Warning labels for sugar-sweetened beverages and fruit juice: evaluation of 27 different labels on health effects, sugar content, energy and exercise equivalency.

OBJECTIVES: Front-of-pack warning labels may reduce consumption of sugar-sweetened beverages, potentially mitigating negative health outcomes. Comparisons between different warning label types to inform future research and policy directions are lacking. This study compared 27 warning labels across six message types for their potential to reduce sugar-sweetened beverage consumption. DESIGN AND METHODS: A national sample of regular soda (n = 2578) and juice (n = 1048) consumers aged 14-60 years participated in an online survey. Participants evaluated randomly allocated labels; one from each of six warning label sets (health-graphic, sugar-pictogram, sugar-text, exercise equivalents, health-text, energy information) on four measures of perceived effectiveness (PE: overall effectiveness, discourage from drinking, emotional response, persuasive potential). Participants could also provide open comments. A general linear model compared differences in mean scores across label sets for each measure of PE. RESULTS: PE ratings differed significantly between label sets. Labels clearly quantifying sugar content (sugar-teaspoons) received consistently high PE ratings, whereas 'high in sugar' labels did not. Health-graphic labels were rated highly across all PE measures except persuasive potential. Exercise labels only rated highly on persuasive potential. Health-text results were mixed, and energy labels were consistently low. CONCLUSIONS: Simple, factual labels were easily interpreted and perceived as most effective. Labels quantifying sugar content were consistently high performers and should be advanced into policy to help decrease overconsumption of sugar-sweetened beverages.

"You can't just eat 16 teaspoons of sugar so why would you drink 16 teaspoons' worth of sugar?": a qualitative study of young adults' reactions to sugary drink warning labels.

BACKGROUND: Several jurisdictions have introduced nutrient warning front of pack (FoP) labels in an effort to curb consumption of ultra-processed foods and beverages high in free sugars (sugars added to foods and beverages, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates). This study aimed to explore consumer understanding and perceptions of FoP warning labels that convey different nutritional and health information messages regarding the consumption of sugary drinks. METHODS: Sixteen focus groups were held with 4-8 young adults per group (aged 18-24; n = 105 participants in total) stratified by education level, location (rural centres, large cities) and gender (males, females) to ensure diversity. Labels shown to participants during group discussions included text warning labels of health effects, exercise equivalents, calorie/kilojoule information and sugar content as a "high in" label and as teaspoons (text and pictograms). Thematic analysis was undertaken. RESULTS: Four themes were identified related to participants' perceived effectiveness of labels: the extent to which labels were perceived to be useful, relevant and credible; the extent to which a label elicited shock or disgust (perceived aversiveness); the extent to which the label message was resistant to self-exemption; and participants' perceived potential of the label to reduce purchasing and consumption behaviour. Across all four themes, labels communicating the number of teaspoons of sugar in a sugary drink (whether by text or pictogram) were perceived as the most impactful, resistant to self-exemption and to have the greatest potential to reduce consumption, with enhanced reactions to the pictogram label. Labels depicting health effects, exercise equivalents, calorie/kilojoule information or a general 'high in sugar' warning were perceived by consumers to be less effective in one or more themes. CONCLUSIONS: Labels conveying the amount of sugar in a beverage in teaspoons were perceived as highly factual, relatable and interpretable, and as having the greatest potential to impact consumption attitudes and intentions. Further quantitative studies are required to compare the potential effectiveness of the teaspoons of sugar labels in reducing purchasing and consumption behaviour than other alternative warning labels, such as health effects or "high in" sugar labels.

The relationship between sun protection policies and practices in schools with primary-age students: the role of school demographics, policy comprehensiveness and SunSmart membership.

