Thesis (M.Fam.Med.)--University of the Witwatersrand, Faculty of Health Sciences, 2014. / Background: Health Care Workers (HCWs) are at risk of many blood borne infections at the workplace following injuries from sharp instruments and also from exposure of skin and mucous membranes to contaminated blood and body fluids. While the risk of exposure to blood and body fluids (BBF) among first level HCWs can be extrapolated to some degree from the literature on secondary and tertiary level HCWs, the rate of reporting of exposures and the reasons for not reporting may be very different. Objective: The objective of this study was to determine the rate of, and reasons for underreporting of blood and body fluid exposures by doctors and nurses working in the public primary health care setting of sub district F in the Johannesburg metropolitan district. Methods: The study was a quantitative descriptive cross sectional survey using an 18-item, self administered, anonymous questionnaire. Results: The study population included 515 health care workers (HCWs). The response rate was 90.1%. Most of the participants were nurses (87.4%) and female (88.1%). One hundred twelve (25.2%) of the participants reported having at least one BBF exposure in the preceding 12 months. The rate of BBF exposure was 80 per 100 HCWs per year. Two hundred ninety one exposures (82.0%) were not reported. Doctors were at increased odds for not reporting BBF exposures compared to nurses (OR = 2.146; P=0.011). The most common reason given for not reporting exposures was lack of time (42.7%). Conclusion: There is a high rate of underreporting of BBF exposures in the primary health care setting mostly due to lack of time. The rate of BBF exposure underreporting at this care level is comparable to that at secondary and tertiary levels. There is a need to improve BBF exposure reporting among workers at primary health care level.

M.Sc. (Med.) (Epidemiology and Biostatistics), Faculty of Health Sciences, University of the Witwatersrand, 2011 / Introduction: Work - related injuries are of major public health importance because they have severe negative economic and social impacts to individuals, families, and a country’s economy as a whole. South Africa is a rapidly expanding economy and so there is great potential for workrelated injuries. Notably, a number of studies on work-related injuries in South Africa and globally are done at the industry level. While no effort to minimise occupational injuries at the enterprise level should be spared, more information is also required on the morbidity burden of these work-related injuries at the general population level. It was therefore against this background, that this research project was carried out. Objective: The objective of this study was to determine the association between injuries and occupations among workers aged 15 - 65 years. Methods: The dataset for this dissertation was extracted from the South African 2001 Labour Force Survey. Only respondents who reported having worked in the previous twelve months were included in the study sample (n=21,751). The outcome variable was injury over the previous twelve months. The explanatory variables were socio-demographic, occupation, and occupationally related characteristics. Logistic regression controlling for the socio-demographic characteristics was used to identify occupational and occupationally related predictors for incidence of injury at 95% confidence level. Results: Injury incidence of 4% (894/ 21751) was reported which was mainly associated with age, gender, ethnicity and province of residence at p<0.05. Male workers were more likely to sustain accidents than female workers with a risk ratio of male/female of 2.4 times. Unexpectedly, injuries increased with age. In respect to ethnicity, the Coloureds, Indian/Asians and Whites were 18%, 48% and 44% less likely to sustain injuries respectively compared to the vi African blacks while workers in the group called “Other” were 5.3 times at risk than African blacks. Adjusted analyses indicated that, workers in mining and quarrying (AOR=2.2), crafts and related trade (AOR=4.0), plant and machine operators (AOR=4.4) and elementary occupations (AOR=2.7) were predisposed to a higher risk of sustaining injury than other occupations. Surprisingly, permanent workers, those with written contract, pension contribution were found to have a higher likelihood of sustaining injuries than their counterparts. Conclusions: The incidence of injury to workers in South Africa was found to be at 4%. The older, male, and permanently employed workers were at a greater risk of sustaining injuries compared to young, female and casual workers respectively. In regards to occupations, mining and quarrying, crafts and related trade and elementary occupations elevated the risk of sustaining injuries than other occupations. It is highly recommended that occupation-specific programmes be instituted to minimise worker injuries particularly among the high risk work places. Further research is also required to investigate findings that were found to be inconsistent with existing literature namely; increase of injuries with increase in age, and why workers on permanent versus casual employment were more likely to sustain injuries.

This pilot study examined the effects of a program designed for Hispanic older adults to promote wellness and a health promoting lifestyle. Pre and post-tests were administered using the Health-Promoting Lifestyle Profile II (HPLP-II) to all participants in the experimental group (n=25) and in the control group (n=19). The experimental group participated in a 16 session health and wellness program that included lectures, activities, and discussions in the areas of health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management. Participants in the program significantly improved their overall HPLP-II score, p < .001, as well as each of the HPLP-II areas. Participants in the program scored significantly higher than the control group on the overall HPLP-II score, p < .001, and in each of the HPLP-II areas. Health perception, although not significantly related to engagement in wellness and a health promoting lifestyle for participants in this study, was in the expected direction rs = 0.28, p = 0.062. Results indicate a culturally-relevant occupational health promotion program can improve wellness and a health promoting lifestyle for Hispanic older adults.

