Browsing by Author "Koen, Nelene"

Now showing 1 - 6 of 6
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    Adaptation of the RenalSmart web-based application for the dietary management of patients with diabetic nephropathy
    (Medpharm Publications, 2013) Esau, Nazeema; Koen, Nelene; Herselman, Marietjie G.
    ENGLISH SUMMARY : Objectives: The aim of this study was to develop and test a web-based application for the dietary management of patients with diabetic nephropathy. Design: Observational descriptive study. Settings and subjects: RenalSmart® is a web-based application used to assist dietitians in clinical practice, from tertiary to primary care, to manage patients with chronic renal failure. The application was adapted and enhanced to include functions for the nutritional assessment of a patient with diabetic nephropathy, the formulation of a dietary prescription and the development of a meal plan and sample menu. It includes a graphical display of anthropometric and biochemical measurements. Quality assurance testing was undertaken throughout the development process by the project team in a pilot study involving generalist dietitians and dietitians who specialise in diabetic and renal nutrition. Nonrandom purposive sampling, including snowball sampling, was used to recruit them. Outcome measures: The application was finally tested for accuracy and acceptability by registered dietitians in South Africa. Results: Thirty-seven dietitians completed the final testing of the application. The mean age of the respondents was 33 years. Thirty-five per cent resided in the Western Cape. The overall acceptability of the application was rated as good to excellent by 81% of respondents. There was a significant difference between dietitians who usually consulted renal patients, compared to those who did not, in their rating of the accuracy of the data-saving function (p-value = 0.02) and the fluid requirements (p-value = 0.03). In this regard, the former group of dietitians was dissatisfied with these functions. Conclusion: The web-based application developed in this study was rated as accurate and acceptable by the majority of respondents. Identified problem areas were addressed in the final version.
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    The development of a single health-endorsement logo for South Africa
    (Cambridge University Press, 2018) Koen, Nelene; Wentzel-Viljoen, Edelweiss; Blaauw, Renee
    Objective: To develop health-endorsement logos (HEL) for food products indicating healthy choices based on the South African nutrient profile model and to pilot test these logos with consumers. Design: Multistage mixed-methods design. Setting: Cape Town, South Africa. Subjects: Nine focus group discussions (FGD) were conducted with adult consumers to explore what types of HEL are preferred and why. Based on the findings, ten HEL were designed by a graphic design team. A modified Delphi technique, conducted with experts in the fields of nutrition and food science, was employed to eliminate lowest-scoring HEL and to improve the design of the remaining logos. Participants from the initial FGD participated in pilot testing the improved logos. Results: Participants from FGD (n 67) were positive about a single HEL, stating it would make food labelling less confusing as they did not understand the various HEL used. Participants indicated the logo should include wording related to ‘healthy choice’ or ‘better choice’ and pictures/symbols related to health and/or food. During two rounds of scoring and comments by experts (n 19), five logos were eliminated and the design of the remaining five improved. Three of five remaining logos received overall rankings of 3·08/5, 3·28/5 and 3·39/5, respectively, during FGD (n 36) in the pilot-testing phase. Conclusion: HEL were designed and consumer tested. Three designs were submitted to the national Department of Health to consider for implementation, after further testing, as a tool to assist in addressing the high incidence of non-communicable diseases in South Africa.
