Thesis (DPhil (Geography and Environmental Studies))—University of Stellenbosch, 2007. / Background The Disaster Management Act (Act 57 of 2002) instructs a paradigm shift from preparedness, response and recovery towards risk reduction. In order to plan for and mitigate risks, all spheres of government must firstly assess their hazards, vulnerabilities, capacity to cope and therefore risks. Studies in this regard, in South Africa, have however only focussed on current risks. Climate Change has now been accepted by leading international studies as a reality. Climate change can impact upon many aspects of life on earth. Studies to quantify the impact of climate change on water resources, biodiversity, agriculture and sustainable development are steadily increasing, but human health seem to have been neglected. Only general predictions, mostly regarding vector-borne disease and injury related to natural disasters are found in literature. Studies in South Africa have only focussed on malaria distribution. Most studies, internationally and the few in South Africa, were based on determining empirical relationships between weather parameters and disease incidence, therefore assessing only the hazard, and not the disaster risk. Methodology This study examines the impact of climate change on human health in the Western Cape, within the context of disaster management. A qualitative approach is followed and includes: · A literature overview examining predicted changes in climate on a global and regional scale, · A discussion on the known relationships and possible impacts climate change might have on human health, · A disaster risk assessment based on the status quo for a case study area, the Cape Winelands District Municipality, · An investigation into the future risks in terms of health, taking into account vulnerabilities and secondary impacts of climate change, resulting in the prioritisation of future risks. · Suggestions towards mitigation within the South African context. Results The secondary impacts of climate change were found to have the larger qualitative impact. The impact of climate change on agriculture, supporting 38% of the population can potentially destroy the livelihoods of the workforce, resulting in poverty-related disease. Other impacts identified were injuries and disease relating to temperature, floods, fire and water quality. Conclusion Risk is a function of hazard, vulnerability and capacity to cope. The impact of an external factor on a ‘spatial system’ should be a function of the impacts on all these factors. Disasters are not increasing because of the increase in the frequency of hazards, but because of the increasing vulnerability to hazards. This study illustrated that the major impacts of the external factor could actually be on the vulnerabilities and the indirect impacts, and not on the hazard itself. Climate change poses a threat to many aspects of the causative links that should be addressed by disaster management, and its impacts should be researched further to determine links and vulnerabilities. This research also illustrates that slow onset disasters hold the potential to destroy just as much as extreme events such as Katrina, Rita or a tsunami. It also reiterates that secondary impacts may not be as obvious, but are certainly not of secondary importance.

Submitted in fulfillment of the requirements for the Degree of Master of Technology Degree : Environmental Health, Durban University of Technology, Durban, South Africa, 2015. / Introduction Informal waste picking has both economic and environmental benefits, however there are many health risks associated with this activity. This cross sectional descriptive study assessed the respiratory health risks and dust (PM2.5) exposure among informal waste pickers operating at the New England landfill site in the Msunduzi Municipality. Data was collected from 102 informal waste pickers using a validated questionnaire adapted from the British Medical Research Council and American Thoracic Society. Our study population comprised of 66.4°/o women with a mean age of 36.7 years. Women reported greater use of safety shoes and gloves compared to men. Very few participants used dust masks or respirators. Results showed a high prevalence of chronic cough (57o/o), wheeze (51°/o) shortness of breath (31.6°/o) and cough with phlegm (29.0°/o) among all participants. Among those who reported having ever smoked, there was a significantly higher prevalence of cough with phlegm (45.2°/o p=0.02) and wheeze (73.1°/o, p= 0.05). Similarly, there was a bivariate association between current smoking and wheeze (p=0.02) and between ever smoked and wheeze {p< 0.05). A random sample of 28 waste pickers was chosen from the 102 participants for personal sampling. The levels and distribution of time weighted average to PM2.5 were calculated during an 8 hour working period. Average personal sampling levels of PM2.5 were very high compared to environmental levels. Personal sampling results showed a maximum exposure of 431 J.,Jg/m 3 and a mean of 187.4 J.,Jg/m 3 compared to a maximum level of 27.9 J.,Jg/m 3 and a mean of 16.5 J.,Jg/m 3 for environmental sampling. Mean personal sampling results significantly exceeded recommended eight hour time weighted average for South African National Standard for Occupational Exposure Limit (Republic of South Africa OHS ACT 85 of 1993), World Health Organisation and United State Environmental Protection Agency guidelines for PM2.5, while the environmental mean was within guidelines. This study showed that waste pickers are exposed to high levels of PM2.5 while working at the landfill site. Limited or no use of personal protective equipment increases risk of dust exposure and adverse respiratory effects. The relatively high prevalence of cough, shortness of breath and wheeze symptoms among these informal waste pickers may be linked to exposure to dust at the landfill site / PDF copy unavailable. please refer to hard copy for full text information / M

