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Considerations in the selection and use of chemicals within the animal facility.

Chemicals are important and unavoidable parameters in the milieu of the laboratory animal used in biomedical research today. Examples of chemicals used include detergents and sanitizing agents. Detergents are used to remove dirt while sanitizing compounds, such as germicidal agents, decrease bacteria, fungi or viruses in the facility. The types used (that is, phenols, alcohols, oxidizing agents) depend upon the degree of cleanliness and the sanitizing properties desired and vary for germfree, specific pathogen-free and conventional animal facilities. Chemicals are routinely added to water to control bacteria in mouse facilities. Similarly, insecticides and pesticides are used to reduce the number of vermin in animal and feed rooms. Also, the bedding may contain chemicals (that is, cedrene and cedral in red cedar shavings). These and other chemicals in the vivarium may influence enzyme induction or inhibition, may result in increased or decreased toxicity, may alter the function or metabolism of organs and can thereby alter the outcome of animal experiments.

Animal Husbandry↗

HACCP models for quality control of entrée production in hospital foodservice systems. I. Development of hazard analysis critical control point models.

HACCP models were developed as part of a research project for quality control of entrée production in three types of hospital foodservice systems: Conventional, cook/chill, and cook/freeze. Critical control points at process stages were identified. Time-temperature was a critical control point throughout entrée production in each model; time-temperature parameters were established for critical control points. Equipment sanitation and personnel sanitation are critical control points for which standards must be established by each foodservice system. Determination of the effectiveness of control measures included continuous monitoring of critical control points for time-temperature. Sanitation of equipment and personnel should be monitored using standards established by the foodservice system.

Cooking↗

[Health promotion and prevention by urban renewal?].

This article is based on a study using different approaches to examine the links between urban development on the one hand and health promotion on the other. The background and basic concepts underlying this study are briefly explained. Programmatic papers from both spheres of approach result in the basic thesis that both urban development and health promotion are aiming at improving the quality of life in city districts (objective conditions of living and subjective feeling tone, i.e. subjective well-being) in the overall sense of a health-promoting general policy. Because of these common goals cooperation between both spheres is hypothesised. However, the study as a whole shows (especially an analysis of the documents of the files of the sanitation committee) that this is not so. To understand this finding better the freedom of both parties concerned to act as they should, is analysed, namely, that of the sanitation committee and of the regional health and environmental office. It becomes evident that in both these spheres the requisite monitoring capacities, such as legal support, finances, information service and counselling activities, are fundamentally lacking or indeed limited. Hence, there are limited chances of success in the spheres of health promotion and preventive care by means of sanitation of city districts. Finally, the authors point to long-term trends and developments that would make a future approach between the two spheres mandatory and (at least partially) possible.

Environmental Exposure↗

[Methods for the curative treatment of pleural empyema with bronchial fistulae in patients with pulmonary tuberculosis].

In contrast to non-specific pleural empyemas in which closed sanitization is sufficiently beneficial, an early application of thoracostoma is essential for patients with tuberculous pleural empyema with bronchial fistulas. Thoracostoma allows for effective sanitization of the cavity, long-term antituberculous chemotherapy and preparation of patients for radical operations. This has been supported by the comparative analysis of the outcomes of radical operations in 139 patients following closed and open management of the empyemic cavity in pulmonary tuberculosis. The site of thoracostoma is defined depending on the location and volume of an abscess and the forthcoming radical operation. Long-acting antiseptic dressings containing chlorohexidine bigluconate, which are based on the polymer polyhydroxyethyl methacrylate and which have been developed in the clinical setting, and ultraviolet irradiation with a unique-design apparatus are proposed for sanitization of open pleural empyemas.

Bronchial Fistula↗

[Typhoid fever in Chile 1977-1990: an emergent disease].

