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BACKGROUND: There is a lack of research on the relationship between water fluoridation and pregnancy outcomes. OBJECTIVES: We assessed whether hypothetical interventions to reduce fluoride levels would improve birth outcomes in California. METHODS: We linked California birth records from 2000 to 2018 to annual average fluoride levels by community water system. Fluoride levels were collected from consumer confidence reports using publicly available data and public record requests. We estimated the effects of a hypothetical intervention reducing water fluoride levels to 0.7 ppm (the current level recommended by the US Department of Health and Human Services) and 0.5 ppm (below the current recommendation) on birth weight, birth-weight-for-gestational age 푧-scores, gestational age, preterm birth, small-for-gestational age, large-for-gestational age, and macrosomia using linear regression with natural cubic splines and G-computation. Inference was calculated using a clustered bootstrap with Wald-type confidence intervals. We evaluated race/ethnicity, health insurance type, fetal sex, and arsenic levels as potential effect modifiers. RESULTS: Fluoride levels ranged from 0 to 2.5 ppm, with a median of 0.51 ppm. There was a small negative association on birth weight with the hypothetical intervention to reduce fluoride levels to 0.7 ppm [-2.2 g; 95% confidence interval (CI): -4.4, 0.0] and to 0.5 ppm (-5.8 g; 95% CI: -10.0, -1.6). There were small negative associations with birth-weight-for-gestational-age z-scores for both hypothetical interventions (0.7 ppm: -0.004; 95% CI: -0.007, 0.000 and 0.5 ppm: -0.006; 95% CI: -0.013, 0.000). We also observed small negative associations for risk of large-for-gestational age for both the hypothetical interventions to 0.7 ppm [risk difference (RD)= -0.001; 95% CI: -0.002, 0.000 and 0.5 ppm (-0.001; 95% CI: -0.003, 0.000)]. We did not observe any associations with preterm birth or with being small for gestational age for either hypothetical intervention. We did not observe any associations with risk of preterm birth or small-for-gestational age for either hypothetical intervention. CONCLUSION: We estimated that a reduction in water fluoride levels would modestly decrease birth weight and birth-weight-for-gestational-age 푧-scores in California. [ABSTRACT FROM AUTHOR]

To investigate the association between mtDNA genetic information and the risk of SF, individuals were conducted in the drinking water endemic fluorosis area in northern China, sequenced the whole genome of mtDNA, identified the SNPs and SNVs, analyzed the haplogroups, and diagnosed SF, and then, the effect of mtDNA genetic information on the risk of SF was evaluated. We find that, D5 haplogroup and its specific SNPs reduced the risk, while the D4 haplogroup and its specific SNPs increased the risk of SF. The number of SNVs in coding regions of mitochondrial respiratory chain (MRC) is different between the controls and cases. This suggests that D5 haplogroup may play a protective role in the risk of SF, while the opposite is observed for the D4 haplogroup, this may relate to their specific SNPs. And SNVs that encode the MRC complex may also be associated with the risk of SF. [ABSTRACT FROM AUTHOR]

This research work was planned to test biosafety of different nanomaterials on the different animals models. These nanoparticles were previously used as potential insecticides of mosquito larvae. The biosafety of these nanoproducts were evaluated on certain organs of non target animals that associated with mosquito breeding sites in Egypt. Animal organs such as the kidneys of rats, toads, and the fish's spleen were used as models to study the biological toxicity of these nanomaterials. After 30 days of the animals receiving the nanomaterials in their water supply, different cell mediated immune cells were assessed in these tissues. Both TNF-α and BAX immuno-expression were also used as immunohistochemical markers. Histopathology was conducted to detect the effect of the tested nanoproducts at the tissue level of the liver and kidneys of both the rats and toads. Green nanoemulsion of the lavender essential oil was relatively more effective, safe, and biodegradable to be used as insecticides against mosquito larvae than the metal-based nanomaterials. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diarrheal disease is a leading cause of childhood morbidity and mortality globally. Household water, sanitation, and handwashing (WASH) interventions can reduce exposure to diarrhea-causing pathogens, but meteorological factors may impact their effectiveness. Information about effect heterogeneity under different weather conditions is critical to refining these targeted interventions. OBJECTIVES: We aimed to determine whether temperature and precipitation modified the effect of low-cost, point-of-use WASH interventions on child diarrhea. METHODS: We analyzed data from a trial in rural Bangladesh that compared child diarrhea prevalence between clusters (푁 = 720) that were randomized to different WASH interventions between 2012 and 2016 (NCT01590095). We matched temperature and precipitation measurements to diarrhea outcomes (푁 = 12,440 measurements, 6,921 children) by geographic coordinates and date. We estimated prevalence ratios (PRs) using generative additive models and targeted maximum likelihood estimation to assess the effectiveness of each WASH intervention under different weather conditions. RESULTS: Generally, WASH interventions most effectively prevented diarrhea during monsoon season, particularly following weeks with heavy rain or high temperatures. The PR for diarrhea in the WASH interventions group compared with the control group was 0.49 (95% CI: 0.35, 0.68) after 1 d of heavy rainfall, with a less-protective effect [PR = 0:87 (95% CI: 0.60, 1.25)] when there were no days with heavy rainfall. Similarly, the PR for diarrhea in the WASH intervention group compared with the control group was 0.60 (95% CI: 0.48, 0.75) following above-median temperatures vs. 0.91 (95% CI: 0.61, 1.35) following below-median temperatures. The influence of precipitation and temperature varied by intervention type; for precipitation, the largest differences in effectiveness were for the sanitation and combined WASH interventions. DISCUSSION: WASH intervention effectiveness was strongly influenced by precipitation and temperature, and nearly all protective effects were observed during the rainy season. Future implementation of these interventions should consider local environmental conditions to maximize effectiveness, including targeted efforts to maintain latrines and promote community adoption ahead of monsoon seasons. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to use machine learning models to predict drinking water quality from a public health nursing approach. Design: Machine learning study. Sample: "Water Quality Dataset" was used in the study. The dataset contains physical and chemical measurements of water quality for 2400 different water bodies. The process consists of four stages: Data processing with Synthetic Minority Oversampling Technique, hyperparameter tuning with 10‐fold cross‐validation, modeling and comparative analysis. 80% of the dataset is allocated as training data and 20% as test data. ML models logistic regression, K‐nearest neighbor, support vector machine, random forest, XGBoost, AdaBoost Classifier, Decision Tree algorithms were used for water quality prediction. Accuracy, precision, recall, F1 score and AUC performance metrics of ML models were compared. To evaluate the performance of the models, 10‐fold cross‐validation was used and a comparative analysis was performed. The p‐values of the models were also compared. Results: N this study, where drinking water quality was predicted with seven different ML algorithms, it can be said that XGBoost and Random Forest are the best classification models in all performance metrics. There is a significant difference in all ML algorithms according to the p‐value. The H0 hypothesis is accepted for these algorithms. According to the H0 hypothesis, there is no difference between actual values and predicted values. Conclusion: In conclusion, the use of ML models in the prediction of drinking water quality can help nurses greatly improve access to clean water, a human right, be more knowledgeable about water quality, and protect the health of individuals. [ABSTRACT FROM AUTHOR]

The aim of the study is to evaluate the quality of water collected during wet and dry seasons of Şanlıurfa and to expand and improve understanding of the pollution status and drinking quality of bottled water used for drinking purposes. To do so, an entropy-weighted water quality index (EWQI) and a groundwater pollution index (PIG) were used to evaluate data on physicochemical parameters related to drinking water quality standards. The parameters related to bottled water quality were evaluated with Piper and Ternary diagrams. The calculated EWQI values ranged from 7.78 to 29.74 in wet season whereas 11.63 to 32.20 in dry season. Overall, EWQI data showed that all of water samples were suitable for drinking. Similarly, the values of PIG varied from 0.09 to 0.3 in wet season but 0.1 to 0.26 in dry season, which also showed that all water samples from the study area were suitable. [ABSTRACT FROM AUTHOR]

General circulation models (GCMs) are developed to simulate the past climate and generate future climate predictions. In the context of global warming, their important roles in identifying possible solutions to water resources planning/management are recognized by the world. However, in actual and regional implementation, due to many factors like initial and boundary conditions, parameters and model structures and so forth, there are great variabilities and uncertainties across the future climate projections of GCMs outputs, which has attracted criticism from water resources planners. Thus, the GCMs usually must be evaluated for assessing their performances in simulating the historical observations. Currently, there are many different conclusions and opinions as to whether the optimal individual model is more advantageous or whether the combined consideration of MME works better. The purpose of this paper is to compare the advantages and disadvantages between the selection of the optimal single GCM and multi‐model ensemble (MME) based on one of the more objective selection methods called TOPSIS. The results show that the performances of GCMs in simulating precipitation and temperature in different climate subregions over China are not identical. For CMIP6 GCMs simulations, the optimal precipitation GCM is CMCC‐CM2‐SR5 for EC, MIROC6 for SC, SWC and NWC, CESM2‐WACCM for NC and NEC, and FGOALS‐g3 for QTP. As for temperature, only NESM3 and BCC‐ESM1 are the optimal GCM for QTP and NWC, respectively; in other subregions, MME is better than single GCM. In general, a simple arithmetic averaging approach employed to generate the MME model is not superior to the optimal GCM, although the error metric with the observed data is reduced, at the cost of a severe compression of the interannual variability. [ABSTRACT FROM AUTHOR]

