Health Risks In Areas Research Articles

Microplastics in commercial bivalves from coastal areas of Thailand and health risk associated with microplastics in ingested bivalves

Microplastics (MPs) contamination in marine organisms is a significant threat to seafood consumers worldwide. This study is the first to investigate the abundance of MPs in the commercial bivalves from six sites along Thailand's coastline, the daily exposure of bivalve consumers to MPs, and potential associated health risks. The microplastic occurrence varied from 69 % to 93 % in four bivalve species while the average abundance of MPs was 1.87 ± 0.86 items/individual or 0.46 ± 0.43 items/g ww. Benthic bivalves (cockles and clams) contained more MPs than their pelagic counterparts (mussels and oysters). Small blue microfibers (<500 μm) were the most abundant. The most common polymers were natural based polymers (cotton and rayon) and polyethylene terephthalate (PET). The daily microplastic exposure for consumers was 0.52 items/person. Although the risk of microplastic contamination is low, we recommend investigation into the transfer of MPs within the food web, notably as it may pose significant human health concerns.

Evaluating heat health risk in Indian cities: Geospatial and socio-ecological analysis

India is home to 11 % of the global urban population and is ranks as the second-largest urban system in the world. This study introduces a Heat Health Risk Index (HHRI) rankings for 37 major Indian cities with more than one million residents, using geospatial and socio-ecological data to identify potential heat health risk areas. In this study, the Otsu method was employed to determine the critical parameters in the heat health index, considering factors such as Land Surface Temperature (LST), solar radiation, population density, mean temperature, urban green cover, rainfall, specific humidity, and wind speed. All data values were standardized to a uniform scale (0–1) for comparability. The standardized values, integrated with the assigned weights, formed the HHRI. Results indicate that cities such as Chennai, Mumbai, Kolkata, and Ahmedabad, each with populations exceeding 10 million, are deemed less livable due to their high HHRI (>0.50). Both Chennai and Mumbai stand out with highest hazard index as 0.66, followed by Kolkata (0.62) and Ahmedabad (0.56). Cities that lack sufficient green spaces are often more vulnerable, display elevated risk levels, and have decreased adaptability. In contrast, cities such as Ludhiana, Theni, Amritsar, and Nabarangpur are perceived as the most livable, with a mean HHRI of 0.21, owing to their higher adaptive capacity and lower exposure. Overall, this study serves as a foundation for conceiving future perspective plans for existing urban and peri‑urban areas, compared to living standards within the realms of sustainability.

A Comprehensive Review on Scrub Typhus: Epidemiology, Transmission, Diagnosis and Management

Scrub typhus is a serious public health risk in areas where it is endemic. It is brought on by the bacterium Orientia tsutsugamushi and is spread via the bite of infected chiggers. The epidemiology, clinical symptoms, diagnosis, treatment, and prevention of scrub typhus are summarized in this overview, along with recent developments. The disease is most common in rural sections of Asia, the Pacific Islands, and portions of Australia, where chigger populations are encouraged by favorable environmental conditions. The clinical signs of chigger bites can range in severity from mild to severe, presenting with symptoms like fever, headaches, and the distinctive Escher at the bite site. Severe cases may result in consequences such as acute respiratory distress syndrome and organ failure, which call for prompt identification and treatment. Molecular techniques and serological testing are used as diagnostic tools. Molecular assays are a quick and reliable way to identify Orientia tsutsugamushi. Antibiotics are the cornerstone of treatment, and doxycycline is the drug of choice. Treatment must be started as soon as possible to avoid problems and enhance results. The importance of public health interventions, such as vector control and health education, is highlighted by issues like antibiotic resistance and restricted access to treatment in rural areas. Personal protection is the main focus of preventive measures, which include donning proper attire and applying insect repellents. Managing the environment and involving the community are important strategies for lowering chigger populations. Additional research is being done to create effective scrub typhus vaccines, even if there isn't one that is now generally authorized.

