Title: Determinants of positive functional outcomes at 16 weeks after flexor tendon repair at a tertiary hospital in the Eastern Cape of South Africa: A descriptive, analytical study. Introduction: Flexor tendon injuries account for a substantial number of hand injuries presenting to health care facilities, yet rehabilitation following flexor tendon repair remains a challenge. There is limited research pertaining to flexor tendon rehabilitation in middle economic income countries like South Africa. Objectives: The aim was to identify determinants of positive functional outcomes sixteen weeks after flexor tendon repair at a tertiary hospital in South Africa. The objectives were: 1) to describe the functional outcomes at four, eight, twelve and sixteen weeks post flexor tendon repair using total active motion (TAM), muscle strength and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, 2) to ascertain the demographic profile for patients presenting to the hospital with a flexor tendon injury, 3) to describe the rate of recovery between the four assessment intervals, and 4) to cross-culturally translate the DASH questionnaire into isiXhosa. Method: Ethical approval was obtained through the University of Cape Town’s Human Research Ethics Committee. A quantitative, descriptive, analytical design was used. The DASH was translated as per the guidelines for cross-cultural translation by the Institute for Work and Health. All patients presenting to the target institution with a flexor tendon injury between February and August 2017 formed the sample. Twenty-two participants were recruited. Participants were assessed at four, eight, twelve and sixteen weeks post operatively using TAM, muscle strength and the DASH questionnaire. Demographic and treatment factors for each participant were compared to 16-week DASH scores using Mann-Whitney U and Kruskal-Wallis ANOVA tests. The rate of recovery was analysed using Spearman’s Rank Correlation Coefficient, Friedman’s ANOVA and Wilcoxon Matched Pairs for TAM, DASH score and muscle strength respectively. Results: Time to repair was the only factor to have statistical significance at 16-weeks post operatively (H(df=9)=15.3; p=0.05). Rate of recovery when compared to DASH (F(df=3)=12.98; p=0.005) and muscle strength (Z=3.076; p=0.002) scores showed statistical significance, though TAM did not (rs(df=2)=0.06; p=0.78). The epidemiological profile was similar to those documented elsewhere in South Africa and globally. Conclusion: The outcomes achieved in the present study were poorer than those described in the vast body of literature in the field, but similar to those described in a similar cohort elsewhere in the country. The demographic profile was similar to those previously documented in South Africa and across the globe, but with different environmental and institutional barriers. Rate of recovery appears greatest between four and eight weeks, as well as between weeks twelve and sixteen. Time to repair showed that it is not harmful to delay primary flexor tendon repair up to six days post injury. Recommendations for future policy, education, practice and research were made.

Includes bibliographical references (leaves 62-68). / Introduction: This study examined the patterns and the prevalence of obstructive lung disease (asthma and COPD) and associated risk factors (age, gender, atopy, smoking history, allergic history, previous history of lung disease, occupational exposures, seafood intake) in a working population of seafood processing workers along the West coast of the Western Cape of South Africa. Materials and method: A cross-sectional study was conducted 643 currently employed workers in two fish processing plants working fish canning and fishmeal processing. A modified version of the European Community Respiratory Health Survey (ECRHS) questionnaire was used. Skin prick tests (SPT) used extracts of common airborne allergen. Lung function spirometry and methacholine challenge tests (tidal breathing method) conducted using Vitallograph S-model bellows volume-time spirometers according to ATS guidelines. Serum omega-3 and omega-6 fatty acid levels also analysed to examine the association between dietary fatty acids and asthma outcomes. Multivariate regression models were developed for asthma outcomes after adjusting for age, gender, sex and atopic status whilst the models were adjusted for age, gender and smoking history for COPD outcomes.

