The development and usability of a web-based mobile application as a dairy intake screener for South African adults.

Paper-based dietary assessment tools such as food frequency questionnaires (FFQ) and especially dietary screeners are making way for versions that use technology. Amidst low intakes of dairy and dairy-related nutrients in South Africa, and to increase public awareness thereof, we aimed to develop and evaluate the usability of an application (app) to screen for dairy intake in higher income South African adults. In a consultative process, a dairy intake screener ('Dairy Diary') was developed as an eight-item quantitative FFQ with four types of commonly consumed local dairy products: milk, maas (fermented milk), yoghurt, and cheese. For each dairy product, usual frequency of consumption and portion size per eating occasion were scored resulting in three risk classes: <1 serving daily; 1≤2 servings daily; ≥2 servings daily. Digitalisation included product- and portion-specific graphics with linkage to risk class-relevant preliminary dairy-related guidance as part of a web-based mobile app. For the evaluation of the usability, the 26-item end-user version of the Mobile Application Rating Scale (uMARS) was used in an online cross-sectional survey (Qualtrics; April 2020). Items were scored on a 5-point Likert-type scale, resulting in three final app scores. From a conveniently recruited sample of 1102, 703 (64%; 81% female; mean age 29.8 ± 11.0 years) were retained for analysis. uMARS-informed descriptive statistics summarise the findings. The uMARS app mean objective quality score (3.9 ± 0.85), app subjective quality score (3.5 ± 0.77), app-specific score (3.6 ± 0.94), and additional question on e-portion (4.3 ± 0.78) met the minimum acceptability score of ≥3.0. For the subscales, the mean score for aesthetics was the highest (4.4 ± 0.82), followed by information (4.3 ± 0.90) and functionality (4.0 ± 1.33). Engagement scored lowest (3.0 ± 1.55). The 'Dairy Diary' is a user-friendly screener for dairy intake.

Twelve tips for supervisors to move towards person-centered research supervision in health care sciences.

The research supervisory role is becoming increasingly complex due to issues such as diversity of students; mismatched expectations between the student, supervisor and higher education institution and shorter and specific time-bound research outcomes. The current postgraduate research supervision culture and supervision practices should change. Moving towards person-centered research supervision practices may enhance the research environment, as healthful relationships between supervisors and postgraduate students may lead to increased postgraduate research outcomes. Using a World Café, we critically reflected on our existing research supervision practices. All healthcare educators involved in postgraduate research supervision were purposively selected to participate. During the café, we explored and shared ideas in a safe space. Twelve tips emerged, which can be implemented to move existing supervision practices towards person-centered research supervision practices. We present these twelve tips from the perspective of the four constructs of person-centeredness as outlined by McCormack and McCance - pre-requisites, environment, process, and outcomes. The use of these tips may enable both supervisors and students to flourish. Avoiding routine, ritual supervision practices and embracing person-centredness, will enable supervisors to form healthful relationships and put the postgraduate student at the heart of our supervision practices.

The Application of the Food Insulin Index in the Prevention and Management of Insulin Resistance and Diabetes: A Scoping Review.

The food insulin index (FII) is a novel algorithm used to determine insulin responses of carbohydrates, proteins, and fats. This scoping review aimed to provide an overview of all scientifically relevant information presented on the application of the FII in the prevention and management of insulin resistance and diabetes. The Arksey and O'Malley framework and the PRISMA Extension for Scoping Reviews 22-item checklist were used to ensure that all areas were covered in the scoping review. Our search identified 394 articles, of which 25 articles were included. Three main themes emerged from the included articles: 1. the association of FII with the development of metabolic syndrome, insulin resistance, and diabetes, 2. the comparison of FII with carbohydrate counting (CC) for the prediction of postprandial insulin response, and 3. the effect of metabolic status on the FII. Studies indicated that the FII can predict postprandial insulin response more accurately than CC, and that a high DII and DIL diet is associated with the development of metabolic syndrome, insulin resistance, and diabetes. The FII could be a valuable tool to use in the prevention and management of T1DM, insulin resistance, and T2DM, but more research is needed in this field.

Areas of delay related to prolonged length of stay in an emergency department of an academic hospital in South Africa.

Introduction: Globally, length of stay of patients in emergency departments remains a challenge. Remaining in the emergency department for >12 h increases health care costs, morbidity and mortality rates and leads to crowding and lower patient satisfaction.The aim of this research was to describe the areas of delay related to prolonged length of stay in the emergency department of an academic hospital. Methods: A quantitative retrospective study was done. The Input-Throughput-Output model was used to identify the areas of patients' journey through the emergency department. The possible areas of delay where then described. Using systematic sampling, a total of 100 patient files managed in an emergency department of an academic hospital in South Africa were audited over a period of 3 months. Descriptive statistics and regression analysis was used to analyse data. Results: The mean length of stay of patients in the emergency department was 73 h 49 min. The length of stay per phase was: input (3 h 17 min), throughput (16 h 25 min) and output (54 h 7 min). A strong significant relationship found between the length of stay and the time taken between disposition decision (throughput phase) disposition decision to admission or discharge of patients from the ED (output phase) (p < 0.05). Conclusion: The output phase was identified as the longest area of delay in this study, with the time taken between disposition decision to admission or discharge of patients from the ED (patients waiting for inpatient beds) as the main significant area of delay.

Length of stay and contributing factors in elderly patients who have undergone hip fracture surgery in a tertiary hospital in South Africa.

