Liking, salt taste perception and use of table salt when consuming reduced-salt chicken stews in light of South Africa's new salt regulations.

This study investigated the impact of salt reduction on liking, salt taste perception, and use of table salt when consuming chicken stew in light of South Africa's new salt recommendations. In total, 432 South-African consumers (aged 35.2 ± 12.3 years) consumed a full portion of a chicken stew meal once at a central location. Four stock cube powders varying in salt content were used to prepare chicken stews: 1) no reduction - 2013 Na level; regular salt level as currently available on the South African market (24473 mg Na/100 g), 2) salt reduction smaller than 2016 level, i.e. 10%-reduced (22025 mg Na/100 g), 3) 2016 salt level, as per regulatory prescriptions (18000 mg Na/100 g), 4) 2019 salt level, as per regulatory prescriptions (13000 mg Na/100 g). Consumers were randomly allocated to consume one of the four meals. Liking, salt taste perception, and use of table salt and pepper were measured. Chicken stews prepared with reduced-salt stock powders were equally well-liked as chicken stews with the current salt level. Moreover, a gradual reduction of the salt in the chicken stews resulted in a reduced salt intake, up to an average of 19% for the total group compared to the benchmark 2013 Na level stew. However, 19% of consumers compensated by adding salt back to full compensation in some cases. More salt was added with increased reductions of salt in the meals, even to the point of full compensation. Further investigation into the impacts of nutrition communication and education about salt reduction on salt taste perception and use is needed. This research provides new consumer insights on salt use and emphasises the need for consumer-focused behaviour change approaches, in addition to reformulation of products.

Estimating the changing burden of disease attributable to high sodium intake in South Africa for 2000, 2006 and 2012.

BACKGROUND: Elevated sodium consumption is associated with increased blood pressure, a major risk factor for cardiovascular and chronic kidney disease. OBJECTIVES: To quantify the deaths and disability-adjusted life years (DALYs) attributed to high sodium intake in persons aged ≥25 years in South Africa (SA) for 2000, 2006 and 2012. METHODS: Comparative risk assessment (CRA) methodology was used and population attributable fractions (PAFs) of high sodium intake, mediated through high blood pressure (BP), for cardiovascular and chronic kidney disease were estimated. This was done by taking the difference between the PAF for elevated systolic BP (SBP) based on the estimated SBP level in the population and the PAF based on the estimated SBP that would result if sodium intake levels were reduced to the theoretical minimum risk exposure level (1 g/day) according to population group and hypertension categories. A meta-regression based on data from nine national surveys conducted between 1998 and 2017 was used to estimate the prevalence of hypertension by age, sex and population group. Relative risks identified from international literature were used and the difference in PAFs was applied to local burden estimates from the second South African National Burden of Disease Study. Age-standardised rates were calculated using World Health Organization (WHO) standard population weights. The attributable burden was also estimated for 2012 using an alternative target of 2 g/day proposed in the National Strategic Plan for the Prevention and Control of Non-communicable Diseases (NSP). RESULTS: High sodium intake as mediated through high SBP was estimated to cause 8 071 (95% uncertainty interval (UI) 6 542 - 15 474) deaths in 2012, a drop from 9 574 (95% UI 8 158 - 16 526) in 2006 and 8 431 (95% UI 6 972 - 14 511) in 2000. In 2012, ischaemic heart disease caused the highest number of deaths in persons (n=1 832), followed by haemorrhagic stroke (n=1 771), ischaemic stroke (n=1 484) and then hypertensive heart disease (n=1 230). Ischaemic heart disease was the highest contributor to deaths for males (27%), whereas for females it was haemorrhagic stroke (23%). In 2012, 1.5% (95% UI 1.3 - 2.9) of total deaths and 0.7% (95% UI 0.6 - 1.2) of total DALYs were attributed to high sodium intake. If the NSP target of <2 g/day sodium intake had been achieved in 2012, ~2 943 deaths and 48 870 DALYs would have been averted. CONCLUSION: Despite a slight decreasing trend since 2006, high sodium intake mediated through raised BP accounted for a sizeable burden of disease in 2012. Realising SA's target to reduce sodium intake remains a priority, and progress requires systematic monitoring and evaluation.

