A critical appraisal of South African oncology pharmacy standards: A comparison with international best practice standards.

INTRODUCTION: The demand for oncology pharmacy services is set to increase as the burden of cancer rises in sub-Saharan Africa. Oncology pharmacists may be exposed to antineoplastic drugs (ADs) and need comprehensive health and safety guidelines. The objective of the study was to assess the effectiveness of the local oncology pharmacy practice standards, by critically evaluating them against international best practice standards. METHODS: We compared the Independent Clinical Oncology Network (ICON) administration of ADs standards resource document (ICON standards) and Good Pharmacy Practice (GPP) standards with the International Society of Oncology Pharmacy Practitioners (ISOPP) Standards for the safe handling of cytotoxics, and the Quality standard for the oncology pharmacy service (QuaPos), using 10 domains: transport of ADs, working arrangements, education and training, engineering controls, use of personal protective equipment, risk management, medical monitoring of personnel, cleaning procedures, accident management and documentation, labelling and checking procedures. RESULTS: The ICON standards align closely with international best practice standards, but the GPP standards focus only briefly on the compounding of ADs.The GPP standards are outdated and some of the stipulations are erroneous. Oncology pharmacists would do better to adhere to the more comprehensive ICON standards, although these standards also need to be updated in line with best practice. CONCLUSION: Revising and improving both these local standards in consultation with key role players in the oncology pharmacy industry will go a long way in protecting the health and safety of oncology pharmacists in South Africa.

Severity of parkinsonism associated with environmental manganese exposure.

BACKGROUND: Exposure to occupational manganese (Mn) is associated with neurotoxic brain injury, manifesting primarily as parkinsonism. The association between environmental Mn exposure and parkinsonism is unclear. To characterize the association between environmental Mn exposure and parkinsonism, we performed population-based sampling of residents older than 40 in Meyerton, South Africa (N = 621) in residential settlements adjacent to a large Mn smelter and in a comparable non-exposed settlement in Ethembalethu, South Africa (N = 95) in 2016-2020. METHODS: A movement disorders specialist examined all participants using the Unified Parkinson Disease Rating Scale motor subsection part 3 (UPDRS3). Participants also completed an accelerometry-based kinematic test and a grooved pegboard test. We compared performance on the UPDRS3, grooved pegboard, and the accelerometry-based kinematic test between the settlements using linear regression, adjusting for covariates. We also measured airborne PM2.5-Mn in the study settlements. RESULTS: Mean PM2.5-Mn concentration at a long-term fixed site in Meyerton was 203 ng/m3 in 2016-2017 - approximately double that measured at two other neighborhoods in Meyerton. The mean Mn concentration in Ethembalethu was ~ 20 times lower than that of the long-term Meyerton site. UPDRS3 scores were 6.6 (CI 5.2, 7.9) points higher in Meyerton than Ethembalethu residents. Mean angular velocity for finger-tapping on the accelerometry-based kinematic test was slower in Meyerton than Ethembalethu residents [dominant hand 74.9 (CI 48.7, 101.2) and non-dominant hand 82.6 (CI 55.2, 110.1) degrees/second slower]. Similarly, Meyerton residents took longer to complete the grooved pegboard, especially for the non-dominant hand (6.9, CI -2.6, 16.3 s longer). CONCLUSIONS: Environmental airborne Mn exposures at levels substantially lower than current occupational exposure thresholds in the United States may be associated with clinical parkinsonism.

Effectiveness of a pre-adolescent inter-generational intervention to address HIV and obesity in South Africa, using a pretest-posttest design.

