Adverse drug reactions (ADRs) constitute a major problem in society and in drug therapy. They are a common cause of short-term hospitalization, prolonged hospitalization and death. Spontaneous reporting of ADRs remains one the most effective methods for detecting new and serious drug reactions. In Sweden physicians are legally required to report fatal and serious ADRs. We know from previous studies that there is a substantial degree of under-reporting of ADRs also in Sweden. Attitudes towards reporting of ADRs among physicians in the northern region of Sweden were investigated using a questionnaire. The most important factor for not reporting ADRs among physicians and general practioners in our region was that the reaction was considered to be well known. However, their attitudes could also allow for a considerable rate of under-reporting. The effect on the reporting rate when nurses received instruction and were encouraged to report ADRs was studied. During a 12-month study period, 18 ADR reports with a total number of 22 ADRs were sent in by the nurses participating in the study to test nurses as reporters of ADRs. Using the Swedish ADR database, we calculated the risk of agranulocytosis associated with the use of metamizole by using consumption data from the case records of scrutinized patients’ and stored prescriptions. Over the period from 1996 to 1999, ten cases of agranulocytosis during treatment with metamizole were reported to SADRAC. Metamizole was prescribed to 666 (19%) inpatients during the 3-month study period and 112 prescriptions were identified at the participating pharmacies. Thirty-eight percent of them indicated treatment for more than 15 days. Making certain assumptions, the calculated risk of agranulocytosis was one out of every 31 000 inpatients and one out of every 1400 outpatients. The degree of under-reporting of serious ADRs was studied in five hospitals. More than 1300 case records were scrutinized and among these we found 107 cases that according to current rules for ADR reporting, should have been reported. Only fifteen of these were found in the SADRAC database, indicating a under-reporting rate of 86%.The effect on the reporting rate of ADRs was studied in an intervention study in which a small economical inducement was given to those who reported ADRs. The effect of a small economical stimulation to increase the reporting rate was studied. From the intervention area we received 62 suspected ADRs compared with 50 from the control area. The increase in the number of reports was 59% compared with an unchanged reporting rate from the control area. The physicians in northern Sweden have a relatively good knowledge of the existing rules for ADR reporting. Nurses could play an important role in detecting and reporting suspected ADRs. The risk of developing an metamizole induced agranulocytosis is considerably increased if metamizole is given to patients for a longer time than recommended. The rate of reported ADRs is very low, also for serious and fatal reactions. An increase in the reporting rate of suspected ADRs was observed during study period.

Mandatory notification of disease forms the backbone of disease surveillance in New Zealand and overseas. Notification data is used by public health professionals and academics to identify cases requiring public health control, monitor disease incidence and distribution, and in epidemiological research. However, there is emerging evidence that notification rates do not accurately reflect the true extent of notifiable diseases within the community, resulting in the underascertainment of many notifiable cases. While adequate surveillance does not necessarily require that all cases of notifiable disease be captured, the systematic underascertainment of disease can have significant implications for perceived spatial and demographic trends in disease prevalence; potentially threatening the credibility of spatial epidemiological research by under or overestimating the burden of disease in different populations. There is evidence that systematic underascertainment occurs as a result of the differential actions of laboratories and general practitioners. It has also been recognised that that underascertainment can be influenced by a patient's willingness to seek medical attention and participate in laboratory tests. However, few studies have investigated whether these factors systematically influence notification either in New Zealand or overseas. Furthermore, the discipline of health geography has been slow to engage with this topic of public health importance, despite the inherently spatial nature of the processes involved, and the close ties to the geographic literature on health service utilization and healthcare provision. This thesis explores the spatial and temporal variation in notification rates in New Zealand for the period 1997-2005 and the potential relationships between notification rates and different variables. Unlike many underascertainment studies, which have used individual data and capture-recapture methods, data constraints inspired a unique ecological approach to investigating the factors which may be associated with notification in New Zealand. Variables were divided into categories based on Anderson's behavioural model for healthcare utilization and the influence of these variables on notification was determined through multiple regression analyses. The main findings of this research indicate that in New Zealand notification rates have increased during the period 1997-2005 and that there is a north-south gradient in notifications, with substantially lower rates in the North Island than in the South Island. Furthermore, it is also evident that the variables associated with notification vary according to disease, spatial aggregation and spatial scale. Notification rates are significantly associated with a range of predisposing and enabling factors which might influence patient choice to consult for many frequently underascertained diseases. More variation in enteric diseases is explained by the independent variables analysed than the variation in non-enteric diseases. However, further research into these relationships, and underascertainment in general, is required before firm conclusions can be drawn.

