Healthy environments for athleTes (HEAT): environmental conditions along a 90 km ultra-marathon event, South Africa.

This paper provides an overview of the HEAT (Healthy Environments for AthleTes) project, which aims to understand the impact of environmental conditions on athlete health and performance during major sporting events such as long-distance running, cycling, and triathlons. In collaboration with the SAFER (Strategies to reduce Adverse medical events For the ExerciseR) initiative, the HEAT project carried out a field campaign at the 2022 Comrades Marathon in the KwaZulu-Natal province of South Africa. The measurement campaign deployed seven weather stations, seven PM2.5 monitors and one spore trap along the 90 km route to capture spatially representative measurements of complex micro-climates, allergenic aerospora, and particulate matter exposure. The results indicate that runners were exposed to moderate risk heat stress conditions. Novel findings from this initial campaign shows elevated and potentially harmful PM2.5 levels at spectator areas, possibly coinciding with small fire events around the race day festivities. Our findings show values PM2.5 levels over the WHO 24-h guidelines at all stations, while 2000 µg/m3 at two stations. However, the lack of an acute exposure standard means direct health impacts cannot be quantified in the context of a sport event. The HEAT project highlights important aspects of race day monitoring; regional scale climatology has an impact on the race day conditions, the microclimatic conditions (pollution and meteorology) are not necessarily captured by proximity instruments and direct environmental measurements are required to accurately capture conditions along the route.

Brief Report: A Randomized Control Trial Assessing the Influence of a Telephone-based Intervention on Readmissions for Patients with Severe Mental Illness in a Developing Country.

Whilst comprehensive post-discharge interventions have been successful in reducing readmissions in our setting, they are possibly not sustainable due to limited resources. We assessed the impact of a more cost-effective telephone-based intervention on readmissions in a developing country over 12 months. 100 patients with severe mental illness were randomized to facilitated care or treatment as usual. All were interviewed prior to discharge and after 12 months. Facilitated care consisted of structured telephonic interviews and motivational support to patients and families. At 12 months no significant differences in either readmissions (p = 0.10) or days in hospital (p = 0.44) could be demonstrated. Substance use was high (64%), particularly methamphetamine (44%) in both groups. The intervention did not have any impact on inpatient usage in our setting. Though this study was limited by its small sample size, the results indicated that affordable post-discharge services may not be comprehensive enough to reduce readmission rates and would have to be tailored to the distinct population of dual diagnosis patients identified in this study.

High incidence of injury at the Sochi 2014 Winter Paralympic Games: a prospective cohort study of 6564 athlete days.

OBJECTIVE: To describe the epidemiology of injuries at the Sochi 2014 Winter Paralympic Games. METHODS: A total of 547 athletes from 45 countries were monitored daily for 12 days during the Sochi 2014 Winter Paralympic Games (6564 athlete days). Daily injury data were obtained from teams with their own medical support (32 teams, 510 athletes) and teams without their own medical support (13 teams, 37 athletes) through electronic data capturing systems. RESULTS: There were 174 total injuries reported, with an injury incidence rate (IR) of 26.5 per 1000 athlete days (95% CI 22.7% to 30.8%). There was a significantly higher IR recorded in alpine skiing/snowboarding (IR of 41.1 (95% CI 33.7% to 49.6%) p=0.0001) compared to cross-country skiing/biathlon, ice sledge hockey or wheelchair curling. Injuries in the shoulder region were the highest single-joint IR (IR of 6.4 (95% CI 4.6% to 8.6%)), although total upper and lower body IR were similar (IR 8.5 vs 8.4 (95% CI 6.4% to 11.1%)). Furthermore, the IR of acute injuries was significantly higher than other types of injury onset (IR of 17.8 (95% CI 14.7% to 21.4%)). CONCLUSIONS: In a Winter Paralympic Games setting, athletes report higher injury incidence than do Olympic athletes or athletes in a Summer Paralympic Games setting. The highest incidence of injury was reported in the alpine skiing/snowboarding sporting category. There was a similar incidence of injury in the upper and lower limbs. The joint with the greatest rate of injury reported was the shoulder joint. Our data can inform injury prevention programmes and policy considerations regarding athlete safety in future Winter Paralympic Games.