BACKGROUND: Strengthening pre-adolescents knowledge and skills through an age- and culturally-appropriate intervention could prevent health issues later in life. Early interventions could influence the trajectory of future risky behaviour, and may influence health behaviour amongst their parents. The CIrCLE of Life Initiative was developed to address HIV and obesity. We evaluated whether the combined intervention increased knowledge, enhanced skills, and/or promoted healthy behaviour among students (9-12 years old) and their parents. METHODS: The study was conducted from May to December 2018. Trained educators delivered 30-min lessons over ten consecutive weeks with 537 Grade 6 students at five government-run schools, in a district, in South Africa. Schools were purposively selected based on socioeconomic status and urban-rural classification. Students communicated with parents through shared homework activities. A pretest-posttest study design was used, with a 3-month follow up. Both groups completed self-administered paper-based questionnaires. A score of subscales was used in analysis. The pretest and posttest scores were compared for students and parents using a dependent t-test. Differences in outcomes by school quintile were compared using one-way ANOVA. RESULTS: Response rates were high for both students (80.6%) and their parents (83.4%). Statistically significant differences were observed in HIV knowledge in students pretest (mean 8.04, SD 3.10) and posttest scores (mean 10.1, SD 2.70; p < 0.01), and their parents (mean 10.32, SD 2.80 vs 11.0, SD 2.50; p < 0.01). For both students and parents, pre- and post-test obesity awareness mean scores were similar, 1.93, SD 0.92 and 2.78, SD 0.57; p < 0.01, for students; and 2.47, SD 0.82 and 2.81, SD 0.54; p < 0.01, for parents. In the posttest, statistically significant changes were also observed in both groups, enhancing skills in measuring body mass index and pulse rate, and interpreting food labels. Students had a high intention to share gained knowledge with parents who had a high intention to receive it (89.4 and 89.5%, respectively). CONCLUSION: The intervention increased knowledge about HIV and obesity-related awareness, and it enhanced skills in selected outcomes among pre-adolescents and parents. Accurate messages and enhanced communication skills could support inter-generational knowledge transfer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04307966 retrospectively registered on 12 March 2020.

Manganese exposure, parkinsonian signs, and quality of life in South African mine workers.

BACKGROUND: Manganese (Mn) neurotoxicity is associated with parkinsonism; the associated motor deficits can affect individuals' quality of life (QoL). We investigated associations between Mn exposure, parkinsonian signs, and QoL in Mn mine workers. METHODS: We assessed parkinsonian signs and QoL in 187 black South African Mn mine workers, using the Unified Parkinson Disease Rating Scale motor subsection 3 (UPDRS3) and the Parkinson Disease Questionnaire (PDQ-39), respectively. We estimated cumulative Mn exposure in mg Mn/m3 -years using complete occupational histories and a job-exposure matrix. We investigated the cross-sectional association between cumulative Mn exposure and UPDRS3 score, and the UPDRS3 score and PDQ-39, adjusting for age, using linear regression. RESULTS: Participants' mean age was 41.8 years (range, 21-67 years); 97.3% were male. Estimated mean cumulative Mn exposure at the time of examination was 5.4 mg Mn/m3 -years, with a mean of 14.0 years working in a Mn mine. The mean UPDRS3 score was 10.1 and 25.7% of the workers had a UPDRS3 score greater than or equal to 15. There was a U-shaped dose-response relation between cumulative Mn exposure and UPDRS3 score, with a positive association up to 15 mg Mn/m3 -years of exposure and an inverse association thereafter. Greater UPDRS3 scores were associated with poorer self-reported QoL. CONCLUSION: In this cohort of employed Mn mine workers, parkinsonian signs were common and were associated with both estimated cumulative Mn exposure and poorer QoL.

Cost and effectiveness of prescribing emollient therapy for atopic eczema in UK primary care in children and adults: a large retrospective analysis of the Clinical Practice Research Datalink.