Review on the Epidemiology and Public Health Importance of Camel Tuberculosis

Camel (Camelus dromedarius), Camels are an important livestock in Ethiopia and are raised in Somali, Afar, and Oromia (Kereyu, Borena, and Guji). They are used for various purposes such as transport, drafting power, ploughing land, festivals, and rivalry as in dashing. The pastoral community utilizes their products such as milk and meat. However, they are also, susceptible to various diseases which can affect their health. One of the major diseases that affect camels is tuberculosis. Camel tuberculosis is a persistent disease that is characterized by the improvement of granulomas inside the breathing tract and associated lymph nodes. The mycobacteria are discharged from those granulomas and might contaminate different prone animals Camel tuberculosis is a chronic disease that is characterized by the development of granulomas in the respiratory tract and related lymph nodes. The mycobacteria are discharged from these granulomas and can contaminate other susceptible animals. Camel tuberculosis is a chronic disease that affects the respiratory system and the lymph nodes of the infected animals. It can also pose a public health risk in areas where people consume raw camel milk or have close contact with camels. The disease is caused by different types of mycobacteria, such as Mycobacterium caprae, Mycobacterium tuberculosis, and Mycobacterium bovis. The diagnosis of camel tuberculosis can be based on clinical signs, history, tuberculin skin tests, post-mortem examinations, bacteriological and molecular methods. Public awareness and control measures are needed to reduce the transmission of the disease and its economic impact.

Profiles of travelers to intermediate-high health risk areas following the reopening of borders in the COVID-19 crisis: A clustering approach

BackgroundThe reactivation of international travel in 2021 has created a new scenario in which the profile of the traveler to medium-high health risk areas may well have changed. However, few studies have analyzed this new profile since the reopening of borders in that year. MethodsWe designed an ad hoc questionnaire that was administered face-to-face by our medical team during appointments with 330 travelers in the second half of 2021. Information was collected on the following topics: sociodemographic and socioeconomic status; type of travel and previous travel experience; health status and risk perception (of COVID-19 and tropical infectious diseases). Using all features simultaneously, an unsupervised machine learning approach (k-means) is implemented to characterize groups of travelers. Pairwise chi-squared tests were performed to identify key features that showed statistically significant differences between clusters. ResultsThe travelers were clustered into seven groups. We associated the clusters with different intensities of perceived risk of acquiring COVID-19 and tropical infectious diseases on the trip. The perceived risk of both diseases was low in the group "middle or lower middle class young inexperienced male tourist" but high in the group "middle or lower middle-class young with children inexperienced business traveler". ConclusionsBroadening our knowledge of the profiles of travelers to intermediate-high health risk areas would help to tailor the health advice provided by practitioners to their characteristics and type of travel. In a changing health context, the k-means approach supposes a flexible statistical method that calculates travelers’ profiles and can be easily adapted to process new information.

Calculating the number of disease cases associated with acute short-term exposure to harmful chemicals in ambient air

The article addresses development of methodical approaches to calculating levels of health disorders caused by short-term exposure to ambient air pollution. We have established and parameterized relationships relevant for quantification of probable health outcomes as responses to elevated levels of chemicals in ambient air higher than their reference ones. These relationships were modeled using system analysis techniques and were based on dynamic data series on ambient air quality at the control points and the number of applications for medical aid in settlements with their overall population being more than 5 million people. We have formalized relationships that describe how intensively acute health disorders develop under short-term exposure to chemical levels in ambient air being higher than the reference ones that are identified at the control points. The resulting models rely on official data and can be used to predict and assess public health risks in any area where ambient air quality is monitored. The formalized relationships were tested within identifying levels of incidence associated with acute short-term exposure to ambient air pollution in a large industrial center. It was established that, according to data collected in 2020, the highest associated incidence was caused by exposure to benzene (on average 0.364 mg/m3 higher than the reference level) in ambient air and was detected as per such nosologies as ‘Allergic rhinitis unspecified’ and ‘Predominantly allergic asthma’. We are planning to use the results obtained at this stage in the research in further development of methodical approaches to assessing and predicting chemical health risks in areas influenced by hazardous chemical objects under short-term exposure to high levels of pollutants.

