OpenUCT :: Browsing by Author "Myers, Jonny"

Browsing by Author "Myers, Jonny"

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Open Access
A study to characterise the “arsenic rash” observed at a copper smelter in Tsumeb, Namibia
(2022) Kew, Gregory Paul; Myers, Jonny; Todd, Gail
This study is located at a copper smelter. Arsenic is a component of copper bearing ore and arsenic trioxide is a by-product of copper smelting. The vapours (“off-gases”) that are released from the molten copper-bearing ore cool and condense in evaporative coolers to form arsenic-containing dust in the smelter's flues and stacks. The dust is filtered in “bag houses” and the captured powder is transported to Godfrey Roasters where the arsenic trioxide is driven off by heat. From there, the hot roaster gases are collected in what are known as “arsenic kitchens”, where fume is allowed to cool. The arsenic trioxide settles to the floor of the rooms as coarse dust and also forms crystalline deposits on the walls and ceilings. It is removed from the kitchens and prepared for shipment as a dust containing approximately 98% arsenic trioxide. Workers are exposed to arsenic containing dust during maintenance work on the copper smelter's flues and the bag houses, or whilst performing various tasks in the arsenic plant roasters and kitchens. The smelter has approximately 500 permanent employees and variable numbers of contractors, which can increase the total employee compliment by 1000. Skin rashes are the most common occupational disease reported at the copper smelter. The underlying cause of these acute transient rashes have historically been attributed by smelter employees to arsenic exposure, as encapsulated in the widely-used term, “arsenic rash”. Previous smelter reports have shown that the highest rates of skin rashes occurred at the arsenic plant and ausmelt baghouse. The appearance and anatomical distribution of the rash was described in these reports. Notwithstanding the use of the term, “arsenic rash”, the role of arsenic trioxide (As2O3) in the development of these rashes has been uncertain. In particular, a question has been raised as to whether the rash represents an allergy to either the arsenic trioxide or some other constituent of baghouse dust. Other uncertainties have related to the roles of skin hygiene practices and Personal Protective Equipment (PPE). This study included three levels of enquiry: a detailed questionnaire (exploring personal risk factors, skin hygiene practices, PPE use and descriptions of the rashes experienced); a clinical examination by a dermatologist; and skin patch testing (using both standard allergens as well as selected chemical agents from 4 selected workplaces, namely “pure” As2O3 powder from the arsenic plant, baghouse dust from the ausmelt & convertor plants, and “cake” from the Effluent Treatment Plant (“ETP”)). Analysis of the chemical compounds present in the four samples was performed by an external certified laboratory in Pretoria, South Africa. For the purposes of skin patch testing, all four samples were “standardised” to 2g/dL As2O3 in water by the Smelter's quality assurance lab. The epidemiological techniques varied according to the different objectives. For objectives 1 and 2: retrospective case control. For objective 3: exposure characterisation for use in exposure-response analysis. For objectives 4 & 5: retrospective case-control study, with controls matched for area of work in the smelter. Cases (N=27) comprised all employees who had one or more work-related rash incident within the preceding 12-24 months. These are relatively rare events, limiting the number of cases available for the study. Controls (N=24) comprised purposively selected co-workers, one control for each case, who performed the same type of work in the same workplace but who had never developed a rash. The principal variables included potential determinants of skin reactions to workplace materials (pure arsenic dust from the arsenic plant, baghouse dust from the ausmelt and converter and filter cake from the effluent treatment plant), reactions to patch testing, a history of allergy, prior experience of a similar rash, duration of service in the smelter and age. Ethical approval to conduct the study was obtained from the University of Cape Town's Health Research Ethics Committee (UCT HREC) (reference number 261/2016), and from the Office of the Permanent Secretary for Health, Namibia (letter dated 17 January 2018). Five study objectives were formulated, the outcomes of which are summarised as follows: Study objective 1: To interrogate if skin hygiene and hand cleansing practices used in the smelter, notably the use of barrier creams and soaps, are risk factors for developing a skin rash, and if so, at which anatomical location. The study data showed that hand washing practices of cases and controls were very similar, suggesting that handwashing practices are not a risk factor for developing a skin rash at any anatomical location, notably the hands. Furthermore, the data showed that the hand cream being issued as a barrier to chemical contact is not protective. However, both findings could be due to a non-differential bias whereby responses to the questionnaires in both groups