[Problems of refuse disposal in the medical establishments].
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Under migration pressure, sanitary educational work is ineffective in the endemic area: newcomers' awareness of opisthorchiasis does not improve as their residence prolongs, the number of persons who recognize the harm of eating of raw fish and meat is increased. Hygienic education of newcomers is late and done only among a part of their contingent. Its unconvincing character is confirmed by late referral of those infected for being treated and struck off the register. Attention to the local population is being relaxed, which determines the low level of knowledge of what measures should be also made to prevent infection in this contingent which is an additional channel of information for new comers. The established epidemic situation in the opisthorchiasis-endemic area is largely determined by the fact that medical specialists know this problem badly.
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On March 2001 the regular quality control test of the water used for dialysis in an urban centre using a reverse osmosis system revealed a high level of organo-halogenated contamination. The compounds implicated were: trichloroethylene (trielene) [M.Wt. 131 D], tetrachloroethylene, trichloromethane (chloroform) [M.Wt. 121 D], chlorodibromomethane. The dialysis unit was closed. Water samples were analysed in duplicate. The table shows the values (in ppm or microgram/l) obtained for chloroform at the given times: March 8th, altered sample; March 12th, confirmation sample; March 16th, after osmosis membranes change; March 22nd, after carbon filtration replacement; March 26th, after softener resins substitution. The AAMI doesn't recommend any value for organo-halogenated compounds in dialysis water. In the past, the European Pharmacopoeia and the Italian Health Ministry released some reference values for tap water, values which were extended to water used for dialysis. The values are 1 ppm as reference value, 30 ppm as maximum accepted value for the sum of all organo-halogenated compounds, and 10 ppm as the recommended value. In conclusion, the problem was solved by progressive replacement of the components of the water treatment system, even though the real cause remained undetermined. No clinical symptom was recorded and no level of chloroform or trielene was detected in patients' sera despite the low molecular weight and low protein binding of the compounds. A strict control of the water quality and a more comprehensive and updated reference guide are needed for better and safer dialysis delivery.
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The chemical environmental pollution of industrial urban areas was comprehensively assessed. There was a correlation between some diseases and chemicals; some pollutants exert unidirectional adverse effects on human health. As a way of influencing the man-made load, the authors suggest that an increasing coefficient to the allocations to the health insurance fund should be introduced for the enterprises that cause the proven hazard to human health. The addressing approach to analyzing morbidity rates increases the validity of studies establishing the relationship of environmental factors to health indices.
The methods for integral assessments of human health indices were tested at different territorial units within the framework of development of sociohygienic monitoring. A microterritory as an information unit is proposed as the most adequate object of observation. The method of integral health indices is recommended for their assessment at the level of microterritories, integral entropy should be used for mapping an urban dwelling area.