Objective: To undertake an economic evaluation of community water fluoridation (CWF) in remote communities of the Northern Territory (NT). Design: Dental caries experiences were compared between CWF and non‐CWF communities before and after intervention. Costs and benefits of CWF are ascertained from the health sector perspective using water quality, accounting, oral health, dental care and hospitalisation datasets. Setting and Participants: Remote Aboriginal population in the NT between 1 January 2008 and 31 December 2020. Intervention: CWF. Main Outcome Measures: Potential economic benefits were estimated by changes in caries scores valued at the NT average dental service costs. Results: Given the total 20‐year life span of a fluoridation plant ($1.77 million), the net present benefit of introducing CWF in a typical community of 300–499 population was $3.79 million. For each $1 invested in CWF by government, the estimated long‐term economic value of savings to health services ranged from $1.1 (population ≤300) to $16 (population ≥2000) due to reductions in treating dental caries and associated hospitalisations. The payback period ranged from 15 years (population ≤300) to 2.2 years (population ≥2000). Conclusions: The economic benefits of expanding CWF in remote Aboriginal communities of NT outweigh the costs of installation, operation and maintenance of fluoridation plants over the lifespan of CWF infrastructure for population of 300 or more. [ABSTRACT FROM AUTHOR]

The impact of water consumption bolus volume and frequency on hydration biomarkers during work in the heat is unknown. In a randomized, crossover fashion, eight males consumed either 500 mL of water every 40 min or 237 mL of water every 20 min during 2 hr of continuous walking at 6.4 kph, 1.0% grade in a 34 °C/30% relative humidity environment, followed by 2 hr of rest. Hydration biomarkers and variables were assessed pre-work, post-work, and after the 2 hr recovery. There were no differences in body mass between trials at any time point (all p > 0.05). Percent change in plasma volume during work was not different when 237 mL of water was repeatedly consumed (−1.6 ± 8.2%) compared to 500 mL of water (−1.3 ± 3.0%, p = 0.92). Plasma osmolality was maintained over time (p = 0.55) with no difference between treatments (p = 0.21). When consuming 500 mL of water repeatedly, urine osmolality was lower at recovery (205 ± 108 mOsmo/L) compared to pre-work (589 ± 95 mOsmo/L, p < 0.01), different from repeatedly consuming 237 mL of water which maintained urine osmolality from pre-work (548 ± 144 mOsmo/L) through recovery (364 ± 261 mOsmo/L, p = 0.14). Free water clearance at recovery was greater with repeated consumption of 500 mL of water (1.2 ± 1.0 mL/min) compared to 237 mL of water (0.4 ± 0.8 mL/min, p = 0.02). Urine volume was not different between treatments post-work (p = 0.62), but greater after 2 hr of recovery when repeatedly consuming 500 mL of water compared to 237 mL (p = 0.01), leading to greater hydration efficiency upon recovery with repeated consumption of 237 mL of water (68 ± 12%) compared to 500 mL (63 ± 14%, p = 0.01). Thirst and total gastrointestinal symptom scores were not different between treatments at any time point (all p > 0.05). Body temperatures and heart rate were not different between treatments at any time point (all p > 0.05). Drinking larger, less frequent water boluses or drinking smaller, more frequent water boluses are both reasonable strategies to promote adequate hydration and limit changes in body mass in males completing heavy-intensity work in the heat. [ABSTRACT FROM AUTHOR]

BACKGROUND: The state of New York expects to receive $115 million in 2022 alone from the U.S. Infrastructure Investment and Jobs Act to support the replacement of lead water service lines. OBJECTIVES: Our objective was to determine the number and proportion of potential lead water service lines across New York City (NYC) and to evaluate the association between census tract-level racial/ethnic composition, housing vulnerability, and child lead exposure vulnerability with service line type (Potential Lead, Unknown) for 푛=2,083 NYC tracts. METHODS: We conducted a descriptive analysis assessing water service line material recorded in the NYC Department of Environmental Protection’s Lead Service Line Location Coordinates database. We used conditional autoregressive Bayesian Poisson models to assess the relative risk [RR; median posterior estimates, and 95% credible interval (CrI)] of service line type per 20% higher proportion of residents in a given racial/ethnic group and per higher housing vulnerability and child lead exposure vulnerability index scores corresponding to the interquartile range. We also evaluated the associations in flexible natural cubic spline models. RESULTS: Out of 854,672 residential service line records, 136,891 (16.0%) were Potential Lead, and 227,443 (26.6%) were Unknown. In fully adjusted models, higher proportions of Hispanic/Latino residents and higher child lead exposure vulnerability were associated with Potential Lead service lines in flexible spline models and linear models [RR=1.15 (95% CrI: 1.11, 1.21) and RR=1.11 (95% CrI: 1.02, 1.20), respectively]. Associations were modified by borough; Potential Lead service lines were associated with higher proportions of non-Hispanic White and non- Hispanic Asian residents in the Bronx and Manhattan, and with higher proportions of non-Hispanic Black residents in Queens. DISCUSSION: NYC has a high number of Potential Lead and Unknown water service lines. Communities with a high proportion of Hispanic/Latino residents and those with children who are already highly vulnerable to lead exposures from numerous sources are disproportionately impacted by Potential Lead service lines. These findings can inform equitable service line replacement across New York state and NYC. [ABSTRACT FROM AUTHOR]

Objective: Helicobacter pylori (H. pylori) is a Gram-negative microaerophilic bacterium that is associated with diseases such as peptic ulcer, chronic gastritis, gastric MALT lymphoma, and gastric cancer. H. pylori infection is more common in developing countries. The high socioeconomic conditions and elimination of bacterial carriage by antimicrobial treatment reduce the prevalence of H. pylori in developed countries. The fecal H. pylori antigen test has been widely used recently. This test with high sensitivity and specificity constitutes a significant diagnostic method alternative due to its cost-effectiveness and rapid results. In this study, we retrospectively analyzed the presence of H. pylori antigen in the stool samples of patients with gastroduodenal complaints from laboratory records. Methods: Test results of patients who underwent H. pylori antigen rapid cassette test from fresh fecal samples between January 2018 and May 2022 in the Medical Microbiology Laboratory were included in the study. Fresh fecal samples from patients were analyzed using H. pylori Antigen Rapid Test Cassette (Acro Biotech Inc, USA) kits. The statistical analysis of the research was made with IBM-SPSS 25.0 (IBM Co., USA). The chi-square test was used to evaluate the research data. P<0.05 value was considered statistically significant. Results: A total of 5,718 patients, 3,285 (57.5%) women with gastroduodenal complaints, were included in the study. Fecal H. pylori antigen test positivity was determined in 1,429 (25%) of these patients. The antigen positivity rate was found to be higher in women (26.6%) compared to men (22.9%) (p<0.05). In addition, this rate was higher in adult patients (27.4%) than in pediatric patients (10.1%). In addition, this rate was higher in adult patients (27.4%) compared with pediatric patients (10.1%) (p<0.01). Conclusion: The regional prevalence data are informative about the development levels of countries in socioeconomic issues such as urbanization, infrastructure services, and access to clean water. In addition, these data may provide insight into the future prevalence of H. pylori-related diseases. We think that this study, in which the data of our region is shared, contributes to the literature. [ABSTRACT FROM AUTHOR]

Droughts are defined by a prolonged absence of moisture. For making drought assessments, a drought index is a crucial tool. This study aims to compare drought characteristics across the Central Main Ethiopian Rift using three drought indices - the Standardized Precipitation Index (SPI), the Reconnaissance Drought Index (RDI), and the Standardized Precipitation Evapotranspiration Index (SPEI) - from 1980 to 2017 at six climate sites in spring, summer, and a 6-month period (March - August). With 1% and 5% significance levels, Modified Mann-Kendall and Sen's Slope Estimators were used to determine trend and magnitude, respectively. The temporal fluctuations of the three drought indices revealed that droughts are frequent, unpredictable, and random. Furthermore, they behaved similarly and had significant links. At most places, the drought indices found no significant trends. However, in the spring season, Butajira (by the three indices) and Wulbareg (by the SPI) showed significantly decreasing trends (increasing drought severity), with change rates ranging from -0.03 to -0.04/year. A comparison of drought characteristics revealed that droughts have become more severe and frequent in recent decades, with spring being more common than summer. This study, which employed a variety of drought indices, could assist water resource planners better understand drought events. [ABSTRACT FROM AUTHOR]

