Background: Adverse birth outcomes present a difficult and chronic challenge in Ontario, in Canada and in developed countries in general. Increasing proportions of preterm births, significant regional disparities and the high cost of treating all adverse birth outcomes have focused attention on explaining them and developing effective treatments. Methods: Birth outcomes and maternal characteristics for approximately 626,000 births, about 90% of births in 2005–2009, were linked to small geographic areas throughout Ontario. For each of four adverse outcomes: late preterm, moderate to very preterm, small for gestation age and still births, proportions of total births were calculated for the full province and for each small geographic area. Geographic hotspots of elevated rates were identified for each of the different adverse birth outcomes using the local Moran’s I statistic. Data for nine known ecologic and individual risk factors were then linked to the areas. Hierarchical regression analysis was used to model each of the outcomes for the full province and for dispersed local areas. The resulting models for the different outcomes were contrasted. Results: Significant geographic hotspots exist for each of the four outcomes. Hotspots for the different outcomes were found to be largely spatially exclusive. For like outcomes, predictive models differed markedly between local areas (i.e. local groups of hotspots) as well as between full-province and local areas. Ecologic level variables played a strong role in all models; the influence of individual level risk factors was consistently modified by ecologic risk factors except for small for gestational births. Conclusions: The finding of significant hotspots for different adverse birth outcomes indicates that certain geographic areas have aetiologies or patterns of predictors sufficient to create significantly elevated levels of particular outcomes. The finding that hotspots for the different adverse outcomes are largely exclusive implies that the aetiologies are specific; i.e., those that are sufficient to create significantly higher levels for one outcome do not also create significantly higher levels of others. The consistently strong role of ecologic level risk factors in modifying individual level risk factors implies that contextual characteristics are an important part of the aetiology of adverse birth outcomes. Differences in local area models suggest the existence of location-specific (rather than universal) aetiologies. The findings support the need for more careful attention to local context when explaining birth outcomes.

The aim of this study was to identify the health needs and problems of black employees within the Germiston City Health Department in order to indicate a possible relationship between such needs and problems and a high rate of absenteeism. Although the findings could relate to all employees, this study was limited to black employees only. Data was collected by means of observation, perusal of health records and personal interviews with personnel as well as with the selected sample. The results of the study highlighted the specific health needs and problems of employees as well as factors which could influence their health status and which could contribute to the problem of absenteeism. The main factors identified included interalia poor working conditions and unsatisfactory methods of solving employees problems. Relevant recommendations were made ;· to address the problem of absenteeism in the Germiston City Health Department / Health Studies / M.A. (Nursing Science)

The aim of this study was to identify the health needs and problems of black employees within the Germiston City Health Department in order to indicate a possible relationship between such needs and problems and a high rate of absenteeism. Although the findings could relate to all employees, this study was limited to black employees only. Data was collected by means of observation, perusal of health records and personal interviews with personnel as well as with the selected sample. The results of the study highlighted the specific health needs and problems of employees as well as factors which could influence their health status and which could contribute to the problem of absenteeism. The main factors identified included interalia poor working conditions and unsatisfactory methods of solving employees problems. Relevant recommendations were made ;· to address the problem of absenteeism in the Germiston City Health Department / Health Studies / M.A. (Nursing Science)

