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Background. University-based research capacity development (RCD) mechanisms tend to focus on staff and postgraduate students, with few structures targeted at undergraduate students. Support for undergraduate research must be tailored to the unique requirements of research at this level, while maintaining links with relevant structures in both the RCD and teaching and learning domains. Objective. To conduct a process evaluation of the Undergraduate Research Office (URO) in the Faculty of Medicine and Health Sciences at Stellenbosch University, South Africa, using RCD and characteristics of excellence in undergraduate research criteria as benchmarks. Methods. A process evaluation of URO's first 6 years was conducted using a logic model of URO's inputs, activities, and outputs. Through a retrospective document review, a descriptive analysis of URO's inputs and activities (narrative) and URO's outputs (statistical) was conducted. Results. Following a description of inputs and activities, results present URO's outputs as a measure of the uptake of these activities. From 2015 to 2020, 259 undergraduate research projects were completed. Research consultations, workshops and undergraduate presentations at the faculty's Annual Academic Day have more than doubled since URO's inception. The Undergraduate Research Ethics Committee has reviewed 243 ethics applications since 2015, with a 1 - 2-week turnaround time. A total of 134 funding applications worth ZAR705 986 have been awarded for research project, conference presentation and publication costs. Conclusion. Results show the potential impact of a formal undergraduate research support entity on the undergraduate research outputs of a Faculty of Medicine and Health Sciences. This article highlights elements for success for formal undergraduate research support, and identifies gaps going forward. [ABSTRACT FROM AUTHOR]

Indigenous leafy vegetables (ILVs) are an underutilized source of minerals and vitamins in sub-South Africa. However, they could play a huge role in addressing household food insecurity and malnutrition. Corchorus is a highly nutritious but underutilized ILV, which is consumed by some rural communities in Africa. This study was thus undertaken to evaluate the nutritional composition and determine the genetic parameters of mineral nutrient traits of 11 Corchorus accessions for potential use in future crop improvement programme. The Corchorus genotypes were grown in a field experiment in a randomized complete block design with three replications over two growing seasons at the Agricultural Research Council, in Roodeplaat, South Africa. Fresh leaves were collected just before flowering, washed in de-ionised water and air-dried before analysis. The mineral nutrients phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg), iron (Fe), zinc (Zn), boron (B), copper (Cu) and manganese (Mn) were analyzed using an atomic absorption spectrophotometer. Data were subjected to ANOVA, principal component analysis and cluster analysis. Genetic parameters were determined for all the traits. The analysis of variance indicated the significant (P<0.05) variation in mineral nutrient content among the accessions. The study also revealed the presence of two singletons (AV006 and SA002), as well as the presence of additive genes for several mineral nutrients. The variation among the accessions was deemed sufficient enough to allow for use of the accessions in a breeding programme [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of overweight and obesity, as well as socio-demographic risk factors associated with childhood overweight and obesity in the Stellenbosch area, Western Cape province. Design: A cross-sectional, comparison study was conducted. Setting and subjects: A representative group of 638 children (aged 6-13 years) attending three randomly selected Stellenbosch primary schools. An additional school was selected for the pilot study. In the screening (first) phase, children were weighed and measured to calculate body mass index using international obesity task force guidelines to determine the prevalence of overweight and obesity. For the comparison (second) phase of the study, only 24 overweight and obese children and 21 children of normal weight (comparison group) (n = 45) were included. Outcome measures: Socio-demographic and eating behaviour data were collected using a structured questionnaire and compared between the overweight and obese group and the comparison group (normal weight) to identify associated risk factors. Results: The prevalence of overweight and obesity was 13%, of which 9% (n = 57) were overweight and 4% (n = 27) obese in the screening phase. In the comparison phase, socio-economic factors, such as maternal employment hours (p-value = 0.0462); family characteristics, such as the number of children in the household (p-value = 0.0231); and time spent participating in sport (p-value = 0.0450); were significantly associated with overweight or obesity. Conclusion: Preventative initiatives should proactively promote healthy eating behaviour and physical activity in children at an early age, based on previous research, particularly in girls. Involving families and schools in these initiatives is recommended, as well as a national childhood obesity monitoring system to identify children at risk, and tracking childhood obesity trends to guide evidence-based interventions to tackle this growing public health issue. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the overall level of job satisfaction among South African registered dietitians and possible relationships between the influencing factors. Design: The design was a cross-sectional descriptive study. Setting and subjects: A national survey was carried out among all dietitians registered with the Health Professions Council of South Africa, excluding community service dietitians. Outcome measures: A two-part, self-administered, adapted job satisfaction survey questionnaire was used. Demographic data were collected. The questionnaire covered nine themes pertaining to job satisfaction: salary, promotion, knowledge and skills, professional colleagues, being a member of the multidisciplinary team, communication, the work environment, rewards of the job and nature of the work. Results: A final response rate of 22.5% (n = 340) was obtained. South African registered dietitians were only slightly satisfied (65.7%) with their current employment. There was no significant difference (p-value = 0.291) pertaining to overall job satisfaction between those working and living overseas and those working and living in South Africa. Primarily, lower levels of satisfaction were observed to be due to poor salaries, lack of promotion opportunities and a poor perception of professional image. Significant positive correlations were found between age (p-value = 0.036), professional experience (p-value = 0.035), area of expertise (p-value = 0.001), hours of work (p-value = 0.021) and location of work (p-value = 0.00001). Conclusion: Although overall job satisfaction scores indicated that South African registered dietitians are only slightly satisfied with their employment, registered dietitians reported that they love the nature of the work and what they do, tending towards confirmation of career satisfaction. Recommendations include re-evaluation of registered dietitian salary scales, career pathing with promotion opportunities, boosting the professional image and expanding the teaching of nondietetic skills to dietetic undergraduates. [ABSTRACT FROM AUTHOR]

