New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Culinary Arts and Meal Science : A new scientific research discipline

A new scientific research discipline has been accepted at the Department of Restaurant and Culinary Arts at Örebro University. The subject area definition of Culinary Arts and Meal Science, as opposed to Culinary Science, was chosen. This is because Culinary Arts places great emphasis on practical skills, aiming to combine these with science as well as with working methods with an artistic content. Thus its scientific approach is a multidisciplinary one, joint efforts with other sciences being necessary, for instance by maintaining a scientifically varied tutorship. Research areas such as ethnology, sociology, anthropology, business economics, nutrition, domestic science and public health all constitute adjacent branches. These areas treat the meal from various aspects, which are examined in this paper. During the course of our educational endeavours at the department, we studied the meal from a five-aspect viewpoint with the following main elements: the room, the meeting, the product, the atmosphere and the management control system, which also constitute the framework within which we formulate our issues and questions. First, this five-aspect approach is a constructive and all-inclusive aid for those who plan and produce meals, especially in restaurants – all with the ultimate aim to achieve maximum satisfaction among the guests in different meal situations. If, then, the guest/diner evaluates the meal with something like these five aspects in mind is the subject of our research! At present, seven PhD students have been admitted to the postgraduate course in Culinary Arts and Meal Science. These students will study the meal, or certain parts of it, and the importance of the various components are presented from a number of perspectives

A New Way of Thinking and Talking About Economy: Clinic Managers’ Perspectives on the Sustainable Implementation of a Decommissioning Programme in Sweden

Healthcare systems may run into economic problems that may require ‘active’ decommissioning by policy-makers and managers. The aim of this study was to investigate, from a sustainability perspective, the implementation of an extensive decommissioning programme in one of the Swedish regions. Interviews were performed with 26 clinic managers 3 years after initial implementation. Those were analysed inductively, and then discussed based on a model of potential influences on sustainability. Although the programme was only ‘partly sustained’, the result point to a sustained attention to the health system’s poor economy, visible in a great effort by the clinics to maintain their budgets. The most important influences were intervention fit and modifications made at the clinic level (i. innovation characteristics), clinic and health system leadership (ii. context), champions (iii. capacity) and shared decision-making and relationship building (iv. processes and interactions). When implementing decommissioning, it is particularly important to engage managers responsible for the care of patients and clinic budgets from an early stage and to allow them to design approaches based on the staff’s and managers’ detailed knowledge of the situation at their clinics and of the disease area, that is, to achieve fit at the clinics. In this way, the decommissioning approaches can more likely get the character of quality improvement efforts, which increases sustainability and may lead to positive quality outcomes. Despite being unpopular, the study suggests that decommissioning can have positive effects as well, such as creating opportunities to make difficult but necessary changes and fostering increased collegial support during the centralisation of services

The Five Aspects Meal Model: a tool for developing meal services in restaurants

Preparing, planning and serving meals require several important steps before you can enjoy a meal. The meal takes place in a room (room), where the consumer meets waiters and other consumers (meeting), and where dishes and drinks (products) are served. Backstage there are several rules, laws and economic and management resources (management control system) that are needed to make the meal possible and make the experience an entirety as a meal (entirety – expressing an atmosphere). These five factors are the major ones for developing meal service in restaurants, and together form the Five Aspects Meal Model (FAMM). Several studies have shown that the context of a meal is important for the acceptance and consumption of a meal. Accordingly, the context has to include the food product itself, the consumer and the environment. These three factors need to be considered in an integrated manner, because they affect each other. A qualitative study of restaurant consumers found that there are at least eight main categories of importance for the experience of the meal: restaurant atmosphere, core items of consumption, restaurant scene, personal service encounter, staff quality, visitors, restaurant decision process and individual circumstances. These categories can easily be related to the 'Five Aspects Meal Model'. The essence of each factor is dependent upon different forms of knowledge, such as science, practical-productive, aesthetical and ethical

Factors that shape the successful implementation of decommissioning programmes : an interview study with clinic managers

