This minor dissertation is built around the Vona du Toit Memorial lecture that was given, by the author, to the Occupational Therapy Association of South Africa (OT ASA) in July 1999. The central theme of both the lecture and the dissertation is professional transformation. the impetus for which is seen to reside in the axiology of the profession, starting with the morn! values, attitudes and beliefs of individual practitioners and moving towards a collectively revisioned professional ontology. It is proposed that the ·identification, analysis and resuscitation of the profession's ethos at an individual level will ultimately impact transformatively on the nature and characteristics of the profession collectively. Particular emphasis is placed on undergraduate ethics curriculum reform for the vision of transform3tion at an individual level to be realised. The dissertation documents the pilot phase of a dialectical research cycle (Reason 1981) during which the author developed perspectives about the ethical concerns that the occupational therapy profession in South Africa needs to consider in the light of its past during apartheid and in view of its future in a developing nation. It contains a conceptual analysis of the pivotal role that professional ethics and morality will have to play in effecting fundamental change in the philosophical, structural, political and education at dimensions of the profession in response to the unique demands of the African context and suggests practical educational strategies through which attitudinal transformation in undergraduate occupational therapy students may be achieved.

Includes bibliographical references (leaves 107-118).

Includes bibliographical references. / Occupational skin disease is common in seafood processing workers. While previous studies have reported an increased prevalence of symptoms (as high as 50%) and protein contact dermatitis (3-11%), the prevalence and patterns of type IV allergic contact dermatitis have not been well characterised in epidemiological studies. The aim of this study was to identify host and environmental risk factors for symptoms, clinical eczema, positive patch tests, possible and probable allergic contact dermatitis in seafood processing workers. A cross-sectional study of 594 seafood processing workers was conducted in two seafood processing plants in the Western Cape Province of South Africa. The study used an interviewer administered questionnaire to collect information on demographic characteristics, occupational history, work practices and skin symptoms in the preceding 12 months. A subgroup of symptomatic workers (n=120) were investigated further and compared to a group of randomly selected asymptomatic workers (n=134). Both groups underwent clinical examination by experienced dermatologists and patch testing with a battery of standard allergens (adapted British Contact Dermatitis Group Standard Series) supplemented by various seafood products and additives used in the factory. Data of skin prick tests to common aeroallergens and seafood products, and serum omega-3 fatty acid (Eicosopentaenoic acid) collected in a previously reported study were also used.

Current re-engineering of primary mental health care in South Africa is directed towards providing a continuum of care for people with serious mental disorders in order to relieve the cost and resource burden of longterm hospitalisation. In the Western Cape, Healthcare 2030 has been adopted as the guiding vision for health system reform. Residential-based rehabilitation programmes have been introduced to assist mental health service users to improve their functioning in occupations of daily life so that they are better equipped to cope with community living. Problem: There is limited South African occupational therapy research into male mental health service users' perspectives on the contribution that residential-based rehabilitation programmes makes to their community integration, despite the high numbers of males using the service. Purpose: To inform public mental health services on the contribution of a residential-based rehabilitation programme to the community integration of men with serious mental disorders. Research question: How does participation in a residential-based rehabilitation programme contribute to the community integration of men with serious mental disorders? Objectives of the study: To identify what men with serious mental disorders consider community integration to be, and to describe the key elements within the residential-based rehabilitation programme that influenced their community integration. Research design and methodology: An instrumental case study design was used to guide the research methodology and five male participants were identified through purposive sampling. Observations, semi-structured interviews, community maps and document analysis w ere used as data collection tools. Data was audio-recorded and transcribed f or inductive and thematic cross-case analysis. Ethical principles of beneficence, autonomy and non-maleficence were upheld throughout the research process. Findings: One theme and three categories emerged in the findings. The theme, 'It's a catch-22 situation', comprises three categories, namely: 'It's not just what you call it'; 'There's no one size for all'; and 'It's tricky choosing between places to go and things to do'. Conclusion: Male mental health service users who participate in a residential-based rehabilitation programme will be better prepared for community integration if they are involved in co-constructing their recovery plan so that it is more personalised.

Includes bibliographical references (leaves 87-96). / This collective case study explores the occupations of women who live and/or work in a rural farming community and who are at risk of having children with Foetal Alcohol Syndrome (FAS). Although FAS is incurable, it is completely preventable. This study approached the issue of FAS from an occupational perspective, highlighting historical and current political, economic, social and individual influences on the occupational engagement of study participants. In-depth unstructured interviews were conducted with three famale farm workers from a rural farming community in the Western Cape, South Africa. Other methods of data collection included direct observation, field notes and an interview with a key informant and gatekeeper. Four themes emerged from a process of inductive analysis. The findings show that despite progressive human rights and labour law policies in South Africa participants still experience extreme forms of occupational injustice. A central theme of suffering is associated with the harsh lives of these three female farm workers. Although feelings of worthlessness, helplessness and powerlessness persist, a strong sense of hope helps these women to make it through yet another day. Ond day they will rise amidst their circumstances, like fully baked bread. Ineffective coping strategies to deal with the stress of having to survive within this context lead to occupational risk behaviour (e.g. abusing alcohol), and hence occupational imbalance. Strategies for addressing individual coping mechanisms are suggested. Deconstructing disabling environments and building support for women in the home and work environment as a combined strategy for all role players (government, local authorities, farmers and farm workers) should be geared towards facilitating healthful participation in occupation of choice. A broader occupational repertoire should be provided from which farm workers can choose.

