The aim of this study was to identify difficulties experienced by caregivers of children orphaned by HIV/AIDS. The aim was achieved through the following objectives: investigate the family background of caregivers of AIDS orphans; investigate the general emotional impact of caring for AIDS orphans on caregivers; investigate the health impact of caring for AIDS orphans on caregivers; investigate the extent of financial impact of caring for AIDS orphans on caregivers; investigate the impact of caring for AIDS orphans on the social life of caregivers; to make recommendations so as to assist in helping caregivers. A literature review and the qualitative empirical research method were used to achieve the aim and thus, the objectives stated above. The literature review revealed the following difficulties experienced by caregivers of AIDS orphans: lack of knowledge regarding the formal adoption of orphans; lengthy process administered by an increasingly overstretched system; bad behaviour by orphans; stress resulting to poor physical and mental health, strained personal relationships and lowering of standards of care; poverty; "role strain" and "identity"; interpersonal and family conflicts; isolation and fear for the future; excessive workload of having to care for children; and stigma and discrimination relating to HIV/AIDS. However, this study highlighted the following difficulties: poverty; stress and depression; family fights; adoption; bad influence on orphans by neighbours; education; lack of training; lack of social services support; lack of community support structures; and lack of prior planning by orphans' parents. The conclusions drawn from this study are that there were similar problems revealed in this study to those identified in the literature. For example, both literature and this study revealed poverty, stress and interpersonal and family conflicts as major problems experienced by caregivers. Grandparents and other family members who were caregivers in this study did not see "role strain" and "identity" as major stumbling blocks. Stigma and isolation were also some of the problems not directly experienced by most caregivers. However, it was evident that lack of involvement of some of these caregivers with the community, has led to their not experiencing stigmatisation and isolation. The following recommendations were made: caregivers should be given adequate training on how to use the grants given to orphans; researchers should use their research findings to influence government policy regarding termination of grants for orphans, that is, as long as orphans are still attending school or university, grants should not be terminated; universities and government should set aside special bursaries or study loans for orphans at universities, and these loans must only be paid when the orphans are in the position to do so; government should make extra funds available to give to caregivers as incentives; Social Welfare Department should be strengthen so that free counselling could be given to caregivers whenever is necessary; School-Based Support Teams (SBST) committees in schools should be capacitated and empowered; capacitate and empower non -governmental organisations (NGOs); and there should be a strong interaction between schools, NGOs, social workers, nurses and police. Limitations of the current study were also identified. This study could not show with absolute certainty whether the problems identified are related to orphanhood in general, rather than orphanhood by HIV/AIDS. Thus it was deemed necessary in future to have a comparison group of caregivers of orphans due to reasons other than HIV/AIDS. Other limitations included reliance on one population race. The study cannot ascertain whether these findings can be applicable to caregivers from other race groups such as white or coloured races. South Africa is a multicultural society with different norms and values. Thus, the way we react to certain stimuli might be influenced to a large extent by our customs and values. Further limitations included reliance on one specific type of caregiving. The study did not explore other type such as orphanages, but concentrated on what is regarded as the traditional safety net. / Thesis (M.Ed.)--North-West University, Vaal Triangle Campus, 2009.

Performance measurement and management have been evolving at state Departments of Transportation (DOTs) in recent years, and a variety of performance data is being utilized in different ways to guide decision-making processes. However, health considerations beyond air quality and safety are not yet being incorporated into performance management programs at state DOTs. Concurrently, Health Impact Assessments (HIAs) and other public health tools have seen increasing use among Metropolitan Planning Organizations (MPOs) and their stakeholders through collaboration with public health professionals. With the 2012 reauthorization of the surface transportation bill - Moving Ahead for Progress in the 21st Century (MAP-21) - state DOTs and MPOs have the opportunity to consider health proactively in transportation decision making to address the environmental sustainability requirements of MAP-21. This study investigates the possibility for integration between transportation performance measurement and management and the HIA approach, identifying and explaining the linkages between the two previously isolated processes. The study draws from best practices in performance measurement/management at state DOTs and various examples of health-related activities among MPOs and other planning to inform a suggested approach for incorporating health considerations and metrics in transportation decision making. The suggested approach recognizes common goals of health and transportation agencies, which are well-aligned with national objectives, and emphasizes the role of multidisciplinary interagency collaboration and partnership. This approach is intended to be a resource for state DOTs and MPOs that are interested in extending their performance measurement/management activities to formally include health considerations, as it can ease many of the implementation issues currently faced when considering broader health impacts of transportation.

