abstract: The purpose of this study was to examine whether a workplace environmental intervention would improve work-related outcomes including productivity, presenteeism and cognition. The secondary aim was to investigate whether work-related outcomes are correlated to observed changes in sitting time, physical activity, and sleep. The study was introduced as part of a naturalistic environmental change in which university staff and faculty were relocated into a new building (n=23). The comparison group consisted of university staff within the same college with no imminent plans to re-locate during the intervention period; there were no environmental changes to this workplace (n =10). Participants wore two behavioral monitoring devices, activPAL and GeneActiv, for 7 consecutive days at two time points (immediately prior and 16 weeks following the office relocation). Measures of productivity and presenteeism were obtained via four validated questionnaires and participants underwent cognitive performance testing. Baseline adjusted analysis of covariance statistical analyses were used to examine differences between groups in work-related outcomes. A residual analysis in regression was conducted to determine the differences between observed changes in sitting time, physical activity and sleep, and work-related outcomes. The results showed that a reduction in work hour sitting time was not detrimental to work related outcomes. Decreased sitting was observed to potentially improve presenteeism and absenteeism. Additionally, physical activity was shown to modestly improve productivity, presenteeism and absenteeism. Poor sleep patterns were associated with work impairment and increased absenteeism. / Dissertation/Thesis / M.S. Exercise and Wellness 2014

Introduction and aim Tobacco farmers are exposed to toxic workplace hazards such as nicotine and pesticides in addition to known agriculture related hazards like dust, and ergonomic factors. Nicotine and pesticide exposure have been linked to the development of chronic respiratory diseases. This study was aimed at determining the prevalence of obstructive lung disease among tobacco farmers in Malawi and its association to nicotine and pesticide exposure. Methods A cross-sectional study was conducted comprising of 279 current workers across four flue-cured tobacco farms in rural Zomba district of Malawi during a tobacco growing season. The assessment involved the use of a modified ECRHS questionnaire and questions on pesticides and nicotine exposure. Voluntary HIV testing was offered to individuals who did not know their HIV status. Health outcomes assessment involved the use of both symptom and spirometry-based diagnoses of obstructive lung disease. The data was analyzed using STATA 14 computer software and included bivariate and multivariate logistic regression analysis. Results The study had predominantly male participants (68%) with a total mean age of 37.7 years, majority (73%) of whom had attained primary education or higher, with 20% being current smokers. Participants had a mean employment duration of 7.3 years and 62% indicated that they worked mainly with tobacco while 57% were involved in pesticides application. HIV prevalence was 16%. The prevalence of current asthma (ECRHS) was 20% whilst for asthma score≥2 it was 23%. The prevalence of chronic bronchitis, work related ocular nasal symptoms and work- related chest symptoms were 17%, 20% and 29%, respectively. Airflow Limitation measured as FEV1 < LLN was 14% (NHANES and sample reference). The prevalence of moderate to severe obstruction was 4%. The prevalence of green tobacco sickness (a proxy for nicotine exposure) in the past year was 26% with an average of 3 episodes within that period. Most workers were exposed to pesticides with 72% reporting exposure during spraying of pesticides while 83% reported re-entry into fields soon after spraying. The main pesticide in use was organophosphates (18%). The majority (51%) of participants reported use of organophosphate pesticides at home. In multivariate analysis nicotine exposure and associated tasks were significantly associated with all respiratory outcomes (OR range 1.78-7.26). Pesticide application was positively associated with all the symptom-based respiratory outcomes (OR 1.96- 2.62) except for work related chest symptoms. Exposure during spraying was significantly associated with asthma score≥2 (OR 2.09, CI 1.01-4.31), current asthma (OR 2.57, CI 1.22-5.40), and work related ocular nasal symptoms (OR 2.43, CI 1.17- 5.04) while pesticide drift was associated with current asthma (OR 2.62, CI 1.00-6.86) and work related ocular nasal symptoms (OR 3.00, CI 1.18-7.62). In spirometry-based outcomes duration of pesticide exposure was significantly associated with FEV1/FVC< LLN (OR 5.11, CI 1.57-16.66), FEV1/FVC< 70% (OR 4.58, CI 1.17-17.98) and moderate to severe obstruction (OR 13.25, CI 1.69-103.93). Nicotine exposure was not significantly associated with spirometry-based outcomes. Conclusion In conclusion, this study showed that tobacco farmers in Malawi have a higher prevalence of asthma and chronic bronchitis compared to the general population or tobacco farmers in other settings. Additionally, exposure to nicotine and pesticides is strongly associated with the prevalence of obstructive lung diseases among these farmers.