К расчету количества случаев заболеваний населения, ассоциированных с острым кратковременным воздействием вредных химических веществ в атмосферном воздухе

The article addresses development of methodical approaches to calculating levels of health disorders caused by short-term exposure to ambient air pollution. We have established and parameterized relationships relevant for quantification of probable health outcomes as responses to elevated levels of chemicals in ambient air higher than their reference ones. These relationships were modeled using system analysis techniques and were based on dynamic data series on ambient air quality at the control points and the number of applications for medical aid in settlements with their overall population being more than 5 million people. We have formalized relationships that describe how intensively acute health disorders develop under short-term exposure to chemical levels in ambient air being higher than the reference ones that are identified at the control points. The resulting models rely on official data and can be used to predict and assess public health risks in any area where ambient air quality is monitored. The formalized relationships were tested within identifying levels of incidence associated with acute short-term exposure to ambient air pollution in a large industrial center. It was established that, according to data collected in 2020, the highest associated incidence was caused by exposure to benzene (on average 0.364 mg/m3 higher than the reference level) in ambient air and was detected as per such nosologies as ‘Allergic rhinitis unspecified’ and ‘Predominantly allergic asthma’. We are planning to use the results obtained at this stage in the research in further development of methodical approaches to assessing and predicting chemical health risks in areas influenced by hazardous chemical objects under short-term exposure to high levels of pollutants.

Assessment of Hg pollution in stream waters and human health risk in areas impacted by mining activities in the Ecuadorian Amazon.

Illegal gold mining activities have contributed to the release and mobilization of Hg and environmental degradation in many parts of the world. This study aims to determine the concentration of Hg in five provinces of the Amazon Region of Ecuador, in addition to assessing the risk to human health of exposed populations, applying deterministic and probabilistic methods. For this purpose, 147 water samples were collected in rivers and streams crossing and/or located near mining areas. As a result, 100% of the samples analyzed exceeded the maximum permissible limit (MPL) according to the water quality criteria for the preservation of aquatic life of the Ecuadorian regulations, while 7% of the samples exceeded the MPL for drinking water. On the other hand, considering the European Environmental Quality Standard (EQS) for surface water bodies, in our study, 100% of the samples exceed the maximum permissible limit (0.07µg/L), and with respect to the Canadian water quality guidelines, 35% of the samples exceed the permissible limit (0.001mg/l) for drinking water, and 100% of the samples exceed the limit for life in water bodies (0.0001mg/l). The risk assessment revealed that the probability of developing adverse health effects from exposure to Hg is below the recommended limits according to the probabilistic assessment; this is in relation to the criterion of residential and recreational use of water resources. However, it was identified that the child population doubles the acceptable systemic risk level according to the results of the deterministic assessment in the residential scenario. This information can be used by decision-makers to implement strategies to reduce Hg contamination and exposure of the population in Ecuadorian Amazonian rivers.

Approaches to Defining Health Risk Areas Using Quality Indicators of Drinking Water Supply

Introduction: There are currently no generally accepted criteria for ranking territories according to a set of indicators characterizing the quality of drinking water supply, which requires the development and verification of criteria for classifying regions. Objective: To develop approaches to ranking territories of the Russian Federation based on indicators characterizing the state of drinking water supply and identifying health risk areas. Materials and methods: We have analyzed tap water quality indicators and characteristics of water supply systems in 15 regions of the Russian Federation included in the Arctic zone and the Northwestern Federal District based on data retrieved from the Federal Statistical Observation Form 18 “Information on the sanitary condition in the region” for 2021. A discriminant and correlation analysis were performed to verify the correctness of area classification. Results: We ranked the study regions based on 31 tap water quality indicators. The results of the discriminant analysis showed that six regions (Novgorod Region, Republic of Karelia, Arkhangelsk Region, Nenets Autonomous Area, Republic of Sakha (Yakutia), Chukotka Autonomous Area) were risk areas, 93.3 % of the original grouped observations were classified correctly. Poor chemical indicators of tap water quality in rural areas made a significant contribution to the classification of the regions as risk territories. Discussion: The selected quality indicators of drinking water supply are appropriate and sufficient for the regional level thanks to their universality for all territories. This fact is also confirmed by a strong statistical inverse correlation between the proportion of the population provided with quality tap water from centralized water supply systems and the calculated total score characterizing the state of drinking water supply. Conclusions: The study proved correctness of the choice of indicators characterizing the quality of drinking water supply for the classification of regions. Ranking of territories will allow developing management solutions to improve the quality of drinking water and identify regions that need priority measures aimed at preserving health of the population.

