The Road Freight Industry accounts for 1 to 5 percent of most countries GDP (AECOM International Development, 2011). According to e-Natis there was 321 056 Trucks (Heavy load Vehicle GVM > 3500 kg) in South Africa by November 2009 (Arrive Alive, 2009). This relative big industry, according to the statistics, influences most other industries value chains. Vehicles are driven by trucks drivers, making driving trucks their living. These drivers have their own lifestyles and ways that they go about. This study focusses on the risk factors of truck drivers’ lifestyles, especially long-distance truck drivers. This mini-dissertation draws attention to the limited research done on lifestyle risk factors and occupational hazards of long-distance truck drivers in South Africa. Most of the legislation regulating road transport is old and outdated, and any existing legislation is not being enforced. The goal of the study is to draw closer attention to the impact of certain lifestyle risk factors, social behaviours and occupational stressors on the lives of long-distance truck drivers, their close families and communities. The research was based on a comprehensive literature review as well as an empirical investigation done in the Gauteng province. A total of 150 long-distance truck drivers participated in the empirical investigation, by completing anonymous questionnaires. It is the researcher’s hope that this mini-dissertation will aid the betterment of long-distance truck drivers’ lives, general health and to make South African roads safer for all road users. / MBA, North-West University, Potchefstroom Campus, 2015

It is well documented that behavioural and biological risk factors for Chronic Diseases of Lifestyle (CDL) such as overweight and high blood pressure persist from childhood into adulthood. CDL is considered to be a group of diseases that shares similar risk factors as a result of exposure over many decades to physical inactivity, unhealthy diets, smoking, lack of regular exercise, and possibly stress. This study assessed health-related physical fitness and risk factors associated with obesity among 1361 (boys: n=678; girls: n=683) primary school children aged 9-12 years in the Limpopo (LP) and Mpumalanga (MP) Provinces, South Africa. Anthropometric and physical fitness measurements were taken using the protocol of the International Society for the Advancement of Kinanthropometry (ISAK) (Marfell-Jones, et al., 2006) and EUROFIT (1988) test batteries. Body composition measures included body mass index (BMI) (weight/height2), percentage body fat (%BF) and waist-to-hip ratio, respectively. BMI for age and gender was used to classify the children as underweight, overweight or obese (Cole et al., 2007), whilst %BF calculated from the sum of two skinfolds (triceps and subscapular) using the equation of Slaughter et al. (1988) indicated adiposity. The International Physical Activity Questionnaire (IPAQ) was used to categorise the children’s physical activity (PA) level as follows: Low (METs scores of less than 500); Moderate (METs scores from 500 to 1499) or High (METs >1500). In general, 75% of the children were underweight/stunted and 1.6% overweight. Frequencies of underweight, normal weight and overweight were 77%, 22.4% and 0.2% in MP and 72%, 24% and 3% in LP province. Boys were generally taller and heavier than girls. At age 10 the MP boys performed significantly (p=0.05) better in sit-ups (SUP: 20.5 ±5.4) than the LP boys (18.6±6.56). However, the LP boys performed significantly better than the MP boys in sit-and-reach (SAR) at ages 10 and 11. The MP boys performed significantly (p=0.00) better in SBJ (121.6±9.1cm) compared to the Limpopo (118.4±11.00cm) boys at age 9. Generally, LP boys were significantly (p=0.00) better than the MP boys across all ages. The PA results showed that 27.7% (377), 58.5% (796) and 13.8% (188) of the children participate in low, moderate and high PA, respectively. Children in the MP province had higher PA (28.6%) in comparison to the low PA participation in LP children (26.7%). Furthermore, 59.7% of MP children compared to the LP children (57.3%) participate in moderate PA. A higher PA participation rate (15.8%) was found among the LP than MP children (11.6%). The girls had non-significantly higher BP values (systolic: 112.94±11.28mmHg; diastolic: (79.40±12.80mmHg) than boys (systolic: 110.71±14.95mmHg; diastolic: (75.53±12.53mmHg) who had higher PA levels (METs =1286.72±317.47) than girls (METs =397.28±30.14) (p<0.01). A total of 81% (n=1089) and 19% (n=253) of the combined samples had normal BP and prehypertension, respectively. When controlled for provinces, gender and