of participants were influenced by a desire to appear compliant with company policy and conscientious with regard to cleanliness. Study objective 2: To interrogate the use of PPE by employees in the smelter, and whether or not this is a contributory factor to the development of the rash Whilst responses for the individual PPE related questions were generally similar in cases & controls, the combined prevalence of rashes in the area of the face (41%), respirator contact points (12.5%) and the neck area (19.6%) is high (73%). The rest of the body combined only accounts for 27%. Also, more specific questioning of the cases suggests that the respirators are a substantial contributor to the rashes in the face & neck areas. The lack of statistical significance between cases and controls for the individual PPE related questions could be due to the same non-differential bias operative in objective 1. Study objective 3(a & b): To characterise the nature of the chemical constituents in the production byproducts obtained from the various workplaces of the smelter operations (“workplace materials”). These “workplace materials” are the substances (usually in dust form) to which employees are exposed and which may trigger the skin reactions. The analysis addressed this in two ways; objective 3a looked at the chemical constituents of the workplace materials “as-is” (taken from the samples collected directly from the various workplaces as part of the smelter's Quality Assurance (QA) programme, and therefore as they are experienced by workers), and objective 3b looked at the chemical solutions used in the study skin tests, after standardisation for arsenic trioxide at 2g of arsenic trioxide per 100mL of water. Objective 3a: The proportionate concentrations of As2O3 varied from 5% to 98% across the 4 samples from the 4 workplace locations, namely the arsenic plant (98%), ausmelt baghouse (83%), convertor baghouse (21%) and ETP (5%). Lead and sulphur were identified as additional potential irritants in the convertor baghouse dust and the ETP cake. Both baghouse dusts (ausmelt & converter) had alkaline pH, the As2O3 sample from the arsenic plant had an acid pH and the pH of the ETP sample was close to neutral. Objective 3b: The samples were standardised to 2g/dL As2O3 in water, to better ascertain the skin responses to arsenic trioxide specifically at varying dilutions. This concentration was chosen because it is the point of solubility of arsenic trioxide in water. Consequently, the two samples with relatively lower As2O3 in the source material (converter Baghouse dust & ETP cake) had proportionately increased concentrations of their non-arsenic constituents after standardisation. These proportionate increases were 19% (ausmelt baghouse), 373% (converter baghouse) and 1799% (ETP). Should any of the non-arsenic constituents be irritants, their irritancies would be equivalently affected. Following standardisation for arsenic, the pH for the ausmelt sample went up from pH 7.8 to pH 8.8, the converter sample went from pH 8.7 to pH 9.6 and the ETP sample went from pH 6.7 to 7.8. The arsenic plant sample had a pH of 4.5 after standardisation. Unfortunately, the smelter lab did not provide a pH of the pre-standardised arsenic plant sample. The high pH levels (8.8 & 9.6) or low pH level (4.5) are independently capable of causing irritation. Study objective 4: To characterise the nature of the dermatological response to these exposures, notably whether the reactions are allergic or irritant in nature. The main finding of this study is that arsenic trioxide is an irritant not an allergen, because of its low pH as well as an inherent dermal toxicity. The grounds for this conclusion are (1) the clinical appearance of the skin reactions where arsenic trioxide was in contact with the skin and (2) the dose-response relationship with increased concentrations of arsenic trioxide with the skin. The presence of arsenic trioxide in the baghouse dust and ETP cake confers irritant properties to these operational materials. The baghouse dusts are additionally irritant because of their high pH. The ETP cake produced a dosedependent irritant reaction even though it was pH neutral. Irritancy has implications on exposure prevention, in that all employees are potentially affected, not only a subset of vulnerable people. Study objective 5: To try to ascertain any causal relationship between baghouse dust (and notably the As2O3 in the dust) and the pathological outcomes The irritancy of arsenic trioxide in the arsenic plant sample was clearly demonstrable even though it was significantly diluted during the standardisation process (to 2g/dL). Arsenic plant workers in the realworld setting are exposed to undiluted concentrations of arsenic trioxide dust, which explains the high prevalence of irritant skin reactions amongst workers in this area. This study has demonstrated that the alkaline pH of baghouse dust confers additional irritancy to that already conferred by the arsenic trioxide present in the dust. This explains the high prevalence of irritant skin reactions amongst workers exposed to baghouse dust. This report ends with some recommendations, based on the findings of the study, as well as knowledge gaps identified.