<p>SCALES, ALICE YOUNG. The Effect of Learning Style, Major, and Gender on Learning Computer-aided Drawing in an Introductory Engineering/Technical Graphics Course. (Under the direction of Dewey A. Adams and Barbara M. Kirby)This correlational descriptive study examined factors that might affect students? achievement in learning computer-aided drawing and engineering/technical graphics concepts in introductory classes at North Carolina State University. The study involved 38 subjects enrolled in introductory classes that combined the teaching of computer-aided drawing and technical graphics. The three dependent variables used in the study were CAD project grade, CAD posttest score, and final course grade. The seven independent variables examined were gender, learning style, major, student classification, final exam grade, final exam with the posttest score removed, and pretest score. Subjects' learning styles were established by the Group Embedded Figures Test, which measures field-dependence and field-independence. Kendall?s Tau B correlations and multiple linear regression models were used in the analysis of the data. The alpha used for statistical significance was .05.Analysis of the data revealed that the research subjects were primarily field dependent, and exactly half of them had prior drafting experience. Subjects in the study represented 19 different majors. Eighteen students were from engineering programs and 20 from non-engineering programs. Females in the sample reported a lower level of computer experience and less prior drafting experience than males. For the total sample, statistically significant correlations were found between the project grade and the final grade with the project score removed, learning style and the final exam grade with the project score removed, computer experience and gender, and the final exam grade and gender. Correlations were found between gender and the final exam grade with the posttest score removed and between learning style and the final exam with the posttest score included. For females, a statistically significant relationship was found between prior drafting experience and the project grade; this was the strongest correlation found in the study. For males, statistically significant relationships were found between learning style and final exam grade, learning style and the final exam grade with the posttest removed, the project grade and the final grade with the project score removed, the project grade and the pretest score, and the pretest and posttest score.Three multiple linear regression models were created as part of the study, two as predictors of computer-aided drawing achievement and one as a predictor of achievement in learning the course content. Model 1 used the final project grade as its dependent variable to measure CAD achievement. The independent variables used in this model were gender, the pretest score, and major. The model?s R square was 0.31 (p = 0.005). Model 2, which used the posttest score as its dependent variable, was the second measure of CAD achievement. The independent variables used in this model were the pretest score, the Group Embedded Figures Test score, and the final exam grade with the posttest score removed. Its R square was 0.19 (p = 0.056). Model 3 used the final course grade as its dependent variable to measure achievement in learning the course content. The independent variables included in this model were gender, the Group Embedded Figures Test scores, and student classification. The R square for this model was 0.21 (p = 0.043).<P>

Background: Skin cancer is an increasing worldwide public health concern. Rates of melanoma and skin cancer continue to rise worldwide, creating a significant public health need for detection. In 2003, nearly 54,000 Americans were diagnosed with melanoma with an expected 7,700 deaths. The visual skin exam is an effective secondary prevention tool in detecting melanoma and nonmelanoma skin cancer and may be implemented in occupational medical clinics. Methods: Applying the results of a comprehensive literature review of skin cancer screening efforts in communities and workplaces to occupational medicine. Results: Skin cancer screening efforts have identified high-risk populations for melanoma and nonmelanoma skin cancer and may detect suspicious lesions early. Conclusions: Occupational physicians may be the only healthcare provider with the opportunity to screen a high-risk population, particularly males over age 50. Integrating a skin examination into pre-employment or periodic examinations would expend minimal time and funds while potentially preventing worker morbidity and mortality. Screening for skin cancer at the workplace may also fulfill a public health need. The integration of skin cancer screening into occupational medicine may simultaneously improve worker health and increase the value of the occupational medicine physician.

Over the past 20 years, the "workplace substance abuse prevention industry" has grown enormously in size and has become more sophisticated in its marketing approach. Drug testing alone has become a $6 billion industry. Employee assistance programs are now widely used by employers at significant cost. This thesis presents a brief review of drug use patterns as related to occupational injuries together with a history of workplace testing. Results from studies suggest that drug-free workplace programs are an important public health approach to improving workplace health and safety through early intervention and, quite possibly, substance abuse prevention.

The public health significance of low back pain results from the economic and social burdens it places on industrialized societies. The primary objective of this paper is to create a definition of low back pain recurrence based on present scientific literature. No unified definition has been offered in current research and a universally accepted definition will help advance the study and treatment of low back pain recurrence. The need for a unified definition comes from the fact it is not easy to compare the various studies of recurrent low back pain. This limitation affects the treatment patients are given and the outcomes they experience. Building on our primary objective of creating a unified definition of low back pain we will then take the definition and use it to evaluate available databases (UPMC Health Plan and Workers Compensation) for low back pain recurrence. The definition and the available data will be used to evaluate the costs, both direct (medical and workers compensation) and indirect (related to lost work time, etc, associated with low back pain). This will be useful in comparing the medical and personnel costs aspects of patients with recurrent low back pain to those without recurrent low back pain. By performing this analysis we will be able to estimate the costs savings of effective treatment for low back pain recurrence. Using the definition of low back pain recurrence developed and the data and clinical resources available we will develop an intervention to reduce recurrence rates of work related low back pain. Specific treatment groups will be identified and compared in a prospective analysis to the usual care low back pain patients receive. The results of this aspect of the study will be used to decide if the proposed treatment was able to reduce medical and other costs as predicted when compared to any increased costs specific treatments may entail. Finally, the rationale for a new universally accepted definition of recurrent low back pain will be given. I will then give a brief outline of a step-wise process to be used by future researchers in addressing recurrent low back pain.

