M.Cur. / With the changes in health care occuring in South Africa, new concepts and functions concerning the community health nurse are being presented. The role of the community health nurse is altering, and with his/her grassroot involvement with the community, the researcher was concerned about what contribution he/she should make on health committees. The goal of the study was to explore and describe the role of the community health nurse on health committees. The objectives were to: - explore and describe the role the community health nurse should play on health committees; explore and describe the role the community health nurse is playing on health committees and - to develop guidelines to describe the role of the community health nurse on health committees. The study was conducted in three phases: PHASE 1: After conducting a literature study, six categories were identified as the role of the community health nurse on health committees. Thereafter a questionnaire was presented to community health nurses to find out what their perceptions were about the role of the community health nurse on health committees. The results of Phase One were used to develop a central question. Individual categories relevant to the role of the community health nurse on health committees were identified and an interview schedule was drafted for presentation to selected members of health committees. ii PHASE 2: Personal interviews based on the results of Phase One were conducted with selected health committee members to find out their perceptions of the same. PHASE 3: ' Guidelines describing the role of the community health nurse on health committees were developed based on the findings of the study. It was found that the literature, the community health nurses and the health committee members all concured as to what the community health nurse should be doing on health committees. This study stresses the importance of the community health nurse's involvement on health committees. It should lead to the implementation of community health nurses being allowed to accept their rightful role on health

M.Cur. / Community nurses have a very important role to play in the planning of health promotion programmes and implementation of the necessary interventions for patients and groups with obesity problems. Obesity is one of the health problems that requires signficant behavioural changes in one's lifestyle as part of such interventions. The research study sought to explore the perceptions of both the patients and the community nurses of the phenomenon of obesity as a health risk, and to identify any areas that could give rise to problems when health promotion actions were planned for obese people. It was specifically important to obtain the perceptions of the community nurse of obesity, since the level of knowledge of the health problem as well as her personal attitude towards this problem, will be crucial in the manner and quality of her interventions. The study explored patients' and nurses' perceptions about obesity as a health risk (Phase I and 2). Factors in the internal and external environments of the obese individual were identified and analysed into categories and subcategories. The study is qualitative and explorative in nature, data was collected through the use of semistructured interviews, and Giorgi's method of data analysis was used. Literature control was done to examine how existing literature compared with data obtained from semistructured interviews on the nature of obesity as a health problem. Obesity is clearly a health risk and affects the person's totality of life experiences as demonstrated by the resultant patterns of interactions between the internal and external environments of an obese person. Results of the data analysis and literature control gave rise to the need to structure recommendations to give the community nurse the capacity and support that was identified as necessary for her to be able to carry out her nursing intervention.

Disease prevalence varies with geographic location. This research pursues a medical geographic perspective and examines the spatial variations in disease patterns between Obuasi, a gold mining town and Asankrangwa, a non gold mining town in Ghana, West Africa. Political ecology/economy and the human ecology frameworks are used to explain the prevalence of diseases. Mining alters the environment and allows disease causing pathogens and vectors to survive more freely than in other similar environments. Certain diseases such as upper respiratory tract infections, ear infections, sexually transmitted diseases such as HIV/AIDS and syphilis, certain skin diseases and rheumatism and joint pains may have a higher prevalence in Obuasi when compared to Asankrangwa due to the mining in Obuasi.

The objective of this study was to examine if intra-racial income inequality contributes to higher infant mortality rates (IMRs) for African-Americans. The conceptual framework for this study is derived from Richard Wilkinson's psychosocial environment interpretation of the income inequality and health link. The hypotheses examined were that race/ethnicity-specific IMRs are influenced by intra-race/ethnicity income inequality, and that these effects of income inequality on health are mediated by level of social mistrust and/or risk profile of the mother. Using state-level data from several sources, the 2000 National Center for Health Statistics Linked Birth Infant Death database, 2000 U.S. Census, and 2000 General Social Survey, a number of regression equations were estimated. Results indicated that the level of intra-racial/ethnic income inequality is a significant predictor of non-Hispanic Black IMRs, but not the IMRs of non-Hispanic Whites or Hispanics. Additionally, among Blacks, the effect of their intra-racial income inequality on their IMRs was found to be mediated by the risk profile of the mother, namely, the increased likelihood of smoking and/or drinking and/or less prenatal care by Black women during pregnancy. Implications of the findings are discussed.

