Winter Illnesses

Winter Illnesses

• Common cold

• Influenza

• Allergies

Possible causes of the increases in frequency of illnesses seen during winter:

• Decreased dietary nutrients

• Decreased levels of vitamin D

• Decreased levels of activity

• Close proximity to sick individuals

• Certain pathogens are more active in dry and cold air

Prevention

• Wash Hands

• Avoid exposure

• Exercise

• Balanced Diet

• Sleep

• Stress management

NATIONAL ENVIRONMENTAL MANAGEMENT: AIR QUALITY ACT, ACT 39 OF 2004: DRAFT DUST CONTROL REGULATIONS

Please note that the Minister of Water and Environmental Affairs, has given notice of her intention to, under paragraphs under paragraph (o) of section 53,read with section 32 of the National Environmental Management: Air Quality Act, 2004 (Act No. 39 of 2004), make the national dust control regulations.

This notice of was published in Government Gazette 34307 under GeN309 on 27 May 2011.

Any person who wishes to submit written representations or comments in connection with the draft amendments was invited to do so within 60 days of the date of the notice. Deadline for submissions: 26 July 2011.

By post to: The Director-General: Environment Affairs

Attention: Mr Olebogeng Matshediso, Private Bag x447, Pretoria, 0001

By fax to: (012) 320-1167

By e-mail to: OMatshediso@environment.gov.za

Hand delivered at: 315 Pretorius Street, Corner Pretorius and Van Der Walt Streets, Fedsure Forum Building, 2nd Floor, North Tower

Any enquiries in connection with the draft regulations can be directed to Dr. Thuli Mdluli at (012) 310-3436 or Mr Olebogeng Matshediso at (012) 310-3102.

Comments received after the closing date may not be considered.

We have for your ease of reference, included a copy of the Notice, and Schedule to it.

SCHEDULE

1. Definitions

In these regulations any word or expression to which a meaning has been assigned in the Act has that meaning, and unless the context indicates

otherwise

"the Act" means the National Environmental Management: Air Quality Act, 2004 (Act No. 39 of 2004); "Air Quality Officer" means an officer designated in terms of section 14 of the Act; "ASTM D1739" means the American Standard for Testing and Materials, which is the standard test method for the collection and measurement of dust fall; "dust" means airborne, particulate matter with a diameter smaller than 100 micrometers other than the small particles of carbonaceous matter directly emitted by a combustion process; "dust fall" means the deposition of dust; "light commercial area" means any area classified for light commercial use as per the local town planning scheme; "Minister" means the Minister of Water and Environmental Affairs; "residential area" means any area classified for residential use as per the local town planning scheme;

2. Purpose of the regulations

The purpose of the regulations is to prescribe general measures for the control of dust in all areas including residential and light commercial areas.

3. Prohibition

No person may conduct any activity in such a way as to give rise to dust in such quantities and concentrations that -

(1) The dust, or dust fall, has a detrimental effect on the environment, including health, social conditions, economic conditions, ecological conditions or cultural heritage, or has contributed to the degradation of ambient air quality beyond the premises where it originates; or

(2) The dust remains visible in the ambient air beyond the premises where it originates; or

(3) The dust fall at the boundary or beyond the boundary of the premises where it originates exceeds

(a) 600 mg/m2/day averaged over 30 days in residential and light commercial areas measured using reference method ASTM D1739; or

(b) 1200 mg/m2/day averaged over 30 days in areas other than residential and light commercial areas measured using reference method ASTM D1739.

4. Dust fall monitoring

(1) An air quality officer may require any person to undertake a dust fall monitoring programme as contemplated In regulation 4(2) if -

(a) the air quality officer reasonably suspects that the person has on one or more occasions contravened regulation 3.

(b) the air quality officer reasonably suspects that the person is contravening regulation 3.

(c) The activity being conducted by the person requires a fugitive emission management plan in terms of any Notice published in terms of Section 21 of the Act.

(2) A dust fall monitoring programme includes the implementation of all reasonable measures required to effectively measure, report and verify compliance or noncompliance with regulation 3 to the satisfaction of the air quality officer.

5. Ambient dust monitoring

An air quality officer may require any person to undertake continuous ambient air quality monitoring in accordance with any Notice published in terms of Section 9 of the Act if a dust fall monitoring programme contemplated in regulation 4(2) or any dust fall monitoring activities undertaken by an air quality officer or on behalf of an air quality officer indicates possible non-compliance with regulation 3.

6. Offences

A person is guilty of an offence if that person-

(1) contravenes a provision of regulation 3.

