An education and home-based pedometer walking program improves physical activity levels, and beneficial changes in other IHD risk factors were noted.

Objective: The present study aimed to assess the relationship between dietary habits, change in socio-economic status and BMI Z-score and fat mass in a cohort of South African adolescents. Design: In the longitudinal study, data were collected at ages 13, 15 and 17 years on a birth cohort who have been followed since 1990. Black participants with complete dietary habits data (breakfast consumption during the week and at weekends, snacking while watching television, eating main meal with family, lunchbox use, number of tuck shop purchases, fast-food consumption, confectionery consumption and sweetened beverage consumption) at all three ages and body composition data at age 17 years were included in the analyses. Generalized estimating equations were used to test the associations between individual longitudinal dietary habits and obesity (denoted by BMI Z-score and fat mass) with adjustments for change in socio-economic status between birth and age 12 years. Setting: Birth to Twenty (Bt20) study, Soweto-Johannesburg, South Africa. Subjects: Adolescents (n 1298; 49?7 % male). Results: In males, the multivariable analyses showed that soft drink consumption was positively associated with both BMI Z-score and fat mass (P , 0?05). Furthermore, these relationships remained the same after adjustment for socioeconomic indicators (P , 0?05). No associations were found in females. Conclusions: Longitudinal soft drink consumption was associated with increased BMI Z-score and fat mass in males only. Fridge ownership at birth (a proxy for greater household disposable income in this cohort) was shown to be associated with both BMI Z-score and fat mass. Keywords Dietary behaviours Socio-economic status Obesity AdolescentsSince the end of the segregationist and discriminatory practices of Apartheid in 1994, South Africa has undergone profound political, social and economic transitions. Parallel to these transformations have been lifestyle changes driven by rapid rates of urbanization, from 10 % in 1990 to 56 % in 2005, especially among black South Africans (1) . In addition to infectious diseases and a rise in non-communicable diseases, the South African population also has the added burden of a high prevalence of HIV/AIDS and violence-related trauma (2) ; often this collection of health challenges has been referred to as the 'quadruple burden of disease'.Urbanization in low-and middle-income countries drives changes in food habits and body composition and is associated with both health gains and health risks.In South Africa, between 1940 and 1992, diet among the black population shifted from a prudent pattern (.50 % carbohydrate, ,30 % total fat, ,15 % protein) to one showing a progressive increase in fat (from 16?4 % to 26?2 %) with a concurrent decrease in carbohydrate (from 69?3 % to 61?7 %) (3) .The worldwide prevalence of obesity has reached alarming levels (475 million), affecting people in both high-income countries and low-and middle-income countries. Furthermore, over a billion adults are overweight (4) . The la...

The International Classification of Functioning, Disability and Health (ICF) short-version checklist was used to assess the impairments, activity limitations and participation restrictions experienced by a sample of HIV-positive in-patients admitted to Chris Hani Baragwanath Hospital in Johannesburg, South Africa. Laboratory tests, observation and review of patients' medical records were used to complete the ICF Checklist. Eighty patients were assessed (23 males and 57 females). Common impairments related to the following functions: digestive, metabolic and endocrine systems (83.9%); sensory (83.5%); haematological, immunological and respiratory systems (82.5%); neuromusculoskeletal movement (73.8%); mental (72.6%); energy and drive (75%); sleep (71%); emotional (62%); and muscle power (75%). Activity limitations were present in the area of mobility (56.4%), major life areas (55.1%), and community, social and civic life (50%). Associations found among impairments, activity limitations and participation restrictions were that patients with sensory problems were five-times more likely to have problems in self-care than people without sensory problems. Patients with impairments in the digestive, genitourinary and neuromusculoskeletal systems experienced problems with general tasks (confidence interval [CI]: 4.05-103.03; p < 0.01). Patients with cardiovascular, haematological, immunological and respiratory system problems were 14-times more likely to have problems with execution of general tasks (odds ratio [OR] 14.06, CI: 2.75-71.94; p = 0.002). Activities of participation restriction, difficulties with general tasks and demands (OR 9.68, CI: 1.20-77.92), interpersonal relationships (OR 3.62, CI: 1.09-12.00), domestic life (OR 3.97, CI: 1.12-14.16), and community, social and civic life (OR 4.13, CI: 1.05-16.20) were closely associated with barriers in obtaining products for personal use and using technology. Understanding the prevalence and associations of disability and function in the course of HIV disease may serve as a baseline for developing appropriate and context-sensitive rehabilitation interventions and management strategies for people living with HIV or AIDS.