Unexpected findings that contradict well-established relationships between exposures and outcomes are often referred to as “paradoxes” in the epidemiologic literature. For example, the “birth weight paradox” refers to the observed protective association between smoking during pregnancy and infant mortality among low birth weight infants. A recent body of literature suggests that this and several other well-known epidemiologic paradoxes can be attributed to collider bias. Collider bias results from conditioning on a variable that is caused by the exposure or shares common cause with the exposure and is caused by the outcome or shares common causes with the outcome. Several recent epidemiology textbooks and methodological studies further suggest that collider bias is the graphical representation of selection bias, suggesting that these two biases are synonymous. This structural approach to bias is conceptually very useful for defining, describing, and identifying selection bias, but it introduces paradoxes of its own due to contradictory conclusions in the selection and collider bias methodologic literatures about their likely impact on study results in terms of magnitude, direction, and strata affected. Resolving these discrepancies is essential for our theoretical understanding of the relationship between selection and collider bias and has important practical implications for how we teach epidemiology, design studies, and evaluate and quantify the potential effects of bias on our results. For example, while patterns of collider bias coincide qualitatively with the birth weight paradox, the magnitude of collider bias would have to be substantial to reverse the sign of the association, contrary to prevailing beliefs that collider bias only minimally affects our results. To date, the plausibility of collider bias as an explanation for the birth weight paradox has not been empirically evaluated using data in which the paradox is observed.Taken together, these inconsistencies and contradictions suggest that our understanding of selection bias and collider bias remains incomplete. The overarching goal of this dissertation was to advance the theoretical and quantitative understanding of the impact of collider bias on study results to clarify the relationship between selection and collider bias. I began by systematically reviewing the methodologic literature on selection and collider bias. I found that selection bias and collider bias are increasingly treated as synonyms, but that conclusions about the magnitude and direction of selection and collider bias, the stratum affected, and the conditions under which the effects of each type of bias were evaluated are highly inconsistent. This suggested that divergent findings about the impact of selection and collider bias might be resolved by considering the impact of collider bias under a broader set of circumstances. I used microsimulations grounded in the sufficient component cause model to examine collider bias not under the null; interrogate why multiplicative interaction appeared central to the impact of collider bias; and clarify which stratum or strata are affected by collider bias. I identified clear patterns for the magnitude, direction, and strata affected by collider bias and successfully reconciled discrepancies with the selection bias literature. This work also enabled me to interrogate both the causal mechanisms and mathematical principles that underlie collider bias, which revealed how collider bias leads to non-exchangeability and when stratifying on a collider results in bias. Finally, I applied this deeper understanding of the mechanisms underlying collider bias to empirically evaluate the plausibility of collider bias as an explanation for the birth weight paradox. Using microsimulations parameterized with 2015 National Center for Health Statistics Cohort Linked Birth-Infant Mortality, I identified scenarios that successfully reproduced the paradox and all observed relationships between smoking during pregnancy, infant mortality, and low birth weight. These findings strengthen the evidence for the role of collider bias in producing the paradox and shed light on the potential magnitude of unmeasured confounding and direct effects of smoking and low birth weight on infant mortality that may be required for the observed magnitude of the paradox to arise. This work clarifies that almost all selection bias is collider bias; that the effects of collider bias vary in magnitude and direction; that selecting on a collider always leads to bias, but this bias may not occur in the stratum that coincides with our analytical sample; and that collider bias may resolve the birth weight paradox, but is unlikely to explain all epidemiologic paradoxes.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2006. xiii, 44 leaves, Annexures A-F / The purpose of this study is to determine whether the cumulative effect of studying, and practising manual therapeutic techniques (including receiving manipulation), is associated with chiropractic students experiencing low back pain (LBP). According to Smith (2005), students currently registered in the Durban Institute of Technology Health faculty were found to have the highest proportion of LBP when compared to students in other faculties. Thirty seven percent of the students with LBP were chiropractic students. In a study performed by Macanuel et al. (2005) on undergraduate chiropractic training, it was concluded that chiropractic students experience side effects during chiropractic technique class. There is epidemiological evidence that chiropractors are a high-risk group of health professionals who experience low back disorders (Tim 1996, Lorme and Naqv 2003, Rupert and Ebete 2004). Rupert and Ebete (2004) suggest that the majority of chiropractors have suffered an occupational injury primarily related to administering manual procedures.

