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Objective: To determine the ability of consumers to: locate and manipulate food label information; assess the accuracy of nutrient content claims and which health/nutrient claims are allowed; and identify symbols on food labels. Associations pertaining to use and knowledge regarding food label information were also determined for consumers from different demographic and related groups.Design: An exploratory descriptive study was undertaken, employing a face-to-face survey focusing on demographic information, shopping behaviour, nutrition is important beliefs, label use, label knowledge and label preference and information sources.Setting: Selected public locations in Potchefstroom in the North West Province of South Africa.Subjects: Respondents (n 229) complying with set inclusion criteria were recruited through purposive sampling.Results: The results indicated respondents' general health and label awareness, as most of them (>80%) could locate label information and identify symbols and specific nutrient content claims although only 53% were able to calculate the number of servings. Nevertheless, an inability was found to assess the accuracy of some nutrient content claims and permissible health/nutrient claims. More educated, younger, Afrikaans- and English-speaking respondents seemed to be more knowledgeable regarding food label information.Conclusions: Respondents who were informed about nutrition were also informed about label information, while label reading practices resulted in label-influenced purchasing decisions. Educational programmes on food labels should start with nutritional background that could be implemented by consumers during label reading and purchasing decisions. [ABSTRACT FROM AUTHOR]

Unhealthy food choices and consumption, coupled with sedentary lifestyles among consumers, intensify public health concerns regarding the quadruple disease burden, despite Primary Health Care (PHC) policy. However, the current relationship between consumer knowledge about healthy foods and following a healthy lifestyle needs to be explored. Our study, therefore, aimed to determine the association between consumers' subjective and objective knowledge about healthy foods and various healthy lifestyle choices. A cross-sectional survey was conducted among employed consumers (N = 157) from South African corporate settings. We used structural equation modelling (SEM) to determine associations between subjective and objective knowledge about healthy foods and healthy lifestyle choices. Our findings showed that most participants scored high on making healthy lifestyle choices relating to avoiding smoking (69.5%) and limiting drinking alcohol (68.7%) but less so for food and sleep (44.4%) while neglecting exercise, relaxation (13.7%), and choices that require dedicated effort (25.2%). On average, participants had high levels of subjective (mean = 3.59; 5-point Likert scale) knowledge and objective knowledge about healthy foods (88.4-95.9% correct responses). However, their objective knowledge about weight and cholesterol had severe deficiencies (36.7%). SEM confirmed an association between subjective knowledge and most healthy lifestyle choice categories, while income contributed to dedicated effort lifestyle choices. By contrast, objective knowledge did not associate with such choices. Our structural model suggests that subjective knowledge about healthy foods contributes to healthy lifestyle choices. Therefore, subjective knowledge and the objective knowledge deficiencies we identified among corporate consumers can serve as a valuable starting point for informed education to promote PHC policy and healthy lifestyle choices., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 van der Merwe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to rate the certainty domain of imprecision is presently not fully operationalized for rating down by two levels and when different baseline risk or uncertainty in these risks are considered. In addition, there are scenarios in which lowering the certainty of evidence by three levels for imprecision is more appropriate than lowering it by two levels. In this article, we conceptualize and operationalize rating down for imprecision by one, two and three levels for imprecision using the contextualized GRADE approaches and making decisions., Methods: Through iterative discussions and refinement in online meetings and through email communication, we developed draft guidance to rating the certainty of evidence down by up to three levels based on examples. The lead authors revised the approach according to the feedback and the comments received during these meetings and developed GRADE guidance for how to apply it. We presented a summary of the results to all attendees of the GRADE Working Group meeting for feedback in October 2021 (approximately 80 people) where the approach was formally approved., Results: This guidance provides GRADE's novel approach for the considerations about rating down for imprecision by one, two and three levels based on serious, very serious and extremely serious concerns. The approach includes identifying or defining thresholds for health outcomes that correspond to trivial or none, small, moderate or large effects and using them to rate imprecision. It facilitates the use of evidence to