Public Health Standards Research Articles

Bridging the gap: how education transforms health outcomes and influences health inequality in rural China.

This study focuses on the impact of education on health and health inequalities in rural areas of China. Education significantly enhances economic status and health, driving economic growth and improving public health standards. Integral to the "Healthy China Strategy," it provides essential guidance for public policy and underscores the need for strategic human capital investments to achieve these goals. The study utilizes data from the China Family Panel Studies (CFPS) spanning 2010-2020 and employs the average educational level within counties as an instrumental variable. The causal impact of education on health and health inequalities is estimated using the two-stage least squares (2SLS) method. The findings reveal a significant positive correlation between enhancing education levels and health improvements. Specifically, after controlling for endogeneity, the duration of individual education significantly improves both subjective and objective health outcomes. It reduces health inequalities, with these effects being more pronounced among women and low-income groups. Mechanistically, education positively impacts health primarily by altering health behaviors and social network levels and reducing health inequalities through socio-economic factors. This paper provides important implications for public policy, suggesting that enhancing educational investments can drive economic development and improve population health standards.

Living conditions in Italian administrative detention centres for migrants: a scoping review

Abstract Since 2011, Italy has experienced a growing flow of migrants, despite the implementation of restrictive and detention-oriented procedures. Detention facilities for migrants must provide health protection and general assistance to the person. Considering the critical state of the centres reported by various sources, this study gives an overview of the conditions in Italian detention facilities for migrants from a public health perspective. A scoping search of the peer-reviewed and grey literature was performed to investigate the public health standards currently in force in Italian detention facilities for migrants and refugees (Hotspot and CPR-Pre-removal Detention Centres). Articles published from 2009 to 2021 in English and Italian were included and qualitatively described in five categories: provision of healthcare, living conditions, protection of vulnerable detainees, access to legal advice, and the Covid-19 pandemic. 11 peer-reviewed studies and 24 grey documents were included. Guidelines on screening procedures for infectious diseases or vaccines appeared to be hastily followed; chronic and mental diseases were not appropriately addressed. The facilities were described as run-down, with scarce and poor-quality meals, and lacking of educational activities. A lack of protection for vulnerable categories was reported, including unaccompanied minors. The Covid-19 pandemic further exacerbated pre-existing issues, highlighting systemic weaknesses in preparedness and response. Life conditions within the centres for migrants in Italy fall significantly short of acceptable standards. The main problems are the unavailability of cultural mediation services and the insufficient protection of mental health. The overall conditions appeared to be not dignifying and violations of the law are, if not frequent, present and well recognised. Urgent reforms are warranted to address these shortcomings and ensure the humane treatment and protection of migrants within these facilities. Key messages • Italy is responding to the recent inflow of migrants with policies oriented to detention and repatriation. To this, it established de-facto detention centres for migrants, namely Hotspot and CPRs. • The public health standards of migrants’ repatriation centres are poorly followed and life inside the centres appears misereble.

Exploring health worker absenteeism at public healthcare facilities in Chhattisgarh, India.

This study aims to assess the health worker absenteeism and factors associated with it in a high-focus district in Chhattisgarh, India. Human resources for health are among the key foundations to build resilient healthcare systems. Chhattisgarh is a high-focus Indian state with a severe shortage of health care workers, and absenteeism further aggravates the shortage. This study was conducted as a mixed-methods study employing sequential explanatory design. Absenteeism was defined as the absence of health worker in the designated position without a formal leave or official reason in two different unannounced visits. A facility survey across all the public healthcare facilities in Jashpur district, Chhattisgarh, was conducted through random, unannounced visits employing a checklist developed based on Indian Public Health Standards. Twelve participants were purposively sampled and interviewed from healthcare facilities to explore factors associated with absenteeism. Survey data were analysed descriptively, and thematic analysis was employed to analyse qualitative interviews. Among all the positions filled at primary health centre level (n = 339), close to 8% (n = 27) were absent, whereas among the positions filled at community health centre level (n = 285), only 1.14% (n = 4) were absent. Absenteeism was not found in the district hospital. Qualitative interviews reveal that macro-level (geographical location and lack of connectivity), meso-level (lack of equipment and amenities, makeshift health facilities, doctor shortage, and poor patient turnover), and micro-level (unmet expectations) factors contribute to health worker absenteeism. Health worker absenteeism was more at PHC level. Systemic challenges, human resource shortages, and infrastructural shortcomings contributed to health worker absenteeism.

