Functional foods constitute a growing focus for research, product development and consumer interest in recent years. This study investigated the factors that affect willingness to pay for high fibre food on the market as well as respondents’ attitude towards the purchase of these products. The results indicated that those consumers in the high income group were more health conscious than their low income counterparts and willing to pay for high fibre products. The results showed that health risk perceptions as well as regulatory programmes affected consumers’ willingness to pay. The results also showed that at low percentage prices consumers were willing to pay for high fibre products. Gender and marital status did not seem to have an influence on willingness to buy for any of the selected products. Findings of the study could encourage food manufacturers to carry on with developments of functional foods since willingness to pay increased with increase in income. / Agriculture, Animal Health and Human Ecology

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Manual therapists are susceptible to occupational low back pain. The aim of this study was to determine the prevalence and risk factors for occupational low back pain in manual therapists and to determine and compare the prevalence and risk factors for occupational low back pain among various types of manual therapists in South Africa. This study was conducted as a cross-sectional survey and a self-administered questionnaire, developed from the literature and validated prior to the study, was mailed to 1500 randomly selected manual therapists, including: physiotherapists, occupational therapists, biokineticists, chiropractors, reflexologists, aromatherapists and massage therapists. A total of 233 completed questionnaires were returned, giving a response rate of 15.53%. Results revealed that the point prevalence of low back pain in manual therapists was very high at 41%, the one-year prevalence was 59% and the career prevalence was 74%. The point prevalence of low back pain was highest in aromatherapists and biokineticists, while both the one-year and career prevalence of low back pain was highest in occupational therapists and massage therapists. The risk factors for low back pain in manual therapists were: BMI; previous abdominal surgery; previous trauma to the low back, hips, knees or ankles; a physically stressful job; not having an assistant and work in a hospital or other setting. In keeping with the literature, various workrelated factors were implicated in the development and / or exacerbation of low back pain in certain manual therapists more than others and low back pain history in the different manual therapists was also in accordance with the literature. To conclude, low back pain is prevalent among South African manual therapists and the development and implementation of preventative programs to reduce rates of occupational low back pain in manual therapists is mandatory.

On t.p.: Master of Arts (Clinical Psychology) / Thesis (MA)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: Progress has been made in the approach to combating the spread of HIV/AIDS with regards to the Department of Health's presentation of the HIV/AIDS/STD Strategic Plan for South Africa. However, deep concem exists with regards to specific marginalized groups such as disabled persons within the South African sector threatened by the spread of HIV/AIDS. The aim of this paper was to review published academic papers on the specific ways in which disabled people are at risk for contracting HIV/AIDS, and the existence of primary prevention programmes designed and specifically aimed at the disability sector. The roles of non-governmental and other organisations were also looked at. The first section of the review focused on high-risk behaviour among disabled persons for contracting HIV/AIDS. Existing literature covered mainly areas of intellectual disability and psychiatric disability. Disabled persons struggle with the same issues of good education, workers' rights, gender equality, health care and social support and well-being as the general population. These issues are however exacerbated by struggles unique to those living with a disability. Inadequate public and social support increase disabled people's vulnerability to issues such as poverty, lack of resources, and inadequate education, heightening their risk of contracting HIV/AIDS. The second section of the review discusses the area of primary prevention, explaining why prevention programmes should be tailormade for specific needs such as those of disabled persons. Examples of prevention programmes from the literature are looked at, as well as a prevention initiative launched in South Africa. / AFRIKAANSE OPSOMMING: Vooruitgang is gemaak op die gebied van die voorkoming van die verspreiding van MIVNIGS met die bekendstelling van die Departement van Gesondheid se MIVNIGS/STD Strategiese Plan vir Suid-Afrika. Daar is wel steeds kommer oor spesifieke gemarginaliseerde groepe, soos gestremde persone, binne die Suid- Afrikaanse sektor wat bedreig word deur