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Biomedical subjects

R Loewenson

Publications and source records attributed to R Loewenson.

At least 19 recordsLinked to original sources
PubMed2001

Globalization and occupational health: a perspective from southern Africa.

Increased world trade has generally benefited industrialized or strong economies and marginalized those that are weak. This paper examines the impact of globalization on employment trends and occupational health, drawing on examples from southern Africa. While the share of world trade to the world's poorest countries has decreased, workers in these countries increasingly find themselves in insecure, poor-quality jobs, sometimes involving technologies which are obsolete or banned in industrialized countries. The occupational illness which results is generally less visible and not adequately recognized as a problem in low-income countries. Those outside the workplace can also be affected through, for example, work-related environmental pollution and poor living conditions. In order to reduce the adverse effects of global trade reforms on occupational health, stronger social protection measures must be built into production and trade activities, including improved recognition, prevention, and management of work-related ill-health. Furthermore, the success of production and trade systems should be judged on how well they satisfy both economic growth and population health.

Africa, Southern↗
PubMed1999

Collaboration between developing and developed countries and between developing countries in occupational health research and surveillance.

Collaborative occupational health and safety studies between counterparts in developing and developed countries and between developing countries have demonstrated their potential for improving occupational health and safety. Such collaboration in occupational health and safety is encouraged in the development of infrastructure in research empowerment and capacity building. This action includes the setting of priorities, the identification and documentation of problems, sponsorship, data bases and surveillance systems, technical support, methodology, publishing, research and training programs, controlled intervention, information exchange, and networking. Examples of priorities in occupational health and safety in the developing world include the informal sector (informally hired and independent workers), temporary work, pesticides, accidents, dusts, carcinogens, solvents, ergonomics, women and child labor, human immunodeficiency virus/acquired immunodeficiencey syndrome (HIV/AIDS), and transfer of hazardous materials and technologies. The sustainability of occupational health and safety structures and functions in the developing countries is a primary concern. Socioethical principles emphasize local, national, mutual and global gains. Examples of collaboration are given. Pervasive problems and strategies toward their solution are highlighted.

Developed Countries↗
PubMed1999

Assessment of the health impact of occupational risk in Africa: current situation and methodological issues.

This paper presents information from the current monitoring systems in Africa, mainly Southern Africa, for occupational illness and injury and discusses the quality of the reported data in estimating the health impact of occupational risk. The paper presents and discusses the current profile of reported injury and fatalities for those countries for which data are available, in particular for the countries of the Southern African Development Community. These data indicate that the reported annual injury rates for wage workers in the Southern African Development Community region range widely from 0.35 to 49.42 injuries per 1,000 workers, and reported occupational fatality in the region ranges from 0.85 to 21.6 fatalities per 100,000 workers. Despite wide variability in reported rates (probably caused by variability in coverage and accuracy of reporting systems), transport, agriculture, mining and, to a lesser extent, construction consistently make up about three-quarters of all fatalities, with vehicle- or transport-related causes accounting for high proportions of fatal accidents. The paper identifies and discusses major sources and direction of bias and error in the reported data and suggests approaches for a better assessment of the health impact of occupational illness, injury, and mortality in African countries.

Africa South of the Sahara↗
PubMed1995

Isolated Musculocutaneous Nerve Injury: A Case Report.

A case report of an isolated musculocutaneous nerve injury distal to the branch to the coracobrachialis muscle of the non-dominant arm is described. The injury occurred in the context of an industrial setting, specifically, an assembly plant. The non-dominant limb was injured; in contrast, most reports indicate the dominant limb was affected during strenuous activity. Nerve function was monitored with serial electromyography. Management of the injury was conservative, with eventual full functional recovery.

Journal Article↗
PubMed1993

Structural adjustment and health policy in Africa.

