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Great leaps in multiple sclerosis treatment but the holy grail is still ahead MS is an autoimmune disease of the central nervous system (CNS), affecting the brain, optic nerve and spinal cord. In MS, the immune system mistakenly attacks the myelin sheath around the nerves, disrupting the conduction of nerve signals to other parts of the body. There are many symptoms that can be variable and unpredictable depending on which part of the CNS is damaged. They can be a one-off occurrence, come and go or change in severity over time, contributing to the uncertainty that MS brings. Here CEO of MS Australia Rohan Greenland highlights the breakthroughs in treating attacks on the brain and spinal cord in multiple sclerosis (MS). But his sights are set firmly on the great unmet needs: to repair damaged nerves, reverse disability, and ultimately, prevent MS.

Multiple sclerosis (MS) is a neurodegenerative disease with symptoms that are varied and unpredictable, and although there are effective medications to treat some forms of MS, there is no cure. For many, an MS diagnosis means decades living with a chronic illness and disability.Providing medical and support care to people with MS can be a long and complex partnership between the patient and the general practitioner (GP). The aim of this article is to provide knowledge of the lived experience of MS and the factors leading to a reduced quality of life.Often alongside the considerable threats to physical health and neurological function that MS poses, there are also significant mental health burdens. This article uses lived experience to outline some of the crucial trigger points where support from the GP, and the wider general practice team, can have a significant impact on a positive path forward for the patient.

usc While penned nearly two decades ago, the words of Remen are increasingly relevant to those providing palliative care. They remind us of the need for cognisance of potential impacts on personal wellbeing and professional capacity when working in contexts of cumulative loss and suffering. More recently, the physical and psychosocial suffering associated with the impact of the COVID-19 pandemic has brought unprecedented operational and ethical challenges for palliative care providers, bringing workforce considerations into sharp focus. Refereed/Peer-reviewed

Background: Front-of-pack nutrition labelling may support healthier packaged food purchases. Australia has adopted a novel Health Star Rating (HSR) system, but the legitimacy of this choice is unknown. Objective: To define the effects of different formats of front-of-pack labelling on the healthiness of food purchases and consumer perceptions. Design: Individuals were assigned at random to access one of four different formats of nutrition labelling—HSR, multiple traffic light labels (MTL), daily intake guides (DIG), recommendations/warnings (WARN)—or control (the nutrition information panel, NIP). Participants accessed nutrition information by using a smartphone application to scan the bar-codes of packaged foods, while shopping. The primary outcome was healthiness defined by the mean transformed nutrient profile score of packaged foods that were purchased over four weeks. Results: The 1578 participants, mean age 38 years, 84% female recorded purchases of 148,727 evaluable food items. The mean healthiness of the purchases in the HSR group was non-inferior to MTL, DIG, or WARN (all p < 0.001 at 2% non-inferiority margin). When compared to the NIP control, there was no difference in the mean healthiness of purchases for HSR, MTL, or DIG (all p > 0.07), but WARN resulted in healthier packaged food purchases (mean difference 0.87; 95% confidence interval 0.03 to 1.72; p = 0.04). HSR was perceived by participants as more useful than DIG, and easier to understand than MTL or DIG (all p < 0.05). Participants also reported the HSR to be easier to understand, and the HSR and MTL to be more useful, than NIP (all p < 0.03). Conclusions: These real-world data align with experimental findings and provide support for the policy choice of HSR. Recommendation/warning labels warrant further exploration, as they may be a stronger driver of healthy food purchases.

Alice Grainger Gasser, Cassandra Welch, Monika Arora, and Eduardo Bianco have worked on projects funded by pharmaceutical companies producing medication for tobacco dependence treatment. The remaining authors report no relationships that could be construed as a conflict of interest. From the *World Heart Federation, Geneva, Switzerland; yCWJ Consulting, Nairobi, Kenya; zPublic Health Foundation of India, New Delhi, India; xHeart Foundation, Melbourne, Victoria, Australia; kWorld Health Organization, Geneva, Switzerland; {University of Melbourne, Melbourne, Victoria, Australia; and the #Framework Convention Alliance (FCA), and The Center for Research on the Tobacco Epidemic (CIET), Montevideo, Uruguay. Correspondence: A. Grainger Gasser (alice. graingergasser@ worldheart.org).

As part of its endorsement of the World Health Organization's Global Action Plan to prevent non-communicable diseases, the Federal Government of Australia has committed to a 30% reduction in average population salt intake by 2025. Currently, mean daily salt intake levels are 8-9 g, varying by sex, region and population group. A number of salt reduction initiatives have been established over the last decade, but key elements for a co-ordinated population-level strategy are still missing. The objective of this review is to provide a comprehensive overview of existing population-level salt reduction activities in Australia and identify opportunities for further action.A review of the published literature and stakeholder activities was undertaken to identify and document current activities. The activities were then assessed against a pre-defined framework for salt reduction strategies.A range of initiatives were identified from the review. The Australian Division of World Action on Salt and Health (AWASH) was established in 2005 and in 2007 launched its Drop the Salt! Campaign. This united non-governmental organisations (NGOs), health and medical and food industry organisations in a co-ordinated advocacy effort to encourage government to develop a national strategy to reduce salt. Subsequently, in 2010 the Federal Government launched its Food and Health Dialogue (FHD) with a remit to improve the health of the food supply in Australia through voluntary partnerships with food industry, government and non-government public health organisations. The focus of the FHD to date has been on voluntary reformulation of foods, primarily through salt reduction targets. More recently, in December 2014, the government's Health Star Rating system was launched. This front of pack labelling scheme uses stars to highlight the nutritional profile of packaged foods. Both government initiatives have clear targets or criteria for industry to meet, however, both are voluntary and the extent of industry uptake is not yet clear. There is also no parallel public awareness campaign to try and influence consumer behaviour relating to salt and no agreed mechanism for monitoring national changes in salt intake. The Victorian Health Promotion Foundation (VicHealth) has recently instigated a State-level partnership to advance action and will launch its strategy in 2015.In conclusion, salt reduction activities are currently being implemented through a variety of different programs but additional efforts and more robust national monitoring mechanisms are required to ensure that Australia is on track to achieve the proposed 30% reduction in salt intake within the next decade.