(2) fails to implement a dust fall monitoring programme as required by an air quality officer in terms of regulation 4.

(3) Fails to undertake continuous ambient air quality monitoring as required by an air quality officer in terms of regulation 5.

7. Penalties

A person convicted of an offence referred to in regulation 6 is liable to -

(1) imprisonment for a period not exceeding five years;

(2) an appropriate fine; or

(3) both a fine and imprisonment.

8. Short title and commencement

These regulations are called the National Dust Control Regulations, 2011 and shall come into operation on a date determined by the Minister by notice in the Gazette

Travellers Being Warned Against Measles

SASTM Newsflash

People travelling to their favourite destinations in the summer have been cautioned agains t measles. Around 10 000 people have been diagnosed with measles this year in 18 EU countries out of which, 4 have died. "All children and young people planning on travelling in Europe should ensure they have had 2 doses of MMR [vaccine] before they go away. France, Germany and Spain are all experiencing quite big outbreaks of measles and there are problems elsewhere in Europe," says Dr Brendan Mason, a consultant epidemiologist.

In the UK, 275 cases have been confirmed been January and April this year, a number much higher than that of last year [2010] which was 33, for the same time period.

France has declared measles epidemic officially as 5000 people have contracted the disease in France in the 3 months from January to March alone, which is almost equal to the total cases reported in the country last year.

Turkey and Bulgaria have faced major outbreaks. Belgium, Germany, Denmark, Romania, the Russian Federation, Sweden, Norway and Switzerland have also reported more cases than they usually do.

Children between one and 4 have the highest probability of getting measles. Vaccination is the only way it can be prevented. In every 1000 people who are affected by measles, one dies.

Communicated by: ProMED-mail

South African Society of Travel Medicine (SASTM)

Colds and Flu

The terms “cold” and “flu” are often used synonymously, however they are actually 2 very different infections.

 

What is a Cold?

 

Other names:

• Acute coryza

• Upper Respiratory Tract Infection

 

Aetiology:

• The common cold refers to a viral infection of the upper respiratory tract. It is caused by a group of viruses called the Picornaviruses.

• The infection causes an inflammation of the mucous membranes lining the upper respiratory tract, resulting in an increase in the mucous production.

 

Symptoms:

• The onset of the symptoms is typically rapid, and the first symptom to develop is usually a sore throat.

• This is followed by itching or burning of the nose.

• Sneezing and rhinorrhoea (discharge of mucous from the nasal cavity, a “runny nose”), is usually the last symptom to develop.

• The discharge is typically watery and clear or white in colour during the first few days, however as the infection progresses the mucous becomes thicker.

• Children also often present with a cough. This may be a result of a postnasal drip irritating the larynx or due to increased mucous production within the lungs.

• The majority of children will appear fatigued and irritable during the infection as the body uses energy to fight the virus.

• Symptoms of the common cold last roughly a week.

• Lymphadenopathy is uncommon in viral infections.

 

Risk factors

• Contrary to popular belief, exposure to cold does not appear to have a significant effect on the chances of contracting a cold. However, there are a few factors which have been shown to increase a person’s susceptibility to developing symptoms in response to a Picornaviruse infection.

• Previous exposure to the virus or to a similar strain of the virus reduces the chances of developing symptoms in response to the infection. The immune system of a child is still developing and has not been exposed to as many pathogens as the immune system of an adult. Thus children are more susceptible to “catching a cold” than adults are.

• A lack of sleep and increased stress levels has also been shown to increase the risk of catching a cold.

• Children who are prone to allergic disorders, such as seasonal allergies, allergic asthma or allergic dermatitis, are at an increased risk of catching a cold.

 

Treatment

• Treatment for patients with the common cold is largely supportive.

• Nasal congestion and sinus pain may be managed by using nasal decongestants, however it is important to remember that a large majority of these have a rebound effect after prolonged use.

• Vapour rub products, are often used to help clear the airways.

• Sore throats or sinus headaches can be treated with mild analgesics.

• Avoid strenuous physical activity and encourage the caretakers to keep the child indoors and allow the child to rest and recuperate.

• A change in temperature and exposure to environmental allergens (such as dust and pollen), may aggravate the symptoms.

• Dairy appears to increase the mucous production, and should therefore be avoided during infection.

• Most importantly, the child needs to be carefully monitored in order to detect any secondary bacterial infection which may require antibiotics or further medical treatment.

 

Complications

• In immunosuppressed or weak individuals who are unable to fight the virus, the infection may spread to the lower respiratory tract.

• Secondary bacterial infection may develop and is characterised by a purulent discharge and the development of a fever.

