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A new catastrophe due to COVID-19 has threatened the whole mankind with its worldwide spread and death tolls. It converted the healthy living places into a hell due to its fast-spreading rate. It originated in December 2019 in Wuhan, China from bats and from that it transmitted to humans. To break the chain of virus transmission, several countries imposed complete lockdown. It includes work from home and travel restrictions. This lockdown was proved to be beneficial for environment; in this study observed and reported environmental repercussion of lockdown because of COVID-19 are summarized in the form of positive and negative impacts. The positive impacts can be seen in metro cities where pollution levels have dwindled and all the organisms like animals and birds roam freely due to less pollution hazard. Blue skies were visible again in cities like Delhi, India where there was so much problem of smog. On the other side, the negative impacts are such as increase in plastic waste as well as biomedical waste. The onset of novel corona virus led to increase in utilization of food sterilization and packaging, toilet papers, face masks, hand gloves, protective shields, cleaning products and hand sanitizers resulting to disposal problem at end of lifecycle and also it generates tones of plastic and other waste. This increment led to plastic pollution on land as well as in oceans, depletes environment quality and causes harm to living beings if not disposed properly. According to WHO data in the world about 16 million hand gloves and 89 million masks are used per day. Similarly, In Wuhan, China the medical waste produces per day in hospitals is 240 metric tons during the pandemic.

Background Numerous biological, maternal, family, and socio-economic factors are regarded as influencers of child morbidity. The current study focuses on determining the factors that regulate the incidence of preventable outbreaks of disease or symptoms among under 5 children in Bangladesh. Methods This study used data from the most recent nationally representable cross-sectional Bangladesh Multiple Indicator Cluster Survey (MICS) data which is conducted in 2019. In this study, the Machine Learning algorithm of Logistic Classifier has been applied to the information of 23,099 children age below 5 years. Result In general, younger children, male children (OR = 1.087, 95% CI (1.012–1.167)), and children of the young mother are more likely to suffer from the disease than their counterparts. Children belonging to the household which have improved toilet (OR = 0.88, 95% CI (0.79–0.98)) and use salt that contains above 15 PPM (OR = 0.926, 95% CI (0.846–1.014)) are faced a lower risk of illness than those households which did not have improved toilet and used salt that contain lower than the 15 PPM iodine. Conclusion Besides those household factors wealth quintile, household size, materials used for hand wash were found with a significant impact on morbidity. However, it is observed that water treatment practice alone had no impact on child morbidity. Accelerated initiatives that encourage access to and use of hygienic sanitation, the use of salt with adequate iodine, and a healthier household climate can be effective in the reduction of childhood morbidity in Bangladesh.

Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management., Graphical abstract Unlabelled Image

Provisions of water sanitation and hygiene (WASH) facilities are essential to make accessible and sustainable through Community Clinics (CCs) to control infection in primary health care service. However, there is scarcity of literature to observe the scenario. This cross-sectional study with mix-method approach conducted a comparative analysis with a focus on compliance with WASH facilities between two categories of CCs in Meherpur and Kustia District in Bangladesh. There were total 420 respondents out of which 400 were selected purposively from the 20 renovated and non-renovated CCs for quantitative approach and 20 respondents for qualitative approach. Data were collected using face-to-face interview method. The study revealed that all of the renovated CCs had safe drinking water source, functioning toilet, hand washing and dust bin facilities except for a few cases with technical problem in water supply. But the reverse scenario was observed in non-renovated CCs. Compliance on WASH facilities in renovated CCs was two times higher than the non-renovated CCs. Clients aged ≤40 years (AOR = 0.41, renovated CCs), and married (AOR = 4.03, non-renovated CCs) did not comply the use of safe drinking water in CCs. Noncompliance of toilet use (AOR = 12.15, renovated CCs and AOR = 8.96, non-renovated CCs) and hand washing facility use (AOR = 8.46, renovated CCs and AOR = 16.8, non-renovated CCs) significantly found higher among respondents who had no formal education. Non-renovated CCs need to develop their WASH facilities as well as ensure maintenance whereas the renovated CCs need dedicated human resource as well as effective policies to maintain the sustainability., Compliance; WASH facilities; Community Clinics; Comparison.

Summary Background There has been an increasing demand for more sanitary bidet seats in many healthcare settings because of concerns regarding potential contamination of the spray nozzles of warm-water bidet toilet seats. This contamination is thought to possibly serve as a reservoir for horizontal transmission of drug-resistant bacteria. Aim This study was performed to determine the optimal Pseudomonas aeruginosa decontamination conditions and verify the effectiveness of these decontamination conditions. Methods An in vitro test of rinsing with neutral electrolysed water was performed using seven strains of P. aeruginosa. The decontamination effect of the neutral electrolysed water was verified by a field test involving an analysis of the number of bacteria isolated from samples collected from the spray nozzles and the sprayed water from 10 toilet seats at the internal medicine ward of Juntendo University Hospital. Findings The in vitro test results showed that the decontamination effect of neutral electrolysed water tended to be higher with higher free chlorine concentrations in the nozzle-cleaning water and shorter intervals of rinsing. The field test involving the hospital ward toilets showed that routine physical cleaning was satisfactorily effective. Conclusion The study results suggest that the risk of horizontal transmission of drug-resistant bacteria via the use of bidet toilet seats in hospitals can be reduced by general cleaning and appropriate control of the free chlorine concentration in the nozzle-cleaning water.