World Bank/International Monetary Fund Structural Adjustment Programs (SAPs) have been introduced in over 40 countries of Africa. This article outlines their economic policy measures and the experience of the countries that have introduced them, in terms of nutrition, health status, and health services. The evidence indicates that SAPs have been associated with increasing food insecurity and undernutrition, rising ill-health, and decreasing access to health care in the two-thirds or more of the population of African countries that already lives below poverty levels. SAPs have also affected health policy, with loss of a proactive health policy framework, a widening gap between the affected communities and policy makers, and the replacement of the underlying principle of equity in and social responsibility for health care by a policy in which health is marketed commodity and access to health care becomes an individual responsibility. The author argues that there is a deep contradiction between SAPs and policies aimed at building the health of the population. Those in the health sector need to contribute to the development and advocacy of economic policies in which growth is based on human resource development, and to the development of a civic environment in Africa that can ensure the implementation of such policies.

Africa↗
PubMed1993

Estimating child mortality in Zimbabwe: results of a pilot study using the preceding births technique.

Using the preceding birth technique, 2,229 mothers were interviewed at four antenatal centres (two of which were urban) over a three month period during a pilot study in Zimbabwe. Results of the study showed that there was a small difference between the under two and under five mortality. The smaller than expected difference could have been due to some degree of urbanisation being experienced at two of the centres, and to a systematic selection bias of the method. Other findings of the study showed that younger mothers (under 20 years of age) and older mothers (over 40 years) experienced higher proportions of mortality, than mothers in the age group between. The higher proportion of male mortality compared to that for females reflected the expected trend, but the size of the difference was somewhat surprising, and could have been due to recall bias. The mean birth interval was 36 months, rather than the expected 30 months, and analysis of mortality in relation to birth interval and maternal age showed that a birth interval of less than 18 months was associated with higher child mortality, significantly so with the second last child, independent of mother's age. Longer birth intervals (more than three years) among older mothers were associated with higher changes of child survival. It is concluded that the Brass-Macrae method is a useful technique to analyse levels and trends of child mortality.

Adult↗
PubMed1992

The impact of home monitoring and daily diary recording on patient status in cystic fibrosis.

An experimental home monitoring system for assessing the progress and planning changes in the care of patients with cystic fibrosis (CF) has been implemented at the University of Minnesota Cystic Fibrosis Center. One group of patients and families did daily recording of physical measurements and symptoms, and sent the diary to the data coordinating center weekly for analysis. The remaining patients were not part of the home monitoring program. Twenty-five patients were randomly selected from the home monitoring group. They were compared to an age- and sex-matched control group not doing home monitoring to ascertain if home self-measurement and daily diary recording, in the absence of any therapeutic intervention, produced any change in physical or psychological status, pulmonary function, or growth over a 4-year study period. Subjects ranged in age from 6 to 43 years. Clinical status was measured by the National Institutes of Health cystic fibrosis scoring system. Pulmonary function was assessed as percent of predicted forced vital capacity and percent of predicted forced expiratory volume in 1 sec (FEV1). Growth was analyzed as percent of predicted weight based on age-, sex-, and height-dependent equations. Psychological status was determined by self-assessment and referral for conseling. Only percent predicted FEV1 in the control group declined significantly. There were no statistically significant changes in any other measures either within or between diary and nondiary groups over the 4-year period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Challenges to equity in health and health care: a Zimbabwean case study.

