Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease characterized by airway inflammation and abnormal alveolar enlargement. It is the third leading cause of death around the world. Although extensive research efforts have been made, there is still no curable treatment available for lung tissue damage in patients with COPD. Therefore, it is of great significance to elucidate the mechanisms of tissue damage and repair in COPD. As the first barrier against environmental insults and pathogens, pulmonary epithelial cells play an essential role in regulating injury response and repair. However, how pulmonary epithelial cells contribute to irreversible alveolar destruction in COPD is not well understood. In this study, we elucidated the mechanisms of epithelial cell damage in both cigarette smoke-induced COPD and alpha1 antitrypsin deficiency (AATD)-associated genetic COPD. To investigate alveolar epithelial cell damage and repair in cigarette smoke-induced emphysema, a lineage tracing model was utilized to fluorescently label and chase alveolar type II (AT2) epithelial cells, the adult progenitor cells in the alveolar epithelium. An assessment of cigarette smoke-induced changes in cellular composition and regenerative capacity of the alveolar epithelial cells was performed. Cigarette smoke was found to impede the AT2-directed alveolar epithelial regeneration and repair process, and this impaired progenitor cell function was not restored after smoke cessation. Moreover, comparison analysis between stains that are sensitive and resistant to smoke-induced damage revealed that deficiency in lipid metabolism may contribute to the dysregulation of alveolar epithelial repair by AT2 cells. Restoring alveolar progenitor functions through lipid metabolism may serve as a novel therapeutic for alveolar destruction in smoke-induced COPD. To explore the mechanism of epithelial damage in AATD-associated genetic COPD, we utilized a PiZ (p.Glu342Lys) transgenic mouse model expressing human ZAAT protein. Morphometric analysis of PiZ lungs suggests that the accumulation of ZAAT polymers in the lung directly leads to the spontaneous development of emphysema. To investigate epithelial damage induced by zAAT accumulation, we isolated the epithelial cell population from the lung of PiZ mice. We identified epithelial-specific expression of cleaved caspase 3, indicating a direct cytotoxic effect of ZAAT in impairing epithelial function and inducing epithelial cell death. Future therapeutics could directly target the cytotoxicity of pulmonary epithelial cells in AATD to reduce lung tissue damage. Overall, our findings suggest that pulmonary epithelial damage plays an essential role in the pathogenesis of lung tissue damage in COPD. Future epithelial cell-based therapies may contribute to pulmonary re-epithelialization and tissue repair in both cigarette smoke-induced and AATD-associated COPD.