The incidence and patterns of illness at the Sochi 2014 Winter Paralympic Games: a prospective cohort study of 6564 athlete days.

OBJECTIVE: To describe the epidemiology of illness at the Sochi 2014 Winter Paralympic Games. METHODS: A total of 547 athletes from 45 countries were monitored daily for 12 days over the Sochi 2014 Winter Paralympic Games (6564 athlete days). Illness data were obtained daily from teams without their own medical support (13 teams, 37 athletes) and teams with their own medical support (32 teams, 510 athletes) through electronic data capturing systems. RESULTS: The total number of illnesses reported was 123, with an illness incidence rate (IR) of 18.7 per 1000 athlete days (95% CI 15.1% to 23.2%). The highest IR was reported for wheelchair curling (IR of 20.0 (95% CI 10.1% to 39.6%)). Illnesses in the respiratory system (IR of 5.6 (95% CI 3.8% to 8.0%)), eye and adnexa (IR of 2.7 (95% CI 1.7% to 4.4%)) and digestive system (IR of 2.4 (95% CI 1.4% to 4.2%)) were the most common. Older athletes (35-63 years) had a significantly higher IR than younger athletes (14-25 years, p=0.049). CONCLUSIONS: The results of this study indicate that Paralympic athletes report higher illness incidence rates compared to Olympic athletes at similar competitions. The highest rates of illness were reported for the respiratory and digestive systems, eye and adnexa, respectively. Thus, the results of this study form a basis for the identification of physiological systems at higher risk of illness, which can in turn inform illness prevention and management programmes with eventual policy change to promote athlete safety in future editions of the Winter Paralympic Games.

Non-fatal injuries among boys and girls presenting to Red Cross War Memorial Children's Hospital, Cape Town, South Africa.

BACKGROUND: In South Africa (SA), road traffic injuries, homicides and burns are the leading causes of injury-related deaths among children. Injury-related deaths are well documented for SA, but this is not the case for non-fatal injuries. OBJECTIVES: To describe the non-fatal injuries sustained among children aged 0 - 13 years, to identify any significant sex differences by age group, cause of injury, admission status and injury severity. METHODS: The trauma unit database from 1997 to 2016 at Red Cross War Memorial Children's Hospital, Cape Town, was utilised for this analysis. The prevalence of injuries and the boy/girl ratios with 95% confidence intervals (CIs) were reported. RESULTS: Analysis indicated significant differences by sex for individual injury causes (transport, assault, burns, falls and other injuries), age group, injury severity and admission status. Moderately severe injuries were largely caused by burns, while severe injuries were mostly transport related. Boys had significantly higher proportions of all injury causes. The boy/girl ratio was lowest for assault (1:18), where significantly more girls aged 1 - 3 and 4 - 6 years were injured. Rape/sexual assault was 5.5 times higher for girls, with a significantly higher proportion of moderate-severity injuries (87%; 95% CI 84.7 - 89.4). CONCLUSION: The study findings call for a more targeted prevention response for boy and girl children. Interventions should be targeted at the prevention of burns, traffic collisions and interpersonal violence, in particular sexual assaults against girls.

Phosphorus removal from anaerobically digested swine wastewater through struvite precipitation.

Phosphorus removal from agricultural wastewater streams is an important aspect of managing surface water quality, due to the contribution of phosphorus to eutrophication. Removal of phosphorus through struvite precipitation allows for its recovery as a potential fertilizer, and by determining the best conditions for struvite precipitation the removal process can be optimized. The effects of pH, Mg:P ratio, and time on struvite precipitation from anaerobically digested swine manure effluent were investigated. Effluent with Mg:P ratios from 1.0:1 to 1.6:1 were adjusted to pH values between 7.5 and 9.5 and left to equilibrate for 24 h. Results indicate that phosphorus removal increased with increasing pH and Mg:P ratio; the maximum phosphorus removal achieved was 80% at pH 9.0 and a Mg:P ratio of 1.6:1. The purest struvite precipitate was found at pH 7.5, with calcium carbonate and struvite precipitating at higher pH values. A continuously stirred batch of centrate was adjusted to pH 8.4 to determine the struvite formation rate constant. The rate constant was found to be 1.55 h(-1), with 17% phosphorus removal during the first 20 min. The results indicate that struvite precipitation could be a viable method of phosphorus removal from anaerobically digested swine manure.