The current economic crisis in Africa has posed a serious challenge to policies of comprehensive and equitable health care. This paper examines the extent to which the Zimbabwe government has achieved the policy of "Equity in Health" it adopted at independence in 1980, that is provision of health care according to need. The paper identifies groups with the highest level of health needs in terms of both health status and economic factors which increase the risk of ill health. It describes a series of changes within the health sector in support of resource redistribution towards health needs, including a shift in the budget allocation towards preventive care, expansion of rural infrastructures, increased coverage of primary health care, introduction of free health services for those earning below Z$150 a month in 1980, increased manpower deployment in the public sector and the reorientation of medical training towards the health needs of the majority. The implementation of equity policies in health have however been challenged by several trends and features of the health care system, these becoming more pronounced in the economic stagnation period after 1983. These include the reduction in allocations to local authorities, increasing the pressure for fees, the static nominal level of the free health care limit despite inflation, the continued concentration of financial, higher cost manpower and other resources within urban, central and private sector health care and the lack of effective functioning of the referral system, with high cost central quaternary facilities being used as primary or secondary level care by nearby urban residents. While primary health care expansion has clearly been one of the success stories of Zimbabwe's health care post 1980, the paper notes plateauing coverage, with evidence of lack of coverage in more high risk, socio-economically marginal communities. Measures to address these continuing inequalities are discussed. Their implementation is seen to be dependent on increasing the capacity and organisation of the poor to more strongly influence policy and resource distribution in the health sector.

Financial Management↗
PubMed1988

Labour insecurity and health: an epidemiological study in Zimbabwe.

Existing data on health status and health care provision in agricultural labour communities in Zimbabwe indicate that both are poor. In addition, there is evidence that the concentration of capital through increased areas of landholdings, through mechanisation and use of agrochemicals produces a rise in under- and unemployment within the agricultural sector, which increases the risk of ill health. This paper addresses this question in Zimbabwe by examining the nature of developments within the large scale agricultural sector in the last decade, and the consequent effects on employment and income. Rising capital intensity in the private large scale sector is found to be associated with increases in unemployment and underemployment. The impact of this socioeconomic pattern on health is assessed in a longitudinal assessment of 78 permanent labour families and 76 non-permanent (underemployed) labour families in the large scale farming sector. The study shows that while poor social, economic and health conditions exist in all groups, non-permanent labour households suffer greater insecurity of employment and income, poorer health status and lesser participation in sociopolitical structures important for negotiating primary health care gains.

Agriculture↗
PubMed1986

Piped water supply and intestinal parasitism in Zimbabwean schoolchildren.

The prevalence of intestinal parasitism in primary schoolchildren in three areas, communal (peasant farm) lands, commercial farms and urban townships, was assessed by examination of concentrated and stained stool specimens to determine the effect of water supply on intestinal parasitism. Piped water in communal lands was associated with decreased frequency of schistosomiasis and hymenolepiasis, but not with decreased frequency of protozoa. Schistosomiasis was very common in commercial farm labour communities, particularly on farms adjoining the local river, despite the availability of stored borehole water supplied through communal taps. The prevalence of intestinal parasitism in children from urban areas with municipal water supplied to taps in each household was similar to that of children in communal areas who obtained water from surface streams. The frequency of Giardia lamblia infection was higher in urban than in rural schoolchildren, and within communal areas was higher in children with access to protected borehole water. The provision of piped water was, therefore, not found to be associated with reduced prevalence of intestinal parasitism, though additional factors such as frequency of contact with infected water, the provision of ancillary improvements and the actual usage of available water supplies would need to be more closely assessed.

Adolescent↗
PubMed1986

Giardiasis and the nutritional status of Zimbabwean schoolchildren.

Stool specimens, obtained from 1813 schoolchildren from communal lands, commercial farms and urban areas in Zimbabwe, were examined for helminth and protozoan parasites. The findings were collated with anthropometric data on the same children to investigate the relationship between intestinal parasitism and nutritional status. Protozoan infections were common with Giardia lamblia being identified in 17.4% of children. There was a strong association between giardial infection and undernutrition, wasting and stunting in these children. There was no evidence of an association between helminth infection and undernutrition. In view of the known impairment of absorption from the gut in giardiasis, it is suggested that giardial infection may be an important factor contributing to the low nutritional status of many primary schoolchildren in Zimbabwe.

Child↗
PubMed1985

Seasonal incidence of phenytoin allergy unrelated to plasma levels.

