119 results on '"Ware, Lisa J"'
Search Results
102. The paradox of improved antiretroviral therapy in HIV: potential for nutritional modulation?
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Ware, Lisa J., primary and Wootton, S. A., additional
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- 2002
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103. Monitoring physical activity after a cardiovascular event: What is 'fit' for purpose?
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Ware, Lisa J, Rennie, Kirsten L, and Schutte, Aletta E
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- 2018
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104. Urinary sodium-to-potassium ratio: it may be SMART, but is it easy?
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Ware, Lisa J, Swanepoel, Bianca, and Schutte, Aletta E
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HYPERTENSION , *RANDOMIZED controlled trials , *SYSTEMATIC reviews , *BLOOD pressure , *COMPARATIVE studies , *SODIUM content of food , *RESEARCH methodology , *MEDICAL cooperation , *POTASSIUM , *RESEARCH , *SODIUM , *EVALUATION research - Published
- 2017
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105. Psychological Distress and the Development of Hypertension Over 5 Years in Black South Africans.
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Schutte, Aletta E., Ware, Lisa J., Huisman, Hugo W., Fourie, Carla M.T., Greeff, Minrie, Khumalo, Tumi, and Wissing, Marie P.
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Alarming increases in the incidence of hypertension in many low- and middle-income countries are related to alcohol overuse. It is unclear whether alcohol overuse is a symptom of psychological distress. The authors assessed psychological distress in Africans and its relationship with a 5-year change in blood pressure ( BP), independent of alcohol intake. The authors followed 107 Africans with optimal BP (≤120/80 mm Hg) (aged 35-75 years) over 5 years. Alcohol intake (self-report and serum γ-glutamyl transferase) and nonspecific psychological distress (Kessler Screening Scale for Psychological Distress [K6]) were assessed. The K6 predicted hypertension development ( P=.019), and its individual component 'nervous' increased a participant's risk two-fold to become hypertensive (hazard ratio, 2.00 [1.23-3.26]). By entering K6 and γ-glutamyl transferase into multivariable-adjusted regression models for change in systolic BP, both were independently associated with change in systolic BP. Psychological distress and scoring high on being nervous predicted the development of hypertension over 5 years, independent of alcohol intake. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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106. Stunting in infancy, pubertal trajectories and adult body composition: the Birth to Twenty Plus cohort, South Africa
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Chidumwa, Glory, Said-Mohamed, Rihlat, Nyati, Lukhanyo H., Mpondo, Feziwe, Chikowore, Tinashe, Prioreschi, Alessandra, Kagura, Juliana, Ware, Lisa J., Micklesfield, Lisa K., and Norris, Shane A.
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2. Zero hunger ,article ,692/700/1720 ,692/308/174 ,human activities - Abstract
Background/objectives: Childhood rapid growth and earlier puberty onset have been associated with adult obesity. However, the association between childhood stunting, pubertal timing and adult obesity is unclear. We examined whether the relationship between stunting at age 2 years (y) and body composition at 23 years is mediated by adolescent body mass index, and pubertal development, using the Birth-to-Twenty Plus cohort (South Africa). Subjects/methods: For 1036 participants, data on anthropometrics between birth and 23 years, maternal factors, and pubertal development (Tanner scale at 9–16 years) were collected. Stunting at 2 years (height-for-age z-score < −2), 5–18 years BMI-for-age trajectories, pubertal development trajectories, and DXA-derived fat mass (FM) and fat free mass (FFM) at 23 years were determined. Data were analysed using hierarchical regressions and structural equation models. Results: Stunting was directly associated with slower pubertal development and with shorter adult stature, but was not associated with adolescent BMI trajectories, adult FM or FFM. However, stunting was indirectly associated with adult FM and FFM through the direct associations between slower pubertal development and lower FM and between shorter height and lower FFM. BMI trajectories were independently associated with FM and FFM. Conclusions: Being stunted in this population predicted adult body composition through slower pubertal development and shorter adult stature.