age, results indicated that BMI was negatively associated with systolic BP (SBP) (-0.54) (p<0.01), but positively correlated with %BF (0.133) (p<0.01), whilst SBP related positively with %BF (0.125) (p<0.01). The children’s PA level correlated positively with BMI (0.86) (p<0.01) but negatively with %BF (-0.67); weight circumference (WC) (-0.41); SUP (sit-up) (-0.22); and predicted 2max • VO (-0.17) (p<0.05). The high percentage of underweight and pre-hypertensive children in the study warrants an urgent need to periodically evaluate PA levels among South African children and design appropriate intervention programmes to alleviate concerns over body weight disorders and low PA levels in children, thus optimising health outcomes. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2015

It is well documented that behavioural and biological risk factors for Chronic Diseases of Lifestyle (CDL) such as overweight and high blood pressure persist from childhood into adulthood. CDL is considered to be a group of diseases that shares similar risk factors as a result of exposure over many decades to physical inactivity, unhealthy diets, smoking, lack of regular exercise, and possibly stress. This study assessed health-related physical fitness and risk factors associated with obesity among 1361 (boys: n=678; girls: n=683) primary school children aged 9-12 years in the Limpopo (LP) and Mpumalanga (MP) Provinces, South Africa. Anthropometric and physical fitness measurements were taken using the protocol of the International Society for the Advancement of Kinanthropometry (ISAK) (Marfell-Jones, et al., 2006) and EUROFIT (1988) test batteries. Body composition measures included body mass index (BMI) (weight/height2), percentage body fat (%BF) and waist-to-hip ratio, respectively. BMI for age and gender was used to classify the children as underweight, overweight or obese (Cole et al., 2007), whilst %BF calculated from the sum of two skinfolds (triceps and subscapular) using the equation of Slaughter et al. (1988) indicated adiposity. The International Physical Activity Questionnaire (IPAQ) was used to categorise the children’s physical activity (PA) level as follows: Low (METs scores of less than 500); Moderate (METs scores from 500 to 1499) or High (METs >1500). In general, 75% of the children were underweight/stunted and 1.6% overweight. Frequencies of underweight, normal weight and overweight were 77%, 22.4% and 0.2% in MP and 72%, 24% and 3% in LP province. Boys were generally taller and heavier than girls. At age 10 the MP boys performed significantly (p=0.05) better in sit-ups (SUP: 20.5 ±5.4) than the LP boys (18.6±6.56). However, the LP boys performed significantly better than the MP boys in sit-and-reach (SAR) at ages 10 and 11. The MP boys performed significantly (p=0.00) better in SBJ (121.6±9.1cm) compared to the Limpopo (118.4±11.00cm) boys at age 9. Generally, LP boys were significantly (p=0.00) better than the MP boys across all ages. The PA results showed that 27.7% (377), 58.5% (796) and 13.8% (188) of the children participate in low, moderate and high PA, respectively. Children in the MP province had higher PA (28.6%) in comparison to the low PA participation in LP children (26.7%). Furthermore, 59.7% of MP children compared to the LP children (57.3%) participate in moderate PA. A higher PA participation rate (15.8%) was found among the LP than MP children (11.6%). The girls had non-significantly higher BP values (systolic: 112.94±11.28mmHg; diastolic: (79.40±12.80mmHg) than boys (systolic: 110.71±14.95mmHg; diastolic: (75.53±12.53mmHg) who had higher PA levels (METs =1286.72±317.47) than girls (METs =397.28±30.14) (p<0.01). A total of 81% (n=1089) and 19% (n=253) of the combined samples had normal BP and prehypertension, respectively. When controlled for provinces, gender and age, results indicated that BMI was negatively associated with systolic BP (SBP) (-0.54) (p<0.01), but positively correlated with %BF (0.133) (p<0.01), whilst SBP related positively with %BF (0.125) (p<0.01). The children’s PA level correlated positively with BMI (0.86) (p<0.01) but negatively with %BF (-0.67); weight circumference (WC) (-0.41); SUP (sit-up) (-0.22); and predicted 2max • VO (-0.17) (p<0.05). The high percentage of underweight and pre-hypertensive children in the study warrants an urgent need to periodically evaluate PA levels among South African children and design appropriate intervention programmes to alleviate concerns over body weight disorders and low PA levels in children, thus optimising health outcomes. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2015

