On t.p.: Master of Arts (Clinical Psychology) / Thesis (MA)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: Progress has been made in the approach to combating the spread of HIV/AIDS with regards to the Department of Health's presentation of the HIV/AIDS/STD Strategic Plan for South Africa. However, deep concem exists with regards to specific marginalized groups such as disabled persons within the South African sector threatened by the spread of HIV/AIDS. The aim of this paper was to review published academic papers on the specific ways in which disabled people are at risk for contracting HIV/AIDS, and the existence of primary prevention programmes designed and specifically aimed at the disability sector. The roles of non-governmental and other organisations were also looked at. The first section of the review focused on high-risk behaviour among disabled persons for contracting HIV/AIDS. Existing literature covered mainly areas of intellectual disability and psychiatric disability. Disabled persons struggle with the same issues of good education, workers' rights, gender equality, health care and social support and well-being as the general population. These issues are however exacerbated by struggles unique to those living with a disability. Inadequate public and social support increase disabled people's vulnerability to issues such as poverty, lack of resources, and inadequate education, heightening their risk of contracting HIV/AIDS. The second section of the review discusses the area of primary prevention, explaining why prevention programmes should be tailormade for specific needs such as those of disabled persons. Examples of prevention programmes from the literature are looked at, as well as a prevention initiative launched in South Africa. / AFRIKAANSE OPSOMMING: Vooruitgang is gemaak op die gebied van die voorkoming van die verspreiding van MIVNIGS met die bekendstelling van die Departement van Gesondheid se MIVNIGS/STD Strategiese Plan vir Suid-Afrika. Daar is wel steeds kommer oor spesifieke gemarginaliseerde groepe, soos gestremde persone, binne die Suid- Afrikaanse sektor wat bedreig word deur die verspreiding van MIVNIGS. Die doel van die studie was om 'n oorsig te kry van akademiese materiaal wat gepubliseer is oor die spesifieke wyses waarop mense met 'n gestremdheid in gevaar verkeer om MIVNIGS op te doen, asook primêre voorkomingsprogramme wat spesifiek ontwerp en gemik is op die gestremde sektor. Daar is ook gekyk na die rol van nie-regerings- en ander organisasies. Die eerste deel van die studie fokus op hoë risiko gedrag van gestremde persone wat hulle in gevaar mag stel vir die opdoen van MIVNIGS. Bestaande literatuur handel meestaloor die areas van intellektuele gestremdheid en psigiatriese siektes. Gestremde persone moet dieselfde uitdagings oorkom as diegene in die algemene populasie, soos byvoorbeeld die gebrek aan goeie onderwys, arbeidsregte, diskriminasie op grond van geslag, gesondheidssorg, asook sosiale steun en algemene welsyn. Gestremde persone se kwessies word egter vererger deur sekere uitdagings wat uniek is aan 'n lewe met 'n gestremdheid. Gestremde persone ontvang meestalonvoldoende publieke en sosiale steun wat dikwels armoede, gebrek aan hulpbronne en onvoldoende opvoeding tot gevolg het. Laasgenoemde verhoog gestremde persone se kanse om MIVNIGS op te doen. Die tweede deel van die studie bespreek primêre voorkomingsprogramme en waarom dit noodsaaklik is om voorkomingsprogramme te ontwerp wat uitsluitlik gemik is op spesifieke populasies. Daar word dan ook gekyk na voorbeelde van primêre voorkomingsprogramme in die literatuur, asook 'n voorkomingsinisiatief wat in Suid-Afrika geloods is.