The effect of a fictitious peer on young children's choice of familiar v. unfamiliar low- and high-energy-dense foods

The present experimental study was the first to investigate the impact of a remote (non-existent) peer on children's food choice of familiar v. unfamiliar low- and high-energy-dense food products. In a computer task, children (n 316; 50·3?% boys; mean age 7·13 (sd 0·75)?years) were asked to choose between pictures of familiar and unfamiliar foods in four different choice blocks using the following pairs: (1) familiar v. unfamiliar low-energy-dense foods (fruits and vegetables), (2) familiar v. unfamiliar high-energy-dense foods (high sugar, salt and/or fat content), (3) familiar low-energy-dense v. unfamiliar high-energy-dense foods and (4) unfamiliar low-energy-dense v. familiar high-energy-dense foods. Participants who were not in the control group were exposed to the food choices (either always the familiar or always the unfamiliar food product) of a same-sex and same-age fictitious peer who was supposedly completing the same task at another school. The present study provided insights into children's choices between (un)familiar low- and high-energy-dense foods in an everyday situation. The findings revealed that the use of fictitious peers increased children's willingness to try unfamiliar foods, although children tended to choose high-energy-dense foods over low-energy-dense foods. Intervention programmes that use peer influence to focus on improving children's choice of healthy foods should take into account children's strong aversion to unfamiliar low-energy-dense foods as well as their general preference for familiar and unfamiliar high-energy-dense foods.     

Expected satiation after repeated consumption of low- or high-energy-dense soup

We investigated whether repeated consumption of a low-energy-dense (LED; 208 kJ/100 g) or high-energy-dense (HED; 645 kJ/100 g) soup modifies expectations relating to the satiating capacity of the food, and its subsequent intake. In study 1, participants consumed either a novel-flavoured LED (n 32; 21 (SD 1·6) years, BMI 21·4 (SD 1·6) kg/m(2)) or HED soup (n 32; 21 (SD 1·6) years, BMI 21·3 (SD 1·7) kg/m(2)). Soup was served in a fixed amount on days 1-4 and ad libitum on day 5. 'Expected satiation' was measured on days 1, 2 and 5. Expected satiation did not change after repeated consumption of the LED or HED soup. Ad libitum intake did not differ between the LED (461 (SD 213) g) and HED soup (391 (SD 164) g). Only on day 1, expected satiation was higher for the HED soup than for the LED soup (P = 0·03), suggesting a role for sensory attributes in expected satiation. In study 2, thirty participants (21 (SD 1·6) years, BMI 21·3 (SD 1·7) kg/m(2)) performed a single measurement of expected satiation of the LED and HED soup, and four commercially available types of soup. Ratings on sensory attributes were associated with expected satiation. Results on expected satiation coincided with those of study 1. Thickness and intensity of taste were independently associated with expected satiation. Expectations may initially rely on sensory attributes and previous experiences, and are not easily changed.     

Misunderstandings and ambiguities in strategic purchasing in low- and middle-income countries

Strategic purchasing is branded as an approach that is necessary for progress towards universal health coverage. While we agree that publicly purchased health services should respond to society's needs and patient expectations, and thus generally endorse strategic purchasing, here we would like to explore two emerging concerns within current discussions in low- and middle-income countries. First, there exists a great deal of misunderstanding and conceptual unclarity, within practitioner groups, around the concept of strategic purchasing and what instruments it incorporates. Second, there is a growing trend to regularly fuse strategic purchasing into a performance-based financing (PBF) discourse in ways that increasingly blur their distinctive properties and policy orientations, while perhaps too easily obfuscating potential tensions. We believe the discourse on strategic purchasing would benefit from better conceptual clarity by dissociating and prioritising its two objectives, namely: priority should be given to needs-based allocation of resources, while rewarding performance is a subsequent concern. We argue there is a need for a more thoroughgoing conceptual and empirical re-examination of strategic purchasing's priorities, its link with PBF, as well as for a wider evidence-base on what strategic purchasing tools exist and which are most appropriate for diverse contexts.     