Thesis (MSc)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: Background: Athletes use androgenic anabolic steroids (AAS) to enhance their physical performance. The abuse of AAS is however associated with a host of side effects including sudden death due to cardiac arrest. The use of AAS leads to myocardial hypertrophy, which possibly makes the heart more prone to ischaemia/reperfusion injury, since it often develops in the absence of proper vasculature development. Chronic AAS use also disrupts myocardial p-adrenoreceptor function and possibly cAMP, signalling in the heart. Drugs increasing cAMP and decreasing cGMP levels in the ischaemic myocardium exacerbate myocardial ischaemia/reperfusion injury. We also know that AAS causes coronary artery disease secondary to the deleterious alteration of lipid profiles by increasing the LOL cholesterol and decreasing the HOLcholesterol levels. AAS treatment may increase systemic TNFa levels by stimulating lymphocyte TNFa secretion that has been implicated in the depression of myocardial function, myocardial hypertrophy and the worsening of ischaemia/reperfsuion injury. Aims: To determine whether chronic AAS treatment in trained and untrained rats influences: 1) heart function and susceptibility to ischaemia/reperfusion injury, 2) myocardial cyclic nucleotide levels (cAMP and cGMP) and 3) myocardial TNFa levels. Material and methods: Male Sprague-Dawley rats (n=100) were divided into 4 groups: sedentary vehicle (placebo) treated group, sedentary AAS treated group, exercise vehicle (placebo) treated group, and exercise AAS treated group. Steroid treated animals received an intramuscular injection of nandrolone laureate (0.375 mg/kg) once a week, for six weeks. Training consisted of swim sessions 6 days a week for 6 weeks. Swim time was incrementally increased up to a maximum of 50 minutes a day. For biometric parameters heart weight and body weight were documented. Hearts were mounted on a l.anqendorff perfusion apparatus and left ventricular developed pressure (LVDP), heart rate (HR) and coronary flow (CF) was monitored. The hearts were subjected to a period of 20 minutes of global ischaemia, followed by 30 minutes of reperfusion. Functional parameters was again monitored and documented. For biochemical analysis, blood was collected for the determination of serum lipid levels and myocardial tissue samples were collected before, during and after ischaemia for the determination of myocardial TNFa, cGMP and cAMP levels and p38 activity. Conclusions: Results obtained would suggest that AAS exacerbate exercise induced myocardial hypertrophy. It also prevents the exercise-induced improvement in cardiac function. AAS use reduces reperfusion function in treated hearts, which may suggest that AAS exacerbates ischaemie and reperfusion injury. Furthermore it was seen that AAS elevates basal (preischaemie) cyclic nucleotide levels and basal (pre-ischaemic) as well as reperfusion TNFa levels. This may also contribute to the exacerbation of ischaemic and reperfusion injury. / AFRIKAANSE OPSOMMING: Agtergrond: Androgeniese anaboliese steroïede (AAS) word dikwels deur atlete gebruik om sportprestasie te verbeter. Die misbruik van AAS het egter talle newe effekte, insluitende skielike dood wat gewoonlik toegeskryf word aan hartaanvalle. Die gebruik van AAS lei onder andere tot miokardiale hipertrofie wat opsigself, as gevolg van ontoereikende vaskulêre ontwikkeling tydens die ontwikkeling van hipertrofie, die hart nog meer vatbaar vir isgemie/herperfusie skade maak. Kroniese AAS toediening versteur miokardiale beta-adtenoresepter funksie en moontlik die tweede boodskapper, sAMP, seintransduksie in die hart. Ons weet ook dat AAS koronêre hartvatsiektes veroorsaak. Laasgenoemde is sekondêr tot die nadelige lipiedprofiel verandering, wat 'n verhoging in LDL-C en 'n verlaging in HDL-C insluit. Middels wat miokardiale sAMP vlakke verhoog en sGMP vlakke in die isgemiese miokardium verlaag, vererger miokardiale isgemie/herperfusie skade. AAS behandeling kan moontlik ook sistemiese TNFa vlakke verhoog deur limfosiet TNFa sekresie te stimuleer. Die verhoogde TNFa vlakke word verbind aan die onderdrukking van miokardiale funksie, miokardiale hipertrofie en die verergering van isgemie/herperfusie skade. Doelwitte: Die doelwitte van die studie was om te bepaal of kroniese AAS toediening in geoefende en ongeoefende rotte 1) hartfunksie en die hart se vatbaarheid vir isgemie/herperfusie skade beïnvloed, 2) miokardiale sikliese nukleotiedvlakke (sAMP en sGMP) beïnvloed en 3) miokardiale TNFa-vlakke beïnvloed. Materiale en metodes: Manlike Sprague-Dawley rotte (n=100) is gebruik en in 4 groepe verdeel: 'n ongeoefende placebo groep (kontrole); 'n ongeoefende steroïedbehandelde groep; 'n geoefende placebo groep (kontrole) en 'n geoefende steroïedbehandelde groep. Steroïed behandelde diere het 'n intramuskulêre nandroloon lauraat inspuiting (0.375 mg/kg) een keer per week vir ses weke ontvang. Die oefenprogram het bestaan uit ses swemsessies 'n week vir ses weke. Die swemtyd is geleidelik weekliks verhoog tot by 'n maksimum tyd 50 min. Die waterbadtemperatuur is tussen 30 - 32 oe gehandhaaf. Vir biometriese parameters is hartgewig en liggaamsgewig genoteer. Harte is op 'n Langendorff perfusie apparaat gemonteer en linker ventrikulêre ontwikkelde druk (LVOD), koronêre vloei (KV) en harttempo (HT) is genoteer. Die harte is vervolgens blootgestel aan 20 minute van globale isgemie gevolg deur 'n 30 minute herperfusieperiode. LVOD, KV en HT is weer eens noteer. Vir biochemiese doeleindes is bloed voor perfusie versamelom serum lipied vlakke te bepaal. Miokardiale weefsel is versamel voor, tydens en na isgemie vir die bepaling van TNFa, cGMP en AMP vlakke asook p38 aktiwiteit. Gevolgtrekkings: Na aanleiding van resultate verkry wil dit voorkom asof die gebruik van steroïde oefeningsgeïnduseerde miokardiale hipertrofie vererger. Dit verhoed ook oefeningsgeïnduseerde verbetering in miokardiale funksie. AAS lei tot 'n verlaagde herperfusiefunksie in behandelde harte, wat dalk mag dui op MS verergering van isgemie en herperfusie skade. Verder was daar ook waargeneem dat MS basale (pre-isgemiese) sikliese nukleotiedvlakke en basale TNFa-vlakke sowel as herperfusie TNFa vlakke verhoog. Die verhoging in TNF-a vlakke mag dus moontlik ook bydra tot die verergering van isgemie- en herperfusieskade.