Paraprofessional home visitation program to prevent childhood unintentional injuries in low-income communities: a cluster randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of a paraprofessional home visitation program (HVP) to improve home safety and prevent injuries among children living in low-income settings. METHODS: The HVP was implemented in two low-income communities in South Africa. In each community, approximately 200 households were randomly selected for the trial. Eligible households were those with children aged < or = 10 years. Intervention households received four visits, one every two weeks, by trained paraprofessionals that focused on a specific injury topic and consisted of: information dissemination about specific injury prevention practices; home inspection accompanied by information about home hazards; and the supply of safety devices. The key outcomes to measure the presence of home hazards were scores for burns (safety practices, paraffin, and electrical), poisoning, and falls. RESULTS: Significant reductions were found for injury risks related to burn safety practices. For injury risks related to electrical burns, paraffin burns, and poisoning, a decline was also noted although this was not statistically significant. No decline was noted for fall-related risks. CONCLUSIONS: Subject to further replication and evaluation, home visits by paraprofessionals providing safety education, home inspection, and safety devices be considered for integration into a comprehensive child injury prevention strategy in low-income communities.

Magnesium supplementation and perinatal hypoxia: outcome of a parallel group randomised trial in pregnancy.

OBJECTIVE: To determine the effects of magnesium supplementation in pregnancy on the incidence of hypoxic-ischaemic encephalopathy (HIE). DESIGN: A randomised double-blind placebo-controlled study. SETTING: A Midwife Obstetric Unit and its two referral hospitals in Cape Town, South Africa. POPULATION: A group of 4494 black pregnant women of low socio-economic status. METHOD: Mothers, from the time of booking until delivery, were randomised to receive two identical tablets daily, containing either 128 mg slow-release magnesium stearate or lactose sugar. MAIN OUTCOME MEASURES: Primary: The incidence of HIE. Secondary: The incidence of fetal heart rate decelerations, term Stillbirths, Low Apgar Scores, Meconium Aspiration Pneumonia. RESULTS: The incidence of HIE (0.9%) was considerably less than anticipated (2%). There were 22 infants in the placebo group and 15 infants in the supplemented group (P = 0.279). The difference was not significant. Secondary outcomes such as late fetal heart rate decelerations (P = 0.002) and term stillbirths (P = 0.016) were reduced significantly in the supplemented group, but this finding needs further substantiation. CONCLUSIONS: Magnesium supplementation did not reduce the incidence of HIE significantly, probably because the study was underpowered and compliance was relatively poor.

Low molecular weight quaternised chitosan (11): in vitro assessment of absorption enhancing properties.

N-Trimethyl chitosan chloride (TMC; high molecular weight) and N-trimethyl chitosan oligosaccharide (TMO; low molecular weight) with different degrees of quaternisation were synthesised and evaluated for their absorption enhancing properties across mucosal epithelia. These quaternised chitosan derivatives (0.0625% w/v-0.5% w/v) showed a significant decrease in the transepithelial electrical resistance (TEER) of cultured rabbit tracheal epithelial cell monolayers as compared to the control. The degree of quaternisation and concentration of the compounds influenced the extent of the reduction in TEER. Higher degrees of quaternisation and an increase in the concentration of the compound were associated with a more pronounced reduction in the TEER. The TMO derivatives seemed to be more effective in lowering the TEER of tracheal cell monolayers as compared to the TMC polymers. Ciliary beat frequency (CBF) is the main defence mechanism of the respiratory tract and is therefore a useful parameter in evaluating the toxicity of nasally administered drugs and additives. The effect of the synthesised chitosan derivatives on the CBF of human nasal epithelial cells at pH 7.4 was determined by a method based on an analogue contrast enhancement technique. The TMO oligomers exhibited lower inhibition of the CBF of human nasal epithelial cells compared to that of the TMC polymers. It was proposed that this reduced effect on the CBF is due to the lower viscosity and molecular weight of TMO. However, no acute toxicity was found with any of the synthesised chitosan derivatives by means of the CBF tests conducted in this study.