The emergence of old and new communicable diseases is becoming an important public health problem in industrialized and developing countries worldwide. Chile experienced, at the end of the seventies and during the eighties, epidemics of several emergent communicable infectious diseases whose relevance as public health problems had steadily decreased in the previous 25 years. The most striking of these epidemics was a severe outbreak of typhoid fever that lasted at least 10 years. The majority of the cases occurred in the urban setting of Santiago. Several investigators suggested, in light of apparently good sanitation statistics, that factors responsible for this outbreak of typhoid were an increase in the number of chronic carriers of Salmonella typhi, the lack of microbiological food controls and the consumption of vegetables irrigated with waste water contaminated with S typhi. However, there is a dearth of epidemiological information and field work confirming the role of these factors in this typhoid outbreak. Moreover, the sudden, massive and urban characteristics of this epidemic, coupled to contemporary information regarding shortcomings on the preparation of drinking water and on decreased availability of drinking water to the population in Santiago regardless of good sanitation statistics, suggest that this outbreak may have been partially waterborne. The beginning of this typhoid outbreak also coincided with increased rain fall, with rapidly deteriorating economic and social conditions manifested in high rates of unemployment, and with decreased government investment on social services, including sanitation and health. All these factors are known to influence the epidemiology of typhoid and other emergent diseases worldwide.

Chile↗

[Breast feeding. Health related and sociocultural influences and challenges].

Breastfeeding is being abandoned as the preferred feeding method in the early months of baby's life, and many early failures take place among the few mothers who attempt to breastfeed their babies. For that reason, sanitation professionals must encourage breastfeeding and convince mothers to keep it up, at least, for 4-6 months after giving birth. Analysis of pregnancy, delivery and after delivery sociocultural and sanitary conditions may help sanitation workers to elaborate an educational strategy that considers breastfeeding as healthy behavior that should he encouraged. The support of sanitation professionals is considered fundamental for breastfeeding maintenance, and a more profound training of these professionals about every aspect of breastfeeding is necessary. More active sanitary policies supporting this healthy behavior should also be established.

Attitude to Health↗

Epidemiology of gastroenteritis on cruise ships, 2001-2004.

BACKGROUND: The incidence of diarrheal disease among cruise ship passengers declined from 29.2 cases per 100,000 passenger days in 1990 to 16.3 per 100,000 passenger days in 2000. In 2002, the Vessel Sanitation Program of the Centers for Disease Control and Prevention reported 29 outbreaks (3% or more passengers ill) of acute gastroenteritis on cruise ships, an increase from 3 the previous year. This analysis of gastroenteritis on cruise ships, conducted in 2005, details the increase in outbreak incidence rates during 2001 through 2004. METHODS: Using Gastrointestinal Illness Surveillance System data, investigators evaluated incidence rates of gastroenteritis on cruise ships calling on U.S. ports, carrying 13 or more passengers, by cruise length and reporting region during the study period. The investigators also evaluated the association between inspection scores, and gastroenteritis incidence and the frequency of outbreaks in 2001 through 2004. RESULTS: During the study period, the background and outbreak-associated incidence rates of passengers with acute gastroenteritis per cruise were 25.6 and 85, respectively. Acute gastroenteritis outbreaks per 1000 cruises increased overall from 0.65 in 2001 to 5.46 in 2004; outbreaks increased from 2 in 2001 to a median of 15 per year in 2002-2004. Median ship inspection scores remained relatively constant during the study period (median 95 on a 100-point scale), and were not significantly associated with either gastroenteritis incidence rates (risk ratio, 1.00; 95% confidence interval, 0.98-1.02) or outbreak frequency (Spearman's coefficient, 0.01, p=0.84). CONCLUSIONS: Despite good performance on environment health sanitation inspections by cruise ships, the expectation of passenger cases of gastroenteritis on an average 7-day cruise increased from two cases during 1990-2000 to three cases during the study period. This increase, likely attributable to noroviruses, highlights the inability of environmental programs to fully predict and prevent risk factors common to person-to-person and fomite spread of disease.

Acute Disease↗

Water source, latrine type, and rainfall are associated with detection of non-optimal and enteric bacteria in the vaginal microbiome: a prospective observational cohort study nested within a cluster randomized controlled trial.