Fluoride acts as a key element in dental caries prevention strategy. The consumption of drinking water with adequate fluoride concentration protects the tooth from dental caries. To assess the fluoride level in various drinking water sources available in Coimbatore city. 100 water samples from corporation water, bore-well water and packaged water were randomly collected from five zones of Coimbatore. Fluoride estimation was done by colour comparator technique. The fluoride concentration in bore well water (0.9 ppm) was found to be high when compare to corporation water (0.48 ppm) and bottled water (0.2 ppm). The result obtained from this study stated that the fluoride level was suboptimal in community water and bottled water. Various alternative measures to be taken to artificially fluoridate the drinking water in Coimbatore to have better dental health. [ABSTRACT FROM AUTHOR]

Simple Summary: Over 100 million individuals worldwide are exposed to arsenic through drinking water. Arsenic is a cancer-causing chemical. While ultraviolet light exposure and skin sensitivity are known risk factors for skin cancers, especially in Caucasians, arsenic exposure may be a major risk factor for other populations. This is the first study to address the genome-wide gene expression in basal cell carcinoma (BCC) of skin in the context of arsenic exposure. Our study confirms many of the gene pathways involved in BCC; in addition, we found that high arsenic exposure was associated with impaired (a) DNA replication, (b) cellular response to DNA damage repair and (c) immune response that leads to BCC. This study suggests a lower chance of platinum drug resistance in BCC patients with high arsenic exposure compared to the higher chance of platinum drug resistance in patients with low arsenic exposure. These findings may have biological and clinical significance. Exposure to inorganic arsenic (As) is recognized as risk factor for basal cell carcinoma (BCC). We have followed-up 7000 adults for 6 years who were exposed to As and had manifest As skin toxicity. Of them, 1.7% developed BCC (males = 2.2%, females = 1.3%). In this study, we compared transcriptome-wide RNA sequencing data from the very first 26 BCC cases and healthy skin tissue from independent 16 individuals. Genes in " cell carcinoma pathway", "Hedgehog signaling pathway", and "Notch signaling pathway" were overexpressed in BCC, confirming the findings from earlier studies in BCC in other populations known to be exposed to As. However, we found that the overexpression of these known pathways was less pronounced in patients with high As exposure (urinary As creatinine ratio (UACR) > 192 µg/gm creatinine) than patients with low UACR. We also found that high UACR was associated with impaired DNA replication pathway, cellular response to different DNA damage repair mechanisms, and immune response. Transcriptomic data were not strongly suggestive of great potential for immune checkpoint inhibitors; however, it suggested lower chance of platinum drug resistance in BCC patients with high UACR compared high platinum drug resistance potential in patients with lower UACR. [ABSTRACT FROM AUTHOR]

The water environment is one of the basic elements that constitute the environment. It is an important place for the survival and development of human society, and it is also the most seriously disturbed and damaged area by humans. The pollution and destruction of water environment has become one of the major environmental problems in the world today. The essence of urban water space landscape design under the concept of integrating people's ecological design is the ecological landscape design of urban water spaces, while the development of ecological landscape design in the field of urban water space landscape design is still in its infancy, and the interpretation of its concept is also different. The ecological design of the landscape reflects a new dream of human beings, a new aesthetics and value: the true cooperative and fraternal relationship between man and nature. At present, the ecological design of urban water space landscape has not put forward a more accurate concept, clear principles and standards, and a complete and systematic theoretical basis, which requires further research, discussion, and continuous practice by this generation of designers to improve it. To this end, this paper proposed a research method on the integration of water environment governance in urban and rural spaces with natural ecological landscape design. This paper mainly talked about the status quo of water environment and its network sensor algorithm research and analyzed its coverage area one by one. Then, the water quality extraction is introduced in detail. And finally, the data analysis of the Beijing river waters, the analyzer rainfall, water quality, and so on are carried out in the experimental part. It could be seen from the experimental results that there were currently 22 reclaimed water plants in six urban areas of Beijing, with a daily water treatment capacity of 4.08 million cubic meters and a sewage treatment rate of 98%. As of 2016, 440 million cubic meters of reclaimed water has been reused. With the commissioning of the new reclaimed water system, the proportion of reclaimed water in the river and lake environment will continue to increase. [ABSTRACT FROM AUTHOR]

The article presents a study which analyzed the arsenic concentrations in community and prison water systems (CWS) in the U.S.' Southwestern region. Other topics include access to safe drinking water as a universal human right, the trends in compliance, water quality and treatment after the adoption of the arsenic maximum contaminant level (MCL) for arsenic in the region, and the effectiveness of arsenic remediation.

Background: Estimates of the effectiveness of water, sanitation, and hygiene (WASH) interventions that provide high levels of service on childhood diarrhoea are scarce. We aimed to provide up-to-date estimates on the burden of disease attributable to WASH and on the effects of different types of WASH interventions on childhood diarrhoea in low-income and middle-income countries (LMICs).Methods: In this systematic review and meta-analysis, we updated previous reviews following their search strategy by searching MEDLINE, Embase, Scopus, Cochrane Library, and BIOSIS Citation Index for studies of basic WASH interventions and of WASH interventions providing a high level of service, published between Jan 1, 2016, and May 25, 2021. We included randomised and non-randomised controlled trials conducted at household or community level that matched exposure categories of the so-called service ladder approach of the Sustainable Development Goal (SDG) for WASH. Two reviewers independently extracted study-level data and assessed risk of bias using a modified Newcastle-Ottawa Scale and certainty of evidence using a modified Grading of Recommendations, Assessment, Development, and Evaluation approach. We analysed extracted relative risks (RRs) and 95% CIs using random-effects meta-analyses and meta-regression models. This study is registered with PROSPERO, CRD42016043164.Findings: 19 837 records were identified from the search, of which 124 studies were included, providing 83 water (62 616 children), 20 sanitation (40 799 children), and 41 hygiene (98 416 children) comparisons. Compared with untreated water from an unimproved source, risk of diarrhoea was reduced by up to 50% with water treated at point of use (POU): filtration (n=23 studies; RR 0·50 [95% CI 0·41-0·60]), solar treatment (n=13; 0·63 [0·50-0·80]), and chlorination (n=25; 0·66 [0·56-0·77]). Compared with an unimproved source, provision of an improved drinking water supply on premises with higher water quality reduced diarrhoea risk by 52% (n=2; 0·48 [0·26-0·87]). Overall, sanitation interventions reduced diarrhoea risk by 24% (0·76 [0·61-0·94]). Compared with unimproved sanitation, providing sewer connection reduced diarrhoea risk by 47% (n=5; 0·53 [0·30-0·93]). Promotion of handwashing with soap reduced diarrhoea risk by 30% (0·70 [0·64-0·76]).Interpretation: WASH interventions reduced risk of diarrhoea in children in LMICs. Interventions supplying either water filtered at POU, higher water quality from an improved source on premises, or basic sanitation services with sewer connection were associated with increased reductions. Our results support higher service levels called for under SDG 6. Notably, no studies evaluated interventions that delivered access to safely managed WASH services, the level of service to which universal coverage by 2030 is committed under the SDG.Funding: WHO, Foreign, Commonwealth & Development Office, and National Institute of Environmental Health Sciences. [ABSTRACT FROM AUTHOR]