Introduction: This dissertation investigates the critical components of school-based food and nutrition education (SBFNE) programs aimed at enhancing their impact on students’ dietary behaviors. Over the past century, significant shifts in the food landscape have altered dietary habits, with a rise in ultra-processed food (UPF) consumption and a decline in fruit and vegetable intake, particularly among children. This trend underscores the importance of SBFNE programs, which, akin to STEAM subjects, are vital for public health. Schools, where children spend much of their time, are ideal settings for implementing comprehensive, research-based SBFNE programs to reconnect students with healthy food sources and promote better eating habits. Research Questions: This three-paper dissertation addresses several key research questions: 1. What educational and programmatic components contribute to effective SBFNE programs? 2. How can these components be synthesized into a comprehensive theoretical framework and practical program evaluation tool? 3. What insights and recommendations can be gathered from a formative evaluation of these tools? Chapter 2 (Article 1): Objective: Identify educational and programmatic components from the research literature that make SBFNE effective in fostering positive dietary behavior among K-12 students. Methodology: An umbrella review of peer-reviewed literature reviews and government reviews on the effectiveness of SBFNE. All included reviews were assessed for methodological quality. Data Analysis: For each included review, a list was made of the components that contribute to the effectiveness of SBFNE to change dietary behavior. These components were compared across reviews. A final list of components contributing to effectiveness of SBFBE was created with their prevalence in the included reviews indicating whether the impact on effectiveness of SBFNE was positive, mixed or not assessed. Key Findings: This umbrella review identified 20 critical components essential for effective SBFNE programs from 44 reviews, encompassing 1,115 unique primary studies conducted between 1900 and 2022. These components, such as cultural inclusivity and connections to school meals, were integrated into a structured theoretical framework based on the Socioecological Model (SEM) with the components mapped to the first four of six SEM levels: individual, interpersonal, community, and organizational. Conclusions: This study is the first to identify and map research-based critical components into an SEM framework, that influence behaviors and outcomes and can be used to further SBFNE research. Chapter 3 (Article 2): Objective: Develop and pilot test a SBFNE program evaluation tool derived from 20 critical components that were integrated into an SEM framework. Methodology: The tool, developed in Google Sheets, employed a 0-3 scoring system to evaluate the integration of each component with an accompanying detailed rating guide. The pilot test involved component ranking exercises, concept mapping, and curriculum lesson reviews with SBFNE program developers (n=3). Data Analysis: Insights from the pilot test led to significant refinements in the tool and data collection protocol. Key Findings: Participants found the ranking exercise uncomfortable due to component interdependencies. They found the concept mapping exercise engaging and intuitive. The program developers found the curriculum review to be tedious and insufficient with only one lesson reviewed, but they thought this type of program review provided valuable guidance for revising and improving SBFNE programs. The interviews were long, usually more than two hours, and transcription was time-consuming. Conclusions: The pilot provided data to refine the program evaluation tool and to refine the data collection protocol for a formative evaluation of the program evaluation tool. Chapter 4 (Article 3): Objective: Conduct a formative, mixed-methods evaluation to refine the integrated SEM and program evaluation tool for SBFNE programs. Methodology: Recruited SBFNE program developers (n=9) who participated in an exercise to categorize 20 critical components for effectiveness of SBFNE, created a concept map on how the 20 components interact, underwent a program review in which programs were scored 0–3 for the 20 components, received recommendations for program improvement for components that scored less than a three, decided on which recommendations they would enact, and provided feedback on the experience. Data Analysis: Descriptive statistics and thematic analysis identified patterns and insights from qualitative responses, leading to revisions in the evaluation tool and a new practice-based tool. Key Findings: For the categorization exercise there was a range of agreement between program developers and the literature on the critical nature of the SBFNE components, with each of the nine participants rating between four and 17 out of the 20 components as essential. The concept maps the program developers created represented the interconnectedness of the components and led to the development of a practice-based logic model. The program review process showed that programs can be scored on how they are using the components, recommendations can be made for components that did not score a three, and program developers can implement the recommendations. The feedback process indicated that program developers found the activities they did for this research useful for refining and improving their programs, to make them more effective at dietary behavior change. Conclusions: The program evaluation tool and new practice-based model showed promise to be used in future research on SBFNE. Conclusions: This dissertation establishes a robust foundation for SBFNE, integrating critical educational and programmatic components with innovative evaluation tools. The integrated SEM and practical program evaluation tools can improve the quality of SBFNE programs, which can help to foster positive dietary behavior change among K-12 students, addressing the rise in UPF consumption and decline in fruit and vegetable intake. This research lays the groundwork for future initiatives aimed at nurturing healthier, informed, and empowered generations.