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Exposure to food contaminates such as mycotoxins have been associated with a variety of animal and human diseases worldwide. In South Africa, maize is the most To further refine risk assessment in the socio-demographic heterogeneous population of South Africa, the development and evaluation of a sensitive and interactive model the Mycotoxin Risk Assessment Model (MYCORAM) proofed to be more sensitive compared to the classical probable daily intake (PDI). The development of the MYCORAM was based on mycotoxin distribution during dry milling of maize in milling fractions intended for human consumption which was superimposed on the maize intake profiles of the South African population. Although dry milling, including a degerming step, is an effective way to reduce mycotoxins, risk and exposure assessment are influenced by maize dietary intakes, gender and ethnicity. This became evident when considering FB dietary exposure in rural maize subsistence farming communities in the Eastern Cape Province, South Africa confirmed the vulnerability of this subpopulation to risk of fumonisin exposure. Specific maximum tolerated maximum levels (MTL) to safeguard these communities fall outside the international regulatory processes and need to be urgently addressed. With the complex nature of cancer development in mind, integration of basic science and nutritional epidemiology will be important to contribute to our understanding of the adverse effects of FB and to define relevant risk assessment parameters. important commercial grain crop not just economically but also as a local food commodity both commercially and in subsistence rural farming communities. In order to control and manage mycotoxin contamination in food, evidence-based risk assessment is needed that includes mechanistic and human exposure studies. From this perspective the current study was conducted and aimed in further unravelling fumonisin B1 (FB1) mycotoxin induced hepatocarcinogenesis via the disruption of the lipid metabolism. The study also critically evaluates aspects of human risk assessment due to its relevance and importance to food safety known to impact on food security. This entails mycotoxin distribution during maize dry milling and the assessment of mycotoxin exposure in the South African population and vulnerable rural communities at risk. Fumonisin B1 affects the integrity of biological membranes by altering key lipid and fatty acid parameter in plasma, microsomal, mitochondrial and nuclear subcellular membrane fractions in rat liver. Changes in the major lipid constituents entailing an increase in cholesterol (CHOL) and phosphatidylethanolamine (PE) whilst sphingomyelin (SM) and phosphatidylcholine (PC) tended to decrease. Isolated plasma membrane lipid rafts, from rat primary hepatocytes exposed to FB1 augments the intricate effects exerted on the lipid metabolism regarding CHOL, SM and PE. The disruption of lipid and fatty acid constituents, such as arachidonic acid and ceramide, are likely to be key determinants affecting growth regulatory signaling pathways relevant to the critical balance between cell proliferation and apoptosis during cancer promotion. These changes provide further evidence that FB1 induce cancer promotion by differential inhibition and/or stimulation process whereby a few resistant “initiated” hepatocytes proliferate in an environment where the growth of normal cells is inhibited. A specific lipogenic phenotype is effected by FB1 which is closely associated with cancer development and considered to occur via an epigenetic-type of mechanism. These effects are not adequately addressed in defining risk assessment parameters. / AFRIKAANSE OPSOMMING: Die blootstelling aan voedsel-kontaminante soos mikotoksienes word wêreldwyd met ‘n verskeidenheid van dierlike en menslike siektes geassosiseer. In Suid-Afrika word mielies as ‘n belangrike graanoes beskou, nie net vir die ekonomie nie maar ook as ‘n plaaslike voedselproduk beide kommersieel en vir bestaansboere in landelike gemeenskappe. Ten einde mikotoksien-kontaminasie van voedsel te kan beheer en bestuur, vereis bewys-gebaseerde risiko-evaluering wat insluit meganistiese en menslike blootstelling studies. Vanuit hierdie perspektief is die huidige studie uitgevoer en gemik op die verdere ontleding van die fumonisin B1 (FB1) mikotoksien geïnduseerde lewer-karsinogenese deur die ontwrigting van die lipiedmetabolisme. Die studie ondersoek terselfdetyd aspekte van menslike risiko-evaluering ingevolge die relevansie en