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Background Occupational low back pain (LBP) has been described as a significant burden to society. Although there is uncertainty and conflicting studies on the exact causes and combination of causes of LBP, it has been found that occupations which require prolonged sitting periods and have exposure to physical factors such as whole body vibration (WBV) and / or awkward posture, results in increased likelihood for LBP. Pilots are not sheltered from the development of LBP, with the lifetime prevalence of LBP varying from 31.5% to a significant 82%. Additionally, point prevalence varies significantly between 5.1% and 68%, which illustrates that individual pilot and / or occupational factors may contribute to specific pilot subgroups. This could apply to commercial pilots, who use seats that were found to be ineffective in terms of their depth and inclination, therefore limiting the height and impact of the lumbar support. There is a paucity of studies performed on LBP relating to commercial pilots, specifically, on their unique occupational setting. Research is therefore warranted to illustrate the possible risk factors to which they are exposed to, as impeded performance may lead to catastrophic consequences if a pilot’s ability to complete actions critical to flight becomes hindered. Aim To determine the prevalence of low back pain (LBP) in commercial pilots and identify possible risk factors that pilots are exposed to. Study designs The study transpired as a cross sectional questionnaire survey. Participants Study comprised of 100 commercial pilots registered with the South African Civil Aviation Authority (SACAA) and affiliated with the various participating companies utilizing O.R. Tambo International Airport. Methodology All commercial pilots registered with the SACAA and who make use of the O.R.Tambo International Airport (operate through or from) and affiliated with the participating companies during the research study, was approached for participation. Pilots were required to sign and agree to the letter of information and informed consent, as well as the confidentiality agreement. Questionnaires were distributed and all documents were collected, following completion thereof. Pilots were not allocated to more than one group during the data collection (recording) phase of the study. Subgroup analysis was however not excluded in the analysis. IBM SPSS version 21 was used for analysis. A p value <0.05 was considered as statistically significant. Demographics of the pilots were described in the same manner as in the case of categorical variables, and using summary statistics such as mean, standard deviation and range for quantitative variables. Prevalence and characteristics of the low back pain is described using relative frequency and percentages, with 95% confidence intervals. Associations between risk factors and low back pain was identified with log linear regression analysis and tested using Pearson’s chi square test in the case of categorical variables and t-tests in the case of continuous variables. Results The lifetime prevalence of LBP amongst commercial pilots was 80.8%, with the annual prevalence reaching 68.7%. Majority of commercial pilots were white, married males, with nearly the entire population having reached similar educational levels. Considering the male predominance of this population, gender was significantly associated with LBP. Although the female population was much smaller than the male population, it was also found that females were six times more at risk of developing LBP; however the risk was not statistically significant. Awkward posture such as twisting and being stressed at work were found to be significantly related to LBP. Having a history as an ex-smoker or non-smoker was found to be a risk for LBP development. BMI was also significantly related to LBP; however, an inverse relationship is indicated. Having a subjective rating of good health versus excellent health was also an indicator of risk for LBP. Conclusion: Commercial pilots have a significant risk for LBP development. It was found that subjective ratings of own health was a good indicator of LBP whereby good health versus excellent health, was a significant risk factor. Although greater portions of the populace are white males, normally less at risk, a significant lifetime and annual prevalence of LBP was found. Furthermore, the small female population had potentially considerable contribution to the prevalence of LBP through their significant odds ratio. Being a current smoker carried less risk in comparison to a history of an ex-smoker or non-smoker, which further complicates the so often debated contribution of this proposed risk factor. Interesting results were found through the inverse proportional relationship that exists between BMI and LBP, whereby every unit increase in BMI results in a relative decreased risk for LBP development. Majority of the proposed risk factors of LBP was not found to be significant, except stress and twisting, which were found to be common risk factors amongst commercial pilots.