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Background Poor growth during infancy and childhood is a characteristic feature of cystic fibrosis (CF). However, the impact of CF on intrauterine growth is unclear. We studied the effect of CF on birth weight in Denmark and Wales, and assessed whether any associations are due to differences in gestational age at birth. Methods We conducted national registry linkage studies in two countries, using data for 2.2 million singletons born in Denmark (between 1980 and 2010) and Wales (between 1998 and 2015). We used hospital inpatient and outpatient data to identify 852 children with CF. Using causal mediation methods, we estimated the direct and indirect (via gestational age) effect of CF on birth weight after adjustment for sex, parity and socioeconomic background. We tested the robustness of our results by adjusting for additional factors such as maternal smoking during pregnancy in subpopulations where these data were available. Results Babies with CF were more likely to be born preterm and with low birth weight than babies with no CF (12.7% vs 5% and 9.4% vs 5.8% preterm; 11.9% vs 4.2% and 11% vs 5.4% low birth weight in Denmark and Wales, respectively). Using causal mediation methods, the total effect of CF on birth weight was estimated to be −178.8 g (95% CI −225.43 to −134.47 g) in the Danish population and −210.08 g (95% CI −281.97 to −141.5 g) in the Welsh population. About 40% of this effect of CF on birth weight was mediated through gestational age. Conclusions CF significantly impacts on intrauterine growth and leads to lower birth weight in babies with CF, which is only partially explained by shorter gestation

Background The socioeconomic determinants of paediatric‐onset psoriasis have not been previously investigated. The aim of this study was to identify whether a social gradient exists for paediatric‐onset psoriasis, using measures of maternal socioeconomic position. Methods Data on paediatric‐onset psoriasis from 36,003 Danish National Birth Cohort offspring were cross‐linked with nation‐wide registry data on maternal age and three measures of maternal socioeconomic position: maternal educational attainment, maternal labour market attachment and equivalised household income. Univariable and multivariable logistic regression analyses were conducted to estimate the odds ratios (ORs) of offspring psoriasis, in cohort analyses for data from the year of enrolment and cross‐sectional analyses from the year of the 11‐year follow up. Results Maternal age at birth, maternal educational attainment, and equivalised household income were inversely associated with offspring psoriasis. Low maternal educational attainment was associated with offspring psoriasis (ORadj 1.62 [1.20‐2.18]) after adjusting for maternal psoriasis and age in cohort analysis. Odds of psoriasis in offspring of mothers in the highest quartile compared to mothers in the lowest quartile of equivalised household income was ORcrude 0.57 (0.43‐0.76), and ORadj 0.59 (0.44‐0.80) after adjusting for maternal psoriasis and age. Similar results were observed for data on maternal socioeconomic position at enrolment and at follow‐up. Conclusion A steep social gradient in paediatric‐onset psoriasis was observed. Maternal socioeconomic position may play a role in early life exposure to modifiable risk factors for psoriasis. Future studies may help elucidate which biological factors mediate the social gradient observed in our study.

Motivation Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with the majority of cases arising in low‐ and middle‐income countries. However, the multi‐sectoral nature of nutrition policymaking adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change may come about within different country settings. Purpose This paper examines multi‐sectoral nutrition policymaking from the health sector perspective, specifically focusing on different sectorial perspectives and the role and use of evidence within this. The case study of Ethiopia provides a unique example of the challenging nature of multi‐sectoral nutrition policy‐making, even with a strong coordinating infrastructure. Approach and methods We undertook 23 in‐depth semi‐structured interviews held in December 2014 with stakeholders from key health sector organisations, and a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi‐lateral organisations, and academic researchers. Findings Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non‐communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight‐ and obesity‐related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. Whilst multi‐sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition lying with the health sector was reinforced by the nature of evidence collected. Conclusion This study of nutrition policymaking in Ethio, Motivation Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with the majority of cases arising in low‐ and middle‐income countries. However, the multi‐sectoral nature of nutrition policymaking adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change may come about within different country settings. Purpose This paper examines multi‐sectoral nutrition policymaking from the health sector perspective, specifically focusing on different sectorial perspectives and the role and use of evidence within this. The case study of Ethiopia provides a unique example of the challenging nature of multi‐sectoral nutrition policy‐making, even with a strong coordinating infrastructure. Approach and methods We undertook 23 in‐depth semi‐structured interviews held in December 2014 with stakeholders from key health sector organisations, and a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi‐lateral organisations, and academic researchers. Findings Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non‐communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight‐ and obesity‐related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. Whilst multi‐sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition lying with the health sector was reinforced by the nature of evidence collected. Conclusion This study of nutrition policymaking in Ethio