Framework for responsive financing of district hospitals of India.

The current financing of public-sector district hospitals in India relies on historical budget allocations rather than actual utilization or healthcare needs. We utilized empirical data on healthcare delivery costs to develop the financing framework for these hospitals using a blended payment approach. The primary data on cost of delivering services in 27 district hospitals across nine states of India was analysed along with indicators influencing the demand and supply of health services. Payment for outpatient, inpatient, and indirect services was assessed using the risk adjusted global budget, case-based bundled payment, and per-bed-global budget, respectively. Risk adjustment weights were computed by regressing the cost of outpatient care with demand and supply side factors which are likely to influence the utilization or the prices. Budget impact analysis was conducted to assess the fiscal implications of this payment approach, accounting for current care standards and two scenarios: upgrading district hospitals to Indian Public Health Standards (IPHS) or medical colleges. The average annual budget for a district hospital in India is estimated at ₹326 million (US$3.35 million), ranging from ₹66 million to ₹2.57 billion (US$0.8-31.13 million). Inpatient care comprises the largest portion (78%) of the budget. Upgrading to IPHS-compliant secondary hospitals or medical colleges would increase average budgets by 131 and 91.5%, respectively. Implementing a blended payment approach would align funding with healthcare needs, enhance provider performance, and support ongoing financing reforms aimed at strategic purchasing and universal health coverage.

Hydraulic Design Concept of 6.60MLD Water Treatment Plant

Abstract: The design and construction of a 6.6 million liters per day (MLD) water treatment plant (WTP) in Belpada Village, Odisha, aim to meet the increasing water demand while ensuring public health through effective water treatment processes. The plant, which sources raw water from the Tel River, follows a well-structured treatment process that includes aeration, sedimentation, filtration, and disinfection. This journal outlines the hydraulic design, treatment schemes, and structural components of the WTP. Design calculations, based on CPHEEO standards, are also discussed, focusing on the hydraulic detention times, surface loading, filtration rates, and sludge management techniques.The design of water treatment plants (WTPs) plays a crucial role in delivering safe drinking water, especially in areas with high population density and industrial growth. The 6.6 MLD WTP designed for Belpada Village in Balangir District draws water from Tel River and utilizes a cascade aeration system for the removal of contaminants. This paper discusses the hydraulic and process design, focusing on flow rates, detention times, and surface loading parameters that meet the Central Public Health and Environmental Engineering Organization (CPHEEO) standards.

Innovative hierarchical porous hydrophilic molecularly imprinted resin for high-throughput detection of perfluorocarboxylic acids in milk using 96-well plate SPE-LC-MS/MS

The accumulation of perfluorocarboxylic acids (PFCAs) in environment and foods represents a significant threat to public health due to the long-term ingestion of contaminated food. This study introduces a novel adsorbent, the hierarchical porous hydrophilic molecularly imprinted resin (HPHMIR), which was synthesized by integrating molecular imprinting techniques with hydrophilic resins. The HPHMIR, characterized by its extensive mesoporous structure (average pore width ∼9.71 nm) and favorable imprinting factors (2.6–5.0), facilitates the effective adsorption of PFCAs from complex matrices through multiple interaction mechanisms, including hydrogen bonding and electrostatic interactions. This innovative material was employed in a 96-well plate format for solid-phase extraction (SPE), and combined with LC-MS/MS, a high-throughput method for the determination of PFCAs in milk was developed. The proposed method demonstrated exceptional performance, including excellent linearity (0.48–240 ng mL−1; r ≥ 0.9986), low detection limits (0.04–0.11 ng mL−1), high precision (relative standard deviation ≤ 9.9 %), and satisfactory recovery (75.7–118.1 %). These results highlight the efficacy of the method in extracting trace levels of PFCAs from complicated sample matrices, presenting a promising alternative for monitoring PFCA contamination and advancing public health standards.