BACKGROUND: The Clinical Practice Research Datalink (CPRD) was used to evaluate the overall costs to the National Health Service, including healthcare utilisation, of prescribing emollients in UK primary care for dry skin and atopic eczema (DS&E). METHODS: Primary care patients in the UK were identified using the CPRD and their records were interrogated for the 2 years following first diagnosis of DS&E. Data from patients with (n = 45,218) and without emollient prescriptions (n = 9780) were evaluated. Multivariate regression models were used to compare healthcare utilisation and cost in the two matched groups (age, sex, diagnosis). Two sub-analyses of the Emollient group were performed between matched groups receiving (1) a colloidal oatmeal emollient (Aveeno-First) versus non-colloidal oatmeal emollients (Aveeno-Never) and (2) Aveeno prescribed first-line (Aveeno-First) versus prescribed Aveeno later (Aveeno-Subsequently). Logistic regression models calculated the odds of prescription with either potent / very potent topical corticosteroids (TCS) or skin-related antimicrobials. RESULTS: Costs per patient were £125.80 in Emollient (n = 7846) versus £128.13 in Non-Emollient (n = 7846) matched groups (p = 0.08). The Emollient group had fewer visits/patient (2.44 vs. 2.66; p < 0.0001) and lower mean per-visit costs (£104.15 vs. £113.25; p < 0.0001), compared with the Non-Emollient group. Non-Emollient patients had 18% greater odds of being prescribed TCS and 13% greater odds of being prescribed an antimicrobial than Emollient patients. In the Aveeno-First (n = 1943) versus Aveeno-Never (n = 1943) sub-analysis, costs per patient were lower in the Aveeno-First compared with the Aveeno-Never groups (£133.46 vs. £141.11; p = 0.0069). The Aveeno-Never group had ≥21% greater odds of being prescribed TCS or antimicrobial than the Aveeno-First group. In the Aveeno-First (n = 1357) versus Aveeno-Subsequently (n = 1357) sub-analysis, total costs were lower in the Aveeno-First group (£140.35 vs. £206.43; p < 0.001). Patients in the Aveeno-Subsequently group had 91% greater odds of being prescribed TCS and 75% greater odds of being prescribed an antimicrobial than the Aveeno-First group. CONCLUSIONS: Acknowledging limitations from unknown disease severity in the CRPD, the prescription of emollients to treat DS&E was associated with fewer primary care visits, reduced healthcare utilisation and reduced cost. Prescribing emollients, especially those containing colloidal oatmeal, was associated with fewer TCS and antimicrobial prescriptions. TRIAL REGISTRATION: The study is registered at http://isrctn.com/ISRCTN91126037 .

38 years of autopsy findings in South African mine workers.

BACKGROUND: South African miners have a statutory right to autopsies for occupational lung disease compensation. These autopsies also provide information for research and surveillance. METHODS: Cardio-respiratory organs are removed where miners die and are examined at the National Institute for Occupational Health. We extracted data from the PATHAUT database and described key demographic, exposure and disease trends (1975-2013). RESULTS: Of 109,101 autopsies, 72,348 (66.3%) were black, and 34,794 (31.9%) were white miners. Autopsies declined from over 3,000 (1975-1998) to 1,118 in 2013. Most were gold miners (74.0%). 78.6% black and 13.2% white miners died while in employment. Overall proportions of silicosis and pulmonary tuberculosis were 12.0% and 13.0% in black, and 20.5% and 2.4% in white miners, respectively. Disease increased over time. CONCLUSIONS: High levels of disease persist. Black ex-miners are underrepresented, indicating a need for strategies to improve awareness and provision of autopsy facilities in labor-sending areas.

Olfactory tract/bulb metal concentration in Manganese-exposed mineworkers.

BACKGROUND: Manganese (Mn) is an essential micronutrient as well as a well-established neurotoxicant. Occupational and environmental exposures may bypass homeostatic regulation and lead to increased systemic Mn levels. Translocation of ultrafine ambient airborne particles via nasal neuronal pathway to olfactory bulb and tract may be an important pathway by which Mn enters the central nervous system. OBJECTIVE: To measure olfactory tract/bulb tissue metal concentrations in Mn-exposed and non-exposed mineworkers. METHODS: Using inductively coupled plasma-mass spectrometry (ICP-MS), we measured and compared tissue metal concentrations in unilateral olfactory tracts/bulbs of 24 Mn-exposed and 17 non-exposed South African mineworkers. We used linear regression to investigate the association between cumulative Mn exposures and olfactory tract/bulb Mn concentration. RESULTS: The difference in mean olfactory tract/bulb Mn concentrations between Mn-exposed and non-Mn exposed mineworkers was 0.16 µg/g (95% CI -0.11, 0.42); but decreased to 0.09 µg/g (95% CI 0.004, 0.18) after exclusion of one influential observation. Olfactory tract/bulb metal concentration and cumulative Mn exposure suggested there may be a positive association; for each mg Mn/m3-year there was a 0.05 µg/g (95% CI 0.01, 0.08) greater olfactory tract/bulb Mn concentration overall, but -0.003 (95% CI -0.02, 0.02) when excluding the three influential observations. Recency of Mn exposure was not associated with olfactory tract/bulb Mn concentration. CONCLUSIONS: Our findings suggest that Mn-exposed mineworkers might have higher olfactory tract/bulb tissue Mn concentrations than non-Mn exposed mineworkers, and that concentrations might depend more on cumulative dose than recency of exposure.