The development of an instrument measuring unintentional injuries in young children in low-income settings to serve as an evaluation tool for a childhood home injury prevention program.

PROBLEM: Responding to the lack of standardized instrumentation, especially as applied in low-income contexts, the researchers decided that an instrument should be developed to serve as an evaluation tool for a childhood (unintentional) injury prevention program as well as a tool from which injury risks (poisonings, burns and falls) could be identified within households. METHODS: Cross-sectional samples of 521 households in four low-income sites in Cape Town and Johannesburg, South Africa, participated in the three phases of the study. The generation of an item pool based on a table of specifications, subsequent scientific item reduction procedures, reviews from experts and pilot tests were used to develop the scales for measuring the injury risks. RESULTS: The developed instrument complies with all the requirements for a valid and reliable measurement instrument. CONCLUSION: The instrument allows valid comparison of risks between communities, as well as before and after comparisons for an intervention program. IMPACT: The provision of this instrument may bring enormous benefits to research studies. It can also provide proactive, rather than reactive, information about injury risks before they develop into injuries and thus allows focusing of safety efforts for improvement of problematic areas in the households.

Prevalence and reliability of asthma symptoms in primary school children in Cape Town.

BACKGROUND: Childhood asthma is believed to be a serious problem in Cape Town, South Africa. This study aimed to measure the prevalence and reliability of asthma symptoms and reported asthma in Cape Town schoolchildren aged mainly 7 and 8 years, and to assess underdiagnosis. METHOD: A questionnaire was completed by parents of 1955 children, followed by 620 personal interviews repeating the questions. RESULTS: The prevalence of recent wheeze (previous 12 months) (26.8%) was high by international comparison, but not that of reported asthma (10.8%). Among children with more than 12 recent attacks of wheeze, only 60% were reported as asthmatic and 55% as receiving regular treatment. Symptom prevalences varied with the respondent's familial relationship to the child. On some questions the interview produced higher wheeze prevalences than the self-administered questionnaire. Repeatability of questions varied: asthma over (kappa = 0.69), recent wheeze (kappa = 0.59), and recent sleep disturbance by wheeze (kappa = 0.56) were the most reliable. CONCLUSIONS: Prevalence based on symptom reports may vary with the respondent and between self- and interviewer-administered questionnaires. Also, certain questions currently proposed for childhood asthma questionnaires may be unreliable. Nevertheless, it can be concluded that the prevalence of wheeze is high in this population, and that underdiagnosis and undertreatment of asthma are a problem.

Community-based intervention: the Coronary Risk Factor Study (CORIS).

The Coronary Risk Factor Study (CORIS) examined the feasibility and effectiveness of a multifactorial community intervention programme to reduce coronary heart disease (CHD) risk factor levels. Three Afrikaner communities were surveyed before and after a 4-year intervention in two of the communities, the third serving as a control (C). Intervention was primarily by small mass media (low-intensity intervention, LII) or by small mass media plus interpersonal intervention to high-risk individuals (high-intensity intervention, HII). After allowing for change in C, significant net reductions in blood pressure, smoking, and risk score were obtained in LII and HII alike. Though the total cholesterol (TC) fell by 10-12%, there was no net reduction in favour of the intervention communities. However, LII and HII resulted in significant increases in high-density lipoprotein cholesterol (HDL-C) levels and HDL-C/TC ratios in comparison to C. Overall, the LII community fared almost as well as the HII community, and high-risk individuals did not show a greater change in risk factors than others. We conclude that community-based intervention works, and that in these particular communities a media-based health education programme was more cost-effective than one which adds a greater degree of interpersonal intervention.

Relationship dynamics and teenage pregnancy in South Africa.