中低收入国家药品定价和采购的政策选择

药品支出上涨是全球问题。为应对这一压力,多数高收入国家制定并实施了一系列的药品定价和采购政策。然而,尽管中低收入国家希望能够有效控制药品支出预算,但其药品市场不规范,并缺乏可行的药品定价或采购政策。高收入国家药品支出通常由国家或社会医疗保险机构支付,而中低收入国家大多是个人自付,这会给政策执行造成阻力。由于对药品定价和采购政策是否高效缺乏严谨的调查研究,因而一定程度上阻碍了中低收入国家政策方案的实施。本文对已发表的有关药品定价和采购政策的文章进行综述发现,许多有效的政策也伴随着各种风险。全球尚没有一种最佳的政策选择,各国应根据具体国情,多种政策结合使用。中低收入国家的实证研究尚不足,由于缺乏完善的法律体系以及未建立专门的药品采购机构,任何一种政策选择所伴随的风险在这些国家都会引起更大的争议,然而这或许是帮助其改善药品定价和采购体系的关键因素。     

Biomarkers and functional foods for obesity and diabetes

Obesity has reached epidemic proportions in many countries around the world. Because of the close relationship between obesity and type 2 diabetes, an epidemic of diabetes is close behind the obesity epidemic. Preventing and treating obesity is becoming an increasing priority. In the United States, over 60 % of the adult population is overweight or obese and thus at increased risk of developing diabetes and cardiovascular disease. While the aetiology of obesity and diabetes is complex, diet clearly plays an important role both in the development and management of these diseases. There is interest in functional foods that could help in prevention and/or management of obesity and type 2 diabetes. This could involve food products that help management of 'hunger' or that increase 'satiety'. It could also involve foods that contribute to more inefficient use of ingested energy (i.e. foods that stimulate energy expenditure more than would be expected from their energy content). As the concept of insulin sensitivity becomes generally more accepted by health care professionals and the public, foods may be targeted towards maximizing insulin sensitivity and towards 'prevention' of diabetes. In addition to foods that impact upon body weight, these may include foods that affect the glucose and/or insulin levels that are seen either following the ingestion of food or later in the day. The present paper reviews the complex aetiology of obesity and diabetes and considers a potential role for functional foods in prevention and treatment of obesity and diabetes.     

Attitudes and intentions toward purchasing novel foods enriched with omega-3 fatty acids

OBJECTIVE: To identify the nature, strength, and relative importance of influences on intentions to consume foods that are enriched with omega-3 fatty acids using the Theory of Planned Behavior (TPB). DESIGN: A cross-sectional self-administered questionnaire. SETTING: Community-based residents living in the Illawarra region of New South Wales, Australia. SUBJECTS: Two subsamples were surveyed via questionnaire: community members who responded to a local media advertisement (n = 79), and subjects in a dietary intervention trial for type 2 diabetes mellitus (n = 50). VARIABLES MEASURED: Using the TPB variables-intention, attitude, subjective norm, and perceived behavioral control-questionnaire items were constructed to measure intention to consume omega-3-enriched novel foods. ANALYSIS: The results from subsamples did not differ and were combined for analysis. The determinants of intention defined in the TPB were investigated using multiple linear regressions. RESULTS: Regression analysis showed that the model was a significant determinant of intention (R2 = .725; P < .001). Attitude was a significant determinant of intention, whereas subjective norms and control beliefs were not. DISCUSSION: With attitude having the greatest influence on intentions, immediate prospects for modifying behavior are likely to come through a change in attitude, specifically in beliefs about the effectiveness of enriched products in achieving specific health benefits. CONCLUSIONS AND IMPLICATIONS: Promoters of omega-3-enriched foods would be advised to direct their promotions toward changing the attitudes of consumers about the effectiveness of the functional ingredient.     

Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults

ObjectivesThe aim of this study was to evaluate the relationship between the consumption of ultra-processed foods and obesity indicators among Brazilian adults and adolescents.MethodsWe used cross-sectional data on 30,243 individuals aged ≥ 10 years from the 2008–2009 Brazilian Dietary Survey. Food consumption data were collected through 24-h food records. We classified food items according to characteristics of food processing. Ultra-processed foods were defined as formulations made by the food industry mostly from substances extracted from foods or obtained with the further processing of constituents of foods or through chemical synthesis, with little if any whole food. Examples included candies, cookies, sugar-sweetened beverages, and ready-to-eat dishes. Regression models were fitted to evaluate the association of the consumption of ultra-processed foods (% of energy intake) with body-mass-index, excess weight, and obesity status, controlling for socio-demographic characteristics, smoking, and physical activity.ResultsUltra-processed foods represented 30% of the total energy intake. Those in the highest quintile of consumption of ultra-processed foods had significantly higher body-mass-index (0.94 kg/m²; 95% CI: 0.42,1.47) and higher odds of being obese (OR = 1.98; 95% CI: 1.26,3.12) and excess weight (OR = 1.26; 95% CI: 0.95,1.69) compared with those in the lowest quintile of consumption.ConclusionOur findings support the role of ultra-processed foods in the obesity epidemic in Brazil.     

肥胖症对孕产妇分娩镇痛及麻醉的影响

肥胖症(obesity)已成为全球性健康问题,孕产妇肥胖不仅导致产科并发症发生率增高,而且导致实施分娩镇痛及麻醉的风险和难度也随之增高。因此,建议对所有符合肥胖症诊断标准的孕产妇,应进行产前麻醉咨询。目前,用于经阴道分娩椎管内阻滞镇痛的方法包括：蛛网膜下腔-硬膜外联合阻滞麻醉(CSEA)、硬脊膜穿破硬膜外阻滞麻醉(DPEA)、硬膜外阻滞麻醉(EA)及连续脊椎麻醉(SA)技术。DPEA作为CSEA的替代技术,成为目前肥胖症孕产妇经阴道分娩镇痛的一种主流选择方案。肥胖症孕产妇剖宫产术分娩镇痛的椎管内麻醉方式,主要采用单次性SA或CSEA。目前CSEA是肥胖症孕产妇剖宫产术分娩镇痛的首选麻醉方式,但是在紧急情况下,也可选用气管插管全身麻醉。笔者拟就肥胖症孕产妇围生期管理、产时镇痛或麻醉及产褥期护理的最新研究进展进行阐述。     

Functional foods in the management of obesity and type 2 diabetes

PURPOSE OF REVIEW: The aim of this article is to evaluate food properties able to influence specific physiological targets that may be helpful for the prevention and management of overweight and diabetes. RECENT FINDINGS: Observational and intervention studies have clearly shown that type 2 diabetes can be prevented by lifestyle measures, including reduced energy intake to induce a modest but sustained weight reduction, together with changes in diet composition. SUMMARY: Foods can be regarded as functional if proven to affect beneficially one or more target functions in the body, beyond adequate nutritional effects, in a way relevant to improved state of health and well-being, reduction of risk of diseases, or both. Functional foods might have a particularly high impact for prevention or treatment of overweight and diabetes for which, more than in many other fields, the link between nutrition, biological responses and diseases is clearly established. Functional foods for obesity should be able to influence the energy balance equation regulated by the control of energy intake or of energy dissipated as heat (thermogenesis). For prevention of type 2 diabetes, several unmodified foods with functional properties have already been identified (low saturated fat products, vegetables, fruit, wholegrain foods, low glycemic index starchy foods). Overall, the available evidence on functional foods so far identified in this field is incomplete: the major gap is the lack of diet-based intervention trials of sufficient duration to be relevant for the natural history of diseases like overweight and diabetes.     

A prospective study of maternal,fetal and neonatal deaths in low- and middle-income countries

Objective

To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths.

Methods

A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum.

Findings

Between 2010 and 2012, 214 070 of 220 235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100 000 live births, ranging from 69 per 100 000 in Argentina to 316 per 100 000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97–11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26–5.67) and 7-day (RR: 3.94; 95% CI: 2.74–5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54–9.77).

Conclusion

Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality.     

Is maternal obesity a cause of poor lactation performance

Several investigators have reported a relationship between maternal obesity and low rates of initiation and duration of breast-feeding. Recent research findings suggest that poor infant feeding behavior and reduced hormonal responses in the early postpartum period result in delayed lactogenesis and early cessation of breast-feeding among overweight/obese women.     