107. Stunting in infancy, pubertal trajectories and adult body composition: the Birth to Twenty Plus cohort, South Africa
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Chidumwa, Glory, Said-Mohamed, Rihlat, Nyati, Lukhanyo H., Mpondo, Feziwe, Chikowore, Tinashe, Prioreschi, Alessandra, Kagura, Juliana, Ware, Lisa J., Micklesfield, Lisa K., and Norris, Shane A.
- Subjects
2. Zero hunger ,article ,692/700/1720 ,692/308/174 ,human activities - Abstract
Background/objectives: Childhood rapid growth and earlier puberty onset have been associated with adult obesity. However, the association between childhood stunting, pubertal timing and adult obesity is unclear. We examined whether the relationship between stunting at age 2 years (y) and body composition at 23 years is mediated by adolescent body mass index, and pubertal development, using the Birth-to-Twenty Plus cohort (South Africa). Subjects/methods: For 1036 participants, data on anthropometrics between birth and 23 years, maternal factors, and pubertal development (Tanner scale at 9–16 years) were collected. Stunting at 2 years (height-for-age z-score < −2), 5–18 years BMI-for-age trajectories, pubertal development trajectories, and DXA-derived fat mass (FM) and fat free mass (FFM) at 23 years were determined. Data were analysed using hierarchical regressions and structural equation models. Results: Stunting was directly associated with slower pubertal development and with shorter adult stature, but was not associated with adolescent BMI trajectories, adult FM or FFM. However, stunting was indirectly associated with adult FM and FFM through the direct associations between slower pubertal development and lower FM and between shorter height and lower FFM. BMI trajectories were independently associated with FM and FFM. Conclusions: Being stunted in this population predicted adult body composition through slower pubertal development and shorter adult stature.
108. Stunting in infancy, pubertal trajectories and adult body composition: the Birth to Twenty Plus cohort, South Africa
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Chidumwa, Glory, Said-Mohamed, Rihlat, Nyati, Lukhanyo H, Mpondo, Feziwe, Chikowore, Tinashe, Prioreschi, Alessandra, Kagura, Juliana, Ware, Lisa J, Micklesfield, Lisa K, and Norris, Shane A
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2. Zero hunger ,Adult ,Adolescent ,Anthropometry ,Infant ,Body Height ,Body Mass Index ,South Africa ,Young Adult ,Child, Preschool ,Body Composition ,Humans ,Child ,Growth Disorders - Abstract
BACKGROUND/OBJECTIVES: Childhood rapid growth and earlier puberty onset have been associated with adult obesity. However, the association between childhood stunting, pubertal timing and adult obesity is unclear. We examined whether the relationship between stunting at age 2 years (y) and body composition at 23 years is mediated by adolescent body mass index, and pubertal development, using the Birth-to-Twenty Plus cohort (South Africa). SUBJECTS/METHODS: For 1036 participants, data on anthropometrics between birth and 23 years, maternal factors, and pubertal development (Tanner scale at 9-16 years) were collected. Stunting at 2 years (height-for-age z-score < -2), 5-18 years BMI-for-age trajectories, pubertal development trajectories, and DXA-derived fat mass (FM) and fat free mass (FFM) at 23 years were determined. Data were analysed using hierarchical regressions and structural equation models. RESULTS: Stunting was directly associated with slower pubertal development and with shorter adult stature, but was not associated with adolescent BMI trajectories, adult FM or FFM. However, stunting was indirectly associated with adult FM and FFM through the direct associations between slower pubertal development and lower FM and between shorter height and lower FFM. BMI trajectories were independently associated with FM and FFM. CONCLUSIONS: Being stunted in this population predicted adult body composition through slower pubertal development and shorter adult stature.
109. Iodine Status Assessment in South African Adults According to Spot Urinary Iodine Concentrations, Prediction Equations, and Measured 24-h Iodine Excretion.
