Knowledge and safer practices regarding occupational exposure are crucial to all employees working in healthcare facilities, especially Tuberculosis (TB) hospitals. This study aimed to explore and describe the knowledge and practices of employees working in three specialised TB hospitals regarding occupational exposure to TB. The results of the study will be used to make recommendations to the Eastern Cape Department of Health (ECDOH) and hospital managers that could assist in reducing the prevalence of occupational TB. This quantitative, descriptive and contextual study was conducted in three specialised TB hospitals in the Nelson Mandela Bay Health District (NMBHD). Convenience sampling was used to select the research participants. The knowledge and practices of 181 employees towards occupational exposure to TB and infection control was measured through a self-administered questionnaire. The questionnaire covered areas such as the knowledge of TB and infection control, the infection control policy, infrastructure as well as patient transportation. The whole population was targeted and out of a potential 253 employees, 181 were on duty during the stage of data collection and agreed to willingly participate in the study. The data was analysed descriptively using MS excel and MS word. This study revealed that 69% (n=124/181) of employees in the three specialised TB hospitals in the NMBHD have adequate knowledge of infection control. However, only 10% (n=18/181) of employees reported appropriate infection control practices, while almost half of the participants 42% (n=76) apparently practice infection control poorly. The majority (78%, n=141) of the employees in the three specialised TB hospitals in the NMBHD reported knowing about the availability of an infection control policy in their respective hospitals, however only 42 % (n=76) have reportedly read the policy. In conclusion, knowledge and practices regarding occupational exposure in specialised TB hospitals in the NMBHD is not optimal. It is however, important to note that the majority of employees have knowledge about the TB disease itself and its symptoms. Recommendations were made in order to improve infection control knowledge and practices. These include the development of a plan for purchasing of equipment to address infection control, development of a curriculum specific for non-nursing personnel and the establishment of a plan to ensure the availability of patient consultation rooms and dining halls. A further recommendation deemed important by the researcher was isolation glass as a compulsory specification when purchasing patient transportation vehicles, in order to provide protection for the drivers transporting patients to and from the hospital.

Human exposure to methylmercury (MeHg) through diets (e.g., fish and rice) is a global health concern. Although MeHg exposure through fish consumption has long been considered the major route of mercury health risks, studies concerning the long-term changes in MeHg exposure from fish remain lacking. In sharply contrast to the fish MeHg issue, the presence of MeHg in rice has only been reported recently and its implications on MeHg exposure, albeit probably important, are still in infancy. Focusing on the discrepancies in the studies of MeHg exposure through fish and rice consumption, this study was aimed to assess the MeHg exposure of human infants through consumption of rice cereals and to evaluate the long-term changes in fish MeHg. The presence of MeHg in rice prompted the studies on MeHg concentrations and bioaccessibility in rice cereals and potential infant dietary exposure to MeHg through cereal consumption, which is believed to be the first of its kind. The analysis of a variety of infant cereals sampled from the common markets in the United States and China showed that the concentrations of MeHg in the cereals ranged from 0.07 to 13.9 µg/kg with a mean of 1.61 µg/kg. On the basis of these MeHg concentrations, the daily intake of MeHg through rice cereal consumption for infants was estimated to be 4-122% of the reference dose (RfD). The MeHg bioaccessibility in the cereals, determined using an in vitro digestion method, ranged from 25 to 74% with a mean of 48±16%. A further examination on these results, however, revealed the occurrence of MeHg re-adsorption during extraction steps, which leads to the underestimation of MeHg bioaccessibility and warrants cautions to be exercised when using these procedures to evaluate bioaccessibility in general. The long-term changes in fish MeHg were investigated through conducting a comprehensive data analysis on datasets for the Everglades, a well-studied aquatic ecosystem for Hg contamination. The results showed a clear decline of MeHg in mosquitofish in the Everglades during the past two decades, which was probably related to changes in environmental conditions (e.g., periphyton, dissolve organic matter, and sulfate) instead of mercury deposition.