The influence of local food environments on adolescents' food purchasing behaviors

This study examined the relationship between the neighborhood food environment and the food purchasing behaviors among adolescents. Grade 7 and 8 students (n = 810) at 21 elementary schools in London, Ontario, Canada completed a questionnaire assessing their food purchasing behaviors. Parents of participants also completed a brief questionnaire providing residential address and demographic information. A Geographic Information System (GIS) was used to assess students' home and school neighborhood food environment and land use characteristics. Logistic regression analysis was conducted to assess the influence of the home neighborhood food environment on students' food purchasing behaviors, while two-level Hierarchical Non-Linear Regression Models were used to examine the effects of school neighborhood food environment factors on students' food purchasing behaviors. The study showed that approximately 65% of participants reported self-purchasing foods from fast-food outlets or convenience stores. Close proximity (i.e., less than 1 km) to the nearest fast-food outlet or convenience store in the home neighborhood increased the likelihood of food purchasing from these food establishments at least once per week by adolescents (p < 0.05). High fast-food outlet density in both home and school neighborhoods was associated with increased fast-food purchasing by adolescents (i.e., at least once per week; p < 0.05). In conclusion, macro-level regulations and policies are required to amend the health-detracting neighborhood food environment surrounding children and youth's home and school.     

Fetal environment and subsequent obesity: a study of maternal smoking

BACKGROUND: The intrauterine environment may influence the development of obesity, but as yet, the long-term effect of growth in utero is unclear. We studied maternal smoking during pregnancy to gain insight on how an insult affecting fetal growth might subsequently influence obesity risk through childhood to age 33. METHODS: Data from the 1958 British birth cohort (all births in England, Wales and Scotland, 3-9 March 1958), including body mass index (BMI), maternal smoking during pregnancy and several potential confounding factors. We assessed obesity risk at ages 7, 11, 16, 23 and 33 associated with maternal smoking. Adjusted odds ratios (OR) for obesity at age 33 were estimated for 2918 men and 2921 women with complete data. RESULTS: Infants of mothers who smoked in pregnancy were lighter at birth than infants of non-smokers, but from adolescence (age 11 for females, 16 for males) they had an increased risk of being in the fattest decile of BMI. The OR for obesity associated with maternal smoking increased with age, suggesting strengthening of the relationship over time. At age 33 the OR was 1.56 (95% CI : 1.22-2.00) for men and 1.41 (95% CI : 1.12-1.79) for women. This was robust to adjustment for factors in early life, childhood and adulthood. CONCLUSIONS: An elevated risk of obesity among the offspring of smokers was not accounted for by other known influences. Findings are consistent with a long-term effect of intrauterine environment on adiposity, possibly through fetal nutrition, although other mechanisms should be investigated in future studies of obesity.     

Relationships of maternal zinc intake from animal foods with fetal growth

Zn is an essential element for human growth. The nutritional adequacy of dietary Zn depends not only on the total Zn intake, but also on the type of food source (i.e. of plant or animal origin). We investigated the association between maternal dietary Zn intake from animal and plant food sources and fetal growth. A total of 918 pregnant women at 12-28 weeks of gestation were selected from the Mothers and Children's Environmental Health study in Korea. Dietary intakes in mid-pregnancy were estimated by a 24 h recall method, and subsequent birth weight and height were obtained from medical records. Multiple regression analysis showed that maternal Zn intake from animal food sources and their proportions relative to total Zn intake were positively associated with birth weight (P = 0.034 and 0.045, respectively) and height (P = 0.020 and 0.032, respectively). Conversely, the percentage of Zn intake from plant food sources relative to total Zn intake was negatively associated with birth height (P = 0.026) after adjustment for covariates that may affect fetal growth. The molar ratio of phytate:Zn was negatively associated with birth weight (P = 0.037). In conclusion, we found that the absolute amounts of Zn from different food sources (e.g. animal or plant) and their proportions relative to total Zn intake were significantly associated with birth weight and height. A sufficient amount of Zn intake from animal food sources of a relatively higher Zn bioavailability is thus encouraged for women during pregnancy.     