Open Access
Assessing quality of existing data sources on road traffic injuries (RTIs) and their utility in informing injury prevention in the Western Cape Province, South Africa
(2011) Chokotho, Linda Carolyn; Matzopoulos, Richard; Myers, Jonny
The aim of this study was to assess whether the quality of the RTI data collected by the South African Police Service (SAPS) and mortuaries was sufficient for determining the burden of RTIs in the Western Cape province, and for implementing and monitoring road safety interventions.
Open Access
A case-control study of mesothelioma in South Africa
(1995) Rees, David John; Myers, Jonny
This thesis reports the results of a prospective multicentred case-control study of mesothelioma carried out in South Africa. The objectives of the study were: 1) to examine asbestos exposure of cases in detail with respect to source, risk occupations, fibre type and duration; 2) to determine relative risks for level (certainty) of exposure (definite, probable, possible, unlikely), for category of exposure (occupational, environmental), and for fibre type and skin colour; 3) to determine whether cases without recall of exposure were exposed to other non-asbestos putative agents; 4) to investigate the possible protective effect of certain dietary components. Previous studies of mesothelioma in South Africa had, with the exception of one incidence study, focused on particular occupational or case material, exposure data had been gathered in a non-systematic way, often indirectly from surrogates, and non-asbestos agents had not been investigated. In this case-control study these issues are all addressed. In addition, special efforts were made to minimise potential sources of bias (e.g. interviewer bias) and so to furnish reliable effect estimates. The study incorporated the following methodological features: 1) a prospective approach to gather exposure and dietary information directly from the cases and controls in life and so avoid the use of surrogates for this information; 2) the study was multicentred with study teams established in six cities, each with a major referral hospital, to maximise nation-wide coverage; 3) information was gathered with interviewers blind (at least at the beginning of the study) to study objectives and case control status at the time of the interview; 4) rigorous pathologic review was used to establish the diagnosis of mesothelioma; 5) two controls were selected for each case, a cancer and a non-cancer patient matched for hospital, sex, age and skin colour; 6) in analysis the case control datasets were treated separately (i.e cases and cancer controls, and cases and non-cancer controls were treated as two separate datasets). One hundred and twenty three cases were accepted into the study. No case was documented with purely chrysotile exposure nor exposure to a putative non-asbestos cause of the tumour without some evidence of asbestos exposure. A minimum of 22 cases (18%) had exclusively environmental exposure, 20 were from the NW Cape (a crocidolite mining region). Fifty eight percent had occupational exposure, three of whom had mined amosite. The relative risks associated environmental exposure in the NW Cape were larger than for environmental exposure in the NE Transvaal: 21.9 versus 7.1 for the cancer control dataset and 50.9 versus 12.0 for the medical control dataset. Increasing consumption of carotene rich fruit was found to be protective for mesothelioma when adjusted for asbestos exposure. The results confirm the high disease burden due to occupational exposure, the importance of environmental exposure in the crocidolite mining area of the NW Cape, the relative paucity of cases linked to amosite, the rarity of chrysotile cases, and are consistent with the view that there is a fibre gradient in mesotheliomagenic potential for South African asbestos with crocidolite > amosite > chrysotile. The evidence for a protective effect of carotene rich fruit is new in the South African context.