Waste from infected individuals can contaminate the soil and water of the community without adequate sanitation facilities, increasing the risk of infection for other individuals. The objective of this study was to assess child feces disposal status and associated factors in community-led total sanitation (CLTS) adopted districts of the Jimma Zone, Ethiopia. This study analyzed comparative cross-section secondary data from 756 households systematically selected in two chosen districts (Kersa and Omo Nadda) of Jimma Zone, Oromia Regional State, Ethiopia in 2018 by our research team. The data used was obtained by interviewing mothers/caregivers using a pre-tested structured questionnaire. About 80% of mothers/caregivers of CLTS adopted kebeles (the smallest administrative structure) and 58.7% of non-CLTS kebeles had practiced safe child feces disposal practices. Compared to their counterparts, the use of unimproved latrine form (AOR=0.45; 95% CI: 0.24–0.83) and location of drinking water storage containers elevated above the floor (OR=0.02; 95% CI: 0.05–0.88) had a negative association with safe disposal practices of child feces. However, among mothers/caregivers indexed as medium (AOR=1.64; 95% CI: 1.03–2.61), rich (AOR=2.17; 95% CI: 1.29–3.66), live with children under five vulnerable to diarrhea (AOR= 1.54; 95% CI: 1.02–2.52) and owned toilet without a handwashing facility (AOR= 2.44; 95% CI: 1.49–3.98), the likelihood of safe child feces disposal practices was increased. In conclusion, our study shows that the study participants' safe child feces disposal status was comparatively higher in CLTS adopted kebeles, but the difference was not significant in the final model.

We report a case of crush syndrome that developed while the patient was squatting to use a Japanese-style toilet. The patient was a 61-year-old male with an obese body. He was sitting on the toilet and couldn't stand up, and after a few hours, the landlord found him and called the emergency services. On presentation, the patient was hyperkalemic and in shock, and his serum creatine kinase levels rose to a maximum of 287,600 U/L. He was diagnosed with postural crush syndrome in both lower extremities due to squatting position in a Japanese-style toilet. Subjective symptoms, physical examination, and blood tests were monitored and the patient was observed. As a result, the patient could be treated conservatively without fasciotomy. Dialysis was not necessary because the fluid infusion maintained adequate urine output and corrected the hyperkalemia. Magnetic resonance imaging of both lower extremities showed multiple high-signal areas in the muscles of the bilateral thighs and lower legs. This case suggested that if the wound is closed, the peripheral pulse is palpable, and the patient's symptoms have improved, a fasciotomy should not be performed. People who are too heavy to squat may need to be careful when using this kind of toilet.

Background Lack of household sanitation, specifically toilet facilities, can adversely affect the safety of women and girls by requiring them to leave their households to defecate alone and at night, leaving them more vulnerable to non-marital sexual violence. This study analyzes the association between household sanitation access and past year victimization from non-marital sexual violence (NMSV) in India. Methods We analyzed 74,698 women age 15–49 from whom information on NMSV was collected in India's National Family Health Survey 2015–16 (NFHS-4). We used multivariable logistic regression to test the relationship between women's household sanitation access and recent NMSV experience, controlling for socioeconomics (SES;e.g., age, marital status, caste, wealth, employment), for the total sample and stratified by rural/urban, given lower access to sanitation and lower NMSV in rural contexts. Results We found that 46.2% of households in our sample lacked their own private sanitation facilities (58.0% rural; 24.5% urban) and were forced to openly defecate (37.3%) or walk to a shared sanitation facility (8.9%), and 0.45% of women report NMSV in the last 12 months (0.33% rural; 0.68% urban). Our multivariable model indicated no significant association between having private household sanitation facilities and NMSV for the total sample, but stratified analyses indicate a significant association for rural but not urban women. In rural India, those who lack private household sanitation, compared to those with a household toilet, have significantly greater odds of NMSV (AOR = 2.45; p, Highlights • Lack of sanitation can adversely affect the safety of women and girls. • In rural India, many women lack household sanitation and openly defecate. • Open defecation can leave women and girls vulnerable to harassment and violence. • We explored this relationship in a nationally representative survey in India. • Lack of sanitation increased the odds of non-marital sexual violence for rural women.