Breast cancer poses a serious public health concern. This case-control study describes the relationship of night-shift working on the development of breast cancer in 57 women diagnosed with breast cancer compared to 49 women with other types of cancer in the Vaal Triangle area (selected through non-probability purposive sampling from CANSA). The study revealed that women who work night-shift developed breast cancer 1.24 times more often than women who do not work nightshift (OR=1.24 [95% CI 0.52 to 2.89]). The odds ratio was further increased in women who worked rotating-shift (OR=1.44 [95% CI 0.58 to 3.59]). Night-shift work exposure was not statistically related to the development of breast cancer. It is recommended that the relationship between night-shift exposure and breast cancer risk be further explored through cross-sectional and cohort studies, and other breast cancer pathways. / Health Studies / M. A. (Public Health)

Operation Enduring Freedom (OEF) (Afghanistan) and Operation Iraqi Freedom (OIF) represent one of the longest wartime deployments in the history of the American military. To date, 1.6 million American military members have deployed. Of these, an estimated 300,000 have returned with a mental health condition, such as depression or PTSD. The Department of Defense has established a robust screening program to identify and track deployment-related physical and psychiatric illnesses. The Post-Deployment Health Reassessment (PDHRA) is a primary tool to identify physical and psychiatric risk following a deployment. The PDHRA is a web-based survey, which is administered between 90-180 days after a deployment. This study seeks to evaluate the psychometric properties and clinical utility of the Post-Deployment Health Reassessment (PDHRA) for accurately identifying truama and depression among Airmen following a deployment. Descriptive statistics, confirmatory factor analysis and structural equation modeling were used to address separate research aims. Study aims assessed the impact of deployment on military members and the clinical utility and psychometric properties of the Post-Deployment Health Reassessment. Findings suggest that the Post-Deployment Health Reassessment is a useful triage tool to identify trauma and depression among Airmen following deployment. The study makes recommendations for improving the clinical utility and psychometric properties of the Post-Deployment Health Reassessment (PDHRA). / text

This study set out to examine the levels of galactic cosmic radiation exposure to Australian aircrew during routine flight operations, with particular attention to the high southern latitude flights between Australia and South Africa. Latitudes as high as 65?? South were flown to gain the data and are typical of the normal flight routes flown between Sydney and Johannesburg on a daily basis. In achieving this objective it became evident that suitable commercially available radiation monitoring equipment was not readily available and scientific radiation monitors were sourced from overseas research facilities to compliment my own FH4lB and Liulin monitors provided by UNSW. At the same time it became apparent that several predictive codes had been developed to attempt to model the radiation doses received by aircrew based on flight route, latitudes and altitudes. Further, it became apparent that these codes had not been subjected to verification at high southern latitudes and that they had not been validated for the effects of solar particle events. Initially measurements were required at the high latitudes followed by mid-latitude data to further balance the PCAIRE code to ensure reasonableness of results for both equatorial and high latitudes. Whilst undertaking this study new scientific monitors became available which provided an opportunity to observe comparative data and results. The Liulin, QDOS and a number of smaller personal dosimeters were subsequently obtained and evaluated. This appears to be the first time that such an extensive cross comparison of these monitors has been conducted over such a wide range of latitudes and altitudes. During the course of this study a fortuitous encounter with GLE 66 enabled several aspects of code validation to be examined, namely the inability of predictive codes to estimate the increased dose associated with a GLE or the effects of a Forbush decrease on the code results. Finally I review the known biological effects as discussed by numerous authors based on current epidemiological studies, with a view to high-lighting were the advent of future technology in aviation may project aircrew dose levels.