Relationship of obesity to diabetes: influence of obesity level and body fat distribution

The relationship of clinical diabetes to body fat distribution and obesity level was examined in 15,532 women. After adjusting for relative weight, all upper body segment girth measurements (neck, bust, and waist) had strong positive associations with diabetes. In contrast, the lower body segment girth measurement (hips) had an equally strong but inverse association with diabetes. Based upon waist-to-hip girth ratio, women were divided into four subgroups. The prevalence of diabetes increased with increasing values of this ratio. Women in the upper quartile had about three times the prevalence of diabetes as women of comparable obesity level in the lowest quartile. Women with both upper body fat predominance and severe obesity had a relative risk of diabetes 10.3 times as great as nonobese subjects with lower body fat predominance. The results suggest that localization of fat in the upper body segment and severe obesity are two distinct additive risks for diabetes.     

Cost-effectiveness of maternal pertussis immunization: Implications of a dynamic transmission model for low- and middle-income countries

ObjectiveThis study evaluates the cost-effectiveness of maternal acellular pertussis (aP) immunization in low- and middle-income countries using a dynamic transmission model.MethodsWe developed a dynamic transmission model to simulate the impact of infant vaccination with whole-cell pertussis (wP) vaccine with and without maternal aP immunization. The model was calibrated to Brazilian surveillance data and then used to project health outcomes and costs under alternative strategies in Brazil, and, after adjusting model parameter values to reflect their conditions, in Nigeria and Bangladesh. The primary measure of cost-effectiveness is incremental cost (2014 USD) per disability-adjusted life-year (DALY).ResultsThe dynamic model shows that maternal aP immunization would be cost-effective in Brazil, a middle-income country, under the base-case assumptions, but would be very expensive at infant vaccination coverage in and above the threshold range necessary to eliminate the disease (90–95%). At 2007 infant coverage (DTP1 90%, DTP3 61% at 1 year of age), maternal immunization would cost < $4,000 per DALY averted. At high infant coverage, such as Brazil in 1996 (DTP1 94%, DTP3 74% at 1 year), cost/DALY increases to $1.27 million. When the model’s time horizon was extended from 2030 to 2100, cost/DALY increased under both infant coverage levels, but more steeply with high coverage. The results were moderately sensitive to discount rate, maternal vaccine price, and maternal aP coverage and were robust using the 100 best-fitting parameter sets. Scenarios representing low-income countries showed that maternal aP immunization could be cost-saving in countries with low infant coverage, such as Nigeria, but very expensive in countries, such as Bangladesh, with high infant coverage.ConclusionA dynamic model, which captures the herd immunity benefits of pertussis vaccination, shows that, in low- and middle-income countries, maternal aP immunization is cost-effective when infant vaccination coverage is moderate, even cost-saving when it is low, but not cost-effective when coverage levels pass 90–95%.     

孕产妇死亡影响因素分析

目的分析孕产妇死亡原因,总结孕产妇死亡救治中存在的问题。方法回顾性分析成都市2007~2012年115例孕产妇死亡原因及评审情况。结果 2007~2012年孕产妇死亡率大致呈逐年下降趋势,2012年孕产妇死亡率明显低于2007年,差异有统计学意义(P0.05)。115例死亡孕产妇中直接产科原因死亡60例(52.17%);间接产科原因死亡55例(47.83%);产科出血(41例)仍居首位,占直接产科原因的68.33%。直接产科原因中产前检查次数5次(含0次)的死亡孕产妇占61.67%,明显高于产前检查5次以上的孕产妇死亡数;而间接产科原因中产前检查次数5次(含0次)的死亡孕产妇占60.00%,也明显高于产前检查5次以上的孕产妇死亡数,两者比较差异均有统计学意义(P0.05)。在省市级医院死亡的孕产妇数量明显多于县级医院、乡镇卫生院及其他(P0.05)。可避免死亡占63.48%,不可避免死亡占36.52%,其中各级医务人员的知识技能问题在可避免死亡孕产妇(73例)的首要影响因素中占首位,为93.15%(68/73),个人及家庭知识技能问题占6.85%,差异有统计学意义(P0.05)。结论影响孕产妇可避免死亡的首要原因是各级医务人员知识技能欠缺,责任心不强。切实加强医疗助产机构的业务培训及监管,是降低孕产妇死亡的重要措施。