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Manual therapists are susceptible to occupational low back pain. The aim of this study was to determine the prevalence and risk factors for occupational low back pain in manual therapists and to determine and compare the prevalence and risk factors for occupational low back pain among various types of manual therapists in South Africa. This study was conducted as a cross-sectional survey and a self-administered questionnaire, developed from the literature and validated prior to the study, was mailed to 1500 randomly selected manual therapists, including: physiotherapists, occupational therapists, biokineticists, chiropractors, reflexologists, aromatherapists and massage therapists. A total of 233 completed questionnaires were returned, giving a response rate of 15.53%. Results revealed that the point prevalence of low back pain in manual therapists was very high at 41%, the one-year prevalence was 59% and the career prevalence was 74%. The point prevalence of low back pain was highest in aromatherapists and biokineticists, while both the one-year and career prevalence of low back pain was highest in occupational therapists and massage therapists. The risk factors for low back pain in manual therapists were: BMI; previous abdominal surgery; previous trauma to the low back, hips, knees or ankles; a physically stressful job; not having an assistant and work in a hospital or other setting. In keeping with the literature, various workrelated factors were implicated in the development and / or exacerbation of low back pain in certain manual therapists more than others and low back pain history in the different manual therapists was also in accordance with the literature. To conclude, low back pain is prevalent among South African manual therapists and the development and implementation of preventative programs to reduce rates of occupational low back pain in manual therapists is mandatory.

Many women experience sexual violence, but bisexual women are at particularly high risk for such victimization. Theories attempting to explain women’s risk for sexual violence have focused on numerous risk factors (e.g., childhood abuse, substance use, sexual risk behavior, among others); however, many of these factors have not been explored with sexual minority survivors. The current study used multiple groups path analysis within a structural equation modeling framework in order to test a theory-driven model of victimization risk, first among a general sample of women, and then among subsamples of heterosexual, lesbian, and bisexual women. The prospective model included childhood sexual, physical, and emotional abuse as three separate exogenous variables; sexual risk behavior, alcohol use, and drug use as separate mediators; and a count-based adult sexual victimization score as the outcome. The prospective model was trimmed until it best represented the observed data for the full sample, which saw the inclusion of childhood sexual and physical abuse as the only exogenous variables, sexual risk behavior as the only mediating variable, and adult sexual victimization as the outcome. Sexual risk behavior mediated the relationship between both childhood abuse variables and adult sexual victimization for the general sample of women. However, within the multiple groups model, sexual risk behavior mediated the relationship between childhood physical abuse and adult sexual victimization among bisexual women only. A mediational relationship between childhood sexual abuse and adult sexual victimization via sexual risk behavior approached significance among bisexual women only. A second-stage moderating effect approached significance whereby the relationship between sexual risk behavior and adult victimization was stronger for heterosexual women than for bisexual women. Additionally, the direct effect of childhood sexual abuse on adult sexual victimization was stronger for lesbian women than for bisexual women. Relationships among variables and the novel and unique findings pertaining to bisexual women’s victimization risk are framed as the compounding effect of childhood trauma and social stigmatization of bisexuality. Implications and future directions are described.