Several nutrition intervention programmes have been implemented to alleviate malnutrition among young children in South Africa. However, both nationwide studies and smaller, region-based reports show that many of these programmes have failed to improve nutritional health among the target groups. This is an overview of the most important nutrition intervention programmes implemented in post-apartheid South Africa. It is based on data sampled between 1994 and 2010, and collected from HighWire Press and MEDLINE data bases, local journals, official reports as well as experience gathered over the past two decades. Abstracts and nutrition issues related to chronic and communicable and non-communicable diseases were not included. The main aim of the implemented supplementation programmes after the Second World War was to correct states of undernutrition. However, these efforts did not benefit the disadvantaged groups, particularly the coloureds and the blacks. Following the downfall of the apartheid regime, various nutrition intervention programmes have been implemented with varying degrees of success. These include health facility-based programmes, community-based programmes as well as nutrition promotion strategies. The more holistic approach of the Integrated Nutrition Programme since 1994 is commendable, but programmes have failed to restore adequate growth rates among the impoverished children. Most likely, the failures are not as a result of inappropriate policies and strategies or lack of knowledge about relevant solutions, but rather inadequate implementation and scale of the programmes. In order to ensure a satisfactory improvement in nutritional health in South Africa, the various programmes should undergo regular evaluations to identify pitfalls and shortcomings. The fight against undernutrition and hunger, which are rooted in poverty and social inequalities, remains a major challenge for the South African health authorities. Urgent scale-up of the current nutrition intervention programmes as well as evaluation of their implementation are needed, coupled with strategies for education, skills development, job creation and poverty alleviation. [ABSTRACT FROM AUTHOR]