Should a single growth standard be used to judge the nutritional status of children under age 5 y globally? Debate consensus

The participants in this debate agreed that: 1) target-based advocacy is required for ensuring countries’ engagement and political commitments toward reducing child malnutrition, and the tools used for monitoring progress should be accurate and pose no risk of harmful consequences; and 2) physical growth is not the only dimension of nutritional status to be monitored in clinical and public health practice; anthropometry is thus only one of the diagnostic indicators of nutritional status. Key disagreements included methodological approaches for developing a single growth standard to evaluate nutritional status globally; the relative utility of universal and contextual growth standards for clinical practice and public health; the balance of benefits, harms, and acceptability among stakeholders; and their use as a screening or a definitive tool in individual and public health nutrition. Noteworthy agreements for research priorities included comparison of benefits and harms of using universal compared with contextual growth standards/references and different stakeholders’ perception of expectations from and utility of growth standards.

Assessment of Sanitation Services and Practices among Local Community in West B Municipality in Zanzibar Island, United Republic of Tanzania

Good basic sanitation services and practices are essential in maintaining generally accepted standards for personal hygiene and public health. The objective of this paper is to assess the sanitation services and practices among the local community in West B Municipality in Zanzibar Island, United Republic of Tanzania. The study uses a cross-sectional study design. Raosoft online sample calculator was used to determine the sample size while systematic random sampling was applied to select the respondents. Results show that a substantial proportion of the community uses on-site sanitation systems by which excreta and wastewater are collected and stored in containments within the vicinity, requiring emptying when full. Many toilets have security issues as they lack privacy and user comfort. About 28.8% have unlockable doors, 21.2% have fixed clothing curtains and 3.8% are completely open. In the area, Indian-type squat toilets are dominant (78.75%), followed by traditional pit latrines (20%). A slightly large percentage (55%) of households use motorised but the remaining percentage (45%) use non-motorised means of emptying and transportation. The study further found limited or ineffectual use of Personal Protective Equipment (PPE) among the sludge workers, thus risking their health and safety. The conveyed sludge waste is usually taken to a designated treatment plant, disposed of in excavated pits or dumped openly in the forest. This implies that sanitation services and practices in West B are inadequate, leading to disease transmission due to environmental pollution. The study recommends compliance with standards and guidelines, awareness and advocacy, technological innovations, stakeholder involvement and research and development on sanitation services and practices.

Integrated assessment of phytochemicals, Antilipase, hemoglobin antiglycation, antihyperglycemic, antifungal and antibacterial properties of vetiveria zizanioides (L.) Nash

ABSTRACT Vetiveria zizanioides, known as vetiver grass, is renowned for its ecological significance in soil erosion control and the restoration of lands polluted by heavy metals. Additionally, this plant is extensively harvested for vetiver oil, widely utilized in both medicine and perfumery. The study was designed to investigate the phytochemicals, antilipase, hemoglobin antiglycation, antihyperglycemic, antifungal, and antibacterial properties of V. zizanioides. The GC-MS analysis revealed the presence of various volatile compounds, among which the most predominant ones, which are, 4,6,6-Trimethyl-2-(3-methylbuta-1,3-dienyl) −3-oxatricyclo [5.1.0.0(2,4)] octane, Cycloisolongifolene (8,9-dehydro-), and 9 H-Cycloisolongifolene (8-oxo-). It is noteworthy that this essential oil has shown significant inhibitory activity against α-amylase, α-glucosidase, pancreatic lipase, and glycation, with respective IC50 values of 0.47 ± 0.01, 0.42 ± 0.004, 0.58 ± 0.008, and 0.49 ± 0.005 mg/mL. Additionally, the antimicrobial activity of EoVZ was assessed against a diverse spectrum of Gram+ and Gram- bacteria, as well as fungi, using both disc-diffusion and broth-microdilution techniques. The results showed significant antimicrobial effects against all tested microorganisms, with inhibition zones ranging from 28.33 ± 1.66 mm to 9.0 ± 0.0 mm for bacteria and from 22.5 ± 1.7 mm to 14.0 ± 0.3 mm for fungi. Moreover, minimum inhibitory concentrations (MIC), minimum bactericidal concentrations (MBC), and minimum fungicidal concentrations (MFC) were determined, with values ranging from 0.0625% to 2.0% (v/v) for bacteria and from 2.0% to 8.0% (v/v) for fungi. The MBC/MIC and MFC/MIC ratios indicated bactericidal and fungicidal mechanisms. This study underscores the prominent attributes of EoVZ, particularly its antimicrobial and antidiabetic properties, suggesting its potential as a natural and effective agent ensuring high safety standards for public health.

