Browsing by Author "Philips, Lauren"
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- ItemThe association between tuberculosis and the development of insulin resistance in adults with pulmonary tuberculosis in the Western Sub-District of the Cape Metropole region(Stellenbosch : Stellenbosch University, 2015-12) Philips, Lauren; Visser, Janicke; Blaauw, Renee; Nel, D. G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.ENGLISH SUMMARY : Introduction: The existence of a bi-directional relationship between tuberculosis (TB) and insulin resistance (IR)/diabetes has been alluded to in literature. Although diabetes has been linked to increased TB risk, the relationship between TB as a causative factor for IR remains unclear. The study aimed to determine if an association existed between TB and IR development in adults with newly diagnosed pulmonary tuberculosis (PTB) at baseline. It was additionally aimed to document changes in IR status during follow-up. Methods: This observational, cross-sectional study evaluated ambulatory participants at baseline for IR prevalence via anthropometrical and biochemical measures, together with diagnostic IR tests [homeostasis model assessment–IR (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI)]. In addition, a prospective cohort sub-section study was performed on approximately half of the baseline study population (n=29), who were followed-up at two and five months whilst on TB treatment. Summary statistics, correlation co-efficients and appropriate analysis of variance were used to describe and analyse data. Participants were excluded if they presented with other forms of TB, were HIV-positive, obese or had any pre-disposing IR conditions such as diabetes or metabolic syndrome. Results: A total of 59 participants were included from August 2013 until December 2014. The majority of participants were male (81.4%) and the mean age was 33.95 ±12.02 years. The prevalence of IR was 25.4% at baseline, determined by using a calculated HOMA-IR cut-off point of 2.477. Patients with IR were shown to be younger (p=0.04) and had a higher fasting insulin level (p<0.01). Although the difference between IR levels in participants between baseline and follow-up was not significant, a decrease was experienced over time. Most participants (61.0%) presented with a normal BMI at baseline and the majority of anthropometrical measurements showed a significant increase over the follow-up period, mainly in the first two months of treatment. The majority of participants (84.7%) had an increased mean CRP (60.18 ±50.92 mg/L) and decreased mean HDL-cholesterol level [69.5% (males: 0.94 ±0.88 mmol/L; females: 1.14 ±0.88 mmol/L)] at baseline. Mean baseline values of fasting glucose and albumin were within normal ranges (4.82 ±0.80 mmol/L and 39.32 ±4.35 g/L respectively). According to fasting glucose levels at baseline, 1.7% and 3.4% of participants presented with impaired fasting glucose and diabetes mellitus respectively. Several biochemical markers (CRP, albumin and white cell count) showed an improvement during the follow-up period. Conclusion: The study found an association between TB and IR development in newly diagnosed PTB patients. Many anthropometrical and biochemical measures showed improvements with time, especially during the intensive phase of treatment. Although not significant, IR levels decreased over time, which could be indicative of a clinical improvement. IR participants were shown to be younger and had a higher fasting insulin measurement. A high prevalence of IR among TB patients therefore highlights the need for early identification in order to facilitate a reversal of IR and prevent possible IR-related complications.
- ItemStaff 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, JanickeBackground: 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
- ItemThe association between tuberculosis and the development of insulin resistance in adults with pulmonary tuberculosis in the Western sub-district of the Cape Metropole region, South Africa : a combined cross-sectional, cohort study(Biomed Central, 2017-08) Philips, Lauren; Visser, Janicke; Nel, Daan; Blaauw, ReneeENGLISH SUMMARY : Background: The existence of a bi-directional relationship between tuberculosis (TB) and insulin resistance (IR)/ diabetes has been alluded to in literature. Although diabetes has been linked to increased tuberculosis risk, the relationship between tuberculosis as a causative factor for IR remains unclear. The study aimed to determine if an association existed between tuberculosis and IR development in adults with newly diagnosed pulmonary tuberculosis at baseline. It was additionally aimed to document changes in IR status during TB follow-up periods. Methods: This cross-sectional study evaluated ambulatory participants at baseline for IR prevalence via anthropometry, biochemistry and diagnostic IR tests [homeostasis model assessment-IR (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI)]. A prospective cohort sub-section study was additionally performed on approximately half of the baseline study population, who were followed-up at two and five months whilst on tuberculosis treatment. Summary statistics, correlation co-efficients and appropriate analysis of variance were used to describe and analyse data. Participants were excluded if they presented with other forms of tuberculosis, were HIV-positive, obese or had any pre-disposing IR conditions such as diabetes or metabolic syndrome. Results: Fifty-nine participants were included from August 2013 until December 2014 (33.95 ± 12.02 years old; 81. 4% male). IR prevalence was 25.4% at baseline, determined by a calculated HOMA-IR cut-off point of 2.477. Patients with IR were younger (p = 0.04). Although the difference between IR levels in participants between baseline and follow-up was not significant, a decrease was observed over time. The majority of participants (61.0%) presented with a normal BMI at baseline. Mean baseline values of fasting glucose were within normal ranges (4.82 ± 0. 80 mmol/L), whereas increased mean CRP levels (60.18 ± 50.92 mg/L) and decreased mean HDL-cholesterol levels (males: 0.94 ± 0.88 mmol/L; females: 1.14 ± 0.88 mmol/L) were found. Conclusions: The study found an association between tuberculosis and IR development in newly diagnosed pulmonary tuberculosis patients. Although not significant, IR levels decreased over time, which could be indicative of a clinical improvement. A high prevalence of IR amongst young tuberculosis patients therefore highlights the need for early identification in order to facilitate a reversal of IR and prevent possible IR-related complications.