Background: Adolescence is a period of immense behavioral, psychological and social changes and challenges and characterized as a stage of increased imitation and exploration with a range of health-risk behaviors (HRBs). Although there is no uniform definition of HRB worldwide, it is generally considered as behavior that negatively affects health. Prior studies reported that HRBs among adolescents mainly include substances use that consist of the use of alcohol, tobacco, psychoactive drugs; behaviors that contribute to unintentional injuries and violence; sleep behaviors that mainly consist of sleep disturbance and insomnia; mental health including depression, suicidal behaviors and so on. Since the 1980s, with the Open Up policy, living conditions and annual incomes have improved dramatically in both urban and rural households in China, and Chinese adolescents are becoming more and more easily exposed to HRBs. Adolescent HRB has been a major public health problem in China. However, to our knowledge, there are only few small scale studies on HRBs among Chinese adolescents: A previous study in Zhejiang province indicated that approximately 40.0% of Chinese adolescent smokers started smoking before 10 years of age; previous studies in Beijing reported that approximately 70.0% of the study adolescents reporting prior alcohol consumption, about 15.9% of juvenile school students and 1.1% of secondary vocational school students admitted illicit drugs use; 20.8% of Chinese adolescents in Guangdong province reported being involved in bullying behaviors; 16.9% of the Chinese adolescents in Shandong province was troubled with sleep disturbance; 15.8% of adolescents in Guangzhou reported having depressive symptoms; 19.0% of Chinese rural adolescents in Shandong province reported having had suicidal ideation, and 7.0% reported having made a suicidal attempt during the past 6 months. It is necessary to conduct large scale survey studies to determine the sheer number of adolescents with HRBs in mainland China and whether HRBs and their correlates occur in Chinese adolescents in similar way to their manifestation in Western countries. Additionally, although HRBs among Chinese adolescents are prevalent, there is few existing policies for preventing or controlling HRBs in China. For example, although China has signed the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2003 and ratified the treaty in 2005, there is no national smoke-free law in China. So far, only 13 cities of China revise or formulate local smoke-free regulations in accordance with FCTC Article 8 Guidelines. Therefore, we conducted a large-scale survey study using a multistage, stratified cluster, random sampling method to obtain a representative sample of high school students and a scoping review summarizing and accessing the existing policies in China to prevent or control adolescent HRBs, in order to estimate the prevalence of current drinking, current smoking, sleep disturbance, depressive symptoms, nonmedical use of prescription drug, illicit drugs use, being bullied, bullying others, both being bullied and bullying others, suicidal ideation, and suicidal attempts among Chinese adolescents; to explore the relationships between sociodemographic, family, school, psychosocial characteristics and each type of HRBs; to examine the internal associations between the HRBs, including the association between sleep disturbance and depressive symptoms, the association between depressive symptoms, bullying and current smoking, and the association between non-medical use of prescription drugs and suicidal behaviors; and to make suggestions for helping develop prevention and intervention programs to reduce adolescent HRBs in China.Methods: A large-scale cross-sectional study was conducted in three provinces of China, and a multistage, stratified cluster, random sampling method was used to a representative sample of junior and senior high school students. Data were collected from a structured questionnaire between 2011 and 2012. Additionally, we conducted a scoping review to summarize the existing policy strategies relating to adolescent HRBs in China. The framework outlines a five-stage approach including identifying the research question; searching for relevant studies; selecting studies; charting data; and collating, summarizing, and reporting the results. Findings: Our survey study findings demonstrated that substance use was prevalent among Chinese adolescents, adolescents’ alcohol use was the highest substance use, and illicit drugs use among Chinese adolescents was lower than other countries; the prevalence rates of bullying behaviors, depressive symptoms, and suicidal behaviors were similar with other previous reports. Moreover, our study found that gender differences were significant in the extent of alcohol use, cigarette use, and drugs use; boys had a higher level of substance use than girls. Students who reported below average family economic status were at a higher risk of HRBs, and poor classmate relations, poor relationships, and below average academic performance were positively associated with most of the HRBs. Furthermore, our scoping review demonstrated that current Chinese national and local efforts focus on expanding smoke-free environments by restricting smoking in schools, hospitals, workplaces, or public places; many of these environments have limited or no restrictions on smoking. Moreover, although more and more public are aware of the problems (e.g. liver and cardiovascular disease, mental disorders, and unintentional injuries) caused by alcohol drinking, there is almost no alcohol control policy in China. Additionally, although the Chinese public are aware of the negative consequences of school bullying behaviors, there is no existing law related to anti-school bullying in China now.Conclusions: In conclusion, Chinese adolescent HRB is a major public health problem nationally, and an adolescent’s family, school, and psychosocial factors have influences on their substance use habits. We suggest that effective prevention and intervention programs should be established and the role of the government, school, family, and individual should be considered. Our study recommends strengthening regulations to limit the sale of substances to adolescents, establishing a surveillance system to monitor and control the adolescent substances use, and providing health services to promote resilience among adolescents involved in mental health problems or bullying behaviors. / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