BACKGROUND: The academic learning of HIV positive children is often negatively impacted by cognitive and learning deficits associated with HIV, and usually leads to poor performance at school. Occupational therapy, a profession that promotes and enhances participation in meaningful occupations, has yet to demonstrate its impact in promoting the occupation of academic learning in HIV positive children on ART. OBJECTIVES: This study investigates and compares the impact of two occupational therapy interventions; conventional one-on-one occupational therapy (control group) and play-informed caregiver-implemented home-based intervention (PICHIBI) (experimental group), in promoting academic learning for HIV positive children aged 5 to 8 year olds on ART. METHODS: The research project followed a pragmatic, single-blinded, randomised baseline, mid and post-test control-group design. From a possible population of 60 dyads who attend the Groote Schuur Hospital (Cape Town, South Africa) ARV clinic, 27 child-caregiver dyads (n=27) were recruited. One dyad was excluded from the study, due to home circumstances, leaving 26 dyads that went through the randomisation and allocation process into the two intervention groups. Randomisation was carried out by a central computer system, before the start of the intervention period. The final total sample (n=23) completed the intervention, a slight decrease from the recruited sample size. Four dyads were lost to follow up after the baseline test. This resulted in 12 dyads in the control group and 11 dyads in the experimental group. Baseline, mid (after 5 months of the intervention) and post (after 10 months of intervention) test data was collected using the Griffiths Mental Developmental Scales-Extended Revised (GMDS-ER) and the short form Beery-Buktenica Visual Motor Integration test , 5th edition (Beery-VMI) as outcome measures. RESULTS: Following randomisation there were minimal variations in the baseline demographics and measurements for the two groups, with the exception of a significant difference in time on ART (p=.021). The majority of each group had suppressed viral loads. The total sample showed delays in all the performance components linked to academic learning at baseline, that is, low for visual motor integration and visual perception, below average for motor coordination, borderline delay in language, and practical reasoning, and low average in eye hand co-ordination, performance and the overall level of functioning (general quotient). Severe delays (<70) were detected in the control group at baseline for visual perception, and at post test for language. Average scores (90-109) at post test for visual perception and motor co-ordination were only seen in the experimental group. No statistical significance was noted for between-group differences at baseline, mid and post test. For within-group changes, statistically significant improvements were observed in the following performance components linked to academic learning: in the experimental group, visual motor integration from baseline to mid test (p=.019); in the control group, visual perception from baseline to post test (p=.009) and visual perception baseline to mid test (p=.001), and in performance from baseline to mid test (p=.027). Following interventions the overall GMDS-ER quotient scores for both groups improved with 70% of the experimental group and 58.3% of the control group scoring more than -2 z-score. In the total sample, the level of severe delay at baseline (68.2%) improved to only 8 out of the 23 (36.4%) of the total sample showing a severe overall delay post intervention. These scores still classified the groups as below average (90-109) under the GMDS-ER UK classifications. Despite these scores, 95.7% of the total sample progressed to the next grade during intervention, with only one child repeating a grade. CONCLUSION: Improvements were seen in both groups from baseline to post test. The advantage of PICHIBI however is that it is better suited for expanding access to occupational therapy services in a context where the occupational therapist/patient ratio in the public health sector is low. The continued underperformance of both groups in academic learning outcomes post intervention, displays the need for ongoing intervention for HIV-infected school going children. This information will inform occupational therapy practice, guide policies and legislations relating to academic learning for children with HIV on ART, in South Africa. It is recommended that future research look into using a larger sample size for generalisability of findings, consider conducting a longitudinal study linking results with school report outcomes and comparing the effects of the intervention at various levels of health care.

Includes bibliographical references (leaves 157-165).

Aim: To assess the health impact of an intervention in supermarket bakeries using fractional exhaled nitric oxide and other clinical endpoints for baker’s allergy and asthma after a one-year follow-up period. Methods: A field randomised controlled trial of 31 bakeries initially assigned to one of two intervention groups (bakery mixer lid and training) (n=244) and a control group (n=93). Health data prior to and after the intervention included a modified ECRHS questionnaire; Phadiatop ® and serum specific IgE to cereal flours (wheat, rye, alpha-amylase); and FeNO performed during the work shift using NIOX MINO®. The data of the two intervention groups was combined into one intervention group for the analysis. Data was analysed using STATA (version 12). Results: The two groups were comparable with regard to age (32-33 years), proportion of females (55%-57%) and smoking status (38%-40%). The intervention group had a significantly higher prevalence of workers with atopy (42%, p=0.025), work-related chest symptoms (25%, p=0.044) and sensitisation to cereal flour allergens (35%, p=0.042) at baseline than the control group (25%, 15%, 23% respectively). At one year of follow-up, the incidence and level of decline of work-related ocular-nasal and chest symptoms, sensitisation status and elevated FeNO (FeNO >25ppb) was similar in the two groups. The mean difference in FeNO was similar across the two groups (2.2ppb vs 1.7ppb, p=0.860). However, when stratifying according to baseline FeNO >25ppb, the FeNO decline was greater in the intervention group (16.9 ppb) than in the control group (7.7ppb), although not statistically significant (p=0.237). Multivariate logistic regression models (adjusting for smoking, baseline sensitisation to cereal flour, baseline FeNO >25ppb) did not demonstrate an appreciable decline in FeNO (>10%) in the intervention compared to the control group. However, stratification according to the presence of work related ocular-nasal symptoms at baseline demonstrated a significant decline (>10%) in FeNO in the intervention group compared to the control group (OR=3.73, CI: 1.22-11.42). Conclusion: This study demonstrates some evidence of an intervention effect on exhaled nitric oxide (FeNO) one year after the intervention, particularly among bakers reporting work-related ocular-nasal symptoms at baseline. The lack of a demonstrably stronger effect on other clinical endpoints can be attributable to the short follow-up period.

Includes abstract. Includes bibliographical references.

Includes abstract. Includes bibliographical references.