The Baby-Friendly Hospital Initiative (BFHI) is a global effort to improve the role of maternity services and to enable mothers to breastfeed their infants, thus ensuring the best start in life for their infants. The foundation for the BFHI is the Ten Steps to Successful Breastfeeding (BF). It has been shown, however, that the selective implementation of only some of the steps may be ineffective and discouraging to successful BF practices. An initial study was therefore conducted to assess the extent of the implementation of the Ten Steps in both public and private maternity facilities. Poor performance for some steps led to a follow-up study to investigate the knowledge and attitudes of health care workers (HCWs) and mothers alike and to evaluate the exclusive BF (EBF) practices of mothers attending private BF clinics. Both studies followed descriptive, cross-sectional designs and were set in the Cape Metropole in the Western Cape. Twenty-six maternity facilities participated in the initial study, for which observation lists were completed and verified by interviewer-administered questionnaires to both HCWs and mothers. Eighteen private BF clinics participated in the follow-up study, which included observations and interviewer-administered questionnaires to 25 HCWs and 64 mothers. During the initial study, lower mean scores were noted for Steps 1, 2, 6 and 10. The overall implementation of the Ten Steps was average. The findings highlighted the importance of the establishment and implementation of BF policies, of appropriate and continuous BF training and better referral systems to ensure initiation and establishment of early BF, EBF practices and support on an ongoing basis to ensure the best start in life for infants. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively evaluate the South African Continuing Professional Development (CPD) system (previous and current) for dietitians, by determining their perceptions of the system's implementation and participation in CPD activities. Design: An observational descriptive study in the quantitative and qualitative research domains. Methods: A national survey of 1 589 dietitians was conducted using a self-administered questionnaire, followed by 3 focus group discussions (FGD) with 19 Pretoria-based dietitians. In-depth interviews were also conducted with 6 CPD/Health Professions Council of South Africa (HPCSA) administrative personnel. Results: Twenty per cent of dietitians responded to the survey. The CPD administration fee was unreasonable to 54.5% (N = 156) of dietitians and most FGD participants. CPD activities were expensive to 55% (N=164) of respondents while 29% (N = 88) of respondents, in agreement with the FGD participants, acknowledged the availability of variably priced activities. Statistically significant cost differences were determined across practice areas, qualifications and provinces. Lectures and seminars were activities most commonly participated in, followed by conferences and articles with multiple choice questions (MCQs) from peer reviewed literature. However, conferences ranked highest as the most preferred activity. Barriers to CPD activities included costs, geographical access, obtaining leave from work, family obligations and internet access. More dietitians were satisfied with the service quality at the CPD office and the Association for Dietetics in South Africa (ADSA) than with that provided by the HPCSA, but requested simpler correspondence from all these offices. In the current system, dietitians need to keep their own CPD records, but 51.7% (N = 161) preferred not to do so. Conclusions: Addressing factors affecting CPD participation will contribute to the acceptability of the system by dietitians. [ABSTRACT FROM AUTHOR]

Aim: To determine the comprehensibility of the preliminary paediatric food-based dietary guidelines (PFBDG) for infants younger than 6 months in South Africa. Methods: This qualitative study used focus group discussions held in the Western Cape to evaluate the comprehensibility and the understandability of the preliminary PFBDG. Groups were convened according to area of residence (rural, urban formal and urban informal) and ethnicity (white, coloured and black) to reflect the Western Cape population. Focus group discussions were conducted in the participant's home language, namely Afrikaans, English or Xhosa. The purposive sample included 89 women with infants younger than 6 months divided in 20 groups. Results: In general, mothers understood the guidelines and could reportedly implement them, but constraints such as having to go back to work, being tired and not having enough breast-milk were volunteered. There were very few problems regarding the PFBDG terminology except with the word 'regularly' in the context of the oral hygiene guideline. With regard to the breast-feeding guideline there was some confusion over whether other foods could be included while breast-feeding. Suggestions were made to include 'only' in the breast-feeding guideline. Some of the participants did not know anything about cleaning the infant's mouth, and suggested it be changed to the overall hygiene of the infant. Conclusion: The findings from this study indicate that it may be possible to use one set of dietary guidelines for infants younger than 6 months for all ethnic groups living in the Western Cape, provided that these guidelines are accompanied by supportive documentation citing examples and reasons for the implementation of the guidelines. Recommendations were made for the PFBDG Work Group to revise the preliminary PFBDG for infants younger than 6 months for implementation and further action. [ABSTRACT FROM AUTHOR]