BACKGROUND: Less than one-third of sub-Saharan Africans have access to improved water sources. In US, Indian, and African studies, Bacterial vaginosis (BV) is increased among women with poor water, sanitation, and hygiene (WASH). We examined water source, sanitation (latrine type), and rainfall in relation to the vaginal microbiome (VMB). METHODS: In a cluster randomized controlled trial of menstrual cups and cash transfer, we measured the impact of cups on VMB via 16S rRNA gene amplicon sequencing in a subset of 436 adolescent girls. We analyzed how self-reported water source and latrine type at home related to VMB over 18-months, examining community state type I (CST-I, L. crispatus dominant) vs. other CST; alpha diversity; targeted taxa (coliform and other water-related pathogens); and non-targeted taxa via machine learning approaches. Mixed effects multivariable longitudinal models were adjusted for intervention arm, age, socioeconomic status, sexual activity, and cluster-level school WASH and rainfall (in millimeters). RESULTS: Adjusting for all covariates in all models: (1) the odds of CST-I were increased among participants with piped water (vs. pond), and decreased with traditional pit latrine vs. flush toilet. (2) Alpha diversity varied by water source and latrine type without consistent trends. (3) Coliform bacteria relative abundance (RA) was higher among participants with traditional pit or ventilated improved pit latrines vs. flush toilet, and higher among participants relying on stream vs. pond water. Streptococcus agalactiae RA was higher among participants with non-flush toilets, while Bacteroides fragilis RA was lower with non-flush toilets. (4) Key taxa from non-targeted analyses associated with water source and latrine type included typical vaginal bacteria, opportunistic pathogens, and urinary tract pathobionts. (6) Increased rainfall was associated with decreased odds of CST-I. TRIAL REGISTRATION: ClinicalTrials.gov NCT03051789, February 14, 2017.

Adolescent↗

The problem and control of gastrointestinal helminthiases in Zimbabwe.

An overview of the problem of gastrointestinal (GI) helminthiases in Zimbabwe is given in terms of prevalence, distribution, clinical significance of individual parasites and their transmission patterns. Although data on these aspects are incomplete, the available information and the results of studies conducted elsewhere should assist in the planning and implementation of effective helminthiasis intervention strategies. Community-based integrated helminthiasis control measures that include mass chemotherapy, improved sanitation and health education are considered to be the most practical interventions and are being evaluated in Zimbabwe. This community-based approach is cost-effective, as most of the control measures are carried out on a self-help basis. Besides, local voluntary health committees provide consistent community-level surveillance to promote and motivate the population to join in the intervention measures that include improved sanitation and health education, aspects which have broader implications for improved health.

Adolescent↗

Hazard analysis and critical control points of weaning foods.

Hazards and critical control points were identified during the preparation, feeding and storage of weaning foods fed to the children (6-24 months) belonging to low income group (LIG) families using survey methods, spot and indepth observations and microbial analysis. High microbial counts were obtained for the weaning food samples procured from the families that were rated as poor for both personal hygiene and environmental sanitation. Food samples that were held at ambient temperature (25-35 degrees C) showed high counts of coliforms, AMCC, yeast and mold, Staphylococcus aureus and Bacillus cereus. Spice mixtures and mop samples also revealed high counts for all these organisms. Coliforms were not isolated from the water samples of all the 10 households. However, a high count of Bacillus cereus (10(3-5)/ml) was observed in water samples of two selected households. The hazards and critical control points identified were high initial contamination of raw foods, poor environmental sanitation and personal hygiene, feeding of overnight moist foods stored at ambient temperature and insufficient steaming of these foods.

Bacillus cereus↗

Reduction in diarrhoeal diseases in children in rural Bangladesh by environmental and behavioural modifications.