Three-dimensional hierarchical porous carbon structure derived from pinecone as a potential catalyst support in catalytic remediation of antibiotics.

In this study, pinecone was converted via two stage pyrolysis to produce low cost activated carbon. Furnace pyrolysis was used in the first step to convert pinecone to carbonized material, followed by microwave pyrolysis of the carbonized material activated with KOH to obtain activated carbon (ACK) materials as a suitable catalyst support. The ACK samples were characterized by their morphology, structural, adsorption and electrochemical properties. The optimized ACK 2.24-16 prepared from the pinecone had a complex three-dimensional (3D)-hierarchical porous structure, with an abundance of micropores and mesopores compared to other ACK samples judging from the high iodine number (1900 mg g-1) and the methylene blue number (4000 mg g-1) capacity. The optimized ACK 2.24-16 had the highest current response and least charge transfer resistance, along with moderate surface area (427 m2 g-1) as a promising photocatalyst support. The 3D hierarchical porous ACK significantly assisted catalyst dispersion, and enhanced visible light absorption and fast interfacial charge transfer. This work shows the promising aspect of utilizing pinecone to produce a low-cost photocatalyst support for environmental remediation.

Comparison of dietary and plasma phospholipid fatty acids between normal weight and overweight black South Africans according to metabolic health: The PURE study.

BACKGROUND: Information regarding circulating fatty acids (FA) in association with metabolic health in black Africans is scarce, while the usefulness of circulating FAs as biomarkers of dietary fat intake and predictors for medical conditions is increasing. OBJECTIVE: We compared eleven dietary and the levels of 26 plasma phospholipid FAs in metabolically healthy and unhealthy phenotypes in black South African adults. METHODS: Adults from the South African arm of the Prospective Urban and Rural Epidemiology study baseline (n = 711) were categorised into four groups, namely normal weight without metabolic syndrome (MetS) (MHNW), normal weight with MetS (MUNW), metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO). Dietary and plasma phospholipid FAs were measured by a quantitative food frequency questionnaire and gas chromatography-tandem mass spectrometry, respectively. We compared dietary FAs, plasma phospholipid FAs, and estimated desaturase activity between the metabolic status groups using ANCOVA adjusted for age and energy intake. RESULTS: MetS was diagnosed in 35% of the participants. After adjustment for age and total energy intake, in comparison to the MHNW reference group, saturated dietary FAs (C14:0 to C18:0) and alpha-linolenic acid intakes were higher in both overweight/obese groups (MHO and MUO), while linoleic acid intakes were higher in the MUO group only. Plasma levels of most saturated FAs (C18:0 to C22:0) and PUFAs were higher, whereas selected MUFAs, palmitic acid, and estimated desaturase activities were lower in the overweight/obese groups. CONCLUSIONS: The overweight groups generally had higher fat intakes than normal-weight groups, but lower plasma levels of palmitic, palmitoleic, oleic, cis-vaccenic and estimated desaturase activities. Therefore, in this population, lower plasma levels of palmitic, palmitoleic, oleic, and cis-vaccenic acids and decreased estimated desaturase activities may be biomarkers of abnormal metabolic health in overweight/obese study participants.

South Africa's salt reduction strategy: Are we on track, and what lies ahead?

On 2 September 2016, 25 local and international participants from various sectors met in Cape Town to take stock of South Africa (SA)'s progress in salt reduction and develop a roadmap for action. SA is centre stage on salt reduction globally, being the first country to mandate salt reduction across a wide range of processed foods. Excessive salt intake contributed by processed foods and discretionary sources motivated SA to implement a public awareness campaign in parallel with legislation to reduce salt intake to the World Health Organization target of 5 g per day. Five priority areas were identified for continued action on salt reduction, including obtaining research funds for continued monitoring and compliance of salt reduction targets. Determining the contribution of foods eaten out of home to total salt intake and implementing strategies to address this sector were also highlighted as key actions. Lastly, implementing the next stage of the Salt Watch awareness campaign to change.

Lean Mass Appears to Be More Strongly Associated with Bone Health than Fat Mass in Urban Black South African Women.