die verspreiding van MIVNIGS. Die doel van die studie was om 'n oorsig te kry van akademiese materiaal wat gepubliseer is oor die spesifieke wyses waarop mense met 'n gestremdheid in gevaar verkeer om MIVNIGS op te doen, asook primêre voorkomingsprogramme wat spesifiek ontwerp en gemik is op die gestremde sektor. Daar is ook gekyk na die rol van nie-regerings- en ander organisasies. Die eerste deel van die studie fokus op hoë risiko gedrag van gestremde persone wat hulle in gevaar mag stel vir die opdoen van MIVNIGS. Bestaande literatuur handel meestaloor die areas van intellektuele gestremdheid en psigiatriese siektes. Gestremde persone moet dieselfde uitdagings oorkom as diegene in die algemene populasie, soos byvoorbeeld die gebrek aan goeie onderwys, arbeidsregte, diskriminasie op grond van geslag, gesondheidssorg, asook sosiale steun en algemene welsyn. Gestremde persone se kwessies word egter vererger deur sekere uitdagings wat uniek is aan 'n lewe met 'n gestremdheid. Gestremde persone ontvang meestalonvoldoende publieke en sosiale steun wat dikwels armoede, gebrek aan hulpbronne en onvoldoende opvoeding tot gevolg het. Laasgenoemde verhoog gestremde persone se kanse om MIVNIGS op te doen. Die tweede deel van die studie bespreek primêre voorkomingsprogramme en waarom dit noodsaaklik is om voorkomingsprogramme te ontwerp wat uitsluitlik gemik is op spesifieke populasies. Daar word dan ook gekyk na voorbeelde van primêre voorkomingsprogramme in die literatuur, asook 'n voorkomingsinisiatief wat in Suid-Afrika geloods is.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Exposure to food contaminates such as mycotoxins have been associated with a variety of animal and human diseases worldwide. In South Africa, maize is the most To further refine risk assessment in the socio-demographic heterogeneous population of South Africa, the development and evaluation of a sensitive and interactive model the Mycotoxin Risk Assessment Model (MYCORAM) proofed to be more sensitive compared to the classical probable daily intake (PDI). The development of the MYCORAM was based on mycotoxin distribution during dry milling of maize in milling fractions intended for human consumption which was superimposed on the maize intake profiles of the South African population. Although dry milling, including a degerming step, is an effective way to reduce mycotoxins, risk and exposure assessment are influenced by maize dietary intakes, gender and ethnicity. This became evident when considering FB dietary exposure in rural maize subsistence farming communities in the Eastern Cape Province, South Africa confirmed the vulnerability of this subpopulation to risk of fumonisin exposure. Specific maximum tolerated maximum levels (MTL) to safeguard these communities fall outside the international regulatory processes and need to be urgently addressed. With the complex nature of cancer development in mind, integration of basic science and nutritional epidemiology will be important to contribute to our understanding of the adverse effects of FB and to define relevant risk assessment parameters. important commercial grain crop not just economically but also as a local food commodity both commercially and in subsistence rural farming communities. In order to control and manage mycotoxin contamination in food, evidence-based risk assessment is needed that includes mechanistic and human exposure studies. From this perspective the current study was conducted and aimed in further unravelling fumonisin B1 (FB1) mycotoxin induced hepatocarcinogenesis via the disruption of the lipid metabolism. The study also critically evaluates aspects of human risk assessment due to its relevance and importance to food safety known to impact on food security. This entails mycotoxin distribution during maize dry milling and the assessment of mycotoxin exposure in the South African population and vulnerable rural communities at risk. Fumonisin B1 affects the integrity of biological membranes by altering key lipid and fatty acid parameter in plasma, microsomal, mitochondrial and nuclear subcellular membrane fractions in rat liver. Changes in the major lipid constituents entailing an increase in cholesterol (CHOL) and phosphatidylethanolamine (PE) whilst sphingomyelin (SM) and phosphatidylcholine (PC) tended to decrease. Isolated plasma membrane lipid rafts, from rat primary hepatocytes exposed to FB1 augments the intricate effects exerted on the lipid metabolism regarding CHOL, SM and PE. The disruption of lipid and fatty acid constituents, such as arachidonic acid and ceramide, are likely to be key determinants affecting growth regulatory signaling pathways relevant to the critical balance between cell proliferation and apoptosis during cancer promotion. These changes provide further evidence that FB1 induce cancer promotion by differential inhibition and/or stimulation process whereby a few resistant “initiated” hepatocytes proliferate in an environment where the growth of normal cells is inhibited. A specific lipogenic phenotype is effected by FB1 which is closely associated with cancer development and