned behavior for 90 minutes; then PCP in brain and corticosterone in plasma were assayed. An additional group (0.43 mg/kg) was established from the reduced-weight rats in order to compare with free-feeding rats given 0.3 mg/kg, the same absolute dose-a circumstance reflecting "street" usage in which doses are not adjusted for body weight differences among users. These low doses of PCP altered exploratory behaviors, but there did not appear to be an interaction between food-deprivational status and drug, with the possible exception of an altered effect of PCP upon habituation in the lighter animals. PCP elevated plasma corticosterone levels over saline controls only in the reduced-weight rats. The drug, possibly reflecting a tranquilizing action of the lowest dose, reduced corticosterone levels in free-feeding controls. Brain levels of drug were directly related to dose, and were elevated in the food-deprived animals 26-30% over those at the same per-weight dose levels in the free-feeding rats, in spite of being given lower absolute amounts of drug. In the 0.43 mg/kg reduced-weight dose group, given the same absolute dose as the 0.3 mg/kg free-feeding group, brain levels were doubled over the latter group, and exploratory behavior was correspondingly different from the free-feeding group.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamic effects of ioversol in the dog and rat.

The hemodynamic effects of selectively administered ioversol were examined in the dog and rat. At concentrations ranging from 32% to 37% I, wt/vol, ioversol was compared with nonionic (iohexol, iopamidol) and ionic (diatrizoate) contrast media for cardiovascular responses following injections into the femoral vein, right and left coronary arteries, left ventricle, and the pulmonary and femoral arteries of the dog, and into the carotid artery of the rat. Regardless of the intravascular route of injection, ioversol generally caused minimal effects on the heart rate, minimal to moderate decreases in myocardial contractility, left ventricular pressure, mean arterial pressure, pulmonary vascular resistance, and systemic vascular resistance. These effects of ioversol were comparable to those of iohexol and iopamidol, and were relatively less profound than those of diatrizoate. Under experimental conditions injections of ioversol exerted hemodynamic effects comparable to those of other nonionic agents, yet relatively diminished as compared with a representative high-osmolality ionic contrast agent. These results suggest that the nonionic contrast agent, ioversol, should be well tolerated in patients following injections via similar intravascular routes.

Acute and subacute toxicity studies of ioversol in experimental animals.

The authors examined the acute and subacute toxicity of the low-osmolality nonionic radiographic contrast agent, ioversol. The median lethal dose (LD50) of ioversol administered intravenously to mice, rats, rabbits, and dogs was more than 12 g I/kg, which exceeds the maximal anticipated clinical dose by at least tenfold. When the acute intravenous toxicity of 35% I, wt/vol, ioversol was compared with 35% I, wt/vol, iohexol and 37% I, wt/vol, iopamidol in mice, no significant differences in LD50 values or general toxicity were found. Ioversol also was administered via intrathecal routes to rats, dogs, and monkeys. In a comparative study, acute intracisternal injections of 35% I, wt/vol, ioversol in rats demonstrated far less toxicity than 35% I, wt/vol, iohexol and 37% I, wt/vol, iopamidol, a result that may be due to the increased hydrophilic tendency of ioversol relative to iohexol and iopamidol. Acute intracisternal injections of 43% I, wt/vol, ioversol, 35% I, wt/vol, iohexol, and 37% I, wt/vol, iopamidol into dogs at 160 or 240 mg I/kg, demonstrated comparable, but only minimal, toxicity. Monkeys given lumbar intrathecal injections of ioversol tolerated 60 mg I/kg well with no resulting arachnoiditis. Subacute toxicity studies involving 4-week daily intravenous injections (0.2, 0.8, and 3.2 g I/kg/day) in rats and dogs showed ioversol to be well tolerated. The signs of toxicity included a reversible renal cytoplasmic tubular vacuolation in the rat at high doses and a reversible hepatocyte vacuolation in the dog at the same high dose. However, clinical chemistry tests showed no signs of renal or hepatic dysfunction, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Biodistribution and excretion of 125I ioversol in conscious dogs.

Radiolabeled ioversol was injected intravenously into two male and two female beagle dogs (6.7 to 10.4 kg) at two dose levels each (0.2 and 1.0 g I/kg). Blood levels of radioactivity were monitored at 2, 5, 10, 20, 40, 60, 90, and 120 minutes and at one and two days. Urine and feces were collected in metabolism cages for two days, at the end of which the dogs were killed and organs or tissues (kidneys, liver, spleen, lungs, thyroid glands, heart, gonads, and muscle) were sampled. Radioactivity in tissues and excreta was assayed. Biexponential disappearance of radioactivity from blood was observed in three of four dogs at each dose level. Distribution half-lives averaged 2.5 to 3.5 minutes. Elimination half-lives averaged 51 to 54 minutes. Volumes of distribution averaged 25% to 27% of body weight. No organ retention was evident at 48 hours. Recovery of ioversol in urine and feces averaged 86% to 88% of the administered dose, of which all but a few percent was recovered in urine. On chromatographic assay, ioversol accounted for an average of 103% to 109% of radioiodine, suggesting, within the experimental limits of the assay, that ioversol is excreted unchanged. No dose-related differences were evident in any of these measures. The pharmacokinetics and biodistribution of ioversol are consistent with those of other extracellularly distributed iodinated contrast agents that are excreted by the kidney.

The selenium status of children with phenylketonuria: results of selenium supplementation.

