Background Occupational exposures are associated with chronic obstructive pulmonary disease (COPD). This study investigated this association among a population with a high prevalence of tuberculosis and smoking. Methods Cases (n¼110) diagnosed by pulmonologists were selected from specialist respiratory clinics. Frequency sex-and age-matched controls (n¼102) were selected from other clinics at the same institutions. Lifetime occupational exposure histories were obtained through interviews. Exposure variables derived from the ALOHA Job Exposure Matrix (JEM) were used to complement the self-reporting variables. ORs were calculated from logistic regression models, adjusting for smoking and past history of tuberculosis. Percentage population attributable risk (PAR%) was also calculated. Results The adjusted ORs for COPD from the JEMderived high cumulative biological dust exposure, high cumulative mineral dust exposure and high cumulative gas and fumes exposure were 2.1 (95% CI 1.1 to 4.2), 1.1 (95% CI 0.6 to 2.4) and 1.8 (95% CI 0.8 to 3.9), respectively. Self-reported occupational exposures were associated with higher risks, with adjusted ORs for high dust exposure-years and high chemical, gas and fumes exposure-years of 5.9 (95% CI 2.6 to 13.2) and 3.6 (95% CI 1.6 to 7.9), respectively. Among ever smokers, there was an increased risk for COPD, with ORs ranging from 5.0 to 5.5. Tuberculosis was a strong risk factor, with an OR ranging from 7.7 to 8.1. The PAR% was 25% for selfreported high exposures, but lower when the JEM variables were used. Conclusions Lifetime occupational exposures contribute to the risk of COPD, adjusted for smoking. These risks are present in populations with a high burden of tuberculosis, which is considered an important causative factor.
Background: South African cities have been beleaguered with urban deterioration challenges, especially dumping and littering, notwithstanding the regulatory framework and the continuous clean-up programmes undertaken by municipalities. This article identifies the challenges within eThekwini Metropolitan Municipality in addressing littering and dumping, and recommends improvements towards urban regeneration efforts.Objectives: To critically evaluate compliance of legislation and efficacy of the urban regeneration programmes implemented, which addressed littering and dumping within the inner city of eThekwini Metropolitan Municipality.Method: This convergent mixed-method research followed a case study approach and involved the analysis of primary data obtained from a qualitative perspective, including semi-structured interviews and questionnaires; and secondary analysis of quantitative data in the form of documents and reports obtained from the municipality.Results: The article identified that urban degeneration, specifically litter and dumping, occurred as a result of ineffective compliance of regulations and lack of enforcement; outdated service levels, lack of monitoring and evaluation of programmes; lack of education initiatives; ineffective leadership and governance; lack of involvement of citizens and businesses in clean city initiatives; and the negative behavioural patterns of citizens.Conclusion: The key recommendations for municipalities include implementing an integrated strategic plan for urban regeneration within a proactive policy and regulatory environment; monitoring and evaluation of programmes related to urban regeneration; increased resources dedicated to waste management and enforcement; implementing enforcement and consequence management strategies; and stimulating change in the behaviour patterns of citizens, businesses as well as municipality employees.
Background: South African cities have been facing challenges since democratisation to meet the expectations of the citizens. The challenges have included fraud and corruption, financial constraints, lack of service delivery and technological progress, amongst others, which were underpinned by weak leadership and governance processes. This article explored eThekwini Metropolitan Municipality’s technological progress and identified that inefficiencies in good governance and the lack of a governance framework have limited digitalisation.Aim: The aim of this study was to assess the progress towards digitalisation and review the effectiveness of the governance processes within the eThekwini Municipality in contributing towards the fourth industrial revolution.Setting: The study was based on the processes at the eThekwini Municipality in KwaZulu-Natal province, South Africa.Methods: A qualitative research approach was used, and the study is exploratory in nature.Results: The study identified that there was limited digitalisation at eThekwini Municipality. Furthermore, governance processes and an overall governance framework were lacking within the municipality. There was also limited support from the national government to address the fourth industrial revolution at local government level.Conclusion: The implications of a lack of a strong public governance framework, and not being supported sufficiently by the national government, mean that the eThekwini Metropolitan Municipality cannot compete internationally within the digital economy. The national government must co-ordinate a collaborated effort towards digitalisation, especially at municipal level. A multilevel governance framework, identifying collaboration between the various levels of government and the public, has been identified as the key response in embracing and enhancing the fourth industrial revolution within municipalities.
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