The impact of a water, sanitation and hygiene education intervention project on diarrhoeal morbidity in children under 5 years old was evaluated in a rural area of Bangladesh. Data were collected throughout 1984-1987, covering both pre- and post-intervention periods, from an intervention and a control area. The 2 areas were similar with respect to most socio-economic characteristics and baseline levels of diarrhoeal morbidity. The project showed a striking impact on the incidence of all cases of diarrhoea, including dysentery and persistent diarrhoea. By the end of the study period, children in the intervention area were experiencing 25% fewer episodes of diarrhoea than those in the control area. This impact was evident throughout the year, but particularly in the monsoon season, and in all age groups except those less than 6 months old. Within the intervention area, children from households living closer to handpumps or where better sanitation habits were practised experienced lower rates of diarrhoea. These results suggest that an integrated approach to environmental interventions can have a significant impact on diarrhoeal morbidity.

Bangladesh↗

Are war and public health compatible?

A public health assessment during March, 1993, in Bosnia-Herzegovina and in the areas of Serbia and Montenegro hosting Bosnian refugees, revealed extensive disruption to basic health services, displacement of more than 1 million Bosnians, severe food shortages in Muslim enclaves in eastern Bosnia, and widespread destruction of public water and sanitation systems. War-related violence remains the most important public health risk; civilians on all sides of the conflict have been intentional targets of physical and sexual violence. The impact of the war on the health status of the population has been difficult to document; however, in the central Bosnian province of Zenica, perinatal and child mortality rates have increased twofold since 1991. The crude death rate in one Muslim enclave between April, 1992, and March, 1993, was four times the pre-war rate. Prevalence rates of severe malnutrition among both adults and children in central Bosnia have been increasing since November, 1992. Major epidemics of communicable diseases have not been reported; however, the risk may increase during the summer of 1993 when the effects of disrupted water and sanitation systems are more likely to promote enteric disease transmission. Economic sanctions against Serbia and Montenegro may lead to declining health care standards in those republics if basic medical supplies cannot effectively be exempted.

Adult↗

Correlates of life expectancy in less developed countries.

Analyses were performed to investigate several hypotheses concerning the multiple determinants of levels of life expectancy in developing countries in recent decades and some possible explanation for the observed variations in amount of gain in life expectancy from the 1950's to the 1970's. The findings were significant. For level of life expectancy the results of this present work conform by and large to results of other scholars in this area, although the present work is unique in that only developing countries were included. From the 1960's to the 1970's there has been a shift in the relative importance of economic indicators and general social indicators in favor of the social indicators. In the period 1960-65 some 70% of the variation in levels of life expectancy was associated with per capita income and literacy rates in a ratio of about three to two in favor of the economic variable. By 1970-75 the ratio has become six to one in favor of literacy. In addition, the multivariate model showed that the sanitation variables began to appear as significant correlates of levels of life expectancy in the more recent time period, playing a larger role than level of income per capita. Work pursued as part of a separate but concurrent project explored explicitly this three-way interaction between literacy, life expectancy and sanitation.

Developing Countries↗

Dilemmas of modernization in primary health care in Western Samoa.

This paper examines the historical development of rural women's associations (komiti tumama) in Western Samoa under New Zealand's colonial administration. These associations came to be the backbone of public health programmes and played a crucial role in preventive medicine at the village level: they embodied all the principles now subsumed under the rubric 'primary health care'. The successful growth of a rural, self-help system of primary health care in Samoa resulted from the use of traditional institutions to promote new practices in sanitation and health care. The system rewarded and fostered village autonomy and enhanced the status of married women. This paper argues that a stagnation in community-based health programmes linked in part to an increasing unwillingness of rural women's associations to support such programmes has occurred most particularly in the past decade. It is proposed that this stagnation may be related to overall problems of modernization in the Western Samoan economy, professionalization and bureaucratization of the national health services, and the ritualization of certain key practices (such as the inspection of village sanitation) in preventive medicine by rural women. The consequences of the stagnation for rural people have been a greater dependence upon curative medical services, and a loss of clearly defined roles for women's institutions in primary health care. The historical drift has been away from rather than towards the PHC model as espoused today by the World Health Organization and as initiated by the New Zealand administration in colonial times.

Cultural Characteristics↗

Relationship between water quality and human health: a case study of the Linggi River Basin in Malaysia.

