Feeding practices of caregivers with children attending early childhood development centres in Xhariep, South Africa.

Background: In low- to middle-income countries, malnutrition is a major contributing factor in children failing to achieve their developmental potential. The prevention of malnutrition requires, among others, nutritious, diverse and safe foods in early childhood. Aim: The study aimed to determine primary caregivers' choices and motivation for the foods they fed their children. Setting: The study was conducted among early childhood development centres in the Xhariep District, Free State. Methods: A qualitative study was undertaken. Twelve participants who met the inclusion criteria were conveniently sampled. Semi-structured interviews were conducted to find out the primary caregivers' choices and motivation for foods they fed their children until data saturation was reached. Results: The mean age of the participants was 31 years. Nine of the participants relied on social grants as a source of income. The participants reported feeding their children mainly maize porridge, milk, juice, and water. Vegetables and meat were fed to the children once a week. Fruits were fed to the children at the beginning of the month. Conclusion: The level of education, employment status, and community support influenced the primary caregivers' feeding practices. The content of the diets of their children was insufficient in vegetables and fruit, not only placing the children at risk of undernutrition but also at risk of obesity and micronutrient deficiencies. Primary caregivers ensured their children were fed, although limited foods were offered. Contribution: This research creates awareness of the level of social progress and access to resources within rural communities in the Xhariep district, and gives the opportunity to extend this research to confirm these findings in other poverty-stricken areas.

Anaemia prevalence and dietary diversity among women in the rural Free State, South Africa.

BACKGROUND: Anaemia, a global public health problem that particularly affects women, holds major consequences for human health. AIM: Determining dietary diversity, prevalence of anaemia and contraception use. SETTING: Rural women, 25-49 years, in the Free State Province, South Africa. METHODS: In a cross-sectional descriptive quantitative study, dietary diversity was determined with a 24-h recall; biochemical markers of anaemia, iron deficiency and inflammation were measured; and contraceptive use was recorded. RESULTS: Of 134 women (median age 41 years), 51.5% had medium, and 44.8% had low dietary diversity. Overall, 76.9% consumed flesh meats and fish, but only 25.4% ate dark green leafy vegetables. Anaemia was present in 4.6%; 1.5% presented with iron deficiency; and 0.7% presented with iron deficiency anaemia, evidenced by low ferritin levels. However, 45.0% had elevated C-reactive protein (CRP). Overall, 7.5% presented with elevated homocysteine levels, but only 3.8% had low red cell folate levels. More than half (54.1%) reported menstruating regularly and 71.6% used injectable contraceptives. Significant associations were found between median mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) and dietary diversity score. CONCLUSIONS: Although the prevalence of anaemia is low in this population, elevated CRP in almost half indicates that inflammation may mask iron deficiency. The older median age of the sample and approximately half of the women not menstruating regularly may also contribute to the low anaemia prevalence. Attention should be given to the women's diets as almost half consume diets of low diversity, and not all consume foods rich in haemopoietic nutrients.

Diagnostic accuracy of magnetic resonance angiography for internal carotid artery disease: a systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Accurate diagnosis of the degree of internal carotid artery (ICA) stenosis is needed for decisions regarding optimal stroke prevention. Noninvasive magnetic resonance angiography (MRA) is being proposed and used as a replacement for the gold standard, intra-arterial angiography. Our purpose was to perform a systematic review and diagnostic meta-analysis to determine the sensitivity and specificity of time-of-flight (TOF) MRA and contrast-enhanced (CE) MRA for the detection of (1) high-grade (> or = 70% to 99%) ICA stenoses; (2) ICA occlusions; (3) moderately severe (50% to 69%) ICA stenoses; and (4) compare the overall accuracy of the 2 MRA techniques. METHODS: The medical literature on MRA and the diagnosis of ICA steno-occlusive disease was reviewed through the PubMed, EMBASE, and SCOPUS databases. All publication years were included through to November 2006. Studies were eligible for inclusion if they compared the accuracy of TOF or CE MRA for the detection of ICA disease against intra-arterial angiography and reported sufficient data. RESULTS: The overall sensitivity of TOF MRA for the detection of > or = 70% to 99% ICA stenoses was 91.2% (95% CI: 88.9% to 93.1%) with a specificity of 88.3% (86.7% to 89.7%), whereas the sensitivity of CE MRA was 94.6% (92.4% to 96.4%) with a specificity of 91.9% (90.3% to 93.4%). For the detection of ICA occlusions, the sensitivity of TOF MRA was 94.5% (91.2% to 96.8%) and the specificity was 99.3% (98.9% to 99.6%), whereas the sensitivity and specificity values for CE MRA were 99.4% (96.8% to 100%) and 99.6% (99.2% to 99.9%), respectively. For moderately severe (50% to 69%) stenoses, TOF MRA had a sensitivity of only 37.9% (29.3% to 47.1%) and a specificity of 92.1% (89.6% to 94.1%); for CE MRA, the pooled sensitivity value was somewhat better at 65.9% (57.0% to 74.0%), whereas the specificity was 93.5% (91.3% to 95.3%). CONCLUSIONS: TOF MRA and CE MRA showed high accuracy for the detection of high-grade ICA stenoses and occlusions with CE MRA having the edge over TOF MRA, but had only poor (TOF MRA) to fair (CE MRA) sensitivity for the detection of moderately severe stenoses.