Quantitative Self-Assessment of Exposure to Solvents among Formal and Informal Nail Technicians in Johannesburg, South Africa.

Participatory research, including self-assessment of exposure (SAE), can engage study participants and reduce costs. The objective of this study was to investigate the feasibility and reliability of a SAE regime among nail technicians. The study was nested in a larger study, which included exposure assessment supervised by experts, i.e., controlled assessment of exposure (CAE). In the SAE approach, ten formal and ten informal nail technicians were verbally instructed to use a passive sampler and complete an activity sheet. Each participant conducted measurements on three consecutive days, whereafter the expert collected the passive samplers. Sixty samples were, thus, analyzed for twenty-one volatile organic compounds (VOCs). The reported concentrations of 11 VOCs were converted into total VOC (TVOC) concentrations, adjusted for their respective emission rates (adj TVOC) to allow comparison within and between nail technician categories (formal vs informal), as well as assessment regimes (SAE versus CAE), using the data from the main study. In total, 57 SAE and 58 CAE results were compared, using a linear mixed-effects model. There were variations in individual VOC concentrations, especially for the informal sector participants. The major contributors to the adj TVOC concentrations were acetone and 2-propanol for the formal category, whereas ethyl- and methyl methacrylate contributed most to the informal nail technicians' total exposures. No significant differences in adj TVOC-concentrations were observed between the assessment regimes, but significantly higher exposures were recorded in the formal technicians. The results show that the SAE approach is feasible in the informal service sector and can extend an exposure dataset to enable reliable estimates for scenarios with substantial exposure variations.

Exposure of formal and informal nail technicians to organic solvents found in nail products.

Nail technicians are exposed to volatile organic compounds (VOCs) emitted from nail products used in their daily work, which may cause adverse health effects. This study aimed to assess VOC exposure of nail technicians in the South African formal and informal sectors and to provide a task-based exposure assessment of different nail applications. Personal passive sampling was conducted on 10 formal and 10 informal nail technicians located in the northern suburbs of Johannesburg and the Braamfontein area, over 3 days. Real-time measurements were taken to determine task-based peak exposures. The number of clients serviced, working hours, type of nail application, type of ventilation, room volume, and carbon dioxide (CO2) concentrations, were also recorded. There were differences in the nail products used, the types of nail applications performed, the number of clients serviced, and breathing zones VOC concentrations of the formal and informal nail technicians. Some formal nail salons were equipped with mechanical ventilation while the informal nail salons relied on natural ventilation. CO2 concentrations were higher in the informal than the formal nail salons and increased during the course of the working day. Formal nail technicians were exposed to higher total volatile organic compounds (TVOC) concentrations than informal nail technicians, which may be due to the different nail application procedures as well as 'background' emissions from their co-workers-the bystander effect. Acetone was the predominantly detected VOC: the formal nail technicians were exposed to significantly higher TWA (8 h) concentrations [geometric mean (GM) 43.8 ppm, geometric standard deviation (GSD) 2.49] than were the informal nail technicians (GM 9.87 ppm, GSD 5.13). Methyl methacrylate among the informal nail technicians was measured at 89.7% detection frequency, far higher than that among the formal nail technicians (3.4%). This may be attributed to the observed popularity of acrylic nail applications in this sector. Nail applications involving soak-off gave rise to high TVOC peaks at the start of the nail application process. This is the first study to compare organic solvent exposures among formal and informal nail technicians and determine task-based peak exposures. It also brings attention to the often-overlooked informal sector of this industry.

Environmental manganese exposure and cognitive control in a South African population.