Recent approaches of regulatory perspectives for the registration of drugs in southern states in India

Recent approaches in regulatory perspectives for the registration of drugs in Southern states of India have been characterized by a focus on enhancing efficiency, transparency, and safety in the drug approval process. This involves the adoption of stringent regulatory frameworks aligned with international standards to ensure the quality, efficacy, and safety of pharmaceutical products. One significant development is the implementation of electronic submission systems for the registration of drugs, streamlining the application process and reducing administrative burdens for regulators and pharmaceutical companies. Additionally, there has been an emphasis on strengthening post-marketing surveillance mechanisms to monitor the safety and efficacy of drugs once they are in the market, enabling prompt identification and mitigation of potential risks or adverse reactions. Collaborative efforts between regulatory authorities, industry stakeholders, and healthcare professionals have also been encouraged to facilitate knowledge exchange and capacity building in regulatory compliance and pharmacovigilance. Overall, these recent approaches reflect a concerted effort to uphold public health standards and ensure access to safe and effective medications for the population of Southern states in India.

Towards an Interoperability Landscape for a National Research Data Infrastructure for Personal Health Data

The German initiative “National Research Data Infrastructure for Personal Health Data” (NFDI4Health) focuses on research data management in health research. It aims to foster and develop harmonized informatics standards for public health, epidemiological studies, and clinical trials, facilitating access to relevant data and metadata standards. This publication lists syntactic and semantic data standards of potential use for NFDI4Health and beyond, based on interdisciplinary meetings and workshops, mappings of study questionnaires and the NFDI4Health metadata schema, and literature search. Included are 7 syntactic, 32 semantic and 9 combined syntactic and semantic standards. In addition, 101 ISO Standards from ISO/TC 215 Health Informatics and ISO/TC 276 Biotechnology could be identified as being potentially relevant. The work emphasizes the utilization of standards for epidemiological and health research data ensuring interoperability as well as the compatibility to NFDI4Health, its use cases, and to (inter-)national efforts within these sectors. The goal is to foster collaborative and inter-sectoral work in health research and initiate a debate around the potential of using common standards.

An Assessment of the Epidemiology and In vitro Susceptibility of Giardia lamblia Trophozoites and Cysts to a Variety of Plant Extracts

