Neonatal outcomes in term and preterm infants following adjunctive azithromycin antibiotic prophylaxis for non-elective cesarean delivery.

OBJECTIVE: It is currently unknown whether adjunctive azithromycin prophylaxis at the time of non-elective cesarean has differential effects on neonatal outcomes in the context of prematurity. The objective of this study was to compare whether neonatal outcomes differ in term and preterm infants exposed to adjunctive azithromycin prophylaxis before non-elective cesarean delivery. STUDY DESIGN: A planned secondary analysis of a multi-center randomized controlled trial that enrolled women with singleton pregnancies ≥24 weeks gestation undergoing non-elective cesarean delivery (during labor or ≥4 h after membrane rupture). Women received standard antibiotic prophylaxis and were randomized to either adjunctive azithromycin (500 mg) or placebo. The primary composite outcome was neonatal death, suspected or confirmed neonatal sepsis, and serious neonatal morbidities (NEC, PVL, IVH, BPD). Secondary outcomes included NICU admission, neonatal readmission, culture positive infections and prevalence of resistant organisms. Odds ratios (OR) for the effect of azithromycin versus placebo were compared between gestational age strata (preterm [less than 37 weeks] versus term [37 weeks or greater]). Tests of interaction examined homogeneity of treatment effect with gestational age. RESULTS: The analysis includes 2,013 infants, 226 preterm (11.2%) and 1,787 term. Mean gestational ages were 34 and 39.5 weeks, respectively. Within term and preterm strata, maternal and delivery characteristics were similar between the azithromycin and placebo groups. There was no difference in the odds of composite neonatal outcome between those exposed to azithromycin versus placebo in preterm neonates (OR 0.82, 95% CI 0.48-1.41) and in term neonates (OR 1.06, 95% CI 0.77-1.46), with no difference between gestational age strata (p = 0.42). Analysis of secondary outcomes also revealed no differences in treatment effects within or between gestational age strata. CONCLUSION: Exposure to adjunctive azithromycin antibiotic prophylaxis for non-elective cesarean delivery does not increase neonatal morbidity or mortality in term or preterm infants. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov, NCT01235546.

Compliance of Australian commercial foods for young children (<36 months) with an international nutrient and promotion profile model.

OBJECTIVE: To assess how Australian infant and toddler foods compare to a nutrient and promotion profile model (NPPM) developed by the World Health Organization to support the appropriate promotion of commercial food products for children aged 6-36 months. METHODS: A cross-sectional audit of infant and toddler foods found at three major Australian supermarkets was conducted in September/October 2022. Using nutrition and promotional data extracted from the packaging, products were classified according to NPPM categories and assessed against relevant compositional, front-of-pack labelling and promotional requirements. RESULTS: Of 330 eligible products identified, just 28% met all NPPM compositional requirements. Toddler foods were less compliant than infant foods overall (18% vs. 31%; p=0.021), and for specific nutrients such as sodium (75% vs. 89%; p=0.003). No products met all NPPM front-of-pack labelling/promotional requirements. Only two-thirds and two-fifths of products were compliant with product name and ingredient list requirements, respectively. CONCLUSION: Australian infant and toddler foods do not fully comply with the NPPM requirements. While toddler foods performed comparatively worse in terms of their nutritional adequacy, there is considerable scope to improve the nutrient profile of both infant and toddler foods. IMPLICATIONS FOR PUBLIC HEALTH: To better support young children's health and development, the introduction of mandatory nutrition standards for Australian toddler foods, and the improvement of nutrition standards for Australian infant foods, in line with the NPPM, is needed. To be most effective, these should be combined with regulations for the labelling and promotion of these foods in line with the NPPM.

Effects of marketing claims on toddler food products on parents' product preferences, perceptions and purchasing intentions: an online experiment.