Thesis (D. Tech. (Environmental Health)) -- Central University of technology, Free State, 2013 / Some epidemiological studies suggest that exposure to high levels of electromagnetic fields (EMFs) may be linked with the development of adverse health effects. However there is still controversy on this matter. Due to rapid technological growth in the modern society, employees in the welding and electrical industries are highly exposed to electromagnetic fields and may be at a high risk for developing occupational diseases. The health effects which may result from exposure to electromagnetic fields are related to the strength and frequency of the fields. This study was conducted to (i) assess the exposure levels to EMFs in the welding industry, (ii) determine the possible health risks associated with exposure levels, and (iii) develop a health and safety model to guide the industry on how to reduce exposure to EMFs. The study was conducted in one mega welding company in the Mangaung Metropolitan Municipality. Welders, fitters and office workers (88 in total) gave consent to participate in the study and completed questionnaires (ethical clearance attached). Measurements of extremely low frequency EMFs were taken in workshop A, workshop B and working offices. Measurements for magnetic fields were taken at distances of 1, 2 and 3 meters (m) from the EMFs sources. The exposure levels of magnetic fields were very high in the workshops, with welders and fitters exposed to about 7.6 microtesla (μT). Electric fields were relatively low in all workstations. Participants in the study were experiencing symptoms of ill health such as headaches, sleep disorders, fatigue and distress. The symptoms reported by the workers were similar in the both groups (exposed and control). There is no clear relationship between recorded exposure levels and the development of the reported symptoms. The health and safety model was developed to guide the industry to reduce exposure to electromagnetic fields. The model describes the implementation of engineering and administrative control measures in an effort to reduce exposure to EMFs. The model also highlights the importance of wearing personal protective equipment to shield against EMFs amongst others. This study suggests that occupational exposure to high levels of extremely low frequency EMFs may increase the risk for development of chronic diseases such as leukaemia, brain and breast cancer and other diseases among highly exposed employees. Implementation of safety measures is necessary to reduce exposure to EMFs.

Thesis (M. Tech. (Biomedical Technology)) -- Central University of technology, Free State, 2013 / Electromagnetic fields are present wherever electricity is created. The frequency range of these electromagnetic fields is from extremely low to extremely high. The fields present in domestic areas fall within the extremely low frequency range. These fields are created by domestic electrical appliances and telecommunication. There has been much debate on the effect of exposure to these fields on human health. Research has not yet been able to prove adverse effect of these fields on human health. In fact, the benefits of magneto therapy has been recognized and used for several decades. Recently a specific electromagnetic signal has been under investigation for its ability to stimulate the immune response. This signal is produced by a patented generator, called Immunent Activator. Studies performed with the Immunent Activator signal on farm animals revealed increased feed conversion and decreased intestinal lesions of animals with intestinal infections. Most of the research was performed on fish and fowls and evidence of similar findings in mammals is lacking. In the current study, mice were exposed to the Immunent BV signal for seven days, after which immune cell counts were performed and compared to the immune cell counts of a control group of mice which received no electromagnetic exposure. It was found that the T-lymphocyte population of immune cells in the exposed group of mice was statistically significantly higher than that of the control group. The neutrophil count was statistically significantly lower in the exposed group compared to the control group. These findings revealed evidence of immune stimulation in the mice which were exposed to the Immunent Activator signal. Suggestions for further research could be made with regard to specific mechanisms of immune stimulation. The findings of this and other related studies hold benefits for the farming and health industry.