Background: Iodine status surveys of women in Somaliland present widely conflicting results. Previous research indicates elevated concentrations of iodine (IQR 18-72 μg/L) in groundwater used for drinking and cooking, but the relation with iodine intake is not well characterized.Objectives: We aimed to investigate the contributions of household water iodine concentration (WIC), breastfeeding, total fluid intake, hydration levels, and urine volume on urinary iodine concentration (UIC) and excretion (UIE) over a 24-h period and to define iodine status from iodine intake estimates and median UIC, normalized to a mean urine volume of 1.38 L/d (hydration adjusted).Methods: The study sample comprised 118 nonpregnant, healthy women aged 15-69 y. All participants resided in Hargeisa, and 27 were breastfeeding. Data collection consisted of a 24-h urine collection, a 24-h fluid intake diary, a beverage frequency questionnaire, and a structured recall interview. We measured UIC and WIC in all urine and in 49 household water samples using the Sandell-Kolthoff reaction.Results: WIC ranged between 3 and 188 μg/L, with significant median differences across the water sources and city districts (P < 0.003). Nonbreastfeeding women were borderline iodine sufficient [hydration-adjusted median urinary iodine concentration (mUIC) 109 μg/L; 95% CI: 97, 121 μg/L], whereas breastfeeding women showed a mild iodine deficiency (73 μg/L; 95% CI: 54, 90 μg/L). There were strong correlations (ρ: 0.50-0.69, P = 0.001) between WIC and UIC, with iodine from household water contributing more than one-half of the total iodine intake. Multivariate regression showed hydration and breastfeeding status to be the main predictors of UIC.Conclusions: Iodine from household water is the main contributor to total iodine intake among women in Hargeisa, Somaliland. Variation in female hydration and spatial and temporal WIC may explain diverging mUIC between studies. Water sources at the extremes of low and high iodine concentrations increase the risk of subpopulations with insufficient or more than adequate iodine intake. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to assess the association between lithium levels in drinking water from public supplies and suicide rates in different municipalities of Lithuania in relation with incidence of affective disorders.Methods: 53 drinking water samples were analysed from the main public drinking water systems of the country's municipalities. Lithium levels were determined using the ion chromatography method. Information on all registered affective disorders across all age groups and gender within the 5-year period was obtained from the Department of Statistics, and was averaged across the investigation time period. For the statistical analysis, lithium levels were averaged per municipality and plotted against suicide standardized mortality rates per 100,000 populations, within the 5-year period.Results: We found that lithium levels in drinking water are positively associated with the incidence of affective disorders. Our findings suggest higher incidence rates of affective disorders in the municipalities with a lithium level in drinking water above median compared to those in the municipalities with a lithium level below median and with the same socio-demographic and psychiatric characteristics. Suicide mortality rates are inversely associated with lithium levels in drinking water only in municipalities with higher lithium levels (above median) and with a high rate of affective disorders.Conclusion: Based on our study results and insights we generate the following hypothesis for the further research, that lithium level in drinking water might have an important protective effect against suicide rates in the population with affective disorders. [ABSTRACT FROM AUTHOR]

Background: In the densely populated slums of Kolkata, informal healthcare providers' (IHP) diarrhea-related knowledge and rationality of practices should be improved to reduce risk of adverse outcome, expenditure, and antimicrobial resistance.Methods: A multicomponent intervention was conducted among 140 representative IHPs in the slums of 8 wards in Kolkata to assess its impact on their diarrhea-related knowledge and practice. Six intervention modules in local languages were provided (1 per month) with baseline (N = 140) and postintervention (N = 124) evaluation.Results: Mean overall (61.1 to 69.3; P < .0001) and domain-specific knowledge scores for etiology/spread (5.4 to 8.1; P < .0001), management (6.4 to 7.2; P < .0001), and oral rehydration solution ([ORS] 5.7 to 6.5; P < .0001) increased significantly (at α = 0.05) after intervention and were well retained. Impact on knowledge regarding etiology/spread (adjusted odds ratio [aOR] = 5.6; P < .0001), cholera (aOR = 2.0; P = .0041), management (aOR = 3.1; P < .0001), ORS (aOR = 2.3; P = .0008), and overall (aOR = 4.3; P < .0001) were significant. Intervention worked better for IHPs who practiced for ≥10 years (aOR = 3.2; P < .0001), untrained IHPs (aOR = 4.8; P < .0001), and pharmacists (aOR = 8.3; P < .0001). Irrational practices like empirical antibiotic use for every cholera case (aOR = 0.3; P < .0001) and investigation for every diarrhea case (aOR = 0.4; P = .0003) were reduced. Rationality of testing (aOR = 4.2; P < .0001) and antibiotic use (aOR = 1.8; P = .0487) improved.Conclusions: Multicomponent educational intervention resulted in sustainable improvement in diarrhea-related knowledge and practices among IHPs in slums of Kolkata. Policy implications should be advocated along with implementation and scale-up. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is a common heart rhythm disorder and a risk factor of adverse cardiovascular diseases. Established causes do not fully explain the risk of AF and unexplained risk factors might be related to the environment, e.g. magnesium in drinking water. Low magnesium levels in drinking water might be associated with higher risk of cardiovascular diseases including AF. With detailed individual data from nationwide registries and long-term magnesium exposure time series, we had a unique opportunity to investigate the association between magnesium in drinking water and AF.Objective: We evaluated the association between magnesium concentration in drinking water and AF risk.Methods: A nationwide register-based cohort study (2002-2015) was used including individuals aged ≥30 years. Addresses were linked with water supply areas (n = 2418) to obtain time-varying drinking water magnesium exposure at each address. Five exposure groups were defined based on a 5-year rolling time-weighted average magnesium concentration. AF incidence rate ratios (IRRs) between exposure groups were calculated using a Poisson regression of incidence rates, adjusted for sex, age, and socioeconomic position. Robustness of results was investigated with different exposure definitions.Results: The study included 4,264,809 individuals (44,731,694 person-years) whereof 222,998 experienced an incident AF. Magnesium exposure ranged from 0.5 to 62.0 mg/L (mean = 13.9 mg/L). Estimated IRR (95% CI) compared to the referent exposure group (< 5 mg/L) was 0.98 (0.97-1.00) for the second lowest exposure group (5-10 mg/L), and 1.07 (1.05-1.08) for the two highest exposure groups (15-62 mg/L). Strongest positive associations were observed among those aged ≥80 years and with lowest education group. An inverse association was found among individuals with highest education group.Conclusion: There might be a small beneficial effect on AF of an increase in magnesium level in drinking water up to 10 mg/L, though an overall positive association was observed. The unexpected positive association and different associations observed for subgroups suggest a potential influence of unaccounted factors, particularly in vulnerable populations. Future research on magnesium in drinking water and cardiovascular diseases needs to focus on contextual risk factors, especially those potentially correlating with magnesium in drinking water. [ABSTRACT FROM AUTHOR]

Groundwater is one of the precious water sources for domestic, irrigation, and industrial demands in arid and semiarid regions of the world. The same is true in Ethiopia context. In this study, seven groundwater samples were collected and analyzed for various chemical constituents (pH, TDS, Na+, K+, Ca2+, Mg2+, SO42-, Cl-, HCO3-, and NO3-) to assess the hydrogeochemical characteristics and water types of the groundwater wells. Among the seven sampled groundwater wells, five wells are found and used for domestic water supply in Arba Minch University (AMU) main campus. The remaining two are used for industrial and irrigation demands located at the compound of Textile Factory and Haile Resort, respectively. Results showed that the main campus groundwater wells are saline and harder than the two wells from Textile Factory and Haile Resort. Moreover, elevated concentration of nitrate and potassium (greater than the maximum permissible level allowed in Ethiopia) were obtained in the groundwater sources used mainly in the AMU main campus wells. These elevated concentrations of potassium and nitrate beyond the enriched salt contents in the AMU main campus wells could pose kidney, cardiovascular, and other related health problems. This study, therefore, recommends the AMU to find other groundwater sources for drinking purpose other than the studied water-well field. [ABSTRACT FROM AUTHOR]

Purpose: Adverse effects of iron fortification/supplements such as Micronutrient Powder (MNP) on gut microbiota have previously been found in infection-prone African settings. This study examined the adversaries of a low-iron MNP compared with the standard MNP on the composition of gut microbiota in Bangladeshi children exposed to a high concentration of iron from potable groundwater. Methods: A randomized controlled trial was conducted in 2- to 5-year-old children, drinking groundwater with a high concentration of iron (≥ 2 mg/L). Children were randomized to receive one sachet per day of either standard MNP (12.5 mg iron) or low-iron MNP (5 mg iron), for 2 months. A sub-sample of 53 children was considered for paired assessment of the gut microbiome by 16S rRNA amplicon sequencing. Results: At baseline, the gut microbiota consisted of Bifidobacteriaceae (15.6%), Prevotellaceae (12.2%), Lactobacillaceae (3.6%), Clostridiaceae (4.1%) and Enterobacteriaceae (2.8%). Overall, there was no significant treatment effect of the low-iron MNP compared to the standard MNP. However, an apparent treatment effect was observed in children with a relative adult-like microbiota, with a higher relative abundance of potentially pathogenic Enterobacteriaceae after receiving the standard MNP compared to the low-iron MNP. This effect, however, was statistically non-significant (p = 0.07). Conclusion: In Bangladeshi children drinking iron-rich groundwater, a low-iron MNP supplementation did not have a significant impact on their gut microbiota profile/composition compared to the standard MNP. The trial registration number is ISRCTN60058115; Date of registration 03/07/2019; retrospectively registered. [ABSTRACT FROM AUTHOR]

Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat. [ABSTRACT FROM AUTHOR]