Schools can implement evidence-based sun protection policies that guide practices to help protect children from harmful sun exposure. This national study assessed the relationship between the existence and comprehensiveness of written policies and the comprehensiveness of sun protection practices. The impact of school demographics on the strength of the relationship was also examined, as was the possibility that 'SunSmart' membership would have an additional impact on practices, beyond having any formal policy. In 2011-12, staff members of 1573 schools catering to primary-age students completed a self-administered survey about sun protection policies and practices (response rate of 57%). Results showed that schools with a written policy had more comprehensive practices than schools without a written policy. The relationship between having a written policy and sun protection practices was stronger for remote schools compared with metropolitan and regional schools, and for schools catering to both primary and secondary students compared with primary students only. In addition, policy comprehensiveness was associated with practice comprehensiveness, and SunSmart membership was indirectly related to practice comprehensiveness via policy comprehensiveness. These results indicate that written policies relate to practice comprehensiveness, but the strength of the association can vary according to the characteristics of the organization.

Evaluación de la coagulopatía por consumo asociada con las hemorragias obstétricas graves / Evaluation of consumptive coagulopathy associated to severe obstetrics hemorrhagies

Objetivo Evaluar la frecuencia, las complicaciones y el pronóstico de la coagulopatía por consumo (CC) en un grupo de pacientes con hemorragias obstétricas graves en el periodo periparto. Material y métodos Estudio retrospectivo y descriptivo, efectuado en 91 enfermas con CC sobre 247 pacientes con hemorragias obstétricas graves en el periodo periparto, ingresadas entre 1991 y 2008 en la División de Cuidados Intensivos de la Clínica y Maternidad Suizo Argentina. Resultados El shock se presentó en 110 enfermas y afectó a más de la mitad de los casos con desgarros cervicovaginales y rupturas uterinas. 61 gestantes con shock presentaron CC, 12 de ellas con sangrado múltiple, confirmando el diagnóstico de coagulación intravascular diseminada. En el grupo sin shock (n=137) el número de casos con CC (n=30) fue menor (p<0,05). El fallo multiorgánico se vinculó con la presencia de shock hemorrágico y CC, resultando las complicaciones más frecuentes el distrés pulmonar y la insuficiencia renal aguda. Todas las puérperas sobrevivieron sin secuelas. Conclusiones La prevalencia de la CC en las pacientes con hemorragias obstétricas graves resultó mayor que la observada en la población general de enfermos en estado crítico. La presencia de shock en el curso de una hemorragia obstétrica grave origina CC en más de la mitad de los casos y, en ocasiones, se asocia con daño orgánico. La prevención del shock hemorrágico no evitó la CC en el 21% de las enfermas. La supervivencia materna fue óptima (AU)

Objective To evaluate the frequency, complications and outcomes of consumptive coagulopathy (CC) in patients with severe obstetric hemorrhage in the peripartum period.Material and methods Of 247 patients with severe obstetric hemorrhage in the peripartum period admitted to the Intensive Care Division of Clínica y Maternidad Suizo, Argentina, between 1991 and 2008, we performed a retrospective and descriptive study of 91 patients with CC.Results Shock occurred in 110 patients and affected more than half of the patients with cervical and vaginal tears and uterine rupture. Shock developed in 61 pregnant women with CC. Of these, 12 showed multiple bleeding, confirming the diagnosis of disseminated intravascular coagulation. In the group without shock (n=137), the number of patient with CC (n=30) was lower (p<0.05). Multiple organ failure was associated with the presence of hemorrhagic shock and CC, the most frequent complications being respiratory distress and acute renal failure. All the puerperal women survived without sequelae.Conclusions The prevalence of CC in patients with severe obstetric hemorrhage was higher than that observed in the general population of critically ill patients. The presence of shock in the course of a severe obstetric hemorrhage causes CC in more than half of affected patients and sometimes is associated with organ failure. Prevention of hemorrhagic shock did not prevent CC in 21% of the patients. Maternal survival was optimal (AU)

[Simultaneous meningitis caused by Candida and tuberculosis as manifestation of AIDS]. / Meningitis simultánea por candida y tuberculosis como debut de SIDA.