In a three-year prospective study of patients to whom phenytoin was administered, 26 (8.5%) of 306 patients manifested an erythematous morbiliform rash within three weeks of onset of therapy. Occurrence of the rash was not related to the mode of administration of treatment (loading v maintenance) or initial phenytoin levels. A striking seasonal incidence of the rash was noted: None of the 79 persons who received the initial dose during December to February had a reaction, whereas 13 (20.6%) of 63 persons treated during June to August manifested the rash. For March to May, the rate was 10% (8/88), and for September to November, 6.7% (5/76). Monthly rates were significantly different by chi 2 test.

Adolescent↗
PubMed1985

Ictal characteristics of pseudoseizures.

The spontaneous pseudoseizures resembling tonic-clonic seizures in 25 patients were recorded on simultaneous videotape and electroencephalograms and were compared with the seizures recorded from 25 patients with true tonic-clonic epileptic events. The goal of the comparison was to identify bedside clinical criteria to assist in differentiating between the two groups. The variables of age, sex, and selected physical manifestations of the events were compared for the two groups by appropriate statistical methods, including a multivariate step-wise discriminate analysis. Significant differences between the two groups of seizures were identified for several variables, and most strikingly for the character of upper and lower extremity movements, the time of vocalization during the event, the character of pelvic movements, and the nature of body tone during the events. Useful bedside criteria for distinguishing a pseudoseizure from a tonic-clonic seizure were identified.

Adolescent↗
PubMed1984

Critical frequency of photic driving in the diagnosis of multiple sclerosis.

Pattern visual evoked response (PVER) and critical frequency of photic driving (CFPD) to repetitive flash stimuli were studied in 68 consecutive patients suspected of multiple sclerosis (MS) and 15 normal controls to assess the diagnostic value of combined PVER-CFPD testing. Clinically, 38 qualified for the diagnosis of MS while 30 did not. The CFPD was found to be unreliable for detecting optic nerve dysfunction (OND) in MS, since well-defined photic driving at all frequencies above 40 flashes per second was not present in 14 patients without MS (47%) and in three normal control subjects (20%). The PVER, on the other hand, was highly sensitive and specific for OND, being abnormal in 12 patients with definite MS (92%) but in none of the normal controls. It is concluded that PVER by itself is a valuable test for the diagnosis of OND in MS and additional CFPD testing is uninformative and may even be misleading.

Adolescent↗
PubMed1984

Home-based oral rehydration therapy in rural Zimbabwe.

A study was carried out in four rural areas of Zimbabwe to assess the acceptability, feasibility and accuracy of sugar-salt solutions and to investigate the action taken during a recalled episode of diarrhoea in a child. Only 5% of respondents gave the child a sugar-salt solution at home during the described illness yet a majority (52%) claimed knowledge of oral rehydration techniques. A great variety of recipes were described; 46% of respondents knew a recipe for a solution containing sugar and salt and 12% were able to describe the standard recipe for sugar-salt solutions. Those who knew a recipe for a sugar-salt solution were asked to prepare a sample for chemical analysis; of those who prepared a sample, 26% prepared a solution having both sucrose and sodium concentrations within the safe and effective ranges. Surprisingly therefore, 12% (26% X 46%) of rural adults were able to prepare a safe and effective oral rehydration solution, despite the fact that there is as yet no concerted programme for the promotion of home-based oral rehydration therapy in Zimbabwe. The standard method of preparation was taught to all respondents who had no previous knowledge of sugar-salt solutions. Recall of the standard method was good; after a period of 11 to 26 days 64% of respondents remembered the correct recipe and 84% prepared a solution having both sucrose and sodium concentrations in the safe and effective ranges. 92% of all households had a teaspoon, sugar and salt and 88% had all the required items: a 750 ml bottle, a teaspoon, sugar and salt. It is concluded that home-based oral rehydration therapy using sugar-salt solutions is an acceptable and feasible strategy for the early management of acute diarrhoea in rural Zimbabwe.

Child↗