Process evaluation of the healthkick action planning process in disadvantaged schools in the Western Cape

Magister Public Health - MPHIn this study a process evaluation of the action planning process of the HealthKick programme in disadvantaged primary school settings in the Western Cape was conducted. A qualitative methodology was adopted to best determine the experiences of the participants and the underlying factors involved. Four schools were randomly selected to participate. Four focus group discussions were conducted with educators, and four in-depth interviews were conducted with principals and champions at schools, (champions are either an educator or school governing body member selected to be the driver of the project at each school, as well as the liaison person between the school and the HealthKick project team). Semi-structured interview guides were used to steer the discussions. Interviews and focus groups were audio taped and transcribed verbatim. The data was thematically analysed with the assistance of Atlas ti computer software. The results of this study indicated that the action planning process did not take place as designed by the project team. Several challenges were identified and experienced by participants. The results further indicated that the challenges of time, workload and competing priorities were intrinsically linked. Positive experiences were also reported and various enablers to the process were identified, such as the facilitation process, the receipt of the resource toolkit as well as the complementary nature of the HealthKick curriculum to the normal academic curriculum.South Afric

The development of a street-food vending model that offers healthy foods for sale

Philosophiae Doctor - PhDBackground: Street foods (SF) contribute significantly to the nutritional intake of adults and children in developing countries. They are inexpensive and a major source of income for a vast multitude. A major concern is the so-called ‘nutrition transition’, which has led to an increase in foods high in saturated fats, trans fats, sugar and salt, along with processed food items sold on urban community streets in developing countries. These foods contribute to nutritional disorders in the communities where consumed. South Africa’s stable unemployment rate, estimated at 25%, has further influenced business growth in the informal sector, particularly SF vending. As such, a well-developed SF-vending model (SFVM) could potentially address the challenges of unemployment and improve the nutritional status of poorer South Africans. Aim: To develop a sustainable SFVM for selling healthy and safe SF in the City of Cape Town enabling street vendors to make a decent living, and consumers to make healthy choices regarding food purchasing. Methods: This cross-sectional study employed mixed methodology (collecting qualitative and quantitative data). The study was conducted in three phases. Phase 1a: Situation Analysis. This a SF-vendor survey which collected a) socio-demographic factors, b) vendors’ business operational models, c) food items sold, d) available facilities, e) challenges faced, f) certification, and g) nutrition knowledge using a validated questionnaire. An observational checklist capturing data on the appearance of vendors, their stalls, available equipment and type of food sold, supplemented this survey. Phase 1b: A consumer survey included collecting, a) socio-demographic factors, b) purchasing habits, c) consumption preferences, and d) nutrition knowledge using a validated questionnaire. Phase 2a: Semi-structured-interviews and focus group discussions with Environmental Health Officials and Economic Development Officials from the City of Cape Town were conducted to explore the existing -vending regulations and/or policies in the City of Cape Town and gain insight into the SF-vending operations from a regulatory perspective. Phase 2b: A document review was conducted to identify existing regulations and policies on SF vending. Phase 3: conducted in three steps: Step 1, data integration of the previous phases. Step 2, a participatory action research component checking the relevance, acceptability and practicability of identified themes and resulting components from Step 1. Step 3, development of the proposed SFVM using the findings of the previous two steps. Data Analysis: Quantitative data were analysed using IBM SPSS, 2010 Statistics version 23. Descriptive statistics and cross-tabulations were used to analyse data. Qualitative data were thematically analysed using the qualitative data software package Atlas ti 7.5.7.Results: Phase 1a: vendors in the Cape Town and surrounding areas work long hours up to seven days a week making a minimal income. Types of food items sold by vendors, their nutrition knowledge and hygiene practices were not ideal. A major lack in basic facilities existed. Phase 2a: SF consumers indicated spending a significant amount of their income on SF, and are open to buying healthier options should these be available. Phase 2a: government officials thought the SF-vending business should be guided by national legislature and provincial bylaws, and felt strongly about nutrition and health education for vendors and consumers. Phase 2b: thirteen regulations and bylaws applicable to SF vending were sourced. Phase 3: Data from the previous phases were integrated within a socio-ecological framework to develop the proposed SFVM. The components of this model are divided into four areas, i.e. a business component, food and nutrition component, hygiene component, and a vending cart. Conclusion: The four components in the proposed SFVM take into account various elements of the socio-ecological framework, i.e. intrapersonal/individual, interpersonal, the physical environment/community and the policy environment. This SFVM should be piloted, evaluated, adapted and before rolling it out on a large scale to test its effectiveness