Open Access
Climate change impacts and adaptation in South Africa
(2014) Ziervogel, Gina; New, Mark; Archer van Garderen, Emma; Midgley, Guy; Taylor, Anna; Hamann, Ralph; Stuart-Hill, Sabine; Myers, Jonny; Warburton, Michele
In this paper we review current approaches and recent advances in research on climate impacts and adaptation in South Africa. South Africa has a well-developed earth system science research program that underpins the climate change scenarios developed for the southern African region. Established research on the biophysical impacts of climate change on key sectors (water, agriculture, and biodiversity) integrates the climate change scenarios but further research is needed in a number of areas, such as the climate impacts on cities and the built environment. National government has developed a National Climate Change Response White Paper, but this has yet to translate into policy that mainstreams adaptation in everyday practice and longer-term planning in all spheres and levels of government. A national process to scope long-term adaptation scenarios is underway, focusing on cross-sectoral linkages in adaptation responses at a national level. Adaptation responses are emerging in certain sectors. Some notable city-scale and project-based adaptation responses have been implemented, but institutional challenges persist. In addition, a number of knowledge gaps remain in relation to the biophysical and socio-economic impacts of climate change. A particular need is to develop South Africa's capacity to undertake integrated assessments of climate change that can support climate-resilient development planning.
Open Access
The effeciveness and determinants of effectiveness of antiretroviral therapy for adults in the Western Cape Province, South Africa
(2009) Boulle, Andrew; Myers, Jonny; Maartens, Gary
Antiretroviral therapy (ART) first became available in the public sector in the Western Cape Province in Khayelitsha in 2001. This thesis describes the effectiveness of ART in Khayelitsha and the Province, following adult patients for up to five years on ART, and examining temporal trends over seven years during which time the availability of ART in the Province increased dramatically. Associations are explored with a range of clinical outcomes, and regimen durability and tolerability are described, together with regimen effectiveness when ART is administered to patients co-infected with tuberculosis. The results chapters of the thesis are presented in the form of published or submitted papers. The first paper corrects for under-ascertainment of mortality through linkages with the death registry. After five years on ART, four out of five patients were still alive. Survival did not deteriorate in more recent years despite the large increase in patient numbers. Patients who remained virologically suppressed experienced on average continued CD4 count recovery throughout follow-up to five years. The second paper describes the tolerability of each commonly used first-line antiretroviral drug in two townships in the Western Cape. Treatment-limiting toxicities were frequent and continued throughout follow-up in patients on stavudine (21% by 3 years on ART). Symptomatic hyperlactataemia or lactic acidosis as well as lipodystrophy were strongly associated with women initiating ART with a high initial body mass. The third paper explores the effectiveness of ART when co-administered with tuberculosis treatment, identifying that co-infected patients initiating nevirapinebased ART may be at a higher risk of virological failure, but that concurrent tuberculosis treatment did not otherwise compromise ART outcomes. The fourth paper, based on a household survey, provides an in-depth description of the Khayelitsha population demonstrating comparability with many of the urban settings in which ART is provided in the region. The final paper demonstrates that outcomes have not been compromised by the wider availability of ART in the Western Cape Province. The thesis concludes that the Khayelitsha and Provincial analyses provide considerable reassurance that the anticipated benefits of ART have not to date been eroded by health system weaknesses or contextual challenges.
Open Access
The epidemiology of asthma and wheeze in primary school children in Mitchell's Plain, Cape Town, with special reference to the role of environmental tobacco smoke
(1999) Ehrlich, Rodney; Myers, Jonny; Burney, Peter
This study was undertaken in the light of the increasing importance of childhood asthma worldwide, an apparently large burden of asthma morbidity disease in Cape Town, high local smoking rates and a lack of epidemiologic information on childhood asthma in South Africa. Two detailed literature reviews were undertaken. The first covered epidemiologic aspects of asthma and allergy in South Africa, as inferred from allergen and atopy studies, clinical series, and studies of prevalence and mortality. The second addressed the international literature on whether environmental tobacco smoke is associated with asthma, wheeze or bronchial hyperresponsiveness in general and asthmatic populations of children. This thesis is based on a self-administered questionnaire survey of the parents of 1 955 sub-8 pupils (90% response rate), aged 7 to 9 years, in Mitchell's Plain, a large, working class area of Cape Town Five empirical questions were asked: 1) is the prevalence of asthma and wheezing in primary school children? (2) What is the reliability (across two questionnaires) of questions about wheezing and asthma? 3) What are the household risk factors for wheezing and asthma; in particular, to what extent is household environmental tobacco smoke (ETS) a risk factor for asthma/wheeze? 4) Among children with asthma/wheeze, is there an association between ETS exposure and bronchial hyper-responsiveness (BHR), and 5) To what extent is asthma underrecognised and undertreated?