Hydrogeochemical evaluation for human health risk assessment from contamination of coastal groundwater aquifers of Indo-Bangladesh Ramsar site

The suitability of groundwater (GW) and the corresponding health risk caused by heavy metals become prime concerns in the recent era; so, the determination of GW quality most important for drinking, agricultural, and domestic purpose is the foremost responsibility of the concurrent researchers. Our study intends to develop an innovative approach to delineate the health hazard risk zone (HHRZ) association to the hydro chemical condition of available GW of the most prominent Indo-Bangladesh Ramsar region by coupling the groundwater quality measurement (GWQM), degree of concentration (Cd), and health risk index (HRI) with the help of hazard quotient (HQ) method. A total of 199 GW samples were collected from the Ramsar sites of both countries and twelve (12) significant physiochemical properties, namely Sodium (Na+), Potassium (K+), Magnesium (Mg2+), Nitrate (NO3−), Bicarbonate (HCO3-), Phosphate (PO42−), Fluoride (F−), Chloride (Cl−), Sulphate (SO42−), pH, Arsenic (As) and Electoral conductivity (EC) considered as water quality and health hazard causative factors for this research work. This study also assesses the individual health of each parameter and anthropogenic pressure on this Ramsar region. The produced GWQM reveals that the GW of extensive areas in the eastern, north-east, central, and south-central zone is characterized by unfit for consumption (11.47%), very poor (14.27%), and poor (20.76%) categories; whereas, health hazard map also identified quite a similar zone for significant health risk and wide geographical area of Indo-Bangladesh Ramsar site fall under very high (17.49%), high (13.26%), moderate (7.91%) health risk zone. Therefore, our study will help the policymakers, and governments of both countries in ensuring the monitoring plans, strict water management policies, and adoption of health hazard mitigating measures to ensure the well beings of the exposed inhabitants of this coastal Ramsar site region.

Long term spatiotemporal trends and health risk assessment of remotely sensed PM2.5 concentrations in Nigeria

PM2.5 is an important indicator reflecting air quality variations. Currently, environmental pollution related issues have become more severe that significantly threaten human health. The current study is an attempt to analyze the spatio-dynamic characteristics of PM2.5 in Nigeria based on the directional distribution and trend clustering analysis from 2001 to 2019. The results indicated that PM2.5 concentration increased in most of the Nigerian states, particularly in mid-northern and southern states. The lowest PM2.5 concentration in Nigeria is even beyond the interim target-1 (35 μg/m3) of the WHO. During the study period, the average PM2.5 concentration increased at a growth rate of 0.2 μg/m3/yr from 69 μg/m3 to 81 μg/m3. The growth rate varied from region to region. Kano, Jigawa, Katsina, Bauchi, Yobe, and Zamfara experienced the fastest growth rate of 0.9 μg/m3/yr with 77.9 μg/m3 mean concentration. The median center of the national average PM2.5 moved toward the north indicating the highest PM2.5 concentration in northern states. The Saharan desert dust is the dominant source of PM2.5 in northern areas. Moreover, agricultural practices and deforestation activities along with low rainfall increase desertification and air pollution in these regions. Health risks increased in most of the mid-northern and southern states. The extent of ultra-high health risk (UHR) areas corresponding to the 8×104−7.3×106 μg⋅person/m3 increased from 1.5% to 2.8%. Mainly Kano, Lagos, Oyo, Edo, Osun, Ekiti, southeastern Kwara, Kogi, Enugu, Anambra, Northeastern Imo, Abia, River, Delta, northeastern Bayelsa, Akwa Ibom, Ebonyi, Abuja, Northern Kaduna, Katsina, Jigawa, central Sokoto, northeastern Zamfara, central Borno, central Adamawa, and northwestern Plateau are under UHR areas.

A combined method for human health risk area identification of heavy metals in urban environments

Multi-medium heavy metals pollution is a crucial pathway to destroy the urban environmental resources cycle. In this study, Nanjing of China, a typical mega city, was taken as the study area. Compared with other cities or countries, Cr, Cu and Zn in human nails and hair in the study area have higher concentration characteristics, while Cd and Pb have lower concentration characteristics. By combining the health risk status of heavy metals in soil and dustfall, the spatial clustering characteristics of heavy metals in soil dustfall and the concentration information of heavy metals in humans in the study area, a potential toxic risk area identification method based on soil-dustfall-human (SDB-HR) was established. Through Monte Carlo analysis, it’s found that the risk of Zn and Cr in soil-dustfall to human health is relatively high, with the probability of carcinogenesis reaching 51.2 % and 50.2 %, respectively. By the proposed method, different levels of heavy metal risk areas in urban environments can be more reasonably and effectively identified, which will provide important technical and theoretical support for the precise management of heavy metals in urban environments.