Socially Disadvantaged Farmer Issues can be Addressed When Diverse Frontline Agricultural Workers Proactively Work Together

This paper focuses on socially disadvantaged farmers (SDFs) and civil rights issues as it relates to the USDA. It also deals with Diversity Initiatives in the 2008 Farm Bill, and discusses an assessment by Jackson Lewis LLC of the USDA’s efforts to deal with the diversity initiatives. Redacted USDA case studies examined at the 2010 Professional Agricultural Workers Conference at Tuskegee University are presented. The findings revealed that at that time the 2008 Farm Bill Initiatives were not effectively being implemented. It was recommended that the USDA should: keep making the effort to reform or improve its civil rights practices; be more customer-oriented; follow-up on clients; be transparent; and continue using 1890s, community-based organizations, and other outreach entities to reach SDFs

Impact of polymorphic variants on the molecular pharmacology of the two-agonist conformations of the human β1-adrenoceptor

β-blockers are widely used to improve symptoms and prolong life in heart disease primarily by inhibiting the actions of endogenous catecholamines at the β1-adrenoceptor. There are two common naturally occurring polymorphisms within the human β1-adrenoceptor sequence: Ser or Gly at position 49 in the N-terminus and Gly or Arg at position 389 in the C-terminus and some clinical studies have suggested that expression of certain variants may be associated with disease and affect response to treatment with β-blockers. The β1-adrenoceptor also exists in two agonist conformations - a high affinity catecholamine conformation and a low affinity secondary agonist conformation. Receptor-effector coupling and intracellular signalling from the different conformations may be affected by the polymorphic variants. Here, we examine in detail the molecular pharmacology of the β1-adrenoceptor polymorphic variants with respect to ligand affinity, efficacy, activation of the different agonist conformations and signal transduction and determine whether the polymorphic variants do indeed affect this secondary conformation. Stable cell lines expressing the wildtype and polymorphic variants were constructed and receptor pharmacology examined using whole cell binding and intracellular secondary messenger techniques. There was no difference in affinity for agonists and antagonists at the human wildtype β1-adrenoceptor (Ser49/Gly389) and the polymorphic variants Gly49/Gly389 and Ser49/Arg389. Furthermore, the polymorphic variant receptors both have two active agonist conformations with pharmacological properties similar to the wildtype receptor. Although the polymorphism at position 389 is thought to occur in an intracellular domain important for Gs-coupling, the two agonist conformations of the polymorphic variants stimulate intracellular signalling pathways, including Gs-cAMP intracellular signalling, in a manner very similar to that of the wildtype receptor

Dietary diversity and its association with nutritional status, cardiometabolic risk factors and food choices of adults at risk for type 2 diabetes mellitus in Cape Town, South Africa

In South Africa, the nutrition transition has led to unhealthy diets lacking variety, contributing to the rise in overweight, obesity and diet-related noncommunicable diseases. Using baseline screening data of the South African Diabetes Prevention Programme (SA-DPP) study, this study aims to determine the relationship of dietary diversity (DD) with nutritional status, cardiometabolic risk factors and food choices of adults at risk of type 2 diabetes in resource-poor communities around Cape Town. Data of 693 adults, 25–65 years old were analysed. This included socio-demographic information, anthropometric measurements, biochemical assessments, food groups consumed the previous day and consumption frequency of certain foods to reflect food choices

Adult food choices in association with the local retail food environment and food access in resource-poor communities: A scoping review protocol

The local retail food environment influences dietary patterns and food choices, as suggested in the literature. The lack of access to healthy food within this environment may result in unhealthy food choices which may lead to obesity and the development of noncommunicable diseases. Evidence suggests that resourcepoor communities may have unhealthy food environments, therefore, preventing residents from making healthy food choices. A systematic scoping review will be conducted to provide an overview of the evidence on adult food choices in association with the local retail food environment and food access in resource-poor communities

Identification of key residues in transmembrane 4 responsible for the secondary, low-affinity conformation of the human 1-adrenoceptor

