Research Articles (Clinical Epidemiology)

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The prevalence of intentional and unintentional injuries in selected Johannesburg housing settlements
(Health and Medical Publishing Group, 2011-11) Mendes, J.F.; Mathee, A.; Naicker, N.; Becker, Piet J.; Naidoo, S.
Intentional and unintentional injuries were reported to be the second leading cause of Disability Adjusted Life Years in South Africa in 2000. We present household experiences of such injuries in 5 impoverished housing settlements in Johannesburg, Gauteng Province. Data for this study were extracted from the database of the Health, Environment and Development (HEAD) project. The incidence of reported intentional injuries was determined to be double that of unintentional injuries. Households in the Hospital Hill and Riverlea settlements reported the highest prevalence of stabbing and gunshot incidents. We concluded that impoverished South African neighbourhoods bear a high burden of intentional injury; surveillance mechanisms are required to inform prevention strategies at an individual, a community and a societal level.
Fischer dinuclear and mononuclear bis-carbene complexes of thiophene and thiophene derivatives
(American Chemical Society, 2012) Lotz, Simon; Van Jaarsveld, Nina Alletta; Liles, David C.; Crause, Chantelle; Görls, Helmar; Terblans, Yvette M.; simon.lotz@up.ac.za
The reaction of dilithiated thiophene and thiophene derivatives with group 6 transition metal carbonyl precursors and subsequent alkylation afforded linearly arranged Fischer 2,5-bis-carbene and the rare unsymmetrical 2,3-bis-carbene chelated complexes. The latter requires a second lithiation to occur at an adjacent, less reactive site on the thiophene ring. The control of reactivity sites was investigated and achieved by either blocking more reactive positions with substituents or activating less reactive positions by lithium−halogen exchange reactions. A series of Fischer bis-carbene chelates were synthesized by manipulating the above variables. Structural features of Fischer mono-carbene, mononuclear bis-carbene, and bis-carbene chelated complexes were studied by IR, NMR, and single-crystal X-ray diffraction
Effect of metformin therapy and dietary supplements on semen parameters in hyperinsulinaemic males
(Wiley, 2015-11) Bosman, E.; Esterhuizen, A.D.; Rodrigues, Frederico Antonio; Becker, Piet J.; Hoffmann, W.A.
Previous reports indicated that hyperinsulinaemic men may exhibit a higher percentage of poorly compacted DNA in their spermatozoa and less success in an IVF programme (Andrologia, 45, 2003, 18; Andrologia, 2014, doi: 10.1111/ and.12227). The aim of this study was to investigate the effect of metformin (Glucophage ) and antioxidant treatment (StaminoGro ) on the semen parameters of hyperinsulinaemic men. Nineteen hyperinsulinaemic male patients were treated for 3 months with metformin alone (Group A), and fifteen patients used metformin in combination with the nutritional supplement (Group B). Combined data of the two groups (pre- and post-treatment) differ significantly regarding sperm morphology (P = 0.0003) and CMA3 (P < 0.0001) values. The improvement in sperm morphology after treatment was similar for the two respective groups (P < 0.05). The morphological normal sperm forms increased from the mean percentage of 3.9 to 5.5% and from 4.2 to 5.5% for Group A and B respectively. Where a combination of metformin and the supplement were used (Group B), the combination treatment proved to be superior in obtaining enhanced chromatin packaging quality although not statistically significant (P = 0.5929) when compared with the metformin (Group A) group. The chromatin packaging quality in Group B improved with 10% while the improvement in Group A was approximately 8.3%. Therefore, infertile hyperinsulinaemic men can benefit from metformin treatment and should be advised on the use of nutritional supplements with antioxidant properties.
Variations in the anatomical dimensions of the mandibular ramus and the presence of third molars : its effect on the sagittal split ramus osteotomy
(Elsevier, 2013-03) Beukes, Jacques Walter; Reyneke, J.P.; Becker, Piet J.