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Charlton, Karen E., Ware, Lisa J., Schutte, Aletta E., Baumgartner, Jeannine, Cockeran, Marike, Naidoo, Nirmala, and Kowal, Paul
- Abstract
The iodine status of populations is conventionally assessed using spot urinary samples to obtain a median urinary iodine concentration (UIC) value, which is assessed against standard reference cut-offs. The assumption that spot UIC reflects daily iodine intake may be flawed because of high day-to-day variability and variable urinary volume outputs. This study aimed to compare iodine status in a sample of South African adults when determined by different approaches using a spot urine sample (median UIC (MUIC), predicted 24 h urinary iodine excretion (PrUIE) using different prediction equations) against measured 24 h urinary iodine excretion (mUIE). Both 24 h and spot urine samples were collected in a subsample of participants (
n = 457; median age 55 year; range 18–90 year) in the World Health Organization Study on global AGEing and adult health (SAGE) Wave 2 in South Africa, in 2015. Kawasaki, Tanaka, and Mage equations were applied to assess PrUIE from predicted urinary creatinine (PrCr) and spot UIC values. Adequacy of iodine intake was assessed by comparing PrUIE and mUIE to the Estimated Average Requirement of 95 µg/day, while the MUIC cut-off was <100 µg/L. Bland Altman plots assessed the level of agreement between measured and predicted UIE. Median UIC (130 µg/L) indicated iodine sufficiency. The prediction equations had unacceptable bias for PrUIE compared to measured UIE. In a sample of adult South Africans, the use of spot UIC, presented as a group median value (MUIC) provided similar estimates of inadequate iodine status, overall, when compared to EAR assessed using measured 24 h iodine excretion (mUIE). Continued use of MUIC as a biomarker to assess the adequacy of population iodine intake appears warranted. [ABSTRACT FROM AUTHOR]- Published
- 2018
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110. How do we best engage young people in decision-making about their health? A scoping review of deliberative priority setting methods.
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Watson, Daniella, Mhlaba, Mimi, Molelekeng, Gontse, Chauke, Thulani Andrew, Simao, Sara Correia, Jenner, Sarah, Ware, Lisa J., and Barker, Mary
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HEALTH policy , *DATABASES , *PATIENT participation , *PATIENT autonomy , *SYSTEMATIC reviews , *DECISION making , *HEALTH planning - Abstract
Introduction: International organisations have called to increase young people's involvement in healthcare and health policy development. We currently lack effective methods for facilitating meaningful engagement by young people in health-related decision-making. The purpose of this scoping review is to identify deliberative priority setting methods and explore the effectiveness of these in engaging young people in healthcare and health policy decision-making. Methods: Seven databases were searched systematically, using MeSH and free text terms, for articles published in English before July 2021 that described the use of deliberative priority setting methods for health decision-making with young people. All titles, abstracts and full-text papers were screened by a team of six independent reviewers between them. Data extraction followed the Centre for Reviews and Dissemination guidelines. The results are presented as a narrative synthesis, structured around four components for evaluating deliberative processes: 1) representation and inclusion of diverse participants, 2) the way the process is run including levels and timing of participant engagement, 3) the quality of the information provided to participants and 4) resulting outcomes and decisions. Findings: The search yielded 9 reviews and 21 studies. The more engaging deliberative priority setting tools involved young people-led committees, mixed methods for identifying and prioritising issues and digital data collection and communication tools. Long-term and frequent contact with young people to build trust underpinned the success of some of the tools, as did offering incentives for taking part and skills development using creative methods. The review also suggests that successful priority setting processes with young people involve consideration of power dynamics, since young people's decisions are likely to be made together with family members, health professionals and academics. Discussion: Young people's engagement in decision-making about their health is best achieved through investing time in building strong relationships and ensuring young people are appropriately rewarded for their time and contribution. If young people are to be instrumental in improving their health and architects of their own futures, decision-making processes need to respect young people's autonomy and agency. Our review suggests that methods of power-sharing with young people do exist but that they have yet to be adopted by organisations and global institutions setting global health policy. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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111. Comparing a range of potassium-enriched low sodium salt substitutes to common salt: Results of taste and visual tests in South African adults.