Open Access
Evaluation of an HIV peer education programme in the workplace
(2001) Sloan, Nicola; Myers, Jonny
The private sector in South Africa has a keen interest in ensuring that all employees are fully educated on issues related to HIV/AIDS (especially transmission mechanisms) to avoid losing a large proportion of the workforce and incurring a subsequent drop in productivity. In 1977, Woolworths, a South African retail company, implemented an HIV peer education programme for its employees. The broad aim of the programme is to reduce the HIV infection rate among staff by providing educational material on safe sexual practices, discussing various issues connected to HIV such as sexuality and modes of transmission and by providing free condoms to staff. The objective of this study is to provide a thorough and realistic evaluation of the Woolworths HIV/AIDS peer education programme. A formal evaluation is required to understand the current position of the programme and to determine its future direction.
Open Access
Exploring whether the needs of dying patients in private sector hospitals are being met
(2003) Van Heerden, Gretha; Myers, Jonny
As palliative medicine is an area only beginning to develop as a speciality in South Africa, it was felt that an investigation into the situation with regard to dying patients in our own private sector hospitals was needed. The objectives were to ascertain whether patient and family needs are met as a means of an index of quality of care and to identify domains of care where improvement is needed most. The validated 'After death Bereaved Family Member interview' from the questionnaire for hospital purposes, as part of the Toolkit of instruments to Measure End-of-life Care (T.l.M.E.), was used as research instrument with the permission of the author Dr JM Teno. Domains that were investigated include the following: physical comfort and emotional support of the patient; focused attention on the individual patient; encouragement of advanced care planning; information and promotion of shared decision-making re care plan; provision of coordinated care of health professions; emotional and spiritual support of the family; and an overall rating for patient focused, family centred care. As a descriptive study with limited numbers this study cannot make any conclusive claims with regard to the care that all terminal patients receive in private hospitals in Port Elizabeth. Results indicate that the single domain with most opportunity to improve for both the oncology group and the general group is attention to the family. The model of patient-focused family-centred care, which is applicable to palliative care, makes this an urgent opportunity for improvement in the care of the dying patients in private hospitals. Control of pain and other symptoms remains an important medical and ethical issue, indicated in this research as needing attention. Information and promotion of shared decision-making is the other domain that warrants attention.
Open Access
An investigation into the neurological and neurobehavioural effects of long-term agrichemical exposure among deciduous fruit farm workers in the Western Cape, South Africa
(1995) London, Leslie; Myers, Jonny
It is increasingly being recognised that agrichemical exposure may have adverse chronic health effects in humans, particularly on central nervous system function. However, much of this evidence sterns from studies relating to the effects of acute intoxications (i.e. short-term high dose exposures) and little data exist on the chronic effects of long-term low-dose exposures to agrichemicals in the absence of acute poisoning. Such a finding would have substantial public health implications for prevention and control of chronic morbidity and mortality. This is particularly important in South Africa, where a sizeable portion of the rural population are employed in agricultural work, often under extremely unhealthy living and working conditions, and where occupational agrichemical exposures appear to be substantial. To address this question, this study investigated the prevalence of neurological and neurobehavioural abnormalities amongst 247 fruit farm workers in the Kouebokkeveld in the Western Cape, of whom 163 were current agrichemical applicators. Outcomes measured included neurological symptoms, peripheral vibration sense, motor tremor, as well as performance on the World Health Organisation Neurobehavioural Core Test Battery (WHO NCTB) and a set of neurobehavioural tests based on the Information Processing model of cognitive psychology. These latter tests have been developed in South Africa for subjects of low educational levels and aim to by-pass the powerful effects of culture that complicate traditional neuropsychological testing, which may mask the smaller effects due to occupational chemical exposures. Cumulative, and average lifetime intensity of exposure to organophosphates were estimated using a job- exposure matrix based on a combination of secondary industry data, interview reports and farmer records. Confounders measured included age, education, smoking and alcohol