The authors undertook a prospective study to evaluate the influence that the anatomical dimensions of the ramus of the mandible and the presence of lower third molar teeth may have on the sagittal split ramus osteotomy. The anatomical dimensions measured included the width of the anterior mandibular ramus, the height of the corpus posterior to the second mandibular molar and the antero-posterior anatomical position of the lingual. The influence that these dimensions of the mandible may have on the successful splitting of the mandibular ramus wasThe effect that the presence of wisdom teeth had on the difficulty of the procedure was also investigated. This study found that, unlike the presence of third molars, there was no single anatomical measurement that contributed to the level of difficulty of the sagittal split osteotomy. For descriptive purposes the authors proposes a classification of the four typical patterns of unfavourable splits.
Prevalence of hyperinsulinaemia among normozoospermic donors at Medfem Clinic, South Africa
(Wiley-Blackwell, 2013-02) Bosman, Edolene; Esterhuizen, Aletta Dorothea; Rodrigues, Frederico Antonio; Becker, Piet J.; Hoffmann, Willem Abraham
The aim of this study was to investigate the prevalence of hyperinsulinaemia in a group of normozoospermic donors and the influence of insulin levels on in vitro fertilisation (IVF) outcome. Fasting insulin and 2 h post-eating insulin levels were determined for a group of thirty-four sperm donors. They were divided into three groups according to their insulin profiles. The association between insulin levels and embryo quality was determined in a clinical study for the different groups. The prevalence of raised insulin in the donor group was 44% with a 95% confidence interval of 27.2% and 62.1%. Donors with normal insulin levels produced more good quality blastocysts in the IVF programme than those with abnormal insulin levels. These differences were not statistically significant (P = 0.8638). Embryo quality in an IVF programme may be influenced by male insulin levels. The role of insulin in male fertility needs to be investigated.
The prevalence of intentional and unintentional injuries in selected Johannesburg housing settlements
(Health and Medical Publishing Group, 2011-11) Mendes, J.F.; Mathee, Angela; Naicker, N.; Becker, P.; Naidoo, S.
Intentional and unintentional injuries were reported to be the second leading cause of Disability Adjusted Life Years in South Africa in 2000. We present household experiences of such injuries in 5 impoverished housing settlements in Johannesburg, Gauteng Province. Data for this study were extracted from the database of the Health, Environment and Development (HEAD) project. The incidence of reported intentional injuries was determined to be double that of unintentional injuries. Households in the Hospital Hill and Riverlea settlements reported the highest prevalence of stabbing and gunshot incidents. We concluded that impoverished South African neighbourhoods bear a high burden of intentional injury; surveillance mechanisms are required to inform prevention strategies at an individual, a community and a societal level.
Erythromycin as an alternative to reduce interfering extra-cardiac activity in myocardial perfusion imaging
(Clinics Cardiv, 2010-05) Vorster, Mariza; Sathekge, Mike Machaba; Rheeder, Paul
OBJECTIVES: We sought to determine whether taking oral erythromycin prior to SPECT myocardial perfusion imaging with Tc99m-sestamibi would reduce the amount of interfering extra-cardiac activity and improve the image quality. METHODS : A total of 96 patients who were routinely referred for myocardial perfusion imaging were randomly assigned to one of two groups. Patients in group A received 500 mg of non-enterically coated erythromycin orally one hour prior to image acquisition (45 patients). Patients in group B received diluted lemon juice which comprises the current standard of care in our department (51 patients). A two-day protocol was followed and study participants received the same intervention on both days. Planar images of both the stress and rest images were assessed visually by three experienced nuclear medicine physicians for the presence of interfering extra-cardiac activity. Physicians were blinded to the detail of the protocol and independently assessed the images. RESULTS : The qualitative results favoured lemon juice in reducing the amount of interfering extra-cardiac activity. The overall incidence of interfering extra-cardiac activity was 46.15% in the lemon juice group vs 55.56% in the erythromycin group. However, this difference was not found to be statistically significant (p = 0.36). The use of a MYO:EXT ratio similar to the one described by Peace and Lloyd, appeared promising in quantifying interfering extra-cardiac activity. CONCLUSION : The difference between the effect of erythromycin and lemon juice on interfering extra-cardiac activity appears statistically insignificant and erythromycin could therefore be considered as a suitable alternative to lemon juice.