nÃo hà / O dengue permanece como problema de saÃde pÃblica no Brasil. No nordeste brasileiro, os grandes depÃsitos domiciliares utilizados para acumular Ãgua sÃo importantes criadouros para reproduÃÃo do Aedes aegypti, o principal transmissor do dengue. O uso de alternativas ao controle quÃmico desse vetor vem sendo incentivado. Os objetivos desse trabalho foram avaliar se a presenÃa de peixes larvÃfagos altera o padrÃo de postura do A. aegypti, identificar a sobrevivÃncia de peixes larvÃfagos ao cloro e descrever a eficÃcia do peixe Betta splendens em condiÃÃes de campo. O padrÃo de postura foi avaliado em uma gaiola com 6 m3. Os peixes avaliados foram Poecilia reticulata e B. splendens. Na gaiola foram inseridos oito depÃsitos, sendo quatro com peixes, quatro sem peixes (controle) e 100 mosquitos. Em cada depÃsito tinha Ãgua e uma palheta de eucatex para postura dos ovos. Ao final de cada semana os ovos postos nessas palhetas foram contados. Os ensaios foram replicados por sete semanas consecutivas para cada espÃcie. A sobrevivÃncia do B. splendens e P. reticulata, ao cloro, foi avaliada para trÃs concentraÃÃes (1,0; 1,5 e 2,0 mg/L) utilizando tambores com 35 litros de Ãgua. Foram utilizados 105, 140 e 175 peixes para cada concentraÃÃo testada, na proporÃÃo de 6 depÃsitos com cloro para cada controle (sem cloro). A eficÃcia foi avaliada a partir de dados gerados pelo Programa Municipal de Controle do Dengue, na cidade de Fortaleza. Foi avaliada a permanÃncia dos peixes em depÃsitos domiciliares e a infestaÃÃo nesses depÃsitos com B. splendens e o larvicida Bacillus thuringiensis israelensis. A presenÃa do B. splendens inibiu a postura de ovos pelas fÃmeas de Aedes aegypti com um Ãndice de Atividade de OviposiÃÃo (IAO) de -0,627. O nÃmero mÃdio de ovos postos em depÃsitos com B. splendens (32,5/semana) foi menor que nos depÃsitos com o P. reticulata (200,5/semana) e os controles (186,5/semana; p < 0,0001). Todos os B. splendens sobreviveram a concentraÃÃo de cloro de 1,0 mg/L; 72,5 e 39,3% sobreviveram as concentraÃÃes de 1,5 e 2,0 mg/L. Por outro lado, apenas 4,4% do P. reticulata sobreviveram a concentraÃÃo mÃnima de 1,0 mg/L. Em campo foram encontrados trÃs depÃsitos com a presenÃa do B. splendens e larvas de mosquitos (1,6%), infestaÃÃo significativamente menor que nos depÃsitos com o Bti, onde essa infestaÃÃo foi de 10,9% (p < 0,001). Nos depÃsitos onde o peixe nÃo permaneceu a infestaÃÃo foi de 27,8%, maior que nos depÃsitos com Bti (p < 0,010). Nos depÃsitos onde o peixe permaneceu ele foi 85% mais eficaz que o larvicida. A permanÃncia dos peixes foi maior nos tanques de alvenaria (48,5%), localizados no peridomicÃlio (47,5%) e ao nÃvel do solo (53,3%). ConcluÃmos que o B. splendens pode ser apropriado para controle biolÃgico de larvas de Ae. aegypti em grandes reservatÃrios domiciliares, desde que possa ser atestada sua permanÃncia nesses depÃsitos. / Dengue fever remains an important public health problem in northeast Brazil. Large domestic containers used to store water are important breeding sites of Aedes aegypti, the main vector. The use of alternatives to chemical vector control has increased in the last years. The objectives of this study were: to evaluate the inhibition of oviposition by female Ae. aegypti in domestic containers with larvivorous fish; to describe the survival of larvivorous fish to different chlorine concentrations; and to describe the efficacy of Betta splendens fish under field conditions. Oviposition was assessed in a cage of 6 m3 of size. The fish species Poecilia reticulata and B. splendens were used in the laboratory assays. In the cage, eight water containers were placed - four with fish, four without fish (control), and 100 mosquitoes. In each container with 15 l water eucatex strips were placed to facilitate oviposition. At the end of each week, eggs laid on these strips were counted. For each species, the assays were repeated for seven consecutive weeks. Survival of B. splendens and P. reticulata to different concentrations of chlorine (1.0, 1.5 and 2.0 mg / L) was assessed in drums with 35 liters of water. We used 105, 140 and 175 fish for each concentration: six test containers with chlorine for each control without chlorine. Secondary data of the Municipal Dengue Control Program of the city of Fortaleza were analyzed to assess the efficacy of B. splendens under field conditions. The presence of fish in household containers was verified after several weeks. Infestation of containers with mosquito larvae was compared to containers with the larvicide Bacillus thuringiensis israelensis. The presence of B. splendens inhibited oviposition by Ae. aegypti with an activity oviposition index of -0.627. The mean number of eggs laid in deposits with B. splendens (32.5 / week) was lower than in deposits with P. reticulata (200.5 / week) and controls (186.5 / week, p <0.0001). All B. splendens specimens survived a chlorine concentration of 1.0 mg / L, and 72.5% and 39.3% survived concentrations of 1.5 and 2.0 mg / L, respectively. On the other hand, only 4.4% of P. reticulata survived a concentration of 1.0 mg / L. Under field conditions, three containers were encountered with B. splendens and mosquito larvae (1.6%), significantly less than infested deposits with Bti (10.9%; p <0.001). In containers where the fish died or disappeared, infestation was 27.8% higher than in deposits with Bti (p <0.010). In deposits where the fish remained, efficacy was 85% better than Bti. The permanence of fish was higher in concrete tanks (48.5%), located outside the house (47.5%) and at ground level (53.3%). We conclude that B. splendens may be suitable for biological control of Ae. aegypti larvae in large domestic water containers.