Accurate self-report assessment of psychopathology depends on individuals responding honestly and accurately. Some respondents, however, may respond in a manner not representative of their traits/symptoms. The MMPI-2-RF contains “validity” scales to detect elevations on over-reporting (OR) or under-reporting (UR) scales which typically correspond to elevations on MMPI-2-RF substantive scales and on instruments administered alongside the MMPI-2-RF. We examined effects of OR and UR on the Personality Inventory for DSM-5 (PID-5); a self-report instrument that assesses 25 pathological traits used with other diagnostic criteria to diagnose personality disorders (PDs) in Section III of the DSM-5. Using MMPI-2-RF validity scale scores, 908 students and 255 psychiatric outpatients were classified into OR, UR or within normal limit response groups. Significant group differences were found such that differences in the frequency of PD diagnosis emerged across response groups. We believe the PID-5 is vulnerable to OR and UR responding, which potentially compromises its validity.

Accurate self-report assessment of psychopathology depends on individuals responding honestly and accurately. Some respondents, however, may respond in a manner not representative of their traits/symptoms. The MMPI-2-RF contains “validity” scales to detect elevations on over-reporting (OR) or under-reporting (UR) scales which typically correspond to elevations on MMPI-2-RF substantive scales and on instruments administered alongside the MMPI-2-RF. We examined effects of OR and UR on the Personality Inventory for DSM-5 (PID-5); a self-report instrument that assesses 25 pathological traits used with other diagnostic criteria to diagnose personality disorders (PDs) in Section III of the DSM-5. Using MMPI-2-RF validity scale scores, 908 students and 255 psychiatric outpatients were classified into OR, UR or within normal limit response groups. Significant group differences were found such that differences in the frequency of PD diagnosis emerged across response groups. We believe the PID-5 is vulnerable to OR and UR responding, which potentially compromises its validity.

Traffic safety has been considered one of the most important issues in the transportation field. With consistent efforts of transportation engineers, Federal, State and local government officials, both fatalities and fatality rates from road traffic crashes in the United States have steadily declined from 2006 to 2011.Nevertheless, fatalities from traffic crashes slightly increased in 2012 (NHTSA, 2013). We lost 33,561 lives from road traffic crashes in the year 2012, and the road traffic crashes are still one of the leading causes of deaths, according to the Centers for Disease Control and Prevention (CDC). In recent years, efforts to incorporate traffic safety into transportation planning has been made, which is termed as transportation safety planning (TSP). The Safe, Affordable, Flexible Efficient, Transportation Equity Act - A Legacy for Users (SAFETEA-LU), which is compliant with the United States Code, compels the United States Department of Transportation to consider traffic safety in the long-term transportation planning process. Although considerable macro-level studies have been conducted to facilitate the implementation of TSP, still there are critical limitations in macroscopic safety studies are required to be investigated and remedied. First, TAZ (Traffic Analysis Zone), which is most widely used in travel demand forecasting, has crucial shortcomings for macro-level safety modeling. Moreover, macro-level safety models have accuracy problem. The low prediction power of the model may be caused by crashes that occur near the boundaries of zones, high-level aggregation, and neglecting spatial autocorrelation. In this dissertation, several methodologies are proposed to alleviate these limitations in the macro-level safety research. TSAZ (Traffic Safety Analysis Zone) is developed as a new zonal system for the macroscopic safety analysis and nested structured modeling method is suggested to improve the model performance. Also, a multivariate statistical modeling method for multiple crash types is proposed in this dissertation. Besides, a novel screening methodology for integrating two levels is suggested. The integrated screening method is suggested to overcome shortcomings of zonal-level screening, since the zonal-level screening cannot take specific sites with high risks into consideration. It is expected that the integrated screening approach can provide a comprehensive perspective by balancing two aspects: macroscopic and microscopic approaches.