OBJECTIVES: To examine the association between body composition (fat mass, lean mass and body mass index, BMI) and bone health (bone mineral density, BMD and fracture risk) in urban black South African women. DESIGN: A cross sectional study examining associations between body composition, dietary intake (food frequency questionnaire), habitual physical activity (Activity energy expenditure (AEE) measured using an accelerometer with combined heart rate monitor and physical activity questionnaire) and bone health (BMD using dual-energy X ray absorptiometry, DXA and fracture risk). SETTING: Urban community dwellers from Ikageng in the North-West Province of South Africa. PARTICIPANTS: One hundred and eighty nine (189) healthy postmenopausal women aged ≥43 years. RESULTS: Fat mass and lean mass were significantly associated with BMD and fracture risk when adjusted for potential confounders. However, lean mass and not fat mass remained significantly associated with femoral neck BMD (ß = 0.49, p <0.001), spine BMD (ß = 0.48, p< 0.0001) and hip BMD (ß = 0.59, p< 0.0001). Lean mass was also negatively associated with fracture risk (ß = -0.19 p =0.04) when both lean and fat mass were in the same model. CONCLUSION: Lean mass and fat mass were positively associated with femoral neck, spine and hip BMDs and negatively associated with fracture risk in urban black South African women. Our finding suggests that increasing lean mass rather than fat mass is beneficial to bone health. Our study emphasises the importance of positive lifestyle changes, intake of calcium from dairy and adequate weight to maintain and improve bone health of postmenopausal women.

Serotonergic targets in the treatment of antidepressant induced sexual dysfunction: a pilot study of granisetron and sumatriptan.

Antidepressant induced sexual dysfunction is a common adverse event that is particularly evident with serotonergic antidepressants. There is a paucity of clinical trial evidence on the treatment of this problem. While there is some evidence of involvement of the serotonin (5-HT2) receptor subtype in this phenomenon, other serotonergic receptor systems are not well studied. In this trial, 35 patients on maintenance therapy with a variety of serotonergic antidepressants, who reported antidepressant induced sexual dysfunction, were enrolled. Patients were given both granisetron 1 mg, and sumatriptan 100 mg, in a crossover design, to be used 1 h before intercourse. Sexual dysfunction was measured using the Feiger scale. There was a high dropout rate in the trial, reflecting both embarrassment with the pharmacological treatment of sexual dysfunction and difficulties with planning and timing the medication. Nevertheless, there was a significant effect of granisetron in this study, with scores decreasing from 23.7 (SD 2.52) to 16.0 (SD 6.42) on the Feiger scale (n = 14, P = 0.001, Wilcoxon sign rank test). Sumatriptan failed to show a significant change from baseline at the 0.01 level of significance. While the small sample size, high dropout rates and open label design are limitations to this study, it suggests efficacy of the granisetron in antidepressant induced sexual dysfunction and the role of the 5-HT3 receptor in this phenomenon.

The prognostic significance of p53, mdm2, c-erbB-2, cathepsin D, and thrombocytosis in stage IB cervical cancer treated by primary radical hysterectomy.

The objective of this study was to evaluate the value of platelet count, p53, MDM2, c-erbB-2, and cathepsin D immunoreactivity as predictors of lymph node metastasis (LNM) as well as their prognostic significance in patients with stage IB cervical cancer treated by radical hysterectomy between 1991 through 1995. We also report on the outcome of a protocol considering lymph-vascular space invasion (LVSI) in addition to LNM as a strong motivation for adjuvant radiotherapy. A total of 93 patients were the subject of this retrospective study. The incidence of positive nodes was high (30.1%). Thrombocytosis (>/= 400.000/mm3) was present in 6.7% of patients. Positive immunostaining was found for p53 (50.6%), MDM2 (21.7%), c-erbB-2 (14.5%), and cathepsin D (45.8%), but none of them was able to predict LNM. Only thrombocytosis was associated with an unfavorable prognosis: a statistically significant association was shown with relapse-free and overall survival in an univariate analysis (P = 0.0431 and P = 0.0012, respectively) with a tendency to significance in multivariate analysis (P = 0.079 and P = 0.0882, respectively). We postulate that thrombocytosis in early stage cervical cancer could be a marker for subclinical tumor burden. LVSI, regarded as an indication for adjuvant radiotherapy, was no longer associated with poor relapse-free or overall survival, but resulted in a 41% postoperative irradiation rate. Further research is needed to establish the value of LVSI in postoperative radiotherapy decision making.

