The first edition of the Quality of Death Index was published in 2010, which sparked a series of policy debates over the provision of palliative care around the world. What has changed since then?
The UK ranks first in the 2015 Quality of Death Index, a measure of the quality of palliative care in 80 countries around the world released today by The Economist Intelligence Unit (EIU). Its ranking is due to comprehensive national policies, the extensive integration of palliative care into the National Health Service, a strong hospice movement, and deep community engagement on the issue. The UK also came top in the first Quality of Death Index, produced in 2010.
The Quality of Death Index, commissioned by the Lien Foundation, a Singaporean philanthropic organisation, is based on extensive research and interviews with over 120 palliative care experts from across the world. It shows that in general, income levels are a strong indicator of the availability and quality of palliative care, with wealthy countries clustered at the top. Australia and New Zealand take second and third place, as they did in 2010, while rich European and Asian countries dominate the top 20, along with the US in 9th place and Canada in 11th.
As expected, many developing countries are still unable to provide basic pain management due to limitations in staff and basic infrastructure. Yet some countries with lower income levels demonstrate the power of innovation and individual initiative. For example, Panama (31st) is building palliative care into its primary care services, Mongolia (28th) has seen rapid growth in hospice facilities and teaching programmes, and Uganda (35th) has made huge advances in the availability of opioid painkillers.
For the first time The EIU has also compared the supply of palliative care—as revealed in the Index—with the demand for such care. The demand analysis, based on countries’ demographic profiles and the burden of diseases for which palliative care is necessary, shows China to be among the most vulnerable from population ageing and the rising incidence of conditions such as cardiovascular disease, which accounted for one-third of all deaths in the country in 2012. Many other developing countries will also need to work hard to meet rising future need as the incidence of non-communicable disease increases and their populations grow older.
美國食品藥物管理局 ( FDA ) 於 20/5/2016頒布包裝食品新的營養成分標籤，以反映最新的科學信息，包括飲食和慢性疾病，如肥胖和心臟疾病之間的聯繫。新標籤將使它更容易為消費者做出更好的食物選擇。
Changes to the Nutrition Facts Label
May 20, 2016
The FDA today finalized the new Nutrition Facts label for packaged foods to reflect new scientific information, including the link between diet and chronic diseases such as obesity and heart disease. The new label will make it easier for consumers to make better informed food choices.
Highlights of the Final Nutrition Facts Label
1. Features a Refreshed Design
The “iconic” look of the label remains, but we are making important updates to ensure consumers have access to the information they need to make informed decisions about the foods they eat. These changes include increasing the type size for “Calories,” “servings per container,” and the “Serving size” declaration, and bolding the number of calories and the “Serving size” declaration to highlight this information.
Manufacturers must declare the actual amount, in addition to percent Daily Value of vitamin D, calcium, iron and potassium. They can voluntarily declare the gram amount for other vitamins and minerals.
The footnote is changing to better explain what percent Daily Value means. It will read: “*The % Daily Value tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.”
2. Reflects Updated Information about Nutrition Science
“Added sugars,” in grams and as percent Daily Value, will be included on the label. Scientific data shows that it is difficult to meet nutrient needs while staying within calorie limits if you consume more than 10 percent of your total daily calories from added sugar, and this is consistent with the 2015-2020 Dietary Guidelines for Americans.
The list of nutrients that are required or permitted to be declared is being updated. Vitamin D and potassium will be required on the label. Calcium and iron will continue to be required. Vitamins A and C will no longer be required but can be included on a voluntary basis.
While continuing to require “Total Fat,” “Saturated Fat,” and “Trans Fat” on the label, “Calories from Fat” is being removed because research shows the type of fat is more important than the amount.
Daily values for nutrients like sodium, dietary fiber and vitamin D are being updated based on newer scientific evidence from the Institute of Medicine and other reports such as the 2015 Dietary Guidelines Advisory Committee Report, which was used in developing the 2015-2020 Dietary Guidelines for Americans. Daily values are reference amounts of nutrients to consume or not to exceed and are used to calculate the percent Daily Value (% DV) that manufacturers include on the label. The %DV helps consumers understand the nutrition information in the context of a total daily diet.