habits, non-occupational exposure to agrichemicals and other potential neurotoxins, past medical history and usage of personal protective equipment. The study results confirmed low levels of education and high alcohol consumption amongst the sample of farm workers. Multiple logistic and linear regression were used to identify exposure-effect relationships and to control for confounding. Neurological symptoms were significantly associated with a history of previous pesticide poisoning, although this may have arisen as a result of reporting bias. Vibration sense and the neurobehavioural tests exhibited associations with established covariates, and regression modelling of the WHO NCTB tests was remarkably similar to findings in another study of solvent-exposed factory workers in South Africa. None of the vibration sense, tremor or neurobehavioural outcomes were associated with past agrichemical poisoning in the sample, and only two tests showed significant relationships with long-term occupational exposure. These included the Pursuit Aiming subtest of the WHO NCTB and one of the tests of long-term semantic memory in the Information Processing tests. However, the strength of these the associations were small (partial r²s less than 2%) and these findings may have occurred due to chance arising from multiple comparisons. The neurobehavioural tests based on the Information Processing model appeared to offer little improvement on the WHO NCTB in terms of being less sensitive to cultural effects, although some evidence was present that tests of semantic access were able to detect occupational effects and were less sensitive to education. The absence of a demonstrable and consistent long-term agrichemical exposure-effect relationship appears to suggest that long-term agrichemical exposure is not associated with adverse chronic nervous system effects, although the lack of organophosphate specificity in construction of exposure indices in the job-exposure matrix may partly contribute to this finding. Recommendations to improve the characterisation of agrichemical exposures at farming work place are made, as well as suggestions concerning the role of biological monitoring for agrichemicals, improving working and living conditions on South African farms, and methods of neurological and neurobehavioural assessment in occupational health.
Open Access
The long-term respiratory health effects of the herbicide, paraquat, among Western Cape workers
(1996) Dalvie, Mohamed Aqiel; White, Neil; Myers, Jonny
Objective: Paraquat is a commonly used herbicide worldwide and is a well-documented cause of pulmonary fibrosis in studies of laboratory animals and in humans following high dose exposure (usually accidental or as parasuicide). The respiratory effects of long-term, low dose paraquat exposure have not been fully evaluated. We set out to evaluate the possible effects of paraquat spraying among deciduous fruit farm workers in the Western Cape, South Africa. Methods: A cross-sectional study of 126 workers was performed. Administered questionnaires generated information on exposure, respiratory symptoms and confounding variables. Spirometry and gas transfer were measured and chest radiographs performed. Oxygen desaturation on exercise testing was by oximetry during a modified stage one exercise test. Results: No association was found between long-term paraquat exposure and reported symptoms, spirometry (FVC, FEVl, FEVl/FVC) and gas transfer (TLco and Kco) or chest radiography. Multivariate analysis showed a significant relationship between measures of long-term paraquat exposure and arterial oxygen desaturation during exercise (p < 0.05). Conclusion: Previous studies have also not shown a significant relationship between measures of paraquat exposure and standard tests of lung function. Arterial oxygen desaturation during exercise represents a more sensitive test. Our findings indicate that working with paraquat under usual field conditions for a long period is associated with abnormal exercise physiology in a dose dependant fashion.
Open Access
Mwebu ducks AIDS deaths
(2005) Ehrlich, Rodney; Myers, Jonny; Sanders, David; Carstens, Sydney
As public health specialists we read with dismay a recent Medical Research Council (MRC) media release, later reprinted in the press, written by Mbewu in both his personal and official capacities as the interim president of the MRC. Entitled ‘Deaths, causes of deaths and rumours of deaths’, the piece appeared to be an intervention in a debate on whether the burden of AIDS deaths can be inferred from explicit death certification alone. It asserts, inter alia, that ‘cause of death information from death certificates are the most reliable and validated measures of mortality and changes in mortality’. We conclude from the timing of the release that it was produced in anticipation of a report on death certifications by Stats SA requested by President Mbeki and that it was directed, inter alia, at a publication by MRC and University of Cape Town researchers of an empirical analysis of death certifications designed to arrive at a complete picture of HIVrelated deaths.