Objective  The lead-in-water impact of the Flint water crisis on the youngest and most neurodevelopmentally vulnerable population was largely unknown. The objective of this study was to investigate and compare cord blood lead levels (CBLLs) in newborns in Flint, Michigan, after the Flint water crisis, to a group of Detroit newborns. Study Design  Mothers of 99 Flint newborns were surveyed about potential lead exposures. These neonates were born after the recognition of population-wide lead-in-water contamination. CBLLs were measured and maternal–fetal metrics were reviewed. CBLLs and maternal–fetal metrics were then compared with those of a retrospective cohort of 116 Detroit newborns who previously shared the same water source. Analysis involved descriptive statistics, independent t -test, and χ 2 analysis. Results  CBLLs greater than or equal to 1 μg/dL (0.05 μmol/L) were more prevalent among Flint newborns (14%), as compared with Detroit newborns (2%; p  = 0.001). This was a sevenfold disparity between Flint and Detroit newborns. No statistically significant differences were found in birth weight, head circumference, small for gestational age status, gestational age, or preterm status among the two groups. Conclusion  The Flint water crisis potentially exposed newborns to lead in utero, implicating maternal–fetal outcomes and future health and development. Primary prevention efforts, including identification and mitigation of lead exposure before conception and during pregnancy, are needed. New environmental exposure detection methods and long-term neurodevelopmental follow-up will complement the findings of this study. [ABSTRACT FROM AUTHOR]

Malnutrition is the leading cause of poor child health in Ethiopia, and progress to avert it is unacceptably slow. In addition, little is known about the magnitude and factors associated with concurrent wasting and stunting (WaSt). Therefore, this study aimed to assess the prevalence and factors associated with WaSt, wasting, stunting and underweight among children 6–59 months in Kersa Health and Demographic Surveillance System, Ethiopia. Data from a total of 1091 children and their parents' were analysed from a cross‐sectional study. Household questionnaires and anthropometric measurements were used for data collection. Height‐for‐age, weight‐for‐height and weight‐for‐age indices are expressed as standard deviation units from the mean for the reference group. Multivariate analyses were conducted to identify factors associated with WaSt, wasting, stunting and underweight. Statistical significance was declared at p < 0.05. The prevalence of indicators of malnutrition was WaSt (5.8%), wasting (16.8%), stunting (53.9%) and underweight (36.9%). Children aged 6–17 months had a higher odds of wasting (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.12–2.75) compared with those aged 36–59 months, whereas children aged 18–35 months (aOR 2.4, 95% CI 1.65–3.47) and 36–59 months (aOR 1.6, 95% CI 1.07–2.37) had higher odds of stunting compared with those aged 6–17 months. Similarly, children aged 18–35 months (aOR 1.6, 95% CI 1.07–2.37) and 36–59 months (aOR 2.2, 95% CI 1.52–3.10) had higher odds of underweight compared with children aged 6–17 months. Households that did not treat drinking water at point of use were at higher odds of WaSt (aOR 3.3, 95% CI 1.16–9.27) and stunting (aOR 1.9, 95% CI 1.31–2.85) compared with those who did treat drinking water. Boys were more likely to be WaSt, wasted, stunted and underweight. Cough was associated with WaSt, wasting and underweight. Furthermore, maternal education, maternal occupation and maternal age were significantly associated with wasting. Maternal body mass index (BMI) of less than 18.5 kg/m2 and maternal BMI between 18.5 and 25 kg/m2 were associated with child stunting. In Kersa, the prevalence of WaSt, wasting, stunting and underweight is very high and requires urgent public health intervention. This study highlights point‐of‐use water treatment, maternal education, hygiene and sanitation, child health service utilization and maternal BMI as important areas to improve to target child malnutrition. Furthermore, a community‐based programmatic and policy direction for early identification and management of WaSt in addition to other indicators of malnutrition is recommended. [ABSTRACT FROM AUTHOR]

Aim: Voluntary dehydration, or lack of fluid intake despite water availability, is common in otherwise healthy children, and can lead to adverse effects. Most dehydration biomarkers are impractical for routine assessment in paediatric populations. This study aimed to assess two non-invasive hydration assessment tools, urine specific gravity (USG ) and a novel point-of-care (POC) salivary osmolarity (SOSM) sensor, in healthy children.Methods: Volunteers were tested by colorimetric USG and a handheld SOSM system. Observed values were compared against previous studies to determine hydration status, as was the concordance between parameters.Results: At the common USG threshold of 1.020, 42.4% of the 139 healthy children were dehydrated. The same prevalence was found using the 70-mOSM cut-off value. Comparative analysis of SOSM at varying USG thresholds demonstrated significantly higher SOSM in dehydrated children with a USG  ≥ 1.030 (P = 0.002).Conclusion: At the USG threshold of 1.020 and SOSM threshold of 70 mOSM, 42.4% of healthy children were found to be voluntarily dehydrated. Significantly higher SOSM was observed in dehydrated children (USG  ≥ 1.030). As the first study on the utility of POC SOSM measurements for detecting dehydration, these results provide a foundation for future POC characterisation of SOSM in other populations and clinical contexts. [ABSTRACT FROM AUTHOR]

Background: Drinking-water salinity has been associated with high blood pressure (BP) among communities in south-west coastal Bangladesh. We evaluated whether access to water from managed aquifer recharge (MAR)-a hydrogeological intervention to lower groundwater salinity by infiltrating rainwater into the aquifers-can reduce community BP.Methods: We conducted a stepped-wedge cluster-randomized trial with five monthly visits between December 2016 and April 2017 in 16 communities. At each visit following baseline, four communities were randomized to access MAR water. Systolic BP was the primary outcome, measured during each visit using Omron® HEM-907 devices. We also measured participants' 24-hour urinary sodium and households' drinking- and cooking-water salinity each visit. We used multilevel regression models to estimate the effects of MAR-water access on participants' BP. The primary analysis was intention-to-treat.Results: In total, 2911 person-visits were conducted in communities randomized to have MAR-water access and 2834 in communities without MAR-water access. Households without MAR-water access predominantly used low-salinity pond water and 42% (range: 26-50% across visits) of households exclusively consumed MAR water when access was provided. Communities randomized to MAR-water access had 10.34 [95% confidence interval (CI): 1.11, 19.58] mmol/day higher mean urinary sodium, 1.96 (95% CI: 0.66, 3.26; p = 0.004) mmHg higher mean systolic BP and 1.44 (95% CI: 0.40, 2.48; p = 0.007) mmHg higher mean diastolic BP than communities without MAR-water access.Conclusions: Our findings do not support the scale-up of MAR systems as a routine drinking-water source, since communities that shifted to MAR water from the lower-salinity pond-water source had higher urinary sodium and BP. [ABSTRACT FROM AUTHOR]

Background: Stunting is a critical public health problem of developing countries like Ethiopia. Different interventions like irrigation activity have been carried out by the government of Ethiopia to improve the nutritional status of the community. However, there is scanty of data on childhood stunting and its associated factors between irrigation user and non-irrigation user. Objective: To assess the magnitude of childhood stunting and its associated factors between irrigation and non-irrigation user in North Mecha District, Northwest Ethiopia. Methods: A community-based comparative cross-sectional study design was employed from October to November 2019. A systematic sampling was used to draw mothers with children age 6–59 months (582 irrigated and 582 non- irrigated household users). Data were collected using questionnaire and anthropometric measurement tools. Multivariable logistic regression was used to identify the predictors of stunting. Adjusted odds ratios with 95% CI were used to determine the degree of association between independent and outcome variable. A-p-value < 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable. Results: The prevalence of childhood stunting (6–59 months) among irrigation users [32.8% at 95%CI [29.1%-36.7%]] was slightly lower than non-users [40.2% at 95%CI [[36.3%-44.2%]]]. However, the difference did not show significant variation. The odds of childhood stunting were higher among a child from a mother had no antenatal visit, a child whose age was between 12 and 47 months, a child from a mother who did not use water and soap always for washing hands, and a child who had fever. Conclusion: The prevalence of childhood stunting was high and did not show significant variation between irrigation and non-irrigation users. A child from mother had no antenatal visit, whose age was between 12 and 47 months, a mother who did not use water and soap always for washing hands, and who had fever were factors associated with higher child stunting. Thus, the identified modifiable factors should be strengthened to reduce stunting. [ABSTRACT FROM AUTHOR]

Global 500-m (18-arcsec) resolution cropland suitability was estimated using recently developed high-resolution global cropland data and a digital elevation model. The high-resolution estimation more precisely represented topographical constraints to agriculture that were not adequately reflected in previous low-resolution estimates. It also successfully suppressed the overestimation of cropland suitability on areas with steep slopes. Furthermore, the distinction of rainfed and irrigated cropland removed suitability overestimation induced by human agricultural intervention and enabled more natural and realistic estimation of cropland suitability. The comparative analysis between the estimated land suitability and actual cropland distribution revealed that, if only natural condition is considered, it is possible to expand cropland area by 9.25 million km², which is more than needed in the future while socioeconomic factors controlling cropland suitability should be considered for more practical assessment. The newly developed highest-resolution cropland suitability map is expected to contribute to solving upcoming water, energy, and food issues, by integrating with water resource models and biomass studies. [ABSTRACT FROM AUTHOR]