More than one billion people, almost one in six of the world's population, are now using GSM mobile phones. The situation in South Africa is no different from that in the rest of the world. The rise of mobile telephone usage in South Africa has been driven by a combination of factors such as demand, sector reform, the licensing of new competition, and the emergence of major strategic investors, such as Vodacom and MTN. It was estimated that by March 2005 there should be approximately 20 million cellular customers in South Africa. The growth in the South African cellular market is proportionate to the potential risks in an environment where organisations are continuously seeking ways of improving efficiency, cutting costs, and staying abreast of technological advances. Elements of risk control such as Safety, Health, and Environmental Management can no longer be left out of the equation while organisations in the GSM industry are considering increasing their networks to meet the demands of growth. Although risk assessments are not specifically defined in the Occupational Health and Safety Act (85 of 1993); Section 8 does, however, stipulate under the general duties of the employer that the employer must establish, as far as is reasonably practicable, which hazards to the health or safety of persons are attached to any work which is performed. This situation has changed with the promulgation of the Construction Regulations, GNR.1010 on 18 July 2003; which state that every contractor performing construction work shall, before the commencement of any construction work and during construction work, cause a risk assessment to be performed by a competent person appointed in writing, and that the risk assessment shall form part of the health and safety plan to be applied on the site. This requirement under the Construction Regulations will have a major impact on organisations in the GSM industry. Integrated Health, Safety and Environmental risk assessments have now become a prerequisite before considering any further expansion of the GSM network in South Africa. The relationship between the operational risk sub-disciplines of health, safety, and environmental management, as part of the risk-management function, has been established, and an operational risk-assessment model for the Global Systems Mobile Telecommunications industry in South Africa that measures occupational health, safety, and environmental management risks on an integrated basis has been developed. The risk assessment model for the South African GSM industry is based on assessing the frequency of an activity in relation to the impact on the organisation's business processes, incident/accident potential, financial impact, legal status, and the nature of ecological impact. / Business Management / D. Com. (Business Management)

The key objective of this study was to determine the relationship between burnout (measured by the Maslach Burnout Inventory – Human Services Survey (MBI-HSS)), work engagement (measured by the Utrecht Work Engagement Scale), and sense of coherence (measured by the Orientation of Life Questionnaire developed by Antonovsky (1987)). A quantitative study using a cross-sectional survey research design was conducted on a randomly selected sample (N = 178) of nurses at a central hospital in Kwa-Zulu Natal. A theoretical relationship was established between the variables. The empirical relationship revealed statistically significant negative relationship between burnout and work engagement. A statistically significant negative relationship was also established between burnout and SOC. The findings add valuable knowledge to industrial and organisational psychology and can be applied to promote employee and organisational wellness. / Industrial and Organisational Psychology / M. Com. (Industrial and Organisational Psychology)

Text in English / Cervical cancer accounts for 34.6% of all the female cancers in Zimbabwe. The purpose of this study was to explore the knowledge, attitudes and perceptions of female student nurses regarding cervical cancer in Zimbabwe using the Health Belief Model (HBM) as a theoretical framework. The ultimate aim was to analyse female student nurses’ risk perception of contracting cervical cancer. A quantitative, cross-sectional descriptive research design was used, using a structured questionnaire for data collection. One hundred and thirty-two (132) respondents were conveniently selected. Descriptive and inferential statistics were calculated using Statistical Package for Social Sciences (SPSS) version 21 software program. The study revealed that 57.9% of the respondents perceive that they are at risk of developing cervical cancer. They believe that screening for cervical cancer is not embarrassing. Knowledge improved with increase in the level of study, there was lack of knowledge of HPV and cervical cancer link. More emphasis on cervical cancer should be put on curricula taught in undergraduate education earlier on in the programme. / Health Studies / M.A. (Nursing Science)