OBJECTIVE: To characterize the association between environmental (residential air) manganese (Mn) exposure and cognitive performance, focusing on cognitive control, in a Black African population. METHODS: We administered the Go-No-Go, Digit Span, and Matrix Reasoning tests to population-based samples age ≥40 from a high Mn (smelter) exposed community, Meyerton (N = 629), and a demographically comparable low (background levels) non-exposed community, Ethembalethu, (N = 96) in Gauteng province, South Africa. We investigated the associations between community and performance on the cognitive tests, using linear regression. We adjusted a priori for age and sex, and examined the effect of adjustment for education, nonverbal IQ, smoking, and alcohol consumption. We measured airborne PM2.5-Mn to confirm community exposure differences. RESULTS: Compared to Ethembalethu residents, Meyerton residents' test scores were lower (poorer) for all tests: 0.55 (95 % confidence interval [CI] 0.08, 1.03) lower scores for Matrix Reasoning, 0.34 (95 % CI -0.07, 0.75) lower for Digit Span, and 0.15 (95 % CI 0.09, 0.21) lower for Go-No-Go (high frequency discriminability index [probability]). The latter represented the most marked difference in terms of z-scores (0.50, 95 % CI 0.30, 0.71 standard deviations lower). The mean of the z-score of each of the three tests was also lower (0.34, 95 % CI 0.18, 0.50 standard deviations lower). These associations were similar in men and women, but attenuated with adjustment for education. Differences for Matrix Reasoning and Digit Span between the two communities were observed only among those who had lived in Meyerton ≥10 years, whereas for Go-No-Go, differences were also apparent among those who had lived in Meyerton <10 years. Mean PM2.5-Mn at a long-term fixed site in Meyerton was 203 ng/m3 and 10 ng/m3 in Ethembalethu. CONCLUSION: Residence in a community near a high Mn emission source is associated with cognitive dysfunction, including aspects of cognitive control as assessed by the Go-No-Go test.

The effect of HIV infection on time off work in a large cohort of gold miners with known dates of seroconversion.

OBJECTIVES: To estimate the effect of HIV infection on time off work. To provide baseline estimates for economic and actuarial models, and for evaluations of ART and other workplace interventions. METHODS: A retrospective cohort study of gold miners with known dates of seroconversion to HIV, and an HIV-negative comparison group, used routinely collected data to estimate the proportion of time off work by calendar period (1992-2002, prior to the introduction of ART), age, time since seroconversion and period before death. The authors calculated ORs for overall time off work and RR ratios (RRR, using multinomial logistic regression) for reasons off work relative to being at work. RESULTS: 1703 HIV-positive and 4859 HIV-negative men were followed for 34 424 person-years. HIV-positive miners spent a higher proportion of time off work than negative miners (20.7% vs 16.1%) due to greater medical and unauthorised absence. Compared with HIV-negative miners, overall time off work increased in the first 2years after seroconversion (adjusted OR 1.40 (95% CI 1.36 to 1.45)) and then remained broadly stable for a number years, reaching 38.8% in the final year before death (adjusted OR 3.27, 95% CI 2.95 to 3.63). Absence for medical reasons showed the strongest link to HIV infection, increasing from an adjusted RRR of 2.66 (95% CI 2.45 to 2.90) for the first 2years since seroconversion to 13.6 (95% CI 11.8 to 15.6) in the year prior to death. CONCLUSIONS: Time off work provides a quantifiable measure of the effect of HIV on overall morbidity. HIV/AIDS affects both labour supply (increased time off work) and demand for health services (increased medical absence). The effects occur soon after seroconversion and stabilise before reaching very high levels in the period prior to death. Occupational health services are an important setting to identify HIV-infected men early.

The risk of asbestos exposure in South African diamond mine workers.