BACKGROUND: The retail market for toddler-specific packaged foods is growing. Many of these products are ultra-processed and high in nutrients of concern for health, yet marketed in ways that may make them appear wholesome. This study aims to assess parents' responses to claims on unhealthy, ultra-processed toddler food products and test whether removing such claims promotes more accurate product perceptions and healthier product preferences. METHODS: Parents of toddlers aged 12 to < 36 months (N = 838) were recruited for an online experiment testing four on-pack claim conditions: control (no claim); 'contains "good" ingredient'; 'free from "bad" ingredient'; and unregulated 'child-related' claim. Participants were randomly assigned to one condition, then viewed images of toddler food products that varied in nutrition content and the claims displayed. Participants completed tasks assessing product preferences (unhealthy product displaying claim vs. a healthier option with no claim, across four food categories (banana bars, strawberry snacks, blueberry yogurt snacks and veggie snacks)), purchase intentions and product perceptions. Poisson regression (count variable) and linear regression (continuous outcomes) analyses were employed to test for mean differences by marketing claim conditions. RESULTS: For the overall sample, brief exposure to 'free from "bad" ingredient' claims increased participant's intentions to purchase unhealthy food products for their toddlers, but there was no clear evidence that 'contains "good" ingredient' claims and 'child-related' claims significantly impacted parent's preferences, purchase intentions and perceptions of toddler foods. However, certain claims influenced particular parent subgroups. Notably, parents with three or more children chose more unhealthy products when these products displayed 'contains "good" ingredient' or 'free from "bad" ingredient' claims; the latter claims also promoted stronger purchase intentions and enhanced product perceptions among this subgroup. CONCLUSIONS: Findings indicate that 'free from "bad" ingredient' claims on unhealthy toddler foods are of most concern, as they boost the appeal of these products to parents. 'Contains "good" ingredient' claims and 'child-related' claims showed limited effects in this study. Considering available evidence, we recommend claims should not be permitted on child-oriented foods, as they may promote inaccurate product perceptions and unhealthy product choices by parents, that can detract from their children's diets and health.

Australian adults' attitudes towards government actions to protect children from digital marketing of unhealthy food and drink products.

ISSUE ADDRESSED: This study assessed Australian adults' attitudes towards government actions to protect children from digital marketing of unhealthy food and drink products. METHODS: An online survey was undertaken by Australian adults aged 18-64 recruited via two national panels in December 2019 (N = 2044). RESULTS: Most respondents (69%) agreed the Government should protect children from unhealthy food and drink marketing and advertising broadly. Those who agreed most commonly indicated children should be protected up to age 16 (34%) or 18 (24%). There was widespread support for government actions to stop unhealthy food and drink marketing on digital platforms (e.g., internet sites) (68%-69%) and various digital marketing techniques (e.g., advertising by brands on social media) (56%-71%). A total ban on targeting unhealthy food and drink marketing to children online received the highest level of support (76%). Most respondents (81%) disagreed unhealthy food and drink companies should be able to collect children's personal information for marketing purposes. Support for examined actions was generally higher among older adults, more educated adults and more frequent internet users, lower among males, and similar between parents and non-parents. CONCLUSIONS: There is public perception that the government is responsible for protecting children, well into adolescence, from unhealthy food and drink marketing broadly. Widespread public support extends to specific actions to reduce children's exposure to digital marketing of unhealthy food and drink products. SO WHAT?: Implementation of policies to protect children from digital marketing of unhealthy food and drink products would be well received by the Australian public.

A framework of NGO inside and outside strategies in the commercial determinants of health: findings from a narrative review.

