MSc (Med), Popualtion-Based Field Epidemiology, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand / Background Improving the health of the poor and reducing health inequalities between the poor and non-poor has become central goals of international organizations like the World Bank and WHO as well as, national governments in the contexts of their domestic policies and development assistance programmes. There are also unquantified and poorly understood inequalities in access to health services within and between various population groups. Little is known about the factors that determine these inequalities and the mechanisms through which they operate in various sub-groups. Objectives The aim of the study was first to describe under-five mortality trend according to wealth index; second to describe risk factors for under five mortality; and finally to investigate the relationship between socio-economic and demographic factors and under five mortality during the period 2001 to 2006. Methods The study involved all children born in 2001-2006. A total of 22,422 children younger than 5 years were found in 21,494 households yielding 36603.13 Person-Years Observed (PYOs) up to 31st December 2006. Household wealth index was constructed by use of Principal Component Analysis (PCA), as a proxy measure of each household SES. From this index households were categorized into five quintiles (i.e., poorest, poorer, poor, less poor and least poor). Life table estimates were used to estimate mortality rates per 1000 PYO for infants (0-1), childhood (1-5) and underfives children. Health inequality was measured by poorest to least poor mortality rate ratio and by computing mortality concentration indices. Trend test chi-square was used to determine significance in gradient of mortality rates across wealth index quintiles. Risk factors of child mortality were assessed by the use of Cox proportional hazard regression taking into account potential confounders. v Results The result indicates unexpected low mortality rate for infant (33.4 per 1,000 PYO, 95% CI (30.4 – 35.6)) and childhood (15.0 per 1,000 PYO, 95% CI (13.9 – 16.3)). Under-five mortality rate was 18.2 per 1,000 PYO (95% CI (75.6 – 108.0)). The poorest to least poor ratios were 1.1, 1.5 and 1.5 for infants, childhood, and under-five year olds respectively, indicating that children in the poorest quintile were more likely to die as compared to those in the least poor household. Computed values for concentration indices were negative (infant C= -0.02, children C= -0.09 and underfive C= -0.04) indicating a disproportionate concentration of under-five mortality among the poor. The mortality rates trend test chi-square across wealth index quintiles were significant for both childhood (P=0.004) and under-five year old children (P<0.005) but not for infants (P=0.134). In univariate Cox proportional hazard regression, children in the least poor households were shown to have a 35% reduced risks of dying as compared to children in the poorest category [crude H.R =0.65, P=0.001, 95% C.I (0.50 – 0.84)]. The results showed that for under five children, a boy is 1.15 times more likely to die as compared to a girl [crude H.R =1.14, P=0.038, 95% C.I (1.00 - 1.31)]. Second born had a 18% reduced risk of dying as compared to first born [crude H.R =0.82, P=0.048, 95% C.I (0.67 – 0.99)]. After controlling for potential confounders, the adjusted hazard ratio for wealth index decreased slightly. The estimated hazard for wealth index in the univariate was 0.65 while in the multivariate modeling the estimated hazard ratio is 0.60 in the first model. Conclusion The study shows that household socio-economic inequality is associated with underfive mortality in the Navrongo DSS area. The findings suggest that reductions in infant, childhood, and under five mortalities are mainly conditional in health and education interventions as well as socioeconomic position of households. The findings further call for more pragmatic strategies or approaches for reducing health inequalities. These could include reforms in the health sector to provide more equitable resource allocation. Improvement in the quality of the health services offered to the poor and redesigning interventions and their delivery to ensure they are more inclined to the poor.

