COVID-19 in Women's health: Pre-operative gynaecological assessment and shared decision making

The National Health Service (NHS) response to the coronavirus disease 2019 (COVID-19) pandemic brought about rapid and innovative changes to surgical care in gynaecology, shared decision making around operative procedures and pre-operative gynaecological pathways. Short-term changes are linked to the redeployment of resources away from elective gynaecology and long-term changes relate to accelerating the streamlining of treatments, telemedicine and education in patient self-management. The speed and recency of the response does not yet permit the creation of a large evidence base for effective and acceptable interventions, apart from anecdotal observations of ‘what works well’’ good practice and guidance from the Royal Colleges and the National Institute for Health and Care Excellence (NICE)

Objective understanding of front-of-package nutrition labels: An international comparative experimental study across 12 countries

Front-of-Package labels (FoPLs) are efficient tools for increasing consumers’ awareness of foods’ nutritional quality and encouraging healthier choices. A label’s design is likely to influence its effectiveness; however, few studies have compared the ability of different FoPLs to facilitate a consumer understanding of foods’ nutritional quality, especially across sociocultural contexts. This study aimed to assess consumers’ ability to understand five FoPLs [Health Star Rating system (HSR), Multiple Traffic Lights (MTL), Nutri-Score, Reference Intakes (RIs), and Warning symbol] in 12 different countries. In 2018, approximately 1000 participants per country were recruited and asked to rank three sets of label-free products (one set of three pizzas, one set of three cakes, and one set of three breakfast cereals) according to their nutritional quality, via an online survey. Participants were subsequently randomised to one of five FoPL conditions and were again asked to rank the same sets of products, this time with a FoPL displayed on pack. Changes in a participants’ ability to correctly rank products across the two tasks were assessed by FoPL using ordinal logistic regression. In all 12 countries and for all three food categories, the Nutri-Score performed best, followed by the MTL, HSR, Warning symbol, and RIs

Evaluation of a workplace health and wellbeing training course delivered online and face-to-face

Organisations may benefit from training champions to promote healthy workplace environments and initiatives. This study compared the perceived usefulness and relative effectiveness of an employee training course offered via online and face-to-face formats. Individuals who took part in the training course were assessed on their perceived competence and confidence to implement changes pre-and post-training. Repeated measures Analysis of Variance (ANOVA) and a t-test were conducted to test for significant differences between pre-and post-training scores and/or mode of training, respectively. Although the face-to-face training course was rated as slightly more useful, there were no significant differences between the two modes of training for the other dependent variables, and both modes led to significantly greater perceived competence and confidence post-training. These findings demonstrate the potential benefits of training employees to implement changes in their workplaces

The types and aspects of front-of-pack food labelling schemes preferred by adults and children.

There is strong interest in front-of-pack labels (FoPLs) as a potential mechanism for improving diets, and therefore health, at the population level. The present study examined Australian consumers' preferences for different types and attributes of FoPLs to provide additional insights into optimal methods of presenting nutrition information on the front of food packets. Much research to date has focused on two main types of FoPLs - those expressing daily intake values for specific nutrients and those utilising 'traffic light' colour coding. This study extends this work by: (i) including the new Health Star Rating system recently introduced in Australia and New Zealand; (ii) allowing a large sample of consumers to self-nominate the evaluation criteria they consider to be most important in choosing between FoPLs; (iii) oversampling consumers of lower socioeconomic status; and (iv) including children, who consume and purchase food in their own right and also influence their parents' food purchase decisions. A cross-sectional online survey of 2058 Australian consumers (1558 adults and 500 children) assessed preferences between a daily intake FoPL, a traffic light FoPL, and the Health Star Rating FoPL. Across the whole sample and among all respondent subgroups (males vs females; adults vs children; lower socioeconomic status vs medium-high socioeconomic status; normal weight vs overweight/obese), the Health Star Rating was the most preferred FoPL (44%) and the daily intake guide was the least preferred (20%). The reasons most commonly provided by respondents to explain their preference related to ease of use, interpretive content, and salience. The findings suggest that a simple to use, interpretive, star-based food label represents a population-based nutrition promotion strategy that is considered helpful by a broad range of consumers

The relative ability of different front-of-pack labels to assist consumers discriminate between healthy, moderately healthy, and unhealthy foods