BACKGROUND: Public health scholarship has uncovered a wide range of strategies used by industry actors to promote their products and influence government regulation. Less is known about the strategies used by non-government organisations to attempt to influence commercial practices. This narrative review applies a political science typology to identify a suite of 'inside' and 'outside' strategies used by NGOs to attempt to influence the commercial determinants of health. METHODS: We conducted a systematic search in Web of Science, ProQuest and Scopus. Articles were eligible for inclusion if they comprised an empirical study, explicitly sought to examine 'NGOs', were in English, and identified at least one NGO strategy aimed at commercial and/or government policy and practice. RESULTS: One hundred forty-four studies met the inclusion criteria. Eight industry sectors were identified: extractive, tobacco, food, alcohol, pharmaceuticals, weapons, textiles and asbestos, and a small number of general studies. We identified 18 types of NGO strategies, categorised according to the target (i.e. commercial actor or government actor) and type of interaction with the target (i.e. inside or outside). Of these, five NGO 'inside' strategies targeted commercial actors directly: 1) participation in partnerships and multistakeholder initiatives; 2) private meetings and roundtables; 3) engaging with company AGMs and shareholders; 4) collaborations other than partnerships; and 5) litigation. 'Outside' strategies targeting commercial actors through the mobilisation of public opinion included 1) monitoring and reporting; 2) protests at industry sites; 3) boycotts; 4) directly engaging the public; and 5) creative use of alternative spaces. Four NGO 'inside' strategies directly targeting government actors included: 1) lobbying; 2) drafting legislation, policies and standards; 3) providing technical support and training; and 4) litigation. NGO 'outside' strategies targeting government included 1) protests and public campaigns; 2) monitoring and reporting; 3) forum shifting; and 4) proposing and initiating alternative solutions. We identified three types of NGO impact: substantive, procedural, and normative. CONCLUSION: The analysis presents a matrix of NGO strategies used to target commercial and government actors across a range of industry sectors. This framework can be used to guide examination of which NGO strategies are effective and appropriate, and which conditions enable NGO influence.

Utility of Weekly Laboratory Monitoring in the Expectant Management of Hypertensive Disorders of Pregnancy.

Our retrospective cohort study evaluates the diagnostic yield of weekly laboratory surveillance in outpatient management of hypertensive disorders of pregnancy (HDP) based on patient clinical status at the time of laboratory testing. The study included 459 patients and 1,082 laboratory episodes: 356 (32.9%) episodes were performed in the setting of concerning clinical findings and 726 (67.1%) when the patient was asymptomatic. Overall, the diagnostic yield for abnormal laboratory values (n=11) was 1.0% (95% CI 0.4-1.6%) of all assessments performed and 2.4% (95% CI 1.0-3.8%) among all patients in the cohort. The prevalence of abnormal test results was higher in patients with clinical findings (2.8%, 95% CI 1.1-4.5%) compared with those who were asymptomatic (0.1%, 95% CI 0-0.2%) ( P <.01). Clinical findings suggestive of worsening disease had a 91% sensitivity (95% CI 59-100%) and a 99% (95% CI 99-100%) negative predictive value for abnormal laboratory values. Directed screening based on signs and symptoms, rather than universal weekly screening, may be a potential strategy to lower costs and reduce multiple blood draws for patients with HDP, because there is a low diagnostic yield for this practice.

The utility of word list and story recall for identifying older U.S. Chinese immigrants with cognitive impairment.

OBJECTIVE: This study examined the utility of the Chinese-language translations of the word list memory test (Philadelphia Verbal Learning Test) and story memory test (Logical Memory subtest of the Wechsler Memory Scale) for differentiating cognitive diagnosis in older U.S. Chinese immigrants. METHOD: Participants were ≥ 60 years old, with Chinese language proficiency to complete a diagnostic workup at the Mount Sinai's Alzheimer's Disease Research Center. The workup included an evaluation by a geriatric psychiatrist and cognitive testing with a psychometrician. Diagnosis of normal, mild cognitive impairment (MCI), and dementia was made independent of the cognitive tests at consensus led by a dementia expert physician. Multivariable logistic regression models were used to assess the sensitivity of story and word list memory tests for distinguishing between groups. Receiver operating characteristic (ROC area/area under the curve [AUC]) was used to compare the predictive accuracy of the two tests. RESULTS: The sample included 71 participants with normal cognition, 42 with MCI, and 24 with dementia. The MCI group was older and less educated than normal controls but younger and more educated than the dementia group. Delayed recall of both memory tests, but not immediate recall of either test, predicted diagnosis. While composite memory score of word list (AUC = 0.90) predicted diagnosis slightly better than that of stories (AUC = 0.85), the difference was not significant in this small sample (p = .14). CONCLUSIONS: Chinese-language translations of verbal memory tests, in particular delayed recall scores, were equally sensitive for classifying cognitive diagnosis in older U.S. Chinese immigrants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Masked pregnancy-associated hypertension as a predictor of adverse outcomes.