This dissertation aims at analyzing the relationship between socio-economic status (SES) and mental health and care. It attempts to understand how different socio-economic groups present unequal risk of mental disorders and to what extent different socio-economic groups use unequal quantity, type and quality of mental care. Since its earlier beginnings, psychiatric epidemiology has evidenced the association between socio-economic status and mental disorder. However, the numerous prevalence studies addressing depression have yielded inconsistent results. This calls for a thorough investigation of the sources of such heterogeneity. This dissertation attempts to achieve the following objectives: · To unfold methodological and contextual covariates influencing the SES/mental health relationship. · To assess the longitudinal influences of material deprivation on depression. · To assess the extent to which outpatient and inpatient mental care are fairly used. The methodological influences of socio-economic inequalities in mental health were tackled through a meta-analysis of previously published works. We built a database of previous published studies addressing the socio-economic factors of depression prevalence, incidence and persistence in adults population studies and being published in English, French, German and Spanish after 1979. The lower socio-economic group has 80% more prevalence of depression. Inequalities are more acute for persistent depression than for new episode. The results indicated that inequalities are much more pronounced when mental health is looked at from a subjective point of view or in terms of resulting disability. Social inequalities in mental health are also influenced by geographic context. Europe has a gradient 30% less pronounced than North-America. As the period of reference decreased, the gradient rose, suggesting that duration might be an explanatory factor. Geographical analysis of socio-economic inequalities in mortality is carried out with the death certificates of the Belgian National Institute of Statistics (NIS), covering all causes mortality and 11 specific mortality causes, from 1985 to 1993. Spatial concentration was computed through a Moran’I. We compare a simultaneous autoregressive model with a weighted-least-square model. Findings show that spatial concentration is pervasive, that suicide and mortality by liver cirrhosis are among the most correlated causes of death. Getting rid of spatial autocorrelation leads to significant change in the relationship between deprivation and mortality, suggesting the influence of contextual effects on socio-economic inequalities. The difficulty to move from correlation to causation between SES and depression owes partly to the difficulty of disentangling the direct effect of socio-economic status from other –and numerous- confounding factors such as family history, genetic endowment, cognitive abilities, early schooling experience, which, for most of them are rather stable overtime. The longitudinal analysis attempts to estimate the impact of time-varying socio-economic covariates on depression. The results show that material deprivation (and change of) does not affect the level or the risk of depression while social network does slightly. We found much stronger gradient with time invariant socio-economic factors such as educational level. Inequity in outpatient mental care was assessed with the data of the first Belgian Health Interview Survey (HIS), a cross-sectional household-health interview survey carried out in Belgium in 1997. The Minimum Psychiatric Summary, a case register of all psychiatric admissions in Belgium (1997-98), allowed us to carry out the study of inpatient inequalities of mental care. In terms of mental health services uses, inequalities arise in the setting were care is delivered: less well-off use more primary care and less specialised care, are more likely to be admitted in a non-teaching, psychiatric hospitals with long length of stay. The lower the socio-economic groups with mood disorders are less likely to receive the expected treatment such as antidepressant and psychotherapies. Finally, the outcomes of the hospitalisation, in terms of overall functioning and in terms of psychological symptoms are less favourable for the individuals of lower socio-economic status. Part of such unequal outcome is related to unequal treatment. We concluded that inequalities in health should be addressed in their geographical context, that early and stable socio-economic factors are more important than time-varying factors. Horizontal socio-economic inequities arise in the type of care used as well as in the appropriateness of care. However, for a given equal treatment and use, outcome inequalities remain so that it seems relevant to consider socio-economic status as a general vertical equity principle.

Made available in DSpace on 2014-10-09T12:33:47Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:03:59Z (GMT). No. of bitstreams: 0 / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP

Made available in DSpace on 2014-10-09T12:33:47Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:03:59Z (GMT). No. of bitstreams: 0 / O propósito deste estudo foi investigar o conhecimento de segmentos da população (constituídos por leigos, por estudantes e profissionais de áreas com possíveis aplicações da radioatividade) em relação aos benefícios da radiação ionizante sobre polímeros de embalagens para alimentos. As questões básicas aqui levantadas foram idealizadas para que suas respostas fornecessem parâmetros de análise para se afirmar ou negar que a população, de um modo geral, desconhece radioatividade e sua aplicação no campo dos alimentos e não se mostra preparada para mudar seus paradigmas, arraigados por impressões que persistem fortes de acidentes nucleares noticiados principalmente em mídia televisiva. Este estudo qualitativo é fundamentado por Bachelard (1996), que avulta a necessidade de uma preparação muito bem estruturada quando se quer extrair as verdades de classes que insistem, por vergonha de seu não-saber, em falsear respostas que, se sinceras, poderiam indicar importantes caminhos a se seguir pelo campo educacional para que se mudassem as características tão conhecidas neste país de um conhecimento de senso comum que ficou pouco ou nada científico. Portanto, este trabalho está norteado por um veio acadêmico que mostra, em seus objetos de pesquisa, elementos (questionários e entrevistas) necessários para que se possa conhecer a verdadeira opinião das pessoas frente à radioatividade. Infelizmente, as repostas não são animadoras, mostrando que há um grande desconhecimento mesmo dos profissionais, sobre o tema. Finalmente, o objetivo maior deste trabalho de pesquisa não foi somente uma investigação, mas a elucidação da necessidade de serem iniciadas ações educacionais que mudem a realidade que hoje se desenha neste país e que, somente com essa mudança, poderá haver, satisfatoriamente, pelo apoio e aceitação social, avanços significativos na área de tecnologia nuclear. / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP

While osteoporosis is a major public health concern in the developed world, little research regarding factors influencing bone mineral accrual in children has been conducted in developing countries. South Africa is of particular interest since the incidence of hip fractures in South African Blacks has been reported to be amongst the lowest in the world (32; 253). In this thesis, the association of lifestyle factors; in particular physical activity (PA), socio economic status (SES) and dietary calcium intakes on the growing skeleton of Black and White South African children is investigated. After using accelerometry to validate a physical activity questionnaire (PAQ), in a convenience sample of South African Black, White, male and female children (n=30), fitness levels were assessed in a larger group (n=69) of similarly aged children, stratified by race and gender. Fittest subjects had significantly greater physical activity scores (p=0.022) as reported on the PAQ, lower body mass index’s (BMI) (p=0.001) and least percentage body fat (p=0.001) (as assessed using Dual Energy X-ray Absorptiometry (DXA), than least fit subjects. White males who reported to be significantly more active than all other groups on the PAQ were significantly fitter (p<0.001) than White females and Black males and females. The next study sought to determine whether differences observed in physical activity levels between groups showed an association with bone mineral content (BMC), density (BMD) and area (BA) (as assessed using DXA). PA was analyzed in terms of a metabolic (METPA; weighted metabolic score of intensity, frequency, and duration) and a mechanical (MECHPA;sum of all ground reaction forces multiplied by duration) component for 386 children aged 9.5 (0.04) years recruited from a longitudinal birth cohort study. White children expended a significantly greater energy score (METPA of 21.7 (2.9)) than Black children (METPA of 9.5 (0.5), p< 0.001). When children were divided into quartiles according to the amount and intensity of sport played, the most active White children had significantly higher (p<0.05) whole body BMD and higher hip and spine BMC and BMD after adjustment for body size than less active children. White children in the highest MECHPA quartile also showed significantly higher (p<0.05) whole body, hip, and spine BMC and BMD after adjustment for body size than those children in the lowest quartile. No association between PA and bone mass of Black children was found. No significant differences between METPA and MECHPA quartiles and BA were observed for any group. Given the disparate backgrounds from which many South African children come, the next study sought to determine whether differences in socio-economic status between Black and White South African children influence PA patterns. This study explored the relationship between socio-economic status, PA anthropometric and body composition (via DXA) variables in 381 children aged (9.5 (0.04) years) recruited from a longitudinal birth cohort study . Children falling into the highest socio-economic status quartile had mothers with the highest educational levels, generally came from dual parent homes, were most physically active, watched less television, weighed more and had greater lean tissue than children in lower socio-economic quartiles (p<0.001). Significantly greater levels of lean mass (p<0.001) with increased activity level were observed after controlling for television watching time and fat mass. There were high levels of low physical activity and high television watching time among lower socio-economic status groups. White children were found to be more active than Black children, more likely to be offered physical education and to participate in physical education classes at school and watched less television than Black children. The final study sought to investigate the association between habitual PA patterns and dietary calcium intakes with bone mass acquisition over a one year period in 321 pre-pubertal South African children recruited from a longitudinal birth cohort study. Data were analyzed by regressing change in BMC and BA from age nine to ten years, against BA (for BMC), height and body weight. The residuals were saved and called residualized BMCGAIN and BAGAIN. Residualized values provide a good indication of weight, height and BA-matched accumulation rates. White children had significantly higher PA levels and calcium intakes than Black children. Most active White males had significantly higher residualized BMCGAIN and BAGAIN at the whole body, hip and spine but not at the radius, than those who were less active. Most active White females had significantly higher residualized BAGAIN at all sites except the radius than less-active girls. No such effects were seen in Black children. There was no interactive effect on residualized BMCGAIN or BAGAIN for calcium intake and PA in boys or Black girls, but an interactive and possible synergistic effect of calcium and physical activity was observed at the spine, radius and hip in White girls. In this population, PA has an osteogenic association with White children, but not Black children, which may be explained by the lower levels of PA in the Black children. Despite this, Black children had significantly greater bone mass at the hip and spine (girls only) (p< 0.001) even after adjustment for body size.In conclusion, differences between White and Black children’s PA levels were observed, with White children reporting higher PA levels and exhibiting higher fitness levels than Black children. Physical fitness correlated well with self reported physical activity levels on the PAQ and objectively measured body composition. Socio-economic status differences between White and Black children are highly related to differences in physical activity patterns and body composition profiles. Bone mass and area gain is accentuated in pre- and early-pubertal children with highest levels of habitual physical activity. Limited evidence of an effect of dietary calcium intakes on bone mass in boys and Black girls was found. The role of exercise in increasing bone mass may become increasingly critical as a protective mechanism against osteoporosis in both South African race groups, especially because the genetic benefit exhibited by Black children to higher bone mass may be weakened with time, as environmental influences become stronger.