The mental health of an increasing ageing population is an important part of healthcare. Research has explored means to enrich the lives of older adults living in residential settings, including approaches like the Eden Alternative. This is a cross-sectional, qualitative study with a quantitative component. It looks at common mental health conditions (CMHCs) in residential-living older adults in South Africa and describes their experiences of intergenerational interactions with playschool children. Participants completed a questionnaire which included the Geriatric Depression Scale and Geriatric Anxiety Scale and a semi-structured interview. Anxiety and depression were common in the sample with limited awareness of non-pharmacological therapy available at the facility. The intergenerational interactions were experienced positively with emerging themes of belonging, sense of purpose, reminiscence and positive affective experiences, but influenced by participants' preconceptions of children. The study concludes that intergenerational interactions may serve as adjunctive therapy in managing CMHCs in residential-living older adults. Recommendations are made for successful implementation of such programs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Earl, Marais. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Very little has been researched about the efficacy, effectiveness, feasibility, sustainability and impact of food-based approaches on the diets and nutritional status of populations at risk of hunger and food insecurity. This study contributes knowledge about the impact of food-based approaches on the diets of populations at risk of hunger and food insecurity in four of the poorest rural communities in South Africa. The study investigated the consumption and production patterns of rural households (278 in summer and 280 in winter) in four sites in the poorest municipalities in South Africa., Methods: A multistage stratified random sampling technique was applied to identify the communities and sample households for the quantitative survey and qualitative assessments. Qualitative and quantitative data were collected between 2013 and 2015 through focus group discussions (FGDs), key informant interviews and the two-round panel survey to cover both the summer and winter seasons at each site., Results: Home gardening led to a significant positive increase in the consumption of white roots and tubers, dark green leafy vegetables, orange-coloured fruit and other fruit in the 24 h prior to the survey. Participation in a community garden led to significant increases in the consumption of dark green leafy vegetables and other vegetables. School gardening did not demonstrate any statistical relationships with the consumption of foods from the crop-related food groups. Crop production improved dietary diversity. Selling produce and irrigation showed a stronger improvement in dietary diversity. Seasonality affected the availability of fresh fruit and vegetables for home consumption in winter., Conclusions: Producing beyond that solely for home consumption has greater benefits for dietary diversity and a consumption-smoothing effect during the post-harvest period. Politicians and the scientific community should recognise the role that household and small-scale crop production plays in supporting household consumption and the provision of essential micronutrients despite constraints and disincentives. Production and education programmes should focus on strengthening existing good consumption patterns and promoting the consumption of foods that can improve dietary diversity.

Background: One genetic cause of markedly low plasma concentrations of apolipoprotein (apo) B and low density lipoprotein (LDL)-cholesterol is familial hypobetalipoproteinemia., Objective: We aimed to determine the molecular basis for the marked hypocholesterolemia consistent with heterozygous familial hypobetalipoproteinemia in a black female subject of Xhosa lineage., Methods: Coding regions of APOB, MTTP, PCSK9,ANGPTL3, SAR1B and APOC3 were sequenced, and APOE was genotyped. COS-7 cells were transfected with plasmids containing apoB variants. Western blotting was used to detect cellular and secreted apoB, and co-immunoprecipitation performed to assess binding with the microsomal triglyceride transfer protein (MTP)., Results: Sequence analysis of the APOB gene revealed her to be heterozygous for two novel variants, c.751G>A (A224T) and c.2854G>C (V925L). She was also homozygous for the APOEε2 allele, and did not carry a PCSK9 loss-of-function mutation. Although Ala(224) is within the postulated MTP binding region in apoB, it is not conserved among mammalian species. Subsequent genotyping showed that Ala224Thr is found in a southern African population (n=654) with an allele frequency of 1.15% and is not associated with plasma lipid levels. Val(925), like Ala(224), is within the N-terminal 1000 amino acids required for lipoprotein assembly, but was not found in the population screen. However, in vitro studies showed that apoB V925L did not affect apoB48 production or secretion nor have a deleterious effect on MTP interaction with apoB., Conclusion: Taken together, this suggests that the hypocholesterolemia in our case may be a result of being homozygous for APOEε2 with a low baseline cholesterol., (Copyright © 2016 National Lipid Association. All rights reserved.)