Open Access
The nervous system effects of occupational exposure to manganese - measured as respirable dust - in a South African manganese smelter
(2003) Young, Taryn; Myers, Jonny
Open Access
Organised care of acute stroke at Groote Schuur Hospital : a controlled trial
(2000) Patel, Nilesh-Kumar; Louw, Stephen; Myers, Jonny
Background and purpose: Groote Schuur Hospital (GSH) admits about 570 stroke patients annually. These patients about occupy 10% of acute medical beds. Recent investigations have demonstrated that stroke services are poorly organised Although "Organised stroke care" has been shown to improve outcomes, this has not been demonstrated locally. This study was undertaken to determine whether stroke unit care within a general medical ward improves outcomes. Study design and sampling: The study was a prospective non-randomised controlled trial, with systematic allocation by admission day. of all acute stroke admissions to the Department of Medicine from 1 January to 15 May 1996. Intervention: There were three comparison groups: in the Stroke Intervention Ward, the intervention was implemented by the author; in the Guidelines Ward, the manner in which the intervention can be set up and implemented was provided in the form of a Guidelines Booklet and in the Control Ward, stroke patients received routine care. The intervention consisted of (i) geographic/spatial unity and allocation of a designated nurse; (ii) use of a Stroke Clerking Pro forma and (iii) a multidisciplinary Team Care Plan and Post Intake Stroke Ward Round. Results: 58 patients were admitted to the Stroke Intervention Ward, 40 patients were admitted to the Guidelines Ward and 91 were admitted to the 2 Control Wards. The groups had similar baseline characteristics, except for the percentage of patients continent on admission. There were no significant differences in the Modified Barthel Index prior to admission, at discharge or at follow-up. There were no significant differences in the principal outcome measures (death, dependency, death or dependency, institutionalisation and death or institutionalisation) between the comparison groups. The median [inter-quartile range] length of hospital stay in days was significantly reduced in the Stroke Intervention Ward (6.5[5-9]) compared to the Guidelines Ward (9[7-14]) and the Control Wards (8[5-12]). The referral rates to Professionals Allied to Medicine were significantly increased in the Stroke Intervention Ward, except for referrals to the Community Liaison Sister. The referral rates to rehabilitation resources on discharge were significantly increased in the Stroke Intervention Ward, except for referrals to physiotherapy. Conclusions: Organised Stroke Care is feasible in our setting and results in improved utilisation of resources without increasing length of stay. However, principle outcome measures were not significantly altered in this study.
Open Access
Performance characteristics of the South African Triage Scale (Adult version)
(2011) Twomey, Michèle; Myers, Jonny; Wallis, Lee; Thompson, Mary Lou
The South African Triage Scale (SATS) was first implemented as an emergency centre triage scale in the Western Cape Province in 2006. This thesis describes the performance characteristics of the SATS when used by different levels of health care workers in Emergency Centres in the province. It explores the most appropriate methods for reliability and validity appraisal and demonstrates good performance characteristics, including reliability and validity. The results chapter of the thesis is presented in the form of published or submitted papers. The thesis concludes that the SATS has good performance characteristics, which supports the feasibility of further implementation in similar settings. It is suggested that this emergency centre triage scale be endorsed and adopted at National Health care level.
Open Access
A planning approach to inform funding for public health care services in South Africa
(2007) Blecher, Mark Stephen; Myers, Jonny; McIntyre, Di
This thesis examines the "supply" and "demand" for health care expenditure in South Africa's public sector health care services. In this context supply refers to the availability of funding and demand to the requirement for funding. The literature review focuses on the health sector planning and its application to inform sector funding. A quantitative health sector planning model is developed and applied to inform the requirement for funding public sector health services. Uses of the model include simulation, forecasting and scenario planning.