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Crouch SH, Ware LJ, Norris SA, and Schutte AE
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- Adult, Humans, Potassium, Potassium Chloride, Sodium, South Africa, Taste, Sodium Chloride, Taste Perception
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Background and Aims: Potassium-enriched low sodium salt substitutes (LSSS), which replace a proportion of sodium chloride (NaCl) with potassium chloride (KCl), have been shown to reduce blood pressure and offer a potential solution to address the high burden of hypertension in South Africa. However, it is unknown which proportions of KCl in LSSS are acceptable. We compared the taste and visual acceptability of various LSSS in South African adults., Methods and Results: Fifty-six adults underwent double-blind taste and visual tests of four LSSS (35%KCl/65%NaCl; 50%KCl/50%NaCl; 66%KCl/34%NaCl; 100%KCl) in comparison to 100%NaCl (common salt). Participants scored each product by taste ranking, taste perception and likeliness to use. Participants then visually inspected the five products and attempted to identify which was which. Almost half (45 %) of participants ranked the taste of 50%KCl/50 %NaCl as fantastic or really good. Furthermore, 62 % of participants liked and would be happy to use the 50 %KCl/50 %NaCl or felt this tasted like common salt. Only 12 % rated the 100%KCl highly for taste, and over half reported being unlikely to use this. Most participants (57.3 % and 36.4 %) were able to visually identify 100%NaCl and 100%KCl, while identification of other blends was generally poor. Responses were similar for 35%KCl/65%NaCl and 66%KCl/34%NaCl throughout., Conclusion: Our findings suggest that the taste of the 50%KCl salt substitute would be well tolerated by South African adults, most of which could not visually differentiate between this salt substitute and common salt., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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112. Examining the referral of patients with elevated blood pressure to health resources in an under-resourced community in South Africa.
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McNulty LK, Stoutenberg M, Kolkenbeck-Ruh A, Harrison A, Mmoledi T, Katiyo D, Mhlaba M, Kubheka D, and Ware LJ
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- Adult, Humans, Blood Pressure, South Africa, Counseling, Referral and Consultation, Community Health Workers, Hypertension diagnosis
- Abstract
Background: Low-and-middle income countries face a disproportionate burden of non-communicable diseases (NCDs) that threaten to overwhelm under-resourced health systems. Community health workers (CHWs) can promote NCD prevention, reach patients, and connect them to local community health resources; however, little has been done to examine how referrals to these resources are utilized by community members. The purpose of this study is to examine the use of referrals to community-based health resources and investigate the factors influencing patient utilization of referrals connecting them to appropriate health resources for elevated blood pressure (BP)., Methods: CHWs conducted home visits, which included BP screening and brief counseling, with community members in Soweto, South Africa. Participants with elevated (systolic BP: 121-139/ diastolic BP: 81-89 mmHg) or high (≥ 140/90 mmHg) BP were referred to either a local, community-based physical activity (PA) program managed by a non-governmental organization or local health clinics. The number of participants that received and utilized their referrals was tracked. Follow-up interviews were conducted with individuals given a referral who: (1) went to the PA program, (2) did not go to the PA program, (3) went to a clinic, and (4) did not go to a clinic. Interviews were transcribed and analyzed to identify common themes and differences between groups regarding their decisions to utilize the referrals., Results: CHWs visited 1056 homes, with 1001 community members consenting to the screening; 29.2% (n = 292) of adults were classified as having optimal BP (≤120/80 mmHg), 35.8% (n = 359) had elevated BP, and 35.0% (n = 350) had high BP. One hundred and seventy-three participants accepted a referral to the PA program with 46 (26.6%) enrolling. Five themes emerged from the interviews: (1) prior knowledge and thoughts on BP, (2) psychosocial factors associated with BP control, (3) perception about receiving the referral, (4) contextual factors influencing referral utilization, and (5) perceived benefits of utilizing the referral., Conclusion: CHWs can successfully increase community members' access to health resources by providing appropriate referrals. However, greater attention needs to address community members' barriers and hesitancy to utilize health resources., (© 2024. The Author(s).)
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- 2024
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113. Acceptability and feasibility of home-based hypertension and physical activity screening by community health workers in an under-resourced community in South Africa.