Giardia lamblia is a prevalent intestinal parasite that cause diarrhea among human beings and the life cycle is complicated and contains two stages for trophozoites and cysts. These stages are hardly eradicated by using prescribed drugs such as metronidazole. Aim: The purpose of this study was to identify the intestinal parasite Giardia lamblia in patients suffering from diarrhea and primary enteritis, then determine the antiparasitic activity of five plant extracts included (Zumeria majda, Thymus migricus, Artemisia santolina, Sargassum and Proskia) compared with available drug of metronidazole (MTZ) as an effective and first-time treatment against Giardia lamblia. Place and Duration of Study: It was performed between January 2023 to February 2024 at the laboratory of parasitology of three hospitals included Ramadi Teaching Hospital, Fallujah Teaching Hospital and Ramadi Teaching Hospital for Maternity and Children in Al-Anbar governorate of Iraq. A total of 1200 stool samples of patients were collected from both genders and ranged in age from 6 months to 65 years. Methodology: The stool samples were examined directly by formalin-ether test using a light microscope to confirm the presence of G. lamblia infection. Test tubes contained 1 mL of every extract at concentrations of 10, 25, 50, 75 and 100 µg/mL before 10,000 cysts or trophozoites were added and then the tubes were incubated at 37°C for a period of 30, 120, and 360 minutes. A light microscope set to 400x magnification, smears made from residual cyst and trophozoite material were arranged individually on glass slides. The mean number of the extracted cysts and trophozoites were assessed using vital 0.1% eosin staining. Results: G. lamblia parasite infections accounted for 47.8% of all infections; males had a greater prevalence of the parasite (49.6%) than females (45.7%). In relation to other age groups, the incidences of G. lamblia infection were higher in the age groups of 6 months to 10 years and (11-20) years, at 55.17% and 47.6%, respectively. At the lowest concentrations of 75μg/mL and 100μg/mL following exposure times of 240 min and 360 min, all five plant extracts examined in this study included Zumeria majda, Thymus migricus, Artemisia santolina, Sargassum and Proskia had a significant effect and killed 100.0% of the cysts and trophozoites of G. lamblia in contrast to the MTZ, which showed the highest reduction rates 68.4% against cysts and 75.4% against trophozoites. Conclusion: To conclude, the study findings indicate that G. lamblia infections are more common in AL-Anbar province particularly in younger people. This can be attributed to a number of factors such as improper eating and drinking habits and an absence of respect for hygiene and public health standards. Plant-based extracts showed promising in vitro activity at low doses and short times of exposure, according to the results on G. lamblia. These findings could lead to the development of a novel therapeutic alternative to treat Giardiasis infections.

Worth a Shot: Experience and Lessons From an Unsuccessful Pediatric Immunization Quality Improvement Effort in a Large Health System During the COVID-19 Pandemic.

During the coronavirus disease of 2019 (COVID-19) pandemic, routine childhood immunization rates dropped dramatically across the world, and the Military Health System (MHS) was no exception. In the MHS, which is a large, universally covered, low-to-no-cost health system, the immunization rates with the measles, mumps, and rubella (MMR) vaccine remain below the rate necessary to prevent community transmission of measles. We aimed to improve childhood immunization rates in the MHS with an expansive quality improvement project. Measles, mumps, and rubella immunization rates served as proxy outcome measures for routine immunization rates tracked by the Center for Disease Control multi-immunization combination measures. The tracked measure was the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2, respectively. Various countermeasures were implemented throughout the study period, and standard quality improvement analyses informed the effect of countermeasures. By January 2023, the percentage of 16- to 18-month olds and 6-year olds who had received MMR #1 and MMR #2 was 85% and 91%, respectively, with no positive shift in immunization rates despite various countermeasures introduced during the study period. For reference, the MMR immunization rates of commercial health maintenance organization and commercial preferred provider organization for 24-month-old populations were 92% and 90.3%, respectively. On chart review, the most common cause for under-immunization (55%) was vaccine abandonment. MMR #1 rates rose to 92% in 24-month olds. Measles, mumps, and rubella immunization rates within the MHS remained below commercial health system rates and below public health standards required for herd immunity despite various countermeasures throughout the COVID-19 pandemic. Immunization rates increased with age, suggesting that children within the MHS eventually catch up despite potential barriers.

Investigating Factors Influencing the National Cancer Screening Program among Older Individuals in Republic of Korea-Data from the Korea National Health and Nutrition Examination Survey VIII.

This study aims to determine the influencing factors of the participation of older individuals aged 65 years and above in South Korea's National Cancer Screening Program (NCSP) using data from the eighth wave (2019-2021) of the Korea National Health and Nutrition Examination Survey (KNHANES VIII), and discuss potential problems and coping strategies. Variables were selected based on Andersen's healthcare utilization model. "Participation in the NSCP" was considered the dependent variable, with independent variables including sociodemographic characteristics (sex, marital status, residence, education level, income level, economic activity, medical coverage type, and private insurance), health conditions (subjective health status, hypertension, and diabetes), and health behaviors (physical activity, monthly alcohol consumption, and current smoking status). The analysis revealed that higher participation rates correlated with being married, having an education level beyond elementary school, being employed, subscribing to private insurance, perceiving oneself as having average or poor health, engaging in physical activity, and not smoking. Sex, residence, income, medical coverage type, hypertension, diabetes, and monthly alcohol consumption were found to be insignificantly correlated. These findings underscore the importance of tailored promotion and health education for older individuals to boost NCSP participation rates, which could ultimately elevate public health standards.