BACKGROUND: Masked hypertension has been described in nonpregnant populations as elevated blood pressure in the home setting that is not reproduced on clinical assessment. Patients with masked hypertension have a greater risk of cardiovascular morbidity than patients who have blood pressures within normal range or those with white coat hypertension. OBJECTIVE: This study aimed to determine whether masked pregnancy-associated hypertension detected on Connected Maternity Online Monitoring, a remote home blood pressure monitoring system, is associated with higher rates of hypertensive disorders of pregnancy during delivery admission and maternal and neonatal morbidities. STUDY DESIGN: This was a retrospective cohort study of all patients on Connected Maternity Online Monitoring who delivered at 6 hospitals in a single healthcare system between October 2016 and December 2020. Patients were classified as having either normal blood pressure or masked pregnancy-associated hypertension. Masked pregnancy-associated hypertension was defined as remotely detected systolic blood pressure of ≥140 mm Hg or diastolic blood pressure of ≥90 mm Hg after 20 weeks of gestation on 2 occasions before diagnosis in a clinical setting. The chi-square test and Student t test were used for demographic and outcomes comparisons. Logistic regression was used to adjust outcomes by race, insurance, and body mass index. RESULTS: A total of 2430 deliveries were included in our analysis, including 165 deliveries that met the criteria for masked pregnancy-associated hypertension. Clinically established pregnancy-associated hypertension, defined at the time of delivery, was more common in the masked pregnancy-associated hypertension group than in the normotensive group (66% vs 10%; adjusted odds ratio, 17.2; 95% confidence interval, 11.91-24.81). Patients with masked pregnancy-associated hypertension had higher rates of preeclampsia with severe features on delivery admission than normotensive patients (28% vs 2%; adjusted odds ratio, 23.35; 95% confidence interval, 14.25-38.26). Preterm delivery (16% vs 7%; adjusted odds ratio, 2.47; 95% confidence interval, 1.55-3.94), cesarean delivery(38% vs 26%; adjusted odds ratio, 1.58; 95% confidence interval, 1.13-2.23), small for gestational age (11% vs 5%; adjusted odds ratio, 2.27; 95% confidence interval, 1.31-3.94), and neonatal intensive care unit admission (8% vs 4%; adjusted odds ratio, 2.20; 95% confidence interval, 1.18-4.09) were more common among patients with masked pregnancy-associated hypertension than among normotensive patients. CONCLUSION: With more outcomes research, remote blood pressure monitoring may prove to be an important tool in identifying pregnancies at risk of complications related to masked hypertension.

Evaluating memory testing to distinguish dementia severity among White, Black, and Spanish-speaking individuals in the Uniform Data Set (UDS).

INTRODUCTION: Little work has compared the effectiveness of using multiple types of memory tests alone or in combination to distinguish dementia severity in diverse research cohorts including Black individuals and Spanish speakers. Here we evaluate word list and paragraph recall tests to distinguish cognitively normal, mild cognitively impaired, and those with Alzheimer's disease in diverse cohorts. METHODS: Using Uniform Data Set (UDS) and site-specific supplemental data, logistic regression models and receiver operating characteristic-area under the curve were used to compare paragraph recall versus word list in differentiating among Clinical Dementia Rating (CDR) scale level. RESULTS: Results reveal high discriminability for all groups and no difference between either test in distinguishing between CDR levels. Combining tests improved discriminability for the whole group but did not for Black individuals or Spanish speakers. DISCUSSION: Our findings indicate that using multiple memory tests may not improve differentiation between cognitive impairment levels for diverse cohorts. The burden of added testing may be a barrier for maximizing inclusion of under-represented groups in research.

Commercially available foods for young children (<36 months) in Australia: An assessment of how they compare to a proposed nutrient profile model.