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    The influence of nutrition labelling and logos on food purchasing behaviour in Cape Town, Western Cape, South Africa
    (Stellenbosch : Stellenbosch University, 2017-12) Koen, Nelene; Blaauw, Renee; Wentzel-Viljoen, Edelweiss; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY : Introduction: Nutrition information on food labels is a population-based approach to nutrition education that enables consumers to make healthier food choices. In South Africa (SA) there has been a paucity of data on food and nutrition labelling and the consumer since the publication of the new food-labelling legislation. Rationale: A better understanding of how consumers engage with nutrition information on food labels is required to make recommendations to improve education campaigns to assist consumers in making healthier food choices. Additionally, food-labelling factors that influence consumer food-purchasing behaviour, and expectations/barriers to reading nutrition information on labels, could assist in making recommendations for a single front-of-pack labelling scheme to be used in SA as well as for its development. Methods: A multi-stage mixed-methods design was employed. In phase one, a cross-sectional, descriptive, interviewer-administered electronic survey was conducted on adult consumers (N=960) at 16 randomly selected grocery stores in four health districts of Cape Town (CT). In phase two, nine focus-group discussions (FGDs) were held with purposively selected consumers (N=67) to further explore phase one’s findings and what type of health- endorsement logos (HELs) are preferred and why. In phase three, ten HELs were developed by a graphic design company based on the data collected in previous phases. A modified Delphi technique, conducted with experts in the fields of nutrition/food science (N=19), was employed to eliminate lowest scoring HELs and to improve the design of the HELs. Participants from the initial survey and/or FGDs took part in pilot testing of the HELs during four FGDs. Results: Main self-reported factors influencing food-purchasing behaviour included price, sell-by date and products on special/promotion, with price being the most important. Taste, brand loyalty, marketing and convenience were also major influencers. Less than half of participants indicated that nutrition information always influenced their product choice. The main reasons for not reading nutrition information included buying the same type of product all the time and being uninterested in the information. In exploring this further with FGDs, a lack of time, poor understanding of nutrition information (specifically the nutrition information table) and lack of trust in labelling information also emerged as important factors. The mean food and nutrition label knowledge score was 44%. The majority of participants preferred a single HEL to be used on food products as they don’t understand the various HELs used. Such a logo should include pictures/symbols directly related to health and/or food and should state “healthy choice”. During the pilot testing, three HELs (developed and improved during two rounds of scoring) received overall rankings of 3.08/5, 3.28/5 and 3.39/5 respectively. Conclusion: CT consumers have poor food and nutrition label knowledge and nutrition information on food labels is not a major influencer of food-purchasing behaviour. Consumers struggle to understand the nutrition information provided and have expressed a need for a single HEL to be used. Consumer education on utilising the nutrition information on labels and the development of a single HEL for SA, could assist consumers to make healthier food choices and in turn address the high incidence of non-communicable diseases in SA.
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    The provision of healthy food in a school tuck shop : does it influence primary-school students’ perceptions, attitudes and behaviours towards healthy eating?
    (Cambridge University Press, 2017) Bekker, Francette; Marais, Maritha; Koen, Nelene
    Objective: To investigate students’ tuck shop buying behaviour, choices of lunchbox items and healthy eating perceptions and attitudes at a school with a nutritionally regulated tuck shop and a school with a conventional tuck shop. Design: Mixed-methods research comprising a cross-sectional survey and focus groups. Setting: Bloemfontein, South Africa. Subjects: Randomly selected grade 2 to 7 students from a school with a nutritionally regulated tuck shop (school A; n 116) and a school with a conventional tuck shop (school B; n 141) completed a self-administered questionnaire about perceptions, attitudes, buying behaviours and lunchbox content. Six students per grade (n 72) in each school took part in focus group discussions to further explore concepts pertaining to healthy eating. Results: In school A, older students had a negative attitude towards their ‘healthy’ tuck shop, while younger students were more positive. School B students were positive towards their conventional tuck shop. In both schools students wanted their tuck shop to allow them to choose from healthy and unhealthy items. School A students mostly bought slushies, iced lollies and baked samoosas, while school B students mostly bought sweets and crisps. The lunchboxes of school A students contained significantly (P<0·05) more healthy items but also significantly more unhealthy items. Conclusions: A single intervention such as having a nutritionally regulated tuck shop at a primary school cannot advance the healthy school food environment in its totality. A multi-pronged approach is recommended and awareness must be created among all role players, including parents who are responsible for preparing lunchboxes.
