Prevalence study of Legionella spp. contamination in ferries and cruise ships.
(25/110)
BACKGROUND: In the last years, international traffic volume has significantly increased, raising the risk for acquisition of infectious diseases. Among travel-associated infections, increased incidence of legionellosis has been reported among travellers. Aim of our study was: to describe the frequency and severity of Legionella spp. contamination in ferries and cruise ships; to compare the levels of contamination with those indicated by the Italian ministerial guidelines for control and prevention of legionellosis, in order to assess health risks and to adopt control measures. METHOD: A prevalence study was carried out on 9 ships docked at the seaports of northern Sardinia in 2004. Water samples were collected from critical sites: passenger cabins, crew cabins, kitchens, coffee bars, rooms of the central air conditioning system. It was performed a qualitative and quantitative identification of Legionella spp. and a chemical, physical and bacteriological analysis of water samples. RESULTS: Forty-two percent (38/90) water samples were contaminated by Legionella spp.. Positive samples were mainly drawn from showers (24/44), washbasins (10/22). L. pneumophila was isolated in 42/44 samples (95.5%), followed by L. micdadei (4.5%). Strains were identified as L. pneumophila serogroup 6 (45.2%; 19 samples), 2-14 (42.9%), 5 (7.1%) and 3 (4.8%). Legionella spp. load was high; 77.8% of the water samples contained > 10(4) CFU/L. Low residual free chlorine concentration (0-0.2 mg/L) was associated to a contamination of the 50% of the water samples. CONCLUSION: Legionella is an ubiquitous bacterium that could create problems for public health. We identified Legionella spp. in 6/7 ferries. Microbial load was predominantly high (> 10(4) CFU/L or ranging from 10(3) to 10(4) CFU/L). It is matter of concern when passengers are subjects at risk because of Legionella spp. is an opportunist that can survive in freshwater systems; high bacterial load might be an important variable related to disease's occurrence. High level of contamination required disinfecting measures, but does not lead to a definitive solution to the problem. Therefore, it is important to identify a person responsible for health safety in order to control the risk from exposure and to apply preventive measures, according to European and Italian guidelines. (+info)
Intersections of 'sanitation, sexual coercion and girls' safety in schools'.
(26/110)
OBJECTIVE: To explore safety for girls in schools, particularly how girls perceive and negotiate dangers and risks associated with the use of toilets. METHODS: Participatory action research over a period of 3 days at three schools in South Africa. Informants were 81 girls 16 years and older, teachers and other relevant school personnel. Data were collected through focus group discussions, in-depth interviews, participant observation, mapping and photography. RESULTS: Toilets had inadequate or no sanitation. Both their use and their avoidance were risky for female students and discouraged hygienic practices. Experience of sexual violence from male students and teachers was a major theme, but unrelated to school toilets. Male teachers used various strategies and opportunities to gain sexual access to the girls and previous experience of victimization prevented the girls from reporting them. CONCLUSION: To ensure a healthy school environment that promotes gender equality, all threats to safety, including the physical and social environment, must be considered. (+info)
Urinary incontinence in dementia - a practical approach.
(27/110)
BACKGROUND: Urinary incontinence is a common problem in dementia. Almost invariably, the person with dementia will develop incontinence as the disease progresses. However, the primary reasons for incontinence are often not because of any significant pathology in the urinary system. Rather, it is due to factors outside the urinary system. The term 'functional incontinence' has hence been applied. Maintenance of continence requires mobility, manual dexterity, mental capacit and motivation. Clearly, the person with dementia is vulnerable to developing problems in these domains. OBJECTIVE: This article provides a comprehensive overview of how the stage and type of dementia may account for cognitive and functional deficits, the psycho-emotional world and behaviour of the patient, their care environment, and possible medical factors and pathology in the urinary system. DISCUSSION: Management is directed at turning around reversible factors, preserving independence and dignity of the patient, and providing sensitive and empathetic care even if the problem is not completely remediable. In those with more advanced dementia, timed and prompted voiding have shown the most promise. (+info)
Pontiac fever: an operational definition for epidemiological studies.