Úlceras por Pressão (UPP) são áreas de necrose isquêmica em partes moles, causadas por uma pressão prolongada maior que a capilar, com ou sem cisalhamento, relacionada à postura e frequentemente localizada junto a uma proeminência óssea em indivíduos com predisposição clínica. Os fatores extrínsecos pressão, fricção, cisalhamento, umidade e alterações de temperatura são relacionados à engenharia biomédica e decorrem da interação do paciente com a superfície de suporte. Já os intrínsecos, notadamente relacionados às condições de saúde, envolvem o desequilíbrio nutricional e as afecções clínicas, tanto as que diminuem a oxigenação tecidual, como as que implicam no comprometimento da mobilidade. Por ser mais prevalente entre os idosos e por decorrer de múltiplas causas e mecanismos patogênicos, as UPP são classificadas como uma Síndrome Geriátrica. Embora associada principalmente a gerontes, o aporte financeiro empregado no grupo de feridas crônicas, como as UPP, remonta o 3o maior bloco de gastos em saúde no mundo. As UPP são frequentes em pacientes hospitalizados, porém ultrapassam este ambiente, havendo expressiva incidência em residentes de Instituições de Longa Permanência para Idosos (ILPIs). No Brasil, as ILPIs são órgãos sociais, o que gera uma lacuna legal quanto à responsabilidade clínica sobre seus residentes e, consequentemente, sobre as afecções que os acometem, particularmente as UPP. Estas feridas são passíveis de prevenção, destacando-se então o cuidador de idosos, ocupação que vem aumentando em número e importância com o envelhecimento da população e que, no entanto, nem sempre é devidamente instruído. Por meio de uma vasta revisão de literatura, esta dissertação objetivou pontuar os fatores relevantes envolvidos na patogenia das UPP, além das especificidades do indivíduo idoso e do ambiente das ILPIs. Neste contexto, o produto final elaborado foi um guia para prevenção de UPP em ILPIs. / Pressure Ulcers (PU) are areas of localized soft tissue ischemic necrosis caused by prolonged pressure higher than the capillary pressure with or without shear, related to posture which usually occurs over a bony prominence in individual with certain clinical susceptibilities. Extrinsic factors – such as pressure, friction and shear, moisture and temperature changes – are related to biomedical engineering and come from the interaction patient-surface. On the other hand, intrinsic factors are related to health conditions and correspond to nutritional imbalance and/or conditions that decrease tissue oxygenation or impair mobility. Since it features different pathogenic mechanisms and it is more prevalent among the elderly, the PU group is classified as a geriatric syndrome. Worldwide, PU are estimated to be the 3rd largest consumer of resources, plus the social burden and consequences of this condition. PU are quite common in hospitals, however there are several cases among the elderly living in Long-Term Care Facilities (LTCFs). In Brazil, these institutions are supported by social organizations, what produces legal gaps with respect to the residents’ clinical responsibility, and reduces the chances of preventing avoidable diseases as PU. The number of elderly caregivers tends to grow accordingly to the population ageing, creating a window of opportunity for continued education of this group of workers. Through an extensive literature review, this thesis aimed to highlight the relevant findings of the different factors involved in PU pathogenesis as well as to ascertain the particularities of elderly individuals and the specific environment of LTCFs. The final product is a PU prevention guide suitable to use in Brazilian long-term care facilities.