Philosophiae Doctor - PhD / Background: There is compelling body of evidence that coronary heart disease (CHD) risk factors are present in people of all ages. The extent to which the problem exists in university students in South Africa (SA) has not been confirmed in the literature. Furthermore, the effects of physical activity, physical fitness, diet and health behaviours on CHD risk factors has not been studied extensively in SA and needs further investigation. Aim: The aim of the study was to assess the impact of multiple behaviour health intervention strategies on CHD risk, health-related physical fitness(HRPF) and healthrisk behaviours (HRB) in first year students at the University of the Western Cape (UWC). It was hypothesized that exposure to various health behavioural interventions would reduce CHD risk factors in subjects at moderate risk, and improve health-related physical fitness, as well as health-risk behaviours.Methods and Study Design: An experimental study design was used wherein subjects at moderate risk for CHD were identified and exposed to multiple health behavioural interventions for 16 weeks in order to determine the impact of the various interventions on CHD risk, health-related physical fitness and health-risk behaviours. Population and Sample: The target population consisted of first year students at UWC aged 18 – 44 years who were screened and a sample of 173 subjects were identified as being at moderate risk for CHD. Next, the subjects were randomly assigned to a control and four treatment groups, namely, health information, diet, exercise, and a multiple group that included all three treatments. The intervention, based upon Prochaska‟s Transtheoretical Model of behaviour change, continued for a period of 16 weeks and, thereafter, the subjects were retested. Data Collection Process: Subject information was obtained using self-reported questionnaires, namely, the physical activity readiness questionnaire (PAR-Q), the stages of readiness to change questionnaire (SRCQ), the international physical activity questionnaire (IPAQ), and the healthy lifestyle questionnaire (HLQ), together with physical and hematological (blood) measurements. The measurements taken before and after the intervention programme were the following:• Coronary heart disease risk factors, namely: family history, cigarette smoking, hypertension, obesity, dyslipidemia, impaired fasting glucose and a sedentary lifestyle; • Health-related physical fitness, namely: body composition, cardiovascular fitness, muscular strength, muscular endurance, and flexibility; and • Health-risk behaviours, namely: physical activity, nutrition, managing stress, avoiding destructive habits, practising safe sex, adopting safety habits, knowing firstaid, personal health habits, using medical advice, being an informed consumer, protecting the environment and mental well-being. Types of interventions: A control group was used in which subjects did not receive any treatment. The health behavioural interventions were arranged into four groups of subjects that received either the health information, diet, exercise or a combination of all three individual treatments. Statistical analyses of data: In the analyses of the data, the procedure followed was that where the outcome variable was approximately normally distributed, the groups were compared using a two-sample t-test. For outcomes with a highly non-normal distribution or ordinal level data, the nonparametric Wilcoxon Rank Sum test was used for group comparisons. To account for baseline differences, repeated measures analysis of variance was used. In the case where nonparametric methods were appropriate, analysis was done using Cochran-Mantel-Haenszel (CMH) methodology stratifying on the baseline values. For the case of nominal level outcomes, groups were compared by Chi-square tests for homogeneity of proportions. When baseline values needed to be incorporated into the analysis, this was done using CMH methodology. Main Outcome Measures: The main outcome measures tested in the study related to the three areas of investigation, namely: • Modifiable CHD risk factors: systolic and diastolic blood pressure, cigarette smoking, total cholesterol (TC) concentration, high-density lipoprotein (HDL) cholesterol concentration, low-density lipoprotein (LDL) cholesterol concentration, triglycerides, fasting glucose, body mass index, waist circumference, waist-hip ratio and physical inactivity; • Health-related physical fitness: body mass, percent body fat, absolute body fat, percent lean body mass, absolute lean body mass, the multi-stage shuttle run, handgrip strength, repeated sit-ups in a minute, and the sit-and-reach test; and • Health-risk behaviours: physical activity, nutrition, managing stress, avoiding destructive habits, practising safe sex, adopting safety habits, knowing first aid, personal health habits, using medical advice, being an informed consumer, protecting the environment and mental well-being. Results: The results showed significant decreases for body mass, waist and hip circumferences, resting heart rate, systolic blood pressure, cigarette smoking and a sedentary lifestyle (p < .05) primarily in the multiple group. No significant differences were recorded for blood biochemistry, however, favourable trends were observed in the lipoprotein ratios. For health-related physical fitness, only the multiple group showed significant (p < .005) improvements in predicted maximal oxygen consumption ( O2max), body composition, muscular strength and muscular endurance. The exercise group also recorded significant differences in muscular endurance. In all groups, including the controls, no significant differences were found for stature, waist-hip ratio, and flexibility at pre- and post-test. Overall, the participants reflected positive health behaviours, especially for managing stress, avoiding destructive habits, practising safe sex, adopting safety habits, personal health habits and mental well-being at pre- and post-test. The intervention programme had a corrective influence on providing the participants with a more realistic perception of their level of physical activity and nutritional habits. The participants scored poorly on being informed consumers and for recycling waste both at pre- and post-test. A substantial net reduction in CHD risk factors as well as in cumulative risk was achieved with treatment that impacted positively on the re-stratification of participants at moderate risk. In terms of treatment efficacy, the dietary intervention appeared to be the least effective (10.91%), with health information and exercise sharing similar levels of efficacy (32.81% and 33.93%, respectively) and, the combined treatment in the multiple group stood out as the most effective treatment (50.00%), and supported the hypothesis of the study. Conclusions: The net and cumulative decline in CHD risk factors was substantial with treatment and was directly related to the number of treatments administered. The evidence suggests that such multiple health behaviour interventions when implemented through a university-based setting have substantial benefits on reducing CHD risk and may be of considerable public health benefit. Key messages • Despite being a relatively educated population, a substantial number of first year university students are at considerable heart disease risk. • Physical inactivity constitutes one of the main CHD risk factors amongst first year students and, together with smoking, place many of them at moderate CHD risk. • The effectiveness of health behavioural strategies designed to modify lifestyle and prevent coronary heart disease is supported by this study.

