A triathlon can be described as the combination of the three athletic competencies swimming, cycling and running where each of the items is performed in a specific order and vary in distance. A triathlon is a very select sport that only attracts specific participants, seeing that constant training is necessary in order to improve fitness and skill in the three different disciplines. Being a triathlete involves a substantial amount of physical and psychological stress over several hours of continuous activity. Therefore the key aspects that drive this study are the following: * The uniqueness of triathlons and triathletes makes it important to research certain aspects such as: Who these participants are? Why they participate in triathlons? And why do they return to the event each year? * Currently most triathlon research is done in countries such as United States of America, Australia, Germany and Japan. There are also numerous studies done on triathletes, although most of these studies focus on physiological and medical aspects of these athletes. * To the best of the author’s knowledge no other study in South Africa has focused on profiling triathletes and gaining knowledge on what differentiates these participants from other endurance sport athletes. * As there is currently a deficiency of information regarding triathletes in South Africa it becomes imperative to research this market through market segmentation. With the latter in mind, the main purpose of this study was to apply market segmentation on triathletes that participate in Ironman South Africa, the only full-length Ironman held on the African continent. In order to achieve this goal a destination-based survey took place during the registration process of participants at The Boardwalk Convention Centre and Spa in Port Elizabeth. A total of 425 completed questionnaires were used in the study. An in-depth literature study was also done to review different aspects of triathlons and triathletes, including the unique nature of the sport and participants as well as analysing previous literature concerning the characteristics of triathletes. Literature also explored market segmentation and the different variables used to segment triathletes and other endurance sport athletes. From literature it became clear that motives to participate and frequency of participation could be useful in segmenting sport participants. These two variables were applied to Ironman South Africa in two separate articles. In Article 1 motives to participate was applied as a market segmentation variable. It was found that triathletes were motivated by seven motivational factors including: Challenge, Inner vie, Health and fitness, Intrinsic achievement and control, Event novelty, Group affiliation and socialisation and lastly, Respect and risk. Based on these motives three distinct clusters of triathlon participants were identified: Devotees, Enthusiasts and Aspirationals. The participants in each cluster showed statistical significant differences with regard to their motives, while age was the only variable with significant socio-demographic differences between the clusters. In Article 2, frequency of participation was used to segment Ironman South Africa participants. Significant differences were found between first time and repeat participants based on the variables: demographic, behaviour and motives to participate. Four segments were identified at Ironman South Africa based on the number of times they have previously participated in the event. The frequent flyer concept was applied which resulted in the dividing of the four participant segments into different loyalty segments. The segments were the Bronze, Silver, Gold and Platinum segment. Three marketing strategies were developed, firstly for the Bronze and Silver segments (these two segments shared similar characteristics), secondly for the Gold and Platinum segments also sharing corresponding characteristics and lastly, a marketing strategy to expand triathlons in South Africa. The information obtained from the two market segmentation variables led to an array of recommendations to attract and retain participants to Ironman South Africa events. Also recommendations focus on how to expand triathlon events in South Africa. Significant contributions were made to literature regarding the profile of the Ironman South Africa participants and how these triathletes compare to other endurance sport athlete. / MCom (Tourism Management), North-West University, Potchefstroom Campus, 2014

A triathlon can be described as the combination of the three athletic competencies swimming, cycling and running where each of the items is performed in a specific order and vary in distance. A triathlon is a very select sport that only attracts specific participants, seeing that constant training is necessary in order to improve fitness and skill in the three different disciplines. Being a triathlete involves a substantial amount of physical and psychological stress over several hours of continuous activity. Therefore the key aspects that drive this study are the following: * The uniqueness of triathlons and triathletes makes it important to research certain aspects such as: Who these participants are? Why they participate in triathlons? And why do they return to the event each year? * Currently most triathlon research is done in countries such as United States of America, Australia, Germany and Japan. There are also numerous studies done on triathletes, although most of these studies focus on physiological and medical aspects of these athletes. * To the best of the author’s knowledge no other study in South Africa has focused on profiling triathletes and gaining knowledge on what differentiates these