3. Updates Serving Sizes and Labeling Requirements for Certain Package Sizes
By law, serving sizes must be based on amounts of foods and beverages that people are actually eating, not what they should be eating. How much people eat and drink has changed since the previous serving size requirements were published in 1993. For example, the reference amount used to set a serving of ice cream was previously ½ cup but is changing to ⅔ cup. The reference amount used to set a serving of soda is changing from 8 ounces to 12 ounces.
Package size affects what people eat. So for packages that are between one and two servings, such as a 20 ounce soda or a 15-ounce can of soup, the calories and other nutrients will be required to be labeled as one serving because people typically consume it in one sitting.
For certain products that are larger than a single serving but that could be consumed in one sitting or multiple sittings, manufacturers will have to provide “dual column” labels to indicate the amount of calories and nutrients on both a “per serving” and “per package”/“per unit” basis. Examples would be a 24-ounce bottle of soda or a pint of ice cream. With dual-column labels available, people will be able to easily understand how many calories and nutrients they are getting if they eat or drink the entire package/unit at one time.
Compliance Dates
Manufacturers will need to use the new label by July 26, 2018. However, manufacturers with less than $10 million in annual food sales will have an additional year to comply.
What's considered a single serving has changed in the decades since the original nutrition label was created. So now serving sizes will be more realistic to reflect how much people typically eat at one time.
Within a month, Zaria McDonald, 17, had surgery, started chemotherapy, signed with a modeling agency and appeared on the cover of a magazine.
The teen’s diagnosis with a rare form of cancer came as a devastating shock but also vindication.
McDonald had been complaining about an ache in her right knee since she was 7. Last year, a curious lump developed there, and her aches could no longer be explained as “growing pains.”
She was diagnosed with an extremely aggressive form of cancer. Since then, her life has become as unpredictable and exhilarating as a roller-coaster.
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Now bald, McDonald recently became a social media sensation by embracing a “no hair, don’t care” attitude. Images of her going to prom April 23 in a St. Louis designer’s gown went viral.
If the high school senior, who graduates May 24, is overwhelmed or frustrated by the attention, the belated cancer diagnosis or her future, she doesn’t show it.
“I knew it wasn’t just your typical growing pains; growing pains shouldn’t last for years, but that’s what they said,” McDonald explained. “I didn’t want to argue with the doctors about it and make a big deal. I know you can’t test for everything.”
Something was growing
Growing pains was a plausible explanation for what she had been feeling. She’d always been tall for her age. She started modeling for Lillian Jones’ Laha children’s clothing line when she was 14, but felt uncomfortable standing head and shoulders above her counterparts.
At 5-foot-8 and the age of 15, she modeled adult clothing at the first Missouri Style Week in 2013.
“There was something special about her,” said Cillah Hall, co-founder of Missouri Style Week. “She was so confident and beautiful. It was something that came from deep inside.”
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Zaria McDonald (center), 17, of St. Louis, and other models wait for instructions on how to walk the runway during rehearsals for the Lindenwood University Fashion Design program fashion show at Mercedes-Benz St. Louis, Saturday, May 7, 2016. McDonald lost her hair after receiving chemo therapy for synovial cell sarcoma which was discovered in her knee in October of 2015. McDonald recently received news that the operation she had in January to remove the tumor had been successful and she is now cancer free. Photo by Roberto RodriguezRoberto Rodriguez
Style Week was where McDonald impressed Gail Lasater of West Model and Talent Management. Lasater wanted to add her to the agency’s model roster but needed McDonald to grow another inch. By October 2015, McDonald was 5-foot-9.
All that growing, and hours of daily dance classes at Grand Center Arts Academy seemed like plausible explanations for McDonald’s knee swelling. But doctors eventually diagnosed a synovial sarcoma tumor.
They concluded that it had probably been there all along. No one knows why. The malignant soft tissue cancer affects fewer than three people in a million.
“All I thought about was ‘what does it mean for cancer to be aggressive?’ How aggressive?” McDonald recalled.
But she didn’t want to think the worst, so she didn’t.
Instead, she prepared for a party. The next day was her school’s homecoming dance.
“It was kind of a bummer,” McDonald said, but she knew that she would feel worse if she didn’t go.
She wore a dress designed by Barbara Bultman, whom she met at Missouri Style Week. The St. Louis designer created a minimalist gown that was sleeveless, backless and deep burgundy. McDonald wore her hair in long cascading curls extending to the small of her back.