Across the African continent especially in Nigeria, solid waste disposal has created significant environmental and health issues. Studies on household decision-making on waste disposal choices are insignificant. This study uses the most recent 2018/2019 General Household Survey (GHS) – a national representative sample of 5000 households collected by the Nigerian Bureau of Statistics (NBS) and World Bank – to offer greater insight on the socio-economic drivers of household's decision-making on the choice of alternative refuse disposal systems and how these choices vary across male-headed households (MHHs) and female-headed households (FHHs) in Nigeria. Adopting the Multinomial Logit and Exogenous Switching Treatment Effects Regression (ESTER) models, estimates show that education, family sizes, non-home ownerships, water availability, toilet locations, electricity connections within buildings, geopolitical zones, and urban areas are some determinants of household waste disposal choices which also varies by household types. However, quite a significant number of FHHs are observed to utilize informal refuse disposal systems than the MHHs representing a gender gap in the informal waste usage of 9%. In the counterfactual scenario FHHs average probability of adopting compound (informal) refuse disposal choices, would have increased by 4.2% (decreased by 5.4%) if they had the same socio-economic characteristics as MHHs. These results present some interesting factors related to the heterogeneity of alternative refuse disposal choices the heterogeneous effects of gender on such decisions. The study thus offers some policy inputs on how to ensure a clean and safe environment through proper disposal options., Household; Waste disposal; Gender; Socioeconomic; Nigeria; Economics; Environmental economics; Environmental management; Environmental pollution; Public health.

Undernutrition affects 20% of children under five in the developing world. Stunting is a form of undernutrition when children have low height for their age. Global prevalence of stunting in 2019 was 21.4%, while current Tanzania national average is 34%. Ruvuma region has one of highest prevalence of stunting (44%) in Tanzania, which prompted this cross-sectional study on correlates responsible for this high prevalence. The study included randomly sampled children below 5 years of age who attended outpatient clinics at hospitals from Ruvuma between April – May 2019. The mean and median ages of children were 18 and 13 respectively. Among children, 46% were females and 45.6% were stunted. More male children (52%) were stunted than females. Through bivariate analysis, stunting was associated with gender (χ2 = 6.6759, df = 1, p = 0.009772), handwashing before food (χ2 = 5.1213, df = 1, p = 0.02363), location of hospital (χ2 = 3.851, df = 1, p = 0.04972) and use of Municipal garbage collection system (χ2 = 3.6814, df = 1, p = 0.05502). Moreover, diarrhea was associated with toilet sharing (χ2 = 5.4703, df = 1, p = 0.002), use of household's toilet (χ2 = 4.0224, df = 1, p = 0.004) and rinsing child feces into toilet (χ2 = 3.6814, df = 1, p < 0.01). Multivariate logistic regression analyses showed that stunting risk increased with male gender (OR (95%CI) = 1.7945 (1.1944 – 2.712), age (OR (95%CI) = 1.3122 (1.1484 – 1.507), and decreased with handwashing before meal (OR (95%CI) = 0.5403 (0.3042 – 0.940). Finally, diarrhea risk increased with toilet sharing (OR (95%CI) = 2.154 (1.153 – 3.953) and decreased with child's use of toilet (OR (95%CI) = 0.510 (0.259 – 0.945). Our study revealed important correlates that determined observed high prevalence of stunting in Ruvuma. These correlates can be modified through health interventions to reduce this high prevalence.

This chapter describes appropriate developmental expectations for toileting based on normative child development. Recommendations for initiating toilet training are provided. Common problems associated with toileting (constipation, encopresis, and enuresis) are identified as the prevalence and etiology of these conditions. Evidence-based medical treatment and behavioral health intervention for these problems are discussed. Evidence-based strategies for the practicing clinician are provided. Psychiatric comorbidities and both short- and long-term outcomes are identified.

A challenge in water reuse for toilet flushing in India and other Asian countries derives from pour flushing practices. It is a common assumption that the amount of pour flushed water used for personal cleansing is small in comparison to the cistern flush volume, however there is a knowledge gap regarding the actual contribution of each water source to the blackwater amount. In this study, digital water meters were used to measure the fraction of water from personal wash tap relative to cistern water that is used for toilet flushing. High temporal resolution measurements were carried in three different urban sites in the city of Coimbatore in the southern Indian state of Tamil Nadu where onsite sanitation treatment prototypes that may provide reclaimed water for cistern flushing are being tested. Data collected over periods of up to 2 months show that the contribution of the cistern flush to the total blackwater volume is low (14–40%). These data highlight an important factor to inform interventions designed around water reuse for flushing in world geographies where personal toilet cleansing by water is the common practice., Graphical abstract Unlabelled Image, Highlights • The ratio of personal wash vs cistern water used for toilet flushing was measured. • The pour flush water use averaged 7 L/use. • The cistern flush contributes to only 14–40% of the volume of water that is flushed. • Extensive pour flushing will limit the impact of reclaimed water use in cistern flush.