Opportunistic germs meningoencephalitis plays an important role within neurologic pathology in aids. Treponema pallidum and Mycobacterium tuberculosis among bacteries, Cryptococcus neoformans in fungus group, Toxoplasma gondii in protozoos group and Papovavirus JC in virus one are the most frequently implicated germs. Sometimes infections are mixed. We present a simultaneous meningitis case produced by Candida albicans and Mycobacterium tuberculosis that coursed with neutrophilic pleocytosis in CSF and normal glucose CSF levels, consisting the clinical debut of aids. Repeated CSF examinations are the diagnostic clue owing, as in our case, instauration of early treatment. Present case of simultaneous tuberculous and candidiasic meningitis is the first one described in a HIV positive patient.

Meningitis simultánea por Candida y tuberculosis como debut de / SImultaneous meningitis caused by Candida and tuber culosis as AIDS manifestation

Las meningoencefalitis por gérmenes oportunistas ocupan un lugar importante dentro de la patología neurológica del sida. Treponema palli dum y Mycobacterium tuberculosis dentro de las baceterias, Crytptococ cus neoformans dentro de los hongos, Toxoplasma gondii dentro de los protozoos y el Papovavirus JC dentro de los virus, son los gérmenes más frecuentes dentro de cada grupo. Con cierta frecuencia las infecciones son mixtas, tal como ocurrió en el caso que se presenta de meningitis simultánea por Candida albicans y Mycobacterium tuberculosis, que cursó con pleocitosis neutrófila y normoglucorraquia, constituyendo la primera manifestación de un sida. El estudio secuencial del LCR es clave para el diagnóstico de estos casos, que, pese a su gravedad, pueden tener un tratamiento efectivo, tal como ocurrió en el que se describe. Es el primer caso descrito de meningitis simultánea candidiásica y tuberculosa en paciente portador de VIH (AU)

[The usefulness of cholesterol determination in the etiology of pleural effusion]. / Utilidad de la determinación del colesterol en la etiología del derrame pleural.

95 pleural effusions of different etiology were studied. 25 were transudate, 22 neoplastic, 28 caused by tuberculosis, and 20 miscellaneous. The Light parameters (pleural protein/plasma) (Prot LP/P), Pleural LDH (LDH LP) and LDH pleural/plasma quotient (LDH LP/P) were determined and compared with the efficacy of pleural cholesterol (Chol LP) and pleural cholesterol/plasma quotient (Chol LP/P) to differentiate the transudate from pleural exudate. With Prot LP/P quotient the sensitivity was of 85% and the specificity 91.6%; with LDH LP the sensitivity was of 74.6% and the specificity 97.6%. With the LDH LP/P quotient the sensitivity was of 89% and the specificity 87.8%. The sensitivity of each parameter was similar to that obtained by Light but less specific. All the transudates had levels of chol LP lower than 55 mq/dl (100% specificity) with a sensitivity of 84%. The Chol LP/P quotient had a limit of 0.3, this being its sensitivity of 91.3% and 93.1% its specificity. The presence of both parameters were necessary to the classification and the sensitivity obtained being of 80.3% and the specificity 100%. We concluded that the determinations of Chol LP and the Chol LP/P quotient are of great advantage in differentiating the pleural transudate from pleural exudate and the predictive value is, at least, similar to that obtained by Light.

[Neoplasm of the ovary as a cause of hyperamylasemia]. / Neoplasia de ovario como causa de hiperamilasemia.

A case of hyperamylasemia produced outside the pancreas and of exceptional origin, is presented. The place of origin is an ovarian carcinoma whose first manifestation was acute abdominal pain. The blood level of amylase was slightly increased mainly in its salivary fraction detected by the chromogenic/inhibition technique. This level, followed the tumor evolution and decreased in parallel to the tumor's response treatment.