Trends in beverage prices following the introduction of a tax on sugar-sweetened beverages in Barbados.

A 10% excise tax on sugar sweetened beverages (SSBs) was implemented in Barbados in September 2015. A national evaluation has been established to assess the impact of the tax. We present a descriptive analysis of initial price changes following implementation of the SSB tax using price data provided by a major supermarket chain in Barbados over the period 2014-2016. We summarize trends in price changes for SSBs and non-SSBs before and after the tax using year-on-year mean price per liter. We find that prior to the tax, the year-on-year growth of SSB and non-SSB prices was very similar (approximately 1%). During the quarter in which the tax was implemented, the trends diverged, with SSB price growth increasing to 3% and that of non-SSBs decreasing slightly. The growth of SSB prices outpaced non-SSBs prices in each quarter thereafter, reaching 5.9% compared to <1% for non-SSBs. Future analyses will assess the trends in prices of SSBs and non-SSBs over a longer period and will integrate price data from additional sources to assess heterogeneity of post-tax price changes. A continued examination of the impact of the SSB tax in Barbados will expand the evidence base available to policymakers worldwide in considering SSB taxes as a lever for reducing the consumption of added sugar at the population level.Financial support for the analyses presented in this paper was from the US Center for Disease Control and Prevention (TEPHINET). The full evaluation is receiving support from the Canadian International Development Research Centre (grant no. 107604-001), the Pan American Health Organization. MA is funded through a Gates Cambridge PhD Scholarship. JA is funded by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged

The Development of Public Policies to Address Noncommunicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs

Background: Government policy measures have a key role to play in the prevention and control of noncommunicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success. Methods: A qualitative case study design was used involving a structured policy document review and semistructured interviews with key informants, identified through stakeholder analysis and ‘cascading.’ Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector. Results: A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of individuals needing to take responsibility for their health rather than requiring government-led environmental changes; lack of appropriate detailed policy guidance for local adaptation; conflicts with other political priorities, such as production and export of alcohol, and political reluctance to use legislative and fiscal measures. Conclusion: The study’s findings indicate mechanisms to promote and support NCD policy development in the Caribbean and similar setting

International collaborative project to compare and track the nutritional composition of fast foods

Background: Chronic diseases are the leading cause of premature death and disability in the world with over-nutrition a primary cause of diet-related ill health. Excess quantities of energy, saturated fat, sugar and salt derived from fast foods contribute importantly to this disease burden. Our objective is to collate and compare nutrient composition data for fast foods as a means of supporting improvements in product formulation. METHODS/DESIGN: Surveys of fast foods will be done in each participating country each year. Information on the nutrient composition for each product will be sought either through direct chemical analysis, from fast food companies, in-store materials or from company websites. Foods will be categorized into major groups for the primary analyses which will compare mean levels of saturated fat, sugar, sodium, energy and serving size at baseline and over time. Countries currently involved include Australia, New Zealand, France, UK, USA, India, Spain, China and Canada, with more anticipated to follow. DISCUSSION: This collaborative approach to the collation and sharing of data will enable low-cost tracking of fast food composition around the world. This project represents a significant step forward in the objective and transparent monitoring of industry and government commitments to improve the quality of fast foods.E Dunford is supported by a Sydney Medical School Foundation scholarship and B Neal by an Australian Research Council Future Fellowship.http://www.biomedcentral.com/1471-2458/12/559am201

Communication strategy to disseminate the results of the evaluation of the Port-of-Spain Declaration (POSDEVAL) across multiple audiences in the Caribbean

Like many nations in the Americas, the countries of the Caribbean are facing increasing morbidity and mortality associated with noncommunicable diseases (NCDs). In 2007, based on advocacy by Sir George Alleyne and others, the Caribbean Community (CARICOM) convened the first in the world Heads of Government NCDs Summit. This summit issued the Port of Spain Declaration that served not only as a rallying point to accelerate the regional NCDs response, but also as a catalyst for the first United Nations high-level meeting on NCDs in September 2011. In 2014, seven years after the CARICOM NCDs Summit, a formal evaluation of the Port of Spain Declaration (POSDEVAL) was conducted to investigate its impact and learn lessons to support and further accelerate its implementation. One mechanism was to review successes and challenges in the NCDs response and effectively communicate findings to stakeholders and the public. The results of the evaluation and the implementation of the Port of Spain Declaration are presented by other papers in this supplement. The present paper describes the communication and social information process used for sharing POSDEVAL findings across multiple layers of social influence in the Caribbean, primarily in 2016 – 2017. The main steps of the communication process are shared as a possible strategy for disseminating NCDs research information and accelerating control and policy adoption in other Small Island Developing States and middle-income countries