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.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

This thesis set out to explore the neglected field of nurses’ occupational health. Evidence from the three case study hospitals confirms that attitudes toward nurses’ health changed between 1888 and 1948. The health of nurses was an issue that was always taken seriously but each institution approached the problem differently and responses showed much variation over time. There were good reasons for this but the failure to adopt a coherent and consistent policy worked to the detriment of nurse health. This difficulty helps explain the ambiguous treatment of occupational health within wider histories of nursing. This can lead to the erroneous conclusion that occupational health was somehow neglected by contemporary actors, thereby facilitating the omission of the subject from historical studies concentrating on professional projects and the wider politics of nursing. This study takes a different approach showing that occupational health issues were inexorably connected to these nursing debates. Occupational health cannot be understood without reference to professional projects. This is as true in debates where occupational health was obscured as it was in cases of overt concern. The history of the occupational health of nurses is also important because it offers a new perspective on two other themes central to nursing history, particularly class and gender. This focus helps understand why attitudes towards the care of sick nurses changed over time and varied between different types of institutions. By concentrating on individual nurses’ experiences we reveal something new about the way national conversations affected ordinary nurses’ lives. Recognition that nursing presents a serious occupational health risk is a relatively recent phenomenon; it was not until the 1990s that most nurses had access to occupational health units. This study not only sheds light on why nurses’ health attracted little attention before the Second World War but also explains why this situation began to change from the 1940s.

M.P.H., Faculty of Health Sciences, University of the Witwatersrand 2011 / Background: The Employee Health and Wellness (EHW) Centre at the Kimberley Hospital Complex (KHC) started off as a staff clinic, rendering nursing services to staff members with occupational injuries and minor ailments such as influenza, colds and headaches. Since the EHW Programme was introduced in 2004 there has been no evaluation of the services provided. There is no information about referrals and current usage of the service, which compromises further planning. Study aim: The aim of the study was to describe the extent and patterns of utilization of the Employee Health and Wellness Services at the Kimberley Hospital Complex for the period 1 January 2008 to 31 December 2009. Methodology: This was a cross sectional descriptive study, involving a retrospective record review at the EHW Centre. Data extraction from various data sources was recorded on data collection tools using coding instead of names to protect the identity of the employees. The study setting was the EHW Centre at Kimberley Hospital Complex, which is the only hospital with a Centre for Employee Health and Wellness in the Northern Cape Province. Conclusion: The utilization rate of the EHW services at KHC is generally low (6.2% and 6.4%) in 2008 and 2009 respectively. There is a need for further research to determine the reasons for low utilisation through employee and employer interviews and focus group discussions. An interesting fact is the steep increase in the number of employees with multiple visits. It would be interesting to conduct a study that will determine the reasons for multiple visits in one month. There was no significant difference between the age and utilization of EHW services but there was a significant association between gender and components of services used, (chi-square test, p<0.001) for both PHC and OHS components. More males used the PHC component whilst more females used the OHS component of the services. While the reasons have not been established, it may possibly be related to a larger number of female employees in the professional category in the health sector. Thus there is a need for further research to explore the gender mismatch in utilising PHC and OHS components of the services. The Wellness programme was minimally used. There was no significant association between age and medical aid status and the usage of service components. The average length of employment for employees who visited the EHW centre was less than 10 years; there was no significant difference in usage of the service between more experienced and less experienced staff. There is a need for further studies to explore reasons for the low utilization rate of the EHW services as well as the perceptions of service providers and employees regarding the utilisation of these services at Kimberley Hospital Complex.

Title: Perceptions of Central Gauteng occupational health nurses of their traditional and expanded roles Background: The majority of the published literature alludes to the evolution of the occupational health nursing practitioner (OHNP) role from a traditional to an expanded role yet there are comparatively few notable studies that have attempted to explore the significance that OHNPs place on both these roles, the extent to which they enact these roles in the workplace and the amount of time they dedicate to these roles. Purpose: The overall purpose of the research was to investigate the perceptions that OHNPs have of their traditional and expanded roles in their current occupational health nursing (OHN) practice. Methodology: Using a survey method, occupational health nursing practitioners (n = 150 ) who practiced and are members of a professional society of occupational health practitioners in the Central Gauteng district were invited to complete a self-administered, structured questionnaire about their perceptions of their traditional and expanded roles. The questionnaire composed of 27 specific task items that reflect OHN practice role activities divided into eight major areas of OHN practice. The items were measured on a 5-point Likert scale ranging from 1 (not significant) to 5 (extremely significant) and participants were also required to estimate in hours, in any given week, the time they believed they dedicated o each of the eight major areas. Main outcome measures: The main outcome measures of the research were perceptions of the OHNPs of their traditional and expanded roles and the time devoted to these roles in their current practice. Findings: A total of 102 questionnaires were completed, yielding a response rate of 68%. The majority of the OHNPs generally regarded their traditional and expanded roles as moderately significant indicating that the roles were at least performed to some extent in their practice. Nevertheless, OHNPs regarded the roles in the traditional domain highly (mean rating = 3.29) than those in the expanded domain (mean = 2.84). Managing an occupational health service (mean= 3.60) and assessment of workers health (mean = 3.61) activities received the highest rankings whereas research-related activities had the lowest (mean = 2.39). On average OHNPs spend 35 hours per week in OHN practice of which 39.7% is spent in management of occupational health services, 33.1% in worker health assessments, 27.1% in rendering curative services, 16% in health promotion activities, 14% in health education activities, 14% in rehabilitation services, 12% in workplace assessments and 9.7% in research-related activities. The perception of the significance of core areas appeared to be mainly dependent on availability of occupational health and safety personnel and the OHNPs job title. Also comparisons made between perception of roles and time devoted to those roles revealed that there were gaps between what they perceived as significant and amount of time dedicated to roles. Conclusions: OHNPs regard both traditional and expanded roles as moderately significant in their current practice. However gaps existed between perception of individual roles and amount of time spent in those roles. In this instance data revealed higher perception of expanded roles yet time devoted to these roles was less than that devoted to traditional roles where the perception of the roles were relatively lower. Implications for OHN practice: Knowledge of what entails significant practice from the OHNPs’ perspective is a good needs assessment technique as it indicates where training and continuing education should be targeted. Also, acknowledgement of the gap that exists between perception of a role and the actual time spent in that role indicates where strategies to reduce role ambiguity, role conflict and resulting occupational stress have to be directed. Key words: occupational health nursing, nurses’ perceptions, role, Role Theory, traditional and expanded role, self-administered questionnaire