Research report in partial fulfillment for the degree of MMed (Occupational Medicine) / Background Occupational asthma is one of the most commonly reported occupational respiratory diseases in industrialized countries. Literature suggests that about 15% of all adult-onset asthma is caused by workplace exposures. It is potentially preventable and the prognosis is good with early diagnosis and adequate treatment. However, occupational asthma is under-diagnosed and under-reported. Identification of common causative agents and employment of preventative measures are necessary for proper management and control. Objectives 1. To characterize occupational asthma cases assessed at NIOH Occupational Medicine Clinic from 1st January 1997 to 31st December 2007 in terms of: • types of industries, occupations and agents • duration of exposure prior to onset of occupational asthma • time from onset of symptoms to diagnosis • nature of exposure e.g. intermittent, daily, etc. 2. To investigate factors influencing latency period in cases of sensitizer-induced asthma 3. To investigate factors influencing lag time to diagnosis in cases of sensitizer-induced asthma Methods A record review of a series of cases of occupational asthma was done. All cases of occupational asthma diagnosed from 1st January 1997 to 31st December 2007 by NIOH doctors were identified from the Clinic’s electronic database. All the records of patients who had a final diagnosis of occupational asthma were assessed using a standard data capture sheet. Doubtful cases were presented at the NIOH Occupational Medicine clinical discussion meeting for a consensus decision as to whether they qualified to be included in the study or not. Ethical approval was granted by the University of the Witwatersrand Human Research Ethics Committee (Medical). vi Results One hundred and forty two cases of occupational asthma were identified. Of these, 131 were sensitizer-induced and 11 were irritant-induced asthma. Low molecular-weight agents were in the majority with isocyanates, welding fumes, vanadium being the most common. Within the high molecular weight category, wheat was the most common. The majority of cases emanated from the Engineering, Chemical, Smelter and Food industries. Latency period from first exposure to development of symptoms was surprisingly long: a mean of 9.8 years and a median of seven years. The time from onset of symptoms to diagnosis was also long (mean of 4.9 years and median of three years). Younger cases had a shorter latency period and a longer delay in diagnosis. Agents and jobs for irritant-induced asthma cases varied widely and some came from unexpected industries. Discussion This review of asthma referrals to the NIOH Occupational Medicine Clinic has highlighted causative industries and identified exposure agents implicated in cases of occupational asthma. The very wide range of industries, occupations and agents associated with these cases is suggestive of a wide-spread occupational asthma problem in the region referring cases to the Clinic. The long latency period and delay in diagnosis are of concern since prompt diagnosis and removal from exposure is associated with a better prognosis. Irritant-induced asthma is infrequently reported in the local literature, but the range of agents and jobs is possibly indicative of under-diagnosis. Conclusion Occupational asthma is potentially preventable. New cases still arise particularly in poorly controlled workplaces which are capable of employing basic measures to control exposures. Medical surveillance, prompt diagnosis, proper medical management and application of workplace preventative measures are essential in decreasing the burden of disease and impairment

Includes abstract. / Includes bibliographical references (leaves 94-100). / The aim of this study was to determine the prevalence of occupational allergy and asthma associated with airborne spice and to determine the host and environmental risk factors associated with allergic respiratory disease among spice mill workers. A cross-sectional epidemiological study of 150 currently employed workers in a spice mill was conducted. Environmental exposure assessment entailed the collection of 62 full-shift airborne personal samples on randomly selected individuals employed in various departments of the spice mill using the NIOSH occupational exposure sampling strategy manual. The samples were analysed for inhalable particulate mass, specific spice dust allergens (garlic) and endotoxin using ELISA inhibition (antibodies from sensitised subjects) and chromogenic LAL assays.

The lack of contextually relevant conceptual tools to promote play makes implementing playbased, occupation-centred practice challenging for occupational therapists working with children with HIV/Aids in low resourced settings. This doctoral thesis focussed on reviewing and generating evidence, and further proposed a play-based intervention framework for children with HIV/Aids living in a low resourced setting. Theoretical frameworks used to guide the intervention development process and content of the play-based intervention were the United Kingdom Medical Research Council (UK MRC) framework for development and evaluation of complex interventions and Cooper's Model of children's play. The development of the play-based intervention involved four phases: 1) conducting a systematic review, 2) profiling of the play of children with HIV/Aids, 3) drawing perspectives of caregivers through in-depth interviews, and 4) gaining consensus from experts on components to include in the play-based intervention framework. In phase 1, a systematic review following the PRISMA guidelines was conducted to identify evidence that support the development of play-based interventions. Eighteen studies that focused on play as an outcome and compared the play of children with Special Health Care Needs (SHCN) to that of typically developing children met the eligibility criteria. The Kmet checklist was used to evaluate the methodological quality of the studies included. The systematic review revealed paucity of research on the play of children with SHCN such as those with HIV/Aids. Phase 2 was undertaken to generate more evidence by comparing the play profiles of 44 children with HIV/Aids aged 4-7 years to that of 52, age and gender matched typically developing children. The children were video-recorded while playing with a playmate at school or clinic and home settings. The Test of playfulness was used to score the videos by two independent raters and the scores were subjected to rasch analysis. A comparison of play profiles revealed that children with HIV/Aids were significantly less playful outdoors as compared to typically developing children (t(94) = 3.57, p = 0.001). Children with HIV/Aids also had more challenges with social play skills. In phase 3, contextual understanding of the play of children with HIV/Aids was sought through in-depth interviews with fifteen purposively selected caregivers whose children with HIV/Aids had participated in phase 2 of the study. The interviews were audio-recorded, transcribed verbatim and analysed thematically. The following four themes emerged: ‘Ubuntu is no more'; ‘survival is primary (chikuru kurarama)'; ‘play affirms that my child is still like other children'; and ‘more is required for a child with HIV'. Caregivers also reported on how contextual factors such as HIV/Aids stigma, poverty and cultural beliefs shaped the play of their children. In phase 4, findings from phases 1, 2 and 3 were synthesised and presented to experts in the field of play, HIV/Aids and intervention development during a two-round Delphi study. Experts were asked about their opinions and to rate what should be included in the play-based intervention framework. Consensus agreement was reached when at least 70% of Delphi experts rated each item at 3 or higher on a 5-point Likert Scale. Experts agreed on the application of Cooper's Model of children's play as a theoretical framework, as well as principles and techniques for the play-based intervention. This study is the second in occupational therapy to report on the play of children with HIV/Aids. It is the first one to review and generate evidence to support play-based interventions targeted at children with HIV/Aids. Evidence generated in this study showcased the need for occupation-centred, play-based services for children with HIV/Aids, particularly those living in low resourced settings. The play-based intervention proposed is child-led, allowing for physical and active involvement of the child. To increase social interaction and continuity into the home environment, playmates and caregivers must be included. Unique to this play-based intervention is advocacy for more play opportunities, access to nutrition and inclusion of culturally sensitive practices. Future studies should include feasibility on various aspects of the play-based intervention before implementing randomised controlled trials to test the effectiveness of the intervention are conducted.