Due to the increasingly documented prevalence of diarrhoeal diseases in Malaysia, a number of water-related programmes have been implemented in an attempt to improve health status through the reduction of incidence of waterborne communicable diseases associated with poor public water supplies. The implicit assumption underlying these projects is that the enhancement of the physical infrastructure, and subsequent improvements in the quality of the water supply, will substantially reduce water-related disease. The present study questions this hypothesis and uses a socio-ecological model as a framework to assess risk factors associated with the increased probability of waterborne disease. Research is centred on Port Dickson, a district which typifies existing water and sanitation conditions in much of semi-rural Malaysia. Health services utilization data and a 268-household diarrhoeal morbidity survey were used to measure the burden of illness of waterborne disease within the district and to identify predictors of morbidity. It was concluded that although treatment facilities will reduce the health burden in the region, a number of behavioural and sanitation factors may be more important and could act to minimize the potential impacts of improved water quality.

Adolescent↗

The social and economic context and determinants of schistosomiasis japonica.

A variety of biological and social factors govern schistosomiasis japonica in China. Social factors include those at a national and regional level, such as policies and patterns of development, which impact on local economic activities, and affect community, household and personal risk factors of infection. Drawing on research conducted in China, we illustrate how social structural and related factors influence individual risk and prevalence of infection. At a macro-level, political changes have occurred resulting in the shift from collective to family-based production, leading to clustering of infection in families. Industrialization and urbanization, and associated increased population mobility, have also influenced patterns of transmission and infection. Types of activities and local production patterns determine the exposure of individuals to schistosome-infested water sources. Fishermen have the most frequent water contact, aquatic workers the second and farmers the third; the relative risk of Schistosoma japonicum infection follows the same order. Among farmers, human infection is significantly related to agricultural production in rice fields infested with the intermediate host snail, and to rates of the infection in livestock. Risk of S. japonicum infection is also influenced by the domestic environment, including both the location of the house in relation to snail-colonized water sources, access to safe water, and improved sanitation. Household wealth and income determine family ability to provide and maintain safe water and sanitation, while determining or interacting with other variables. At an individual level, sex, age, educational level and ethnicity are all associated with different patterns of water use and water contact behaviour thereby affecting infection rates. Schistosomiasis impairs the growth and nutrition of children and the physical work capacity of adults, and so affects economic development. Given this, we note the importance of further research and social and contextual aspects of schistosomiasis infection in order to develop and sustain sound control strategies.

Child↗

School-based prevention of schistosomiasis: initiating a participatory action research project in northern Tanzania.

The main aim of this project was to undertake participatory action research in two primary schools in northern Tanzania in order to create enabling environments for the schoolchildren and other community members to adapt practices relevant for reducing the transmission of schistosomiasis. This paper describes the process of initiating the project. The school activities started in 2002 by screening all schoolchildren (n=1146) in the two schools for schistosomiasis and intestinal helminths and treating those infected. This was interspersed with school essay writing, video recorded dramas and household sanitation observations. The first activities made the researchers realise that they had to focus more on the teachers and change their perspective from one of "helping the research team with their project" to become full partners in the research process. Preliminary results are the actions taken by the teachers to develop a curriculum for enhanced schistosomiasis education in primary schools, making household sanitation surveys part of school activities, better links between the school and the community, and actions taken by community members to create safe swimming places. The experiences and lessons learned so far are discussed.

Adult↗

Earthquakes in El Salvador: a descriptive study of health concerns in a rural community and the clinical implications--part II.

Results reported in Part I of the Earthquakes in El Salvador series (see Disaster Management & Response 2003;1:105-9) indicated clinically relevant findings. The findings indicated a need for greater public health action within all five categories reviewed: healthcare, access to healthcare, housing, food, water and sanitation. Significant results between urban and rural communities indicated a need for broader community aid, public health and sanitation services to rural areas. Faster and more efficient disaster management and care services throughout the San Sebastian community were also necessary modifications.

Adult↗