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Stoutenberg M, Crouch SH, McNulty LK, Kolkenbeck-Ruh A, Torres G, Gradidge PJL, Ly A, and Ware LJ
- Abstract
Background: Low-middle-income countries (LMICs) face increasing burdens from non-communicable disease (NCDs) requiring primary care task shifting to community health workers (CHWs). This study explored community members' perceptions of NCD-focused, CHW-led home visits in a historically disadvantaged township of South Africa., Methods: Trained CHWs visited community member homes, performing blood pressure and physical activity (PA) screenings, followed by brief counselling and a satisfaction survey. Semi-structured interviews were conducted within 3 days of the visit to learn about their experiences., Results: CHWs visited 173 households, with 153 adult community members consenting to participate (88.4%). Participants reported that it was easy to understand CHW-delivered information (97%), their questions were answered well (100%), and they would request home service again (93%). Twenty-eight follow-up interviews revealed four main themes: 1) acceptance of CHW visits, 2) openness to counselling, 3) satisfaction with screening and a basic understanding of the results, and 4) receptiveness to the PA advice., Conclusion: Community members viewed CHW-led home visits as an acceptable and feasible method for providing NCD-focused healthcare services in an under-resourced community. Expanding primary care reach through CHWs offers more accessible and individualized care, reducing barriers for individuals in under-resourced communities to access support for NCD risk reduction., Competing Interests: Conflicts of interest/competing interestsThe authors have no relevant financial or non-financial interests to disclose., (© The Author(s) 2023.)
- Published
- 2023
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114. Rural-Urban Differences in Diabetes Care and Control in 42 Low- and Middle-Income Countries: A Cross-sectional Study of Nationally Representative Individual-Level Data.
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Flood D, Geldsetzer P, Agoudavi K, Aryal KK, Brant LCC, Brian G, Dorobantu M, Farzadfar F, Gheorghe-Fronea O, Gurung MS, Guwatudde D, Houehanou C, Jorgensen JMA, Kondal D, Labadarios D, Marcus ME, Mayige M, Moghimi M, Norov B, Perman G, Quesnel-Crooks S, Rashidi MM, Moghaddam SS, Seiglie JA, Bahendeka SK, Steinbrook E, Theilmann M, Ware LJ, Vollmer S, Atun R, Davies JI, Ali MK, Rohloff P, and Manne-Goehler J
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- Cross-Sectional Studies, Developing Countries, Female, Humans, Income, Male, Prevalence, Urban Population, Diabetes Mellitus epidemiology, Diabetes Mellitus therapy, Rural Population
- Abstract
Objective: Diabetes prevalence is increasing rapidly in rural areas of low- and middle-income countries (LMICs), but there are limited data on the performance of health systems in delivering equitable and effective care to rural populations. We therefore assessed rural-urban differences in diabetes care and control in LMICs., Research Design and Methods: We pooled individual-level data from nationally representative health surveys in 42 countries. We used Poisson regression models to estimate age-adjusted differences in the proportion of individuals with diabetes in rural versus urban areas achieving performance measures for the diagnosis, treatment, and control of diabetes and associated cardiovascular risk factors. We examined differences across the pooled sample, by sex, and by country., Results: The pooled sample from 42 countries included 840,110 individuals (35,404 with diabetes). Compared with urban populations with diabetes, rural populations had ∼15-30% lower relative risk of achieving performance measures for diabetes diagnosis and treatment. Rural populations with diagnosed diabetes had a 14% (95% CI 5-22%) lower relative risk of glycemic control, 6% (95% CI -5 to 16%) lower relative risk of blood pressure control, and 23% (95% CI 2-39%) lower relative risk of cholesterol control. Rural women with diabetes had lower achievement of performance measures relating to control than urban women, whereas among men, differences were small., Conclusions: Rural populations with diabetes experience substantial inequities in the achievement of diabetes performance measures in LMICs. Programs and policies aiming to strengthen global diabetes care must consider the unique challenges experienced by rural populations., (© 2022 by the American Diabetes Association.)
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- 2022
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115. Social vulnerability, parity and food insecurity in urban South African young women: the healthy life trajectories initiative (HeLTI) study.