belangrikheid hiervan in voedselveiligheid wat ook ‘n impak op voedselsekerheid sal maak. Dit sluit in die verspreiding van mikotoksiene gedurende die droëmaalproses van mielies en mikotoksien blootstelling in Suid-Afrika asook onder kwesbare landelike gemeenskappe. Fumonisin B1 beïnvloed die integriteit van biologiese membrane deur die modulasie van die belangrike lipied en vetsuur samestelling van plasma, mikrosomale, mitochondriale en kern subsellulêre membraan-fraksies in rot lewer. Veranderinge in die belangrike lipiedbestanddele, insluitende ‘n verhoging in cholesterol (CHOL) en phosphatidylethanolamine (PE), terwyl sphingomyelin (SM) en phosphatidylcholine (PC) geneig was om te verlaag. Geïsoleerde plasma membraan lipied vlotte (lipid rafts), vanaf primêre rot hepatosiete blootgestel aan FB1, versterk die ingewikkelde gevolge wat uitgeoefen word op die lipiedmetabolisme insluitende die voorgestelde veranderings in CHOL, SM en PE vlakke. Die versteuring van lipiede en vetsure soos aragidoonsuur (arachidonic acid) en ceramied kan beskou word as belangrike determinante wat inmeng in groei-regulerende seinbane verwant aan die kritiese balans tussen selgroei en seldood. Die versteurings verskaf verdere bewyse dat FB1 kanker bevorder deur ‘n seleksie proses wat onderskeidelike die onderdrukking en\of die stimulasie van ‘n paar weerstandige of geneties veranderde hepatosiete laat vermeerder in ‘n omgewing waar die groei van normale selle geïnhibeer word. Die spesifieke lipogeniese fenotipe wat FB1 versoorsaak hou ten nouste verband met kankerontwikkeling en die voorkoms van epigenetiese-soort meganismes word voorgestel. Hierdie oorsake word tans nie voldoende aangespreek tydens die bepaling van risiko-evaluerings limiete nie. Om risiko-bepaling verder te verbeter in die sosio-demografies heterogene populasie van Suid-Afrika, was die ontwikkeling en evalueering van ‘n sensitiewe en interaktiewe model, die “Mycotoxin Risk Assessment Model” (MYCORAM) meer doeltreffend vergeleke met die gewone waarskynlike daaglikse inname. Die ontwikkeling van die MYCORAM was gebaseer op die mikotoksien verspreiding tydens die droëmaalproses van mielies in fraksies wat vir menslike verbruik bedoel was tesame met mielie dieetinnames van die Suid-Afrikaanse populasie. Alhoewel, die droëmaalproses van mielies, insluitende die verwydering van die kiem doeltreffende maniere is om mikotoksienes te verminder, word risiko- en blootstellings evaluering beinvloed deur mielie dieetinnames, geslag en etnieseverbandskap. Hierdie was veral opmerklik gedurende blootstelling aan FB in die dieet van landelike mielie bestaansboer gemeenskappe in die Oos-Kaap van Suid- Afrika en bevestig hoe kwesbaar hierdie populasie is. Spesifieke maksimum toelaatbare vlakke om hierdie gemeenskappe te beskerm val buite die huidige internasionale regulatoriese prosesse en benodig dringende aandag. Met die ingewikkelde aard van kankerontwikkeling in gedagte, sal die integrasie van basiese wetenskappe en voedingsepidemiologie, ‘n belangrik bydrae lewer tot die kennis van die negatiewe eienskappe van FB om toepaslike risiko-evaluerings limiete te kan bepaal.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Environmental Management / Master / Master of Science in Environmental Management

The purpose of this study was to retrospectively identify risk factors of elderly nursing home residents that may predict the hospitalization of recently admitted elderly nursing home residents. Two groups of randomly chosen residents were studied. The non-hospitalized group (n = 100) were admitted to a nursing home and remained in the facility for at least 90 days. The hospitalized group (n = 100) were discharged to a hospital within 30 days of admission to the nursing home. The presence of HCFA irregularities increased the odds for hospitalization of an elderly nursing home resident by 1.67. Regular medication orders on discharge increased the odds of hospitalization by 1.25. This study showed that the use of the 33 HCFA indicators are useful in identifying elderly nursing home residents that may be at an increased risk of hospitalization.