Teenage pregnancy is extremely common in South Africa. Whilst its 'problematic' nature is a subject of debate, it reflects a pattern of sexual activity which puts teenagers at risk of HIV. Currently one in five pregnant teenagers is infected with the virus. This creates a new imperative to understand teenage pregnancy and the pattern of high risk sexual activity of which it is one consequence. This was an exploratory study undertaken to investigate factors associated with teenage pregnancy amongst sexually active adolescents in an urban and peri-urban context. The study used a matched case control design, with 191 cases and 353 school or neighbourhood, age-matched controls. Subjects were under 19 years and recruited from township areas of Cape Town. A structured questionnaire was used to obtain information on socio-economic factors, contraceptive knowledge and use, and sexual behaviour. Conditional logistic regression was used to analyse the relationship between teenage pregnancy and the factors investigated. The results presented focus on relationship dynamics and their association with the risk of pregnancy. Both groups of teenagers had been dating for a mean of two and a half years and about half were still with their first sexual partner. The partners of the pregnant teenagers were significantly older, less likely to be in school and less likely to have other girlfriends. The pregnant teenagers were significantly more likely to have experienced forced sexual initiation and were beaten more often. They were much less likely to have confronted their boyfriend when they discovered he had other girlfriends. Multiple modelling shows that both forced sexual initiation and unwillingness to confront an unfaithful partner are strongly associated with pregnancy and also related to each other. We argue that the associations are mediated through unequal power relations within the relationship which are reinforced by violence. We further discuss indicators of greater intimacy within relationships of the pregnant teenagers which may suggest that more of the pregnancies were wanted than was suggested. Both of these conclusions pose critical challenges for health promoters.

Level of physical activity and CHD risk factors in black South African men.

Coronary heart disease (CHD) is uncommonly low among black South Africans. Although dietary and genetic influences probably contribute to their favorable serum lipid profile, other cardioprotective factors may also play a significant role in explaining the low incidence of CHD. From a socioeconomic perspective, it appears that the black community engages in regular physical activity (PA) more so than other populations. Since data are lacking, our aim was to provide preliminary data on the association between PA and the traditional CHD risk factors. The sample consisted of 212 working, middle-aged men drawn from an epidemiological database on the African population of metropolitan Cape Town. Analysis of responses to basic questions on PA behavior indicated i) 43% of the sample were employed in jobs requiring moderate to strenuous PA, and ii) the most favorable blood pressure and serum lipid profiles were associated with low to moderate levels of habitual exercise. As this community becomes more urbanized, job-related PA as well as PA of daily living will decline. The need for sports and leisure-time PA programs will become more important and should be considered as part of a public health strategic plan.

Suicide attempts in an African schizophrenia population: an assessment of demographic risk factors.

This study investigated demographic variables, including affected sibling pair status, as risk factors for suicidal behavior in schizophrenia patients of African (Xhosa) descent. Xhosa subjects with schizophrenia were interviewed with the Diagnostic Interview for Genetic Studies (DIGS) and then stratified into two groups: those with ( n = 90) and those without ( n = 364) a history of previous suicide attempts. Demographic parameters (including gender, age, and social circumstances, sib ship) were then compared across these groups. Demographic predictors of suicide included sib ship status ( p = 0.038; OR = 1.7) and age of onset of illness ( p = 0.008; OR = 2.5). On further analysis of suicide in siblings, only a minority of sib pairs was found to be concordant for a lifetime history of suicide attempts (3%). These findings raise the possibility that affected sib pair status may be protective in nature. Given the counter-intuitive nature of this finding, further work is needed to replicate it, and to explore possible underlying mechanisms.

The influence of different centralised pre-packaging systems on the shelf-life of fresh pork.

The influence of different centralised pre-packaging systems (PVC, modified atmosphere packaging (MAP), 25% CO(2) and 75% O(2), vacuum skin packaging (VSP) and the mother bag concept, 100% CO(2)) on the shelf-life (0, 7, 14 and 21 days at 0°C) of fresh pork was determined using microbiological, colour, odour and acceptability characteristics. All the packaging treatments were equally efficient for the first 4 days of retail display. In the extended shelf-life study (7, 14 and 21 days) the mother bag centralised packaging system gave the most promising shelf-life results (21 days) and was also judged superior in terms of odour. Modified atmosphere packaging (14 days) and VSP (7 days) may be considered as other possible options.