considered to occur via an epigenetic-type of mechanism. These effects are not adequately addressed in defining risk assessment parameters. / AFRIKAANSE OPSOMMING: Die blootstelling aan voedsel-kontaminante soos mikotoksienes word wêreldwyd met ‘n verskeidenheid van dierlike en menslike siektes geassosiseer. In Suid-Afrika word mielies as ‘n belangrike graanoes beskou, nie net vir die ekonomie nie maar ook as ‘n plaaslike voedselproduk beide kommersieel en vir bestaansboere in landelike gemeenskappe. Ten einde mikotoksien-kontaminasie van voedsel te kan beheer en bestuur, vereis bewys-gebaseerde risiko-evaluering wat insluit meganistiese en menslike blootstelling studies. Vanuit hierdie perspektief is die huidige studie uitgevoer en gemik op die verdere ontleding van die fumonisin B1 (FB1) mikotoksien geïnduseerde lewer-karsinogenese deur die ontwrigting van die lipiedmetabolisme. Die studie ondersoek terselfdetyd aspekte van menslike risiko-evaluering ingevolge die relevansie en belangrikheid hiervan in voedselveiligheid wat ook ‘n impak op voedselsekerheid sal maak. Dit sluit in die verspreiding van mikotoksiene gedurende die droëmaalproses van mielies en mikotoksien blootstelling in Suid-Afrika asook onder kwesbare landelike gemeenskappe. Fumonisin B1 beïnvloed die integriteit van biologiese membrane deur die modulasie van die belangrike lipied en vetsuur samestelling van plasma, mikrosomale, mitochondriale en kern subsellulêre membraan-fraksies in rot lewer. Veranderinge in die belangrike lipiedbestanddele, insluitende ‘n verhoging in cholesterol (CHOL) en phosphatidylethanolamine (PE), terwyl sphingomyelin (SM) en phosphatidylcholine (PC) geneig was om te verlaag. Geïsoleerde plasma membraan lipied vlotte (lipid rafts), vanaf primêre rot hepatosiete blootgestel aan FB1, versterk die ingewikkelde gevolge wat uitgeoefen word op die lipiedmetabolisme insluitende die voorgestelde veranderings in CHOL, SM en PE vlakke. Die versteuring van lipiede en vetsure soos aragidoonsuur (arachidonic acid) en ceramied kan beskou word as belangrike determinante wat inmeng in groei-regulerende seinbane verwant aan die kritiese balans tussen selgroei en seldood. Die versteurings verskaf verdere bewyse dat FB1 kanker bevorder deur ‘n seleksie proses wat onderskeidelike die onderdrukking en\of die stimulasie van ‘n paar weerstandige of geneties veranderde hepatosiete laat vermeerder in ‘n omgewing waar die groei van normale selle geïnhibeer word. Die spesifieke lipogeniese fenotipe wat FB1 versoorsaak hou ten nouste verband met kankerontwikkeling en die voorkoms van epigenetiese-soort meganismes word voorgestel. Hierdie oorsake word tans nie voldoende aangespreek tydens die bepaling van risiko-evaluerings limiete nie. Om risiko-bepaling verder te verbeter in die sosio-demografies heterogene populasie van Suid-Afrika, was die ontwikkeling en evalueering van ‘n sensitiewe en interaktiewe model, die “Mycotoxin Risk Assessment Model” (MYCORAM) meer doeltreffend vergeleke met die gewone waarskynlike daaglikse inname. Die ontwikkeling van die MYCORAM was gebaseer op die mikotoksien verspreiding tydens die droëmaalproses van mielies in fraksies wat vir menslike verbruik bedoel was tesame met mielie dieetinnames van die Suid-Afrikaanse populasie. Alhoewel, die droëmaalproses van mielies, insluitende die verwydering van die kiem doeltreffende maniere is om mikotoksienes te verminder, word risiko- en blootstellings evaluering beinvloed deur mielie dieetinnames, geslag en etnieseverbandskap. Hierdie was veral opmerklik gedurende blootstelling aan FB in die dieet van landelike mielie bestaansboer gemeenskappe in die Oos-Kaap van Suid- Afrika en bevestig hoe kwesbaar hierdie populasie is. Spesifieke maksimum toelaatbare vlakke om hierdie gemeenskappe te beskerm val buite die huidige internasionale regulatoriese prosesse en benodig dringende aandag. Met die ingewikkelde aard van kankerontwikkeling in gedagte, sal die integrasie van basiese wetenskappe en voedingsepidemiologie, ‘n belangrik bydrae lewer tot die kennis van die negatiewe eienskappe van FB om toepaslike risiko-evaluerings limiete te kan bepaal.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Environmental Management / Master / Master of Science in Environmental Management

The purpose of this study was to retrospectively identify risk factors of elderly nursing home residents that may predict the hospitalization of recently admitted elderly nursing home residents. Two groups of randomly chosen residents were studied. The non-hospitalized group (n = 100) were admitted to a nursing home and remained in the facility for at least 90 days. The hospitalized group (n = 100) were discharged to a hospital within 30 days of admission to the nursing home. The presence of HCFA irregularities increased the odds for hospitalization of an elderly nursing home resident by 1.67. Regular medication orders on discharge increased the odds of hospitalization by 1.25. This study showed that the use of the 33 HCFA indicators are useful in identifying elderly nursing home residents that may be at an increased risk of hospitalization.