Utvecklingen av den moderna arbetsplatsen har tagit form i hög konkurrens mellan organisationer, otrygga anställningar, orimliga krav på anställda som leder till ohälsa samt höga stressnivåer. Dagens ledare behöver ett aktivt arbete för att främja och bevara sina medarbetare och utveckla deras kompetens. Organisationer som mister medarbetare till konkurrenter eller sjukskrivningar förlorar resurser och blir lidande i längden. Detta leder till att organisationer behöver se över hållbarheten inom arbetsplatsen och ledarskapet. Att arbeta förebyggande med arbetshälsa och ledarskap kan påverka medarbetarna och gynna företag.Med kvalitativa metoder intervjuades chefer och medarbetare inom offentlig sektor för att fånga deras upplevelser kring hållbart ledarskap och dess påverkan på arbetshälsan. Studien använde en kombination av målinriktaturval och snöbollsurval. Resultatet från denna studie tyder på att ledarskap påverkar arbetshälsan till en viss del, allt ansvar ligger inte på en ledare. Den moderna arbetsplatsen kan arbeta med att minska stress och arbetsbelastning men inte ta bort det helt inom organisationen. Företag behöver se över resursanvändningen och se till att de använder dessa till sin fulla potential. / The development of the modern workplace has taken the form of high competition between organizations, insecure employment, unreasonable demands on employees that lead to an unhealthy environment and high stress levels. The leaders of today need to work actively in order to promote and retain their employees and develop their skills. Organizations that lose employees to competitors or sick leave lose resources and suffer in the long run. This means that organizations need to review sustainability in the workplace and leadership. Working preventively with occupational health and leadership can affect employees and benefit companies. Using qualitative methods, managers and employees in the public sector were interviewed to capture their experiences of sustainable leadership and the impact on occupational health. The study used a combination of targeted selection and snowball sampling. The results from this study indicate that leadership affects occupational health to a certain extent, all responsibility does not lie with a leader. The modern workplace can work to reduce stress and workload but not remove it completely within the organization. Companies need to review resource use and ensure that they utilize it to its full potential.

Magister Chirurgiae Dentium (MChD) / An analysis of the oral health related quality of life (OHRQoL) of patients with orofacial clefts at the Wentworth Foundation in Durban, KZN is presented. Objectives: To assess whether the OHRQoL of orofacial cleft patients varies amongst different age groups, genders or cleft types as well as demographic factors. Method: 46 participants, aged 8- 18, completed a self-administered Child Oral Health Impact Profile (COHIP) questionnaire. Results: The most prevalent cleft type was the Unilateral Cleft Left, 45.7%. The COHIP mean score was 84.195 (SD 18.244) ranging from 35 to 110. The age related subscales which were statistically significant included Functional well-being (p value: 0.0456), School Environment (p value: 0.0145) and Treatment Expectancy. The subscale School Environment was statistically significant for: Transport (p value: 0.0267) and Place of accommodation (p value 0.028). The Oral Health subscale and the Educational level were statistically significant (p value 0.043). Conclusion: Statistically significant age-related differences and demographic factors were noted. The OHRQoL of cleft patients was low largely due to socioeconomic factors and difficulty accessing multidisciplinary care. Therefore, our findings highlight the importance of establishing a Cleft lip and palate multidisciplinary facility for these patients in the Wentworth foundation and subsidised transport to the Wentworth Foundation is recommended.