La mayoría de los bosques del planeta, exceptuando, quizá, el cinturón más húmedo del trópico, han sufrido perturbaciones recurrentes por incendios, desde hace miles de años. Sin embargo, en el último siglo, la combinación de factores socio-económicos y ambientales han alterado la frecuencia y distribución de incendios en casi todos los ecosistemas forestales. Esta mala distribución del fuego ha conllevado la acumulación de este elemento perturbador en ecosistemas poco adaptados a su presencia (e.g. bosques tropicales húmedos), mientras que otros ecosistemas han sufrido los efectos de las políticas de supresión de incendios (e.g. bosques templados norteamericanos). Entre las consecuencias de estas alteraciones, algunas se refieren a variaciones en el régimen de incendios, con implicaciones en términos de conservación forestal, impacto ecológico, económico y social. La presente tesis analiza la influencia de factores ambientales y socio-económicos en algunas características del régimen de incendios en ecosistemas tropicales y mediterráneos. En el ámbito tropical, la zona de estudio es el Estado mexicano de Chiapas, y los objetivos son básicamente dos: 1) caracterizar el régimen de incendios en el Estado, en términos de frecuencia de incendios, distribución, áreas y ecosistemas afectados, tipología de incendios, causalidad, y su interacción con algunos factores como el fenómeno de El Niño, la distribución de la tenencia de la tierra o la variación de las precipitaciones. 2) Analizar la influencia relativa de factores ambientales frente a factores socio-económicos, en años de condiciones climáticas normales y años de El Niño. El objetivo último era determinar variaciones en la afectación de los principales ecosistemas y listar los factores más importantes a considerar, a nivel de gestión forestal contra incendios. A nivel de ecosistemas mediterráneos, se seleccionó el incendio del Solsonés 1998, como caso estudio, siendo los principales objetivos: 3) Seleccionar la metodología de clasificación post-incendio más eficiente entre varias técnicas analizadas (teledetección y muestreo de campo). 4) Analizar la influencia de diversos factores ambientales en la formación de islas de vegetación en un gran incendio, empleando las laderas como unidad espacial. 5) Verificar la importancia de la estructura forestal y la continuidad del combustible en la heterogeneidad final de las severidades de afectación de un incendio. En relación a estos objetivos, las principales aportaciones de este estudio han sido, en lo referente a ecosistemas tropicales: La descripción de los incendios en Chiapas como mayoritariamente superficiales, afectando principalmente a estratos no arbóreos, de grandes dimensiones, de origen antrópico y con cierta propensión a afectar zonas protegidas. La aportación clave sin embargo, hace referencia a la demostración de la importancia de El Niño en la afectación de los ecosistemas tropicales húmedos, principalmente influenciado por la presencia de pastos alrededor de bosques fragmentados. El cambio de importancia relativa de los factores ambientales en años de no-ENSO frente a la mayor importancia de los factores socio-económicos en años de ENSO. También se puede remarcar el cambio de ecosistema afectado condicionado por el tipo de año (condiciones climáticas normales o extremas, ENSO o no ENSO: pino-encino versus bosques tropicales húmedos). En relación a los bosques mediterráneos, las técnicas más sencillas de teledetección resultaron las adecuadas para la identificación de islas. La formación de estas islas se ve condicionada por el tamaño y orientación y pendiente de las laderas, así como la cantidad y madurez de los rodales afectados, siendo las laderas más extensas, de orientación noroeste, de mayor pendiente, con mayores extensiones forestales y bosques más maduros (en términos de mayores tamaños), las más propicias a formar islas. Las características estructurales de los rodales fue de gran importancia para predecir la supervivencia forestal en zonas de condiciones climáticas moderadas. / The great majority of the forests of the world, excepting perhaps, the wettest belt of the tropics, have been burned over, at more or less frequent intervals, for many thousands of years. In the last century however, a combination of human and environmental factors have altered the frequency and distribution of fire, almost everywhere. This maldistribution of fire has resulted in an accumulation of this element in ecosystems not adapted to high frequencies of fire (i.e. tropical and sub-tropical areas), while other ecosystems have suffered the effects of fire suppression policies (i.e. north American temperate forests). Among the consequences of these alterations, some of them refer to variations in fire regimes, with implications in terms of forest conservation, ecological, economic and social impact. The present thesis analyses the influence of environmental and socio-economic factors for certain elements of the fire regime in tropical and Mediterranean ecosystems. In tropical areas, the study case relates to the tropical Mexican State of Chiapas, and the objectives are basically two: 1) to characterize the fire regime in the State, in terms of frequency of fires, fire distribution, areas and ecosystems affected, type of fires, causality, and their interaction with some factors like the phenomenon of El Niño, the land distribution, or the variation of rainfall values. 