Plasma levels of beta-carotene are inversely correlated with circulating neutrophil counts in young male cigarette smokers.

Relationships between plasma levels of beta-carotene (BC) and the numbers and oxidant-generating activities of circulating neutrophils have been investigated in a group of asymptomatic young male cigarette smokers (N = 40) and in a group of nonsmoking control subjects. Plasma BC levels were measured using HPLC, while oxidant generation was measured using a phorbol myristate acetate (PMA) activated whole blood luminol-enhanced chemiluminescence (LECL) method. Relative to nonsmokers, the numbers of circulating neutrophils, as well as the LECL responses of these cells, were increased by 41% (p = 0.0001) and 47% (p = 0.004), respectively, while plasma BC levels were decreased by 24% (p = 0.01). In cigarette smokers, but not in nonsmokers, the numbers of circulating neutrophils, as well as the LECL responses of these cells, were significantly and inversely correlated with plasma BC levels (r = -0.36, p = 0.02; and r = -0.33, P = 0.04 respectively). Diminished plasma levels of BC in cigarette smokers probably reflect the increased numbers and prooxidative activities of circulating neutrophils. Intake of this antioxidant nutrient may be a determinant of susceptibility to smoking-related pulmonary dysfunction mediated by oxidants derived from smoke-activated phagocytes.

Health and hygiene knowledge, attitudes and behaviour.

The aim of this study was to develop and test measures of health and hygiene knowledge, attitudes and behaviour. A questionnaire was administered to 240 women: 80 from a squatter camp, 80 from an informal settlement and 80 from a formal township. Reliability of the knowledge scale was 0.73. Coefficient alpha was 0.87 for the attitude and behaviour scales. The knowledge, attitude and behaviour scales were significantly related (P<0.001). Factor analysis confirmed that domestic and personal hygiene were core components of the attitude scale, whereas the emphasis for behaviour was on personal hygiene. Stepwise regression showed that age explained 23% of the variance in knowledge and 18% in behaviour. Waste management significantly affected knowledge, attitudes and behaviour, suggesting that dustbin ownership was an important public health measure. It was concluded that these scales were useful measures of health and hygiene knowledge, attitudes and behaviour; provided baseline information for planning health promotion programmes; and could be used to evaluate the effectiveness of such programmes.

Clinical features of Black African neonates with Down's syndrome.

Early reports indicated a low prevalence of Down's syndrome (DS) in black African children. More recent research demonstrates an incidence similar to, or higher than that reported to occur in First World populations. One of the possible reasons for underreporting of DS in Africa, appears to be the lack of recognition of the problem at birth. In this study, the musculoskeletal, central nervous system and craniofacial features are documented in 40 black DS neonates and 50 black control neonates without DS, and the findings are compared with those from a reported series of 37 caucasian DS and 40 healthy newborns. Musculoskeletal and central nervous system features were markedly similar in black and caucasian infants. However, the craniofacial features of the African DS newborns approximated more closely those of the normal African neonates, than was the case in the caucasian DS and normal neonates. This finding may partially explain the underreporting of DS in this population, and it emphasizes the need for a clinical awareness of DS and for complete clinical examination to identify affected infants.

Changes in haematocrit after treatment of uncomplicated canine babesiosis: a comparison between diminazene and trypan blue, and an evaluation of the influence of parasitaemia.