Elements of effective nutrition education for adults with diabetes mellitus in resource-poor settings
(OpenJournals, 2009-06) Muchiri, Jane Wanjiku; Gericke, Gerda J.; Rheeder, Paul; jane.muchiri@up.ac.za
This review article highlights the key factors that need consideration in planning an effective nutrition education programme for adults with type 2 diabetes mellitus in resource-poor settings. Type 2 diabetes is increasing to epidemic levels globally. Low socio-economic status is associated with poorer health outcomes and a higher economic burden. Individuals with diabetes cite dietary adherence as the most difficult self-care area. Effective nutrition education achieves the desired goals and outcomes, which include appropriate change in dietary behaviour, improved glycaemic control, plasma lipid levels, blood pressure and body weight, as well as improved potential mediators (knowledge, skills and attitudes). Elements that contribute to a successful nutrition education programme include interventions tailored to the needs, abilities and socio-cultural context of the target group, the active involvement of the patient, a behaviour-focused approach based on appropriate theory, suitable delivery methods and individual / group approaches. Adequate contact time with an educator (> 10 hours), the educator's competence, provision of social support and follow-up intervention are also crucial. Effectively educating diabetic individuals from resource-poor settings in nutrition is a challenging task. It needs innovative and skilled educators who are sensitive to the unique needs of the target group and who use appropriate approaches to address these needs. AFRIKAANS: Hierdie artikel beklemtoon die sleutelfaktore wat in oorweging geneem moet word wanneer 'n effektiewe voedingsopleidingprogram vir volwassenes met tipe 2-diabetes uit hulpbron-arm agtergronde beplan word. Tipe 2-diabetes is besig om globaal tot epidemiese vlakke toe te neem. Lae sosio-ekonomiese status word geassosieer met swakker gesondheidsresultate en 'n hoër ekonomiese las. Dieetnakoming word deur persone met diabetes as die moeilikste selfversorgingsgebied uitgewys. Doeltreffende voedingsopleiding bereik die gewenste doelwitte en resultate wat toepaslike veranderings in dieetgedrag, verbeterde glisemiese beheer, verbeterde bloedlipiede, bloeddruk en liggaams-gewig, en verbeterde potensiële bemiddelaars (kennis, vaardighede en houdings), insluit. Elemente wat tot 'n suksesvolle voedingsopleidingprogram bydra, sluit ingrypings in wat geskoei is op die behoeftes, vaardighede en sosiaal-kulturele konteks van die teikengroep, aktiewe betrekking van die pasient, gebruik van 'n benadering wat ingestel is op gedrag en gegrond is op toepaslike teorie, toepaslike metodes van aflewering en individuele / groepbenaderings, geskikte duur en kontaktyd (> 10 uur), een wat vir sosiale ondersteuning en opvolgintervensie sorg, en deur 'n bedrewe verskaffer bemiddel word. Om diabetiese individue uit hulpbron-arm agtergronde op te lei in voeding is 'n uitdagende taak wat vindingryke en bedrewe opvoeders verg. Hierdie opvoeders moet sensitief wees vir die unieke behoeftes van die teikengroep en toepaslike benaderings volg om genoemde behoeftes aan te spreek.
Effectiveness of influenza vaccination in the elderly in South Africa
(Cambridge University Press, 2009-07) Van Vuuren, A.; Rheeder, Paul; Hak, E.