OBJECTIVES: Asbestos is associated with South African diamond mines due to the nature of kimberlite and the location of the diamond mines in relation to asbestos deposits. Very little is known about the health risks in the diamond mining industry. The objective of this study was to explore the possibility of asbestos exposure during the process of diamond mining. METHODS: Scanning electron microscopy and energy-dispersive X-ray spectroscopy analysis were used to identify asbestos fibres in the lungs of diamond mine workers who had an autopsy for compensation purposes and in the tailings and soils from three South African diamond mines located close to asbestos deposits. The asbestos lung fibre burdens were calculated. We also documented asbestos-related pathological findings in diamond mine workers at autopsy. RESULTS: Tremolite-actinolite asbestos fibres were identified in the lungs of five men working on diamond mines. Tremolite-actinolite and/or chrysotile asbestos were present in the mine tailings of all three mines. Mesothelioma, asbestosis, and/or pleural plaques were diagnosed in six diamond mine workers at autopsy. CONCLUSIONS: These findings indicate that diamond mine workers are at risk of asbestos exposure and, thus, of developing asbestos-related diseases. South Africa is a mineral-rich country and, when mining one commodity, it is likely that other minerals, including asbestos, will be accidentally mined. Even at low concentrations, asbestos has the potential to cause disease, and mining companies should be aware of the health risk of accidentally mining it. Recording of comprehensive work histories should be mandatory to enable the risk to be quantified in future studies.

Trends in lung cancer mortality in South Africa: 1995-2006.

BACKGROUND: Cancer remains a major cause of morbidity and mortality worldwide. In developing countries, data on lung cancer mortality are scarce. METHODS: Using South Africa's annual mortality and population estimates data, we calculated lung cancer age-standardised mortality rates for the period 1995 to 2006. The WHO world standard population was used as the reference population. Scatter plots and regression models were used to assess linear trends in mortality rates. To better characterise emerging trends, regression models were also partitioned for defined periods. RESULTS: Lung cancer caused 52,217 deaths during the study period. There were 4,525 deaths for the most recent year (2006), with men accounting for 67% of deaths. For the entire South African population, the age-standardised mortality rate of 24.3 per 100,000 persons in 1995 was similar to the rate of 23.8 per 100,000 persons in 2006. Overall, there was no significant decline in lung cancer mortality in South Africa from 1995 to 2006 (slope = -0.15, p = 0.923). In men, there was a statistically non-significant annual decline of 0.21 deaths per 100,000 persons (p = 0.433) for the study period. However, from 2001 to 2006, the annual decline of 1.29 deaths per 100,000 persons was statistically significant (p = 0.009). In women, the mortality rate increased significantly at an annual rate of 0.19 per 100,000 persons (p = 0.043) for the study period, and at a higher rate of 0.34 per 100,000 persons (p = 0.007) from 1999 to 2006. CONCLUSION: The more recent declining lung cancer mortality rate in men is welcome but the increasing rate in women is a public health concern that warrants intervention. Smoking intervention policies and programmes need to be strengthened to further reduce lung cancer mortality in men and to address the increasing rates in women.

High rates of recurrence in HIV-infected and HIV-uninfected patients with tuberculosis.

BACKGROUND: The rate of recurrent tuberculosis disease due to reinfection, compared with the incidence of new tuberculosis, in those with and without HIV infection is not known. METHODS: In a retrospective cohort study of South African gold miners, men with known dates of seroconversion to HIV (from 1991 to 1997) and HIV-negative men were followed up to 2004. Rates of tuberculosis recurrence >2 years after the first episode were used as a proxy for reinfection disease rates. RESULTS: Among 342 HIV-positive and 321 HIV-negative men who had had 1 previous episode of tuberculosis, rates of recurrence were 19.7 cases per 100 person-years at risk (PYAR; 95% confidence interval [CI], 16.4-23.7) and 7.7 cases per 100 PYAR (95% CI, 6.1-9.8), respectively. The recurrence rate did not vary by duration of HIV infection. Recurrent pulmonary tuberculosis rates >2 years after the first episode were 24.4 cases per 100 PYAR (95% CI, 17.2-34.8) in HIV-positive men and 4.3 cases per 100 PYAR (95% CI, 2.2-8.3) in HIV-negative men, compared with incidence rates of new pulmonary tuberculosis of 3.7 cases per 100 PYAR (95% CI, 3.3-4.1) in HIV-positive men and 0.75 cases per 100 PYAR (95% CI, 0.67-0.84) in HIV-negative men in the same cohort. CONCLUSIONS: Tuberculosis recurrence rates, likely due to reinfection, were much higher than incidence rates. The findings suggest heterogeneity in susceptibility, implying that a vaccine could still provide useful protection in the population and strengthening the case for secondary preventive therapy.