It has been suggested that the antibabesial drug diminazene causes a rapid decline in haematocrit after treatment of dogs with high Babesia canis parasitaemias, compared with trypan blue. To test this, 19 dogs with clinically mild to moderate, uncomplicated babesiosis were placed in low, moderate or high parasitaemia groups, based on venous parasitaemias, and were allotted randomly to diminazene or trypan blue treatment groups. Haematocrit and parasitaemia were determined before treatment, and at 2, 6, 12, 18 and 24 hours. The drugs were compared for effects on haematocrit and parasite clearance. Changes in haematocrit after treatment were analysed. There were no significant differences between diminazene and trypan blue for haematocrit or parasite clearance. There was no correlation between initial parasitaemia and initial or post-treatment haematocrit. In all dogs, haematocrit fell following treatment. The maximum mean reduction from the baseline (0 h) was 0.046 l/l (range 0.02-0.07 l/l); this most often occurred at 6 or 12 h. The 24 h haematocrit ranged from 70.5-113.6% of baseline (mean absolute haematocrit 0.019 l/l below baseline). All dogs improved clinically during the study period. It was concluded that either diminazene or trypan blue can be safely used to treat dogs with clinically mild or moderate, uncomplicated babesiosis. Parasitaemia need not be taken into account when deciding which antibabesial drug to administer and does not appear to be related to the degree of anaemia.

Utilisation of oral health services, oral health needs and oral health status in a peri-urban informal settlement.

Interviews were conducted with 294 black residents (155 females and 138 males) of a peri-urban informal settlement in Gauteng to ascertain utilisation of oral health services, oral health needs and oral health status. Only 37 per cent of the sample had consulted a dentist or medical practitioner, usually for extractions. Teenagers and employed persons were significantly less likely to utilise dentists than the older age groups and unemployed persons. Forty per cent were currently experiencing oral health problems such as a sore mouth, tooth decay and bleeding/painful gums. Two hundred and twelve (73 per cent) interviewees wanted dental treatment or advice. Residents who rated their oral health status as fair or poor appeared to have the greatest need for oral health services. The use of interviews appears to be a cost-effective method of determining oral morbidity.

Satisfaction with family planning services. Interpersonal and organisational dimensions.

In South Africa, client satisfaction with the quality of health care has received minimal attention; probably due to the lack of locally developed and tested measures. Therefore, we developed and tested a 20-item attitude scale to determine satisfaction with Family Planning (FP) services. The objectives of this study were to: ascertain reliability of the scale and confirm, through factor analysis, that satisfaction with the FP service was based on interpersonal and organisational dimensions. The sample comprised 199 black adult interviewees (158 women and 41 men), who had previously used or were currently using contraception, from an informal settlement in Gauteng, South Africa. Three items were removed from the scale due to unacceptable communality estimates. The reliability coefficient of 0.76 for the 17-item scale was satisfactory. The principal components analysis, with orthogonal and oblique rotations, extracted two factors; accounting for 51.8% of the variance. The highest loadings on Factor I involved an interpersonal dimension (friendly, encouraging, competent, informative and communicative). Factor II tended to focus on the organisational elements of the system, such as different methods, choice of methods, service availability and length of waiting time. It was concluded that this scale was a reliable, easily administered and scored measure of satisfaction, with underlying interpersonal and organisational dimensions.

Expressed health education needs of black adults living in Ivory Park (Gauteng).

The overall aim of this study was to ascertain African male and female expressed needs for health education programmes. A random sample of 599 adults (229 males and 370 females over 15 years of age) from an informal settlement area (Ivory Park, Gauteng) was interviewed. Out of the 599 respondents, 467 (78%) said that they had received health education, usually through the radio or at a clinic/hospital. Ninety three per cent stated that they would like to receive health education; 52 topics were mentioned. Responses were grouped into six categories: AIDS (32%); Specific Diseases (31%); Child Health (13%); Family Planning (12%); General Health (10%); and Other (2%). Gender and age group were not related to health education category. Doctors and nurses were the preferred presenters of health education at a hospital, clinic or community health centre, through a talk or TV/Video. It was concluded that: (1) there was a definite need for health education, with a focus on AIDS, tuberculosis, child health and family planning; (2) men wanted to be involved in health education programmes; and (3) innovative delivery options need to be developed.

The epidemiology of malocclusion in Zambian urban school children.

This survey was undertaken to determine the occlusal status of a selected group of urban Zambian Black 9-12 year old children at 5 different schools in the same geographical area in order to determine their need for orthodontic treatment. The examination criteria of the Occlusal Index of Summers (1966) were used. Six hundred and one children who had not previously received orthodontic treatment were examined. The data were analysed statistically by using the calculated Summers Index. The results showed that 83 per cent of the subjects required no orthodontic treatment. Of the 17 per cent who did require orthodontic treatment, 5.2 per cent needed specialized treatment. The malocclusion status of Black Zambian children is very similar to that recorded in epidemiological studies on South African and Swazi Black children. This study indicates that only a small need exists for orthodontic treatment amongst Black Zambian children.