Water is at the core of sustainable development and is critical for socio-economic development, energy and food production, as well as healthy ecosystems and the benefits they deliver to us. Water and sanitation are vital for reducing the global burden of disease and improving the health, education and economic productivity of populations. Water reuse closes the loop between water supply and sanitation and provides an alternative water source. Wastewater treated to the right quality can replenish water supplies and reduce the demand and availability gap. The transition to a circular economy has the potential to transform current barriers to water reuse, and this chapter investigates its role in closing the loop in water management. Examining various advanced treatment technologies, we conclude that effective water reuse applications can deliver environmental, economic and social benefits. By the time recycled water has passed through the right combination of treatment processes, it is in fact cleaner than regular drinking water. The issue, however, comes down to how much people trust governments to make sure water is safe. As the public is becoming more environmentally aware—maybe more willing to accept “drinking toilet water,” the current prevailing perception of water reuse and main barrier to its widespread application.

Objective: Keeping unnecessary drugs at home is a situation showing both causes and consequences of irrational use of medicine. This study aimed to evaluate the approaches of a company's employees regarding drug storage, use, and disposal. Method: This online-based descriptive study was held in a multi-centered private-sector company in a voluntary basis. The survey assessing participants' drug handling and storage behaviors was answered by 1121 employees from across eight provinces of Turkey in 2016. Main outcome measures were storage and disposal of unused/unwanted drugs at home in a rational way. Results: The percentage of participants who declared that they keep unused/unwanted drugs at home was 28.0%. About one-third of participants disposed their unused/unwanted drugs via the garbage, sink, toilet, etc.. Participants >= 30 years old and living with < 4 household members significantly tended to bring their unused/unwanted drugs to the company's drug-box. Nearly half of all participants (46.5%) stated a recent change in their disposal behavior. The vast majority of participants (94.6%) who previously took drugs back to the company's drug-box stated that they either had, or would, help their contacts adopt such behaviors. These participants were also significantly less likely to dispose of drugs inappropriately, practice self-medication, be unaware of expired drugs at home, or fail to store drugs according to the labelling. Conclusion: While our findings showed that a substantial number of participants still had unused drugs at home and disposed of them inappropriately, it is understood that they started to exhibit more favorable behaviors in recent years. (C) 2017 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University.

In recent years, there has been a rise in the number of product liability cases involving the failure of toilet water supply line acetal plastic nuts. These nuts can fail in service, causing water leaks that result in significant property and financial losses. This study examines three possible failure modes of acetal plastic toilet water supply nuts. The three failure modes tested were all due to over load failure of the acetal nut and are as follows: (1) Overtightening of the supply line acetal nut, (2) Supply line lateral pull and, (3) Embrittled supply line lateral pull. Additionally, a “hand-tight” torque survey was conducted. The fracture surfaces and characteristics of these failure tests were examined with Stereo Microscopy and Scanning Electron Microscopy (SEM). The failure modes were compared and contrasted to provide guidance in determination of cause in these investigations.

A prototype of a non-fluid based mechanical toilet flush was tested in a semi-public, institutional setting and in selected peri-urban households in eThekwini municipality, Republic of South Africa. The mechanism's functionality and users' perception of the flush were assessed. User perception varied depending on background: Users accustomed to porcelain water flush toilets were open to, yet reserved about the idea of using a waterless flush in their homes. Those who commonly use Urine Diversion Dehydration Toilets were far more receptive. The user-centred field trials were complemented by a controlled laboratory experiment, using synthetic urine, -faeces, and -menstrual blood, to systematically assess the efficiency of three swipe materials to clean the rotating bowl of the flush. A silicone rubber with oil-bleed-effect was found to be the best performing material for the swipe. Lubrication of the bowl prior to use further reduced fouling. A mechanical waterless flush that does not require consumables, like plastic wrappers, is a novelty and could – implemented in existing dry toilet systems – improve acceptance and thus the success of waterless sanitation., Graphical abstract Unlabelled Image, Highlights • Prototype mechanical toilet flush successfully user-tested in households and lab • User feedback positive but dependent on toilet habit • Removal of fouling from soft faeces not satisfactory • Surface lubrication improves fouling removal.

Oppositional defiant disorder commonly cooccurs with many other developmental problems including problems with independent sleep and toilet training and learning and social skills problems. Behavioral strategies for managing independent sleep and toilet training problems are detailed. Social skills training for improving child social skills is described. Strategies for interacting with school personnel and advocating for child academic concerns are discussed. Finally, medication options for comorbid problems are discussed. Relevant online and text resources are provided.

