Front of pack nutritional labelling schemes: a systematic review and meta-analysis of recent evidence relating to objectively measured consumption and purchasing.

BACKGROUND: Front of pack labelling (FOPL) provides visible nutritional information and appears to influence knowledge and reformulation. However, a recent Cochrane review found limited and inconsistent evidence for behaviour change. The present review aimed to examine studies published subsequent the Cochrane review, focusing on prepackaged foods, examining the impact of FOPL on purchasing and consumption. METHODS: Controlled experimental/intervention and interrupted time series (ITS) studies were included, with no age/geography restrictions. Exposures were FOPL with objectively measured consumption/purchasing outcomes. Thirteen databases were searched (January 2017 to April 2019) and forward citation searching was undertaken on the included studies. Purchasing data from experimental studies were meta-analysed. Two series of meta-analyses were undertaken; combined FOPL versus no-FOPL and specific FOPL scheme versus no-FOPL. Outcomes were sugar (g 100 g-1 ), calories (kcal 100 g-1 ), saturated fat (g 100 g-1 ) and sodium (mg 100 g-1 ). RESULTS: We identified 14 studies, reporting consumption (experimental; n = 3) and purchasing (n = 8, experimental; n = 3, ITS). Meta-analysis of experimental studies showed sugar and sodium content of purchases was lower for combined FOPL versus no-FOPL (-0.40 g sugar 100 g-1 , P < 0.01; -24.482 mg sodium 100 g-1 , P = 0.012), with a trend for lower energy and saturated fat (-2.03 kcal 100 g-1 , P = 0.08; -0.154 g saturated fat 100 g-1 , P = 0.091). For specific FOPL, products purchased by 'high in' FOPL groups had lower sugar (-0.67 g sugar 100 g-1 , P ≤ 0.01), calories (-4.43 kcal 100 g-1 , P < 0.05), sodium (-33.78 mg 100 g-1 , P = 0.01) versus no-FOPL; Multiple Traffic Light had lower sodium (-34.94 mg 100 g-1 , P < 0.01) versus no-FOPL. Findings regarding consumption were limited and inconsistent. FOPL resulted in healthier purchasing in ITS studies. CONCLUSIONS: This review provides evidence from experimental and 'real-life' studies indicating that FOPL encourages healthier food purchasing. PROSPERO CRD42019135743.

Deliberate self-harm and the elderly: a volatile combination-an overview from the plastic surgery perspective.

Aims. To study the factors associated with the DSH in the elderly group of 60 years and above and to recommend changes to be implemented in order to improve the management in this specific group. Materials and Methods. Five-year retrospective study was undertaken from July 2005 to July 2010 in the Plastic Surgery Department of the Royal Preston Hospital, NHS Trust. A Performa was designed to collect data about the inpatient admission and included certain areas of key information. The case notes for all patients were extensively analysed in order to gather adequate information for the devised Performa. Results. DSH is getting more common in the elderly group, and males are more affected than females. 60% of the patients had a previous history of DSH. A large number (80%) of patients had a previous history of mental illness. 60% of those DSH patients were living with family. Almost all patients (90%) were reviewed by the Psychiatry Liaison Team. The timing of patients being assessed was highly variable. Conclusions. Marriage is not a protective factor in the prevention of the DSH in the elderly group. A mental health team referral in the early phases of the management would be of huge benefit and a likely step to prevent possible future admissions. The Department would benefit from the creation of a protocol for the management of these patients. There should be a joint effort of the professionals in the management of DSH in the elderly, and GPs play a very important role in the prevention of DSH in the later life.

Guerrillero Heroico--a lasting impression.

What once was simply a cultural tradition is fast becoming a popular phenomenon amongst Western tourists. Temporary henna tattoo designs performed by street or beach vendors are prevalent throughout the Middle East and Asia, particularly in holiday resorts. The public may be mistaken in thinking that the fashionable trend comes without significant risk. The main ingredient in the temporary tattooing method is henna (Lawsonia inermis), a flowering plant with dyeing properties that takes only several hours to be absorbed but provides an effect lasting around ten to fifteen days on the recipient's skin. The side effects of henna tattoos are well documented in the literature, although it is not clear whether the side effects directly relate to the henna ingredient or the additives used to prolong the designs. The most commonly noted complications include allergic contact dermatitis, infection, hypertrophic and keloid scarring and temporary or permanent hypo- or hyperpigmentation. In very rare cases, type 1 hypersensitivity reactions (angioedema and anaphylaxis) have been reported. The following case report highlights several of these complications and the relevant management.