Background: Supply driven programs that are not closely connected to community demand and demand-driven programs that fail to ensure supply both risk worsening inequity. Understanding patterns of uptake of behaviors among the poorest under ideal experimental conditions, such as those of an efficacy trial, can help identify strategies that could be strengthened in routine programmatic conditions for more equitable uptake. WASH Benefits Bangladesh was a randomized controlled efficacy trial that provided free-of cost WASH hardware along with behavior change promotion. The current paper aimed to determine the impact of the removal of supply and demand constraints on the uptake of handwashing and sanitation behaviors across wealth and education levels. Methods: The current analysis selected 4 indicators from the WASH Benefits trial— presence of water and soap in household handwashing stations, observed mother's hand cleanliness, observed visible feces on latrine slab or floor and reported last child defecation in potty or toilet. A baseline assessment was conducted immediately after enrolment and endline assessment was conducted approximately 2 years later. We compared change in uptake of these indicators including wealth quintiles (Q) between intervention and control groups from baseline to endline. Results: For hand cleanliness, the poorest mothers improved more [Q1 difference in difference, DID: 16% (7, 25%)] than the wealthiest mothers [Q5 DID: 7% (− 4, 17%)]. The poorest households had largest improvements for observed presence of water and soap in handwashing station [Q1 DID: 82% (75, 90%)] compared to the wealthiest households [Q5 DID: 39% (30, 50%)]. Similarly, poorer household demonstrated greater reductions in visible feces on latrine slab or floor [Q1DID, − 25% (− 35, − 15) Q2: − 34% (− 44, − 23%)] than the wealthiest household [Q5 DID: − 1% (− 11, 8%). For reported last child defecation in potty or toilet, the poorest mothers showed greater improvement [Q1–4 DID: 50–54% (44, 60%)] than the wealthier mothers [Q5 DID: 39% (31, 46%). Conclusion: By simultaneously addressing supply and demand-constraints among the poorest, we observed substantial overall improvements in equity. Within scaled-up programs, a separate targeted strategy that relaxes constraints for the poorest can improve the equity of a program. Trial registration: WASH Benefits Bangladesh: ClinicalTrials.gov, identifier: NCT01590095. Date of registration: April 30, 2012 'Retrospectively registered'. [ABSTRACT FROM AUTHOR]

Introduction: Per- and polyfluoroalkyl substances (PFAS) are a class of synthetic compounds used industrially for a wide variety of applications. These PFAS compounds are very stable and persist in the environment. The PFAS contamination is a growing health issue as these compounds have been reported to impact human health and have been detected in both domestic and global water sources. Contaminated water found on military bases poses a potentially serious health concern for active duty military, their families, and the surrounding communities. Previous detection methods for PFAS in contaminated water samples require expensive and time-consuming testing protocols that limit the ability to detect this important global pollutant. The main objective of this work was to develop a novel detection system that utilizes a biological reporter and engineered bacteria as a way to rapidly and efficiently detect PFAS contamination.Materials and Methods: The United States Air Force Academy International Genetically Engineered Machine team is genetically engineering Rhodococcus jostii strain RHA1 to contain novel DNA sequences composed of a propane 2-monooxygenase alpha (prmA) promoter and monomeric red fluorescent protein (mRFP). The prmA promoter is activated in the presence of PFAS and transcribes the mRFP reporter.Results: The recombinant R. jostii containing the prmA promoter and mRFP reporter respond to exposure of PFAS by activating gene expression of the mRFP. At 100 µM of perfluorooctanoic acid, the mRFP expression was increased 3-fold (qRT-PCR). Rhodococcus jostii without exposure to PFAS compounds had no mRFP expression.Conclusions: This novel detection system represents a synthetic biology approach to more efficiently detect PFAS in contaminated samples. With further refinement and modifications, a similar system could be readily deployed in the field around the world to detect this critical pollutant. [ABSTRACT FROM AUTHOR]

Hybridization of 'green' and engineered infrastructure, informed by protecting or restoring catchment processes, can resolve interconnected demands on catchment ecosystems, potentially also reversing historic degradation of socio-ecological systems. Pressures are acute in water-scarce, developing regions with episodic rainfall, exacerbated by historic presumptions favouring engineered management. Comparing conditions, histories and emerging approaches in contrasting regions – the Central Plateau of Burkina Faso, Rajasthan State (India) and Ayacucho Region (Peru) – reveals similar yet distinct approaches reflecting different starting regimes. Transferrable learning about hybridizing localized, nature-based solutions and engineered technology informs the necessary transition towards a sustainable approach in these and other regions. [ABSTRACT FROM AUTHOR]

Previous research has drawn attention to the health risks and poor living conditions that families of Haitian descent contend with in the Dominican Republic, particularly in rural, agricultural communities. Less clearly described is whether these problems persist as households transition to non-agricultural work and increasingly urban residence patterns. This study compares the use of health care services and access to water, sanitation, and food for Haitian and Dominico-Haitian families living in the city of Puerto Plata with households located on the rural-urban fringe. Data were collected during household surveys with 61 urban and 30 rural/peri-urban families. Households residing in the rural/peri-urban community had lower incomes, more unmet sanitation needs, and less stable access to water than urban families. Overall, households lacked adequate food, with 74.4% experiencing food insufficiency. Respondents reported using diverse types of health services and treatments, but households in the rural/peri-urban community had higher rates of health care use than urban families. These findings indicate urban families have better access to some resources that promote health than rural/peri-urban households. By identifying health issues and environmental conditions in rural/peri-urban and urban areas, this study aims to provide guidance for policy-makers, agencies, and organisations that serve Haitian migrant communities. [ABSTRACT FROM AUTHOR]

Introduction: Unsafe tap water temperatures (>120 °F) are a risk factor for pediatric burns, which may disproportionally impact low-income, urban communities. We sought to estimate the incidence and demographic characteristics of tap water burns and their association with housing characteristics.Methods: We performed a secondary data analysis to summarize emergency department discharge records from 2016 to 2018 involving children <18 years with an ICD-10-CM code for tap water burn (X11), and town-level housing data from the American Community Survey. Unpaired student's t-test and spearman's correlation analysis were performed for comparative analyses.Results: A total of 146 tap water burn visits were identified, representing an incidence of 2 per 10,000 ED visits. The majority of cases were male, non-Hispanic White, of public insurance type, and from an urban CT town. The median age was 3 years, with 58% of cases <5 years. Towns with at least one tap water burn had a significantly higher average percentage of multi-family unit and renter housing as compared to towns with no tap water burns (p < 0.0001).Conclusions: Our results identified a significant number of tap water burns in children. Primary prevention efforts targeting education or regulation of water temperatures may work to reduce burns in underserved areas. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the United States, nationwide estimates of public drinking water arsenic exposure are not readily available. We used the U.S. Environmental Protection Agency's (EPA) Six-Year Review contaminant occurrence data set to estimate public water arsenic exposure. We compared community water system (CWS) arsenic concentrations during 2006–2008 vs. after 2009–2011, the initial monitoring period for compliance with the U.S. EPA's 10?µg/L arsenic maximum contaminant level (MCL). OBJECTIVE: Our objective was to characterize potential inequalities in CWS arsenic exposure over time and across sociodemographic subgroups. METHODS: We estimated 3-y average arsenic concentrations for 36,406 CWSs (98%) and 2,740 counties (87%) and compared differences in means and quantiles of water arsenic (via quantile regression) between both 3-y periods for U.S. regions and sociodemographic subgroups. We assigned CWSs and counties MCL compliance categories (High if above the MCL; Low if below) for each 3-y period. RESULTS: From 2006–2008 to 2009–2011, mean and 95th percentile CWS arsenic (in micrograms per liter) declined by 10.3% (95% CI: 6.5%, 14.1%) and 11.5% (8.3%, 14.8%) nationwide, by 11.4% (4.7%, 18.1%) and 16.3% (8.1%, 24.5%) for the Southwest, and by 36.8% (7.4%, 66.1%) and 26.5% (12.1%, 40.8%) for New England, respectively. CWSs in the High/High compliance category (not MCL compliant) were more likely in the Southwest (61.1%), served by groundwater (94.7%), serving smaller populations (mean 1,102 persons), and serving Hispanic communities (38.3%). DISCUSSION: Larger absolute declines in CWS arsenic concentrations at higher water arsenic quantiles indicate declines are related to MCL implementation. CWSs reliant on groundwater, serving smaller populations, located in the Southwest, and serving Hispanic communities were more likely to continue exceeding the arsenic MCL, raising environmental justice concerns. These estimates of public drinking water arsenic exposure can enable further surveillance and epidemiologic research, including assessing whether differential declines in water arsenic exposure resulted in differential declines in arsenic-associated disease. [ABSTRACT FROM AUTHOR]