This thesis is the culmination of a series of studies designed to improve the management of musculoskeletal (MSK) injury in an infantry training centre (ITC Catterick, UK). The overall aim of this thesis is to develop and evaluate a management strategy for MSK injury during Combat Infantryman’s Courses (CIC) training. Included is an epidemiological study of MSK injuries in the British Army (Study1), a risk factor model for MTSS (Study 2) and two randomised controlled trials (RCTs) in which the effects of prevention (Study 3) and rehabilitation interventions (Study 4) were examined. The aim of Study 1 was to quantify incidence, type and impact of the MSK injuries during military CIC training (26 weeks). Over a two year period (April 2006 -March 2008), 6608 British infantry CIC trainees completed an informed consent form to take part in this study. A prospective epidemiological study was conducted. Data for the injuries were reported according to: onset, anatomical location, diagnosis and regiment-specific incidence, week and months, impact and occupational outcome. It was clearly demonstrated that MSK injuries are a substantial burden to the British Army. Injury rate was 48.65% and overuse injury was significantly higher than acute and recurrence. Most overuse injuries occurred in the lower limb (82.34%) and were more frequent (p <0.01) in the first phase of training (Weeks 0-13). One third of the recruits (33%) were discharged prior to completion of training. A further 15% (n=991) were removed from training for further rehabilitation. Rehabilitation time ranged from 21 to 168 days and 12% of total training time was lost due to injury (equivalent to 155,403 days of training). Owing to its high severity index, medial tibial stress syndrome (MTSS) is argued to be the most impactful of these injuries despite only being second most frequent. Implications for practice and research (Study 1): MSK injuries are a significant burden to the British Army and strategies to improve prevention and treatment need to be explored. An initial focus on MTSS is warranted. In order to develop interventions for Studies 3 and 4 it is necessary to identify those risk factors for developing MTSS. The aim of Study 2 was to determine prospectively whether gait biomechanics and/or lifestyle factors can identify those at risk of developing MTSS. Again, British Infantry male recruits (n = 468) were selected for the study. Based on a review of the literature of known risk factors for MSK injury, plantar pressure variables, lifestyle factors comprising smoking habits and aerobic fitness as measured by a 1.5 mile timed-run were collected on the first day of training. A logistic regression model for membership of the MTSS and non-MTSS groups showed that an imbalance in foot pressure (heel rotation = pressure on the medial heel minus pressure on the lateral heel) was the primary risk factor for MTSS. Low aerobic fitness and smoking habit were also important, but were additive risk factors for MTSS. The logistic regression model combining all three risk factors was capable of predicting 96.9% of the non-injured group and 67.5% of the MTSS group with an overall accuracy of 87.7%. Implications for practice and research (Study 2): Foot pronation, as measure by heel rotation, is a primary risk factor for MTSS. Previous studies have shown that gait retraining can change risk factors for injury. The aim of Study 3 was to examine the effectiveness of gait retraining on reducing risk factors associated with MTSS and on reducing the incidence of MTSS during the subsequent 26 week training period. British Infantry recruits (n = 450) volunteered for the study and baseline plantar pressure variables were recorded on the first day of training. Based on the findings of Study 2, those with abnormal foot pronation at baseline (n = 134, age 20.1 ± 2.03 years; height 167 ±1.4 cm; body mass 67 ± 2.4 kg) were randomly allocated to an intervention (n = 83) or control group (n = 83). The intervention group undertook a gait retraining program which included targeted exercises three times a week and biofeedback on risk factors once per week. Both groups continued with the CIC training concurrently. Injury diagnoses over the 26 week training regimen were made by physicians who were blinded to the study. Post-measures of plantar pressure were recorded at 26 weeks. There was a significant reduction in the pronation (p <0.001) and overall difference survival function between MTSS and non-MTSS (Log rank test X2 = 6.12, p = 0.013). The absolute risk reduction was 60% in the intervention group. Implications for practice and research (Study 3): Gait retraining can reduce risk factors and incidence of MTSS injury. Based on such positive findings for the prevention of MTSS in Study 3, it was hypothesised that gait retraining may also have potential for the rehabilitation of MTSS. The aim of Study 4 was to examine the effectiveness of a gait retraining on plantar pressure variables, pain intensity and time spent in rehabilitation due to MTSS. Recruits diagnosed with MTSS but not responding to current treatment were eligible for this study (n = 66, age 20.85 ± 2.03 years; height 167 ±1.4 cm; body mass 67 ± 2.4 kg). The participants were randomly allocated to an intervention (n = 32) or control group (n = 34). In order to overcome the debilitating pain suffered by MTSS patients during exercise, the intervention group received a corticosteroid injection prior to the gait retraining programme. The control group continued with the current rehabilitation programme. There were significant improvements in terms of time to reach peak heel rotation (p<0.001), pain intensity (p<0.001) and positive occupational outcome in the intervention group (p<0.019). Implications for practice and research (Study 4): A combined corticosteroid-exercise intervention is beneficial in normalising plantar pressure, reducing rehabilitation times, pain intensity and occupational outcome of MTSS.