Health Impact Related to Ambient Particulate Matter Exposure as a Spatial Health Risk Map Case Study in Chiang Mai, Thailand

Chiang Mai has been one of the most polluted cities globally, exceeding the PM2.5 quality standards for decades and facing hazardous air pollution on an annual basis. As ambient PM2.5 strongly affects human health, this study aims to investigate the hotspots of PM2.5 and health impact areas due to exposure to PM2.5 by illustrating a spatial distribution via a Chiang Mai health risk map. The association between PM2.5 concentration and human health impact were assessed using Pearson’s correlation, focused on the peak period from January to April 2021 in Chiang Mai. The primary data on PM2.5 concentration were collected using low-cost sensors. The health impact is based on the number of hospital admissions in all incidences of diseases due to PM2.5 exposure following the ICD-10. The results showed that the highest polluted and health-risk areas were located in the center of Chiang Mai, especially in the Mueang district. PM2.5 concentration was highly correlated with the incidence of dermatitis (R = 0.84), conjunctivitis (R = 0.81), stroke (R = 0.74), and lung cancer (R = 0.73). Thus, the increased PM2.5 concentration resulted in heightened hospital admissions. The results provide insightful information for policymakers and local public health organizations regarding priority areas in resource management.

How urbanization affects residents' health risks: evidence from China.

Continued urbanization requires a deep understanding of how urbanization affects residents' health risks. This study used regression analysis of Chinese provincial-level panel data from 2004 to 2019 and empirically analyzed the nonlinear effects of urbanization on health risks and regional differences using STIRPAT model. Health risks were assessed by the average number of residents' visits to medical facilities and population mortality. We also examined the moderating effect of income and environmental factors. The results show that (1) urbanization increases the average number of residents' visits and reduces population mortality. The positive effect of urbanization in increasing the average number of visits is reinforced by an increase in income level and environmental pollution, whereas the negative effect of urbanization in reducing population mortality is weakened by environmental pollution. (2) Regarding long-term trends, urbanization has an N-shaped relationship with the average number of residents' visits, and a U-shaped relationship with population mortality; (3) Urbanization has an N-shaped relationship with the average number of residents' visits in the eastern, central, and western regions and an inverted N-shaped relationship with population mortality in the eastern region. Urbanization has significant effects on residents' health risks in areas with high levels of infrastructure. According to the results, suggestions are proposed, such as developing new-type urbanization, improving infrastructure, focusing on green urbanization, and promoting national fitness programs.

Non-carcinogenic health risk assessment of nitrate and fluoride contamination in the groundwater of Noyyal basin, India

The study aims to assess the nitrate and fluoride concentration in groundwater and its adverse effects on human health. In 2019, 42 groundwater samples were collected from various bore wells within the western Noyyal basin, India. Sodium and chloride are the dominant cation and anion, respectively. The nitrate concentration in groundwater samples varies from 2 to 89 mg/L, of which 33.33% are above the permissible limit of 45 mg/L for drinking water. The fluoride concentration ranges from 0.2 to 2.4 mg/L, with 28.57% of the samples exceeding the safe value of 1.5 mg/L for drinking water. Correlation plots demonstrate that the potential of hydrogen (pH), electrical conductivity (EC), total dissolved solids (TDS), Na+ and HCO3− are positively correlated with F−, whereas Ca2+ is negatively correlated. Mixed Ca–Mg–Cl is the most common water type in the investigated region. The Gibbs diagram demonstrates that the interaction between rock and water impacts the groundwater chemistry. Using the method of the United States Environmental Production Agency (USEPA), this study assesses the non-carcinogenic health risk posed by nitrate and fluoride in different age groups (infants, children, and adults). The values of total hazard index (THI) vary from 0.59 to 10.07 (mean = 4.76) for infants, 0.36 to 6.23 (mean = 2.95) for children, and 0.19 to 3.32 (mean = 1.57) for adults. Furthermore, 97.62%, 92.86%, and 73.81% of the samples surpass the recommended limit (THI = 1) for infants, children, and adults, respectively. Thus, the health risk assessment (HRA) indicates that infants and children are more susceptible to non-carcinogenic health hazards than adults. The THI spatial variation map shows that central and southern regions of the study area have been identified as high health risk areas (THI >3.0) for all age groups.