Job satisfaction and self-esteem of South African nurses.

The overall aim of this study was to investigate job satisfaction and self-esteem among South African nurses. The objectives of the study were to: (1) ascertain South African nurses' satisfaction with their work, pay, promotion, supervision and co-workers; (2) compare job satisfaction of South African nurses with that of North American nurses; (3) determine levels of self-esteem; and (4) test the direct and indirect effects of self-esteem on job satisfaction. A postal survey was conducted on a random sample of 2,000 nurses registered with the South African Nursing Council; 396 persons returned the questionnaires (Group 1). A subsample of 93 nonrespondents was traced and agreed to complete the questionnaire (Group 2). Minimal differences justified combining the groups and conducting subsequent analyses on total sample scores. Nurses were most satisfied with supervision and co-workers and least satisfied with promotion and pay. Reliability coefficients for the five job satisfaction subscales and overall scale ranged between 0.79 (work) and 0.93 (overall scale). South African nurses were significantly less satisfied with all aspects of their jobs than their American counterparts. Coefficient alpha for the self-esteem scale was 0.72, 0.87 for the work-related needs scale and 0.80 for the social approval scale. High self-esteem nurses were more likely to attend to work-related needs in judging their job satisfaction than low self-esteem nurses. The best model for predicting job satisfaction was the linear incorporation of self-esteem and work-related needs. It was concluded that: (1) the Job Descriptive Index (JDI) was a useful measure of job satisfaction; (2) the quality of life in the South African nursing profession was lower than their American counterparts; (3) nurses had high levels of self-esteem; and (4) self-esteem directly and indirectly affected job satisfaction.

Monitoring utilisation, quality & effectiveness of free antenatal care in an informal settlement in Gauteng.

The aim of this study was to monitor utilisation, quality and effectiveness of free antenatal care from a review of clinic records. Starting randomly, 197 clinic records from four clinics were reviewed. Antenatal care was initiated at the end of the second trimester or in the third trimester, in an inadequate quantity (64% had made less than three visits). Teenagers were significantly more likely to attend only once than the older age groups (Chi-square = 12.5, df = 6, p = 0.05). Standard tasks such as age, weight, blood pressure, foetal heart monitoring, estimated gestational age and urine test results were recorded correctly. However, the effectiveness of care was difficult to assess due to incomplete records and the lack of blood test results. It was concluded that the provision of a free antenatal care service does not automatically increase utilisation; timing and quantity of care obtained were inadequate; and improvements in record keeping are essential for assessing the quality and effectiveness of care.

Epididymal markers in rats exposed to the xenoestrogen p-nonylphenol: no biochemical effects at low dosages.

Harmful micro- and macroscopic effects of the environmental xenoestrogen p-nonylphenol (p-NP) on the male rat reproductive system have been previously reported. In our study, biochemical evidence of epididymal involvement was sought by determining epididymal marker values after exposure at levels below (5, 20 and 50 mg kg-1) and above (100, 250 and 400 mg kg-1) the "no observed adverse effect" level (NOAEL: 50 mg kg-1 day-1). Exposure to p-NL below the NOAEL did not affect biochemical marker values. At levels above the NOAEL, biochemical markers of epididymal function were affected by the exposure of adults, and by maternal exposure (gestational and lactational periods followed by oral exposure until sexual maturity). l-carnitine was unchanged at all levels of exposure. Exposure of adult males to levels above the NOAEL resulted in higher alpha-glucosidase, suggesting increased epididymal secretory activity. This could upset the balance between secretory and reabsorptive function, and could alter the biochemical composition of the epididymal luminal fluid surrounding spermatocytes during the maturation process. Maternal exposure at levels above the NOAEL resulted in higher tartrate-resistant acid phosphatase activity in the caput-corpus epididymidis, which could indicate an oestrogen-mimicking effect.