Dairy intake-related intentions, attitudes, subjective norms and perceived behavioural control of South African nutrition professionals

Background: Intake of dairy-related nutrients of South Africans is low. Nutrition professionals may influence dietary behaviour. Their own disposition related to dairy is unknown, yet important in promoting the “have milk, maas or yoghurt every day” guideline.Aim: Guided by the Theory of Planned Behaviour (TPB), this study aimed to describe determinants of target behaviour of consumption of 2–3 servings of dairy daily among nutrition professionals.Methods: An electronic survey (Qualtrics Online Survey Software) of conveniently sampled Association for Dietetics in South Africa (ADSA) and Nutrition Society of South Africa (NSSA) members determined their dairy-related behaviour, intentions, attitudes, subjective norms and perceived behavioural control regarding dairy in general, and of milk, maas, yoghurt and cheese.Results: Three hundred and six (306) responses (aged 36.4 ± 10.5 years) were received. A third of nutrition professionals reported that their daily dairy intake was 2–3 servings 4–6 times per week, yet over 40% met the target once per week or less often. Intake differed across products. Intention to consume the target was high (5.2 ± 0.12; scale 1–7). Attitudinal evaluations revealed highest belief scores related to nutritional quality and bone health. Associations with cancer development, diabetes and the environment were believed to be least likely. Professional training and scientific evidence emerged as the strongest subjective norms. Nutrition professionals perceived themselves to be in control of the target behaviour, yet their clients significantly less so (p < 0.0001).Conclusion: Nutrition professionals’ attitudes, subjective norms and behavioural control can aid responsive empowerment to support dairy-related nutrition education of South Africans.Keywords: dairy intake, nutrition professionals, Theory of Planned Behaviou

Dairy intake-related intentions, attitudes, subjective norms and perceived behavioural control of South African nutrition professionals

BACKGROUND : Intake of dairy-related nutrients of South Africans is low. Nutrition professionals may influence dietary behaviour. Their own disposition related to dairy is unknown, yet important in promoting the “have milk, maas or yoghurt every day” guideline. Aim: Guided by the Theory of Planned Behaviour (TPB), this study aimed to describe determinants of target behaviour of consumption of 2–3 servings of dairy daily among nutrition professionals. METHODS : An electronic survey (Qualtrics Online Survey Software) of conveniently sampled Association for Dietetics in South Africa (ADSA) and Nutrition Society of South Africa (NSSA) members determined their dairy-related behaviour, intentions, attitudes, subjective norms and perceived behavioural control regarding dairy in general, and of milk, maas, yoghurt and cheese. RESULTS : Three hundred and six (306) responses (aged 36.4 ± 10.5 years) were received. A third of nutrition professionals reported that their daily dairy intake was 2–3 servings 4–6 times per week, yet over 40% met the target once per week or less often. Intake differed across products. Intention to consume the target was high (5.2 ± 0.12; scale 1–7). Attitudinal evaluations revealed highest belief scores related to nutritional quality and bone health. Associations with cancer development, diabetes and the environment were believed to be least likely. Professional training and scientific evidence emerged as the strongest subjective norms. Nutrition professionals perceived themselves to be in control of the target behaviour, yet their clients significantly less so (p < 0.0001). CONCLUSION : Nutrition professionals’ attitudes, subjective norms and behavioural control can aid responsive empowerment to support dairy-related nutrition education of South Africans.This study was funded by the Consumer Education Project (CEP) of Milk SA, but conducted and published independently.The Consumer Education Project (CEP) of Milk SAhttp://www.sajcn.co.za/index.php/SAJCNam2017Human Nutritio

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.The development of the “Dairy Diary” was supported by the CEP of Milk SA and study is partially funded by Nestle Nutrition Institute of Africa (NNIA).https://www.cambridge.org/core/journals/journal-of-dairy-researchhj2023Human Nutritio

Imagination Tool: Accessible AI Image Generation Software to Support Child Ideation and Creative Expression