Thesis (MAud)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: In developing countries, like Namibia, there is limited data pertaining to the number of individuals with hearing loss and its associated factors. This study aimed to determine the prevalence of potential hearing loss in Namibian Class A mines and to describe the extrinsic and intrinsic factors associated with hearing loss. A cross-sectional design was utilised and data were collected from 132 respondents (mining employees) from five different Class A mines throughout the country. A questionnaire and a retrospective review of respondents’ medical records were utilised to determine the risk factors. The most recent audiogram found in the respondents’ records was used to determine the presence of potential hearing loss. Three definitions of potential hearing loss were used in this study and included all major frequency hearing loss (AFHL), high frequency hearing loss (HFHL) and low frequency hearing loss (LFHL). Potential hearing loss was identified when the pure tone average (PTA) of 0.5, 1, 2, & 4kHz, 0.5, 1 & 2kHz and 4 & 8kHz respectively was greater than 25dBHL in either one or both ears. Chi-square measurements or, where necessary, Fisher’s exact tests, as well as Odds Ratios were used for the analysis of data. In general a significance level of 5% was applied for all analyses. Results indicated the prevalence of potential hearing loss in Namibian mining employees to be 27% and that both extrinsic and intrinsic factors were associated with hearing loss. The extrinsic factors significantly associated with potential hearing loss were both occupational and medical. The occupational factors found to be significant were the number of years employed in whole life >10 years (p=0.012; OR=3.1, 95% CI=1.3-7.9), the number of years employed in current job > 10 years (p=0.01; OR=3.9, 95% CI1.7-8.8) and the non-availability of formal training in prevention of hearing loss (p=0.022; OR=0.3, 95% CI (0.1-0.9). Diabetes was the sole significant extrinsic medical factor (p=0.035, OR=5, 95% CI 1.1-22.1). The only intrinsic factor which was found to be significantly associated with hearing loss was Age, specifically being older than 40 years (p=0.002; OR=3.5, 95% CI 1.6-7.8) and 50 years (p=0.001, OR=5.5, 95% CI1.9-15.8). A multiple logistic regression model of all significant factors found that only no formal training of prevention of hearing loss was found to be significant in the presence of all other factors (p=0.036, OR=0.036, 95% 0.1-0.92). Findings from this study suggest that multiple factors may be associated with potential hearing loss and not just the exposure to hazardous occupational conditions. Recommendations for future research and clinical practice should, therefore, include thorough investigations into the aetiology of hearing loss. As this study focused on Class A mines, it is recommended that future research be conducted in other mines that are not categorised as Class A mines. Keywords: prevalence, extrinsic factors, intrinsic factors, extrinsic occupational factors, extrinsic social factors, extrinsic medical factors, potential hearing loss, mining industry, Class A mine, Namibia. / AFRIKAANSE OPSOMMING: In ontwikkelende lande, soos Namibië, is daar beperkte data met betrekking tot die aantal individue met gehoorverlies en sy verwante faktore. Hierdie studie het gepoog om die voorkoms van gehoorverlies in Namibiese Klas A myne te bepaal en die ekstrinsieke en intrinsieke faktore wat verband hou met potensiale gehoorverlies te beskryf. 'n Deursnee-ontwerp is gebruik en data is ingesamel uit 132 respondente (mynbou werknemers), uit vyf verskillende Klas A myne regdeur die land. 'n Vraelys en 'n retrospektiewe oorsig van die respondente se mediese rekords is gebruik om die risiko faktore te bepaal. Die mees onlangse oudiogram wat in die respondente se rekords gevind is, is gebruik om die teenwoordigheid van potensiale gehoorverlies te bepaal. Drie definisies van potensiale gehoorverlies is gebruik in hierdie studie, ingesluit al die groot frekwensie gehoorverliese (AFHL), hoë frekwensie gehoorverlies (HFHL) en 'n lae frekwensie gehoorverlies (LFHL). ‘n Gehoorverlies was teenwoordig wanneer die suiwer toon gemiddelde (PTA van 0.5 , 1 , 2, & 4kHz , 0.5, 1 & 2kHz en 4 & 8kHz onderskeidelik , groter was as 25dBHL in een of albei ore. Chi -square metings of, waar nodig, Fisher se presiese toetse, asook kans verhoudings is gebruik vir die ontleding van data. In die algemeen is 'n beduidendeidsvlak van 5% gebruik en toegepas vir al die ontledings. Resultate het aangedui die voorkoms van gehoorverlies in Namibiese mynbouwerknemers tot 27 % was en dat beide ekstrinsieke en intrinsieke faktore ‘n verband toon met potensiaal gehoorverlies. Die ekstrinsieke faktore wat ‘n beduidende verband getoon het met gehoorverlies was albei beroeps- en mediese faktore. Die beroepsfaktore wat betekenisvol was, was die aantal jare diens in hele lewe > 10 jaar ( p = 0,012 ; OR = 3.1 , 95 % CI = 1.3-7.9) , die aantal jare in huidige pos> 10 jaar diens (p = 0,01 ; OF = 3.9 , 95 % CI1.7-8.8 ) en die onbeskikbaarheid van formele opleiding in die voorkoming van potensiaal gehoorverlies (p = 0,022 ; OF = 0,3 , 95 % CI ( 0,1-0,9 ). Diabetes was die enigste beduidende ekstrinsieke mediese faktor (p = 0,035 , OR = 5 , 95 % CI 1,1-22,1 ). Die enigste intrinsieke faktor watbeduidend was en verband hou met gehoorverlies was ouderdom, spesifiek om ouer as 40 jaar ( p = 0,002 ; OF = 3.5 , 95 % CI 1,6-7,8 ) en 50 jaar ( p = 0.001 , OR = 5.5 , 95 % CI1.9-15.8 ) te wees. 