PURPOSE: The purpose of this study was to compare relationships between dietary and physical activity (PA) behaviors and body composition and body fat distribution, as measured by percent body fat (BF%), waist-to-height ratio (WHt), waistto- hip ratio (WHp) and body mass index (BMI) in post-menopausal women (Post), with the same relationships in pre-menopausal women (Pre). METHODS: Ninety-two subjects (n = 48 Post; n = 44 Pre) were measured for height, weight, waist and hip circumferences and skinfold thicknesses. Dietary content was obtained from a Diet History Questionnaire (DHQ II); PA was estimated from responses to the International Physical Activity Questionnaire (IPAQ). RESULTS: Multiple regression identified no modifiable predictor variables for Pre. Models for Post identified saturated fat grams (SFGs), PA, years postmenopause (YrsPost), and Alcohol (Alc) as predictors of WHt, WHp, BMI and BF%. CONCLUSIONS: PA, SFG and Alc are modifiable variables related to postmenopausal body composition and fat distribution. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

The purpose of this study was to determine whether an educational tobacco intervention impacted college students' perceptions relative to tobacco, self-efficacy, and perceived stress levels. The Health Belief Model (HBM) provided a theoretical framework to distinguish differences relative to tobacco between groups. Both the control (N=155) and intervention (N=184) group consisted of a convenience sample of students from a 2000-level health course. A pre- and post-test questionnaire was administered to both groups which included questions regarding demographics, tobacco use, HBM, self-efficacy, and perceived stress. Data analysis included frequency counts, confirmatory factor analysis, Cronbach's alpha, and two-way ANOVA. Two-way ANOVA results indicated statistically significant differences for the Health Belief Model questions (p=0.002) and self-efficacy items (p=0.03). No statistical significance was found regarding perceived stress. These findings provide evidence an educational tobacco intervention administered at the college level can have a significant impact on students. / by Kelley E. Rhoads. / Thesis (M.S.)--Florida Atlantic University, 2012. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2012. Mode of access: World Wide Web.

Thesis (MTech(Environmental Health)--Cape Technikon, Cape Town,1997 / The study project researched the quality of the investigations and the institutional transfer of data regarding notifiable food poisoning outbreaks reflected in "the study region", that is to say North-, East- and Western Cape Provinces. In comparing the data of the central-, provincial- and local governments' total notifiable food poisoning outbreaks notifications for specific local areas, problems relating to incomplete and poor data, poorly completed reports and ignorance of health workers re notifiable medical conditions were identified. Various conclusions and recommendations were made for "the purpose of future improvements.

Increasing the independence of students with disabilities involves an in-depth assessment of their inclusion in driver’s education. This study addresses (a) the plight of disabled students within the state of New Jersey who are unable to access driver’s education, despite the provisions of the Americans with Disabilities Act; (b) the need to evaluate the potential role of health educators in conducting individualized health assessments to determine the readiness, motivation, and self-efficacy of students with disabilities to participate in driver’s education; (c) the perceived benefits and barriers to the participation of students with disabilities in driver’s education including the need for individually tailored accommodations; and (d) whether the goal of driving is appropriate and accessible for students with disabilities. A case-study approach was used in this research to evaluate the innovative practice of school health educators conducting individualized health assessments of current students and some graduates of the study-site university. The school implemented the described innovation during the academic years of 2007-08 and 2008-09. This research was also designed with a mixed-method approach including quantitative data limited to frequencies and percentages and qualitative data collected from student interviews. The findings indicate that the ability of students with disabilities to drive is beneficial to their quality of life. Driving significantly impacts the self-esteem, independence, and personal freedom of this population, as well as their overall freedom to travel.

ContexteDe nombreux facteurs influencent l’exposition des agriculteurs aux produits phytopharmaceutiques (PP) : facteurs techniques (matériel de pulvérisation, forme et type des PP employés), agronomiques (pression parasitaire, doses employées, type de culture) et humains. La perception d'un risque est un facteur déterminant du comportement humain face à celui-ci. La perception du risque phytosanitaire chez les agriculteurs et ses conséquences sur l'exposition aux substances actives des utilisateurs sont peu étudiées.ObjectifL’objectif de ce travail est d’évaluer comment la perception du risque influe sur les pratiques des agriculteurs. Il vise aussi à décrire et évaluer les déterminants de cette perception, et leurs impacts sur le risque sanitaire des utilisateurs de PP. Méthode.Des entretiens individuels sont menés pour évaluer la perception du risque auprès d’utilisateurs de PP. Des mesures et modélisations d’exposition complètent