Background: Patients with Addison's disease (AD) in Scandinavia have an increased risk for premature death due to cardiovascular disease (CVD). Serum lipids are important risk factors for CVD and vascular mortality. Replacement doses of hydrocortisone have historically been higher in Sweden than South Africa. The primary aim was to study the lipid profiles in a large group of patients with AD with the hypothesis that the lipid profile in patients in Sweden would be worse than in South Africa., Methods: In a cross-sectional study, 110 patients with AD (55 from South Africa, 55 from Sweden) matched for age, gender, ethnicity and BMI were studied. Anthropometric measures, blood pressure, lipids, highly sensitive C-reactive protein (hs-CRP) and adiponectin were studied., Results: All patients were Caucasian and the majority were women N = 36 (65.5%). Mean (standard deviation; SD) ages of the Swedish and South African patients were 52.9 (13.0) and 52.6 (14.4) years and BMI 25.3 (3.2) and 25.8 (4.1) kg/m2, respectively. The mean total daily hydrocortisone dose was greater in the Swedish patients than the South African patients, [33.0 (8.1) versus 24.3 (8.0) mg; p<0.0001]. South African patients had higher median (interquartilerange; IQR) triglycerides (TG) [1.59 (1.1-2.46) versus 0.96 (0.74-1.6) mmol/l; p<0.001], total cholesterol (TC) [6.02(1.50) versus 5.13 (0.87) mmol/l; p<0.001], LDL-C [4.43 (1.44) versus 2.75 (0.80) mmol/l; p<0.001] and median hs-CRP [2.15 (0.93-5.45) versus 0.99 (0.57-2.10) mg/L; p<0.003] and lower HDL-C [0.80 (0.40) versus 1.86 (0.46) mmol/l; p<0.001] than the Swedish patients. Approximately 20% of the patients in both cohorts had hypertension and diabetes mellitus., Conclusions: South African patients with AD have worse lipid profiles and higher hs-CRP compared to their matched Swedish patients, despite lower doses of hydrocortisone. It is uncertain at this time whether these are due to genetic or environmental factors.

Background: A randomised, double-blind, placebo-controlled trial found the vaginal microbicide Carraguard unable to prevent HIV infection. A substudy assessed the association of genital high-risk human papillomavirus (HR-HPV) in women at study end with Carraguard use., Methods: Participants received Carraguard gel or placebo plus condoms, and were instructed to use gel plus condoms during each act of vaginal intercourse. HR-HPV detection on cervical samples from 1,723 women was by Digene Hybrid Capture 2 analysis. Poisson regression analysis assessed the prevalence of genital HR-HPV for individuals receiving Carraguard relative to individuals receiving placebo., Results: In the Carraguard arm (n=875) the end trial unadjusted HR-HPV prevalence was 23.5% (95% CI 20.8-26.3) and 23.0% (95% CI 20.2-25.8) in placebo arm (n=843). Significant risk factors for HR-HPV infection were younger age, being single, an abnormal pap smear, multiple sexual partners and promiscuous behaviour without the use of a condom. There were 348 compliant women (174 Carraguard, 174 placebo users), with relatively high adherence to gel use, who inserted 80% of their opened, returned applicators of test product with the proportion of applicator insertions to sex acts >30%. After adjusting for risk factors, these compliant Carraguard users were 0.62 as likely to be classified HR-HPV positive (95% CI 0.41-0.94) as compliant placebo users., Conclusions: The prevalence of HR-HPV infection was lower in compliant Carraguard users than compliant placebo users. To our knowledge, this is the first report showing a negative association of HPV infection with a vaginal microbicide.

Objective: The aim of this qualitative study was to test the comprehensibility of the preliminary food-based dietary guidelines (FBDG) for healthy South African children aged 1-7 years. Objectives included assessing exposure to FBDG, comprehension of the proposed paediatric FBDG (PFBDG) and whether the guidelines can be used in meal planning., Design: Focus group discussions were used to collect data. Discussions were facilitated by the investigator in either English or Afrikaans, according to a predetermined discussion schedule. Focus groups were formed on the basis of language and socio-economic status (SES)., Setting: Areas within the City of Cape Town representing lower, middle and upper SES groups., Subjects: A total of seventy-six English- and Afrikaans-speaking mothers were contacted via randomly selected consenting preschool groups to participate voluntarily., Results: Most mothers reported that they do not use guidelines. They had a good grasp of the concepts of and need for PFBDG. They suggested slight alterations to wording/phrasing of the guidelines. The most problematic guidelines were those regarding starch, milk and sweet treats/drinks. No substantial differences were found between English and Afrikaans data. Differences were found between SES groups, with the upper SES groups comprehending the guidelines better., Conclusion: The proposed PFBDG were well received. The target population that would benefit the most from these guidelines would be the less educated, lower SES groups. The present study shows that once the guidelines have been modified, they may be used as a comprehensive guide for nutritional education.