Petroleum refineries emit a variety of airborne substances which may be harmful to human health. HEIDI II (Health Effects Indicators Decision Index II) is a computer-based decision analysis tool which assesses airborne emissions from Canada's oil refineries for reduction, based on ordinal ranking of estimated health impacts. The model was designed by a project team within NERAM (Network for Environmental Risk Assessment and Management) and assembled with significant stakeholder consultation. HEIDI II is publicly available as a deterministic Excel-based tool which ranks 31 air pollutants based on predicted disease incidence or estimated DALYS (disability adjusted life years). The model includes calculations to account for average annual emissions, ambient concentrations, stack height, meteorology/dispersion, photodegradation, and the population distribution around each refinery. Different formulations of continuous dose-response functions were applied to nonthreshold-acting air toxics, threshold-acting air toxics, and nonthreshold-acting CACs (criteria air contaminants). An updated probabilistic version of HEIDI II was developed using Matlab code to account for parameter uncertainty and identify key leverage variables. Sensitivity analyses indicate that parameter uncertainty in the model variables for annual emissions and for concentration-response/toxicological slopes have the greatest leverage on predicted health impacts. Scenario analyses suggest that the geographic distribution of population density around a refinery site is an important predictor of total health impact. Several ranking metrics (predicted case incidence, simple DALY, and complex DALY) and ordinal ranking approaches (deterministic model, average from Monte Carlo simulation, test of stochastic dominance) were used to identify priority substances for reduction; the results were similar in each case. The predicted impacts of primary and secondary particulate matter (PM) consistently outweighed those of the air toxics. Nickel, PAH (polycyclic aromatic hydrocarbons), BTEX (benzene, toluene, ethylbenzene and xylene), sulphuric acid, and vanadium were consistently identified as priority air toxics at refineries where they were reported emissions. For many substances, the difference in rank order is indeterminate when parametric uncertainty and variability are considered.

Syftet med examensarbetet är att bidra med ökad kunskap om hur plastanvändningen ser ut i dagens  byggande och vad den har för miljö- och hälsomässiga konsekvenser. Målet med studien är även att kunna visa på hur plastanvändningen kan förändras på ett hållbart sätt. Föratt kunna uppnå examensarbetets syfte och mål har tre stycken frågeställningar formulerats. Hur mycket och vilken typ av plast förekommer i en nybyggd villa idag? Vilka miljö- och hälsomässiga konsekvenser medför den plast som används i dagens byggande? Vad finns det för alternativa material, produkter och metoder? För att svara på dessa frågor har en grundläggande litteraturstudie gjorts kompletterat men enkvantitativ fallstudie. Fallstudien utgår från en villa som är typisk för hur nybyggda villor byggsidag,  år  2018.  Objektet  som  valts  för  fallstudien  är  en  nyproducerad  enplansvilla  på  170kvadratmeter boyta. Plastprodukter har inventerats i stommaterial, installationer, emballageoch förpackningar. Resultatet  av  inventeringen  visar på att  3181 kg plastprodukter inventerats i villan vilket betyder att nästan 19 kilogram plast går åt för varje kvadratmeter boyta. Viktmässigt återfanns85 procent av plasten i stommaterial, 11 procent i installationer och 4 procent till emballageoch förpackningar. Sammanställningen visar även att en övervägande del av plasten utgörs avpolystyren (PS). Därefter är polyvinylklorid (PVC), polyeten (PE) och polypropen (PP) de mestf örekommande plasterna. Plasterna har även bedömts ur ett miljö- och hälsoperspektiv. Bedömningen utgår ifrån trekategorier; toxicitet, klimatpåverkan och avfall. Resultatet av miljö- och hälsobedömningenvisar att polyeten (PE) och polypropen (PP) är de mest skonsamma plasterna för miljö ochhälsa,  bortsett  från  biobaserade  plaster.  Den  farligaste  plasten  är  enligt  denna  studiepolyuretan (PUR) tätt följt av polyvinylklorid (PVC), polykarbonat (PC) och polystyren (PS). Miljö- och hälsobedömningen av olika plasttyper visar på att det är viktigt att plast inte ses somett material utan en grupp av många olika material med olika egenskaper som är mer ellermindre  problematiska  för  hälsa  och  miljö.  Analysen  visar  även  att  flera  plastprodukter  i byggnadens stomme kan ersättas med alternativa material och på så sätt reducera inte baramängden plast utan även de miljö- och hälsokonsekvenser som plasten medför. För installationsplast är det bästa alternativet i dagsläget att byta PVC-plast till bättre plast såsom PE och PP. Detta för att minska påverkan på miljö och hälsa både vid tillverkning ochåtervinning. För emballage- och förpackningsplast gäller det främst att minska engångsanvändningen och öka återanvändningen av förpackningsplasten. För vidare studier kan det undersökas med vilka medel kan man hjälpa beslutsfattare inombyggbranschen att välja mer hållbara material, och studera hur stor påverkan den ekonomiskaaspekten har när material ska väljas. Ett annat förslag är att titta på hur plastanvändningenskiljer sig åt för olika typer av byggnader; flerbostadshus, offentliga byggnader, fritidshus.