Within a month, she’d lose all of her hair.
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Cancer and coincidence
That same month, McDonald appeared on the cover of Gazelle STL Magazine, founded by Hall. It was an eerie coincidence that the October issue was dedicated to breast cancer awareness and included articles on various types of cancer, early detection and survivors.
“I got chills when we found out a few weeks later that Zaria had cancer,” Hall said. “But I knew right away that she would be impactful. And she is. She carries herself with such dignity. There’s no way that she’s not destined for greatness.”
McDonald is already a muse to designer Nasheli Juliana Ortiz Gonzalez. McDonald modeled her look in a St. Louis Fashion Week art-inspired design competition for which Gonzalez won a $5,000 grand prize.
“There’s this strong, powerful look to her. I just love her,” Gonzalez said.
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Zaria McDonald, 17, of St. Louis, is seen walking the runway through a backstage area during rehearsals for the Lindenwood University Fashion Design program fashion show at Mercedes-Benz St. Louis, Saturday, May 7, 2016. McDonald lost her hair after receiving chemo therapy for synovial cell sarcoma which was discovered in her knee in October of 2015. McDonald recently received news that the operation she had in January to remove the tumor had been successful and she is now cancer free. Photo by Roberto RodriguezRoberto Rodriguez
Gonzalez, an assistant professor at Lindenwood University with the fashion design program, discovered McDonald in 2013 at a model audition for the school’s annual fashion show. Gonzalez was immediately charmed by the teen’s maturity. She had no idea McDonald was a sophomore in high school.
“She had such confidence and such a great walk that I put her in the collection (of a designer) who did a lingerie and swimwear line,” Gonzalez said. “I think her mother almost died when she saw her (and her mother, Kendra McDonald, confirms that she nearly did), but Zaria was great. I didn’t find out until later her age, and I felt so guilty.”
Gonzalez has hired the teen to be in every runway show she’s produced since, including the most recent Lindenwood University student fashion show May 7.
“She’s one of the few models who can go from full hair to bald and look fantastic. I mean she is even missing a (ligament) in her knee, and she still has the great walk in those high heels,” Gonzalez said. “She’s incredible.”
McDonald looks the picture of health. She said people often assume she’s bald by choice.
“Sometimes I see people staring, and I’m like, ‘Why are they staring?’ And then I remember, ‘Oh, yeah, I have no hair,’” McDonald said laughing over a meal at City Diner in Grand Center. “It’s weird, but I guess it’s a good thing. One guy walked up and said, ‘You have the perfect bald head,’ and I was like, ‘Um, thanks.’”
McDonald didn’t lose much weight from chemotherapy and remains naturally slim at 125 pounds and 5-foot-9. She finished her last chemo treatment in April, just in time for senior prom. McDonald wore a dress designed by Gonzalez.
Fairytale gown
Her sleeveless gown had a sheer illusion bodice nearly the color of her skin embellished with coffee-colored pearls and brown applique florals. The skirt was a billowing mass of chocolate tulle. She looked like someone transformed by a fairy godmother.
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And just like a typical teen, she had her friends snap a few photos of her wearing the magical gown and promptly posted them to Facebook and Instagram.
Within 24 hours, tens of thousands of people shared her images with inspired messages and praise. Someone with the Twitter handle @blackgirlswinni said, “Cancer can’t stop you from slaying #prom2K16” along with a trio of smiley-faced emoticons with heart-shaped eyes. That posting attracted 32,000 likes and 21,000 shares. There was a seemingly endless ripple of shares, likes and reposts.
“It was a shock because I didn’t expect anything like that. I mean, I was just going to prom,” said McDonald, who went with a date she described as a friend. “But I’m really glad that some people found it inspirational.”
Kendra McDonald said that she’s thrilled that her daughter hasn’t missed a beat pursuing her dream to model and has maintained a high grade point average, but she’s still praying because they aren’t out of the woods yet. They have to wait until December to see if doctors clear her for surgery to replace the ligament in her knee.
“All along, I found this much harder than she did,” her mom said. “But all along, Zaria handled it like a champion, so I just followed her lead,” Kendra McDonald said. “Without her strength, I would have been in the corner somewhere bawling.”
Now they are celebrating. On April 25, the Monday after prom, McDonald was declared cancer-free. She will start college in the fall and plans to keep modeling.
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