'n Veelvuldige regressie model van alle beduidende faktore het bevind dat slegs geen formele opleiding in die voorkoming van gerhoor verlies beduidende was in die teenwoordigheid van al die ander faktore ( p = 0,036 , OR = 0,036 , 95 % 0,1-0,92 ) . Bevindinge van hierdie studie dui daarop dat verskeie faktore geassosieer kan word met gehoorverlies en nie net die blootstelling aan gevaarlike beroepstoestande nie. Aanbevelings vir toekomstige navorsing en kliniese praktyk moet dus 'n grondige ondersoek na die etiologie van gehoorverlies uitvoer. Aangesien hierdie studie gefokus het op die Klas A- myne , word dit aanbeveel dat toekomstige navorsing gedoen word in ander myne wat nie gekategoriseer is as Klas A myne nie. Sleutelwoorde: Voorkoms, ekstrinsieke faktore, instrinsieke faktore, ekstrinsieke beroepsfaktore, ekstrinsieke sosiale faktore, ekstrinsieke mediese faktore, potensiale gehoorverlies, Klas A myn, Namibië.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The wildlife industry in Namibia continues to grow as the production and consumption of game meat increases. However, the health risks posed by the trade in wildlife and related by-products to livestock and humans have not been fully assessed. The main objective of this study was to investigate the potential health risks related to the increased consumption of game meat and relevant by-products by assessing the quality of game meat, as well as determine the role of game meat species in the transmission of zoonoses. The microbiological quality and safety of export game meat was assessed. No differences in the aerobic plate count (APC) were observed between the years (2009 and 2010), but the mean Enterobacteriaceae count was 1.33±0.69log10 cfu/cm2 compared to 2.93±1.50log10 cfu/cm2 between the years. Insignificant heterotrophic plate count (HPC) levels were detected in 9/23 field water samples, while faecal bacteria (coliforms, Clostridium perfringens and enterococci) were not isolated in all samples. Seven serogroups, with the exception of O26, were detected in exotic species. A white tailed deer sample had a serotype belonging to O45 which confirmed positive for stx1 gene. In springbok, 5/15 pools of faecal samples tested positive for the intimin gene. No Salmonella spp were isolated, and all E. coli isolates from the meat samples were negative for STEC virulence genes (i.e. stx1, stx2, eae and hlyA). A linear regression analysis was conducted on selected variables to identify the main predictors and their interactions affecting pH of meat 4 hours post-slaughter. In an increasing order of magnitude during winter time, the pH reached at 16-36hr post slaughter in springbok heart, liver, spleen, kidney and lungs was significantly higher than pH 6.0, while no significant differences were observed from the regulatory reference (pH 6.0) in the heart. There was a positive association between the pH of game meat 4hr post-slaughter, and liver congestion. The pH of game meat 4hr post slaughter, increased by 0.11 units per mL increase in liver congestion, and decreased by 0.04 units per minute increase in the shooting to bleeding interval, irrespective of the species. Worm eggs of strongylids, Strongyloides papillosus, Toxocara spp, Trichuris spp and coccidia were found in variable numbers in both springbok and gemsbok faeces, indicating a potential risk of transmission to other species in the ecosystem. On examination of carcasses, a novel parasite, Skjabinodera kuelzii, was identified and noted to be associated with inguinal fascia and renal fat, but the public health significance remains unclear. Nevertheless, S. kuelzii should be considered as of potential significance during routine game meat inspection. A total of 12 310 springbok were harvested from 26 commercial farms over a period of two years. Tissue samples (i.e. 60 livers, 41 kidneys and 52 hindquarter muscles) were collected from randomly selected healthy animals. The mean values (i.e. above the detection limit) of cadmium (Cd) and lead (Pb) were 0.10±0.05mg/kg and 1.04±0.21mg/kg in the liver, respectively; and 0.33±0.22mg/kg and 0.905±0.51mg/kg in the kidney of springbok, respectively. The levels of cadmium and lead in the hindquarter muscles were below the detection limit. Serum samples (n=1692) collected from sheep, goats and cattle from four presumably at-risk farms, and 900 springbok (Antidorcas marsupialis) serum samples collected from 29 mixed farming units, were screened for Brucella antibodies by using the Rose-Bengal test (RBT). Positive cases were confirmed by complement fixation test (CFT). To assess the prevalence of human brucellosis, 137 abattoir employees were tested for Brucella antibodies using the standard tube agglutination test (STAT), and the enzyme linked immunosorbent assay (ELISA). Cattle and sheep from all four farms were negative by RBT and CFT, but two of the four farms carried 26/42 and 12/285 seropositive goats, respectively. Post mortem examination of seropositive goats revealed no gross pathological lesions. Culture for brucellae from organs of seropositive animals was negative. None of the wildlife sera tested positive by either RBT or CFT. Occurrence of confirmed brucellosis in humans was linked to the consumption of unpasteurized goat milk, home-made goat cheese and coffee with raw milk and prior contact with goats. All abattoir employees (n=137) tested negative by STAT, but 3 were positive by ELISA. The three abattoir workers were clinically normal, and lacked historical connections with clinical cases. This study illustrates the importance of microbiological, parasitic and residue monitoring as critical components