Evidence for HTR1A and LHPP as interacting genetic risk factors in major depression.

The HTR1A -1019C>G genotype was associated with major depression in the Utah population. Linkage analysis on Utah pedigrees with strong family histories of major depression including only cases with the HTR1A -1019G allele revealed a linkage peak on chromosome 10 (maximum HLOD=4.4). Sequencing of all known genes in the linkage region revealed disease-segregating single-nucleotide polymorphisms (SNPs) in LHPP. LHPP SNPs were also associated with major depression in both Utah and Ashkenazi populations. Consistent with the linkage evidence, LHPP associations depended on HTR1A genotype. Lhpp or a product of a collinear brain-specific transcript, therefore, may interact with Htr1a in the pathogenesis of major depression.

Safety of low-dose radiocontrast for interventional AV fistula salvage in stage 4 chronic kidney disease patients.

The Dialysis Outcomes Quality Initiative emphasizes increasing arteriovenous fistula prevalence, by promoting referral for fistula creation in patients with stage 4 chronic kidney disease (CKD). The aim is to provide an optimal access for initiation of dialysis, thus avoiding central venous catheter use. The endovascular management of nonmaturing fistulas is more complicated in these patients, where the expected benefit of catheter avoidance must be weighed against the risk of contrast induced nephropathy (CIN). This study reports on the safety of a low-dose radiocontrast regimen, used in performing endovascular fistula salvage procedures in patients with stage 4 CKD. All consecutive endovascular procedures performed over a 2-year period in patients with stage 4 CKD and nonmaturing access were identified. Data collected included the type of procedure, contrast volume per procedure, pre, 2- and 7-day creatinine, need for acute dialysis, and the type of access used to initiate dialysis. Total of 65 procedures were performed in 34 patients. The mean contrast volume was 7.8 ml per procedure. The incidence of CIN (25% increase in serum creatinine) was 4% at 2 days and 4.6% at 1 week. All values returned to baseline within 2 weeks, and no patient required acute dialysis. Among the 33 patients with nonmaturing fistulas, 20 initiated dialysis during the follow-up period, 15 (75%) using their fistula, and five (25%) using a catheter. This study demonstrates that in patients with advanced CKD, fistulas can be successfully salvaged using small contrast volumes with a low incidence of CIN.

Distribution and functional characterization of human Nav1.3 splice variants.

The focus of the present study is the molecular and functional characterization of four splice variants of the human Nav1.3 alpha subunit. These subtypes arise due to the use of alternative splice donor sites of exon 12, which encodes a region of the alpha subunit that resides in the intracellular loop between domains I and II. This region contains several important phosphorylation sites that modulate Na+ channel kinetics in related sodium channels, i.e. Nav1.2. While three of the four Nav1.3 isoforms, 12v1, 12v3 and 12v4 have been previously identified in human, 12v2 has only been reported in rat. Herein, we evaluate the distribution of these splice variants in human tissues and the functional characterization of each of these subtypes. We demonstrate by reverse transcriptase-polymerase chain reaction (RT-PCR) that each subtype is expressed in the spinal cord, thalamus, amygdala, cerebellum, adult and fetal whole brain and heart. To investigate the functional properties of these different splice variants, each alpha subunit isoform was cloned by RT-PCR from human fetal brain and expressed in Xenopus oocytes. Each isoform exhibited functional voltage-dependent Na+ channels with similar sensitivities to tetrodotoxin (TTX) and comparable current amplitudes. Subtle shifts in the V 1/2 of activation and inactivation (2-3 mV) were observed among the four isoforms, although the functional significance of these differences remains unclear. This study has demonstrated that all four human splice variants of the Nav1.3 channel alpha subunit are widely expressed and generate functional TTX-sensitive Na+ channels that likely modulate cellular excitability.

Phylogenomic analysis and evolution of the potassium channel gene family.

Potassium channels govern the permeability of cells to potassium ions, thereby controlling the membrane potential. In metazoa, potassium channels are encoded by a large, diverse gene family. Previous analyses of this gene family have focused on its diversity in mammals. Here we have pursued a more comprehensive study in Caenorhabditis elegans, Drosophila melanogaster, and mammalian genomes. The investigation revealed 164 potassium channel encoding genes in C. elegans, D. melanogaster, and mammals, classified into seven conserved families, which we applied to phylogenetic analysis. The trees are discussed in relation to the assignment of orthologous relationships between genes and vertebrate genome duplication.