ISSUE ADDRESSED: To assess the nutritional composition of commercially available foods (CAFs) for infants and toddlers sold in Australia to determine whether they meet World Health Organization (WHO) Europe's proposed standards for nutritionally appropriate foods for children <36 months. METHODS: A cross-sectional retail audit of infant (n = 177) and toddler (n = 73) foods found in-store and online at three major Victorian supermarkets was conducted in August/September 2019. Products were grouped according to WHO Europe's food categories and their nutrient content assessed against specific composition standards applicable to their category. The presence of added sugar in each product was also recorded. RESULTS: Most infant products (71%) were soft-wet spoon-able, ready-to-eat foods whereas the most prevalent category for toddler products was dry finger foods and snacks (71%). Overall, just one-third of CAFs met all the nutrient recommendations for their category, with infant foods more likely to be compliant than toddler foods (43% vs. 10%; P < .001). Around 9 in 10 infant (93%) and toddler (89%) CAFs contained added sugar according to the Public Health England definition of 'free' sugars. CONCLUSIONS: There is considerable scope to improve the nutritional composition of Australian CAFs for both infants and toddlers, to reduce harmful sugars in these foods and to improve the energy density of them. For CAFs marketed as suitable for toddlers there is also considerable scope to reduce the sodium content. SO WHAT?: These findings support the need for stronger regulation of CAFs for infants and toddlers to better promote healthy eating patterns and taste preferences in young children.

Pregnancy Outcomes in Patients After Completion of the mRNA Coronavirus Disease 2019 (COVID-19) Vaccination Series Compared With Unvaccinated Patients.

OBJECTIVE: To compare frequency of perinatal death between pregnant patients who completed the mRNA coronavirus disease 2019 (COVID-19) vaccination series and unvaccinated patients. METHODS: This retrospective cohort study included 15,865 pregnant patients who delivered 16,132 newborns after 20 weeks of gestation within a large regional health system between January 1, 2021, and December 31, 2021. Patients who received two doses of mRNA vaccine (Pfizer-BioNTech [BNT162b2] or Moderna [mRNA-1273]) were included in the vaccinated group and were compared with unvaccinated patients. Exclusions included partial vaccination, viral-vector vaccine, major congenital anomalies, and higher-order multiple gestation. Our primary outcome was perinatal death, including stillbirth and neonatal death, which was evaluated by logistic regression. Unadjusted odds ratios and adjusted odds ratios (aORs) were reported, controlling for age, body mass index (BMI), diabetes, hypertension, smoking, twin gestation, and insurance status. Propensity score matching was also performed. RESULTS: A total of 15,865 patients were included in the final analysis: 2,069 in the vaccination group and 13,796 in the control group. Only 13.0% of the cohort was included in the vaccination group; however, the vaccination rate increased over the course of the study period as the vaccine became more widely available and accepted. Vaccinated patients were older, with higher rates of people of non-Black racial non-Hispanic ethnic backgrounds, people with private insurance, and those with higher BMIs. Vaccination was associated with a lower incidence of perinatal death (0.5% vaccinated group vs 0.8% unvaccinated group, aOR 0.20 0.05-0.88). Vaccination against COVID-19 was also associated with lower rates of preterm delivery (aOR 0.63, 0.48-0.82), neonates with very low birth weight (aOR 0.35, 0.15-0.84), and neonatal intensive care unit (NICU) admission (aOR 0.66, 0.52-0.85). The association between vaccination and lower rates of perinatal death was no longer significant after propensity score matching. CONCLUSION: In a large retrospective cohort study, receipt of the primary mRNA COVID-19 vaccination series was associated with a lower rate of several adverse pregnancy outcomes, including perinatal death, preterm delivery, neonates with very low birth weight, and NICU admission. Although the decreased rates of perinatal death did not remain significant after propensity score matching, there was evidence of directional benefit for vaccinated patients.

The use of subjective cognitive complaints for detecting mild cognitive impairment in older adults across cultural and linguistic groups: A comparison of the Cognitive Function Instrument to the Montreal Cognitive Assessment.