of a hazard analysis and critical control point based system for game meat. The study also provides the basis for increased integrated health research, surveillance and meat safety risk analysis. / AFRIKAANSE OPSOMMING: Die Namibiese wildbedryf raak toenemend groter soos die produksie en verbruik van wildsvleis toeneem. Die verwante gesondheidsrisiko’s wat die gebruik van wildsvleis en verwante produkte vir mens en dier inhou, is nog nie volledig geassesseer nie. Die doelwit van die studie was om ondersoek in te stel na die potensiële gesondheidsrisiko's wat wildsvleis en verwante neweprodukte vir mens en dier inhou deur middel van die assessering van vleisgehalte en die bepaling van die rol van die wildsvleis spesies in die oordrag van soönoses. Die mikrobiologiese gehalte en veiligheid van uitvoer wildsvleis was geassesseer. Geen verskille in die aerobiese plaat telling (APC) vir monsters versamel tydens 2009 en 2010 is aangeteken nie. Die gemiddelde Enterobacteriaceae telling was 1.33± 0.69log10 cfu/cm2 in vergelyking met 2.93±1.50log10 cfu/cm2 tussen die jare. Onbeduidende heterotrofe plaattelling (HPC) vlakke is waargeneem in 9/23 water monsters, terwyl fekale bakterieë (d.i. kolivorme, Clostridium perfringens en enterokokke) nie in enige van die monsters geïsoleerd is nie. Sewe serogroepe, met die uitsondering van O26, is aangeteken vir die eksotiese spesies. Monsters verky van ʼn white tailed deer is as positief vir 'n serotipe van O45 getoets, en die teenwoordigheid van die stx1 geen is bevestig. In springbok het 5/15 poele van fekale monsters positief getoets vir die intimien geen. Geen Salmonella spp is geïsoleer nie en alle E. coli geïsoleer in die vleismonsters was negatief vir die Stec virulensie geen (d.i. stx1, stx2, EAE en hlyA). ʼn Liniêre regressie-analise is op geselekteerde veranderlikes wat as die belangrikste indikators kan dien, en enige moontlike interaksie wat die pH van wildsvleis 4 uur na-slag kan beïnvloed, uitgevoer. In 'n toenemende orde van grootte gedurende die winter tyd, die pH teen 16-36hr na slagting in springbok hart, lewer, milt, niere en longe was aansienlik hoër as die pH 6.0, terwyl geen beduidende verskille waargeneem is wanneer dit met die regulasie verwysingswaarde van die hart (pH 6.0) vergelyk is nie. Daar was 'n positiewe assosiasie tussen die pH van wildsvleis 4 uur na-slag en mate van aansameling in die lewer. Die pH van wildsvleis 4 uur na-slag, het toegeneem met 0.11 eenhede per mL toename in lewer aansameling en afgeneem met 0.04 eenhede per minuut toename in die skiet tot uitbloei interval, ongeag die spesie. Wurmeiers van rondewurms, Strongyloides papillosus, Toxocara spp, Trichuris spp en koksidia het in verskillende ladings in die mis van beide springbok en gemsbok ontlasting, voorgekom. Dit dui op 'n potensiële risiko van oordrag na ander spesies in die ekosisteem. Die voorkoms van ʼn nuwe parasiet, Skjabinodera kuelzii, in wildskarkasse is aangeteken en was geassosieer met inguinale fascia en renale vet, maar die openbare gesondheidsrisiko bly onduidelik. Daar word aanbeveel dat dié parasiet as ʼn potensiële risiko faktor tydens roetine vleisinspeksies beskou moet word. ʼn Totaal van 12 310 springbokke is oor 'n tydperk van twee jaar van 26 kommersiële plase geoes. Weefselmonsters (d.i. 60 lewers, 41 niere en 52 agterkwart spiere) is ewekansig versamel van gesonde diere. Die gemiddelde waardes (d.i. hoër as die opsporingslimiet) van kadmium (Cd) en lood (Pb) was 0.10 ± 0.05mg/kg en 1.04 ± 0.21mg/kg in die lewer onderskeidelik en 0.33 ± 0.22mg/kg en 0.905 ± 0.51mg/kg in die niere van springbok, onderskeidelik. Die vlakke van kadmium en lood in die agterkwart spiere was laer as die opsporingslimiet. Serum monsters (n=1692) is van skape, bokke en beeste van vier vermoedelik hoë risiko plase en springbok (Antidorcas marsupialis, n=900) van 29 gemengde boerdery sisteme versamel en getoets vir die teenwoordigheid van Brucella teenliggaampies deur middel van die Rose-Bengal-toets (RBT). Positiewe gevalle is bevestig deur die komplement binding toets (CFT). Die voorkoms van menslike brusellose is bepaal deur 137 abattoir werknemers te toets vir Brucella teenliggaampies deur gebruik te maak van die standaard buis agglutinasie toets (STAT) en die ensiembinding immunosorberende toets (ELISA). Beeste en skape van die vier hoë risiko plase het negatief getoets met die RBT en CFT metodes, maar bokke van twee van die vier plase het seropositief getoets (26/42 en 12/285 onderskeidelik). Nadoodse ondersoek van seropositief bokke het geen patologiese letsels aangedui nie. Die kultuur van orgaanmonsters van seropositief diere vir Brucellae was negatief. Die monsters versamel van wild het negatief getoets deur middel van die RBT en CFT toets metodes. Die voorkoms van brusellose in mense in die studie was geassosieer met die gebruik van ongepasteuriseerde melk, tuisgemaakte bokmelkkaas en koffie met ongepasteuriseerde melk, asook direkte kontak met bokke. Alle abattoir werknemers (n=137) het negatief getoets met die STAT metode, maar drie werknemers het positief getoets met die ELISA metode. Die drie abattoir werkers was klinies normaal en het nie vorige kontak met bevestigde kliniese gevalle gehad nie. Hierdie studie bevestig die belang van mikrobiologiese, parasitiese en residu monitering as kritieke komponente van 'n gevaar-analise en kritiese kontrolepunt gebaseerde stelsel vir die produksie en verbruik van wildsvleis. Die studie verskaf ʼn basis vir toekomstige navorsing gefokus op ʼn geïntegreerde benadering van mens- en diergesondheid, monitering en vleis veiligheid risiko-analises.