The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs

Background Government policy measures have a key role to play in the prevention and control of noncommunicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success. Methods A qualitative case study design was used involving a structured policy document review and semistructured interviews with key informants, identified through stakeholder analysis and ‘cascading.’ Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector. Results A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of individuals needing to take responsibility for their health rather than requiring government-led environmental changes; lack of appropriate detailed policy guidance for local adaptation; conflicts with other political priorities, such as production and export of alcohol, and political reluctance to use legislative and fiscal measures. Conclusion The study’s findings indicate mechanisms to promote and support NCD policy development in the Caribbean and similar settings

The pea3 subfamily ets genes are required for HER2/Neu-mediated mammary oncogenesis

AbstractBackground: The PEA3 Ets transcription factor is overexpressed in the vast majority of human breast tumors and in nearly all of those of the HER2/Neu-positive subclass. PEA3 is also overexpressed in various transgenic mouse models of this disease. Whether PEA3 plays an essential role in HER2/Neu-mediated oncogenesis has heretofore not been addressed.Results: Here, we report that each of the three highly related ets genes of the pea3 subfamily (pea3, er81, and erm) were coordinately overexpressed in mammary tumors of MMTV-neu transgenic mice. Other ets genes normally expressed in the mammary gland were not upregulated in these tumors. Expression of a dominant-negative pea3 transgene under the control of the MMTV promoter in mammary epithelial cells of MMTV-neu transgenic mice dramatically delayed the onset of mammary tumors and reduced the number and size of such tumors in individual mice. Those tumors that arose in bitransgenic mice expressed the MMTV-neu transgene, but not the MMTV-dominant-negative pea3 transgene.Conclusions: These findings imply that one or more of the PEA3 subfamily Ets proteins or other Ets proteins with related DNA binding specificity play an essential role in Neu-mediated mammary oncogenesis. Hence, agents that inhibit the expression or activity of the PEA3 subfamily proteins may prove efficacious in the treatment of breast cancer

Mejor control de la presión arterial para reducir la morbilidad y mortalidad por enfermedades cardiovasculares: Proyecto de Prevención y Tratamiento Estandarizado de la Hipertensión Arterial * Traducción oficial al español efectuada por la Organización Panamericana de la Salud a partir del artículo original publicado en el Journal of Clinical Hypertension, con autorización de John Wiley and Sons. En caso de discrepancia prevalecerá la versión original (en inglés).

RESUMEN La hipertensión arterial es el principal factor de riesgo corregible de las enfermedades cardiovasculares y, a nivel mundial, afecta a más de mil millones de personas y causa más de diez millones de muertes evitables cada año. Aunque puede diagnosticarse y tratarse de forma satisfactoria, solo una de cada siete personas hipertensas tiene la presión arterial controlada. A fin de abordar este reto, se ha puesto en marcha el Proyecto de Prevención y Tratamiento Estandarizado de la Hipertensión Arterial con el propósito de mejorar el control de la hipertensión, particularmente en los países de ingresos bajos y medianos. Este proyecto consiste en aplicar un enfoque de fortalecimiento de los sistemas de salud que promueva el tratamiento estandarizado de la hipertensión arterial por medio de intervenciones basadas en la evidencia, como el uso de protocolos estandarizados de tratamiento y de un conjunto básico de medicamentos, junto con mecanismos optimizados de compra para aumentar su disponibilidad y asequibilidad, el uso de registros clínicos para el seguimiento y la evaluación de cohortes de pacientes, el empoderamiento de los pacientes, el trabajo en equipo (delegación de tareas), y la participación de la comunidad. Si se dispone de voluntad política y se establecen alianzas fuertes, este enfoque permite sentar las bases para reducir la hipertensión arterial y la morbilidad y mortalidad asociadas a las enfermedades cardiovasculares