• Children with asthma and respiratory disorders are at risk of complications associated with a flare up of respiratory systems, such as an asthmatic attack.

 

What is the Flu?

 

Other names:

• Influenza

 

Aetiology:

• Influenza is caused by the Influenza virus type A, B or C.

• The influenza virus results in inflammation of the lower respiratory tract.

• Outbreaks of influenza type A and B are most common during the autumn and winter months.

• Type C infections occur throughout the year, however the symptoms caused by type C are slightly different to those caused by types A and B.

• The Influenza virus is highly mutanogenic, in other words, it is able to mutate and evolve relatively quickly. This results in slightly different variations of the virus appearing each year.

• Unfortunately this means that one exposure to the virus does reduce the chances of developing symptoms after the next exposure.

• This also means that vaccinations are seldom effective for longer than a year as each new strain requires a new vaccination.

• The use of vaccinations against the Influenza virus is therefore debateable. However children at risk of infection, whose health is compromised or in whom the virus has the potential to do more damage, are likely to benefit from annual Influenza vaccinations, when available.

 

Symptoms:

• The incubation period is around 2 days, after which the following symptoms begin to develop:

• Chills and fever with hot, moist and flushed skin.
• Pain and aching in the muscles and joints.
• Fatigue
• Headache
• Sore, itchy throat
• Irritating and non-productive cough.
• The eyes may appear red with inflamed conjunctiva and photophobia.

 • As the infection progresses, lower respiratory tract symptoms, such as a persistent and productive cough, become more pronounced. The cough may become suffocating and painful and in severe cases blood may be visible in the sputum.

Treatment

 • Again, treatment is largely supportive and includes pain management.

 • It is important to keep the child hydrated and warm and allow plenty of rest and recovery time.

 • Severe cases of the flu may be fatal and whilst the flu is common, it should not be taken lightly.

 • All children should be closely monitored for any signs of complications.

 • Should the symptoms not begin to clear within 5 days, or should there be any signs of secondary infection, encephalitis or pneumonia, then it is vital that the child receives prompt medical care by a suitably qualified healthcare practitioner.

Transmission of the Viruses:

 • Both viruses are transmitted via droplets of respiratory secretions or via contaminated hands or fingers. Thus the following measures are helpful in reducing the spread of infection:

•  Washing hands after sneezing
• Blowing the nose on disposable tissue paper and discarding the used tissue paper in the rubbish.
• Covering the nose and mouth during coughing and sneezing.

 • Children should be encouraged from a young age to follow the above guidelines.

 • It is also advisable that children remain at home whilst contagious (symptomatic) to prevent the spread to other children in the class or day care.

  

Dr. Carrie Minnaar (M.Tech Hom.)

 

  

References

 Dolin R. (2005) Influenza in Harrison’s Principles and Practice of Internal Medicine 16th Edition Edited by Kasper D.L., Braunwald E., Rauci A.S., Huaser S.L., Longo D.L. and Jameson J.L. London: McGraw-Hill, pp: 1066-

  

Merck Manual Seventeenth Edition (2005) Viral Infections Edited by Beers M.H. and Berkow R. Published by Merck Research Laboratories U.S.A. Pp: 1277-1289

  

Prescott C.J. (2006) Ear, Nose and Throat Disorders in Handbook of Paediatrics for Developing Countries Sixth Edition Edited by Harrisen V.C. Published by Oxford University Press, South Africa, Pp: 109-111

 

 

BREAKING NEWS! NEW CPR Protocol

The International Resuscitation Councils have announced a major change in the CPR Protocol. As of 2011 the following amendments are being agreed upon:

1. A patient who does not breathe is considered not to have heartbeat

2. Hence the checking of the pulse is no longer recommended

3. If a patient has breathing arrest, immediate CPR is required

4. During CPR, the helper FIRST administers the Chest compressions to supply the brain with immediate oxygen

5. Only then are mouth to Mouth Ventilations administered

6. Untrained Lay helpers are to be encouraged to assist by administering Chest Compressions ("fast and hard") while the trained First Aider administers the Mouth to Mouth ventilations

7. CPR is not to be interrupted every minute in order to reassess the breathing and/or pulse

8. CPR Rhythms remain unchanged:

      a. 1 Rescuer   30 Chest compressions : 2 Artificial Ventilations

      b. 2 Rescuers 15 Chest Compressions : 2 Artificial Ventilations

The old protocol is NOT incorrect, still it is believed that these amendments add to the effectiveness as well as to the simplicity of CPR.

Thermal conditions at work can lead to a strike!