Thesis (PhD)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Healthcare workers (HCWs) wear latex gloves to protect themselves and their patients against the transmission of microbial, viral and bloodborne diseases. These individuals are primarily exposed to latex via cutaneous (direct contact) and mucocutaneous (inhalation of airborne allergens on glove powder) routes. Repeated exposure leads to the formation of circulating latex-specific IgE and subsequent sensitisation with varying clinical expression. The airconditioning system of the Tygerberg Hospital (TBH) complex was investigated for the presence of aerosolised cornstarch glove powder and proteins. Dust samples were collected from 14 areas with different levels of latex glove usage. Dust samples were spectrophotometrically compared to a calibration graph of pure glove powder. The detection of starch and proteins in all the dust samples confirmed the presence of glove powder and possibly airborne latex allergens in the airconditioning ducts. As expected, the high exposure areas showed the highest concentrations of both starch and proteins. It is possible that other proteins than latex were involved, but the confirmed high level of protein contamination should be a cause for concern. Correlation between starch and protein levels was highly significant (p<0.01) in all instances. A total of 500 questionnaires were circulated for completion by HCWs from TBH. The response rate was 69.8%. After considering specific inclusion criteria, a study group of 152 individuals was compiled (28 males, 124 females). All subjects had current latex exposure and suffered from at least three pre-defined symptoms. Serum was collected from all subjects and dermal fluid from 31 subjects. Total IgE and latex specific IgE analysis were done on all serum and dermal fluid samples. Latex-specific IgE was positive (>0.35 IU/ℓ) in 23 serum and six dermal fluid samples. Skin prick tests (SPTs)for latex were done on 59 subjects with negative serum latex-specific IgE and 34 had positive results. Twelve subjects with negative latex-specific IgE and latex SPTs underwent patch tests with the European Standard Series, a piece of latex glove and glove powder in petrolatum. Three subjects had positive results to one or more of these allergens. Western blot analysis for latex was done on all positive sera and dermal fluid collected from these subjects. Western blot analysis for latex proved to be more sensitive than the capRAST, because it was able to identify specific bands in samples with negative capRAST results. All subjects showed a band for Hev b 1, which has been confirmed as a powder-bound airborne allergen. Hev b 6.01 is associated with HCWs with cutaneous symptoms and this band was recognised by 81% of the subjects. These findings confirmed that airborne and cutaneous routes are the major routes of exposure in HCWs. According to their laboratory results, subjects were divided into the following subgroups and compared statistically: Group A (serum positive, n=23), Group B (SPT positive, n=34) and Group C (negative, n=25). Group D (withdrawn, n=70) could not be used for statistical comparisons, due to incomplete results. An overall latex allergy prevalence of 38% was found. Group A differed significantly from Group B and Group C for most clinical and special investigations. Group A and B were also combined to represent all subjects with positive results (Cohort AB). The Allergy Score and Class were highly significant when Cohort AB was compared to Group C. The selection of clinical symptoms was confirmed to be relevant and work-related deterioration on any of the symptoms should bear a high index of suspicion in the evaluation of latex allergy. Numerical indices and specific symptoms showed high positive predictive values and the Allergy Score produced statistical significance in the positive subgroups when compared to the negative subgroup. Paired statistical significance was confirmed between the Allergy Score and occupational exposure (number of years, hours and pairs per week). The areas with the highest occupational latex exposure in HCWs are the face and hands. Different occupations also have different levels of exposure and two subgroups of HCWs (16 laboratory technologists and 13 theatre staff) were investigated for sebum content on different facial areas and the palms and dorsal areas of both hands. Baseline measurements were done before putting on gloves. In 21 subjects follow up measurements were done following three to four hours of occupational exposure, but before washing their hands. Baseline and follow up values were compared for all the different anatomical regions. Levels on the forehead and cheeks increased over time, while the level on the nose decreased. All hand regions decreased significantly during occupational exposure, suggesting that glove powder contributes to dryness of the skin. In conclusion, the problem posed by latex allergy will not be solved overnight and will probably remain a major occupational hazard for years to come. It is currently not possible to avoid exposure to latex, but it is imperative to institute safety measures to prevent further sensitisation in predisposed individuals and manage those already