Background Integrated team working is increasingly being used as a model of care within NHS Services. Whilst the integration agenda has evolved over time with increasing recognition of the continuum integration can refer to, consistent use of language and terminology has remained a challenge. The factors influencing integrated team working could be perceived as aspects of team, organisational and professional culture but there is a lack of studies formally assessing culture within an integrated team. Case studies also seldom appeared to include Allied Health Professionals with the reasons for this unclear. Care Aims is also being increasingly used as a model of care within NHS services particularly by Allied Health Professions yet the evidence base appears sparse, particularly exploring the use of Care Aims in an integrated team. Aim The overall aim of this study was to explore the effect of culture and context on integrated team working for Allied Health Professions in community settings. Methodology This exploratory study took place in two parts. The first part of the study investigated the Care Aims approach and the effect of culture and context for integrated team working for Allied Health Professionals in primary care settings and comprises of four case studies. The second part of the study evaluated and compared the case studies with other relevant models for promoting integrated team working for Allied Health Professionals (AHPs) in community settings. Data collection was primarily qualitative using both questionnaires and semi-structured interviews based on the critical incident technique. The Team Climate Inventory (TCI) and Organisational Culture Assessment Instrument (OCAI) were used to explore culture and climate to provide supplementary contextual information. The individual case studies were analysed using thematic networks. Cross case analysis was employed to identify themes for comparison. Findings The cross case analysis identified ten categories that appeared to influence integrated team working. Some of these categories were similar to themes identified in the literature exploring facilitators and barriers to integrated team working, such as leadership, staff roles and responsibilities, vision and professional culture. However different categories also emerged e.g. service type, team climate and relationship with the patient. The interdependency between the categories is also apparent, with philosophy and approach to care influencing all. Where there was a less dominant biomedical approach to care teams appeared to work in a more integrated way. Similarly, Care Aims implementation appeared to be influenced by similar factors. The approach to care pre-Care Aims and how the introduction of Care Aims was managed appearing most significant. The findings also appeared consistent with the evidence base for managing change. This study also suggested parallels between extent of integrated team working and success of Care Aims implementation. The more integrated a team appeared to be, the more successful Care Aims implementation also was. Whether level of team integration or introduction of Care Aims was the more significant factor is unclear. One of the challenges of this study has been to identify other sufficiently detailed published case studies to enable comparative analysis. As a result of the comparative analysis in this thesis a framework for a minimum data set to enable cross case analysis of case studies exploring integrated team working is proposed. This will facilitate a better understanding of the evidence base. This study adds to the literature for integrated team working by exploring and comparing several integrated teams within the same organisation. Unlike previous studies, these case studies explicitly explored the role and impact for AHPs of working in an integrated team. This study has led to the development of a framework to support implementation of Care Aims by identifying the potential barriers and facilitators to implementing Care Aims. This could support teams to identify those areas which may benefit from greater attention and support during implementation. This study also adds to the limited evidence base for Care Aims by exploring the implementation and use of Care Aims in integrated teams and undertaking a comparative analysis of teams in the same organisation.

Inexpensive instruments that measure concentrations of airborne particles in workplaces have grown to become an efficient way to estimate personal aerosol exposure of workers. This study evaluates the performance of two types of inexpensive instruments: an “active” version which pulls particle-laden air into a sensing zone for measurement, and a “passive” version which does not. The response of these instruments to clean air over time was evaluated as an indicator of contamination in laboratory and factory settings. Additionally, the effect cleaning of the instruments had on performance was evaluated. After exposure to high concentrations of particles in the laboratory, the active and passive versions of the instruments lost partial to full ability to detect particle concentrations. In the factory, this change was only seen in the active version, and occurred over a longer amount of time. Cleaning of the instruments returned some ability to detect particles, but not to the ability a new instrument. The accumulation of particles within instruments used to estimate aerosol exposures can affect the output of and overall performance of the instruments. Cleaning of the instruments after accumulation results a lessening of the effect, but not completely. Cleaning can be a way to extend the lifetime of these instruments. However, the time and financial costs related to cleaning several sensors within a workplace should be considered.