Aims: To describe the health behaviours and health of those described as health workers; explore the possible effect of work on their health and early exit from the workforce; and make comparisons to other occupational groups. Study design and methods: The aims were addressed through 5 studies incorporating both a literature review and secondary analyses of existing data sets using both cross-sectional and longitudinal approaches. Data was collected on demographic data, health, health behaviours, impact of health on work, and workforce exit. Descriptive analysis was used to summarise the comparisons and binary logistic regression and Cox proportional Hazard models were applied to give more in depth analysis. Results: A disability was reported by 11.1% of nursing and midwifery professionals compared to 7.1% of health professionals and 16.8% of caring personal service workers. One in four nursing and midwifery professionals reported a health problem that affected the amount and type of work they could undertake compared to one in two workers categorised in other occupations. Predictors of poor health included demographics, occupation and health behaviours. Age appeared to be the only significant predictor of workforce exit in the study. Compared to nursing and midwifery professionals, those identifying themselves as nursing auxiliaries, care assistants, and home carers were significantly more likely to leave the workforce before retirement age (p ˂ 0.001).Conclusion: The findings suggest that nurses' health is poorer than some other health professionals and that they engage in a number of health behaviours known to lead to health problems. Occupation plays a direct or indirect role on health and early exit from the labour market; however, the inter-relationship appears complex. Further research is needed to understand, address and improve the health of nurses and care workers. Factors that explain auxiliaries', care assistants' and carers' workforce exit also require further examination.