ces observations. Les mesures se focalisent sur les paramètres influencés par la perception du risque décrits lors des entretiens. Les résultats des mesures d’exposition sont comparés aux pratiques observées et servent à qualifier et quantifier l’impact de la perception sur le risque sanitaire.RésultatsCe travail montre que la perception des agriculteurs du risque liés aux PP est empirique et se base sur des critères tels que l'odeur, le type, la forme ou l'efficacité des produits pour estimer le risque. Les comportements des agriculteurs pour réduire leur exposition sont corrélés à leur perception des produits employés. L'utilisation des équipements de protection individuelle (EPI) est le marqueur le plus fort de la perception. Plus le risque est perçu comme important, plus l'utilisation d'EPI est élevée. Mais les pratiques de réduction du risque ne sont pas toujours efficaces pour réduire l'exposition. En effet, les mesures d'exposition réalisées montrent que les opérateurs, même utilisateurs d'EPI, n'ont pas conscience des phénomènes de contaminations indirectes (cabine des tracteurs, environnement de travail). Combinés à un mauvais usage fréquent des EPI (réutilisation d'EPI à usage unique, utilisation partielle ou inadaptée), ces défauts de perception jouent sur l'exposition aux PP.Les modélisations et mesure d’exposition en fonction des pratiques observées ont permis de quantifier les conséquences sanitaires de ces comportements. Il ressort que le risque sanitaire lors de l'utilisation des PP dans le cadre des bonnes pratiques est acceptable. Cependant ces bonnes pratique sont théoriques et les observations montrent que les opérateurs ont des comportements qui s'éloignent des bonnes pratiques et les exposent aux PP, mais ces comportements ne sont pas perçus comme tels. Le risque sanitaire associé aux pratiques est très individuel et difficilement généralisable. Cependant, ce travail exploratoire a permis de mettre à jour des profils de risque et de décrire les déterminants forts de la perception. La sensation de maîtrise du risque est le déterminant clef dans l'acceptation du risque par les agriculteurs. ConclusionCe travail montre que la perception du risque joue un rôle décisif dans l'exposition totale des agriculteurs aux PP. Le risque sanitaire est sensiblement dépendant de la perception du risque. Les politiques de prévention des risques doivent s'appuyer sur cet aspect afin d'adapter les messages et d'éduquer les opérateurs aux pratiques exposantes telles que la contamination indirecte ou le mauvais usage des EPI, aujourd'hui peu pris en compte par les utilisateurs de pesticides. / IntroductionMany factors influence the exposure of farmers to pesticides. Technical (spraying equipment, type of pesticides used), agronomic (type of crop, doses used, frequency) and human factors. The perception of risk is a determinant key of human behavior and how human faces to risk. Pest risk perception among farmers and the consequences of exposure to active substances of farmers have not been clearly studied.AimsThe objective of this study is to evaluate how risk perception affects farmers' practices. It also aims to describe and assess the determinants of this perception, and their impact on the health risk of pesticides users.Individual interviews are conducted to describe the perception of risk of pesticides' users. Measurements and modeling of exposure complement these observations. The measures focus on the parameters influenced by the perception of risk described in the interviews. The results of exposure measurements are compared to practices observed and used to qualify and quantify the impact of perception on health risk.ResultsThis work shows that farmers' perceptions of risk related to pesticides used is empirical and based on criteria such as smell, type, form or effectiveness of products to estimate the risk. Farmers' behavior to reduce exposure is correlated with their perception of the products used. The use of personal protective equipment (PPE) is the strongest marker of perception. The higher the risk perceived, the greater the use of PPE is high. But the practical risk reductions are not always effective in reducing exposure. Indeed, exposure measurements show that operators, even in users of PPE, are unaware of indirect contamination (cab tractors, work environment). Combined with frequent misuse of PPE (reuse of disposable PPE, partial or improper use), these defects perception are increase exposure to pesticides.Modeling and exposure’s measurement based on observed practices are used to quantify the health consequences of these behaviors. It appears that the health risk of pesticides is acceptable when used as recommended. However, recommended practices are theoretical and observations show that operators have behaviors that deviate from recommended practices depending on pesticides used. But these behaviors are not perceived as risky. The health risks associated with individual practice is very difficult to generalize. However, this work highlights profiles of risk and describes strong determinants of perception. The risk-control feeling is the key determinant in risk acceptance by farmers.ConclusionThis work shows that the perception of risk plays a decisive role in the exposure to pesticide of farmers. The health risk is substantially dependent on the perception of risk. The risk prevention policies must support this risk perception to adapt messages and educate the operators to not adapted practices such as indirect contamination or improper use of PPE, few considered by some pesticides users.