A microbiological survey of fresh meat in the supermarket trade. Part 1: Carcasses and contact surfaces.

Sanitary conditions were monitored at eleven supermarkets (from two major chains, Sup groups A & B) in the South African butcher industry. The variables measured were the temperature of carcasses and environments, the muscle pH of carcasses and the microbiological status of carcasses and human or personal and equipment contact surfaces (chillers-three surfaces, delivery trucks-five surfaces, cutting rooms-16 surfaces). All supermarkets, except one, received beef carcasses, distributed by one of two wholesale organizations from the same abattoir. No consistency was found in the contamination level of different parts of carcasses at different supermarkets, although there was a tendency for fore quarters to be more contaminated than hind quarters. Chiller surfaces, delivery truck surfaces and equipment had significantly different microbial counts at the different supermarkets. Sup group B received carcasses with higher mean surface temperatures and microbial counts than those of the carcasses received by Sup group A, but the mean microbial count of equipment was lower than that encountered at Sup group A. The result was less contaminated meat at the supermarkets in Sup group B, illustrating how a combination of the microbial quality of carcasses received by such supermarkets, and the sanitary programme in operation at such supermarkets affects the contamination level of retail premises. It could furthermore be shown that personnel surfaces (hands and clothes) and equipment like saws and mincers are consistent contributors to contamination at the retail level of the meat industry.

A microbiological survey of fresh meat in the supermarket trade. Part 2: beef retail cuts.

An assessment was made of the microbiological quality of the final product (different retail cuts), produced by two different retail supermarket groups (A & B). The influence of sanitary conditions on the microbiological quality of the final product was evaluated, and the possible influences on shelf life were determined. Supermarket group A (Sup group A) received carcasses with significantly lower surface counts of micro-organisms than supermarket group B (Sup group B), while the latter had a more efficient overall sanitation programme than supermarket group A. Five cuts were monitored for the presence of total aerobic counts, psychrotrophic counts, lactobacilli, Enterobacteriaceae and numbers of Pseudomonadaceae present. A shelf life study was also executed by repeating these enumerations on the same meat samples after refrigerated storage at 5°C for 2 and 4 days, respectively. It is generally accepted that a good refrigeration or chilling regime will preserve the inherent meat quality, but in this study it was found that neither served as a guarantee of quality. The more stringent hygiene at retail level of Sup group B yielded consistently lower mean counts of the different bacterial groups for all the meat cuts monitored and, thus meat with an extended shelf life. The total count (at 30°C) on meat cuts was the highest, followed by the psychrotrophs, the Pseudomonadaceae the Enterobacteriaeae and the lactobacilli. Minced meat generally had the highest mean aerobic total microbial counts. This count on minced meat might be a suitable indicator for monitoring the overall sanitary condition of a retail premises. The results re-emphasized the multi-factorial complexity of fresh meat quality and shelf life. The microbial quality of the raw material (carcasses), the maintenance of the cold chain, sanitary condition of premises, equipment and personnel surfaces and general management practices are factors that collectively determine the microbiological quality of the product.

The control of bacterial contamination in carcass meal with propionic acid.

The effect of the addition of 2, 3, 5, 7 and 10% respectively of propionic acid on known numbers of bacteria added to or contained in carcass meal was examined. Escherichia coli was totally inhibited by 2% propionic acid, while 5% of the acid both inhibited Salmonella typhimurium and brought about a 74,7% reduction in the total aerobic bacterial count.

Determination of the physicochemical and microbiological quality of carcass, bone and blood meal.

The pH value and the moisture, fat and protein content of abattoir by-products which are commercially available in the Republic of South Africa were examined, and the total bacterial count and the extent of Salmonella, Escherichia coli, Bacillus, yeast and fungus contamination were determined. The extremes and reasonably attainable quality standards were deduced from the highest frequency and mean values of these figures. The total bacterial count was not statistically predictable from variables such as pH, moisture, protein and fat, but was found to be related to the combined effect of all 4 independent variables.