participants from other endurance sport athletes. * As there is currently a deficiency of information regarding triathletes in South Africa it becomes imperative to research this market through market segmentation. With the latter in mind, the main purpose of this study was to apply market segmentation on triathletes that participate in Ironman South Africa, the only full-length Ironman held on the African continent. In order to achieve this goal a destination-based survey took place during the registration process of participants at The Boardwalk Convention Centre and Spa in Port Elizabeth. A total of 425 completed questionnaires were used in the study. An in-depth literature study was also done to review different aspects of triathlons and triathletes, including the unique nature of the sport and participants as well as analysing previous literature concerning the characteristics of triathletes. Literature also explored market segmentation and the different variables used to segment triathletes and other endurance sport athletes. From literature it became clear that motives to participate and frequency of participation could be useful in segmenting sport participants. These two variables were applied to Ironman South Africa in two separate articles. In Article 1 motives to participate was applied as a market segmentation variable. It was found that triathletes were motivated by seven motivational factors including: Challenge, Inner vie, Health and fitness, Intrinsic achievement and control, Event novelty, Group affiliation and socialisation and lastly, Respect and risk. Based on these motives three distinct clusters of triathlon participants were identified: Devotees, Enthusiasts and Aspirationals. The participants in each cluster showed statistical significant differences with regard to their motives, while age was the only variable with significant socio-demographic differences between the clusters. In Article 2, frequency of participation was used to segment Ironman South Africa participants. Significant differences were found between first time and repeat participants based on the variables: demographic, behaviour and motives to participate. Four segments were identified at Ironman South Africa based on the number of times they have previously participated in the event. The frequent flyer concept was applied which resulted in the dividing of the four participant segments into different loyalty segments. The segments were the Bronze, Silver, Gold and Platinum segment. Three marketing strategies were developed, firstly for the Bronze and Silver segments (these two segments shared similar characteristics), secondly for the Gold and Platinum segments also sharing corresponding characteristics and lastly, a marketing strategy to expand triathlons in South Africa. The information obtained from the two market segmentation variables led to an array of recommendations to attract and retain participants to Ironman South Africa events. Also recommendations focus on how to expand triathlon events in South Africa. Significant contributions were made to literature regarding the profile of the Ironman South Africa participants and how these triathletes compare to other endurance sport athlete. / MCom (Tourism Management), North-West University, Potchefstroom Campus, 2014

“Off-label use” is defined as the use of medicine for indications other than recommended or registered for, e.g. the prescribing of a particular active substance for a patient younger than the substance is recommended or indicated for, or different formulations or dosages of a substance (Ekins-Daukes et al., 2004:349; Stedman’s medical dictionary, 2006). Off-label prescribing is common, and fluctuates by physician, patient and drug (Eguale et al., 2012:781). Drug classes most commonly prescribed off-label include anti-asthmatic, cardiovascular drugs and antidepressants. Lee et al. (2012:140) found that 9 out of 10 antidepressants prescribed were associated with unapproved usage of antidepressants. An antidepressant can be defined as a substance that prevents or relieves depression or depressive episodes (Mosby, 2009:115). There is paucity of information on the off-label prescribing practices of antidepressants in the South African private health sector. According to Eguale et al. (2012:781), the paucity of information on off-label prescribing practices may be, in part, ascribed to the difficulty in the establishment of reasons for treatment. The objective of this study was to determine the prescribing patterns of antidepressants as well as to identify off-label prescribing of antidepressants among adults in a section of the private health sector of South Africa by using a medicine claims database. A quantitative and observational, descriptive cross-sectional design was followed in this study. Data for a period of a year, from January to December 2010 were obtained for analysis. The data set consisted of medicine claims for a total number of 1 220 289 patients, containing a total of 8 515 428 prescriptions and 20 527 777 medicine items. The study population (patients receiving antidepressants 18 years and older) accounted for 14.8% (n = 1 220 289) of the total data set. The average age of patients receiving antidepressants was 56.1 ± 16.6 (median = 56.2) (Inter quartile range = 43.3–68.1). Results of the study showed that antidepressant prescriptions accounted for 8.3% (n = 8 515 428) of all prescriptions claimed during 2010. A total 3.5 % (n = 20 527 777) of antidepressants were claimed during the study period. Using the DU90% method it was established that the majority of antidepressant medicine items were prescribed by general practitioners (i.e. 75.7%, n = 702 285) and psychiatrists (14.9%, n = 