The β1-adrenoceptor exists in two agonist conformations/states: 1) a high-affinity state where responses to catecholamines and other agonists (e.g., cimaterol) are potently inhibited by β1-adrenoceptor antagonists, and 2) a low-affinity secondary conformation where agonist responses, particularly CGP12177 [(−)-4-(3-tert-butylamino-2-hydroxypropoxy)-benzimidazol-2-one] are relatively resistant to inhibition by β1-adrenoceptor antagonists. Although both states have been demonstrated in many species (including human), the precise nature of the secondary state is unknown and does not occur in the closely related β2-adrenoceptor. Here, using site-directed mutagenesis and functional measurements of production of a cyclic AMP response element upstream of a secreted placental alkaline phosphatase reporter gene and accumulation of 3H-cAMP, we examined the pharmacological consequences of swapping transmembrane (TM) regions of the human β1- and β2-adrenoceptors, followed by single point mutations, to determine the key residues involved in the β1-adrenoceptor secondary conformation. We found that TM4 (particularly amino acids L195 and W199) had a major role in the generation of the secondary β1-adrenoceptor conformation. Thus, unlike at the human β1-wild-type adrenoceptor, at β1-TM4 mutant receptors, cimaterol and CGP12177 responses were both potently inhibited by antagonists. CGP12177 acted as a simple partial agonist with similar KB and EC50 values in the β1-TM4 but not β1-wild-type receptors. Furthermore pindolol switched from a biphasic concentration response at human β1-wild-type adrenoceptors to a monophasic concentration response in the β1-TM4 mutant receptors. Mutation of these amino acids to those found in the β2-adrenoceptor (L195Q and W199Y), or mutation of a single residue (W199D) in the human β1-adrenoceptor thus abolished this secondary conformation and created a β1-adrenoceptor with only one high-affinity agonist conformation

Nutrient density and cost of commonly consumed foods: A South African perspectiv

Food-based dietary guidelines promote consumption of a variety of nutritious foods for optimal health and prevention of chronic disease. However, adherence to these guidelines is challenging because of high food costs. The present study aimed to determine the nutrient density of foods relative to cost in South Africa, with the aim to identify foods within food groups with the best nutritional value per cost. A checklist of 116 food items was developed to record the type, unit, brand and cost of foods. Food prices were obtained from the websites of three national supermarkets and the average cost per 100 g edible portion was used to calculate cost per 100 kcal (418 kJ) for each food item. Nutrient content of the food items was obtained from the South African Food Composition Tables. Nutrient density was calculated using the Nutrient Rich Food (NRF9.3) Index. Nutrient density relative to cost was calculated as NRF9.3/price per 100 kcal. Vegetables and fruits had the highest NRF9.3 score and cost per 100 kcal. Overall, pulses had the highest nutritional value per cost. Fortified maizemeal porridge and bread had the best nutritional value per cost within the starchy food group. Foods with the least nutritional value per cost were fats, oils, foods high in fat and sugar, and foods and drinks high in sugar. Analysis of nutrient density and cost of foods can be used to develop tools to guide low-income consumers to make healthier food choices by identifying foods with the best nutritional value per cost

Negative cooperativity across 1-adrenoceptor homodimers provides insights into the nature of the secondary low-affinity CGP 12177 1-adrenoceptor binding conformation

At the β1-adrenoceptor, CGP 12177 potently antagonizes agonist responses at the primary high-affinity catecholamine conformation while also exerting agonist effects of its own through a secondary low-affinity conformation. A recent mutagenesis study identified transmembrane region (TM)4 of the β1-adrenoceptor as key for this low-affinity conformation. Others suggested that TM4 has a role in β1-adrenoceptor oligomerization. Here, assessment of the dissociation rate of a fluorescent analog of CGP 12177 [bordifluoropyrromethane-tetramethylrhodamine-(±)CGP 12177 (BODIPY-TMR-CGP)] at the human β1-adrenoceptor expressed in Chinese hamster ovary cells revealed negative cooperative interactions between 2 distinct β1-adrenoceptor conformations. The dissociation rate of 3 nM BODIPY-TMR-CGP was 0.09 ± 0.01 min−1 in the absence of competitor ligands, and this was enhanced 2.2- and 2.1-fold in the presence of 1 µM CGP 12177 and 1 µM propranolol, respectively. These effects on the BODIPY-TMR-CGP dissociation rate were markedly enhanced in β1-adrenoceptor homodimers constrained by bimolecular fluorescence complementation (9.8- and 9.9-fold for 1 µM CGP 12177 and 1 µM propranolol, respectively) and abolished in β1-adrenoceptors containing TM4 mutations vital for the second conformation pharmacology. This study suggests that negative cooperativity across a β1-adrenoceptor homodimer may be responsible for generating the low-affinity pharmacology of the secondary β1-adrenoceptor conformatio