Variability in public health programming and priorities to address health inequities across public health units in Ontario, Canada.

In 2018, Ontario Public Health Standards were updated to include the foundational Health Equity Standard to guide planning, implementation, and evaluation of public health programs and services. Public health units (PHUs), the regional public health bodies, are now required to address health equity through four requirements: (a) Assessing and Reporting; (b) Modifying and Orienting Public Health Interventions; (c) Engaging in Multi-sectoral Collaboration; and (d) Health Equity Analysis, Policy Development, and Advancing Healthy Public Policies. This qualitative descriptive study explored how the 27 participating PHUs (out of 34) serving urban (N = 10), mixed urban-rural (N = 15), and rural (N = 9) populations addressed the Health Equity Standard. Using document analysis, we inductively and deductively coded the content of 68 PHU Annual Service Plan and Budget Submissions from a 3-year period (2018-2020) received from the 27 PHUs. Emergent categories were organized into the four requirements and one additional emergent theme: Organizational Implementation of Health Equity. The approaches of embedding health equity into PHUs' activities varied across groups. Urban PHUs presented more diverse strategies, including working with a larger number of organizations, and participating in academic research projects. We found more process standardization and greater discussion of capacity building in urban and mixed urban-rural PHUs. Rural PHUs strategically addressed the needs of their diverse populations through relationship building with Indigenous communities. Findings suggest broad implementation of health equity approaches in public health independent of PHUs' geographic size and population dispersion, though strategies and key challenges differ across units.

Patching sustainability loopholes within the lead-acid battery industry of Bangladesh: An environmental and occupational health risk perspective

Despite global efforts to phase out lead (Pb) products, their widespread use persists, notably in the lead-acid battery (LAB) industry. This trend is also evident in Bangladesh, where sustainability concerns surrounding the largely unexplored, yet highly vibrant informal sector remain unaddressed. It is imperative to unravel a comprehensive picture to implement targeted formalization strategies effectively at a meso level. This study aims to achieve this by using a substance flow analysis (SFA), life cycle assessment (LCA), and human health risk assessment (HHRA) approach, to highlight the environmental impacts and health risks associated with the industry's thriving informal sector. This sector emerges as a towering colossus of Pb pollution in the country, with a striking 86 % of the total Pb loss occurring from informal recycling alone. Informal electric vehicle (EV) LAB manufacturing is identified as a major contributor to land use, global warming, fine particulate matter formation, and terrestrial acidification impacts, with global warming and fine particulate matter contributing about 40 % each to the total human health impacts. Workers in the informal sector, the most overlooked victims of this industry, face alarming risks of non-carcinogenic and carcinogenic toxicity-related diseases, with oral exposure route making up 90.8 % of the total non-carcinogenic risks. As developing nations grapple with similar waste management challenges, often exacerbated by their socio-economic and political contexts, these findings underscore the urgent need for a robust national action plan. Collaboration among governmental entities and international stakeholders is imperative to execute targeted cleanup initiatives and uphold compliance with international environmental and public health standards.

Measuring The Amount Of Ammonia Gas In Cattle Using The MQ137 Sensor In Rawan Village, Mayang District, And Member District With The Goal Of Raising Public Health Standards

The majority of the farmers in Pringtali Hamlet, Mayang Village, Jember Regency, are also cattle breeders. Cattle breeders make up the majority of farmers. They construct basic cow enclosures; the majority are joined to the home, while others are independent. For the two of them, the cage's quality does not match the standards for cleanliness. Even in cages attached to the home, the smell of cow poo can be detected up to three meters outside the cage and within the main house. Ammonia is often the gas that is released from either liquid or solid cow manure. This gas can have some negative effects on health; in fact, it can irritate respiratory blood vessels in those 60 years of age and older. Because ammonia gas from cages has not been handled adequately, the living environment is contaminated. The goal of our service is to measure the threshold level of ammonia gas surrounding the cage (using the MQ-135 sensor) in order to ascertain whether the cage is ecologically friendly and healthy. Two cow pens one adjacent to a domestic main house in Pringtali Hamlet and the other from a separate traditional pen have had measurements taken. By monitoring liquid excrement drainage channels and promoting air circulation around the cage, the measurements seek to maintain the cleanliness of the cage environment and the management of ammonia gas content. Cage management so that the livestock community can improve the cleanliness of the living environment.