In 1996, a Food and Agricultural Organization/World Health Organization expert panel proposed the development of food-based dietary guidelines (FBDGs) that would be unique and specific to the needs of the populations of different countries. In 1997, a South African FBDG Working Group was initiated to develop a single set of FBDGs aimed at optimal nutrition for all South Africans older than 5 years. Thereafter, additional working groups investigated the development of FBDGs for specific priority groups including HIV/AIDS sufferers, the elderly, pregnant and lactating women and children under 5 years. This resulted in the formation of an expert paediatric FBDG Working Group in 2000, in Cape Town with the task to develop paediatric FBDGs (PFBDGs) for children younger than 5 years. However, it was decided to raise the 5-year-age limit to 7 years, which corresponds to one of the recommended dietary allowance (RDA) cut-offs for both genders and that would cover most pre-schoolers. Ultimately, three age subcategories were identified for developing specific PFBDGs, i.e. 0-6 months, 6-12 months and 12-84 months. In May 2003, after thorough review of the relevant literature, discussions with various stakeholders and pre-testing for comprehensibility, a set of preliminary PFBDGs for each of the subcategories was approved by the Working Group to be subjected to consumer testing. The proposed guidelines were considered to be the most appropriate ones for each age group, based on scientific and local evidence, and were evaluated utilizing qualitative methodologies. The results of these data are presented and discussed below. However, further testing is required for the diverse groups in the country.

Despite various national nutrition and primary healthcare programmes being initiated in South Africa over the last decade, child health has deteriorated. This is seen by the rise in infant and child mortality rates, the high prevalence of preventable childhood diseases, e.g. diarrhoea and lower respiratory tract infections, and the coexistence of under-nutrition along with HIV/AIDS. Poor dietary intake, food insecurity and poor quality of basic services prevail within this precarious causal web. The national Integrated Nutrition Programme is a comprehensive nutrition strategy that focuses on children below 6 years old, at-risk pregnant and lactating women, and those affected by communicable and non-communicable diseases. Focus areas relevant to pre-school children include disease-specific nutrition treatment, support and counselling; growth monitoring and promotion (GMP); micronutrient malnutrition control; breastfeeding promotion, protection and support; contributions to household food security; nutrition interventions among HIV-infected children; and nutrition promotion, education and advocacy. Progress towards this includes the Baby-Friendly Hospital Initiative; mandatory fortification of maize meal and wheat flour with multiple micronutrients; vitamin A supplementation coverage and mandatory iodization of salt by legislation; the provision of free road-to-health charts for GMP; and the National School Nutrition Programme. Since 2003, the basis of the nutrition education strategy has been the locally developed food-based dietary guidelines (FBDGs), directed at adults and school-going children. This review sketches the backdrop to and motivation for the introduction of specifically targeted paediatric FBDGs, for mothers and caregivers of children from birth to age 7 years, as a national initiative.

Objective: This study aimed to assess mother's/caregiver's understanding, practical application and cultural acceptability of a preliminary set of South African food-based dietary guidelines (FBDGs) for children aged 6-12 months living in the Little Karoo area of the Western Cape Province., Design: An observational, descriptive and cross-sectional study design was followed. Focus group interviews, recorded on videotape, were analysed for qualitative data. Quantitative questionnaires measured knowledge and comprehension of guidelines, perceived constraints to compliance with and importance of guidelines as well as socio demographic data prior to the focus group interviews., Setting: Afrikaans-, English- and Xhosa-speaking communities of the Little Karoo area of the Western Cape Province of South Africa, including the urban areas of Oudtshoorn, Bongulethu, Bridgton, Toekomsrus and the adjacent rural areas of Dysselsdorp, Calitzdorp, Uniondale, Ladismith and Zoar., Subjects: Sixty-four mothers or caregivers to infants 6-12 months of age were included in the sample., Results: Information obtained through the questionnaires supported what was said during discussions. Although perceived as important by the majority of respondents, some of the guidelines were not well understood without prior explanation. Such guidelines were those pertaining to meal frequency and cup feeding, while application of the guideline to prolonged breast-feeding seemed the most problematic., Conclusions: The FBDGs for this age group will have to be supported by extensive and appropriate educational material to be effective when introduced to the public. The fact that the applicability of the guideline to prolonged breast-feeding seemed to be the most problematic is a cause for concern.