decision frameworks and also provides guidance for how to address imprecision about implausible large effects and trivial or no effects using the concept of the 'review information size' and for varying baseline risks. The approach is illustrated using practical examples, an online calculator and graphical displays and can be applied to dichotomous and continuous outcomes., Conclusion: In this GRADE guidance article, we provide updated guidance for how to rate imprecision using the partially and fully contextualized GRADE approaches for making recommendations or decisions, considering alternate baseline risks and for both dichotomous and continuous outcomes., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To identify challenges in the application of GRADE for diagnosis when assessing the certainty of evidence in the test-treatment strategy (diagnostic accuracy, test burden, management effectiveness, natural course, linked evidence) in an illustrative example and to propose solutions to these challenges., Study Design and Setting: A case study in applying GRADE for diagnosis that looked at the added value of IgE for diagnosing allergic rhinitis., Results: Evaluation of the full test-treatment strategy showed a lack of (high-quality) evidence for all elements. In our example, we found a lack of evidence for test burden, natural course, and link between the test result and clinical management. Overall, systematically reviewing the evidence for all elements of a test-treatment strategy is more time-consuming than only considering test accuracy results and management effectiveness. For increasing efficiency, the guideline panel could determine critical elements of the test-treatment strategy that need a systematic review of the evidence. For less critical elements, a guideline panel can rely on gray literature and professional expertise., Conclusion: A lack of high-quality evidence and time investment if the full test-treatment strategy is assessed, creating challenges in applying GRADE for diagnosis. Discussion within guideline panels about critical elements that need to be reviewed might help., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Clear communication of systematic review findings will help readers and decision makers. We built on previous work to develop an approach that improves the clarity of statements to convey findings and that draws on Grading of Recommendations Assessment, Development and Evaluation (GRADE)., Study Design and Setting: We conducted workshops including 80 attendants and a survey of 110 producers and users of systematic reviews. We calculated acceptability of statements and revised the wording of those that were unacceptable to ≥40% of participants., Results: Most participants agreed statements should be based on size of effect and certainty of evidence. Statements for low, moderate and high certainty evidence were acceptable to >60%. Key guidance, for example, includes statements for high, moderate and low certainty for a large effect on intervention x as: x results in a large reduction…; x likely results in a large reduction…; x may result in a large reduction…, respectively., Conclusions: Producers and users of systematic reviews found statements to communicate findings combining size and certainty of an effect acceptable. This article provides GRADE guidance and a wording template to formulate statements in systematic reviews and other decision tools., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Laboratory animal studies are used in a wide range of human health related research areas, such as basic biomedical research, drug research, experimental surgery and environmental health. The results of these studies can be used to inform decisions regarding clinical research in humans, for example the decision to proceed to clinical trials. If the research question relates to potential harms with no expectation of benefit (e.g., toxicology), studies in experimental animals may provide the only relevant or controlled data and directly inform clinical management decisions. Systematic reviews and meta-analyses are important tools to provide robust and informative evidence summaries of these animal studies. Rating how certain we are about the evidence could provide important information about the translational probability of findings in experimental animal studies to clinical practice and probably improve it. Evidence summaries and certainty in the evidence ratings could also be used (1) to support selection of interventions with best therapeutic potential to be tested in clinical trials, (2) to justify a regulatory decision limiting human exposure (to drug or toxin), or to (3) support decisions on the utility of further animal experiments. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach is the most widely used framework to rate the certainty in the evidence and strength of health care recommendations. Here we present how the GRADE approach could be used to rate the certainty in the evidence of preclinical animal studies in the context of therapeutic interventions. We also discuss the methodological challenges that we identified, and for which further work is needed. Examples are defining the importance of consistency within and across animal species and using GRADE's indirectness domain as a tool to predict translation from animal models to humans.