Background The prevalence of obesity and overweight has been increasing in many countries. Many factors have been identified as contributing to obesity including the food environment, especially the access, availability and affordability of healthy foods in grocery stores and supermarkets. Several interventions have been carried out in retail grocery/supermarket settings as part of an effort to understand and influence consumption of healthful foods. The review’s key outcome variable is sale/purchase of healthy foods as a result of the interventions. This systematic review sheds light on the effectiveness of food store interventions intended to promote the consumption of healthy foods and the methodological quality of studies reporting them. Methods Systematic literature search spanning from 2003 to 2015 (inclusive both years), and confined to papers in the English language was conducted. Studies fulfilling search criteria were identified and critically appraised. Studies included in this review report health interventions at physical food stores including supermarkets and corner stores, and with outcome variable of adopting healthier food purchasing/consumption behavior. The methodological quality of all included articles has been determined using a validated 16-item quality assessment tool (QATSDD). Results The literature search identified 1580 publications, of which 42 met the inclusion criteria. Most interventions used a combination of information (e.g. awareness raising through food labeling, promotions, campaigns, etc.) and increasing availability of healthy foods such as fruits and vegetables. Few used price interventions. The average quality score for all papers is 65.0%, or an overall medium methodological quality. Apart from few studies, most studies reported that store interventions were effective in promoting purchase of healthy foods. Conclusion Given the diverse study settings and d, Background The prevalence of obesity and overweight has been increasing in many countries. Many factors have been identified as contributing to obesity including the food environment, especially the access, availability and affordability of healthy foods in grocery stores and supermarkets. Several interventions have been carried out in retail grocery/supermarket settings as part of an effort to understand and influence consumption of healthful foods. The review’s key outcome variable is sale/purchase of healthy foods as a result of the interventions. This systematic review sheds light on the effectiveness of food store interventions intended to promote the consumption of healthy foods and the methodological quality of studies reporting them. Methods Systematic literature search spanning from 2003 to 2015 (inclusive both years), and confined to papers in the English language was conducted. Studies fulfilling search criteria were identified and critically appraised. Studies included in this review report health interventions at physical food stores including supermarkets and corner stores, and with outcome variable of adopting healthier food purchasing/consumption behavior. The methodological quality of all included articles has been determined using a validated 16-item quality assessment tool (QATSDD). Results The literature search identified 1580 publications, of which 42 met the inclusion criteria. Most interventions used a combination of information (e.g. awareness raising through food labeling, promotions, campaigns, etc.) and increasing availability of healthy foods such as fruits and vegetables. Few used price interventions. The average quality score for all papers is 65.0%, or an overall medium methodological quality. Apart from few studies, most studies reported that store interventions were effective in promoting purchase of healthy foods. Conclusion Given the diverse study settings and d

The rise of obesity and overweight is a global health challenge. Obesity is a complex phenomenon that can be attributed to multiple factors. One of these factors is the food environment, and particularly the food retailers. This study is part of a big project that aims to evaluate cost-effectiveness of alternative interventions in retail store settings. In cooperation with a supermarket chain in Denmark, we manipulated food locations inside the store so that relatively low energy dense products were placed favorable shelf locations. The underlying theory for the experiment was the behavioral approach (so-called “nudging”) theory popularized by Thaler and Sunstein (2008). Five stores were chosen for the intervention while five comparable stores acted as controls. Results based on total of 28 breakfast cereals showed a decline in calories at intervention stores relative to both pre-intervention period and control stores. However, this is achieved at the expense of somewhat lowered revenue from sales. There are several implications of this study. First, supermarkets may not have an incentive to change current marketing practices as their top priority is their own welfare. Secondly, while the reduction in revenues directly affects only the retail sector, the benefits of calorie reduction are a welfare gain to society. The next question is then whether society should compensate supermarkets for giving more focus on healthy foods. But before any general welfare recommendations are made, the cost-effectiveness of current shelf space management intervention strategy must be compared to other possible alternative strategies.

Der er penge at spare for forbrugeren ved at købe sodavand i store flasker. Alligevel vil en afgift, der fjerner de økonomiske fordele ved at købe store portioner, ikke mindske forbruget af sukker fra drikkevarer. Det mest effektive i forhold til at regulere forbruget er en afgift direkte på indholdet af tilsat sukker.

Monthly data from GfK Consumerscan Scandinavia for the years 2006 – 2009 are used to estimate the effects of different tax scenarios on the consumption of sugar sweetened beverages (SSB’s). Most studies fail to consider demand interrelationships between different types of soft-drinks when the effects of taxation are evaluated. To add to the literature in this aspect we estimated a two-step censored dynamic almost ideal demand system where we include the possibilities that consumers have to substitute between diet and regular soft-drinks, between discount and non-discount (normal) brands as well as between different container sizes. Especially the large sizes and discount brands provide considerable value for money to the consumer. Three different type of taxes is considered; a tax based on the content of added sugar in various SSB’s, a flat tax on soft-drinks alone and a size differentiated tax on soft-drinks that remove the value for money obtained by purchasing large container sizes. The scenarios are scaled equally in terms of obtained public revenue. Largest effect in terms of reduced intake of calories and sugar are obtained by applying the tax on sugar in all beverages, even though detrimental health effects in terms of increased intake of diet soft-drinks has to be considered. A flat tax on soft-drinks decrease the intake of sugar, but leave total calorie intake unaltered due to substitution with other SSB’s. A tax aimed at removing the value added from purchasing large container sizes increase sugar and total calorie intake due to substitution towards discount brands. Hence the results show the importance of considering substitution between different sizes, brands and discount versus normal brands when simulating the effects of soft-drinks taxation and point toward a tax on the sugar content of SSB’s as the most effective in the regulation of obesity.

Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with most cases arising in low- and middle-income countries. However, the multi-sectoral nature of nutrition policy-making adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change can come about within different country settings. This article examines multi-sectoral nutrition policy-making from the health sector perspective, specifically focusing on different sectoral perspectives and the role and use of evidence within this. Ethiopia provides a unique example of the challenging nature of multi-sectoral nutrition policy-making, even with a strong co-ordinating infrastructure. In December 2014 we undertook 23 in-depth semi-structured interviews with stakeholders from key health sector organizations, along with a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi-lateral organizations and academic researchers. Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non-communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight- and obesity-related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. While multi-sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition resting with the health sector was reinforced by the nature of evidence collected. This study of nutrition policy-making in Ethiopia highlights the complex interaction of evidence within different conceptualisations of policy problems and responses. Despite Ethiopia's strategic framewo