Ancylostoma duodenale, Necator americanus, Ascaris lumbricoides and Trichuris trichiura, the four major Soil-transmitted helminths (STHs) and also Strongyloides stercoralis infect humans worldwide. Most studies on Soil-transmitted helminths (STHs) carried out in Ibadan were faecal examination based while relatively few soil examination based studies were carried out mostly around school premises using limited number of sampling locations. This study was therefore designed to assess the level of soil contamination with STH and associated risk factors in the eleven local government areas of Ibadan. A total of 1980 soil samples were purposively collected monthly, between January and December 2017, from toilet areas, refuse dump sites, house vicinities, playgrounds, roadsides/walk ways, and examined for the presence of parasite eggs or larvae using automated analysis of light microscopy images by computer. Well-structured questionnaires were administered to 620 consenting participants to obtain information on the Knowledge of STH infections, Attitudes and Practices towards the infections. Data were analyzed using SPSS version 21, Chi-square and ANOVA were used in the analysis at p

Highlights • The performance of Stirling engine integrated to a micro-combustor in the NMT system was investigated. • Energy recovery and power generation of 27 Wh/h from combustion of human faeces. • The integrated position of the Stirling engine to the micro-combustor is highly paramount. • Sensitivity of the performance of the Stirling engine to working gas temperature. • Requirements for optimum performance of the Stirling engine for integration with micro-combustor., The demand for better hygiene has increased the need for developing more effective sanitation systems and facilities for the safe disposal of human urine and faeces. Non-Sewered Sanitary systems are considered to be one of the promising alternative solutions to the existing flush toilet system. An example of these systems is the Nano Membrane Toilet (NMT) system being developed at Cranfield University, which targets the safe disposal of human waste while generating power and recovering water. The NMT will generate energy from the conversion of human waste with the use of a micro-combustor; the heat produced will power a Stirling engine connected to a linear alternator to generate electricity. This study presents a numerical investigation of the thermodynamic analysis and operational characteristics of a quasi steady state model of the gamma type Stirling engine integrated into a combustor in the back end of the NMT system. The effects of the working gas, at different temperatures, on the Stirling engine performance are also presented. The results show that with the heater temperature of 390 °C from the heat supply via conduction at 820 W from the flue gas, the Stirling engine generates a daily power output of 27 Wh/h at a frequency of 23.85 Hz.

Background The Thar Desert of India is a severely drought-prone and impoverished region. As a result of water scarcity, communities live in deep-rooted poverty, which has a major impact on health status. Lack of nutritious foods leads to malnutrition and the scarcity of water also poses sanitation challenges. Nutrition and sanitation are therefore two critical health challenges in the region. GRAVIS, a non-governmental organisation, has launched an intervention known as Improving Health through addressing Nutrition and Sanitation (IHNS) in Thar. Methods The programme has two main focuses. First, to address nutrition, a community-based nutrition curriculum has been designed to enhance knowledge on nutritional facts. The curriculum is used in schools for children and in the community for adults. Further, the concept of Household Horticulture Units has been developed whereby domestic waste water is used for growing fruits and vegetables. Second, on sanitation, low-cost, low-water-use toilets have been designed. Various toilet models have been studied to produce the optimum design for desert conditions. Bio-sand-water filters have been designed that provide rural people with potable water. A cadre of village health workers has been developed that constantly educates communities. In the past 5 years, GRAVIS has covered over 4000 people with these interventions with a holistic approach. GRAVIS conducts an annual review of the programme to understand outcomes. The annual review is done through a participatory approach in which communities are fully involved, and inputs are taken from concerned local government health authorities. GRAVIS and an external reviewer do a beneficiary survey with the help of a questionnaire and focus group discussions with key informants from the communities to understand the progress made and challenges encountered. The review report helps us analyse the outcomes and plan future interventions. In the annual review, we cover at least 20% of our beneficiaries. The selection is done on a random basis. The last annual review was done in January, 2017. Findings About 60% of beneficiaries report significant improvement in their general health, as reported in a health study by GRAVIS in 2017, which included about 200 households and about 1400 individuals. In the project area, which included more than 250 school children, more than 90% of school children were fully aware of their nutritional requirements. According to outpatient records from the GRAVIS hospital in the area, the incidence of diarrhoeal disease has decreased by 20% in the past 2 years. The interventions are low cost, well accepted, and sustainable. Interpretation Moving forward, GRAVIS envisions scaling up the IHNS model. It will be an effective approach to combat nutrition- and sanitation-related health issues, particularly in arid settings. GRAVIS foresees for itself a role as educator and provider of resources to help other organisations implement IHNS. We will explore resources and funding partnerships for replication and scale up. Funding Government of Finland and People for Progress in India, USA.