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    Staff and student health and wellness at the Faculty of Medicine and Health Sciences, Stellenbosch University : current status and needs assessment
    (MedPharm Publications, 2017) Koen, Nelene; Philips, Lauren; Potgieter, Sunita; Smit, Yolande; Van Niekerk, Evette; Nel, Daan G.; Visser, Janicke
    Background: Emphasis is currently placed on the importance of employee and student wellness initiatives. The aim was to assess staff and student health status at the Faculty of Medicine and Health Sciences (FMHS), Stellenbosch University (SU), and to conduct a wellness needs assessment. Methods: Online, self-administered questionnaires were used to collect data concerning staff and students. Additionally, students’ anthropometric and biochemical parameters were assessed. Summary statistics, correlation coefficients and appropriate analysis of variance were used for data analyses. Results: Data were obtained from staff (survey: n = 300) and students (screening: n = 536; survey: n = 330). Some 58% (n = 174) of staff had a self-reported BMI of ≥ 25 kg/m2 whilst mean screening values for all variables fell within normal reference ranges for students. In all, 78% (n = 232) of staff reported to exercise < 150 min/week and 28% (n = 91) of students were sedentary for > 8 h/day; 63% (n = 188) of staff expressed the need to make better food choices, 17% (n = 55) of students were aware of the need to change but experienced reluctance, and both staff and students felt dietary assistance would be beneficial (43% vs. 46%). In addition, 79% of staff (n = 208) and 42% of students (n = 138) reported being under constant pressure. Conclusion: Much can be done to improve the health and well-being of both staff and students at the FMHS, SU. Wellness is a multifactorial concept; as such, health-promotional strategies for classrooms and workplaces should consider all factors in order to provide a holistic approach and potentially identify those who are at risk of a sub-optimal wellness status. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2018; DOI: 10.1080/20786190.2017.1396788
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    A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting
    (BioMed Central, 2014-03) Viljoen, Estelle; Visser, Janicke; Koen, Nelene; Musekiwa, Alfred
    Background and objectives: Nausea and vomiting during pregnancy (NVP) occur commonly. Possible harmful side-effects of conventional medicine to the fetus create the need for alternative options to relieve NVP. This systematic review (SR) investigated current evidence regarding orally administered ginger for the treatment of NVP. The primary objective was to assess the effectiveness of ginger in treating NVP. The secondary objective was to assess the safety of ginger during pregnancy. Methods: A comprehensive electronic bibliographic database search was carried out. Randomized controlled trials (RCTs) of the efficacy of orally administered ginger, as treatment for NVP in pregnant women at any stage of pregnancy, published in English, were included. Two researchers independently extracted data and assessed trial quality. RevMan5 software (Cochrane Collaboration) was used for data analysis. p < 0.05 was considered statistically significant. Results: Twelve RCTs involving 1278 pregnant women were included. Ginger significantly improved the symptoms of nausea when compared to placebo (MD 1.20, 95% CI 0.56-1.84, p = 0.0002, I² = 0%). Ginger did not significantly reduce the number of vomiting episodes during NVP, when compared to placebo, although there was a trend towards improvement (MD 0.72, 95% CI −0.03-1.46, p = 0.06, I² = 71%). Subgroup analyses seemed to favor the lower daily dosage of <1500 mg ginger for nausea relief. Ginger did not pose a significant risk for spontaneous abortion compared to placebo (RR 3.14, 95% CI 0.65-15.11, p = 0.15; I² = 0%), or to vitamin B₆ (RR 0.49, 95% CI 0.17-1.42, p = 0.19, I² = 40%). Similarly, ginger did not pose a significant risk for the side-effects of heartburn or drowsiness. Conclusions: This review suggests potential benefits of ginger in reducing nausea symptoms in pregnancy (bearing in mind the limited number of studies, variable outcome reporting and low quality of evidence). Ginger did not significantly affect vomiting episodes, nor pose a risk for side-effects or adverse events during pregnancy. Based on evidence from this SR, ginger could be considered a harmless and possibly effective alternative option for women suffering from NVP. International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42011001237.