Aim: Antipsychotic medication is the predominant intervention used for psychosis in the UK. However, there are risks associated, it is not always effective and service-users express ambivalence towards taking it. The research aims to explore community mental health professionals’ perspectives on working with people with psychosis who express antipsychotic ‘medication refusal’. Method: A mixed-methodology was utilised. A survey of community mental health professionals was undertaken (N=74) to enquire about frequency of medication refusal and actions taken by professionals. Four uni-professional focus-groups were held to discuss the topic. The resulting data was subjected to a discursive analysis. Findings: Antipsychotic medication refusal was presented as a common experience by participants, with service-users often stopping against advice. A substantial proportion of survey participants reported experience of supporting service-users without using antipsychotics or to come off, with good rates of success. ‘Risk talk’ was a prevalent feature of the focus-groups: a range of ‘risk’ repertoires were drawn on by participants to warrant particular actions. Implications: Government initiatives relating to service-user choice, empowerment and recovery in mental health are in opposition to more pervasive ‘risk’ discourses. The notion of ‘risk’ in relation to antipsychotics needs further consideration, with professionals made more aware of its social construction and alternative conceptualisations of psychosis and antipsychotics.

Aims: To study practices and procedures with respect to electrotherapy in physiotherapy departments and to study physiotherapists’ perception of health risk, health consequences and protection of health from different risks including electromagnetic field emissions from electrotherapy devices. Methods: This cross-sectional study was conducted in three phases from June 2002 to December 2003. The first phase was an audit of the practices and procedures regarding electrotherapy in National Health Service physiotherapy departments (N = 46 including 7 departments in pilot study) located in 12 counties in the southeast and southwest of England including Greater London. The second phase comprised one observational visit to each of the same physiotherapy departments to characterise their occupational environment. The third phase was a questionnaire survey of 584 physiotherapists working in these departments. Variables concerned perception of health risk, health consequences and protection of health associated with different risk factors. Results: In the first two phases, the recruitment rate of the departments was 80.7% (46 out of 57) and response rate of those recruited was 100% (n=46). The response rate for the last phase of the study was 66.8% (390 out of 584). Results of the practices and procedures audit show that ultrasound was the most common form of electrotherapy while microwave diathermy was neither available nor used in these departments. Pulsed shortwave diathermy was used 4-5 days per week while continuous shortwave diathermy was used rarely. Electrotherapy was provided to up to 50% of patients per week in the departments. The observational visits to the departments revealed that there were metallic objects within close proximity of diathermy equipment and wooden treatment couches for treatment with PSWD and CSWD were rare. The risk perception survey showed that physiotherapists generally perceived a moderate health risk and health consequences (harm) from exposure to EMF emissions from electrotherapy devices. Protection from EMFs in physiotherapy departments was generally perceived as ‘usually’ possible. Conclusions: Physiotherapy departments report safe electrotherapy practices. Use of diathermy devices that use RF EMFs is declining. The key predictors of physiotherapists’ perception of health risk were perception of health consequences and vice versa. Gender was a significant predictor of the perception of health risks and health consequences. The main predictor of perception of protection against risk was the knowledge of environmental and health issues. Latent dimensions of perceptions of health risk, health consequences and protection from risk were identified and confirmed and their predictors were determined.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: Health risk behaviours can directly affect health outcomes. Healthy behaviours such as exercising and eating sensibly can lower the risk of conditions like heart disease and diabetes, while unhealthy behaviours such as smoking and excessive drinking raise the risk of conditions like lung cancer and liver disease. In a study using two large national data sets, the Youth Risk Behaviour Survey (YRBS) and Add Health, the Center on Addiction and Substance Abuse (CASA) found that teenagers who consume alcohol or take illicit drugs are more likely to engage in sex, to do so at a younger age, and to have several partners. For adolescents who are 14 years old and younger, consuming alcohol or using drugs doubles and quadruples, respectively, the likelihood that sexual intercourse has ever been experienced compared to adolescents who have never used these substances. A study reported that early onset of alcohol, tobacco and other drugs, school problems, delinquency, and physical aggression are significantly associated with early onset of sexual behaviour. Alcohol use in adolescence has also been found to be related to more frequent sexual activity and less frequent use of condoms. Aim: To investigate and explore the effect of a youth development programme (YDP) of combatting health risk behaviours amongst 250 Grade 8 learners in a selected high school in the Paarl area.