Pharmaceuticals have been detected throughout the environment where at least in some cases, they have been shown to have a detrimental effect. Many result from improper patient disposal of unused pharmaceuticals via environmentally-unfriendly routes, such as the sink, toilet or rubbish bin. This review surveys the current peer-reviewed literature on attitudes and practices to medicine disposal methods as reported by patients and the various medication disposal and destruction systems around the world. A literature search was carried out using the keywords 'medicines disposal', 'unused medicines', 'medicines wastage', and 'medication disposal' in the PubMed TM, ISI Web of Knowledge TM, Google Scholar TM, Medline TM, Scopus TM and International Pharmaceuticals Abstracts TM up to the end of May 2010. Twelve peer-reviewed articles with specified sample sizes were selected. The most popular methods for medication disposal were in the garbage, toilet or sink. Liquid medications were more likely to be rinsed down the sink, as opposed to solid tablets and capsules which were more likely deposited in the rubbish bin. Much confusion exists about the 'proper' way of medication disposal as many countries do not have standard medication disposal protocols. Furthermore, some pharmacies around the world refused to accept unused medications or discouraged the practice. Patients with knowledge about the impact of pharmaceuticals in the environment were more likely to return medications for proper disposal and destruction. It is concluded that it is of paramount importance that a formalized protocol for patient disposal and destruction of pharmaceuticals be implemented around the world. Keywords: Medicines disposal, Unused medicines, Medicines wastage, Medication disposal

Open defecation is practised by over 600 million people in India and there is a strong political drive to eliminate this through the provision of on-site sanitation in rural areas. However, there are concerns that the subsequent leaching of excreta from subsurface storage could be adversely impacting underlying groundwater resources upon which rural populations are almost completely dependent for domestic water supply. We investigated this link in four villages undergoing sanitary interventions in Bihar State, India. A total of 150 supplies were sampled for thermotolerant (faecal) coliforms (TTC) and tryptophan-like fluorescence (TLF): an emerging real-time indicator of faecal contamination. Sanitary risk inspections were also performed at all sites, including whether a supply was located within 10 m of a toilet, the recommended minimum separation. Overall, 18% of water supplies contained TTCs, 91% of which were located within 10 m of a toilet, 58% had TLF above detection limit, and sanitary risk scores were high. Statistical analysis demonstrated TLF was an effective indicator of TTC presence-absence, with a possibility of TTCs only where TLF exceeded 0.4 μg/L dissolved tryptophan. Analysis also indicated proximity to a toilet was the only significant sanitary risk factor predicting TTC presence-absence and the most significant predictor of TLF. Faecal contamination was considered a result of individual water supply vulnerability rather than indicative of widespread leaching into the aquifer. Therefore, increasing faecal contamination of groundwater-derived potable supplies is inevitable across the country as uptake of on-site sanitation intensifies. Communities need to be aware of this link and implement suitable decentralised low-cost treatment of water prior to consumption and improve the construction and protection of new supplies.

Parasites have been infecting humans throughout our evolution. However, not all people suffered with the same species or to the same intensity throughout this time. Our changing way of life has altered the suitability of humans to infection by each type of parasite. This analysis focuses upon the evidence for parasites from archaeological excavations at medieval sites across Europe. Comparison between the patterns of infection in the medieval period allows us to see how changes in sanitation, herding animals, growing and fertilizing crops, the fishing industry, food preparation and migration all affected human susceptibility to different parasites. We go on to explore how ectoparasites may have spread infectious bacterial diseases, and also consider what medieval medical practitioners thought of parasites and how they tried to treat them. While modern research has shown the use of a toilet decreases the risk of contracting certain intestinal parasites, the evidence for past societies presented here suggests that the invention of latrines had no observable beneficial effects upon intestinal health. This may be because toilets were not sufficiently ubiquitous until the last century, or that the use of fresh human faeces for manuring crops still ensured those parasite species were easily able to reinfect the population.

This chapter describes the major government programs and policies that provide direct and indirect assistance to caregivers of Americans aged 65 and older who require human and technological assistance with functional activities, such as personal care tasks (e.g., bathing, dressing, getting in and out of bed, and using the toilet), as well as other aspects of daily living (e.g., grocery shopping, cooking meals, housework, taking medications, using the telephone, and managing money). We focus exclusively on caregiver support policies and programs that operate under federal legislative authority, including programs that, though administered by state or local government entities or nonprofit organizations, are federally financed (even if they also receive state or local funding).

The study by Clasen and colleagues does not have enough evidence for the effectiveness of the sanitation programme, but denotes the clear message that the health benefi ts might not be assumed only by construction of latrines. We doctors, having grown up in villages of Odisha, are aware of the practice of many people using latrines initially and then moving to a nearby pond to clean their anal orifi ce with their hand. These practices lead to contaminate water, hands, and soil. Poor adherence to toilet use at home can also be attributed to the traditional habit of defecating in the open air while visiting fi eld crops. Many children aged 6–18 months defecate on the fl oor and then take their contaminated fi ngers to their mouth. Transformation of sanitation-related knowledge into routine practice is hindered by traditional mindsets and the absence of awareness and an attitude to learn. Poverty has been described as a barrier to following safe hygiene practices. Regular use of footwear is equally important for the prevention of soil-transmitted helminth infection. Personal and domestic hygiene practices are difficult to improve without upgrading basic amenities, such as water supply, waste water disposal, and solid waste management. Health education could be a very promising approach to improve awareness and encourage the adoption of good hygienic practice. The integration of health education and practice to fi ll the gaps of understanding of what works and what does not work is needed. We also need to keep focused on the important task of winning the battle for rural sanitation.