The degree to which different front-of-pack labels (FoPLs) can assist consumers to make healthy choices seems to depend on the extent to which the FoPLs provide an interpretation of the nutrition information presented. The aim of this study was to assess the effectiveness of three FoPLs that vary by interpretive content in allowing consumers to discriminate between products of varying healthiness. Australian consumers (n = 2058) rated the perceived healthiness of mock food pack images that varied according to: nutritional profile (healthy, moderately healthy, unhealthy); FoPL (Daily Intake Guide (DIG), Multiple Traffic Lights (MTL), Health Star Rating (HSR), or control); and food type (cookies, cornflakes, pizza, yoghurt). Respondents were most accurate at differentiating unhealthy products from healthy (p < 0.001) and moderately healthy products (p = 0.015) when the HSR appeared on packs. The MTL was marginally (p = 0.052) effective at helping respondents distinguish between healthy and unhealthy products. When the DIG or no FoPL was used, however, respondents were unable to discriminate between a healthy and an unhealthy nutritional profile. Findings indicate that the HSR is more effective than other commonly used FoPLs in assisting consumers to accurately evaluate the healthiness of food products

A randomized trial assessing the effects of health claims on choice of foods in the presence of front-of-pack labels

Background: As a public health intervention, front-of-pack labels (FoPLs) have the potential to reach large numbers of consumers and promote healthier food choices. Of the different FoPLs, those that summarize a product's overall nutritional profile tend to be most effective in guiding healthier choices. However, information is lacking as to whether FoPLs are as effective when nutrient or health claims also appear on-pack. Objective: The aim of this study was to examine how the choice of foods of varying levels of healthfulness (less healthy, moderately healthy, and healthier) is affected by the appearance of various FoPLs (Daily Intake Guide, Multiple Traffic Lights, Health Star Rating) when shown in combination with different claim conditions (no claim, nutrient claim, general-level health claim, and higher-level health claim). Design: Adults and children (n = 2069) completed a discrete-choice experiment online. Respondents were shown 8 choice sets, each containing 4 alternatives of the same food type (cookies, cornflakes, pizza, or yogurt) of varying levels of healthfulness and were asked which product they would likely purchase (or they could select none). Respondents were randomly assigned to view 1 of the 3 FoPLs across all choice sets. Claim type and healthfulness varied within choice sets in accordance with a D-efficient design. Results: The probability of choosing a healthy product and avoiding an unhealthy product was greatest when only an FoPL (especially the Health Star Rating) appeared on-pack. The addition of a nutrient or health claim did not affect the likelihood of picking healthier products but did increase the likelihood of selecting less healthy foods across all FoPL conditions. Conclusions: FoPLs are most effective in helping consumers make better food choices when nutrient and health claims are not present. Policies are required to control how nutrient and health claims are applied to less healthy foods. This trial was registered as ACTRN12617000015347 (www.anzctr.org.au/Trial/Resgistration/TrialReview.aspx?id=372055&isReview=true)

Vibrational contribution to the thermodynamics of nanosized precipitates: vacancy-copper clusters in bcc-Fe

Within the harmonic approximation, the effects of lattice vibration on the thermodynamics of nano-sized coherent clusters in bcc-Fe consisting of vacancies and/or copper are investigated. A combination of on-lattice simulated annealing based on Metropolis Monte Carlo simulations and off-lattice relaxation by Molecular Dynamics is applied to obtain the most stable cluster configurations at T = 0 K. The most recent interatomic potential built within the framework of the embedded atom method for the Fe-Cu system is used. The vibrational part of the total free energy of defect clusters in bcc-Fe is calculated using their phonon density of states. The total free energy of pure bcc-Fe and fcc-Cu as well as the total formation free energy and the total binding free energy of the vacancy-copper clusters are determined for finite temperatures. Our results are compared with the available data from previous investigations performed using empirical many-body interatomic potentials and first-principle methods. For further applications in rate theory and object kinetic Monte Carlo simulations, the vibrational effects evaluated in the present study are included in the previously derived analytical fits based on the classical capillary model.Comment: 6 figure

Protocol for a randomized trial assessing consumer evaluations of pre-packaged foods that systematically vary by nutrition information and product attributes