This study investigated the effectiveness of a nonoxynol-9 (52.5mg, 3.5%), vaginal gel (Advantage S), in the prevention of human papillomavirus (HPV) infection in female sex workers. We showed by HPV DNA determination in cervico-vaginal rinses a significant increase in multiple (>1) HPV infection in HIV-1 seropositive women compared with HIV-1 seronegative women (OR 4.0, 95% CI 1.3-11.9). We also demonstrated a significant increase in multiple HPV infections in HIV-1 seronegative women using nonoxynol-9 compared with HIV-1 seronegative women using placebo (OR 3.5 95% CI 1.0-11.8). We conclude that the use of nonoxynol-9 did not prevent genital HPV infection and could increase the virus' ability to infect or persist.

WebCT, a web-based virtual learning environment (VLE) and Interactive TV (ITV) are relatively new technologies that are used to deliver distance education at the Faculty of Health Sciences, Stellenbosch University. This study explores how effective current approaches to instructional design and interaction have been in utilizing these two technologies to support interaction and what lessons can be learnt. Five focus-group interviews were held with students and lecturers to assess the perceived quality of student-lecturer/student-student interactions. All students were invited to complete a questionnaire at the end of every module to assess their perceptions of interaction. Interaction was highly valued by students and lecturers participating in distance-learning programmes utilizing either VLE or ITV. Students rated courses using both technologies as moderately interactive. Significant differences between VLE and ITV were detected in student-lecturer and student-student interactions, use of additional modes of communication, instructional design, technological interactivity and social rapport activities. The groups did not differ across a number of likely barriers to interaction and both also reported the need for more flexible and better paced instructional designs.

Introduction: This study focuses on the quality of interaction in interactive TV (ITV), WebCT bulletin boards (BBs) and chat rooms (CRs) and addresses the question of how effectively new collaborative electronic technologies have been married with new pedagogical ideas to create effective learning for distance education students., Methods: Fifteen (out of 68) BB, 14 (out of 32) CR and 13 (out of 25) ITV conversations were randomly selected for coding using a modified exchange structure analysis. The roles that students and lecturers took in the conversations were determined from this., Results: The percentage of turns made by lecturers as opposed to students was 51% in CRs, 14% in BBs and 68% in ITV. The percentage of turns spent on actual coursework was 73% in CRs, 89% in BBs and 82% in ITV. Comparisons between tutors' and students' roles within as well as between ITV, BBs and CRs were all statistically significant with P < 0.05. In CRs the main roles of both students and lecturers were those of elaborators, inquirers and explainers. In BBs the main roles of students and lecturers were those of explainers and evaluators. In ITV sessions students' main roles were those of elaborators and explainers, whereas lecturers' main roles were those of lecturers, elaborators, inquirers and evaluators., Conclusion: In terms of creating a constructivist and active learning community that can operate within a distance learning paradigm, WebCT appears superior to ITV.

Objective: To determine the relationship between R563Q, a mutation of the renal epithelial sodium channel, and hypertension., Methods: Hypertensive patients with low renin and aldosterone, hypokalemia or resistant hypertension were selected for DNA analysis. Genomic DNA encoding the C-terminal domain of the epithelial sodium channel beta subunit from hypertensives and controls was amplified by polymerase chain reaction and screened for the R563Q mutation by digestion with Sfc1 restriction enzyme, or sequenced., Results: A previously undescribed mutation, R563Q, of the beta epithelial sodium channel was found in 10 of 139 black hypertensives, but was not present in any of 103 black normotensives, a significant (P = 0.0058) difference in frequency. The frequency of the mutation in the subgroup of black low-renin, low-aldosterone hypertensives (four of 14) was significantly (P = 0.0001) greater than in normotensives, and was also greater (P = 0.041) than in normal-high renin hypertensives, suggesting that R563Q is an activating mutation of the epithelial sodium channel. R563Q was also found in seven out of 250 mixed ancestry hypertensives, and was significantly (P = 0.017) associated with low-renin, low-aldosterone hypertension in this population group. The mutation was found in one of 100 mixed ancestry normotensives but not in any of 136 white hypertensives. Of the 18 R563Q patients, 11 had severe hypertension, leading to renal failure in two cases, while only two had hypokalaemia., Conclusions: R563Q, a new variant of the beta epithelial sodium channel, is associated with low-renin, low-aldosterone hypertension, in South African black and mixed-ancestry patients. Only a minority of individuals with the R563Q allelle fully express the Liddle's syndrome phenotype.