Quantitative soil ingestion studies employing a mass balance tracer approach have been used to determine soil ingestion rate for use in human health risk assessments (HHRAs). Past studies have focused on soil ingestion in populations living in urban/suburban environments and the results have been highly variable. Moreover, there is a paucity of reliable quantitative soil ingestion data to support human health risk assessments of other lifestyles that may be predisposed to ingesting soil, such as indigenous populations following traditional lifestyles. Thus, the primary objective of the research was to determine if populations following lifestyles typical of traditional land use practices in rural or wilderness areas ingest more soil than populations living in urban or suburban environments. Further, the research investigated the use of alternative mass balance tracers, specifically isotopes of the 238U and 232Th decay series, to reduce soil ingestion estimate variability. Mass balance tracer methods were developed and validated in a pilot canine study, and methods using isotope tracers were adapted to permit quantification of sediment ingestion in the benthic fish Moxostoma macrolepidotum (Shorthead Redhorse Sucker). A pilot human soil ingestion study of 7 subjects from an Aboriginal community in British Columbia was conducted over a 3-week period. The mean soil ingestion rate calculated using the daily means of the 4 elemental tracers with the lowest food-to-soil ratios (i.e., Al, Ce, La, Si) was observed to be approximately 74 mg d-1 (standard deviation 91 mg d-1), The median soil ingestion rate was 60 mg d-1, and the 90th percentile was 196 mg d-1. These soil ingestion rate estimates are higher than those currently recommended for HHRAs of adults, and higher than those obtained in most previous studies of adults. However, the estimates are much lower than the earlier qualitative assessments for subsistence lifestyles (i.e., 330-400 mg d-1). The study results also demonstrated that isotopes of the 238U and 232Th decay series radionuclide are not reliable mass balance tracers for estimating soil ingestion in humans; however, they may be useful for quantifying soil and sediment ingestion in wildlife.

Background: Oral health is crucial for overall health. Oral health care need is the most prevalent unmet health care need among children and adolescents in the United States. Youth characteristics and socio-demographic factors are known to influence dental health service utilization. While there have been studies listing the factors contributing to the oral health disparities in the Appalachian region, very few studies have inspected the risk behaviours of the youth and their association with dental health care utilization. Methods: A structured questionnaire was administered to high school students in five counties of South-Central Appalachia. The survey included a question on a recent dental visit. The students provided information on socio-demographic characteristics and risk behaviours. Descriptive analysis was performed and the association between recent dental visit as the outcome variable and sociodemographic factors and health risk behaviours as independent variables were analyzed using logistic regression analysis. The analysis was performed using SAS 9.4. Results:80.1% (N= 129) of the adolescents who had admitted to using tobacco products or electronic vapour products reported having visited the dentist in the past 12 months. 87.5% (N= 168) of the females and 80.3% (N=127) of the males reported having visited the dentist in the past 12 months and 81.43% (N=114) of the adolescents who received free or reduced lunch reported having visited the dentist in the past 12 months. Use of tobacco products was the only health risk behaviour significantly associated with dental visit in the past 12 months (p=0.04) after adjusting for covariates with OR=0.5 (95% C I:0.312 -1.01). Conclusion: The findings suggest that health risk behaviours such as using tobacco products may be associated with dental health care utilization and future research should focus on adolescents with health-risk behaviours with the goal of identifying interventions for at-risk populations. Keywords: Oral health, health disparities, youth, health risk behaviours

Philosophiae Doctor - PhD / The increasing evidence of chemicals of emerging concern (CECs) in water bodies is causing major concern around the world because of their toxicological effects upon humans and aquatic organisms. The release of wastewater to the aquatic environment is most likely to introduce some trace levels of organic contaminants, some of which may be toxic, carcinogenic, or endocrine disruptors, as well as, persistent in the environment. These compounds are often persistent but not regularly monitored because they are mostly still excluded from environmental legislation. Their fate and persistence in the environment are not well understood