This study primarily aimed to estimate the association between influenza vaccination and the occurrence of hospitalization for acute respiratory or cardiovascular diseases, or all-cause death during the influenza season in an elderly population in South Africa. We conducted a nested case-control study using data from a cohort of 45 522 elderly members of a private medical funding organization during the moderate 2004 influenza season. In 1282 (2·8%) subjects the combined outcome occurred and the influenza vaccination rate in controls was 15·4%. After adjustments for measured confounders, vaccination was associated with a statistically significant reduction of 19% (95% confidence interval 3·1–32·9) in the combined outcome. Post-hoc sensitivity analysis of the potential impact of potential healthy user bias showed that confounding, if present, could have caused this finding. Our data were inconclusive regarding the benefits of influenza vaccination in elderly persons in South Africa and given the low vaccine uptake, long-term follow-up is warranted.
Rheumatoid arthritis functional disability in a public health care clinic
(Health and Medical Publishing Group, 2008-09) Westaway, Margaret S.; Rheeder, Paul; Guloba, Geoffrey
No abstract available.
Adjunctive corticosteroid treatment of clinical Pneumocystis jiroveci pneumonia in infants less than 18 months of age - a randomized controlled trial
(Health and Medical Publishing Group, 2008-04) Terblanche, Alta J.; Green, Robin J.; Rheeder, Paul; Wittenberg, Dankwart F.
OBJECTIVES: To determine the efficacy and safety of adjunctive corticosteroid therapy in clinical Pneumocystis jiroveci pneumonia (PCP) in infants exposed to HIV infection. DESIGN: Double-blind randomised placebo-controlled trial. METHODS: Infants with a clinical diagnosis of PCP, based on an 'atypical' pneumonia with : (i) hypoxia out of proportion to the clinical findings on auscultation; (ii) C-reactive protein count less than 10 mg/l; (iii) lactate dehydrogenase level above 500 IU/l; (iv) compatible chest radiograph findings; and (v) positive HIV enzyme-linked immunosorbert assay (ELISA) were included in the study. Patients were randomised to receive either prednisone or placebo. The protocol provided for the addition of prednisone to the treatment at 48 hours if there was clinical deterioration or an independent indication for steroid therapy. Other treatment was carried out in accordance with established guidelines. The primary study endpoint was in-hospital survival. Secondary outcome was time from admission to the first day of mean oxygen saturation above 90% in room air. RESULTS: One hundred patients were included, 47 in the prednisone and 53 in the placebo group. Patients in the prednisone group had a 43% better chance of survival than the placebo group (hazard ratio (HR) 0.57, 95% confidence interval (CI) 0.30 - 1.07, p =0.08). No significant differences could be demonstrated between groups with regard to other parameters of recovery. CONCLUSIONS: in HIV-exposed infants with clinical PCP, adjunctive corticosteroid treatment does not appear to add benefit regarding time to recovery or oxygen independency, but early administration may improve survival. A large multicentred trial is needed to confirm these findings.
Knowledge of foot care in people with diabetes in a tertiary care setting
(Health and Medical Publishing Group, 2008-12) Rheeder, Paul; Venn, Marie; De Korte, Ewald; Van Zyl, Danie G.; paul.rheeder@up.ac.za
BACKGROUND: The objective of this study was to investigate levels of foot care knowledge among patients attending the diabetes clinic at Pretoria Academic Hospital by comparing the knowledge of patients with ‘at risk’ feet (ARF) to those with normal/not at risk’ feet (NARF) and so assess whether the education effort by the clinic is effective. METHODS: Patients attending the clinic completed an interviewer-assisted questionnaire with 11 questions concerning foot care knowledge. A knowledge score for each patient was calculated. RESULTS: Possible scores ranged from 4 to 11 (maximum 11). The mean score for the ARF group was 8.9 (standard deviation (SD) 1.4) (range 4 - 11) compared with 8.9 (SD 1.4) for the NARF group (range 5 - 11) (p>0.05). The most substantial difference between the two groups was that the ARF group gave 20% more correct answers than the NARF group with regard to frequency of foot inspection (daily) (p=0.025). CONCLUSIONS: Both groups of patients had a reasonable knowledge regarding foot care. The patients at risk were more aware of the need for daily foot inspection.