Vitamin D status, hypertension and body mass index in an urban black community in Mangaung, South Africa.

BACKGROUND: A strong relationship exists between hypertension and body weight. Research has linked both higher blood pressure and body weight with lower vitamin D status. OBJECTIVE: This study assessed the vitamin D status of a low-income, urban, black community in South Africa, to examine whether serum levels of 25-hydroxy vitamin D [25(OH)D] are associated with hypertension and body mass index (BMI). METHODS: Data collected from 339 adults (25-64 years) from the Assuring Health for All in the Free State (AHA-FS) study were analysed. Variables measured include serum 25(OH)D, blood pressure, weight and height to determine BMI, and HIV status. RESULTS: Mean 25(OH)D level was 38.4 ± 11.2 ng/mL for the group; 43.5 ± 11.8 ng/mL and 37.0 ± 10.6 ng/mL for males and females, respectively. Approximately 40% of the participants were HIV-positive and 63.4% hypertensive. Based on BMI, 11.8% were underweight, 33.0% normal weight, 23.0% overweight and 32.1% obese. HIV status showed no correlation with 25(OH)D levels when controlling for BMI. Poor inverse relationships were found between BMI and 25(OH)D (p = 0.01), and between mean arterial blood pressure and 25(OH)D (p = 0.05). When controlling for BMI, no correlation was found between 25(OH)D and the prevalence of hypertension or mean arterial blood pressure. CONCLUSION: Approximately 96% of participants had an adequate vitamin D status, which could be attributed to latitude, sunny conditions and expected high levels of sun exposure because of living conditions. Results confirmed a poor inverse relationship between vitamin D status and hypertension, which seems to be dependent on BMI.

Body adiposity indices are associated with hypertension in a black, urban Free State community.

BACKGROUND: Non-communicable diseases, including hypertension, are increasing rapidly in resource-poor, developing countries amongst populations transitioning from traditional to westernised lifestyles; and are associated with excess weight. AIM: To investigate the relationship between hypertension and various indices of body adiposity in a transitioning, urban, black population. SETTING: Three hundred and thirty-nine adults (25-64 years) from a larger cross-sectional study (Assuring Health for All in the Free State) conducted in Mangaung, South Africa, were included. METHODS: Standard techniques were used to determine blood pressure, HIV status, body mass index (BMI), waist-to-height ratio (WHtR) and body adiposity index (BAI). RESULTS: Approximately 40% of the sample was HIV-positive and 63.4% hypertensive, with the greatest risk of hypertension being amongst older men. Based on BMI, 23.0% were overweight and 32.1% obese. Waist-to-height ratio showed that 58.6% had increased cardiovascular risk. Mean BAI was 34.1%, whilst 76.3% had a body fat percentage in the overweight/obese category. Waist circumference representing increased cardiovascular risk was found in 44.3% of women and 3.9% of men. Significant positive correlations between mean arterial bloodpressure and BMI (r = 0.261; p < 0.001), WHtR (r = 0.357; p < 0.001) and BAI (r = 0.245; p <0.001) were found. WHtR was a stronger predictor of mean arterial pressure than BMI or BAI. HIV status showed an inverse correlation with all adiposity indices (p < 0.001). CONCLUSION: Our findings promote WHtR as a practical screening tool for increased hypertension risk in populations undergoing westernisation, and support weight loss as afirst-line intervention for the prevention and management of hypertension.

Body mass index of 16-year olds in urban Maseru, Lesotho.