Introdução: Estudos têm encontrado uma transição da obesidade da população adulta para crianças e adolescentes, que por sua vez, pode acarretar manifestações clínicas, como: doenças coronarianas, diabetes tipo 2, e complicações psicossociais cada vez mais precocemente. Contudo, métodos para avaliação da composição corporal para essa faixa etária, principalmente envolvendo técnicas de baixo custo como as medidas de dobras cutâneas (DC) apresentam imprecisões em estudos brasileiros. Fator o qual pode levar a uma interpretação equivocada da composição corporal dos avaliados. Objetivo: desenvolver novos modelos matemáticos utilizando medidas de DC, tendo como referência a absorciometria de raios-X de dupla energia (DXA), para estimativa de massa de gordura (G) em adolescentes. Métodos: Trata-se de um estudo exploratório descritivo onde foram avaliados 416 adolescentes do gênero masculino de 12 a 17 anos, sendo 42 destinados para compor a amostra de validação da pesquisa. Foram coletadas medidas de massa corporal total, estatura, circunferência da cintura e quadril, nove pontos anatômicos baseados em DC: bíceps, tríceps, subescapular, peitoral, axilar média, abdominal, supra-ilíaca, coxa e panturrilha, além da G e densidade mineral óssea (DMO) aferida com a tecnologia de DXA. Para o desenvolvimento das equações foi utilizado um modelo de regressão linear múltipla através do método de mínimos quadrados ordinários (OLS). Resultados: O grupo apresentou índice de massa corporal (IMC) médio de 21,25±4,12kg/m² e %G = 20,57±5,80%. A partir do %G, a prevalência de excesso de gordura foi verificada em 38,3% dos adolescentes. O impacto da gordura na DMO dos adolescentes indicou uma associação na ordem de r = -0,358; p<0,005, sendo verificada redução de até 14% da DMO para a região da coluna em adolescentes com obesidade em comparação aos eutróficos. O desenvolvimento de novos modelos matemáticos que atendessem critérios de alto coeficiente de determinação (R²), baixo erro padrão de estimativa (EPE), controle de colinearidade, normalidades dos resíduos, homoscedasticidade e praticidade, possibilitaram a apresentação de três opções com R² = 0,932 e EPE 1,79; R² = 0,912 e EPE = 1,78; R² = 0,850 e EPE = 1,87, respectivamente. Em todas as opções, as variáveis idade e estatura foram empregadas, bem como as DC de tríceps e subescapular. Conclusão: Os resultados obtidos evidenciam a possibilidade de desenvolvimento de novos modelos matemáticos para a avaliação da gordura corporal em adolescentes com resultados superiores aos modelos existentes na literatura. / Introduction: Studies have found a transition from obesity of the adult population to children and adolescents, which in turn, can lead to clinical manifestations, such as: coronary diseases, type 2 diabetes, and psychosocial complications increasingly early. However, methods for evaluating nutritional status for this age group, mainly involving low cost techniques such as skinfold thickness measurements (ST), are imprecise in Brazilian studies. Factor which can lead to a mistaken interpretation of the body composition of the evaluated ones. Objective: To develop new mathematical models, based on DC measurements, based on dual energy X-rays absorptiometry (DXA), to estimate fat mass (G) in adolescents. Methods: This was an exploratory descriptive study in which 416 male adolescents aged 12 to 17 years were evaluated, 42 of whom were separated to compose the study validation sample. Measurements of total body mass, stature, waist and hip circumference were obtained, nine anatomical points based on ST: biceps, triceps, subscapular, pectoral, mid axillary, abdominal, suprailiac, thigh and calf muscles, as well as G and bone mineral density (BMD) measured with DXA technology. For the development of the equations, a multiple linear regression model was used by the ordinary least square (OLS) method. Results: The group had a mean body mass index (BMI) of 21.25± 4.12 kg / m² and %G = 20.57 ± 5.80%. From %G, the prevalence of excess fat was verified in 38.3% of adolescents. The impact of fat on adolescent BMD indicated an association in the order of r = -0.358; P <0.005, with BMD reduction up to 14% for the spine region in adolescents with obesity compared to eutrophic. The development of new mathematical models that meet criteria of high coefficient of determination (R²), low standard error of estimation (SEE), control of colinearity, residue normalities, homoscedasticity and practicality, allowed the presentation of three options with R² = 0.932 and SEE 1.79; R² = 0.912 and SEE = 1.78; R² = 0.850 and SEE = 1.87, respectively. In all the options, the variables age and height were employed, as well as triceps and subscapular ST. Conclusion: The results obtained evidenced the possibility of developing new mathematical models for the evaluation of body fat in adolescents with results superior to the existing models in the literature.