702 285). Almost 72% (n = 702 885) of antidepressant medicine items claimed for the study population were for women. The most prescribed antidepressants (based on the DU90%) were amitriptyline (20.6%, n = 702 885), citalopram (19.2%), escitalopram (14.6%), fluoxetine (11.7%), venlafaxine (5.7%), paroxetine (5.2%), duloxetine (4.4%), sertraline (3.8%), bupropion (3.1%) and mirtazapine (2.6%). Amitriptyline accounted for 82.4% of off-label prescriptions (n = 2 635), whereas escitalopram and fluoxetine accounted for 4.2% and 3.8%, respectively. The tricyclic antidepressants (TCAs) were mostly prescribed off-label for migraine, headache and sleep disorders. The off-label prescribing of selective serotonin re-uptake inhibitors (SSRIs) included menopause, schizophrenia and headache. The off-label indicated prescriptions of the serotonin and noradrenaline re-uptake inhibitors (SNRIs) were mostly for schizophrenia and other anxiety disorders. Mirtazapine, a serotonin modulator/tetracyclic antidepressant, was mostly prescribed off-label for anxiety disorders. Off-label prescriptions for bupropion, a noradrenaline and dopamine re-uptake inhibitor mainly included other anxiety disorders and attention deficit hyperactivity disorder (ADHD). Furthermore, the prescribed daily dose (PDD) of each active antidepressant for all off-label indications was determined. In conclusion: This study investigated the off-label prescribing patterns of antidepressants among adults a section of the private health sector of a South Africa, using a large medicine claims database. Recommendations for future research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

“Off-label use” is defined as the use of medicine for indications other than recommended or registered for, e.g. the prescribing of a particular active substance for a patient younger than the substance is recommended or indicated for, or different formulations or dosages of a substance (Ekins-Daukes et al., 2004:349; Stedman’s medical dictionary, 2006). Off-label prescribing is common, and fluctuates by physician, patient and drug (Eguale et al., 2012:781). Drug classes most commonly prescribed off-label include anti-asthmatic, cardiovascular drugs and antidepressants. Lee et al. (2012:140) found that 9 out of 10 antidepressants prescribed were associated with unapproved usage of antidepressants. An antidepressant can be defined as a substance that prevents or relieves depression or depressive episodes (Mosby, 2009:115). There is paucity of information on the off-label prescribing practices of antidepressants in the South African private health sector. According to Eguale et al. (2012:781), the paucity of information on off-label prescribing practices may be, in part, ascribed to the difficulty in the establishment of reasons for treatment. The objective of this study was to determine the prescribing patterns of antidepressants as well as to identify off-label prescribing of antidepressants among adults in a section of the private health sector of South Africa by using a medicine claims database. A quantitative and observational, descriptive cross-sectional design was followed in this study. Data for a period of a year, from January to December 2010 were obtained for analysis. The data set consisted of medicine claims for a total number of 1 220 289 patients, containing a total of 8 515 428 prescriptions and 20 527 777 medicine items. The study population (patients receiving antidepressants 18 years and older) accounted for 14.8% (n = 1 220 289) of the total data set. The average age of patients receiving antidepressants was 56.1 ± 16.6 (median = 56.2) (Inter quartile range = 43.3–68.1). Results of the study showed that antidepressant prescriptions accounted for 8.3% (n = 8 515 428) of all prescriptions claimed during 2010. A total 3.5 % (n = 20 527 777) of antidepressants were claimed during the study period. Using the DU90% method it was established that the majority of antidepressant medicine items were prescribed by general practitioners (i.e. 75.7%, n = 702 285) and psychiatrists (14.9%, n = 702 285). Almost 72% (n = 702 885) of antidepressant medicine items claimed for the study population were for women. The most prescribed antidepressants (based on the DU90%) were amitriptyline (20.6%, n = 702 885), citalopram (19.2%), escitalopram (14.6%), fluoxetine (11.7%), venlafaxine (5.7%), paroxetine (5.2%), duloxetine (4.4%), sertraline (3.8%), bupropion (3.1%) and mirtazapine (2.6%). Amitriptyline accounted for 82.4% of off-label prescriptions (n = 2 635), whereas escitalopram and fluoxetine accounted for 4.2% and 3.8%, respectively. The tricyclic antidepressants (TCAs) were mostly prescribed off-label for migraine, headache and sleep disorders. The off-label prescribing of selective serotonin re-uptake inhibitors (SSRIs) included menopause, schizophrenia and headache. The off-label indicated prescriptions of the serotonin and noradrenaline re-uptake inhibitors (SNRIs) were mostly for schizophrenia and other anxiety disorders. Mirtazapine, a serotonin modulator/tetracyclic antidepressant, was mostly prescribed off-label for anxiety disorders. Off-label prescriptions for bupropion, a noradrenaline and dopamine re-uptake inhibitor mainly included other anxiety disorders and attention deficit hyperactivity disorder (ADHD). Furthermore, the prescribed daily dose (PDD) of each active antidepressant for all off-label indications was determined. In conclusion: This study investigated the off-label prescribing patterns of antidepressants among adults a section of the private health sector of a South Africa, using a large medicine claims database. Recommendations for future research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014