Wissen - macht -Vertrauen? Der Einfluss von Kompetenzen bei Biolebensmitteln auf die Akzeptanz und das Vertrauen

Ein Haupthindernis für den Kauf ökologischer Lebensmittel ist mangelendes Vertrauen. Die vorliegende Studie untersucht, wie Verbraucherkompetenzen, die sich aus Wissen in Kombination mit Werten, Normen und Fähigkeiten zusammensetzen, mit der Akzeptanz von Bio-Lebensmitteln zusammenhängen

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Demand for Processed Indigenous Fruit and Vegetable Products – Insights from East Africa

There is an increasing understanding that food systems need to provide not only calories but micronutrients as well. Simultaneously, consumption patterns are transforming around the globe. Convenience foods that are quick and easy to prepare are gaining more and more importance on the market. While these products provide fast access to carbohydrates that satisfy hunger, essential nutrients are often missing. In combination with an insufficient intake of fruits and vegetables (FV), this phenomenon leads to an undersupply of minerals and vitamins. This trend is observed in East Africa, despite the ample presence of highly nutritious FV growing naturally around the continent and is especially pronounced during lean seasons. The potential of indigenous plants is often neglected, and farmers experience significant postharvest losses of up to 50% due to inadequate access to processing knowledge and technologies. Recent literature emphasizes the approach of processing highly perishable indigenous plants into more durable products to counter deficiencies in nutrient supply caused by postharvest losses and off-season gaps. However, processing will only be successful if the final products are regularly demanded and consumed. Insights into consumer perception towards processed indigenous FV (IFV) are rare. Few studies analyze consumer demand for value-added plants, such as sundried cowpea leaves, but only for a single, region-specific product at a given time. This misses the opportunity to draw a more comprehensive understanding of drivers that shape consumers’ demand for processed IFV on a general basis. Additionally, while recent literature acknowledges the potential of value addition to improve income generation within local agriculture, there is a need to understand how to market processed IFV appropriately to derive benefits. The present dissertation contributes to the existing literature by analyzing demand for several IFV products across East Africa and considering three bodies of literature: (1) addressing micronutrient deficiencies; (2) the growing demand for processed food products; (3) and improving the utilization of currently neglected plants, thereby lowering postharvest losses and bridging off-season gaps. The dissertation is part of the project “Fruits and Vegetables for all Seasons (FruVaSe)” that aims to process highly nutritious surplus FV into more durable products to improve access to nutritious foods. Food scientists of the FruVaSe project developed novel products obtained from underutilized African plants. To our knowledge, this is the first study aiming to understand consumers’ perceptions of several processed IFV products more comprehensively. The dissertation consists of four papers based on a total of three consumer surveys that were conducted between October 2019 and March 2020. The surveys include consumers from rural and urban areas in East Africa. In total, we interviewed 1444 people across the region about eight products. The surveys include an economic investigation of consumers’ willingness to pay (WTP) for the products combined with sensory testing. The target products include guava nectar and cowpea leaf soup mix in Kenya; dried cashew apples, African nightshade relish, dried African nightshade in Tanzania; and porridge combined with cowpea leaf powder, jackfruit-nut-bars, and jackfruit juice in Uganda. The IFV under investigation are highly nutritious and occur naturally in East Africa but are mainly grown on smaller scales, subject to significant losses, and rarely processed. In addition to providing general insights regarding consumers’ demand for processed IFV, each paper carries unique contributions. The first paper investigates consumers’ demand for IFV products across rural and urban populations in Kenya, Tanzania, and Uganda. The objective of the analysis is to discern whether we can, in general, identify similar drivers shaping consumers’ demand for processed IFV in these countries. To achieve this objective, the study combines sensory analysis with consumers’ WTP. The research adds to the existing literature by combining several products and investigating three different countries. The results exhibit high scores for all sensory characteristics and similar socio-demographic drivers shaping consumers’ demand across all three regions. Women, the elderly, and the rural population tend to be less willing to pay for the products. In contrast, younger, male, and urban participants show a higher WTP. The findings suggest that processing alone is not the solution to improve nutrition among the most sensitive population groups and interventions are necessary to enhance their demand. The second paper evaluates marketing strategies for processed IFV. Value-addition is presumed to lead to higher incomes for farmers. We focus on the same sample discussed in paper 1. The objective of this paper is to improve the marketing of IFV products. We present different marketing options and discuss their suitability. The findings suggest that a reasonable share of participants are already willing to pay prices that exceed production costs for most products. Still, marketing strategies are important to establish the products on the markets in the long run. While the first two papers focus on introducing new products, the third paper explores consumers’ demand for nutritionally enriched traditional porridges in Kayunga, Uganda. Porridge is already well established in the research area but is usually of low nutritional value. Previous research primarily focused on adding nutrients via biofortification. Combining traditional foods with local vegetables adds new insights. This paper aims to investigate maize and millet porridges combined with cowpea leaf powder as a channel to enhance the utilization of indigenous plants. We find that sensory perception is a significant determinant in shaping consumer demand for the products and that adding cowpea leaf powder lowers sensory perception. Still, almost half of the participants value the combined porridges as much as the plain ones. We conclude that enriching traditional porridges with cowpea leaf powder brings economic risks but can provide better nutrition for a specific consumer group. The fourth paper analyzes the demand for jackfruit-nut-bars among students and staff of the Makerere University in Kampala, Uganda. The jackfruit-nut-bars can provide a healthier alternative to the currently consumed sugared snacks and can overcome the major obstacle hindering jackfruit consumption, namely its stickiness. Moreover, the results suggest that an acceptable sweetness of processed products can be derived without adding industrialized sugar. In conclusion, our results demonstrate that processed IFV products are mostly well perceived among a reasonable share of people and can provide a new income source for small-scale farmers. Still, product-specific marketing strategies are indispensable for product implementation. Sensory perception is the most important factor explaining consumers’ WTP, which aligns with previous findings on consumers’ demand. We find similar factors driving demand across different products. Population groups that are more prone to micronutrient deficiencies, however, are more reluctant to pay. These findings call for interventions to raise familiarity with healthy processing and education campaigns informing about the importance of year-round consumption of nutritious foods.2022-07-0

Acceptability of jackfruit-nut-bars as a healthy snack in Uganda

The growing prevalence of ultra-processed foods in Uganda is driving the double burden of malnutrition. Overweight and obesity are on the rise while the intake of micronutrients remains insufficient. Simultaneously, jackfruits that are rich in minerals and vitamins remain underutilized. Its large size, sticky insides, and high perishability make it challenging to handle and cause high postharvest losses. In an attempt to address both issues, the present study investigates the potential of long-lasting, nutritious, and sugar-free jackfruit-nut-bars (JNBs) as a channel to enhance and promote the utilization of jackfruit, and provide healthier options of processed foods. To analyze consumer demand for the products, we first assess the sensory perception of four different JNBs at a university campus in Uganda. We then use Van Westendorp’s price sensitivity meter to elicit consumers’ willingness to pay (WTP) and identify factors shaping their demand. The results show that the sensory properties are, on average, rated positively, and price preferences are similar to established snacks. Based on our findings, we conclude that JNBs provide an option to enhance jackfruit utilization. A random effects model shows that WTP increases with sweetness, age, and frequency of snack consumption that JNBs can potentially substitute. These findings help future development and promotion of processed jackfruit products

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research