INTRODUCTION: This pilot study aims to explore the psychometric properties of the Cognitive Function Instrument (CFI) as a measure of subjective cognitive complaints (SCC) and its performance in distinguishing mild cognitive impairment (MCI) from normal control (NC) compared to an objective cognitive screen (Montreal Cognitive Assessment [MoCA]). METHODS: One hundred ninety-four community-dwelling non-demented older adults with racial/ethnic diversity were included. Unidimensionality and internal consistency of the CFI were examined using factor analysis, Cronbach's alpha, and McDonald's omega. Logistic regression models and receiver operating characteristic (ROC) analysis were used to examine the performance of CFI. RESULTS: The CFI demonstrated adequate internal consistency; however, the fit for a unidimensional model was suboptimal. The CFI distinguished MCI from NC alone or in combination with MoCA. ROC analysis showed comparable performance of the CFI and the MoCA. DISCUSSION: Our findings support the use of CFI as a brief and easy-to-use screen to detect MCI in culturally/linguistically diverse older adults. HIGHLIGHT: What is the key scientific question or problem of central interest of the paper? Subjective cognitive complaints (SCCs) are considered the earliest sign of dementia in older adults. However, it is unclear if SCC are equivalent in different cultures. The Cognitive Function Instrument (CFI) is a 14-item measure of SCC. This study provides pilot data suggesting that CFI is sensitive for detecting mild cognitive impairment in a cohort of older adults with racial/ethnic diversity. Comparing performance, CFI demonstrates comparable sensitivity to the Montreal Cognitive Assessment, an objective cognitive screening test. Overall, SCC may provide a non-invasive, easy-to-use method to flag possible cognitive impairment in both research and clinical settings.

Unexpected Term Neonatal Intensive Care Unit Admissions and a Potential Role for Centralized Remote Fetal Monitoring.

OBJECTIVE: Centralized remote fetal monitoring (CRFM) has been proposed as a method to improve the performance of intrapartum fetal heart rate (FHR) monitoring and perinatal outcomes. The purpose of this study is to determine whether CRFM was associated with a reduction in unexpected term neonatal intensive care unit (NICU) admissions. STUDY DESIGN: A pre-post design was used to examine the effectiveness of CRFM which was implemented in stages across five hospitals. The exposure group was all women who underwent intrapartum monitoring via CRFM. The unexposed group was of women who delivered at the same hospitals prior to implementation of CRFM. Pregnancies with expected NICU admissions, gestational age <37 weeks, birth weight <2,500 g, or major fetal anomalies detected prenatally were excluded. The primary outcome was unexpected term NICU admission; secondary outcomes were cesarean and operative vaginal delivery (OVD), and 5-minute Apgar's score of <7 rates. Maternal and delivery characteristics were examined with Student's t, Wilcoxon's, Chi-square, and Fisher's exact tests. Multivariable logistic regression was performed to control for potential confounders. RESULTS: There were 19,392 live births included in this analysis. In the univariable analysis, the odds of unexpected term NICU admission was lower among the CRFM exposed group compared with the unexposed group (odds ratio [OR] = 0.86, 95% confidence interval [CI]: 0.75-0.99; p = 0.038). In multivariable analysis, this did not reach statistical significance (OR = 0.92, 95% CI: 0.79-1.06; p = 0.24). Cesarean and OVD were less likely in the exposed group (OR = 0.91, 95% CI: 0.85-0.97; p = 0.008) and (OR = 0.70, 95% CI: 0.59-0.83, p < 0.001), respectively, in univariable analysis. When adjusted for potential confounders, the effect remained statistically significant for cesarean delivery (OR = 0.92, 95% CI: 0.85-0.98; p = 0.012). When adjusted for hospital, OVD rate was lower at the highest volume and highest acuity site (OR = 0.48, 95% CI: 0.36-0.65, p < 0.001). CONCLUSION: In some practice settings, utilization of a CRFM system may decrease the risk of unexpected term NICU admission, cesarean, and OVD rate. KEY POINTS: · CRFM may decrease unexpected term NICU admissions in some clinical settings.. · CRFM may decrease cesarean delivery rates in some clinical settings.. · CRFM may decrease OVD rates in some clinical settings..

Obesity prevention and related public health advertising versus competing commercial advertising expenditure in Australia.

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016-18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.

Atropine, Ondansetron, and Ketorolac: Supplemental Management of Amniotic Fluid Embolism.

Background: Amniotic fluid embolism (AFE) is a rare cause of severe maternal morbidity and mortality. No well-studied protocols are available for management of AFE. We present a case of cardiac arrest secondary to presumed AFE and the use of atropine-ondansetron-ketorolac (AOK). Case Report: A 34-year-old gravida 4, para 2012 underwent a repeat cesarean section at 39 weeks of gestation. After delivery of the placenta, hypoxia and hypotension developed, followed by cardiac arrest. Protocols for management of maternal cardiac arrest were followed. Echocardiogram demonstrated right ventricular dilation and hypokinesis. AOK was administrated during prolonged cardiac arrest, and spontaneous circulation returned. The patient was extubated on postoperative day 3 and discharged on postoperative day 10 without neurologic deficits. Conclusion: Management of AFE should include consideration of the addition of AOK to typical guidelines.