affected. / AFRIKAANSE OPSOMMING: Gesondheidswerkers dra lateks handskoene om hulleself en hulle pasiënte te beskerm teen die oordrag van mikrobiale, virale en bloed-gedraagde siektes. Die lateks blootstelling vind hier hoofsaaklik plaas via kutane (direkte velkontak) en mukokutane (inaseming van lug-gedraagde allergene op hanskoen poeier) roetes. Herhaalde blootstelling veroorsaak sirkulerende lateksspesifieke IgE en sensitisasie met variërende kliniese beelde. Die lugreëlingstelsel van die Tygerberg hospitaalkompleks is ondersoek vir die teenwoordigheid van handskoenpoeier (stysel) en lateks proteïene. Stofmonsters is versamel in 14 areas wat verskillende blootstellingsvlakke verteenwoordig het. Die stofmonsters is spektrofotometries vergelyk met "n kalibrasiekurwe van suiwer hanskoenpoeier. Stysel en proteïene kon in al die stofmonsters aangetoon word en het die teenwoordigheid van handskoenpoeier en moontlike luggedraagde lateks proteïene in die lugreëlingstelsel bevestig. Soos verwag kon word, het die hoogste stysel en proteïen waardes in hoë blootstellingsareas voorgekom. Hoogs beduidende statistiese korrelasies (p<0.01) tussen die stysel en proteïenvlakke kon aangedui word in alle monsters. "n Totaal van 500 vraelyste is gesirkuleer vir voltooiing deur TBH gesondheidswerkers, waarvan 69.8% voltooide vraelyste terugontvang is. Na evaluering van insluitingskriteria, is "n studiegroep van 152 individue saamgestel (28 mans, 124 vrouens). Almal het huidige lateks blootstelling en ten minste drie het vooraf gedefinieerde simptome gerapporteer. Serum is van die hele groep versamel en dermale vog van 31 proefpersone. Totale IgE en lateks-spesifieke IgE vlakke is op alle serum en dermale vog bepaal. Positiewe resultate (>0.35 IU/ℓ) is verkry in 23 serum en ses dermaIe vog monsters. Velpriktoets vir lateks is op 59 proefpersone uitgevoer en 34 daarvan het positiewe resultate opgelewer. Twaalf proefpersone met negatiewe lateks-spesifieke IgE en velpriktoets resultate het kutane plaktoetse ondergaan met die Europese Standaard Reeks, "n stukkie lateks handskoen en handskoenpoeier in petrolatum. Drie proefpersone het positiewe resultate teen een of meer van die allergene gehad. Westerse kladanalise vir lateks is op alle positiewe serum gedoen, asook die dermale vogte van hierdie proefpersone. Westerse kladanalise vir lateks blyk baie meer sensitief te wees as die capRAST, aangesien dit spesifieke bande kon identifiseer in monsters capRAST resultate. Alle monsters het "n band getoon vir Hev b 1, "n poeier-gebinde, luggedraade allergeen. Hev b 6.01 is geassosieer met gesondheidswerkers met velsimptome en hierdie band is gevind in 81% van die monsters. Hierdie resultate bevestig dat die belangrikste blootstelling aan lateks in gesondheidswerkers deur die vel en inaseming plaasvind. Proefpersone is in die volgende drie groepe verdeel volgens laboratorium resultate en statisties vergelyk: Groep A (positiewe serum, n=23), Groep B (positiewe velpriktoetse, n=34) en Groep C (negatief, n=25). Groep D (onttrek, n=70) kon nie vir betekenisvolle statistiese vergelykings aangewend word nie, as gevolg van onvolledige resultate. 'n Finale lateks allergie prevalensie van 38% is gevind. Groep A het hoogs beduidend verskil van Groep B en C vir die meeste van die kliniese en spesiale laboratoriumondersoeke. Groep A en B is gekombineer om alle proefpersone in te sluit met positiewe resultate (Kohort AB). Die Allergie Telling en Klas van Kohort AB was hoogs beduidend in vergelyking met Groep C. Die gekose simptome is bevestig as relevant en enige werksverwante verergering van simptome moet met 'n hoë mate van agterdog bejeën word in lateks allergie. Numeriese indekse en spesifieke simptome het hoë positiewe voorspellingswaardes gelewer en die Allergie Telling was hoogs beduidend in die positiewe subgroep in vergelyking met die negatiewe subgroep. Gepaarde statistiese beduidenheid is ook gevind tussen die Allergie Telling en beroepsblootstelling (jare van blootstelling, uur en paar handskoene per week). Die meeste beroepsblootstelling aan lateks in gesondheidswerkers vind plaas op die hande en gesig. Verskillende beroepe het ook verskillende blootstellingsvlakke en two subgroepe gesondheidswerkers (16 laboratorium tegnoloë en 13 teater personeel) is ondersoek vir die sebumgehalte op veskillende areas van die gesig en hande. Basislynvlakke is gemeet voordat handskoene aangetrek is en in 21 gevalle is opvolgvlakke gemeet na drie tot vier uur beroepsblootstelling, maar voor die hande gewas is. Basislyn en opvolgvlakke is met mekaar vergelyk vir al die anatomiese areas. Die voorkop en wange het 'n toename in sebumgehalte getoon, terwyl dié van die neus afgeneem het. AI die areas op die hande toon 'n hoogs beduidende afname tydens beroepsblootstelling, wat impliseer dat hanskoenpoeier moontlik bydra tot droogheid van die vel. In samevatting, die lateks allergie probleem sal nie oornag opgelos word nie en sal waarskynlik 'n belangrike beroepsrisiko bly vir die aansienlike toekoms. Totale vermyding van lateks is tans onmoontlik en daarom is dit van uiterste belang om voorsorgmaatreëls in plek te stel om verdere sensitisasie in blootgestelde individue te verhoed en die wat reeds geaffekteer is, effektief te hanteer.