Risk factors precipitating exacerbations in adult asthma patients presenting at Kalafong Hospital, Pretoria
(Medpharm Publications, 2008-07) Geyser, M.M. (Mimi); Rheeder, Paul; mimi.geyser@up.ac.za
BACKGROUND: Research into asthma is proceeding at an unprecedented rate and yet we live with a disease that escalates in prevalence and severity, despite a greater understanding of its pathophysiology and the necessary therapy. The total prevalence of asthma is estimated to lie at 7.2% of the world’s population (6% in adults, 10% in children). Data from Australia, Canada and Spain report that acute asthma accounted for 1 to 12% of all adult emergency department visits. The prevalence of asthma in South Africa lies at 5% for adults and 10% for children. Asthma is reported as taking up 1 to 2% of the total health budget in direct costs, with equally large indirect costs being incurred for time lost from work and reduced productivity. It has also been reported that approximately one-third of the direct care costs of asthma are attributable to emergency department visits and hospitalisations. In some cases, exposure may be unavoidable (for example exposures to cold air, exercise or the asthma-inducing effects of pregnancy). Many studies have been done in other countries on specific triggers, especially allergens and viral respiratory infections. However, circumstances differ in the public sector in South Africa and other factors such as compliance and under-treatment, which may be applicable, should be studied in contention. METHODS: A matched case-control study was undertaken matched on age and gender between December 2003 and May 2005. Known asthma patients with exacerbations presenting at Kalafong Hospital’s emergency unit were chosen as cases. Controls were stable asthma patients recruited from the outpatient departments. A structured questionnaire was used to interview patients concerning their possible exposure to certain triggers and risk factors. Univariate and multivariate analyses with conditional logistic regression were done to determine any significant exposures. Participants were between 18 and 65 years of age. RESULTS: In total, 356 patients were evaluated. Fifty cases and 100 controls were enrolled. Cases were shown to be more non-compliant than controls (OR = 2.18; 95% Confidence interval (CI): 1.09 to 4.38, p = 0.03). Missing follow-up doctor’s appointments for the last six months were statistically significant with an OR of 2.39 (95% CI 1.08 to 5.27) and p = 0.03. CONCLUSIONS: Non-compliance was a strong predictor of exacerbations in adult asthma patients at Kalafong Hospital.
Photo identification : facial metrical and morphological features in South African males
(Elsevier, 2008-05-20) Roelofse, M.M. (Michelle Marizan); Steyn, Maryna; Becker, Piet J.; msteyn@medic.up.ac.za
Personal identification of individuals is very important in forensic sciences. Facial identification is becoming even more relevant with increasing crime rates, problems with access control and terrorist attacks. To make facial identification more accurate, an in depth knowledge of the common and rare facial characteristics seen in various populations is needed. This will be advantageous when comparing facial photographs. Currently very little data is available on the facial variation of South Africans. Therefore the aim of this study was to analyse the facial features of a group of South African Bantu-speaking men, to determine the common and rare facial features seen in the group. Facial photographs were taken of 200 volunteers from the Pretoria Police College, in the norma frontalis position. The subjects were between 20 and 40 years of age, with no facial deformities. Thirteen measurements were taken directly from the photographs and used in 12 indices. Eight morphological features were also analysed on each face. Each feature was divided into different categories, which described variants of that feature. The metrical and morphological data were then used to create various combinations of facial characteristics that described different regions of the face. The frequency of occurrence of these combinations was calculated for the study population. The most common features were oval or inverted trapezoid facial shapes, intermediate size noses with a down-turned septum tilt and intermediate size mouths with a flat V-shaped upper lip notch (cupid’s bow). The eyes were mostly situated closely together. Some of the rare or absent features included round or square facial shapes and narrow noses with an upturned septum tilt. Matching these rare features on facial photographs will be useful during cases of disputed identification.