BACKGROUND: Length of stay and factors that contribute to length of stay in elderly patients who have undergone hip fracture surgery is under researched in developing countries, including South Africa. The purpose of this study was to describe the factors that increase length of stay (LOS) among elderly patients who have had hip fracture surgery. METHODS: A retrospective review of patient records of elderly (>65 years) patients who had hip fracture surgery in a public hospital in South Africa. Descriptive statistics were used to report demographic data, LOS and frequency distributions of individual factors relating to LOS. Two sample t-tests were used to compare the LOS in patients with and without main complications reported. RESULTS: The mean total length of stay was 33 (19) days. Patients presented with numerous comorbidities, with hypertension (n = 93) being the most prevalent. The most frequently occurring complications included anaemia (n = 42) and wound infection (n = 21). The LOS was significantly lower for patients not presenting with wound infections compared to those who sustained a wound infection (p = 0.041). Social factors delayed departure from the hospital for 48 patients. CONCLUSION: Elderly patients who had hip fracture surgery and developed wound infections had an increased LOS. However social issues also contributed to the increase in length of stay that could be addressed by proper planning and involvement of families and care givers. The factors identified could be used as a starting point for planning services aimed at decreasing the hospital stay of elderly patients.

Developing an Impedance Based Equation for Fat-Free Mass of Black Preadolescent South African Children.

Bioelectrical impedance analysis (BIA) is a practical alternative to dual-energy X-ray absorptiometry (DXA) for determining body composition in children. Currently, there are no population specific equations available for predicting fat-free mass (FFM) in South African populations. We determined agreement between fat-free mass measured by DXA (FFMDXA) and FFM calculated from published multi-frequency bioelectrical impedance prediction equations (FFMBIA); and developed a new equation for predicting FFM for preadolescent black South African children. Cross-sectional data on a convenience sample of 84 children (mean age 8.5 ± 1.4 years; 44 {52%} girls) included body composition assessed using Dual X-ray Absorptiometry (FFMDXA) and impedance values obtained from the Seca mBCA 514 Medical Body Composition analyzer used to calculate FFM using 17 published prediction equations (FFMBIA). Only two equations yielded FFM estimates that were similar to the DXA readings (p > 0.05). According to the Bland-Altman analysis, the mean differences in FFM (kg) were 0.15 (LOA: -2.68; 2.37) and 0.01 (LOA: -2.68; 2.66). Our new prediction equation, F F M = 105.20 + 0.807 × S e x + 0.174 × W e i g h t + 0.01 × R e a c t a n c e + 15.71 × log ( R I ) , yielded an adjusted R2 = 0.9544. No statistical shrinkage was observed during cross-validation. A new equation enables the BIA-based prediction of FFM in the assessment of preadolescent black South African children.

Bone Health, Body Composition, and Vitamin D Status of Black Preadolescent Children in South Africa.

Optimal bone health is important in children to reduce the risk of osteoporosis later in life. Both body composition and vitamin D play an important role in bone health. This study aimed to describe bone health, body composition, and vitamin D status, and the relationship between these among a group of conveniently sampled black preadolescent South African children (n = 84) using a cross-sectional study. Body composition, bone mineral density (BMD), and bone mineral content (BMC) were assessed using dual x-ray absorptiometry. Levels of 25-hydroxyvitamin D (25(OH)D) (n = 59) were assessed using dried blood spots. A quarter (25%) of children presented with low bone mass density for their chronological age (BMD Z-score < -2) and 7% with low BMC-for-age (BMC Z-score < -2), while only 34% of the children had sufficient vitamin D status (25(OH)D ≥ 30 ng/mL). Lean mass was the greatest body compositional determinant for variances observed in bone health measures. Body composition and bone health parameters were not significantly different across vitamin D status groups (p > 0.05), except for lumbar spine bone mineral apparent density (LS-BMAD) (p < 0.01). No association was found between bone parameters at all sites and levels of 25(OH)D (p > 0.05). Further research, using larger representative samples of South African children including all race groups is needed before any conclusions and subsequent recommendation among this population group can be made.

Effects of a high walnut and high cashew nut diet on selected markers of the metabolic syndrome: a controlled feeding trial.

We investigated the effects of a high walnut diet and a high unsalted cashew nut diet on selected markers of the metabolic syndrome. In a randomized, parallel, controlled study design, sixty-four subjects having the metabolic syndrome (twenty-nine men, thirty-five women) with a mean age of 45 (sd 10) years and who met the selection criteria were all fed a 3-week run-in control diet. Hereafter, participants were grouped according to gender and age and then randomized into three groups receiving a controlled feeding diet including walnuts, or unsalted cashew nuts or no nuts for 8 weeks. Subjects were required to have lunch at the metabolic ward of the Nutrition Department of the North-West University (Potchefstroom Campus). Both the walnut and the unsalted cashew nut intervention diets had no significant effect on the HDL-cholesterol, TAG, total cholesterol, LDL-cholesterol, serum fructosamine, serum high-sensitivity C-reactive protein, blood pressure and serum uric acid concentrations when compared to the control diet. Low baseline LDL-cholesterol concentrations in the cashew nut group may have masked a possible nut-related benefit. Plasma glucose concentrations increased significantly (P = 0.04) in the cashew nut group compared to the control group. By contrast, serum fructosamine was unchanged in the cashew nut group while the control group had significantly increased (P = 0.04) concentrations of this short-term marker of glycaemic control. Subjects displayed no improvement in the markers of the metabolic syndrome after following a walnut diet or a cashew nut diet compared to a control diet while maintaining body weight.