"No Child or Adult Would Ever Probably Choose to Have 16 Teaspoons of Sugar": A Preliminary Study of Parents' Responses to Sugary Drink Warning Label Options.

Front-of-pack (FoP) warning labels are a viable policy option with the potential to inform consumer choice and assist in reducing sugar-sweetened beverage (SSB) consumption as part of a multi-faceted approach. This study explored parents' perceptions and understanding of a range of SSB warning labels. Focus groups (n = 12) with 82 parents of school-aged children were conducted, stratified according to education level, sex and location. Health effects, exercise equivalents, sugar content (teaspoons in text and pictograms, "high in") and energy content labels were shown. Through thematic analysis we identified three themes. Theme 1 related to perceptions of effectiveness of labels, underpinned by four subthemes: perceptions of labels as credible, informative and useful, personally relevant and having the potential to change be haviour. Theme 2 related to participants finding opportunities for self-exemption (e.g., physically active) and message rejection (e.g., misinterpretation). Theme 3 encompassed the potential negative consequences of some labels (e.g., body image concerns). The text teaspoons label was perceived most favourably across all themes, with minimal negative issues raised. These results provide in-depth insight into potential responses to labelling as a policy intervention, providing important guidance for the development of labels to ensure optimal message content and framing for future testing and subsequent implementation.

The commercial determinants of unhealthy diets.

Unhealthy diets are a leading risk factor for obesity and non-communicable disease. Food choices are made within the context of people's social circumstances as well as the broader food environment, which is shaped extensively by food and beverage industry practices, which include market, financial and political activities undertaken to increase the sale and consumption of highly processed food and beverages. To reduce the burden of unhealthy diets, there is a clear need for government-led action to disrupt the balance of power that currently favours commercial interests over public health.

Exploring the effects of added sugar labels on food purchasing behaviour in Australian parents: An online randomised controlled trial.

BACKGROUND: Evidence of the effects of front-of-pack added sugar labelling remains limited, especially for foods other than sugary drinks. More information is needed about which labels are likely to be most effective in reducing intended purchases of products with higher added sugar content in realistic contexts to inform policymakers' decisions. OBJECTIVE: To determine the impact of added sugar labels on intended purchases of high sugar breakfast cereals, yoghurt, and non-alcoholic beverages. METHODS: Australian parents who were regular purchasers of relevant product categories completed an online parallel randomised controlled trial from 31 August 2020 to 13 February 2021. Participants selected their intended purchase from 10 products in each of packaged beverages, breakfast cereal, and yoghurt categories after randomisation to one of seven added sugar labelling conditions in current use or under consideration by the Australian Government. Logistic regressions assessed differences between intervention and control conditions in the odds of intended purchases of a high sugar product. RESULTS: 2825 eligible participants were randomised with 2582 valid surveys analysed (Control n = 367; 'Nutrition Information Panel (NIP) with Added Sugar' n = 364; 'Teaspoons of Sugar' n = 369; 'Warning' n = 371; 'Health Star Rating (HSR) using Total Sugar' n = 368; 'HSR with Added Sugar' n = 371; 'Sugar in the Ingredients List' n = 372). No consistent effects were found on intended purchases of high sugar products overall or within product categories for any of the tested labels compared to controls (overall, 'NIP with Added Sugar': OR 1.00 [95%CI 0.83,1.20]; 'Teaspoons of Sugar': 0.94[0.80,1.11]; 'Warning': 1.10[0.93,1.30]; 'HSR with Total Sugar': 1.01[0.85,1.21]; 'HSR with Added Sugar': 1.09[0.92,1.30]; 'Sugar in the Ingredients List': 1.01[0.85,1.21]). CONCLUSIONS: Findings reinforce the importance of ensuring nutrition labelling policies are introduced as part of a suite of interventions to influence both consumer and manufacturer behaviour. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12620000858998. Registered 28 August 2020, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000858998.