Glycaemic control improves fibrin network characteristics in type 2 diabetes : a purified fibrinogen model
(Schattauer, 2008-04) Pieters, Marlien; Covic, Namukolo; Van der Westhuizen, Francois Hendrikus; Nagaswami, Chandrasekaran; Baras, Yelena; Loots, Du Toit; Jerling, Johann C.; Elgar, Dale; Edmondson, Kathryn S.; Van Zyl, Danie G.; Rheeder, Paul; Weisel, John W.; danie.vanzyl@up.ac.za
Diabetic subjects have been shown to have altered fibrin network structures.One proposed mechanism for this is non-enzymatic glycation of fibrinogen due to high blood glucose.We investigated whether glycaemic control would result in altered fibrin network structures due to decreased fibrinogen glycation. Twenty uncontrolled type 2 diabetic subjects were treated with insulin in order to achieve glycaemic control. Twenty age- and body mass index (BMI)-matched non-diabetic subjects were included as a reference group. Purified fibrinogen, isolated from plasma samples was used for analysis.There was a significant decrease in fibrinogen glycation (6.81 to 5.02 mol glucose/mol fibrinogen) with a corresponding decrease in rate of lateral aggregation (5.86 to 4.62) and increased permeability (2.45 to 2.85 x 10–8 cm2) and lysis rate (3.08 to 3.27 μm/min) in the diabetic subjects after glycaemic control.These variables correlated with markers of glycaemic control. Fibrin clots of non-diabetic subjects had a significantly higher ratio of inelastic to elastic deformation than the diabetic subjects (0.10 vs. 0.09). Although there was no difference in median fiber diameter between diabetic and non-diabetic subjects, there was a small increase in the proportion of thicker fibers in the diabetic samples after glycaemic control. Results from SDS-PAGE indicated no detectable difference in factor XIIIa-crosslinking of fibrin clots between uncontrolled and controlled diabetic samples. Diabetic subjects may have altered fibrin network formation kinetics which contributes to decreased pore size and lysis rate of fibrin clots. Achievement of glycaemic control and decreased fibrinogen glycation level improves permeability and lysis rates in a purified fibrinogen model.
Fibromyalgia syndrome : current concepts
(Medpharm Publishers, 2006-04) Meyer, Helgard Pieter; hpmeyer@kalafong.up.ac.za
Fibromyalgia (FM) is a recognised chronic pain syndrome that is diagnosed without any special investigations.This syndrome constitutes widespread pain in a specific distribution, for a specific period of time, as well as tenderness over at least 11 out of 18 clearly defined tender points. This syndrome is a common cause of other conditions commonly encountered in general practice and this article provides a practical and clinical approach to diagnosis and treatment.
Frequency of the metabolic syndrome in screened South African corporate executives
(Clinics Cardiv, 2007-01) Ker, James A.; Rheeder, Paul; Van Tonder, R.
The aim of the study was to determine the frequency of the metabolic syndrome in a specific group of people. The ATP III criteria were used to identify the metabolic syndrome in a group of 1 410 corporate executives belonging to a specialist health and fitness company in South Africa. The metabolic syndrome was common in a group of corporate executives.