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Ware LJ, Kim AW, Prioreschi A, Nyati LH, Taljaard W, Draper CE, Lye SJ, and Norris SA
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- Female, Health Promotion, Humans, Pregnancy, Socioeconomic Factors, South Africa, Urban Health, Young Adult, Food Insecurity, Parity, Urban Population statistics & numerical data, Vulnerable Populations statistics & numerical data
- Abstract
Social vulnerability indices (SVI) can predict communities' vulnerability and resilience to public health threats such as drought, food insecurity or infectious diseases. Parity has yet to be investigated as an indicator of social vulnerability in young women. We adapted an SVI score, previously used by the US Centre for Disease Control (CDC), and calculated SVI for young urban South African women (n = 1584; median age 21.6, IQR 3.6 years). Social vulnerability was more frequently observed in women with children and increased as parity increased. Furthermore, young women classified as socially vulnerable were 2.84 times (95% CI 2.10-3.70; p < 0.001) more likely to report household food insecurity. We collected this information in 2018-2019, prior to the current global COVID-19 pandemic. With South Africa having declared a National State of Disaster in March 2020, early indicators suggest that this group of women have indeed been disproportionally affected, supporting the utility of such measures to inform disaster relief efforts., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)
- Published
- 2021
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116. Salt Use Behaviours of Ghanaians and South Africans: A Comparative Study of Knowledge, Attitudes and Practices.
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Menyanu E, Charlton KE, Ware LJ, Russell J, Biritwum R, and Kowal P
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- Cohort Studies, Diet, Healthy ethnology, Female, Ghana epidemiology, Health Status Disparities, Humans, Hypertension epidemiology, Hypertension ethnology, Hypertension prevention & control, Longitudinal Studies, Male, Middle Aged, Nutrition Surveys, Patient Compliance ethnology, Prevalence, Prospective Studies, Risk, Self Report, Sodium Chloride, Dietary adverse effects, South Africa epidemiology, Cooking, Diet ethnology, Feeding Behavior ethnology, Health Knowledge, Attitudes, Practice ethnology, Health Transition, Hypertension etiology, Sodium Chloride, Dietary administration & dosage
- Abstract
Salt consumption is high in Africa and the continent also shares the greatest burden of hypertension. This study examines salt-related knowledge, attitude and self-reported behaviours (KAB) amongst adults from two African countries-Ghana and South Africa-which have distributed different public health messages related to salt. KAB was assessed in the multinational longitudinal World Health Organisation (WHO) study on global AGEing and adult health (WHO-SAGE) Wave 2 (2014-2015). Respondents were randomly selected across both countries-Ghana ( n = 6746; mean age 58 years old; SD 17; 41% men; 31% hypertensive) and South Africa ( n = 3776, mean age 54 years old; SD 17; 32% men; 45% hypertensive). South Africans were more likely than Ghanaians to add salt to food at the table (OR 4.80, CI 4.071-5.611, p < 0.001) but less likely to add salt to food during cooking (OR 0.16, CI 0.130-0.197, p < 0.001). South Africans were also less likely to take action to control their salt intake (OR 0.436, CI 0.379-0.488, p < 0.001). Considering the various salt reduction initiatives of South Africa that have been largely absent in Ghana, this study supports additional efforts to raise consumer awareness on discretionary salt use and behaviour change in both countries., Competing Interests: The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, nor in the decision to publish the results.
- Published
- 2017
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117. Effect of a Web-Based Behavior Change Program on Weight Loss and Cardiovascular Risk Factors in Overweight and Obese Adults at High Risk of Developing Cardiovascular Disease: Randomized Controlled Trial.