Distinctly African health-promoting human occupations are under-researched in occupational therapy. Many occupational therapy interventions used in South Africa have been developed elsewhere and may be inaccessible to many. African dance that produces neurogenic tremors (ADNT) is an occupation that may already be accessible to many, and a potential resource for health and could be used in occupational therapy. Research Question: What is the nature and enactment of ADNT? Aim: The study aimed to explore, describe and explain the nature and enactment of ADNT among professional dancers in Cape Town, South Africa. Research objectives: To explore the perceived temporal, spatial and sociocultural conditions conducive for ADNT. To describe and explain the enactment of ADNT in terms of format, pace, and the sequence of steps involved in performing African dance repertoires that are known to produce neurogenic tremors. To describe the experience of those who participate in ADNT by exploring the subjective effect it has had on stress levels or during stressful periods. Methodology: Case study methodology was used. Semi-structured interviews, focus groups, and participant observation were the data collection methods used. Thematic analysis was employed to analyse the data. Findings: Four themes emerged from the study (1) Triggers: Improvisation, Energy and pushing beyond limits. (2) Essence of self: Embodying Africa through dance. (3) Leaving and returning to the body and (4) Creatures of the soil: Connected to the ground and beyond…for health. Discussion: ADNT is healing, relational, transcendent, and contextually situated. It facilitates self-acceptance (ubuwena) through embodying Africa (KwaNtu) and holds potential to promote social cohesion (ubuntu). It is mainly enacted through improvisation (on and off-stage), through which socio-historical-cultural intergenerational resources (isintu) embedded within, are tapped into. ADNT offers opportunities for connectedness with the self, other people, as well as with transcendent beings. Conclusion: This study has illuminated the nature of ADNT as an extraordinary human occupation that offers participants instances of personal and collective meaning-making, healing, and transcendence. Transcendence is proposed as a source of personal and shared meaning.

Includes bibliographical references (leaves 93-101). / This study focused on a small business enterprise in the Western Cape that primarily employs people with disabilities (PWDs) in the open labour market arena. However, the company has been experiencing annual turnover rates of 26.6% in terms of labour, resulting in a substantial financial loss. The purpose of the study was, therefore, to identify reasons for this attrition by PWDs, which effectively defeats the objective of the economic empowerment of PWDs that the company has set for itself.

Includes bibliographical references (leaves 110-123) / There is a growing demand for primary health care services in South Africa following its adoption by the National Departmet of Health in 1995. To address this demand, the government has implemented compulsory community service (CCS) for all health professional graduates, many of whom are placed in unde-resourced areas of the country with limited infrastructure or professional supervision. Occupational therapy graduates therefore require appropriate knowledge, skills and attitudes for primary health care practice.

Bibliographical references.

Includes abstract. / Includes bibliographical references (leaves 140-147). / This study focused on the process of forming partnerships between a supported environment programme and three businesses. A qualitative approach, namely collective case study, was used.