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Background: United States pharmacies repackage medications into multi-dose vials, enabling customized dosing for prescription drugs. Investment in infrastructure has made this the predominant approach to packaging for US prescriptions. Although recent changes to labeling now discourage the use of auxiliary labels (small stickers highlighting information germane to the safe and effective use), they are still allowed by USP, provided their use comes from an evidence-based perspective. Objectives: Evaluate how ‘interactive,’ placements of auxiliary labels (placement requiring physical manipulation of the warning to accomplish a task (e.g. opening)) garner attention as compared to those placed vertically or horizontally. Methods: Ninety-six participants were eye tracked while opening three prescription vials (each with an auxiliary warning label with a different placement: vertical, horizontal and interactive). Recall and recognition were tested subsequently. Linear mixed models were used to analyze the continuous variables while the binary response variables were analyzed using generalized linear mixed models. The effect of auxiliary labels was fitted as a fixed effect and the subject-to-subject variation was considered as a random effect in the model. Participants’ age, health literacy and sex were added to the models if their effect was statistically significant at alpha=0.05. Results: The placement of the warnings significantly impacted the time spent viewing the information they contained at alpha=0.05; people spent significantly longer on interactive placements (0.96; SD 0.13 seconds) than either, horizontal placements (0.27; SD 0.037 seconds) or those placed vertically (0.18 seconds; SD 0.035). Participants were equally as likely to see information presented in an interactive placement (90%; SD 3.8) or horizontal placement (78%; SD 05.5) but less likely to view warnings placed vertically (60%; SD 6.9). Free recall responses also supported the use of interactive placement (62%; SD 6.8 recall) as compared to horizontal placements which were 29%; SD 3.0 and 20%; SD 6.0 for vertical placements. Conclusions: Data provides evidence which suggests that interactive and horizontal placements out-perform auxiliary labels placed vertically on prescription vials with regard to garnering patient attention.

We compared the level of attention capacity between adolescents from the center and south of Europe. The study included 627 European adolescents (54% girls), aged 12.5-17.5 years, who participated in the HELENA Study. The d2 Test of Attention was administered to assess attention capacity. The main results showed that adolescents from the south of Europe had significantly higher score in attention capacity compared with adolescents from central Europe (score + 8.1; 95%CI, 2.44-13.61) after adjustment for age, sex, socioeconomic indicators, body mass index, cardiorespiratory fitness and diet quality index (p = 0.012).Adolescents from the south of Europe had higher levels of attention capacity than their counterparts from central Europe independently of sociodemographic and health-related factors. These differences should be taken into account by educational institutions when promoting new approaches for putting into the practice student's capacities. What is Known? • Attention is a crucial capacity during adolescence. • Several health-related factors (i.e., physical activity, fitness or fatness) may influence attention capacity in adolescents. What is New? • Adolescents from the south of Europe had higher levels of attention capacity than their counterparts from the center, after accounting for socioeconomic factors, fitness, fatness and quality of diet. • These differences should be taken into account by educational institutions when promoting new approaches for putting into the practice student's capacities.

On behalf of the HELENA project group., Objectives To examine the association of health-related physical fitness components and accurate measures of fatness with attention in European adolescents. Design Cross-sectional study. Methods A sub-sample of 444 adolescents from the HELENA study (14.5 ± 1.2 years) from 6 different countries participated in this study. Adolescents underwent evaluations of fitness (20 m shuttle run, handgrip strength, standing long jump and 4 × 10 m shuttle run tests), fatness (body mass index, skinfold thicknesses, bioelectrical impedance, Bod Pod and dual-energy X-ray absorptiometry) and attention (d2-test). Results Higher cardiorespiratory fitness was positively associated with better attention capacity (β = 0.1, p = 0.03). Body mass index and fat mass index measured by Bod Pod and dual-energy X-ray absorptiometry in a subset were negatively associated with attention (β = −0.11, p = 0.02; β = −0.36, p = 0.02; β = −0.34, p = 0.03; respectively). All models were adjusted for age, sex, family-affluence scale and mother education. When these models were additionally adjusted for cardiorespiratory fitness when fatness was the main predictor and vice versa, the associations were somewhat attenuated and were no longer statistically significant. Muscular strength, speed-agility and body fatness markers measured by bioelectrical impedance and skinfolds were not associated with attention. The fit and non-overweight adolescents presented the highest values of attention capacity whilst their unfit and overweight peers showed the lowest values of attention (47.31 ± 2.34 vs. 33.74 ± 4.39; p, The HELENA Study was carried out with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034) and of the Stockholm County Council. FBO and JRR are supported by grants from the Spanish Ministry of Science and Innovation (RYC-2011-09011 and RYC-2010-05957, respectively). CCS is supported by grants from the University of Granada and Spanish Ministry of Economy and Competitiveness (FPU2013/55, BES-2014-068829). In addition, this study takes place under the umbrella of the ActiveBrains project, funded by the Spanish Ministry of Economy and Competitiveness (Ref. DEP2013-47540); and it was further supported by the SAMID III network, RETICS, funded by the PN I+D+I 2017-2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF) (Ref. RD16/0022). This work is part of a Ph.D. Thesis conducted in the Biomedicine Doctoral Studies of the University of Granada, Spain.

Adolescence represents an important period for the development of executive functions, which are a set of important cognitive processes including attentional control. However, very little is known regarding the associations of nutrition with components of executive functions in adolescence. Thus, the aim of this study was to investigate associations of dietary patterns and macronutrient composition with attention capacity in European adolescents. This cross-sectional study included 384 (165 boys and 219 girls) adolescents, aged 12·5–17·5 years, from five European countries in the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Attention capacity was examined using the d2 Test of Attention. Dietary intake was assessed through two non-consecutive 24 h recalls using a computer-based self-administered tool. Three dietary patterns (diet quality index, ideal diet score and Mediterranean diet score) and macronutrient/fibre intakes were calculated. Linear regression analysis was conducted adjusting for age, sex, BMI, maternal education, family affluence scale, study centre and energy intake (only for Mediterranean diet score). In these adjusted regression analyses, higher diet quality index for adolescents and ideal diet score were associated with a higher attention capacity (standardised β =0·16, P =0·002 and β=0·15, P=0·005, respectively). Conversely, Mediterranean diet score or macronutrient/fibre intake were not associated with attention capacity (P >0·05). Our results suggest that healthier dietary patterns, as indicated by higher diet quality index and ideal diet score, were associated with attention capacity in adolescence. Intervention studies investigating a causal relationship between diet quality and attention are warranted. The HELENA project was supported by the European Community Sixth RTD Framework Programme (contract FOODCT-2005-007034). P. H. was supported by a grant from Henning and Johan Throne-Holst Foundation. F. B. O. and I. E.-C. were supported by the Spanish Ministry of Science and Innovation (RYC-2011-09011 and FJCI-2014-19563). H. H. was supported by grants from the Swedish Society of Medicine and the County Council of Östergötland, Sweden. In addition, this study took place under the umbrella of the ActiveBrains project, funded by the Spanish Ministry of Economy and Competitiveness (Ref. DEP2013-47540); it was further supported by the SAMID III network, RETICS, funded by the PN I + D + I 2017-2021 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (Ref. RD16/0022) and by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Unit of Excellence on Exercise and Health.

International audience; Objective: To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents.Study design: The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity.Results: After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents' attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day−1 for moderate, ≥12 min·day−1 for vigorous, and ≥58 min·day−1 for MVPA.Conclusion:These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.