BACKGROUND: As a response to many years of repetitive budget deficits, Region Dalarna in Sweden started a restructuring process in 2015, and implemented a decommissioning programme to achieve a balanced budget until 2019. Leading politicians and public servants took the overall decisions about the decommissioning programme, but the clinical decision-making and implementation was largely run by the clinic managers and their staff. As the decommissioning programme improved the finances, met relatively little resistance from the clinical departments, and neither patient safety nor quality of care were perceived to be negatively affected, the initial implementation could be considered successful. The aim of this study was to investigate clinic managers' experience of important factors enabling the successful implementation of a decommissioning programme in a local healthcare organization. METHODS: Drawing on a framework of factors and processes that shape successful implementation of decommissioning decisions, this study highlights the most important factors that enabled the clinic managers to successfully implement the decommissioning programme. During 2018, an interview study was conducted with 26 clinic managers, strategically selected to represent psychiatry, primary care, surgery and medicine. A deductive content analysis was used to analyze the interviews. By applying a framework to the data, the most important factors were illuminated. RESULTS: The findings highlighted factors and processes crucial to implementing the decommissioning programme: 1) create a story to get a shared image of the rationale for change, 2) secure an executive leadership team represented by clinical champions, 3) involve clinic managers at an early stage to ensure a fair decision-making process, 4) base the decommissioning decisions on evidence, without compromising quality and patient safety, 5) prepare the organisation to handle a process characterised by tensions and strong emotions, 6) communicate demonstrable benefits, 7) pay attention to the need of cultural and behavioral change and 8) transparently evaluate the outcome of the process. CONCLUSIONS: From these findings, we conclude that in order to successfully implement a decommissioning programme, clinic managers and healthcare professions must be given and take responsibility, for both the process and outcome

Comparison between optical readable and open-ended weighed food records

BACKGROUND: A simplified optically readable food record (ORFR) was developed and compared with an open-ended weighed record (WR). OBJECTIVE: To compare intake of nutrients and foods using a seven-day ORFR with intake estimated using a seven-day WR. The results from each method were validated against 24-h urinary nitrogen excretion and energy intake (EI)/estimated basal metabolic rate (BMR) cut-off values. DESIGN: The study comprised 73 free-living, healthy 70-year-old Swedish men. Dietary data were collected during seven consecutive days, starting either with WR or ORFR. RESULTS: Average intakes of energy and several nutrients were significantly lower when estimated using ORFR than when using WR. However, when adjusted for nutrient density, only a few nutrients were still lower with ORFR. Spearman correlation coefficients between the two methods regarding intakes of energy and energy-yielding nutrients were moderate to high, i.e. 0.4-0.6, while figures for most micro-nutrients were in the range 0.3-0.5. A large proportion of subjects under-reported their EIs, a higher proportion doing so when using ORFR. Protein intake obtained using ORFR was 31% lower than the values calculated from the 24-h urine nitrogen excretion, and 22% lower than those obtained from WR. Average intakes of milk, cheese and other milk products as well as coffee, tea and alcohol were significantly higher when estimated using ORFR than when using WR, while intakes of vegetables, meat and meat products, fish, bread and cereal products as well as number of sweet foods were significantly lower with ORFR. CONCLUSIONS: Based on these results, adjustments of some portion sizes in ORFR are suggested. In view of the advantages of ORFR with respect to lower response burden and rapid processing of data, such adjustments would make ORFR a suitable dietary assessment tool for use in dietary surveys, including larger resource-demanding epidemiological investigations

Sensory description labels for food affect consumer product choice

Purpose - This observational study set out to investigate the effect of sensory description labels on consumer choice of apples in a grocery retail store. Design/methodology/approach - An independent observation study was conducted in a retail grocery store setting. A total of 1623 consumers were observed over a four day period in four different sessions, each using three apple varieties (JONAGOLD, INGRID MARIE, and ELISE). Marketing strategies differed between the sessions as follows: (1) sort name labelling only, (2) sort name and sensory description labelling, (3) sort name and sensory semantic description labelling, and (4) sort name labelling and allowing consumers to taste the apples before choosing. Findings - Consumer product choice was affected by the sensory description labels. When only the sort name was given on the label, the consumers tended to choose INGRID MARIE, which has a strong sort name. With the addition of sensory description labels, the consumer choice shifted to ELISE, which had been chosen with a low frequency when only sort name was given, but was chosen with a high frequency when sensory description labelling was used. Research limitations/implications - The study was limited to red apples and one national market. Practical implications - Practitioners, managers, and marketers may benefit from using proper sensory labelling as a marketing tool for various food products, such as a apples, in a grocery retail store. Originality/value - This study shows the importance and value of sensory description label marketing for food products in grocery retail stores. Little attention has previously been paid to the research area within sensory marketing communication concerning the interplay of sensory perception of food and the formulation of marketing labels, or taste marketing. This paper also addresses the possible interaction between the disciplines of sensory and marketing scienc