Le recours de plus en plus fréquent à l’évaluation monétaire des impacts sanitaires permet de les intégrer aux processus de décision, souvent fondés sur des critères essentiellement économiques, et de prendre en compte les préférences des personnes concernées. Il conduit à s’interroger sur la fiabilité des méthodes et sur leur adaptation au contexte de la décision. Ce travail se propose de déterminer la robustesse des valeurs monétaires des impacts sanitaires estimées par évaluation contingente en traitant de la question suivante : la cause de l’impact sanitaire influence son évaluation ? La théorie économique précise d’une part que l’évaluation d’un impact sanitaire ne devrait dépendre que de ses caractéristiques et non de ses causes, et d’autre part, qu’il faut fournir l’ensemble des informations nécessaires à l’évaluation. En pratique, les évaluations contingentes énoncent parfois des causes, avec des résultats variables. Une évaluation contingente a été conduite pour analyser l’influence des causes de la bronchite pulmonaire chronique obstructive sur son évaluation, en comparant quatre versions du questionnaire : la cause n'est pas citée ; la cause est principalement imputable au tabac et à la pollution de l’air ; la cause n'est que la pollution de l’air ; ou que le tabac. Les résultats montrent que la mention des causes possibles et crédibles augmente l’acceptabilité du questionnaire. Lors de la détermination du consentement à payer, les divers contextes ont moins d’influence que les caractéristiques des personnes interrogées, en particulier leur santé et l’environnement (alimentation saine, activité physique, pollution du lieu de vie). Par conséquent, fournir des informations sur les causes de l’impact sanitaire évalué permettrait d’améliorer la fiabilité de l’évaluation. Il faut noter que les incertitudes restent importantes, notamment parce que l’exercice reste inusité en France où la Sécurité Sociale couvre en grande partie les dépenses de santé. / Monetary valuation of health impacts is increasingly used to support decision process, often relying mainly on economic criteria, and to take into account preferences of concerned people. This use leads to questioning the reliability of the methods and their adaptation to the context of decisions support. This work aims at determining the robustness of monetary values of health impacts estimated by contingent valuation via the following question: does the cause of the assessed health impact influence its monetary value? Economic theory outlines that, on the one hand monetary value of an health impact should depend on its characteristics only and not on its causes, on the other hand all information useful to the valuation should be provided. In practice, contingent valuations sometimes state the causes, with inconsistent results. A contingent valuation was conducted to analyze the effect of cause of chronic obstructive pulmonary disease, with four versions of the questionnaire: the cause is not indicated, the causes are said to be mainly smoking and air pollution, the cause is said to be air pollution only, and smoking only. Results show that stipulating the possible causes increases the acceptability of the questionnaire. The willingness to pay depends less on the causes but more on the personal characteristics of the respondents, especially their health and environment (healthy diet, sport practice, pollution in living area). To conclude, providing information about the causes of the valued health impact would increase the reliability of the assessment. Uncertainties remain high in particular as this valuation stays unusual in France where the National Health Service covers most of health expenses.

Health impact assessments for fine particulate matter (PM2.5) often rely on simulated concentrations generated from air quality models. However, at the global level, these models often run at coarse resolutions, resulting in underestimates of peak concentrations in populated areas. This study aims to quantitatively examine the influence of model resolution on the estimates of mortality attributable to PM2.5 and its species in the USA. We use GEOS-Chem, a global 3-D model of atmospheric composition, to simulate the 2008 annual average concentrations of PM2.5 and its six species over North America. The model was run at a fine resolution of 0.5 × 0.66° and a coarse resolution of 2 × 2.5°, and mortality was calculated using output at the two resolutions. Using the fine-modeled concentrations, we estimate that 142,000 PM2.5-related deaths occurred in the USA in 2008, and the coarse resolution produces a national mortality estimate that is 8 % lower than the fine-model estimate. Our spatial analysis of mortality shows that coarse resolutions tend to substantially underestimate mortality in large urban centers. We also re-grid the fine-modeled concentrations to several coarser resolutions and repeat mortality calculation at these resolutions. We found that model resolution tends to have the greatest influence on mortality estimates associated with primary species and the least impact on dust-related mortality. Our findings provide evidence of possible biases in quantitative PM2.5 health impact assessments in applications of global atmospheric models at coarse spatial resolutions.

Globally, coal-fired power plant (CFPP) is a major source of mercury. China is developing its first National Implementation Plan on Mercury Control, which priorities the control of emissions from CFPPs. While social benefits play an important role in designing environmental policies in China, the benefits associated with mercury control are not yet understood, mainly due to the scientific challenges to trace mercury's emissions-to-impacts path. This study evaluates the benefits of mercury reductions in China's CFPPs for China and its three neighboring countries in East Asia. Four policy scenarios are analyzed following the policies-to-impacts path, which links a global atmospheric model to health benefit analysis models to estimate the economic gains from avoided mercury-related adverse health outcomes under each scenario, and take into account key uncertainties in the path. Under the most stringent scenario, the benefits of mercury reduction by 2030 are projected to be $432 billion (95% CI: $166–941 billion), with the benefits for China and the neighboring countries accounting for 96% and 4% of the total benefits, respectively. Policy scenario analysis indicates that coal washing generates the greatest benefits in the near term, whereas upgrading air pollution control devices maximizes health benefits in the long term.