2) To analyse the relative influence of environmental factors versus socio-economic factors, in years of normal climatic conditions and years of El Niño. The final objective is to detect variations in the affectation of the major ecosystems and to list the most important factors to consider for forest fire management. For the Mediterranean ecosystems, the fire of Solsonés 1998 was selected as case study. Main objectives are: 3) To select the most efficient methodology for post-fire classification among several techniques: image classification and field survey. 4) To determine the influence of diverse environmental factors in the formation of vegetation islands inside a large forest fire, using "slope", as the spatial unit. 5) To verify the importance of forest structure and fuel continuity in the final heterogeneity of fire severities in a large fire. In relation to these objectives, the main contributions of this study are, with respect to tropical ecosystems: The characterization of fires in Chiapas, as in other tropical areas, mainly as superficial fires, frequently affecting non-arboreal layers. Major problems focus on large forest fires, which are responsible for the major burned areas. Fires are mainly human related and display certain propensity to affect protected zones. The key contribution nevertheless, refers to the major importance of El Niño in the affectation of humid tropical ecosystems. This is specially enhanced by the presence of cattle pasture surrounding the fragmented forests. The shift on the importance of environmental factors in years of no-ENSO versus the greater importance of socio-economic factors in years of ENSO, is also a major achievement. Moreover, shifts in ecosystem affectation have also been observed depending on the climatic conditions: pine-oak in no-ENSO years versus humid tropical forests in ENSO years. Regarding the Mediterranean forests, the simplest techniques of teledetection were the best performing ones for island identification. The formation of these islands is conditioned by the size and aspect of the slopes, as well as by the amount and maturity of the affected patches. Most extensive slopes, north-western orientations, more abrupt, larger forest extensions per slope, and more mature forests (in terms of greater sizes), are the most suitable combination of factors to form islands. This formation of islands does not have, therefore, a random distribution. Besides, the structural characteristics of the forest patches was confirmed to be of great importance to predict the forest survival in areas were fire burned under moderate climatic conditions. Larger patches and larger trees are the ones that will survive fire the best.

This study addressed important issues on infant and child mortality in Zimbabwe. The broad objective of the study is to establish levels and trends of under-5 mortality and to determine the impact of maternal, socioeconomic and environmental contamination variables on infant and child mortality. Data from four DHS surveys conducted in Zimbabwe were used. It was found that mortality at all ages below 5 years old remained more or less constant from the period 1990-1994 to the period 1995-1999 and declined from the period 1995-1999 to 2001-2005. Mortality below 5 years old declined from 102 deaths per 1,000 live births during 1995-1999 to 82 deaths in 2001-2005. This decline was unexpected and it is argued that this decline is probably not genuine. Various types of evidence are provided to support the view that this decline in mortality probably did not take place. Analysis of ZDHS 2005- 06 showed that births of order 6+ and short preceding interval (intervals of less than or equal to 18 months) had the highest infant mortality risk. Infants with these characteristics were significantly more likely (2.75 times) to die in infancy relative to births of order 2-5 and long preceding birth interval (p<0.001). The infant mortality risk associated with multiple births was 2.08 times more relative to singleton births (p<0.001). The results indicated that socioeconomic variables did not have a distinct impact on infant mortality. Determinants of child mortality were different in relative importance from those of infant mortality. The effect of maternal education, though not significant, implied a decline in child mortality with increasing maternal schooling. The provision of piped drinking water and flush toilets to the households had a stronger impact on child mortality than infant mortality. Including HIV prevalence in the models elevated the odds of dying in infancy and childhood stages by 10 percent and 63 percent, respectively. This suggests that HIV/AIDS directly and/or indirectly influences the current levels of under-5 mortality in Zimbabwe. This study supports health policy initiatives stimulating use of family planning methods to increase birth intervals. Family planning programmes should be aimed at educating women and men with low educational levels and those in rural areas about the potential benefits of long-term birth spacing. These and other results are expected to assist policy makers and programme managers in the child health sector to formulate appropriate strategies to improve the situation of under-5 children in Zimbabwe. / Thesis (PhD)--University of Pretoria, 2010. / School of Health Systems and Public Health (SHSPH) / PhD / Unrestricted