Despite the rising popularity in image AI generation systems, key open questions remain as to both (1) how to design such systems for use by children, and (2) what roles generative AI may play in contexts in which media creation is not the end goal, but is rather used to support other human endeavours such as communication and ideation. We describe a new AI image generation tool, designed to support children engaging in creative ideation, expression, and visually communicating their ideas—in particular, their visions for the future. We describe key aspects of the system’s implementation, including ensuring the system produces child-safe and task-appropriate images, and mechanisms for supporting children in ideation. This work can thus inform researchers in computational creativity who aim to address safety and usability of systems for children

Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: interrupted time series analysis with economic evaluation

Objectives To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking. Design Interrupted time series analysis of routine data before and after introducing the intervention, within-study economic evaluation. Setting Eight acute NHS hospital trusts and 12 local authority areas in North East England. Participants 37 726 records of singleton delivery including 10 594 to mothers classified as smoking during pregnancy. Interventions A package of measures implemented in trusts and smoking cessation services, aimed at increasing the proportion of pregnant smokers quitting during pregnancy, comprising skills training for healthcare and smoking cessation staff; universal carbon monoxide monitoring with routine opt-out referral for smoking cessation support; provision of carbon monoxide monitors and supporting materials; and an explicit referral pathway and follow-up protocol. Main outcome measures Referrals to smoking cessation services; probability of quitting smoking during pregnancy; additional costs to health services; incremental cost per additional woman quitting. Results After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter. Conclusions The implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery

Bioavailability of iron from fortified maize using stable isotope techniques

Thesis (Ph.D. (Nutrition))--North-West University, Potchefstroom Campus, 2007Background: The high prevalence of iron deficiency and anaemia among South African children highlights the need for iron fortification, especially with a highly bioavailable iron compound. Fortification of staple foods is an adequate strategy to provide additional iron to populations at risk. In South Africa it is mandatory to fortify maize meal and wheat flour with iron, as well as other micronutrients. Elemental iron, specifically electrolytic iron, is currently the preferred choice but other compounds that might be more effective in alleviating iron deficiency are under consideration. Objectives: The objective of this study was to provide information about the bioavailability of ferrous fumarate and NaFeEDTA from maize meal porridge in young children, which would assist in selecting a bioavailable alternative to electrolytic iron in the South African National Food Fortification Programme, Methods: A randomized parallel study design was used, with each of the 2 groups further randomised to receive either one of two test regimens in a crossover design in which each child acted as his/her own control. Iron bioavailability was measured with a stable-isotope technique based on erythrocyte incorporation 15 days after intake. Results: The mean absorption of iron from NaFeEDTA and ferrous fumarate from the maize porridge meal was 11.5% and 9.29% respectively. NaFeEDTA and ferrous fumarate are both sufficiently bioavailable from a maize based meal rich in phytates. Conclusion: Both NaFeEDTA and ferrous fumarate would provide a physiologically important amount of iron should they replace electrolytic iron as fortificant in maize flour fortification. The final choice between ferrous fumarate and NaFeEDTA as when it comes to finding the alternative iron fortificant will depend on factors such as technical compatibility, bioavailability, relative cost and organoleptic characteristics.Doctora

Avocados: consumer beliefs and effect on weight loss and markers of cardiovascular health

Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2004.Motivation - The objective of the South African Avocado Growers Association (SAAGA) is to increase the demand of avocados by advertising, promoting and other means deemed fit by them. In order to promote and advertise a product, consumer research has to be done to determine the consumers' attitudes towards and beliefs concerning the product. These findings then need to be followed up by scientific studies, targeted at specific problems and target groups to yield scientific evidence. Little consumer research has been done on avocados and studies investigating the health effects of avocados are limited, with available literature only focusing on the cholesterol lowering effect of avocados. Objectives - Firstly, the objective is to investigate the beliefs and attitudes of the South African consumer towards avocados and health; to determine whether gender, age group, race or living standard influence the consumers beliefs towards avocados. Secondly, the objective is to dispel the myth that avocados are fattening and should therefore be avoided in energy restricted diets; to examine the effects of avocados, a rich source of monounsaturated fatty acids, as part of an energy restricted diet on weight loss, serum lipids, fibrinogen and vascular function in overweight and obese subjects. Methods - Consumer study: One thousand nine hundred and ninety-seven South African individuals, randomly selected from metropolitan areas in South Africa, participated in this survey. Data were weighed to reflect the adult metropolitan population based on gender, age and race distribution. The total population (10 695 000) was representative of both genders (5 423 000 men and 5 272 000 women) and major race groups (2 615 000 whites, 6 252 000 blacks, 1 255 000 coloureds and 573 000 Indians) from different age groups and living standards. The questionnaires were designed by a multidisciplinary team and consisted of seventeen food related questionnaires, of which one questioned the beliefs regarding avocados. Trained field workers administrated questionnaires by conducting face-to-face interviews with consumers. The market research company, MARKINOR, was contracted to collect the data. Quantitative data was statistically analysed in order to generate the relevant descriptive statistics, cross tabulations and statistical tests. Dietary intervention study: Sixty one free-living volunteers (13 men; 48 women), with a mean (standard deviation) body mass index (BMI) of 32 (3.9) kg/m2, participated in this randomised, controlled parallel study. The subjects were paired according to gender, BMI and age and randomly assigned to one of two groups. The experimental group consumed 200 g of avocado (1 avocado) per day, substituting 30 g of other mixed dietary fats, and the control group excluded avocado from their energy restricted diet for six weeks. Seven-day isoenergetic menu plans were given according to mean energy requirements of both genders to provide 30% fat, 55% carbohydrates and 15% protein of total energy intake. Anthropometric measurements, physical activity, dietary intakes, blood pressure and arterial compliance were measured with standard methods at the beginning and end of the intervention. Fasting blood samples were drawn at the beginning and end of the intervention period. Results - Consumer study: There were no practical significant differences in the consumers responses in terms of gender or age. Practical significant differences were found between different race and LSM (Living Standard Measure) groups for some variables. The overall response of consumers towards the effect of avocados on health, heart health, children's health and the health effects associated with the fat content of avocados were very positive. However, almost half the consumers are still not convinced of or are uncertain as to the cholesterol content of avocados, while 47% of the consumers still believe that avocados are fattening. More than 80% of the consumers agreed that avocados are a good source of vitamins and minerals, and 76% consider avocados to be a good source of fibre. Almost 70% of the consumers agreed that avocados are good for sportsmen and -women. Avocados were seen by 49% of the consumers to be an aphrodisiac. Dietary intervention study: Fifty-five subjects completed the study. Compliance with avocado intake in the experimental group was 94.6%. Anthropometric measurements (weight, body mass index and percentage body fat) decreased significantly in both groups during the study (p<0.001), and the change was similar in both groups. Serum lipid levels (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides), fibrinogen, blood pressure and arterial compliance did not change significantly within or between the two groups. Conclusions - Consumer study: There are still a few myths and misconceptions that exist among some consumers regarding avocados, especially with regard to sexual functioning, cholesterol content, and fattening effect of avocados. The agricultural industry can use these results to plan different marketing campaigns focused on certain target groups to change the misperceptions concerning avocados and convey the positive nutritional value of avocados. Dietary intervention study: The consumption of 200 g avocado per day, within an energy restricted diet, does not compromise weight loss when substituted for 30 g of mixed dietary fat. The serum lipid levels, plasma fibrinogen, arterial compliance, as well as systolic and diastolic blood pressure were not affected by weight loss or avocado intake.Master

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.https://www.elsevier.com/locate/afjempm2021Human NutritionNursing Scienc

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

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

BAKGROUND : 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.https://www.elsevier.com/locate/ijotn2020-12-09hj2020Nursing Scienc