Green tea catechins partially protect DNA from (.)OH radical-induced strand breaks and base damage through fast chemical repair of DNA radicals.

The catechins, (-)-epicatechin (EC), (-)-epigallocatechin (EGC), (-)-epicatechin gallate (ECG) and (-)-epigallocatechin gallate (EGCG) are believed to be active constituents of green tea accounting for the reported chemoprevention of certain cancers. The molecular mechanisms by which the measured low concentrations (ca. micromolar) of catechins in humans can reduce the incidence of carcinogenesis is not clear. Using an in vitro plasmid DNA system and radiolytically generating reactive oxygen species (ROS) under constant scavenging conditions, we have shown that all four catechins, when present at low concentrations, ameliorate free radical damage sustained by DNA. A reduction in both prompt DNA single-strand breaks and residual damage to the DNA bases, detected by subsequent incubation with the DNA glycosylases formamidopyrimidine (FPG), endonuclease III (EndoIII) and 5' AP endonuclease exonuclease III (ExoIII), was observed. EGCG was found to be the most active of the catechins, with effects seen at micromolar concentrations. Combined fast-reaction chemistry studies support a mechanism of electron transfer (or H-atom transfer) from catechins to ROS-induced radical sites on the DNA. These results support an antioxidant role for catechins in their direct interaction with DNA radicals.

Reduction in free-radical-induced DNA strand breaks and base damage through fast chemical repair by flavonoids.

This paper provides evidence that dietary flavonoids can repair a range of oxidative radical damages on DNA, and thus give protection against radical-induced strand breaks and base alterations. We have irradiated dilute aqueous solutions of plasmid DNA in the absence and presence of flavonoids (F) in a "constant *OH radical scavenging environment", k of 1.5 x 10(7) s(-1) by decreasing the concentration of TRIS buffer in relation to the concentration of added flavonoids. We have shown that the flavonoids can reduce the incidence of single-strand breaks in double-stranded DNA as well as residual base damage (assayed as additional single-strand breaks upon post-irradiation incubation with endonucleases) with dose modification factors of up to 2.0+/-0.2 at [F] < 100 microM by a mechanism other than through direct scavenging of *OH radicals. Pulse radiolysis measurements support the mechanism of electron transfer or H* atom transfer from the flavonoids to free radical sites on DNA which result in the fast chemical repair of some of the oxidative damage on DNA resulting from *OH radical attack. These in vitro assays point to a possible additional role for antioxidants in reducing DNA damage.

Developing a measure of unmet health care needs for a pediatric population.

BACKGROUND: Quantified measures of unmet health care needs can be used to evaluate health care interventions, assess the impact of managed care, monitor health status trends in populations, or assess equity of access to medical care across population subgroups. Such a measure needs to be simple, relatively easy to obtain, inexpensive, and appropriately targeted to the population of interest. OBJECTIVE: To develop a measure of unmet health care needs that is specifically targeted to a pediatric population. SUBJECTS: Study participants consisted of children, aged 1 to 5 years (n = 1,031), and adolescent mothers, aged 13 to 19 years (n = 172), predominantly from poor, minority families in New York City. RESEARCH DESIGN: Based on a measure, the symptoms-response ratio, developed for all age groups, this study replicated Taylor's procedures specifically for children and adolescents. Respondents were asked if they had experienced a set of physical symptoms and if they saw a doctor in response. A panel of pediatricians rated the same symptoms as to whether health care should be sought. RESULTS: The measure achieved adequate inter-rater reliability and good construct validity. The children's overall use of health services did not differ from the pediatric panel's expectations, but with differing degrees of unmet needs by symptom. Adolescents sought care less often than the expert panel members believed they should. CONCLUSIONS: The symptoms-response ratio provides a good balance of a simple and inexpensive measure while yielding a fair estimate of unmet needs for primary care. This analysis created a pediatric measure targeted to the needs of young children and adolescent females.

Smart technology improves patient-controlled analgesia: a preliminary report.