For generations, researchers have been examining attributes that make low socioeconomic status students resilient. Attributes that help one become resilient are known as protective factors. The purpose of this study was to describe the protective factor(s) that contributed to the first-generation, low socioeconomic status students’ enrollment at The University of Kentucky. The population for this study consists of the University of Kentucky First Scholars participants during the 2015 – 2016 academic year. The researcher examines the existing literature on low socioeconomic status effects on post-secondary education. Recommendations were made for the University of Kentucky’s First Scholars Program on how to further enhance their program and continue promoting low socioeconomic status students with opportunities in higher education.

The aim of this thesis is to describe the distribution of feeding habits and dietary habits of Swedish children of different ages, to search for determinants of the observed distributions and to analyse some possible implications of those habits regarding health and growth. The present results emanate from a longitudinal study of feeding, growth and development of 312 infants and from a cross-sectional study on the dietary habits of 738 children aged 4,8 and 13 years. The dietary assessement techniques used in these epidemiological studies are evaluated (e.g. 24-hour recall, 7-day recording of food intake and dietary history technique). The infant feeding habits in three communities are described and the variation of those habits in different strata is discussed. Breastfeeding habits are analysed using multivariate techniques. The energy and nutrient intake of weaned infants aged 6 and 12 months was characterized by a good supply of most nutrients in comparison with recommended dietary allowances. The mean energy intake of the studied, normally-growing infants at 6 months was 80 per cent of the recommended intake. The growth velocity during the first three months of life for entirely breastfed infants was found to be higher than for mixed-fed or formula-fed infants. The need for a revision of present growth standards for use in breastfed populations during the first 6 months of life is discussed. An attempt was made to formulate a causal model for dental caries, including dietary factors and caries-preventive activities, and to make som quantitative interpretations from this model and the present set of data. Dietary habits associated with different short- or long-term health risks were analysed in the ages 4, 8 and 13 years. The dietary intake of iron was satisfactory and no cases of iron deficiency anaemia were found. On average 10 per cent of the daily energy intake derived from sucrose. The fat intake was characterized by a high intake of saturated fat and a low P/S ratio. Most children had a daily sodium intake above recommended levels. The prevalence of obesity differed between different social strata, especially in the oldest age group. Overweight children did not have a higher energy intake than normal-weight children. The need for a population approach to prevention in childhood of some diet-related health problems in adult life is discussed. The present dietary patterns and health of children in northern Sweden are compared with the situation 15 and 50 years ago, when nutrition surveys were performed in the same areas. / <p>[2] s., s. 1-30: sammanfattning, s. 31-103: 7 uppsatser</p> / digitalisering@umu

Over the past 20 years there has been a clear shift in Peru’s mortality profile towards non-communicable diseases. As part of this transition, childhood overweight and obesity (O&O) has become a growing public health concern. In order to address this challenge, context-specific information is needed concerning prevalence, associated factors and culturally appropriate interventions. To this end, I conducted a mixed methods study using a socio-ecological framework to investigate childhood overweight and obesity in Peru. This study found a prevalence of 19.2% overweight and 8.6% obesity among children aged seven to eight in a pro-poor cohort in Peru. Factors associated with being overweight in this cohort included: a high socioeconomic status, living in metropolitan Lima, an O&O mother, being male and being an only child or having only one sibling. The quantitative analysis highlighted the prevalence in O&O in this population and revealed a number of relationships explored in more depth via interviews and focus group discussions. The qualitative component of this research explored these associations amongst a sub-sample of children, parents and teachers in three distinct geographical regions in Peru. My qualitative research showed that parents, teachers and children are aware of the health implications of childhood overweight and obesity and that they have a sophisticated understanding of the many factors that influence its aetiology. Participants also had many suggestions for ways to address this issue in their community. This information was complemented by a systematic review and meta-analysis of the evidence of childhood O&O interventions that took place in Latin America published between 1990 and 2011. A combination of diet, physical activity and pharmaceutical strategies have shown modest effect on BMI reduction in O&O children, but more evidence is needed for effective population-level prevention strategies. The findings highlight the need for comprehensive, multi-level interventions. Notable intervention components include: kiosco reform, junk food taxation, creation of recreational space and enhancement of school-based physical activity programmes. To accomplish this, communities need to be mobilised and work together with school administration, municipal and national government.