Dysrhythmogenic potential in acute admissions to psychiatric hospitals and clinics
(Clinics Cardiv, 2007) Grant, C.C. (Catharina Cornelia); Steenkamp, B.; Gauche, L.; Becker, Piet J.; Ker, James A.; Roos, J.L. (Johannes Louw); Viljoen, Margaretha
Co-morbidity between physical disease, especially cardiovascular, and psychological disturbances is well documented. In psychiatric patients, the potential for dysrhythmogenic incidences is increased by the fact that many psychiatric medications influence cardiovascular function. AIM: The aim of the study was to examine the dysrhythmogenic potential of 30 psychiatric patients (group A), irrespective of diagnoses or medication, at admission to psychiatric institutions. METHODS: The dysrhythmogenic potential was determined in terms of heart rate-corrected QT intervals (QTc), heart rate-corrected JT intervals (JTc), QT and JT dispersion (QTcd and JTcd) between leads v1 and v6, and heart rate variability (HRV) as determined from lead v6 of the ECG. Values were compared with 30 age- and gender-matched controls (group B). In the second part of the study the dysrhythmogenic indicators were assessed in a patient group (group C; n 5 43) with only psychiatric disorders and compared to a group with psychiatric as well as medical disorders (group D; n 5 27). RESULTS: The patient group A had significantly higher values than the control group for mean QTc (v6) (0.4579 + 0.0328 vs 0.4042 + 0.0326; p 5 0.0470), mean JTc (v6) (0.3883 + 0.0348 vs 0.3064 + 0.0271; p 5 0.0287) and mean QT and JT dispersion values (QTcd 5 0.0443 + 0.0203 vs 0.0039 + 0.0053 and JTcd 5 0.0546 + 0.1075 vs 0.0143 + 0.1450, p < 0.05). A statistically significant difference (p < 0.0001) was found between the patients' (group A) HRV and that of the controls (group B). No statistically significant differences were found between the values of the dysrhythmogenic indicators for patients with only psychiatric illness (group C) and those with psychiatric as well as medical disorders (group D). CONCLUSIONS: Psychiatric patients at the point of admission to psychiatric institutions may have an increased dysrhythmogenic potential, not necessarily caused by physical disease. The potential of an augmented risk for cardiovascular incidents in psychiatric patients should be considered when treating such patients.
Work and family support systems and the prevalence of lower back problems in a South African steel industry
(Springer, 2007-09) Van Vuuren, Bernard J.; Zinzen, Evert; Van Heerden, Hendrik J.; Becker, Piet J.; Meeusen, Romain; bernard.vanvuuren@up.ac.za
INTRODUCTION : Back complaints are common in society. METHODS : An analytical cross-sectional epidemiological study was carried out among 366 steel plant workers to examine the prevalence and association between lower back problems (LBP) and family and workplace related psychosocial risk factors. RESULTS : Using inclusive and stringent definitions for LBP, point prevalence was 35.8% and 15.3%, respectively. Logistic regression analyses indicated significant adjusted odd ratios (OR) for negative perceptions of workplace support (2.32; CI 1.09–4.92), unexpected events (2.58; CI 1.19–5.59) and working under time pressures and deadlines (2.83; CI 1.24–6.48). A significant protective association was found for control over the order and pace of working tasks (OR 0.30; CI 0.14–0.63). A significant univariate association was further found between LBP and negative perceptions of family (1.97; CI 1.06–3.68) support. CONCLUSION : These findings suggest that workers who feel more in control on the job and who have good family and workplace support systems intact are less likely to experience LBP. Supervisors are therefore encouraged to develop appropriate support and organizational systems which may be an inexpensive, but potentially beneficial, means of reducing worker stress and LBP.
Lower back problems and work-related risks in a South African Manganese factory
(Springer Verlag, 2007-03) Van Vuuren, Bernard J.; Van Heerden, Hendrik J.; Becker, Piet J.; Zinzen, Evert; Meeusen, Romain; bernard.vanvuuren@up.ac.za
An analytical cross-sectional epidemiological study carried out among 109 manganese plant workers aimed to examine the prevalence and association between lower back problems (LBP) and occupational risk factors. Outcome was defined using a guided questionnaire and a functional rating index. Exposure to occupational risk factors was determined using self-reported questionnaires and workstation analyses. Multivariate logistic regression analyses indicated significant adjusted odds ratios (OR) for prolonged 90 degrees trunk flexion (OR 2.16; CI 1.15–4.05); manual handling (1.89; 1.17–3.08); load carriage (1.54; 1.08–2.19); and lifting (4.61; 1.37–15.47). The findings illustrate regional and occupational specifics of risk for LBP, and indicate that self-selection or adaptation to task-specific demands could possibly lead to observations of ergonomically relevant risk factors, which do not necessarily yield statistically significant associations with LBP. The findings further support multi-modal preventative approaches.

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