BACKGROUND: Overweight and/or obesity amongst children and adolescents is a global epidemic with health consequences that track into adulthood. No data are currently available regarding overweight/obesity amongst adolescents in Lesotho.Aim and setting: To assess the prevalence of overweight and/or obesity and the associated risk factors amongst 16-year olds in urban Maseru, Lesotho. METHOD: A cross-sectional descriptive study was conducted on a systematic sample of 16-year olds ingrade four (N = 221; 56.6% girls) from randomly-selected schools in urban Maseru. Diet histories and data on lifestyle, physical activity and knowledge, attitudes and/or perceptions and practices regarding nutrition were obtained during structured interviews and body mass index (BMI) was determined. RESULTS: Amongst these 16-year olds, 27.2% girls and 8.3% boys were overweight and/or obese based on World Health Organization cut-offs for BMI; 39.8% were insufficiently active or inactive;6.4% used alcohol regularly; and 11.7% used tobacco. Whilst 28.1% reported no television watching/electronic gaming/computer usage (combined screen time) outside school, 23.6% reported ≥ 4 hours of combined screen time outside school. Most (91.4%) consumed < 3 servings of vegetables/day; 86.4% consumed < 2 servings of fruits/day; and 95.5% consumed < 2 servings of dairy/day. The majority consumed maize porridge (56.1%), bread (63.8%) and margarine/oil/fat (82.3%) daily and added sugar to their food (74.2%). Fruits, vegetables, dairy, meat, pulses and traditional foods were only consumed weekly or less often. Most bought from tuck shops (18.6% daily; 54.3% weekly). Various gaps in knowledge, perceptions and practices were identified that may benefit from educational intervention. CONCLUSIONS: The current study identifies westernised dietary and lifestyle changes, along with overweight and/or obesity, amongst 16-year old adolescents in Lesotho.

Vascular biology: cellular and molecular profiling.

Our understanding of the mechanisms underlying cerebrovascular atherosclerosis has improved in recent years, but significant gaps remain. New insights into the vascular biological processes that result in ischemic stroke may come from cellular and molecular profiling studies of the peripheral blood. In recent cellular profiling studies, increased levels of a proinflammatory T-cell subset (CD4 (+)CD28 (-)) have been associated with stroke recurrence and death. Expansion of this T-cell subset may occur after ischemic stroke and be a pathogenic mechanism leading to recurrent stroke and death. Increases in certain phenotypes of endothelial cell microparticles have been found in stroke patients relative to controls, possibly indicating a state of increased vascular risk. Molecular profiling approaches include gene expression profiling and proteomic methods that permit large-scale analyses of the transcriptome and the proteome, respectively. Ultimately panels of genes and proteins may be identified that are predictive of stroke risk. Cellular and molecular profiling studies of the peripheral blood and of atherosclerotic plaques may also pave the way for the development of therapeutic agents for primary and secondary stroke prevention.

Intensive care unit length of stay: Benchmarking based on Acute Physiology and Chronic Health Evaluation (APACHE) IV.

OBJECTIVE: To revise and update the Acute Physiology and Chronic Health Evaluation (APACHE) model for predicting intensive care unit (ICU) length of stay. DESIGN: Observational cohort study. SETTING: One hundred and four ICUs in 45 U.S. hospitals. PATIENTS: Patients included 131,618 consecutive ICU admissions during 2002 and 2003, of which 116,209 met inclusion criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The APACHE IV model for predicting ICU length of stay was developed using ICU day 1 patient data and a multivariate linear regression procedure to estimate the precise ICU stay for randomly selected patients who comprised 60% of the database. New variables were added to the previous APACHE III model, and advanced statistical modeling techniques were used. Accuracy was assessed by comparing mean observed and mean predicted ICU stay for the excluded 40% of patients. Aggregate mean observed ICU stay was 3.86 days and mean predicted 3.78 days (p < .001), a difference of 1.9 hrs. For 108 (93%) of 116 diagnoses, there was no significant difference between mean observed and mean predicted ICU stay. The model accounted for 21.5% of the variation in ICU stay across individual patients and 62% across ICUs. Correspondence between mean observed and mean predicted length of stay was reduced for patients with a short (< or =1.7 days) or long (> or =9.4 days) ICU stay and a low (<20%) or high (>80%) risk of death on ICU day 1. CONCLUSIONS: The APACHE IV model provides clinically useful ICU length of stay predictions for critically ill patient groups, but its accuracy and utility are limited for individual patients. APACHE IV benchmarks for ICU stay are useful for assessing the efficiency of unit throughput and support examination of structural, managerial, and patient factors that affect ICU stay.

A phenomenological exploration of spirituality among African American women recovering from substance abuse.

Spirituality among African American women recovering from substance abuse is a recovery phenomena: little is known about the individual's experience in this process. The ameliorating effect of spirituality covering a broad range of positive outcomes has been consistent across populations, regardless of gender, race, study design, and religious affiliation. Giorgi's phenomenological method was used to explore and described the meaning of spirituality of 15 African American women recovering from substance abuse. The findings are described and discussed relative to the state of the science on spirituality. Implications for substance abuse and recovery practitioners are presented.