Thesis (M. Tech.) - Central University of Technology, Free State, 2006 / Occupational noise affects industries in many countries around the world, and there is strong evidence from previous research linking it to noise-induced hearing loss (NIHL). More than 30 million workers in the United States of America alone were exposed to hazardous noise at the workplace before 1998. In South Africa, workers are not supposed to be exposed to a noise rating limit at or above 85dB(A). Abattoir employees are subjected to high noise levels when compared to the occupational noise rating limit of 85dB(A). Noise is generated from various mechanised and manual processes and activities in the abattoir during the slaughter of different animal species. Noise sources include conveyers, circular saws, air conditioners and pumps, pneumatic and other mechanical equipment. The aim of this study was to characterise noise exposure in different grades of abattoirs during the slaughter of cattle and sheep. The grading of abattoirs was previously done according to Grade A-E. Grade A-C is now referred to as high throughput abattoirs while Grade D and E are referred to as low throughput abattoirs. Personal and environmental noise exposure levels of workers in Grade A, C and D abattoirs in the Free State were therefore investigated. Noise measurements were done in accordance with the methods stipulated in the South African National Standards (SANS) Code of Practice 10083. Environmental and personal sampling were conducted with a calibrated Type 1 Quest integrated sound level meter (ISLM) and a Quest noise dosimeter respectively. Calibration was checked before and after taking measurements to ensure reliability and validity of results. The average noise exposure level in the high throughput abattoirs was above the recommended standard of 85dB(A). In the low throughput abattoirs the noise exposure levels were below this level. There were no statistically significant differences between the noise exposure levels during the slaughter of different species (P>0.05), or between Grade A and Grade C (P>0.05). There was a statistically significant difference (P<0.05) however between Grade A and Grade D noise exposure levels. The results indicate that workers in Grade A and C abattoirs are exposed to unacceptable noise levels. Further research is recommended to include all categories of abattoirs and to determine the impact of noise exposure on the worker’s hearing in order to develop strategies to protect employees from the effects of excessive exposure to noise.

Recent and past events in the South Durban Basin (SDB) have highlighted the possible connection between perceived air pollution concerns and deteriorating health. The aim of this study is to explore how the SDB community perceives air pollution and if this can be related to some of the health problems that are experienced in these communities. The ultimate aim is to determine whether the respondents connect air pollution to specific illnesses and also how they perceive the actions used to combat air pollution and its negative health impacts. This information is gathered through a questionnaire conducted in various study areas both within and outside the SDB, then compared with demographic variables. This is done to determine if perception is related to direct industrial activity or if there are other factors influencing results. Variables such as race and level of education had little impact on the results. The results showed that areas within the SDB experience a high neighborhood satisfaction despite the current general belief of air pollution being connected to ill health. The control areas outside of the SDB support theories of gender and race and its relationship to air pollution, currently presented by researchers in the perception field. Strong associations’ do exist between general environmental satisfaction and gender. Perception of current legal enforcement is exerting a strong effect on air pollution perception formation. Vitally important is the connection of daily concrete experiences of air pollution with the lack of transparency and communication between industry and communities. It is resulting in the current perception of illness being connected to tangible air pollution. The aim is to further future studies on establishing links between health and air quality. Gaining insight from the study of public risk perceptions based on local knowledge and experience in particular places, will help shape the role of environmental policy and management response systems. / Geography / M.A. (Geography)

Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all. / Health Studies

Submitted in fulfilment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, 2014. / Introduction High maternal, perinatal and under-five morbidity and mortality are some of the formidable development challenges in Africa. The World Health Organisation (WHO) estimates that worldwide, as many as 1500 women die every day due to complications related to pregnancy or childbirth (WHO 2010). The partograph or partogram, an inexpensive tool, was designed by WHO to be used by midwives for decision-making during labour. Many studies conducted in and out of Africa reflect sub-optimal use of the partograph. Aim of the study The aim of the study was to describe the utilisation of the partograph by registered midwives working in the maternity sections of public hospitals in the uMgungundlovu District in the province of KwaZulu-Natal. Methodology A quantitative descriptive cross-sectional study was used to describe the use of the partograph in the selected hospitals, and carried out in two phases. In phase one, 197 participants completed a questionnaire. In phase two, retrospective audits on 310 completed maternity records were done. The collected data was analysed using SPSS version 20 and presented in frequency tables, cross-tabulations and graphs. Results The results revealed that there were certain parameters that were given more focus when it came to correct and consistent recording, such as contractions (80.0%) and cervical dilatation (89%) whilst others were poorly done, such as the duration of labour (13.5%), pain relief (23.5%) and unrecorded partographs from the primary health care clinics and community health centres (80.8%).

