Effects of front-of-package nutrition labelling systems on understanding and purchase intention in Jamaica: results from a multiarm randomised controlled trial

Early diagnosis of early childhood caries: A simple novel tool (MAAC charts) for parents and caretakers

Early Childhood Caries (ECC) is a condition associated with nearly 123 risk factors. Among all the risk factors, enamel defects or enamel hypoplasia (ED/EH) has been shown to be the primary risk factor. ED/EH comprises the earliest changes that manifest on newly erupted primary tooth surfaces soon after its eruption. ED/EH appears as white lines or patches, either as demarcated or diffuse opacities on the enamel surface. It is often observed on the labial and buccal surfaces of the newly erupted primary maxillary incisors. A simple self-report tool for mothers/caretakers, healthcare professionals, and primary care workers to diagnose early changes in ECC may facilitate early diagnosis. The MAAC chart was developed to prevent ECC in children with cleft lip and palate. These charts, primarily developed to educate parents, caregivers, healthcare professionals, and primary health care providers, illustrate the variations in ED/EH on the enamel surface (demarcated and diffuse opacities on various maxillary teeth) as a collage of pictures organized as incisors and canines. This paper describes a novel and simple, tool called 'MAAC charts' providing guidance on early signs of Early childhood caries (ECC) for health professionals, parents and caretakers. MAAC charts can be useful for Pediatric dentists while providing anticipatory guidance during early first dental visits in their office. Pediatric dentists can suggest paediatricians to use these MAAC charts, in vaccinations clinics and various in/out patient settings to provide oral health related anticipatory guidance. Pediatric dentists can use these MAAC charts in large scale public health campaigns focused on preventing ECC.

Impact of Five Types of Front-of-Package Nutrition Labels on Consumer Behavior among Young Adults: A Systematic Review

The World Health Organization (WHO) recommends that governments promote and implement front-of-package (FoP) nutrition labels to prevent noncommunicable diseases. Recently, additional research has focused on various views on FoP label creation. However, few review studies have examined how different FoP labels affect young consumer behavior. Therefore, this study thoroughly analyzed the evidence on how FoP labels in five categories affect young consumer purchasing intention and behavior. We searched for keywords in the Web of Science, Scopus, and EBSCO databases and screened study samples according to inclusion and exclusion criteria. Fourteen studies that matched the criteria were included in this review. We discovered that numerous studies support the efficacy of the "graded indicators" category labels, with the "color-coded" and "positive logos" categories trailing closely behind. The effectiveness of the "warning" FoP label category is mixed on consumers' healthy purchasing behavior and intention. The numerical FoP labels were most commonly used to indicate ineffectiveness. Future studies should investigate the effects of FoP labels on various subpopulations and conduct thorough evaluations of the design elements of FoP labels. Also, they should offer evidence-based recommendations, supported by both quantitative and qualitative data, for regions that have not yet implemented FoP labeling systems.

How Promising Are "Ultraprocessed" Front-of-Package Labels? A Formative Study with US Adults

High levels of food processing can have detrimental health effects independent of nutrient content. Experts and advocates have proposed adding information about food processing status to front-of-package labeling schemes, which currently exclusively focus on nutrient content. How consumers would perceive "ultraprocessed" labels has not yet been examined. To address this gap, we conducted a within-subjects online experiment with a convenience sample of 600 US adults. Participants viewed a product under three labeling conditions (control, "ultraprocessed" label, and "ultraprocessed" plus "high in sugar" label) in random order for a single product. The "ultraprocessed" label led participants to report thinking more about the risks of eating the product and discouraging them from wanting to buy the product more than the control, despite not grabbing more attention than the control. The "ultraprocessed" plus "high in sugar" labels grabbed more attention, led participants to think more about the risks of eating the product, and discouraged them from wanting to buy the product more than the "ultraprocessed" label alone. "Ultraprocessed" labels may constitute promising messages that could work in tandem with nutrient labels, and further research should examine how they would influence consumers' actual intentions and behaviors.

Adapting power calculations to include a superiority margin: what are the implications?

This paper examines the application of super-superiority margins in study power calculations. Unlike traditional power calculations, which primarily aim to reject the null hypothesis by any margin, a super-superiority margin establishes a clinically significant threshold. Despite potential benefits, this approach, akin to a non-inferiority calculation but in an opposing direction, is rarely used. Implementing a super-superiority margin separates the notion of the likely difference between two groups (the effect size) from the minimum clinically significant difference, without which inconsistent positions could be held. However, these are often used interchangeably. In an audit of 30 recent randomized controlled trial power calculations, four studies utilized the minimal acceptable difference, and nine utilized the expected difference. In the other studies, this was unclarified. In the post hoc scenario, this approach can shed light on the value of undertaking further studies, which is not apparent from the standard power calculation. The acceptance and rejection of the alternate hypothesis for super-superiority, non-inferiority, equivalence, and standard superiority studies have been compared. When a fixed minimal acceptable difference is applied, a study result will be in one of seven logical positions with regards to the simultaneous application of these hypotheses. The trend for increased trial size and the mirror approach of non-inferiority studies implies that newer interventions may be becoming less effective. Powering for superiority could counter this and ensure that a pre-trial evaluation of clinical significance has taken place, which is necessary to confirm that interventions are beneficial.

Sodium and potassium consumption in Jamaica: National estimates and associated factors from the Jamaica Health and Lifestyle Survey 2016-2017

This study aimed to estimate dietary sodium and potassium consumption among Jamaicans and evaluate associations with sociodemographic and clinical characteristics. A cross-sectional study was conducted using data from the Jamaica Health and Lifestyle Survey 2016-2017. Participants were noninstitutionalized Jamaicans aged ≥15 years. Trained staff collected sociodemographic and health data via interviewer-administered questionnaires and spot urine samples. The Pan American Health Organization formula was used to estimate 24-hour urine sodium and potassium excretion. High sodium level was defined as ≥2000 mg/day, and low potassium levels as <3510 mg/day (World Health Organization criteria). Associations between these outcomes and sociodemographic and clinical characteristics were explored using multivariable ANOVA models using log-transformed 24-hour urine sodium and potassium as outcome variables. Analyses included 1009 participants (368 males, 641 females; mean age 48.5 years). The mean sodium excretion was 3582 mg/day (males 3943 mg/day, females 3245 mg/day, P < .001). The mean potassium excretion was 2052 mg/day (males, 2210 mg/day; females, 1904 mg/day; P = .001). The prevalence of high sodium consumption was 66.6% (males 72.8%, females 60.7%, P < .001) and that of low potassium intake was 88.8% (85.1% males, 92.3% females, P < .001). Sodium consumption was inversely associated with older age, higher education, and low glomerular filtration rate but was directly associated with being male, current smoking, and obesity. Overall, males had higher sodium consumption than women, with the effect being larger among hypertensive men. Women with hypertension had lower sodium consumption than nonhypertensive women; however, hypertensive men had higher sodium consumption than nonhypertensive men. Potassium consumption was higher among men, persons with obesity, and those with high total cholesterol but was lower among men with "more than high school" education compared to men with "less than high school" education. We conclude that most Jamaican adults have diets high in sodium and low in potassium. In this study, sodium consumption was directly associated with male sex, obesity, and current smoking but was inversely associated with older age and higher education. High potassium consumption was associated with obesity and high cholesterol levels. These associations should be further explored in longitudinal studies and population-based strategies should be developed to address these cardiovascular risk factors.