UNLABELLED: A new adaptive system has been designed to improve patient-controlled analgesia through the use of a variable bolus dose and a variable background infusion of analgesic. A novel hand set allows patients to rate their own pain on a linear scale of 1 to 10. Data derived from the hand set signals are used by an expert algorithm to repeatedly adapt the drug dosage of the bolus and of the background infusion according to both current pain intensity and the patient's response to previous dosage. To test the system, we performed a small pilot clinical study, using a randomized, double-blinded, cross-over design. The new system was alternated with a conventional system every 12 h. Use of the new system was associated with significantly lower pain scores and fewer bolus requests but more analgesic administration, though without increased adverse effects. It was very well accepted by both patients and clinical staff. IMPLICATIONS: Pain relief after surgery is often best provided by patient-controlled analgesia, which uses an IV infusion pump and a patient-activated switch. We have developed a new computer-controlled or "smart" patient-controlled analgesia that rapidly learns a patient's individual needs and provides continuously tailored pain relief.

Pain relief using smart technology: an overview of a new patient-controlled analgesia device.

A new adaptive patient-controlled analgesia (PCA) system designed to improve PCA through the use of a variable bolus dose and a variable background infusion is outlined here. The handset allows patients to rate their pain on a scale of 1-10. Data derived from the handset signals are used by an expert algorithm to repeatedly adapt the drug dosage of the bolus and the background infusion according to both pain intensity and patient response to previous dosages. A feasibility study of the system consisted of a small number of randomized, double-blind, crossover clinical trials. The new system was alternated with a conventional system every 12 h. When the new system was active, 12-h questionnaire pain scores were significantly lower and a trend toward fewer bolus requests was found in alternating intervals. In addition, when the new system was used to commence trials, the number of bolus requests were significantly lower and there was a trend toward lower handset scores, lower questionnaire pain scores, and lower verbal pain scores over the entire trial period. The new adaptive PCA system was well accepted by both patients and clinical staff. The trials successfully established the feasibility of the new system. Further development is being carried out as a result.

Quality in perspective.

Quality and accreditation have taken great strides in recent years. If you are one of the many who find the subject confusing then blame the relentless changes in concepts and terminology that swept into health care. To put this in perspective, I will look at where we have been, where we are, and where we are headed.

Severe deformity of a Palmaz-Schatz stent after normal surgical manipulation.

This report describes a case in which normal surgical manipulation during dissection of the heart while performing a repeat revascularization procedure produced a significant deformity in Palmaz-Schatz stents previously implanted in a saphenous vein graft. The graft had shown satisfactory angiographic appearance immediately before the operation, and consideration was given to leaving it in place. Its replacement, however, prevented a major intraoperative mishap.

Inhibition by penem of processing peptidases from cyanobacteria and chloroplast thylakoids.

Proteins targeted to the thylakoid lumen of plants and cyanobacteria and the periplasmic space of cyanobacteria are synthesised with N-terminal presequences which are removed following translocation across the membrane. These presequences are thought to direct translocation of the preprotein by a sec-type pathway. Detergent extracts of cyanobacterial and chloroplast membranes contain enzymes which are capable of processing precursors to the mature size. We show that the processing of a range of precursors by both cyanobacterial and chloroplast enzymes is inhibited by the penem SB216357. This is the first report of an inhibitor of these enzymes and indicates that they are type 1 signal peptidases.

Some characteristics of cytochrome f in the cyanobacterium Phormidium laminosum: its sequence and charge properties in the reaction with plastocyanin.

Part of the petCA operon was cloned and the sequence of the cytochrome f gene from the moderately thermophilic cyanobacterium Phormidium laminosum determined. A partial sequence of the petC gene encoding the Rieske iron-sulphur protein was also obtained. The cytochrome f gene encodes a mature protein of 385 residues and a leader sequence of 45 residues. The mature protein contains several acidic or neutral residues corresponding to basic residues in the turnip protein. Some of the latter are thought to be important for the interaction with plastocyanin via its "eastern' face. Many of the corresponding residues on the eastern face of P. laminosum plastocyanin are either basic or neutral instead of acidic. These comparisons suggested that the local charges on P. laminosum cytochrome f that are important for its interaction with the homologous plastocyanin may be negative rather than positive. The importance of acidic groups was confirmed by measuring the rates of reduction of horse heart cytochrome c and P. laminosum and spinach plastocyanins by the cytochrome bf complex isolated from P. laminosum. P. laminosum plastocyanin gave the highest rates, which decreased at high ionic strength, confirming the importance of positive local charges on this protein. When extrapolated to infinite ionic strength the rates observed with the two kinds of plastocyanin were similar, but cytochrome c became unreactive. An optimum was observed in the ionic strength response with P. laminosum plastocyanin.