It's officially winter and time to wrap-up and stay warm - if possible! Do you know that there are thermal requirements that you have to follow? This week's question is very interesting because our expert advises about PPE, appropriate temperature control, and strikes!

Question

A company  received a formal complaint from the union regarding the temperatures in the warehouse in the winter. The doors are only opened when they are loading parcels into the vehicles.

Can the company be held liable to install heaters in an area exceeding 1500 m2?

Must the company supply the employees with special protective clothing against the winter chill, or is it for their own account?

The employees are not working with or in refrigerated areas.

Can they call for a strike, because they get cold at work?

Answer


If the company needs to provide protective clothing, the company must carry the cost.


The company needs to do a risk assessment of the problem and determine what the actual ambient temperatures are where the employees are working. Then look at the Environmental Regulations for Workplaces Section 2(1) which deals with thermal requirements.

Essentially if the temperature goes below 6 degrees Celsius the employer must provide protective clothing. It is quite possible that the ambient temperature will be below 6 degrees at times.


What also needs to be taken into consideration is the fact that one of the first effects of being cold is the loss of muscle and grip strength. This could occur at temperatures above 6 degrees where people have been exposed to the cold for some time (the lower the temperature the shorter the time to experience this effect). The wind chill factor also needs to be taken into account.

Update on National Health Insurance

Health Minister Dr Aaron Motsoaledi has urged citizens who are concerned about the establishment of the National Health Insurance (NHI) to be patient as government is working around the clock on this issue.

"The problem is that many believe that NHI is just the release of a document. For us in health, we know that it also involves an extensive preparation of the health care system, while at the same time preparing a policy document and in this case, the reengineering of the Health Care System is very vital," Motsoaledi said.

Motsoaledi, who was presenting the department's R25.7-billion for 2011/12 on Tuesday, announced that additional earmarked funding has been allocated at provincial level for preparatory work for the NHI, which amounts to R16.1-billion over a three-year period.

He, however, pointed out that under the present health care system, whether public or private, no NHI can ever survive.

"I know that at face value, problems in the health system are said to be existing only in the public sector and the private sector must be left alone to some wayward phenomena called market forces, even though these market forces dismally failed to stop or more appropriately caused the most recent global economic collapse," Motsoaledi said.

He said while it is true that the public health care system is bedevilled by very poor management leading to poor quality care, adding to the very low resources available in the public health sector, the current overall health care system, both public and private, will be completely re-engineered.

"The present health care system is characterised by four very clearly identified negatives. It is unsustainable, very destructive, extremely costly and very hospicentric or curative in nature. For any intervention dealing with the cost of health care, like the NHI, to make any sense, a complete re-engineering is essential and it is an obligation placed upon our shoulders," Motsoaledi said.

Elaborating on the re-engineering of the health care system, Motsoaledi said it will be according to three main streams, with the first being a district based model, where a team of five specialist or clinicians shall be deployed in each district.

The team will consist of a principal obstetrician, a paediatrician, a family physician and an advanced midwife, while a senior primary care nurse will specifically focus on maternal and child mortality.

Motsoaledi said he has consulted all the deans of the eight medical schools in the country, the professional associations of paediatricians, obstetricians, family physicians, the Colleges of Medicines of South Africa responsible for specialist training and the nursing fraternity during the recent nursing summit, who supported the initiative.

He said his intention is that by the end of this calendar year, they should be far ahead in implementing this initiative, which will include the creation of the posts at district level, something that has never existed before and will be completely new in the public service.

"We are absolutely determined to make sure that this model is implemented. Once appointed, these teams will deal with guidelines and protocols at our antenatal care clinics, labour wards, post natal health care, and paediatrics and child health clinics.

"They will follow up on every case of mortality to make sure that ...meetings are held for every single incident, to deal with the cause at hospital level immediately rather than waiting for research studies and results later.

"The specialist teams will deal with training of interns, as well as community service doctors and medical officers. They will also focus on midwives and their practice in helping to bring down maternal mortality.

They will also assist primary health care nurses on following up on patients in their communities, especially for post natal care," said an optimistic Motsoaledi.

The second stream includes a school health programme, which will be launched with the Ministers of Basic Education and Social Development.

Mostoaledi said a task team established about two weeks ago is working around the clock to deal with these issues.

"This stream of Public Health Care (PHC) will deal with basic health issues like eye care problems, dental problems, hearing problems, as well as immunisation programmes in our schools ... It will move further on to deal with more complex problems like contraceptive health rights, which will include issues such as teenage pregnancy and abortions ... and HIV and Aids programmes among learners. Added to this will be [information on] drugs and  alcohol abuse in schools," Motsoaledi explained.