Objectives: This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for development of clinical, public health, and health system guidelines., Study Design and Setting: We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve., Results: We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation., Conclusion: Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

The physical stature of Surinamese soldiers is estimated to have increased by more than 3cm between 1870 and 1909. In the subsequent four decades, the increase in adult male and female height amounted to 0.3-0.5cm and 0.9-1.0cm per decade, respectively. This increase in height continued and accelerated during the second half of the twentieth century. Height increase among African and Hindustani Surinamese males and females was similar. Height differences between African and Hindustani Surinamese were therefore fairly constant over time, at 4-5cm. Other indicators of nutritional and health status, such as infant mortality, showed continuous improvement, whereas per capita calorie and protein availability improved in the twentieth century., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Rationale, Aims and Objectives: Randomized controlled trials (RCTs) are the preferred source for evidence for the effect of treatment. However, patients participating in RCTs often manifest important differences from patients seen in practice. Therefore, guideline developers have to decide whether the results are generalizable to the target population not represented in RCTs., Method: A systematic review of the literature was undertaken to identify methods to decide whether to generalize the results from RCTs to patients who were not represented in these trials., Results: One approach is to examine the in- and exclusion criteria of trials and infer from these whether the trial population was sufficiently representative. Other authors suggest, because of the inclusion of a broader range of patients, reliance on observational studies if no direct evidence for the target population is available. Another approach is to apply the relative effect of treatment found in trials to patients in practice unless there is a compelling reason to believe the results would differ substantially as a function of particular characteristics of those patients. Although there are exceptions, this approach is supported by empirical evidence that, in general, relative effect of treatment on benefit outcomes seldom differs to an important extent across subgroups of patients., Conclusion: We propose this last approach: focusing on RCTs unless there is a compelling reason not to do so. Compelling reasons will most often be found with respect to issues of rare adverse effects, for which observational studies are likely to provide the best estimates., (© 2012 John Wiley & Sons Ltd.)

The positive relationship between per capita availability of dairy products and average height found in historical studies (for instance in nineteenth century Bavaria, Prussia and France; Baten, 2009) does not necessarily indicate a causal relationship. Historical studies usually apply non-experimental methods that may produce substantial bias. Modern experimental controlled studies may provide high quality evidence supporting a causal relationship between consumption of dairy products and physical growth. This paper provides a systematic review and meta-analysis of controlled trials investigating the effect of supplementing usual diet with dairy products on physical growth. Twelve studies provided sufficient, independent data for meta-analysis. Seven studies were conducted since the 1990s. The other studies were conducted between 1926 and 1980. Studies were conducted in Europe, USA, China, Northern Vietnam, Kenya, Indonesia and India. Many studies had some internal validity problems such as lack of randomisation or dissimilarity of groups at baseline regarding height and age, which affects the quality of evidence. Meta-analysis and sensitivity analysis showed that the most likely effect of dairy products supplementation is 0.4 cm per annum additional growth per ca 245 ml of milk daily. Meta-regression analysis indicated that milk might have more effect on growth than other dairy products while lower height-for-age and being a teenager increased the effect of supplementation. In conclusion, there is moderate quality evidence that dairy products supplementation stimulate linear growth supporting hypotheses that changing levels of consumption of dairy products in the 19th and 20th centuries contributed to trends in height., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: To identify the information that adult consumers use on food labels, the difficulties they experience when using food labels and their reasons for not always using food labels. The relationship between their understanding of the information on the food label and their ability to make informed food choices was also investigated by means of their being required to perform labelling tasks., Design: A cross-sectional and descriptive research approach was followed. Data were collected by means of the administration of questionnaires., Setting: Selected supermarkets in Potchefstroom and Klerksdorp in the North West Province, South Africa., Subjects: Questionnaires were administered to 174 consumers of African descent and Caucasians, ≥18 years of age, who were involved in purchasing household food products., Results: The information that is mostly used on food labels includes the expiry date, the list of ingredients and nutritional information, such as fat and cholesterol content. The difficulties associated with food labels were indicated mainly as being the font size of the print, whereas the reasons for not reading food labels were related to product attributes ('taste and price are more important than is the nutritional content of the food product'), demographic characteristics ('lack of education and nutritional knowledge') and situational factors ('experiencing time constraints')., Conclusions: Results from the present study indicated that the expiry date was the most important information on a food label used by consumers. Scores from the labelling tasks showed that the respondents did not always understand how to use the information on food labels in order to make informed food choices. Barriers to consumer understanding and the use of food labels are highlighted. Improvements on current food labels in South Africa are suggested. Guidelines for consumer education regarding the use of food labels are also provided.