Background Nutrition information is increasingly provided on pre-packaged foods as a public health measure to help consumers make healthier food choices. Many studies have looked at the independent effects of three main sources of nutrition information: the Nutrition Information Panel (NIP), front-of-pack labels and health claims. However, few studies have considered their interactive effects. A better understanding of how these different sources of nutrition information interact with each other is important given they frequently appear together on food packs. There are also policy implications since many countries specifically mandate the provision of an NIP whenever a health claim is made. Methods This paper outlines a protocol for an experimental study assessing how nutrition information (FoPLs, health claims and NIP), in combination with food type, price and product healthiness interact to affect consumers’ product evaluations. Consumers’ global impressions, perceptions of healthiness, purchase intentions and assumptions relating to the amount of the product that is appropriate/desirable to consume will be assessed. The nutrition information presented will include NIPs, front-of-pack labels (Daily Intake Guide, Multiple Traffic Light system, Health Star Rating system) and health claims (nutrient content, general level, higher level). A diverse sample of approximately 2000 Australians will be recruited to complete an online survey that will require them to evaluate a range of hypothetical products with varying nutrition and price attributes. All attribute levels will be fully crossed with each other, resulting in a full factorial design. This design has not been used in past studies and offers a higher level of control than achieved previously due to the ability to explore interactions between all attribute levels. Discussion Study results will indicate (1) the independent and combined effects of each attribute on consumer evaluations, (2) which front-of-pack labels are more effective at helping consumers distinguish between healthier and less healthy foods and (3) how health claims affect perceptions of healthiness. The study will also provide crucial information on the effectiveness of the new Health Star Rating system, for which quantitative research is currently lacking

Protocol for a randomized trial assessing consumer evaluations of pre-packaged foods that systematically vary by nutrition information and product attributes

Background: Nutrition information is increasingly provided on pre-packaged foods as a public health measure to help consumers make healthier food choices. Many studies have looked at the independent effects of three main sources of nutrition information: the Nutrition Information Panel (NIP), front-of-pack labels and health claims. However, few studies have considered their interactive effects. A better understanding of how these different sources of nutrition information interact with each other is important given they frequently appear together on food packs. There are also policy implications since many countries specifically mandate the provision of an NIP whenever a health claim is made. Methods: This paper outlines a protocol for an experimental study assessing how nutrition information (FoPLs, health claims and NIP), in combination with food type, price and product healthiness interact to affect consumers’ product evaluations. Consumers’ global impressions, perceptions of healthiness, purchase intentions and assumptions relating to the amount of the product that is appropriate/desirable to consume will be assessed. The nutrition information presented will include NIPs, front-of-pack labels (Daily Intake Guide, Multiple Traffic Light system, Health Star Rating system) and health claims (nutrient content, general level, higher level). A diverse sample of approximately 2000 Australians will be recruited to complete an online survey that will require them to evaluate a range of hypothetical products with varying nutrition and price attributes. All attribute levels will be fully crossed with each other, resulting in a full factorial design. This design has not been used in past studies and offers a higher level of control than achieved previously due to the ability to explore interactions between all attribute levels. Discussion: Study results will indicate (1) the independent and combined effects of each attribute on consumer evaluations, (2) which front-of-pack labels are more effective at helping consumers distinguish between healthier and less healthy foods and (3) how health claims affect perceptions of healthiness. The study will also provide crucial information on the effectiveness of the new Health Star Rating system, for which quantitative research is currently lacking. Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12616000626460. Retrospectively registered: 16 May, 2016.Zenobia Talati, Simone Pettigrew, Helen Dixon, Bruce Neal, Clare Hughes, Trevor Shilton and Caroline Mille

Consumers’ views on the importance of specific front-of-pack nutrition information: a latent profile analysis

Nutrition labelling can influence consumers' assessments of food healthiness and their food choices. However, there is a lack of consensus about the optimal type and amount of nutrition information to provide on food packages. This study analysed consumers' preferences for front-of-pack information relating to energy and various nutrients (sugar, saturated fat, sodium, fibre, carbohydrate, and protein). The aim was to identify discrete preference segments within the Australian market where the current Health Star Rating front-of-pack labelling system can be displayed with different levels of nutrition information. Adults (n = 1558) completed a survey assessing socio-demographics, self-reported nutrition knowledge, diet healthiness, special dietary requirements, and perceived importance of the provision of energy and nutrient information on the front of food packs. Latent profile analysis identified five consumer segments within the sample that ranged from groups exhibiting high levels of interest in various forms of nutrition information to one with very low interest and one with divergent scores according to whether nutrients were perceived as positive or negative for health. The results indicate that different forms of front-of-pack labelling featuring varying degrees of information about energy and specific nutrients are likely to be of interest and use to different market segments.Liyuwork Mitiku Dana, Kathy Chapman, Zenobia Talati, Bridget Kelly, Helen Dixon, Caroline Miller and Simone Pettigre