Determinants of per- and polyfluoroalkyl substances (PFAS) exposure among Wisconsin residents

BackgroundPer- and polyfluoroalkyl substances (PFAS) include thousands of manufactured compounds with growing public health concerns due to their potential for widespread human exposure and adverse health outcomes. While PFAS contamination remains a significant concern, especially from ingestion of contaminated food and water, determinants of the variability in PFAS exposure among regional and statewide populations in the United States remains unclear. ObjectivesThe objective of this study was to leverage The Survey of the Health of Wisconsin (SHOW), the only statewide representative cohort in the US, to assess and characterize the variability of PFAS exposure in a general population. MethodsThis study sample included a sub-sample of 605 adult participants from the 2014–2016 tri-annual statewide representative sample. Geometric means for PFOS, PFOA, PFNA, PFHxS, PFPeS, PFHpA, and a summed measure of 38 analyzed serum PFAS were presented by demographic, diet, behavioral, and residential characteristics. Multivariate linear regression was used to determine significant predictors of serum PFAS after adjustment. ResultsOverall, higher serum concentrations of long-chain PFAS were observed compared with short-chain PFAS. Older adults, males, and non-Hispanic White individuals had higher serum PFAS compared to younger adults, females, and non-White individuals. Eating caught fish in the past year was associated with elevated levels of several PFAS. DiscussionThis is among the first studies to characterize serum PFAS among a representative statewide sample in Wisconsin. Both short- and long-chain serum PFAS were detectable for six prominent PFAS. Age and consumption of great lakes fish were the most significant predictors of serum PFAS. State-level PFAS biomonitoring is important for identifying high risk populations and informing state public health standards and interventions, especially among those not living near known contamination sites.

Influence of physical and water quality parameters on residual chlorine decay in water distribution network

Chlorine is the most common disinfectant in drinking water distribution practice. World Health Organization recommends 0.2–5.0 mg/l of residual chlorine in drinking water. This paper analyzed influence of physical and water quality parameters on chlorine decay in drinking water distribution. Principal component analysis, directed tree and regression were used to investigate influence of these parameters on chlorine from water treatment plant to water consumption points. Results show that initial chlorine, electrical conductivity and distance explain 62 % of chlorine decay with estimated error of 0.045 mg/l. The decision-tree feature importance scores of initial chlorine and electrical conductivity were 0.47 and 0.23 respectively. The combined feature importance scores of physical parameters of distance (0.09), pipe diameter (0.06), flow velocity (0.03), pressure (0.02) and travel time (0.046) were less than that for initial chlorine concentration (0.47) alone. These results show that conventional chlorination at water treatment plants removes largely fast inorganic reactants leaving traces of slow organic reactants as the dominant secondary contaminants in water distribution system. The key policy recommendation is to use water quality parameters more than physical parameters in order to enable water utility managers maintain residual chlorine within safe public health standards.

Assessment of Primary Laboratory Facilities for Rural Health Care Preparedness in Osmanabad District, India

Government of India has provided Indian Public Health Standards to improve rural health care services and health status, but still rural laboratory is a cause of concern. This study is performed to understand the laboratory facility-level gaps that need to be addressed to improve the public primary health centres (PHCs) present in rural areas. The laboratory assessment is performed for governance, financing, resources and services, and results are validated with the PHC laboratory performance. The current assessment shows critical gaps in the facilities regarding governance, services, resources and financing required for the laboratory services at the rural primary health care level. Governance and services need to be strengthened the most, followed with sustained availability of resources and financing. Poor health status in rural areas necessitates public health response based on health systems. Therefore, health system preparedness in the form of laboratory services is essential in primary health care facilities.