The selenium status of children with phenylketonuria on a synthetic low phenylalanine diet was assessed. Correlation between blood selenium and red cell glutathione peroxidase was unsatisfactory (r = 0.65) due to the poor discrimination of red cell glutathione peroxidase with a low selenium diet. No symptoms of deficiency were observed. Supplementation with 50 micrograms per week of selenium as brewers yeast tablets over a period of 6 months significantly increased the blood selenium of the phenylketonuric children. Plasma Vitamin E levels were within normal limits. The supplementation effectively doubled their selenium intake to 15-17 micrograms per day, which is probably sufficient for this group with an adequate Vitamin E status, though considerably lower than the recommended minimum intake of 50 micrograms per day.

Comparison of technetium-99m MAG3 kit with HPLC-purified technetium-99m MAG3 and OIH in rats.

Technetium-99m (99mTc) mercaptoacetylglycylglycylyglycine (MAG3) in high (greater than or equal to 95%) radiochemical purity is prepared from lyophilized kits containing benzoylMAG3, sodium tartrate, lactose, and stannous chloride by adding sodium [99mTC]pertechnetate and heating the contents briefly. Constant-infusion renal whole-blood clearance obtained with [99mTc] MAG3 kits was compared with that obtained with high performance liquid chromatography (HPLC) pure [99mTc]MAG3 and with co-infused iodine-131 (131I) iodohippurate (OIH) in anesthetized rats. Average renal whole-blood clearance of [99mTc]MAG3 from kits was 3.9 +/- 0.4 ml/min/100 g body weight (mean +/- s.e.m. n = 5) and that for HPLC-pure [99mTc]MAG3 was 4.6 +/- 0.3 (n = 3). Renal whole-blood clearance ratios for [99mTc]MAG3 to co-infused iodine-131 (131I) OIH were greater than unity for both kit formulation (1.7 +/- 0.1) and HPLC-pure [99mTc]MAG3 (1.9 +/- 0.2). Differences in these two measures were not significant. Plasma binding (determined from blood drawn at the end of the infusion) of [99mTc]MAG3 prepared from both kits (75 +/- 2%, n = 4) and HPLC-separation (76 +/- 4%) were greater than that of [131I]OIH in corresponding plasma samples (31 +/- 1% and 32 +/- 2%) respectively). Renograms performed in anesthetized rats revealed no statistically significant differences between kit-prepared [99mTc]MAG3 and [131I]OIH in terms of time-to-peak renal activity (5.0 +/- 1.7 min, n = 6; and 2.2 +/- 0.2 min, n = 3, mean +/- s.e.m. for [99mTc]MAG3 and [131I]OIH, respectively), in terms of time to fall to half-maximal activity (15.3 +/- 2.4 min and 9.6 +/- 2.1 min, respectively), or in terms of fraction of peak radioactivity in right kidney (0.53 +/- 0.01 for both substances). To assess possible interference from hepatobiliary uptake and excretion in renal failure, radioactivity in liver regions of interest was followed by gamma camera scintigraphy for 30 min after intravenous injection of [131I]OIH and kit and HPLC-purified [99mTc]MAG3 in anesthetized rats rendered anephric by ligating renal peduncles. Liver activity was 25% of total for both preparations of [99mTc]MAG3 and was 22% of total for [131I]OIH. There were no significant differences among the substances.

Detailed characterization and comparison of four lactic streptococcal bacteriophages based on morphology, restriction mapping, DNA homology, and structural protein analysis.

Bacteriophages uc1001 and uc1002, which are lytic for Streptococcus cremoris UC501 and UC502, respectively, were characterized in detail. Comparisons were made with a previously characterized phage, P008, which is lytic for Streptococcus lactis subsp. diacetylactis F7/2, and uc3001, which is a lytic phage for S. cremoris UC503. Phages uc1001 and uc1002 had small isometric heads (diameters, 52 and 50 nm, respectively) and noncontractile tails (lengths, 152 and 136 nm, respectively), and uc1002 also had a collar. Both had 30.1 +/- 0.6 kilobase pairs (kbp) of DNA with cross-complementary cohesive ends. Restriction endonuclease maps made with seven endonucleases showed no common fragments. Despite this there was a very high level of homology between uc1001 and uc1002, and results of cross-hybridization experiments showed that the organization of both phage genomes was similar. Heteroduplex analysis confirmed this and quantified the level of homology at 83%. The regions of nonhomology comprised 2.1-, 1.1-, and 1.0-kbp deletion loops and 13 smaller loops and bubbles. The sodium dodecyl sulfate-polyacrylamide gel electrophoretic structural protein profiles were related, with a major band of about 40,000 molecular weight and minor bands of 35,000 and 34,000 molecular weight in common. There were also differences, however, in that uc1001 had a second major band of 68,000 molecular weight and two extra minor bands. Except for the restriction maps, which were strain specific, phages uc1001, uc1002, and P008 were closely related by all the criteria listed above. Their DNAs also showed a very significant bias against the cleavage sites of 9 of 11 restriction endonucleases. Phage uc3001 was unrelated to uc1001, uc1002, or P008 in that it had a prolate head (53 by 39 nm) and a shorter tail (105 nm), contained approximately 22 kbp of DNA, had unrelated cohesive ends, showed no DNA homology with the isometric-headed phages, and displayed a very different structural protein profile.

Goat's milk and infant feeding.

As goat's milk becomes more popular in Australia, clinicians are being asked about its suitability as an infant feed. The popularity of goat's milk in part comes from unsubstantiated claims that it is less allergenic and more digestible than is cow's milk. Raw goat's milk is used by those who believe that pasteurization is detrimental, although the risks of consuming unpasteurized milk have been well documented and recent reports have warned about the dangers of feeding unmodified goat's milk to infants. If goat's milk is to be fed to infants it should be pasteurized or boiled, diluted to reduce solute load, and then fortified with vitamins. Although these modifications do not produce an ideal milk, they do minimize the risks of using goat's milk as an infant feed.