Spatiotemporal estimation of the PM2.5 concentration and human health risks combining the three-dimensional landscape pattern index and machine learning methods to optimize land use regression modeling in Shaanxi, China

PM2.5 pollution endangers human health and urban sustainable development. Land use regression (LUR) is one of the most important methods to reveal the temporal and spatial heterogeneity of PM2.5, and the introduction of characteristic variables of geographical factors and the improvement of model construction methods are important research directions for its optimization. However, the complex non-linear correlation between PM2.5 and influencing indicators is always unrecognized by the traditional regression model. The two-dimensional landscape pattern index is difficult to reflect the real information of the surface, and the research accuracy cannot meet the requirements. As such, a novel integrated three-dimensional landscape pattern index (TDLPI) and machine learning extreme gradient boosting (XGBOOST) improved LUR model (LTX) are developed to estimate the spatiotemporal heterogeneity in the fine particle concentration in Shaanxi, China, and health risks of exposure and inhalation of PM2.5 were explored. The LTX model performed well with R2 = 0.88, RMSE of 8.73 μg/m3 and MAE of 5.85 μg/m3. Our findings suggest that integrated three-dimensional landscape pattern information and XGBOOST approaches can accurately estimate annual and seasonal variations of PM2.5 pollution The Guanzhong Plain and northern Shaanxi always feature high PM2.5 values, which exhibit similar distribution trends to those of the observed PM2.5 pollution. This study demonstrated the outstanding performance of the LTX model, which outperforms most models in past researches. On the whole, LTX approach is reliable and can improve the accuracy of pollutant concentration prediction. The health risks of human exposure to fine particles are relatively high in winter. Central part is a high health risk area, while northern area is low. Our study provides a new method for atmospheric pollutants assessing, which is important for LUR model optimization, high-precision PM2.5 pollution prediction and landscape pattern planning. These results can also contribute to human health exposure risks and future epidemiological studies of air pollution.

Fluoride contamination, spatial variation, and health risk assessment of groundwater using GIS: a high-density survey sampling in Weifang City, North China.

The present study, with the aid of GIS, utilizes high-density groundwater (GW) sampling data (1398 samples) to analyze the spatial variation characteristics of GW fluoride in Weifang City (WFC), and evaluate the health risks associated with drinking water routes. The concentration of fluoride in the GW of WFC is observed to be between 0.08 and 9.16mg/L, with a mean value of 0.62mg/L. The fluoride concentration of a total of 192 GW samples exceeded the limit of China's GW quality standards (1mg/L), accounting for 14.74%. The GW fluoride concentration in most areas of WFC is less than 1mg/L. However, the relatively high-value zones are mostly concentrated in the upper reaches of Wen River, the east of Shouguang, the southeast of Anqiu, the east of Qingzhou, the east of Fangzi, and the southeast and northwest of Gaomi. The hydrochemical types of GW in WFC are mostly HCO3-Ca·Mg and SO4·Cl-Ca·Mg, while GW samples with hydrochemical types HCO3-Na and SO4·Cl-Na are characterized by high fluoride content. The hydrochemical characteristics of GW in WFC are mostly dominated by rock weathering. In addition, the northern coastal plain is evidently influenced by seawater intrusion. The concentration of fluoride in GW is affected by the dissolution of fluorine-containing minerals, cation exchange, and alkaline environmental factors. The effect of GW by seawater intrusion and very high content of Na+ will decrease the fluoride content of the GW through cation exchange. Health risk assessment demonstrated that the mean values of non-carcinogenic hazard quotient (HQ) for infants, children, teenagers, and adults were 0.52, 0.35, 0.31, and 0.30, respectively. In addition, the distribution characteristics of GW fluoride in high health risk areas (HQ > 1) in WFC are further consistent with the spatial variation of GW fluoride content. Overall, the health risk distribution area of GW fluoride in WFC is decreasing in the following order: infants > children > teenagers > adults.

A real-time investigation on public health consequences of chromium laden effluent from the leather industries.