Open Access
Postgraduate Diploma in Occupational Health (DOH) - Module 3
(2014-09-19) Jeebhay, Mohamed; Myers, Jonny
Designed to help teach doctors currently practising occupational health. The third module of a total of 8 modules for a two year part-time flexible distance learning course aimed primarily at medical doctors currently practising occupational health. It includes a residential block release component which consists of between 3 or 4 weeks over the two year cycle for practicum. While the course is aimed primarily at medical doctors currently practicing occupational health, it is also suited to selected graduates with appropriate University qualifications in relevant health sciences, as long as these individuals are currently practicing professionally in an occupational health setting. There are 8 modules (the two included here cover Occupational Hygiene and Epidemiology and Biostatistics). Each module has a theme around which the inputs are organised. Teaching inputs are intended to be non-didactic, and to allow student participation wherever possible. Candidates are expected to undertake substantial homework preparation and activities as well as self-directed learning. They will be expected to read widely and intensively around topics, and to provide teaching inputs themselves either directly or by way of specially structured interactive debates and role-play simulations. The content of these activities will include critical appraisal of the occupational health literature, project work, presentations by students as well as epidemiological, bio statistical, toxicological and occupational clinical assignments. Module 3 deals with basic occupational medicine and toxicology. Module 4 covers intermediate occupational medicine and toxicology, and Module 5 is advanced occupational medicine and toxicology.
Open Access
Postgraduate Diploma in Occupational Health (DOH) - Modules 1 and 2
(2014-09-19) Myers, Jonny
Designed to help teach doctors currently practising occupational health. First two modules of a two year part-time flexible distance learning course aimed primarily at medical doctors currently practising occupational health. It includes a residential block release component which consists of between 3 or 4 weeks over the two year cycle for practicum. There will be substantial requirements for homework in the form of assignments and project related work, expected self-directed learning and distance communication between students and teachers extending over the two years. While the course is aimed primarily at medical doctors currently practicing occupational health, it is also suited to selected graduates with appropriate University qualifications in relevant health sciences, as long as these individuals are currently practicing professionally in an occupational health setting. There are 8 modules (the two included here cover Occupational Hygiene and Epidemiology & Biostatistics). Each module has a theme around which the inputs are organised. Teaching inputs are intended to be non-didactic, and to allow student participation wherever possible. Candidates are expected to undertake substantial homework preparation and activities as well as self-directed learning. They will be expected to read widely and intensively around topics, and to provide teaching inputs themselves either directly or by way of specially structured interactive debates and role-play simulations. The content of these activities will include critical appraisal of the occupational health literature, project work, presentations by students as well as epidemiological, bio statistical, toxicological and occupational clinical assignments.
Open Access
Prevention of cervical cancer in South Africa : opportunities and challenges
(2011) Moodley, Jennifer Rose; Myers, Jonny; Hoffman, Margaret
This thesis examines the challenges to and opportunities for comprehensive (primary and secondary) prevention of cervical cancer in South Africa (SA), a middle-income country.
Open Access
The regulation of health and safety in South Africa's manufacturing industry
(1989) Macun, Ian; Maree, Johann; Myers, Jonny
This thesis will be concerned with trying to develop an understanding of what the difficulties have been in bringing about improvements to the working environment in manufacturing. The role of labour will be of central concern, but an attempt will also be made to analyse the role of the other participants in the regulatory process, namely, the state and employers. The period with which the thesis is concerned is the 1980s. The area is clearly a very broad one and no claims will be made to providing a comprehensive study. Rather, it is hoped that the present study will provide some new data and some original insights into the regulatory process which will provoke further discussion and research in the field of occupational health and safety in South Africa.
Open Access
Risk factors for oesophageal cancer in the Eastern Cape Province of South Africa
(2006) Sewram, Vikash; Myers, Jonny; Sitas, F
A multicenter hospital-based case-control study with incidence density sampling was conducted between November 2001 and February 2003 to assess the impact of social and dietary habits, and the consumption of dietary and medicinal wild plants on the risk of developing oesophageal cancer (OC) among residents of the Eastern Cape Province of South Africa. The study was conducted on 670 incident cases (98/% response rate) and 1188 controls (96/% response rate) attending either of the three major referral hospitals in the Province, i.e Umtata General, Frere and Cecilia Makiwane Hospitals.