Household chemicals such as oven cleaners, toilet bowl cleaners, drain cleaners, antifreeze, motor oil, various products used in gardening, and chlorine used in swimming pools and various household products can cause significant oxidative stress if absorbed through the skin or vapor is inhaled. Many of these products can be fatal to children if ingested. Proper handling of these household products, such as by wearing gloves and a face mask, is important to reduce exposure to the chemicals, thus reducing oxidative stress caused by them.

The modern city is a marvellous mixture bringing all manner of products, foods and people together. The end result of these activities is waste; waste that magically disappears with the flush of a toilet or placement of a bag on a curb. In this view, metropolises are waste aggregators and generators with all of the waste having to leave the city, by conservation of mass. It is in our interest to separate the benign components but this is rarely easy and never free. This chapter discusses several industrial separation processes and important metrics for their comprehension.

This chapter discusses how to calculate water usage of various types of low- and high-volume toilets, focusing on reported savings due to use of low-flow toilets in the US. Toilets consume the most water in residences, and, as such, they have been the focus of the greatest attention, but showerheads, faucets, and clothes washers have also been considered in these studies, although clothes washers will not be subject to national standards until 2004. While it is widely believed that the installation of water-efficient showerheads and sink faucets also results in significant savings, the studies we reviewed are not in complete agreement on this point. The East Bay, California, study reported savings of 1.7 gallons per capita per day with low-flow showerheads—about one-third of the savings resulting from toilet replacement. Americans flush about 4.8 billion gallons of water down toilets each day, according to the U.S. Environmental Protection Agency. According to the Plumbing Foundation, replacing all existing toilets with 1.6 gallons per flush, ultra-low-flow (ULF) models would save almost 5500 gallons of water per person each year.

Source separation and decentralization for better resource management in wastewater treatment are gaining ground. This chapter summarizes the rationale for this development, followed by an extensive review of the literature on source-separated gray water, urine, and feces. For comparison, a short section on decentralized treatment of combined domestic wastewater is added. For all source-separated waste streams, the following issues are discussed: production rate and composition, reuse purposes and regulation, risk aspects, and public perception, followed by a review of the different technology options. The main purpose of decentralized gray water treatment is the reuse of water within or nearby the building, and the most severe problems are linked to hygiene and surfactants in irrigation water. Urine is primarily interesting due to the high content of nutrients and has a high potential for efficient nutrient recovery and removal. Urine source separation is publicly well accepted, given that toilet comfort is not compromised. In dry sanitation systems, separation of urine and feces is standard technology, but there is a lack of suitable technologies for further processing of urine in different settings. Feces have a high impact on urban hygiene and are interesting from the point of view of phosphorus. The most important decisions concerning technology choice are taken with the choice of toilet. Two main factors are decisive: amount of flushing water and separation of urine. For comparison with source-separating technologies, two exemplary decentralized technologies for combined wastewater are discussed: the septic tank and the Japanese johkasous. Both technologies depend on uncontrolled anaerobic degradation, which is problematic from the point of view of greenhouse gases. We discuss the trade-off between energy use for aerobic treatment and methane emissions from uncontrolled anaerobic treatment.

Improving the toilet environment holds promises for increasing the quality of life for elderly and disabled persons. This is one of the goals of the Friendly Rest Room (FRR) project. The study described in this article explored the preference and use of supports in the toilet environment during the entire toilet ritual. An adjustable test frame was built with a toilet and three types of supports. Fourteen subjects were asked which positions they favoured for each support. After using all three supports they were asked which support they found most comfortable. In general, the preferred positions depended on personal preferences more than on dimensions of the body. It was concluded that there is a preference for vertical supports for sitting down and standing up. During toilet use the side supports were equally appreciated.

Publisher Summary The chapter discusses application of superabsorbent polymers (SAPs) for sanitary products of pets. For the indoor care of small dogs, a product called pet sheet is used. The pet sheet, which can be used several times, is then disposed of as common household rubbish in the same way as disposable diapers. The appearance and construction of pet sheets are discussed in the chapter. The structure is nearly identical to the flat-type disposable diaper used by humans. Toilet sand for pets is generally known as cat litter or pet sand. Mainly 30 to 50% of the organic-type toilet sands contain SAP, and the concentration of SAP varies widely depending on the products. Thus, it is difficult to estimate the annual domestic consumption, but a rough estimate is several hundred metric tons. The requirements for SAP used for toilet sand are briefly described in the chapter. The recent trend in this material is that because it is a consumable, the economic factor plays an important role, and as expected, issues concerning environmental pollution cannot be ignored.