BACKGROUND: Manganese (Mn) in drinking water may increase the risk of several neurodevelopmental outcomes, including attention-deficit hyperactivity disorder (ADHD). Earlier epidemiological studies on associations between Mn exposure and ADHD-related outcomes had small sample sizes, lacked spatiotemporal exposure assessment, and relied on questionnaire data (not diagnoses)—shortcomings that we address here. OBJECTIVE: Our objective was to assess the association between exposure to Mn in drinking water during childhood and later development of ADHD. METHODS: In a nationwide population-based registry study in Denmark, we followed a cohort of 643,401 children born 1992–2007 for clinical diagnoses of ADHD. In subanalyses, we classified cases into ADHD-Inattentive and ADHD-Combined subtypes based on hierarchical categorization of International Classification of Diseases (ICD)-10 codes. We obtained Mn measurements from 82,574 drinking water samples to estimate longitudinal exposure during the first 5 y of life with high spatiotemporal resolution. We modeled exposure as both peak concentration and time-weighted average. We estimated sex-specific hazard ratios (HRs) in Cox proportional hazards models adjusted for age, birth year, socioeconomic status (SES), and urbanicity. RESULTS: We found that exposure to increasing levels of Mn in drinking water was associated with an increased risk of ADHD-Inattentive subtype, but not ADHD-Combined subtype. After adjusting for age, birth year, and SES, females exposed to high levels of Mn (i.e., >100µg/L) at least once during their first 5 y of life had an HR for ADHD-Inattentive subtype of 1.51 [95% confidence interval (CI): 1.18, 1.93] and males of 1.20 (95% CI: 1.01, 1.42) when compared with same-sex individuals exposed to <5µg/L. When modeling exposure as a time-weighted average, sex differences were no longer present. DISCUSSION: Mn in drinking water was associated with ADHD, specifically the ADHD-Inattentive subtype. Our results support earlier studies suggesting a need for a formal health-based drinking water guideline value for Mn. Future Mn-studies should examine ADHD subtype-specific associations and utilize direct subtype measurements rather than relying on ICD-10 codes alone. [ABSTRACT FROM AUTHOR]

Water supply pipes age, deteriorate and break, which puts at risk the continuous provision of safe potable water endangering the public health in cities. Risk management methods are increasingly applied to optimise the capital investment for pipe replacement and rehabilitation, taking into account the probability and hydraulic impact of pipe breaks. As part of this process, however, historic pipe break data and statistical methods should be utilised to gather causal insights for past breaks to inform operational changes and/or capital investment decisions in order to reduce future breaks. This paper presents a comparative study of statistical and machine learning methods to carry out an exploratory causal analysis for historic pipe breaks in an operational water supply network. Regression models for count data and probabilistic models have been developed. The performance of these models was assessed and enhanced with the introduction of interactions and the inclusion of different network representations. [ABSTRACT FROM AUTHOR]

The growth in the number of pools to more than 7.4 million in the U.S. has been accompanied by a rise in recreational water illnesses (RWIs). Effective pool management, though, can mitigate RWI risks. Inadequate management presumably occurs more frequently where training is less formalized and/or pool operation is a minor aspect of the job of the responsible pool manager(s). During summer 2018, weekly evaluations were performed at public venues in Louisville, Kentucky. Disinfectant levels and other items were monitored and compared with venue-specific (pool or spa) criteria. Among 1,312 venue surveys, 1,173 (89.4%) met criteria and 139 (10.6%) did not meet criteria. Overall, multivariable logistic regression showed a significant association between the likelihood of a venue meeting criteria and setting type. Specifically, hotels had 120% increased odds of not meeting criteria (adjusted odds ratio = 2.2; 95% confidence interval [1.3, 3.8]) compared with other settings. Despite spas having an 80% elevated odds of not meeting criteria compared with pools in a univariate analysis, upon adjusting for setting, spas were not associated with an increased risk of not meeting criteria. Research identifying reasons for these differences in meeting criteria between settings would be beneficial for informing public health interventions for aquatic environments. [ABSTRACT FROM AUTHOR]

Background: In sub-Saharan Africa, burn and scald injuries occur more commonly in children aged less than five years, than in any other age group, and carry a high lifetime morbidity. The optimal first aid at the time of injury includes the use of cool running water, which can reduce pain, scarring, and skin grafting. Data on the types of first aid used in Malawi is lacking, as is an in-depth understanding of the underlying factors which may influence this health behaviour. This study sought to: (a) document the types of first aid after paediatric burn and scald injuries in Southern Malawi; and (b) explore factors affecting the choice of first aid used.Methods Andfindings: We conducted a sequential explanatory mixed methods study. Quantitative analysis of a prospectively collected database of all patients aged less than 17 years admitted to the only burn unit in Southern Malawi was followed by thematic analysis of semi-structured interviews with 15 adults who had witnessed a paediatric burn or scald injury. 1326 patients aged less than 17 years were admitted to the Queen Elizabeth Central Hospital between July 2009 and December 2016. Median age was 3.0 years (IQR 1.9-5.0) and male to female ratio 1:0.9. The commonest cause of injury was hot liquid (45%), followed by open fire (31%) and porridge (12%). First aid was applied in 829 patients (69%), the commonest applications used were water (31%) and egg (21%). There was a statistically significant association between the type of first aid and secondary education of the father (p = 0.009) or mother (p = 0.036); however, the type of first aid used was more likely to be egg rather than water. Analysis of qualitative interviews identified four main themes: perceived roles and responsibilities within the community, drivers of individual behaviours, availability, and trust. Participants reported using eggs as a first aid treatment, as these were readily available and were seen to reduce the occurrence of blisters and prevent peeling of the skin. By comparison, there was a strong underlying fear of using water on burn injuries due to its association with peeling of the skin. Intergenerational learning appeared to play a strong role in influencing what is used at the time of injury, and mothers were the key source of this information.Conclusions: This study provides the largest description of first aid use in sub-Saharan Africa, strengthening the evidence that remedies aside from water are commonly used and that higher parental education levels do not translate to increased use of water, but rather use of alternative treatments. Our qualitative findings allow improved understanding of how first aid for paediatric burns is perceived in rural Malawi communities, providing insight as to why certain first aid choices are made and the possible barriers and facilitators to the adoption of water as a first aid treatment. [ABSTRACT FROM AUTHOR]

Background We hypothesized that drinking water, sanitation, handwashing (WSH), and nutritional interventions would improve environmental enteric dysfunction (EED), a potential contributor to stunting. Methods Within a subsample of a cluster-randomized, controlled trial in rural Bangladesh, we enrolled pregnant women in 4 arms: control, WSH, child nutrition counseling plus lipid-based nutrient supplements (N), and nutrition plus WSH (N+WSH). Among the birth cohort, we measured biomarkers of gut inflammation (myeloperoxidase, neopterin), permeability (alpha-1-antitrypsin, lactulose, mannitol), and repair (regenerating gene 1β) at median ages 3, 14, and 28 months. Analysis was intention-to-treat. Results We assessed 1512 children. At age 3 months, compared to controls, neopterin was reduced by nutrition (–0.21 log nmol/L; 95% confidence interval [CI], –.37, –.05) and N+WSH (–0.20 log nmol/L; 95% CI, –.34, –.06) interventions; similar reductions were observed at 14 months. At 3 months, all interventions reduced lactulose and mannitol (–0.60 to –0.69 log mmol/L). At 28 months, myeloperoxidase was elevated in the WSH and nutrition arms (0.23–0.27 log ng/mL) and lactulose was higher in the WSH arm (0.30 log mmol/L; 95% CI,.07,.53). Conclusions Reductions in permeability and inflammation at ages 3 and 14 months suggest that the interventions promoted healthy intestinal maturation; however, by 28 months, the WSH and nutrition arms showed elevated EED biomarkers. These results underscore the importance of developing a better understanding of EED pathophysiology and targeting interventions early in childhood, when they are likely to have the largest benefit to intestinal health. Clinical Trials Registration NCT01590095. [ABSTRACT FROM AUTHOR]

Background: Despite a strong theoretical rationale for combining water, sanitation and hygiene (WaSH) interventions to improve child health, study findings are heterogeneous with little understanding of the mechanisms for these effects. Our study objective was to demonstrate the utility of structural equation modeling (SEM) to assess intervention effects on height-for-age z score (HAZ) through the complex system of WaSH pathways.Methods: We used data from a matched cohort effectiveness evaluation of a combined on-premise piped water and improved sanitation intervention in rural Odisha, India. Height/length was measured in children 0-59 months old (n = 1826) from 90 matched villages in February-June 2016. WaSH behaviours and infrastructure were assessed through household surveys and observation, respectively. We used SEM to calculate the standardized path coefficients and the total contributions of WaSH pathways to HAZ.Results: Intervention improvements on HAZ were through the sanitation pathway (coverage → use β: 0.722; use → HAZ β: 0.116), with piped water coverage indirectly affecting HAZ through improved sanitation use (β: 0.148). Although the intervention had a positive association with handwashing station coverage, there was no evidence of a total hygiene pathway effect on HAZ or further direct effects through the water pathways.Conclusions: This study demonstrates the utility of SEM to assess the mechanisms through which combined WaSH interventions impact HAZ as a system of pathways, providing a more nuanced assessment than estimation of the total intervention effect. Our finding, that water impacts HAZ through the sanitation pathway, is an important and actionable insight for WaSH programming. [ABSTRACT FROM AUTHOR]