State-approved membrane filtration (MF) techniques for water quality assessments were contrasted with metagenomic shotgun sequencing (MSS) protocols to evaluate their efficacy in providing precise health-risk indices for surface waters. Using MSS, the relative numerical abundance of pathogenic bacteria, virulence and antibiotic resistance genes revealed the status and potential pollution sources in samples studied. Traditional culture methods (TCM) showed possible fecal contamination, while MSS clearly distinguished between fecal and environmental bacteria contamination sources, and pinpointed actual risks from pathogens. RNA MSS to detect all viable microorganisms and qPCR of fecal biomarkers were used to assess the possible environmental risk between runoff drainage canals and a swamp area with no anthropogenic impact. Results revealed higher levels of pathogenic bacteria, viruses, and virulence and antibiotic resistance genes in the canal samples. The data underscore the potential utility of MSS in precision risk assessment for public and biodiversity health and tracking of environmental microbiome shifts by field managers and policy makers. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第22766号 / 工博第4765号 / 新制||工||1745(附属図書館) / 京都大学大学院工学研究科都市環境工学専攻 / (主査)教授 米田 稔, 教授 高野 裕久, 准教授 藤森 真一郎 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

Endocrine disrupting chemicals (EDCs) are ubiquitous in the environment and have been detected in drinking water. Although various water treatment processes can remove EDCs, chemicals can migrate from pipes that transport water and contaminate drinking water. Globally bottled water consumption is steadily rising as an alternative to tap water, but EDCs have also been detected in bottled water. Sources of EDCs in bottled water include contamination of the water source, contamination through the production process or the migration of EDCs from the packaging material. There is limited information on EDCs in drinking water and bottled water from South Africa. The aim of this study was to determine the estrogenic activity, levels of selected EDCs and the potential health risks associated with the consumption of water from selected distribution points in Pretoria (City of Tshwane) and Cape Town as well as bottled water. The study consisted of 3 phases. Phase 1 included the analysis of drinking water samples from ten water distribution points in Pretoria and Cape Town collected over four sampling periods. In phase 2, ten brands of bottled water were analysed after exposure to different storage conditions (20°C, 40°C, light and dark) for 10 days. Samples were extracted using a C18 solid phase extraction method. Estrogenic activity was assessed using the recombinant yeast estrogen screen (YES) bioassay and the T47D-KBluc reporter gene bioassay. The extracts were analysed for di(2-ethylhexyl) adipate (DEHA), di(2-ethylhexyl) phthalate (DEHP), diisononylphthalate (DINP), dibutyl phthalate (DBP), bisphenol A (BPA), nonylphenol (NP), 17β-estradiol (E2), estrone (E1) and ethynylestradiol (EE2) using UPLC-MS. Phase 3 consisted of a scenario based health risk assessment to assess the carcinogenic and toxic human health risks associated with the consumption of distribution point and bottled water. All the samples were below the detection limit (dl) in the YES bioassay, but estrogenic activity was detected in bottled and distribution point water using the T47D-KBluc bioassay. All samples were below the 0.7 ng/L trigger value for estrogenic activity in drinking water. NP was below the dl for all the samples, E2 was detected in five distribution point samples and E1, EE2, DEHA, DEHP, DINP, DBP and BPA were detected in distribution point and bottled water samples. The estrogenic activity and levels of target chemicals were comparable to the levels found in other countries. Hazard quotients for BPA, DEHA and DINP were higher in bottled water compared to distribution point water. The greatest non-carcinogenic health risk was posed by E1 in distribution point water from Pretoria and the highest cancer risk by levels of DEHP in distribution point water from Cape Town. However, overall, health risk assessment revealed acceptable health and carcinogenic risks associated with the consumption of distribution point and bottled water. Although the potential health risks posed by the EDCs found in the water samples in this study were low, the fact that potential EDCs were found in the water samples are still of concern. A monitoring strategy that also includes water from other municipalities and other brands of bottled water are therefore recommended. / Thesis (PhD)--University of Pretoria, 2016. / School of Health Systems and Public Health (SHSPH) / PhD / Unrestricted