Background: A key objective of the Guidelines International Network (GIN) is to reduce duplication of effort. To address this objective, a working group was established to define a minimum dataset for inclusion in all evidence tables., Methods: A literature review was conducted to identify existing evidence tables, and GIN member organisations were asked to provide the tables they use. The results were used to develop a minimum dataset (template) for studies addressing intervention questions. The template was pilot-tested by a group of guideline developers and reviewed at GIN conferences. RESULTS The literature search yielded 65 articles. These dealt with reporting standards and trial quality (eg, CONSORT statement) rather than which data should be extracted from studies. However, the checklist items given were considered useful. Nineteen GIN members provided evidence tables; 17 tables were used for analysis. The number of items included in the tables ranged from 8 to 19, with several items common to all tables. Within individual items, the level of detail varied widely. The draught template included a majority of items relating to objective data. Pilot testing revealed that the median time to read a paper and complete the template was 2 h for a randomised controlled trial and 2½ h for a non-randomised, controlled intervention study. The median rating for both relevance and clarity of items was high. CONCLUSION The template listing the items needed to summarise an interventional study is now available for large-scale testing by all organisations.

Four isolates from freshly caught fish samples obtained from the South Atlantic Ocean off the South African coastline were shown to represent a novel species in the genus Chryseobacterium by means of a polyphasic taxonomic study. The four isolates had virtually identical whole-cell protein profiles, fatty acid profiles and biochemical properties. Analysis of the 16S rRNA sequence of strain LMG 23089(T) revealed 99.3 and 98.9 % similarity to the 16S rRNA sequences of the type strains of Chryseobacterium balustinum and Chryseobacterium scophthalmum, respectively. Strain LMG 23089(T) and the C. balustinum and C. scophthalmum type strains formed a stable lineage supported by a bootstrap value of 100 %. The levels of DNA-DNA hybridization towards these nearest phylogenetic neighbours were below 57 %. The absence of growth on MacConkey agar or at 37 degrees C (on nutrient agar), the capacity to grow in the presence of 5 % NaCl and the production of urease activity differentiate this novel taxon from C. balustinum and C. scophthalmum. The four isolates are formally classified as Chryseobacterium piscium sp. nov., with strain LMG 23089(T) (=CCUG 51923(T)) as the type strain. Its DNA G + C content is 33.6 mol%.

Yellow-pigmented, Gram-negative organisms isolated from raw chicken were investigated by means of a polyphasic taxonomic approach and were shown to represent a novel species in the genus Chryseobacterium, for which the name Chryseobacterium vrystaatense sp. nov. is proposed. Its nearest phylogenetic neighbours were Chryseobacterium joostei, Chryseobacterium indologenes and Chryseobacterium gleum, which showed 16S rRNA gene sequence similarity levels of 96.9, 97.1 and 96.1%, respectively. Levels of DNA-DNA hybridization between strains of C. vrystaatense and Chryseobacterium reference species were below 46%. Strain LMG 22846(T) (=CCUG 50970(T)) was chosen as the type strain and has a DNA G+C content of 37.1 mol%.

In the late-Middle Ages and at the onset of the early modern period, the Dutch population was taller than in the first half of the 19th century. This inference is partially based on skeletal evidence, mainly collected by the Dutch physical anthropologist George Maat and his co-workers. A spectacular increase in Dutch heights began in the second half of the 19th century and accelerated in the second half of the 20th century. At the end of the 20th century, the Dutch became tallest in the world.

Attention is drawn to the widespread use of bleaching preparations by Black women. These products often contain hydroquinone. They act efficiently as bleaching agents, but chronic oversaturation of the skin with hydroquinone eventually produces ochronosis. This complication has reached epidemic proportions in the Transvaal. Although the assay of hydroquinone in cosmetic products has not yet been standardized, we present some provisional results. The clinical, social and industrial aspects are also significant.

The type of skin reactions which occur in commerce and industry and the causal agents are summarized.

Subcutaneous phycomycosis in a Black child is reported, together with clinical, histological and mycological studies. This is the first case, to our knowledge, to be identified mycologically in South Africa. Oral potassium iodide gave an excellent therapeutic result.