Process evaluation of a pre-adolescent transdisciplinary health intervention for inter-generational outcomes.

BACKGROUND: The CIrCLE of Life Initiative was implemented to 537 grade 6 learners and their parents, in five Government-run South African primary schools. The transdisciplinary intervention was intended to increase knowledge and skills on HIV and obesity. The study aim was to assess and report on the implementation process. METHODS: Data was collected on an adapted Proctor's taxonomy of implementation outcomes, and to assess participants' experiences. Qualitative and quantitative data were collected through educator logbooks, researcher observations, and learner-parent workbooks. RESULTS: Differentiations between the various school contexts were observed. The process evaluation revealed high learner penetration (97.2%), but lower learner and parent exposure (44.3% and 55.5%, respectively). All educators thought that the intervention was a fit for both rural and urban schools, different socio-economic groups, and people of different ethnic and cultural backgrounds. The intervention was perceived to be sustainable, and there were recommendations for adoption into the school curriculum and scale-up if found to be effective. CONCLUSION: The process evaluation facilitated the assessment of the implementation outcomes, described its processes, and acknowledged fundamental characteristics that could justify variability in the intervention impact and outcomes. The value of process evaluations and their benefit to the science of implementation were demonstrated.

Physicochemical Properties of Indoor and Outdoor Particulate Matter 2.5 in Selected Residential Areas near a Ferromanganese Smelter.

Particulate matter (PM) of different sizes and elemental composition is a leading contributor to indoor and outdoor air pollution in residential areas. We sought to investigate similarities between indoor and outdoor PM2.5 in three residential areas near a ferromanganese smelter in Meyerton to apportion the emission source(s). Indoor and outdoor PM2.5 samples were collected concurrently, using GilAir300 plus samplers, at a flow rate of 2.75 L/min. PM2.5 was collected on polycarbonate membrane filters housed in 37 mm cassettes coupled with PM2.5 cyclones. Scanning electron microscopy coupled with energy-dispersive spectroscopy was used to study the morphology, and inductively coupled plasma-mass spectroscopy was used to analyse the elemental composition of the PM2.5. Mean indoor and outdoor PM2.5 mass concentrations were 10.99 and 24.95 µg/m3, respectively. Mean outdoor mass concentration was 2.27-fold higher than the indoor concentration. Indoor samples consisted of irregular and agglomerated particles, ranging from 0.09 to 1.06 µm, whereas outdoor samples consisted of irregular and spherical particles, ranging from 0.10 to 0.70 µm. Indoor and outdoor PM2.5 were dominated by manganese, silicon, and iron, however, outdoor PM2.5 had the highest concentration of all elements. The ferromanganese smelter was identified as the potential main contributing source of PM2.5 of different physicochemical properties.

Occupational Hearing Loss for Platinum Miners in South Africa: A Case Study of Data Sharing Practices and Ethical Challenges in the Mining Industry.

BACKGROUND: The relevant legislation ensures confidentiality and has paved the way for data handling and sharing. However, the industry remains uncertain regarding big data handling and sharing practices for improved healthcare delivery and medical research. METHODS: A semi-qualitative cross-sectional study was used which entailed analysing miners' personal health records from 2014 to 2018. Data were accessed from the audiometry medical surveillance database (n = 480), the hearing screening database (n = 24,321), and the occupational hygiene database (n = 15,769). Ethical principles were applied to demonstrate big data protection and sharing. RESULTS: Some audiometry screening and occupational hygiene records were incomplete and/or inaccurate (N = 4675). The database containing medical disease and treatment records could not be accessed. Ethical challenges included a lack of clarity regarding permission rights when sharing big data, and no policy governing the divulgence of miners' personal and medical records for research. CONCLUSION: This case study illustrates how research can be effectively, although not maliciously, obstructed by the strict protection of employee medical data. Clearly communicated company policies should be developed for the sharing of workers' records in the mining industry to improve HCPs.

A Rapid Motor Task-Based Screening Tool for Parkinsonism in Community-Based Studies.