Thesis (DPhil (Psychology))--Stellenbosch University, 2008. / HIV/AIDS has emerged as one of the biggest epidemics in modern human history, and is perhaps the most researched and written about epidemic. Southern Africa is at the epicentre of the global HIV/AIDS epidemic, with almost one third of the world’s HIVpositive population living here. HIV is known to affect predominantly vulnerable populations; thus it is surprising that persons with disabilities have been largely overlooked. Little is known about how HIV/AIDS affects persons with disabilities in South Africa. This dissertation, therefore, aims to explore the extent to which organizations and schools working with persons with disabilities are dealing with HIV/AIDS, and how they are dealing with it. The study made use of an integration of quantitative and qualitative research methods. An existing survey questionnaire used in the World Bank/Yale University Global Survey on HIV/AIDS and Disability was used, with permission, as the survey instrument in a national survey of disability organizations and special needs (LSEN) schools in South Africa. The survey was distributed by post and email to 601 organizations and schools across the country, in all nine provinces. Various contacts and postings of the survey were made to organizations and schools, in an attempt to improve response rates. The response rate from national disability organizations was 57%, while the response rate for regional and local organizations and schools was very poor, with an overall response rate of 18%. The sample, however, was representative of the population. The results of the survey indicate a high level of concern about HIV/AIDS as a risk for persons with disabilities. The majority of organizations and schools were involved in providing HIV prevention education. However, most organizations and schools felt that persons with disabilities were excluded from general HIV prevention campaigns, and were thus receiving less information. A second study, using qualitative research methods, used case studies of three organizations/schools to explore more in-depth staff difficulties, challenges and particularly anxieties related to dealing with sex, sexuality and HIV among persons with disabilities. The case studies were analysed from a psychosocial framework, using social constructionist theory with psychoanalytic theory, to explore how social discourses about HIV and disabilities are internalized by staff. It is theorized that people draw on particular social discourses, in this case about HIV and disability, as a defence against threats to the self. Texts were analysed using discourse analysis to identify social discourses. A further analytic layer used psychoanalytic theory to identify unconscious communication of emotions and defence mechanisms. The case studies found that staff have considerable anxiety with regards raising issues of sex, sexuality and HIV with persons with disabilities. Staff from all three organizations were varyingly anxious about needing to protect the people they work with from harm. Disabled people were constructed as innocent, vulnerable, and needing protection. In other cases disabled people were constructed as deviant and their behaviour needing to be controlled. The use of an integration of qualitative and quantitative methods is useful, in allowing to explore more in-depth the lived experience of research participants. While the survey indicated that organizations were providing HIV prevention education, the case studies revealed much anxiety about this, and in some cases education was partly avoided. The results also suggest that HIV prevention education may be used in a way to control and restrict disabled people’s sexual expression, using a demonizing discourse about sex as dangerous and in some circumstances immoral. This may be done in an absence of a discourse of pleasure, where disabled people may be empowered to have fulfilling sexual lives. The study also highlights sexual abuse and rape of persons with disabilities as a serious issue. The dissertation ends with recommendations for further research, including exploring the experience of disabled people themselves, and the need to address the silence around sexual abuse and rape of persons with disabilities.

The purpose of this study was to evaluate the effectiveness of the database system used at the South African Radiation Control Authority and compare it with RAIS (Regulatory Authority Information System). A radiation regulatory authority requires an adequate and effective data management system in order to carry out its regulatory control program efficiently and effectively. RAIS is a comprehensive system that includes all of the main functionality required to support a regulatory framework. A mixed methods approach, including a quantitative descriptive comparative evaluation research study was conducted to determine if the database system currently used by the South African Radiation Control Authority is effective as a data management tool for a regulatory body. Two analyses were conducted. Firstly, the specification records of the South African database system were compared with that of RAIS. Secondly, current database users were surveyed by means of a structured questionnaire. Both analyses reveal that RAIS performs better than the Radiation Control database in the main areas of the regulatory framework. The study results also highlight some of the shortcomings and strengths of the Radiation Control database / Medical Informatics / M.A. (Public Health)