Gilbey House is a unit with 15 beds in a Community Home School for boys in a suburban area of a major city in the United Kingdom. It is staffed by six residential care workers, under the direction of a warden, and a teacher, none of whom had experience of using social learning practice as had none of the senior staff within the establishment. The accommodation in Gilbey House comprises a self-contained block of rooms—kitchen, sitting room, dining room/play room, small study room, office and cloakroom downstairs, and three four-bedded and three single bedrooms upstairs, adjacent to washing, toilet and shower facilities. The classroom is situated in a separate part of the school buildings. Gilbey House uses a social learning environment to attempt to enable youngsters in serious trouble and with a range of other presenting problems to achieve in as short a time as possible sufficient increments in educational, social, emotional, self-help, and other basic skills for survival as emerging adults. The unit attempts to return its clientele to the community in good time for preparation for work and a productive fulfilling adult life. This chapter describes the way the social learning environment is organized in the unit and discusses some of the problems encountered by the unit in its implementation and administration.

Publisher Summary The evidence clearly shows that, for trainees who have few toileting skills, independent toileting and bladder and bowel control are more likely to be acquired when training involves a number of procedures and treats toileting as a complex behavioral sequence. However, the common assumption that systematically applied contingent reinforcement is the major or most effective training procedure under these circumstances. Nevertheless, reinforcement becomes important once the entire sequence is established and ready for the final strengthening and generalization to take place. Some important aspects of research methodology in the evaluation of training programs for complex skills are highlighted. Much toilet-training research has been limited both by a lack of adequate baselines and by the response measures used. A baseline, which provides only a simple measure of voiding accident rate in the natural environment, may only indicate the rate of accidents maintained by that environment rather than the level of toileting skill possessed by an individual. In some other study, the baseline is taken in a controlled environment that removed the natural contingencies and constraints in order to determine the operant level of each component skill. Under these conditions several potential trainees with high accident rates in the natural environment became self toileting and accident free without training. It is demonstrated that the component skills involved in toileting may respond in different ways to different aspects of training. It is therefore important that each component be monitored adequately both before and during training.

Publisher Summary This chapter discusses the behavior of retardates who score below IQ 50 on a standardized test. Severely retarded persons, especially those in residential centers, most frequently do not dress themselves, are not totally toilet trained, and in many instances do not even feed themselves. Their social reactions to people vary a great deal. The chapter provides the solution of practical problems through the use of operant techniques. The social reactions of moderately retarded children to adults are somewhat more varied than those of the severely retarded, and they usually exhibit a more extensive verbal repertoire. In cases where operant techniques are applied, the reported results are encouraging. Thus, it may be expected that these advances will lead to the development of training and educational programs, which one day will allow these people to live in and contribute to the noninstitutional community. The extent to which such a goal is accomplished depends primarily on the ingenuity and effort of interested workers.

Publisher Summary This chapter discusses the education pattern in a school for autistic children. All the children had their own particular difficulties, varying in degree, and to cope with their separate deviations. It was found that in the first instance a one staff to one child ratio is the most successful. This high staff/child ratio ensures that each child has someone on hand to help him overcome his inability to make use of what he sees and hears. It means that in group lessons or games, each child has a teacher to stimulate and encourage his efforts. The teacher on her part observed and assessed the child's strengths and weaknesses. As the child developed and became more aware of his environment, the situation was changed and one teacher was allotted for two or three children. Finally, the children were graded into small groups according to age and capability A young autistic child often needs training to become socially acceptable—training in toilet habits, in drinking and eating; training in behavior in public; and training in road drill. Side by side with this initial training, children are encouraged to do things for himself and to become independent so far as he is able, to hang up his own coat, change his shoes, arrange his own clothes when using toilet facilities, wash his hands, and feed himself.

This chapter discusses the learning of new things that a child learns in his 1–3 years of life. By the separation from the mother through the weaning process, he is at the very beginning of the development of his independence as an individual. This is further developed by his efforts at standing and walking. As in all developmental stages, there are great individual differences in the ages at which the child learns to walk, and the mother must be ready to recognize the signs that show that the child has reached the optimum moment to attempt this new skill. If this optimum moment is missed, the child may be retarded and the learning process may be slower. With the widening of his experience through his independent moving, there comes a widening and enrichment of his relationships with other personalities in his environment. As in all aspects of development, there are also great differences in the times at which children begin to speak. As he becomes more adept in his use of language, at between two and three years of age, he will begin to accompany his actions with words. This is the time when the child takes great pleasure in picture books. By the time he is three years old, the child made tremendous steps forward in his intellectual development.