Background: The prevalence of parkinsonism in developing countries is largely unknown due to difficulty in ascertainment because access to neurologists is often limited. Objective: Develop and validate a parkinsonism screening tool using objective motor task-based tests that can be administered by non-clinicians. Methods: In a cross-sectional population-based sample from South Africa, we evaluated 315 adults, age >40, from an Mn-exposed (smelter) community, using the Unified Parkinson Disease Rating Scale motor subsection 3 (UPDRS3), Purdue grooved pegboard, and kinematic-UPDRS3-based motor tasks. In 275 participants (training dataset), we constructed a linear regression model to predict UPDRS3. We selected motor task summary measures independently associated with UPDRS3 (p < 0.05). We validated the model internally in the remaining 40 participants from the manganese-exposed community (test dataset) using the area under the receiver operating characteristic curve (AUC), and externally in another population-based sample of 90 participants from another South African community with only background levels of environmental Mn exposure. Results: The mean UPDRS3 score in participants from the Mn-exposed community was 9.1 in both the training and test datasets (standard deviation = 6.4 and 6.1, respectively). Together, 57 (18.1%) participants in this community had a UPDRS3 ≥ 15, including three with Parkinson's disease. In the non-exposed community, the mean UPDRS3 was 3.9 (standard deviation = 4.3). Three (3.3%) had a UPDRS3 ≥ 15. Grooved pegboard time and mean velocity for hand rotation and finger tapping tasks were strongly associated with UPDRS3. Using these motor task summary measures and age, the UPDRS3 predictive model performed very well. In the test dataset, AUCs were 0.81 (95% CI 0.68, 0.94) and 0.91 (95% CI 0.81, 1.00) for cut points for neurologist-assessed UPDRS3 ≥ 10 and UPDRS3 ≥ 15, respectively. In the external validation dataset, the AUC was 0.85 (95% CI 0.73, 0.97) for UPDRS3 ≥ 10. AUCs were 0.76-0.82 when excluding age. Conclusion: A predictive model based on a series of objective motor tasks performs very well in assessing severity of parkinsonism in both Mn-exposed and non-exposed population-based cohorts.

Depression and anxiety in a manganese-exposed community.

OBJECTIVE: To characterize the association between residential environmental manganese (Mn) exposure and depression and anxiety, given prior associations among occupationally-exposed workers. METHODS: We administered the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) to 697 study participants in their preferred languages. These participants represented a population-based sample of residents aged ≥40 from two predominantly Black African communities in Gauteng province, South Africa: 605 in Meyerton, adjacent to a large Mn smelter, and 92 in Ethembalethu, a comparable non-exposed community. We investigated the associations between community (Meyerton vs. Ethembalethu) and severity of depression and anxiety, using linear regression, adjusting for age and sex. To document community-level differences in Mn exposure, we measured airborne PM2.5-Mn. RESULTS: Meyerton residents had BDI scores 5.63 points (95 % CI 3.07, 8.20) higher than Ethembalethu residents, with all questions contributing to this significant difference. STAI-state scores were marginally higher in Meyerton than Ethembalethu residents [2.12 (95 % CI -0.17, 4.41)], whereas STAI-trait scores were more similar between the communities [1.26 (95 % CI -0.82, 3.35)]. Mean PM2.5-Mn concentration was 203 ng/m3 at a long-term fixed site in Meyerton and 10 ng/m3 in Ethembalethu. CONCLUSION: Residence near Mn emission sources may be associated with greater depression symptomatology, and possibly current, but not lifetime, anxiety.

Oscillating migration and the epidemics of silicosis, tuberculosis, and HIV infection in South African gold miners.

BACKGROUND: Hundreds of thousands of men from rural areas of South Africa and neighboring countries have come to seek work in the gold mines. They are not immigrants in the usual sense as they work for periods in the mines, go home, and then return. This is termed oscillating or circular migration. Today we have serious interrelated epidemics of silicosis, tuberculosis, and HIV infection in the gold mining industry. METHODS: This article discusses the role of oscillating migration in fuelling these epidemics, by examining the historical, political, social, and economic contexts of these diseases. RESULTS: The impact of silicosis, tuberculosis, and HIV infection extends beyond individual miners to their families and communities. CONCLUSION: Failure to control dust and tuberculosis has resulted in serious consequences decades later. The economic and political migrant labor system provided the foundations for the epidemics seen in southern Africa today.