In a program announcement in 2005, The Office of Biodefense Research, the National Heart, Lung and Blood Institute, and the National Institutes of Health expressed concern about an issue of significant public health importance: the US population's potential exposure to aerosolized, inhaled harmful chemicals possibly liberated as part of bioterrorism attacks against assembled groups of the civilian populace. The primary stated objective of the program was to encourage research about how the upper respiratory tract and lungs respond to acute exposure to highly toxic chemicals and subsequent inhalation, so that preventive strategies can be improved, antidotes devised to lessen initial irritation of mucosal surfaces, mucosal absorption minimized, and acute lung injury causing pulmonary edema counteracted. In the context of this objective, a review of the basic and applied science of inhalation toxicology was undertaken and a research proposal developed to demonstrate the relevance of an established mouse bioassay, documented to identify and quantify the effects of inhaled agents at all three regions of the respiratory tract, by evaluating the inhalation toxicity of methyl isocyanate, an agent known to affect all three regions of the respiratory tract. Human observational methyl isocyanate exposure data from the Bhopal industrial accident are available, as are experimental animal exposure data, offering the opportunity to further establish the reproducibility and validity of the bioassay. In addition, the mouse biosassay detects effects of inhaled agents at concentrations below those at which histopathological changes occur, enabling the rapid screening of administered treatments and antidotes for effectiveness. This capacity is of fundamental importance in the development of future therapeutic agents. With experience gained in the practical management of the experimental apparatus with the methyl isocyanate proposal, a study using the mouse bioassay to reproduce unpublished data investigating therapeutics against the inhalation toxicity of ricin would be proposed at a future date. Ricin is of outmost importance for biodefense since it is extremely potent and readily available. Furthermore, no antidote or treatment exists against this agent and the unpublished data on possible treatment should be pursued..

Cadmium (Cd) is a heavy metal with public health importance because it is known to present environmental and occupational hazards and a threatening to public health. Cd has negative effects on the liver, kidney, and male fertility. However, relatively little is known about the molecular toxicology of Cd in the epithelial cells of the male reproductive system. Thus, we studied the effects of Cd on the critical metal binging protein, metallothionein-1 (MT-1), in the epididymis of the intact rat. CdCl2 (2 mg/kg/day) was administered for 10 days via minisomotic pumps implanted subcutaneously in mature male rats, and the rats were then sacrificed and their tissues , including the kidney and epididymis, were quickly frozen and examined via immunohistochemistry for MT-1, vacuolar H+ - ATPase (V-ATPase) at confocal microscopic level or MT-1 (Western blot). We observed a significant upregulation of MT-1 expression in kidney proximal tubules by immunofluorescence and Western blot. MT-1 was positive over most of the basal cells (BC) along the epididymal duct and part of the clear cells (CC) in the caudal duct that co-localized with V-ATPase, a CCs marker. MT-1 expression was upregulated in distal caudal CCs after Cd treatment. However, the overall MT-1 expression assayed by Western blot in the epididymal duct decreased after treatment. This study indicated the validity of Cd administration via subcutaneous minipump. MT-1 was upregulated in caudal CCs after Cd treatment. The MT-1 change deserves further investigation.

Despite advances in technology and medicine, safety for working adolescents still challenges 21st century Americans. One would think that by now, in the beginning of the new millennium, America would have cured this disease of child labor that infects its younger population. Yet, injuries still maim and kill Americas working youth. Politicians speak out against child obesity, and both celebrities and ordinary citizens criticize school violence, especially after a Columbine or Virginia Tech massacre. Human rights activists picket clothing lines that depend upon the work of underpaid children in developing countries, and Congress holds hearings to ensure that American consumers do not buy goods produced by these exploited children. However, health care providers, legislators, and the general public often relegate child labor to the back burner. Moreover, many diminish the role of child labor in the United States by viewing child labor as a social, economic, and political problem limited to developing countries. The employment of children in the work force should be in the forefront of domestic health policy because of its social and economic significance to public health. Even though current societal awareness indicates some understanding of the health risks of adolescent workers, statistics continue to show a bleak picture of preventable workplace injuries and fatalities of this vulnerable population. This paper defines child or youth as any individual 17 or younger who engages in some kind of work. In discussing youth employment, the paper does more than just describe child labor laws; it also focuses on the unique traits of this young population and the trends that characterize its employment. This gives an identity to the faceless young men and women who deal with the risks of the industrial and agricultural work places. Once presenting the current statistics on injuries and fatalities incurred by youth in both the industrial and agricultural sectors, the paper compares the similarities and differences in the major industries between youth and adult workers. It then moves into the legal arena, describing what has been done and what still needs to happen to combat child labor problems.