He noted that the task team consisted of all relevant stakeholders from the three departments, nongovernmental organisations (NGOs) dealing with children, universities and individual experts.

"When the team has completed its work, we will start implementation in the poorest schools ... which are also far from the nearest health centres."

The third stream will be a ward based PHC model, which will deploy at least 10 well trained PHC workers per ward.

"This method is being put to good use in Brazil, where 30 000 ... community health care agents have been deployed to various communities. I was also highly encouraged when the Minister of Health in India announced during the Moscow gathering last month that in his country, they are deploying 800 000 such cadres and they call them health care activists.

"A total of 251 teams have already been deployed and in just three months, have reached 41 000 families and, in the process, discovered that 18% of the screened people had TB," Motsoaledi said, pointing out that in the past they would never have picked up the cases and would have waited for them to show up in healthcare institutions when it was already too late.

He emphasised that the re-engineering of PHC system into three streams will consolidate PHC as the country's primary mode of health care delivery.

"It will encourage prevention of disease and promotion of health in contrast to the present obsession with treatment of individual disease when it is already too late for many individuals and at great cost to the fiscus and the GDP of our country.

"It is because of this hugely curative and costly health care system that some so-called experts believe NHI is an impossible dream."

Edited by: Bua News

The validity of medical certificates

Do your employees suffer from chronic Friday or Monday flu? Are they ill every other weekend and never hand in a sick note because it was only one day? What about that “clinic note” handed in, confirming a check-up, which resulted in a claim for paid sick leave at the end of the month? What about the medical certificate which was issued a day before the employee’s return from being ill for a week. And then there is also the occasional medical certificate that is completely illegible, from a strange doctor, and from a strange area, which is not even close to the employee’s home or workplace.

What are your rights with regards to accepting or refusing medical certi ficates and requiring one for the Monday or Friday flu?

If an employee is off sick for more than 2 consecutive days, OR for one day, but on 2 or more occasions in an 8 week period, you are entitled to request a medical certificate. An employer also has the right to refuse a medical certificate if the certificate is not valid. A medical certificate is only valid if:

• It states that an employee was UNFIT TO WORK for the duration of the employee’s absence on account of SICKNESS or INJURY; and

• It is issued and signed by a medical practitioner or another person who is certified to diagnose and treat patients AND who is registered with a professional council established by an act of parliam ent.

A medical certificate stating that the employee(patient) informed the doctor of his illness or that the doctor “saw” the patient, will not suffice, as the practitioner did not declare, in his professional opinion, that the employee(patient) WAS UNFIT TO PERFORM HIS DUTY – thus, unpaid leave. Clinic notes will also only be valid, if signed by a medical practitioner authorised to make a diagnosis and not if signed by the nurse or only stamped by the clinic. Check-ups, fetching of medicine, tests and examinations will not enable the employee to claim for paid sick leave, as it does not render him UNFIT TO PERFORM HIS DUTIES DUE TO ILLNESS OR INJURY – again, unpaid leave.

Unfortunately, the last-day-of-illness medical certificate has to be accepted if the medical professional s tated that, in his opinion, the employee (patient) was unfit to fulfil his duties due to illness. In this instance, warn the employee that in future, a medical certificate has to be obtained sooner than the last day of illness.

A Medical practitioner will be a doctor, dentist, psychologist with a Master degree, registered at the HPCSA, or if the practitioner is registered in terms of the Allied Health Services Profession Act.

Altered certificates will of course be rejected from the start, as well as illegible certificates.

The Health Professions Council of South-Africa’s (HPCSA’s) guidelines for a medical certificate shortly state that:

• it has to stipulate the name, address and qualifications of the medical practitioner,

• name of the patient, date and time of the exam,

• if the diagnosis was made in his professional opinion or if the patient informed him of the illness,

• the illness itself,

• if the patient is totally or partially unfit for duty and

• the recommended period of sick leave.

The patient has to consent to the details of the illness being stated in the medical certificate, and if withheld, a simple “illness” is sufficient.

Employers must also take into consideration that if they signed a collective agreement which states that medical certificates from traditional healers will be accepted, employers will have to accept these certificates.

If an employer normally accepted medical certificates from a traditional healer, the employer will be forced to accept similar medical certificates in the future.

Fraud is common practise when it comes to medical certificates. Take the time to phone the suspicious practitioner and confirm the appointment when in doubt. You’ll be amazed how often these practitioners don’t e xist or ever heard of the employee.