Objective: We assessed the prevalence of eating disorder symptoms in Black South African men and also explored their possible links with acculturation., Method: The Eating Disorders Inventory (EDI) and the South African Acculturation Scale (SAAS) were administered to a sample of undergraduate students consisting of 50 Black women, 50 Black men and 50 White men., Results: The Black men had significantly higher scores than the White men on the psychological subscales of the EDI and higher than cut-off scores on perfectionism, interpersonal distrust and maturity fears subscales. There were marginal racial differences in the average acculturation scores, whereas gender appeared to have a variable effect on acculturation attitudes. Specific acculturation strategies were found to be differentially associated with the EDI subscales. The association between acculturation and eating disorder symptoms in Black men was significantly higher than that in White men., Discussion: Our results indicate that there is a higher prevalence of eating disorder pathology in Black men than in White men. This lends support to the possible association between acculturation and eating disorders, and challenges the assumption that non-Western individuals--and Black men in particular--are protected from body image disturbances and disordered eating patterns.

Human papillomavirus (HPV) associated cancers are more prevalent in developing countries compared to developed countries. The major cancer caused by HPV is cervical cancer. The humoral immune response to HPV can be a marker of past infection but may also reflect persistent infection and cervical disease. IgA antibodies to HPV in oral fluid were also found to be markers of cervical disease. Cell mediated immunity is important in clearing HPV infection and for regression of the associated lesions: this means that women infected with HIV have a high prevalence of co-infection with HPV. Good cervical screening programmes can control HPV associated cervical neoplasia. However, in countries such as South Africa, where these programmes are inadequate, there is a need for an HPV vaccine. The development of HPV vaccines is reviewed. There is a call for an inexpensive vaccine that will be accessible to the women that do not have access to adequate screening programmes and are therefore at the greatest risk of cervical cancer.

Virus-like particles (VLPs) of the high-risk human papillomavirus (HPV) types 16, 18, 31, 33, and 45 were used as antigen in enzyme-linked immunosorbent assay (ELISA) to determine the prevalence of serum IgG in a group of San people originally from Namibia, now residing in South Africa. The San children had low seroprevalence to all VLP types, but 26/115 (22.6%) of the children were seropositive to at least 1 VLP type. Among the adults, seroprevalence was significantly higher. The seroprevalence of antibodies in 101 San women to VLP-16 was 16.8%, VLP-18 18.8%, VLP-31 12.9%, VLP-33 17.8%, and VLP-45 22.8%. Five of the 11 men were seropositive: 2 for VLP-31, 1 for VLP-18, 1 for VLP-33, and 1 for VLP-45. Seroreactivity appeared to be type specific, except possibly to VLP-18 and -45. Of the adults, 50.5% were seropositive to at least 1 VLP type and 24.8% were seropositive to >1 VLP type. From this study, it is concluded that the San people are exposed to HPV-16, -18, -31, -33, and -45, with antibodies to VLP-45 being the most prevalent., (Copyright 2000 Wiley-Liss, Inc.)

Simvastatin, an inhibitor of HMG CoA reductase, lowers the plasma total cholesterol and LDL-cholesterol concentration in familial hypercholesterolemic patients. The efficacy of the drug shows considerable inter-individual variation, however. In this study we have assessed the influence of certain LDL-receptor gene mutations on this variation. A group of 20 male and female heterozygotic familial hypercholesterolemic patients, all Afrikaners and each bearing one of two different LDL receptor gene mutations, FH Afrikaner-1 (FH1) and FH Afrikaner-2 (FH2), was treated with simvastatin (40 mg once daily) for 18 months. The average reduction in total plasma cholesterol was 35.3% in the case of the FH2 men but only 23.2% in that of the FH1 men (P = 0.005); the reduction in LDL cholesterol concentrations was also greater in the FH2 group (39% as opposed to 27.1%, P = 0.02). The better response of the FH2 group was also evident when men and women were considered together. Female FH1 patients responded better to simvastatin treatment, however, than did males with the same gene defect. Mutations at the LDL-receptor locus may thus play a significant role in the variable efficacy of the drug. The particular mutations in the males of this group may have contributed up to 35% of the variance in total cholesterol response and 29% of the variance in LDL-cholesterol response to simvastatin treatment.