A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in Community Health (Occupational Medicine) Johannesburg, March 2017. / Introduction: The Occupational Diseases in Mines and Works Act (ODMWA) 1973 (as amended in 2002) provides for compensation of occupational lung diseases in living and deceased miners and ex-miners. Certification data constitute a valuable source of information on occupational diseases in the mining industry. Objectives: The objectives of the study were: i) To describe the extent and type of compensable lung diseases in South African mining from 2004-2012, by commodity; ii) to describe certification trends over 2004-2012; iii) to examine specific issues related to some of the compensable occupational lung diseases (including service duration in coal miners with coal workers’ pneumoconiosis by coal type, describe asbestos related diseases in women and number of miners with exclusive diamond miners certified with mesothelioma during this period); iv) to determine the odds of developing mesothelioma from chrysotile mining and other associated risk factors and v)to determine time from the certification to compensation payment, using a proportion of cases certified in 2009, 2010 and 2011 financial years. Methods: A descriptive analysis was conducted using the Medical Bureau of Occupational Diseases (MBOD) dataset using claims from living miners, certified from 2004 up to 2012, certified with compensable disease, for the first three objectives. For the fourth objective, the MBOD database was used to select diseases with considerable numbers from the 2009, 2010 and 2011 years. A ten percent sample of each disease group was selected through random sampling using stata 12, to determine time to compensation, joined with Commission for Compensation of Occupational Diseases (CCOD) compensation database. Stataversion 12 was used to clean and analyse data. For the fifth objective, a case control analysis was conducted to estimate the risk of mesothelioma from miners with exclusively chrysotile mining, using exposure data from an external database. Results: There were67660 compensable disease certifications from 2004 to 2012 financial years, in living current and ex-miners. Almost 62% of the certification outcomes for compensable diseases were from tuberculosis alone, comprising of current, first and second degree TB. First and second degree diseases with no tuberculosis comprised 27% and 1.3% respectively. There were 6601 diseases (9.7%) certified as second-degree with tuberculosis. The proportion of specific diseases other than tuberculosis comprised of silicosis (14%); silico-tuberculosis (9%);obstructive airways disease (2.2%);coal workers’ pneumoconiosis (0.5%); asbestos pleural disease (6.7%) ; asbestos interstitial disease (5.2%); mesothelioma (0.2%); lung cancer (0.04%) and 0.1% were from other diseases. Females contributed 3.8% to the disease burden while black miners had 92%. Twenty five percent of the compensable diseases were from ex-miners and 49 179from active miners. Although 63% of compensable diseases were from unknown commodity (missing), 30% were from gold mining. The certification trends for pneumoconiosis and tuberculosis peaked in 2008, with statistically significant trend for asbestosis (p=0.01) and silico-TB (P=0.038). Examination of the specific issues showed no statistically significant difference between CWP certification from anthracite and bituminous coal ranks with regards to service duration, silicosis was certified in 544 platinum miners but none of them had exclusively platinum mining. Asbestos related disease was certified in 2241 women, with 55.4% being pleural disease in the first degree and none of the certified women were younger than 30 years of age, and the average service duration was approximately seven years (mean=6.97 years, SD 6.37 years). From the sample of 389 certified cases, 26.5% (n=103) were certified at the end of the 2012 financial years. The mean time to compensation 38 months, 36 months and 19.4 months for 2009, 2010 and 2011 financial years respectively. The case-control analysis found no statistically significant association between chrysotile mining and mesothelioma from univariate analysis (OR=2.0 p>0.05; 95% CI: 0.7-5.4); as well as multivariate analysis (OR=1.5; p>0.05; 95%CI: 0.4-5.2) compared to the reference group. Conclusion:The burden of occupational lung diseases in living current miners and ex-miners is high, mainly from tuberculosis during this period, irrespective of the commodity and population group. A significant finding from this study was the significant proportion of miners certified with pneumoconiosis with less than fifteen years of mining service. The number of women certified during this period was mainly from asbestos related diseases, a far lesser number of women were certified with disease from other commodities. The findings from this study support what was reported in literature namely; unacceptably long time to compensation; incomplete documentation of exposure history in the form of service records and no established risk for mesothelioma from exclusive chrysotile miners. / MT2017

Thesis (M.Sc. (Med.) (Pharmaceutical Affairs))--University of the Witwatersrand, Faculty of Health Sciences, 2012

Thesis (Ph. D.)--University of Washington, 1991. / Vita. Includes bibliographical references (leaves [113]-123).

No description available.

Thesis (Ph. D.)--University of Florida, 2002. / Typescript. Vita. Includes bibliographical references (leaves 98-110).

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Virginia, 1997. / Includes bibliographical references (152-164). Also available online through Digital Dissertations.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine. Johannesburg, 2014 / BACKGROUND: Interstitial lung disease (ILD) is one of the leading causes of death in systemic sclerosis (SSc). PATIENTS AND METHODS: A retrospective review of case records, over 20 years, of SSc patients attending a tertiary Connective Tissue Diseases Clinic. Comparisons between ILD and non-ILD groups at presentation were performed in order to identify baseline associations and predictors of ILD. RESULTS: Of the 151 participants that met inclusion criteria, 60 (40%) had ILD. On multivariate analysis the only three variables to remain significant were median duration of disease (OR 1.2 (1.1-1.3); p<0.001), speckled anti-nuclear antibody (ANA) pattern (OR 2.95 (1.22-7.15); p=0.017) and bibasal crackles (OR 5.4 (2.1- 13.5); p<0.0001). Univariate analysis of baseline variables associated with interstitial lung disease in systemic sclerosis. Baseline Variable ILD (n=60) Non-ILD (n=91) OR (CI 95%) p Bibasal crackles (%) 28 (46.7) 10 (11.0) 7.1 (3.1-16.3) <0.0001 Diffuse disease subtype (%) 49 (81.7) 45 (48.9) 4.6 (2.1-9.9) <0.001 Limited disease subtype (%) 8 (13.3) 38 (41.3) 0.2 (0.1-0.5) <0.001 Anti-centromere antibodies (%) 0 (0.0) 10 (13.0) - 0.006 Cough (%) 21 (35.0) 15 (16.5) 2.7 (1.3-5.9) 0.007 Median duration in years (IQR) 6.1 (8.3) 4.0 (5.0) 2.2 (1.8-2.4) 0.009 Speckled ANA pattern (%) 29 (50.9) 25 (32.5) 2.5(1.2-4.9) 0.010 Dyspnoea (%) 27 (45.0) 24 (26.4) 2.3 (1.1-4.6) 0.014 Gold mining history (%) 5 (8.3) 1 (1.1) 8.2 (0.9-71.9) 0.037 ANA=antinuclear antibody; ILD=interstitial lung disease; IQR= interquartile range; OR=odds ratio Additionally, dyspnoea was associated with ILD severity (p=0.008). Bibasal crackles (p=0.014), increased plasma urea (p=0.041), and reduced serum albumin (p=0.007) were associated with mortality in the ILD group. CONCLUSION: Interstitial lung disease in South African SSc patients is common. The diffuse cutaneous disease subtype appears to drive the disease process. There should be a high index of suspicion for ILD in SSc patients presenting with a gold mining history, dyspnoea, cough and bibasal crackles.

No description available.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2006. / Härtill 3 uppsatser.