Background: Open defecation is widespread in rural India, and few households have piped water connections. While government and other efforts have increased toilet coverage in India, and evaluations found limited immediate impacts on health, longer-term effects have not been rigorously assessed.Methods: We conducted a matched cohort study to assess the longer-term effectiveness of a combined household-level piped water and sanitation intervention implemented by Gram Vikas (an Indian NGO) in rural Odisha, India. Forty-five intervention villages were randomly selected from a list of those where implementation was previously completed at least 5 years before, and matched to 45 control villages. We conducted surveys and collected stool samples between June 2015 and October 2016 in households with a child <5 years of age (n = 2398). Health surveillance included diarrhoea (primary outcome), acute respiratory infection (ARI), soil-transmitted helminth infection, and anthropometry.Results: Intervention villages had higher improved toilet coverage (85% vs 18%), and increased toilet use by adults (74% vs 13%) and child faeces disposal (35% vs 6%) compared with control villages. There was no intervention association with diarrhoea [adjusted OR (aOR): 0.94, 95% confidence interval (CI): 0.74-1.20] or ARI. Compared with controls, children in intervention villages had lower helminth infection (aOR: 0.44, 95% CI: 0.18, 1.00) and improved height-for-age z scores (HAZ) (+0.17, 95% CI: 0.03-0.31).Conclusions: This combined intervention, where household water connections were contingent on community-wide household toilet construction, was associated with improved HAZ, and reduced soil-transmitted helminth (STH) infection, though not reduced diarrhoea or ARI. Further research should explore the mechanism through which these heterogenous effects on health may occur. [ABSTRACT FROM AUTHOR]

Understanding people's perceptions of the environment, drinking water issues, and protecting and preserving water resources is of great importance. This study aims to assess and compare the perceptions of the general public (n = 414), post‐secondary students (n = 103), and water professionals (n = 104) in Oklahoma on water issues in the state. To address these goals, a 53‐item paper questionnaire was first administered to a randomly sampled mailing list of Oklahoma residents. As a follow up to the initial survey, post‐secondary students at Oklahoma State University were sampled in addition to Oklahoma water professionals at regional conferences. Respondents ranged from 18 to over 65 years old, with all three demographics agreeing the top water priority to be clean drinking water. The majority were satisfied with their home water supply and felt it was safe to drink, while they were not sure of the quality of ground and/or surface water. Age was a key factor in information delivery and learning preferences as the older participants favored print material versus the younger demographic interest in technology. Data collected via this study provide insight into the perceptions, priorities, and learning preferences of these three populations. Despite our finding that clean water is a priority in Oklahoma, regardless of demographic, results suggest more education and outreach is needed to provide additional information regarding water in Oklahoma. [ABSTRACT FROM AUTHOR]

During the water crisis in Flint, Michigan, USA (2014-2015), 2 outbreaks of Legionnaires' disease occurred in Genesee County, Michigan. We compared whole-genome sequences of 10 clinical Legionella pneumophila isolates submitted to a laboratory in Genesee County during the second outbreak with 103 water isolates collected the following year. We documented a genetically diverse range of L. pneumophila strains across clinical and water isolates. Isolates belonging to 1 clade (3 clinical isolates, 3 water isolates from a Flint hospital, 1 water isolate from a Flint residence, and the reference Paris strain) had a high degree of similarity (2-1,062 single-nucleotide polymorphisms), all L. pneumophila sequence type 1, serogroup 1. Serogroup 6 isolates belonging to sequence type 2518 were widespread in Flint hospital water samples but bore no resemblance to available clinical isolates. L. pneumophila strains in Flint tap water after the outbreaks were diverse and similar to some disease-causing strains. [ABSTRACT FROM AUTHOR]

El articulo discute sobre la problemática de la construcción de la represa de Yacambú en Venezuela con el enfoque de la os desafíos técnicos, financieros y administrativos que han obstaculizado su finalización. El articulo también se centra en la importancia para el desarrollo agrícola y el suministro de agua en la región y se comparan proyectos similares en otros países, como la presa de Olmos en Perú.

Purpose: The Flint, Michigan, water crisis (2014 to present) increased awareness of the dangers of lead-contaminated water. Consumption of lead-contaminated water is associated with adverse pregnancy outcomes. The purpose of this research was to identify intervention strategies to decrease consumption of lead-contaminated water among women of reproductive age.Approach: Qualitative data were collected via an online survey consisting of open-ended questions among 63 women and 3 focus groups among 27 women.Setting: The University of Michigan-Flint.Method: Qualitative data were analyzed utilizing a grounded theory approach.Results: Participants recommended professional educational reading materials regarding lead be placed in public places. Women highlighted the need for interventions where women, partners, and relatives test water in homes, install water filters, cook lead-mitigating meals, and receive education on the pregnancy risks of consuming contaminated water.Conclusion: The study offers women perspectives on strategies to decrease consumption of lead-contaminated water. Future investigations may examine the influence of such strategies on knowledge and behaviors that promote safe water drinking. [ABSTRACT FROM AUTHOR]

BACKGROUND: The effects of weather on diarrhea could influence the health impacts of climate change. Children have the highest diarrhea incidence, especially in India, where many lack safe water and sanitation. OBJECTIVES: In a prospective cohort of 1,284 children under 5 y of age from 900 households across 25 villages in rural Tamil Nadu, India, we examined whether high temperature and heavy rainfall was associated with increased all-cause diarrhea and water contamination. METHODS: Seven-day prevalence of diarrhea was assessed monthly for up to 12 visits from January 2008 to April 2009, and hydrogen sulfide (H2S) presence in drinking water, a fecal contamination indicator, was tested in a subset of households. We estimated associations between temperature and rainfall exposures and diarrhea and H2S using binomial regressions, adjusting for potential confounders, random effects for village, and autoregressive-1 error terms for study week. RESULTS: There were 259 cases of diarrhea. The prevalence of diarrhea during the 7 d before visits was 2.95 times higher (95% CI: 1.99, 4.39) when mean temperature in the week before the 7-d recall was in the hottest versus the coolest quartile of weekly mean temperature during 1 December 2007 to 15 April 2009. Diarrhea prevalence was 1.50 times higher when the 3 weeks before the diarrhea recall period included ≥1 d (vs. 0 d) with rainfall of >16:82 mm (95% CI: 1.12, 2.02), and 2.60 times higher (95% CI: 1.55, 4.36) for heavy rain weeks following a 60-d dry period. The H2S prevalence in household water was not associated with heavy rain prior to sample collection. CONCLUSIONS: The results suggest that, in rural Tamil Nadu, heavy rainfall may wash pathogens that accumulate during dry weather into child contact. Higher temperatures were positively associated with diarrhea 1-3 weeks later. Our findings suggest that diarrhea morbidity could worsen under climate change without interventions to reduce enteric pathogen transmission through multiple pathways. [ABSTRACT FROM AUTHOR]

Efficient treatment methods for the removal of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) from drinking water are needed to reduce health risks. However, there is a lack of empirical data on ARB and ARG removal during conventional water disinfection processes. In this study, the removal of ARB and ARGs by three disinfection processes (chlorination, ozonation, and UV treatment) was investigated on a laboratory scale using Escherichia coli and Enterococcus faecium carrying ARGs. Bacterial inactivation was determined by plate count methods, and ARG damage was quantified using real-time PCR. Only for ozone treatment, similar inactivation rates for bacterial cells and ARGs were observed when 1 mg*L-1 of ozone, with a contact time of 5 min, was used, which resulted in a 5.0 log reduction of bacterial cells and a 4.3-4.6 log reduction of ARGs. For chlorine and UV, inactivation of bacterial cells was observed at lower doses than those needed for the decrease of ARG copy numbers. The use of 0.5 mg*L-1 free chlorine (30 min contact time) led to a 3.8-5.6 log reduction of the bacterial numbers and to a 0.8-2.8 log reduction of ARGs. Ultraviolet light irradiation with 600 J*m-2 resulted in a 4.8-5.5 log reduction of bacterial cells, but in a negligible reduction (0-1.0 log) of ARGs. Although UV and chlorine treatments were effective in the inactivation of bacterial cells, incomplete degradation of ARGs was observed. Therefore, plasmid-borne ARGs can potentially be transferred to other bacteria even after the disinfection process. Our results provide important insights into the fate of ARGs during drinking water disinfection processes. [ABSTRACT FROM AUTHOR]