Extensive evidence of elevated chromium (Cr) in the surface and groundwater exists. However, the importance of exposure toward Cr-associated health risks in areas with tanneries is still often neglected. These situations prompted an independent research study to investigate the views of those close-knit communities who are being directly affected by this tannery village. To establish an understanding of the local demographics and; exploratory data analysis (EDA) to discover patterns in the occurrence of diseases; measure the awareness of residents of the presence of Cr and its harmful health effects. The EDA technique was used to conduct survey studies on data to uncover patterns, identify anomalies, test hypotheses, and validate assumptions using summary statistics and graphical representations. Out of 14 diseases directly linked to high Cr toxicity, the study reported high levels of diarrhea, epigastric pain, and moderate-to-severe cases of vertigo among those aged more than 22 years. With over 90 active tanneries and toxic Cr released to the environment in a town of <78 km2 area (1.2 tannery/km), there are only 15 hospitals (0.2 hospitals/km) for the population currently accommodating more than a quarter-million people daily (3205 people/km). New mitigation strategies must be put forth to alleviate the negative impacts of the tanneries on the residents and nature most affected as well as the population as a whole.

44 BONE HEALTH AND FRACTURE RISK: KNOWLEDGE, OPINION AND PRACTICE OF PHYSIOTHERAPISTS

Abstract Background Osteoporotic-related fractures are responsible for excess mortality, morbidity, chronic pain, reduction in quality of life, admission to long-term care and health and social care costs (Papaioannou et al, 2010). Evidence for using Fracture Risk Assessment Tool (FRAX®) based community-screening in older people is increasing (Kanis et al, 2020). There is no published evidence on the use of FRAX® by Physiotherapists. Methods A questionnaire was sent to South Eastern Branch members of the Irish Society of Chartered Physiotherapists (ISCP). Survey themes were: participant characteristics, knowledge and opinion in the areas of Bone Health and Fracture Risk. Responses were downloaded from Survey Monkey and analysed using descriptive statistics. Results The response rate was 27% (n = 56). 72% (n = 40) of those surveyed had at least 10 years clinical experience. For 65% (n = 37) of participants, older people made up more than half of their clinical caseload. 96% (n = 54) of participants treated people with frailty and other bone health risk factors; falls (93%), osteoporosis (89%), fracture or reduced mobility (87%). On a scale of 1–10 (1 = least confident, 10 = most confident) 49% of respondents rated confidence in prescribing Bone Health Physiotherapy interventions at ≤5. When interpreting results of a DEXA scan; 80% reported confidence to be ≤5. Half (49%) of participants had never heard of FRAX®. 95% of respondents felt fracture risk was under addressed in clinical practice. All felt it was within their professional responsibility to discuss fracture risk with patients. Conclusion This is the first evaluation of bone health and fracture risk knowledge, opinion and practice of physiotherapists. The need for more knowledge of DEXA, FRAX® and bone health was highlighted. The use of FRAX® may improve fracture risk assessment in patients attending Physiotherapy. Based on these results, FRAX® has been introduced into a Rehabilitation Unit by Physiotherapists as part of Quality Improvement Project.

Identifying and addressing digital health risks associated with emergency pandemic response: Problem identification, scoping review, and directions toward evidence-based evaluation

Background and objectiveThe COVID-19 pandemic has accelerated digital health applications in multifaceted disease management dimensions. This study aims (1) to identify risk issues relating to the rapid development and redeployment of COVID-19 related e-health systems, in primary care, and in the health ecosystems interacting with it and (2) to suggest evidence-based evaluation directions under emergency response. MethodAfter initial brainstorming of digital health risks posed in this pandemic, a scoping review method was adopted to collect evidence across databases of PubMed, CINAHL, and EMBASE. Peer-review publications, reports, news sources, and websites that credibly identified the challenges relating digital health scaled for COVID-19 were scrutinized. Additional supporting materials were obtained through snowball sampling and the authors’ global digital health networks. Studies satisfying the selection criteria were charted based on their study design, primary care focus, and coverage of e-health areas of risk. ResultsFifty-eight studies were mapped for qualitative synthesis. Five identified digital health risk areas associated with the pandemic were governance, system design and coordination, information access, service provision, and user (professional and public) reception. We observed that rapid digital health responses may embed challenges in health system thinking, the long-term development of digital health ecosystems, and interoperability of health IT infrastructure, with concomitant weaknesses in existing evaluation theories. ConclusionThrough identifying digital health risks posed during the pandemic, this paper discussed potential directions for next-generation informatics evaluation development, to better prepare for the post-COVID-19 era, a new future epidemic, or other unforeseen global health emergencies. An updated evidence-based approach to health informatics is essential to gain public confidence in digital health across primary and other health sectors.