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Watson S, Woodside JV, Ware LJ, Hunter SJ, McGrath A, Cardwell CR, Appleton KM, Young IS, and McKinley MC
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- Adult, Aged, Female, Humans, Male, Middle Aged, Risk Factors, Self Care methods, Surveys and Questionnaires, Treatment Outcome, Cardiovascular Diseases prevention & control, Internet statistics & numerical data, Obesity complications, Overweight complications, Weight Loss physiology
- Abstract
Background: Web-based programs are a potential medium for supporting weight loss because of their accessibility and wide reach. Research is warranted to determine the shorter- and longer-term effects of these programs in relation to weight loss and other health outcomes., Objective: The aim was to evaluate the effects of a Web-based component of a weight loss service (Imperative Health) in an overweight/obese population at risk of cardiovascular disease (CVD) using a randomized controlled design and a true control group., Methods: A total of 65 overweight/obese adults at high risk of CVD were randomly allocated to 1 of 2 groups. Group 1 (n=32) was provided with the Web-based program, which supported positive dietary and physical activity changes and assisted in managing weight. Group 2 continued with their usual self-care (n=33). Assessments were conducted face-to-face. The primary outcome was between-group change in weight at 3 months. Secondary outcomes included between-group change in anthropometric measurements, blood pressure, lipid measurements, physical activity, and energy intake at 3, 6, and 12 months. Interviews were conducted to explore participants' views of the Web-based program., Results: Retention rates for the intervention and control groups at 3 months were 78% (25/32) vs 97% (32/33), at 6 months were 66% (21/32) vs 94% (31/33), and at 12 months were 53% (17/32) vs 88% (29/33). Intention-to-treat analysis, using baseline observation carried forward imputation method, revealed that the intervention group lost more weight relative to the control group at 3 months (mean -3.41, 95% CI -4.70 to -2.13 kg vs mean -0.52, 95% CI -1.55 to 0.52 kg, P<.001), at 6 months (mean -3.47, 95% CI -4.95 to -1.98 kg vs mean -0.81, 95% CI -2.23 to 0.61 kg, P=.02), but not at 12 months (mean -2.38, 95% CI -3.48 to -0.97 kg vs mean -1.80, 95% CI -3.15 to -0.44 kg, P=.77). More intervention group participants lost ≥5% of their baseline body weight at 3 months (34%, 11/32 vs 3%, 1/33, P<.001) and 6 months (41%, 13/32 vs 18%, 6/33, P=.047), but not at 12 months (22%, 7/32 vs 21%, 7/33, P=.95) versus control group. The intervention group showed improvements in total cholesterol, triglycerides, and adopted more positive dietary and physical activity behaviors for up to 3 months verus control; however, these improvements were not sustained., Conclusions: Although the intervention group had high attrition levels, this study provides evidence that this Web-based program can be used to initiate clinically relevant weight loss and lower CVD risk up to 3-6 months based on the proportion of intervention group participants losing ≥5% of their body weight versus control group. It also highlights a need for augmenting Web-based programs with further interventions, such as in-person support to enhance engagement and maintain these changes., Trial Registration: ClinicalTrials.gov NCT01472276; http://clinicaltrials.gov/ct2/show/study/NCT01472276 (Archived by Webcite at http://www.webcitation.org/6Z9lfj8nD).
- Published
- 2015
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118. Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care.
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Yardley L, Ware LJ, Smith ER, Williams S, Bradbury KJ, Arden-Close EJ, Mullee MA, Moore MV, Peacock JL, Lean ME, Margetts BM, Byrne CD, Hobbs RF, and Little P
- Subjects
- Adult, Aged, Aged, 80 and over, Cost-Benefit Analysis, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Nurses, Treatment Outcome, Young Adult, Internet, Obesity therapy, Primary Health Care, Weight Reduction Programs
- Abstract
Background: There is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity. Automated web-based interventions might provide a solution, but evidence suggests that they may be ineffective without additional human support. The main aim of this study was to carry out a feasibility trial of a web-based weight management intervention in primary care, comparing different levels of nurse support, to determine the optimal combination of web-based and personal support to be tested in a full trial., Methods: This was an individually randomised four arm parallel non-blinded trial, recruiting obese patients in primary care. Following online registration, patients were randomly allocated by the automated intervention to either usual care, the web-based intervention only, or the web-based intervention with either basic nurse support (3 sessions in 3 months) or regular nurse support (7 sessions in 6 months). The main outcome measure (intended as the primary outcome for the main trial) was weight loss in kg at 12 months. As this was a feasibility trial no statistical analyses were carried out, but we present means, confidence intervals and effect sizes for weight loss in each group, uptake and retention, and completion of intervention components and outcome measures., Results: All randomised patients were included in the weight loss analyses (using Last Observation Carried Forward). At 12 months mean weight loss was: usual care group (n = 43) 2.44 kg; web-based only group (n = 45) 2.30 kg; basic nurse support group (n = 44) 4.31 kg; regular nurse support group (n = 47) 2.50 kg. Intervention effect sizes compared with usual care were: d = 0.01 web-based; d = 0.34 basic nurse support; d = 0.02 regular nurse support. Two practices deviated from protocol by providing considerable weight management support to their usual care patients., Conclusions: This study demonstrated the feasibility of delivering a web-based weight management intervention supported by practice nurses in primary care, and suggests that the combination of the web-based intervention with basic nurse support could provide an effective solution to weight management support in a primary care context., Trial Registration: Current Controlled Trials ISRCTN31685626.