Abstracts in English, Afrikaans and Southern Sotho / The prevalence of hate victimisation in South Africa remains unknown, as does its full impact. Anecdotal evidence, borne out by recent research findings, suggests hate-based attacks on non-nationals have increased in recent years, distinctly reflecting a picture of heightened vulnerability. For several reasons, the severity of such victimisation, and their physical and psychological impact, go mostly unseen. Hate-motivated incidents, such as hate speech and intentional unfair discrimination, are possible precursors to additional criminal victimisation. Records of such incidents can be helpful to demonstrate both a context of harassment and evidence of escalating patterns of violence. Worldwide, under-reporting of hate victimisation is a longstanding concern and requires an urgent solution. In South Africa, under-reporting has contributed to the nonrecognition of hate crime as a separate crime category. Towards aiding in finding a solution, this study explored the psychological barriers to reporting xenophobic victimisation to relevant authorities. The study, furthermore, explored with a group of victims who experienced xenophobia whether they reported victimisation, the reasons for reporting and under-reporting, and their thoughts and opinions on the workability of a third-party reporting mechanism. Non-probability sampling, specifically applying convenience and purposive sampling was used to obtain 19 participants for the four semi-structured focus groups. While all participants reported being victimised because of their nationality, the study found that multiple psychological barriers prevent such victims of xenophobia from reporting victimisation to authorities. Many of the participants do not believe in the workability of third-party reporting mechanisms. / Dit is onbekend hoe algemeen viktimisering op grond van haat in Suid-Afrika voorkom, en daarom ook wat die volle impak daarvan is. Onlangse navorsingsresultate dui egter daarop dat aanvalle op nielandsburgers wat uit haat voortspruit, toegeneem het die afgelope paar jaar, wat hulle groter kwesbaarheid duidelik weerspieël. Die intensiteit van hierdie viktimisering, asook die fisieke en sielkundige impak daarvan word in die meeste gevalle om verskeie redes ook nie bekendgemaak nie. Voorvalle wat uit haat voortspruit, soos haatspraak en doelbewuste onregverdige diskriminasie, is moontlik voorlopers van verdere kriminele viktimisering. Die optekening van sulke gevalle kan help om bewys te lewer van die teisteringskonteks, sowel as van patrone van toenemende misdaad. Die gebrekkige aanmelding van viktimisering op grond van haat is wêreldwyd lank reeds ’n probleem, en een waarvoor daar dringend ’n oplossing gevind moet word. In Suid-Afrika het gebrekkige aanmelding daartoe bygedra dat haatmisdaad nie as ’n aparte misdaadkategorie erken word nie. Ten einde ’n oplossing te help vind, het die navorser vir die doeleindes van hierdie studie die sielkundige faktore ondersoek wat verhoed dat xenofobiese viktimisering by die betrokke owerhede aangemeld word. Die studie bevat ook die terugvoer van ’n groep slagoffers van xenofobie oor hulle aanmelding van die viktimisering al dan nie, die redes waarom hulle dit aangemeld het of nie aangemeld het nie, en hulle gedagtes en menings oor hoe lewensvatbaar ’n stelsel vir derdeparty-aanmelding is. Niewaarskynlikheid-steekproefneming, en spesifiek doelbewuste en gemaksteekproefneming is gebruik om 19 deelnemers vir die vier semigestruktureerde fokusgroepe te vind. Alhoewel al die deelnemers bevestig het dat hulle geviktimiseer is op grond van hulle nasionaliteit, het die navorser met hierdie studie bevind dat verskeie sielkundige faktore die slagoffers van xenofobie verhoed om die viktimisering by die owerhede aan te meld. Talle van die deelnemers glo nie dat stelsels vir derdeparty-aanmelding ’n werkbare oplossing is nie. / Hore na tshwaro e mpe ka lebaka la lehloyo e atile hakae Afrika Borwa ho ntse ho sa tsejwe, le ditlamorao tsa yona ha di tsejwe. Bopaki bo sa netefatswang, bo hlaheletseng dipatlisisong tsa morao tjena, bo bontsha hore ditlhaselo tse etswang ho batho ba tswang dinaheng tse ding di eketsehile morao tjena, e leng se bontshang hore ba kotsing le ho feta. Ho na le mabaka a mmalwa a etsang hore ho pharalla ha tshwaro e mpe jwalo, ho hlokofatswa mmeleng le maikutlong ho se ke ha bonahala. Diketso tse hlohleletswang ke lehloyo, tse kang dipuo tse nang le lehloyo le kgethollo e etswang ka boomo, e ba selelekela sa diketso tsa bonokwane tsa tshwaro e mpe. Ho tlalehwa ho diketso tseo ho ka thusa ho bontsha maemo a lebisang tshwarong e mpe mme ha fana ka bopaki ba hore diketso tse mabifi di ntse di eketseha. Lefatsheng ka bophara, taba ya ho se tlalehwe ha tshwaro e mpe e hlohleletswang ke lehloyo haesale e le qaka mme ho hlokahala tharollo ka potlako. Afrika Borwa, ho se tlalehwe hona ho entse hore diketso tsa bonokwane tse hlohleletswang ke lehloyo di se ke tsa nkwa e le diketso tse ikemetseng tsa bonokwane. Ho thusa ho fumana tharollo, phuputso ena e lekola mathata a maikutlo a sitisang matswantle ho tlaleha tshwaro e mpe ho ba boholong ba ikarabellang. Ho feta moo, phuputso ena e lekola matswantle ao e leng mahlatsipa a tshwaro e mpe hore na a ile a e tlaleha, mabaka a entseng hore a e tlalehe, a se ke a tlaleha le hore na a nahanang ka ho sebediswa ha mokena-dipakeng. Ho kgethilwe bankakarolo ba 19 ka hloko e le sampole, ba kgethwa ka sepheo le morero o tobileng hore ba be dihlopheng tse nne tse sa hlophiswang ka ho feletseng. Le hoja bankakarolo bohle ba tlalehile hore ba tshwerwe hampe ka lebaka la botjhaba ba bona, phuputso e fumana hore ho na le mathata a mmalwa a maikutlo a thibelang mahlatsipa a tshwaro e mpe ya matswantle ho tlalehela ba boholong. Bankakarolo ba bangata ha ba dumele hore ho tlalehela mokena-dipakeng ho tla thusa. / Psychology / M.A. (Psychology)