BackgroundThe HIV epidemic in East Africa is of public health importance with an increasing number of young people getting infected. This study sought to identify spatial clusters and examine the geographical variation of HIV infection at a regional level while accounting for risk factors associated with HIV/AIDS among young people in Uganda.MethodsA secondary data analysis was conducted on a survey cross-sectional design whose data were obtained from the 2011 Uganda Demographic and Health Survey (DHS) and AIDS Indicator Survey (AIS) for 7 518 young people aged 15-24 years. The analysis was performed in three stages while incorporating population survey sampling weights. Maximum likelihood-based logistic regression models were used to explore the non-spatially adjusted factors associated with HIV infection. Spatial scan statistic was used to identify geographical clusters of elevated HIV infections which justified modelling using a spatial random effects model by Bayesian-based logistic regression models.ResultsIn this study, 309/533 HIV sero-positive female participants were selected with majority residing in the rural areas [386(72%)]. Compared to singles, those currently [Adjusted Odds Ratio (AOR) =3.64; (95% CI; 1.25-10.27)] and previously married [AOR = 5.62; (95% CI: 1.52-20.75)] participants had significantly higher likelihood of HIV infections. Sexually Transmitted Infections [AOR = 2.21; (95% CI: 1.35-3.60)] were more than twice likely associated with HIV infection. One significant (p < 0.05) primary cluster of HIV prevalence around central Uganda emerged from the SaTScan cluster analysis. Spatial analysis disclosed behavioural factors associated with greater odds of HIV infection such as; alcohol use before sexual intercourse [Posterior Odds Ratio (POR) =1.32; 95% (BCI: 1.11-1.63)]. Condom use [POR = 0.54; (95% BCI: 0.41-0.69)] and circumcision [POR = 0.66; (95% BCI: 0.45-0.99)] provided a protective effect against HIV.ConclusionsThe study revealed associations between high-risk sexual behaviour and HIV infection. Behavioural change interventions should therefore be pertinent to the prevention of HIV. Spatial analysis further revealed a significant HIV cluster towards the Central and Eastern areas of Uganda. We propose that interventions targeting young people should initially focus on these regions and subsequently spread out across Uganda.

In 2005, 16.6% of South Africans between 15 and 49 years of age were HIV positive. The advent of anti-retroviral therapy has led to improved longevity, CD4 counts and clinical well-being of people living with HIV/AIDS (PLWHA). Physical impairments, activity limitations and participation restrictions of PLWHA have profound effects on the Health-related Quality of Life and functional abilities of those with the disease, and understanding thereof may assist in the formulation of rehabilitation protocols, health care interventions as well as vocational and legislative policies. The International Classification of Function, Disability and Health (ICF) is a standardised tool, endorsed by the World Health Assembly for international use, which aims to classify functioning and disability. It is structured to assess body functions and structure, functional activities and associated personal and environmental factors.This study aimed to develop a profile of the level of functional activity, using the ICF Checklist, of an urban cohort of 45 South African individuals who are HIV positive attending an outpatient clinic at the Helen Joseph Memorial Hospital, Gauteng, South Africa. The results showed a high prevalence of physical impairments, participation restrictions and selective activity limitations and that environmental factors influence their level of ability. Specific impairments where patients had problems were mental functions (69% (n=31), sensory and pain -- 71% (n=32), digestive and metabolic functions 45% (n=20) and neuromuscular 27% (n=12). Activity limitations included major life areas' 58% (n=26), interpersonal relationships 56% (n=25), mobility 40% (n=18) and general tasks and demands 38% (n=17). Limitations in mobility were significantly associated with problems of sensory functions (p=0.05), pain (p=0.006), neuromusculoskeletal and movement-related functions (p=0.006), muscle power (p=0.006) as well as energy and drive functions (p=0.001). The study identifies the level of function and ability of PLWHA, clinical markers, and how these affect the physical, psychological and social functioning of this population.

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Matrix metalloproteinase-3 (MMP-3) is involved in the immunopathogenesis of rheumatoid arthritis (RA), but little is known about its relationship to genetic susceptibility and biomarkers of disease activity, especially acute phase reactants in early RA. MMP-3 was measured by ELISA in serum samples of 128 disease-modifying, drug-naïve patients and analysed in relation to shared epitope genotype, a range of circulating chemokines/cytokines, acute phase reactants, autoantibodies, cartilage oligomeric protein (COMP), and the simplified disease activity index (SDAI). MMP-3 was elevated >1.86 ng/ml in 56.25% of patients (P < 0.0001), correlated with several biomarkers, notably IL-8, IL-6, IFN γ, VEGF and COMP (r values = 0.22–0.33, P < 0.014–0.0001) and with CRP and SAA levels (r = 0.40 and 0.41, resp., P < 0.0000) and SDAI (r = 0.29, P < 0.0001), but not with erosions or nodulosis. However, the correlations of CRP and SAA with SDAI were stronger (respective values of 0.63 and 0.54, P < 0.001 for both). COMP correlated with smoking, RF, and MMP-3. MMP-3 is significantly associated with disease activity, inflammatory mediators and cartilage breakdown, making it a potential biomarker of disease severity, but seemingly less useful than CRP and SAA as a biomarker of disease activity in early RA.