- Published
- 2014
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119. Rates and determinants of uptake and use of an internet physical activity and weight management program in office and manufacturing work sites in England: cohort study.
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Ware LJ, Hurling R, Bataveljic O, Fairley BW, Hurst TL, Murray P, Rennie KL, Tomkins CE, Finn A, Cobain MR, Pearson DA, and Foreyt JP
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- Body Weight, Cohort Studies, Electronic Mail, England, Health Promotion, Humans, Learning, Longitudinal Studies, Monitoring, Physiologic instrumentation, Monitoring, Physiologic methods, Patient Participation, Patient Selection, Self Care, Exercise, Internet statistics & numerical data, Motor Activity, Occupational Health, Online Systems, Patient Education as Topic, Software, Weight Loss
- Abstract
Background: Internet-based physical activity (PA) and weight management programs have the potential to improve employees' health in large occupational health settings. To be successful, the program must engage a wide range of employees, especially those at risk of weight gain or ill health., Objective: The aim of the study was to assess the use and nonuse (user attrition) of a Web-based and monitoring device-based PA and weight management program in a range of employees and to determine if engagement with the program was related to the employees' baseline characteristics or measured outcomes., Methods: Longitudinal observational study of a cohort of employees having access to the MiLife Web-based automated behavior change system. Employees were recruited from manufacturing and office sites in the North West and the South of England. Baseline health data were collected, and participants were given devices to monitor their weight and PA via data upload to the website. Website use, PA, and weight data were collected throughout the 12-week program., Results: Overall, 12% of employees at the four sites (265/2302) agreed to participate in the program, with 130 men (49%) and 135 women (51%), and of these, 233 went on to start the program. During the program, the dropout rate was 5% (11/233). Of the remaining 222 Web program users, 173 (78%) were using the program at the end of the 12 weeks, with 69% (153/222) continuing after this period. Engagement with the program varied by site but was not significantly different between the office and factory sites. During the first 2 weeks, participants used the website, on average, 6 times per week, suggesting an initial learning period after which the frequency of website log-in was typically 2 visits per week and 7 minutes per visit. Employees who uploaded weight data had a significant reduction in weight (-2.6 kg, SD 3.2, P< .001). The reduction in weight was largest for employees using the program's weight loss mode (-3.4 kg, SD 3.5). Mean PA level recorded throughout the program was 173 minutes (SE 12.8) of moderate/high intensity PA per week. Website interaction time was higher and attrition rates were lower (OR 1.38, P= .03) in those individuals with the greatest weight loss., Conclusions: This Web-based PA and weight management program showed high levels of engagement across a wide range of employees, including overweight or obese workers, shift workers, and those who do not work with computers. Weight loss was observed at both office and manufacturing sites. The use of monitoring devices to capture and send data to the automated Web-based coaching program may have influenced the high levels of engagement observed in this study. When combined with objective monitoring devices for PA and weight, both use of the website and outcomes can be tracked, allowing the online coaching program to become more personalized to the individual.
- Published
- 2008
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