Environmental Impact Assessments ("EIA") have been regulated for the last 12 years in South Africa, initially through the Environment Conservation Act 1989, and since 2006 through the National Environmental Management Act 1998 ("NEMA"). The former applied the standard of "substantial detrimental effect" to the environment in determining whether an authorisation should be granted. NEMA requires the authority to take into account environmental management principles. These principles inter alia require that development must be socially, environmentally and economically sustainable. This is also known as sustainable development ("SD"). Administrative officials tasked with considering EIAs have been given legislative direction with respect to the environmental issues which need to be assessed. They have been given no direction on how to assess socioeconomic issues. Notwithstanding this there have been an increasing number of decisions based on socio-economic factors, notwithstanding that the environmental impacts have been determined to be acceptable. In Fuel Retailers Association of South Africa v Director-General: Environmental Management, Department of Agriculture, Conservation and Environment, Mpumalanga Province and Others the Constitutional court held that SD must be applied by environmental authorities when they consider applications for EIA authorisation. However a careful analysis of NEMA and the Constitution of the Republic of South Africa, 1996, highlight that our administrators and courts have adopted a one dimensional and ultimately inaccurate interpretation of the application of SD. This is prejudicing the fulfilment of the objective of EIA, namely the determination of the acceptability of a project's environmental impacts. Whilst SD does have a role to play in the EIA process it is more defined, and does not take the central role the Constitutional Court has indicated. The aim of is to determine whether there are adverse impacts associated with a project. If there are, then ordinarily authorisation should be refused. However the authorities are enjoined to go a step further. They must determine whether the identified adverse impacts can be satisfactorily mitigated, and whether any positive socio-economic factors would accrue Page (iii) should the project be authorised. If both are answered in the affirmative, then a positive decision is appropriate. This is the balance which NEMA calls for, and this is the correct application of SD in an EIA. The broader application of SD espoused by the Constitutional Court is achieved not through the environmental authorities in the EIA process alone, but through the constitutional principle of cooperative governance. All authorities with an interest in a particular project must apply the principle of SD within the scope of their administrative functions. The environmental authorities consider the environmental impacts, the planning authorities consider the socio-economic impacts, the agricultural authorities determine the project's impacts on agricultural land, etc. The outcome of their individual decisions can then collectively be assessed to determine whether a project is sustainable or not. There are various measures which can be employed to address the interpretational deficiency which has now manifested. These include improving cooperative governance principles and practices in decisionmaking; undertaking strategic environmental assessments; and a dedicated Sustainable Development Act. / Dissertation (LLM)--University of Pretoria, 2011. / Centre for Human Rights / unrestricted

Magister Scientiae Dentium - MSc(Dent) / General dentists in practice (both public and private) are often reluctant to perform interceptive orthodontic procedures on patients that present to their practices. As interceptive orthodontic treatment (IOT) can be of great benefit to some patients, it validates the need to assess the factors that influence the implementation of such treatment.

No / Background. The placement of welfare advice services in family practice to assist patients with health-related social and economic issues (e.g. disability benefits) has gathered momentum over the last decade in the UK. This expansion of primary care raises a number of issues for practices hosting these services. Objectives. To gain the views of advice workers and primary care staff about the issues raised in hosting a welfare advice service across 30 practices in inner city Bradford. Methods. Views were obtained through focus groups with six advice workers, and primary care staff in 14 practices. A questionnaire was also posted to all practice managers asking their opinions about the service. Results. The focus groups highlighted a number of advantages for patients, including improvements in health and quality of life through increased income and reduced stress from social and economic issues. For practice staff, the service provided a resource to refer patients for welfare advice, reducing the time spent dealing with welfare issues, thereby reducing workload. This was confirmed in the questionnaire to practice managers where 72% said the service had saved time for GPs and reception/office staff. The advice workers raised concerns about the perceived level of commitment to the service from some staff at some practices. Practice staff were particularly concerned about the need for feedback about referrals. Conclusion. Providing welfare advice in family practice can act as a valuable resource for primary care staff helping to address their patients health-related social and economic needs.