(28/110)
BACKGROUND: Pontiac fever is usually described in epidemic settings. Detection of Pontiac fever is a marker of an environmental contamination by Legionella and should thereby call for prevention measures in order to prevent outbreak of Legionnaire's disease. The objective of this study is to propose an operational definition of Pontiac fever that is amenable to epidemiological surveillance and investigation in a non epidemic setting. METHODS: A population of 560 elderly subjects residing in 25 nursing homes was followed during 4 months in order to assess the daily incidence of symptoms associated, in the literature, with Pontiac fever. The water and aerosol of one to 8 showers by nursing home were characterized combining conventional bacterial culture of Legionella and the Fluorescence In Situ Hybridization (FISH) technique that used oligonucleotides probes specific for Legionellaceae. A definition of Pontiac fever was devised based on clinical symptoms described in epidemic investigations and on their timing after the exposure event. The association between incidence of Pontiac fever and shower contamination levels was evaluated to test the relevance of this definition. RESULTS: The proposed definition of Pontiac fever associated the following criteria: occurrence of at least one symptom among headache, myalgia, fever and shivers, possibly associated with other 'minor' symptoms, within three days after a shower contaminated by Legionella, during a maximum of 8 days (minimum 2 days). 23 such cases occurred during the study (incidence rate: 0.125 cases per person-year [95% CI: 0.122-0.127]). A concentration of Legionella in water equal to or greater than 10(4).L(-1) (FISH method) was associated with a significant increase of incidence of Pontiac fever (p = 0.04). CONCLUSION: Once validated in other settings, the proposed definition of Pontiac fever might be used to develop epidemiological surveillance and help draw attention on sources of Legionella. (+info)
The in-home environment and household health: a cross-sectional study of informal urban settlements in northern Mexico.
(29/110)
People living in poverty make up nearly half of the global population and a large proportion of these individuals inhabit cities, living in informal settlements. However, only limited research on in-home environmental exposures and the associated health effects in these communities is available. This research investigates the home environment in unplanned settlements of a rapidly growing city on the U.S.-Mexico border and its impact on the health of households with children under 12 years of age. A cross-sectional design was used to assess household exposures and health outcomes at the household level. A total of 202 households were selected from two informal settlements in the peri-urban region of Ciudad Juarez, Mexico. The following variables were significantly associated with the report of at least one household member experiencing a health outcome in a two week period. Allergies were positively associated with insecticide use inside the home (adjusted Relative Odds (RO), 2.71; 95% confidence interval (CI), 1.2-6.3). Respiratory problems were associated with households using a wood burning stove vs. a gas stove (adjusted RO, 5.64; 95% CI, 1.1-27.9). Diarrhea was negatively associated with presence of a flush toilet in the home (adjusted RO, 0.22; 95% CI,0.1-0.6). Finally, eye irritations were positively associated with indoor tobacco smoke (adjusted RO, 2.23; 95% CI, 1.1-4.5). This research highlights exposures associated with poor living conditions in informal settlements and their associations with detrimental effects on health. More efforts should be made to understand the dynamics of poor urban environments including the health effects of exposures linked with poor housing conditions. (+info)
Follow-up of a low cost latrine promotion programme in one district of Amhara, Ethiopia: characteristics of early adopters and non-adopters.
(30/110)
OBJECTIVES: To verify reported construction of 22 385 household latrines in 2004, after community mobilization, as part of a trachoma control programme in one district of Amhara, Ethiopia, and to explore characteristics of early latrine adopters and non-adopters. METHODS: We used a two-stage cluster sample survey design to randomly select eight sub-districts and 160 households listed as having built a latrine, and visited them to verify presence and use. Household heads were interviewed to determine latrine cost and knowledge, attitude and practice regarding latrines. Non-latrine adopting neighbours were interviewed for comparison. We estimated district latrine ownership and calculated adjusted odds ratios for factors associated with latrine use. RESULTS: Latrines were present in 87% (95% CI 77-97) of listed households; 90% (81-99) were in use. Among all district residents we estimated ownership as 50.2% (44-56) and use as 45.2% (36-55). Of latrine owners who had built in 2004, 69% (53/77) had spent nothing on their latrine, those who paid spent an average of US$4.0 [standard deviation (SD) US$3.6]; overall the median cost was US$0 and the mean US$0.80 (SD US$1.7). Household heads adopting latrines were 1.9 times (95% CI 1.3-2.8) more likely to have any education and 1.5 times (95% CI 1.1-2.0) more likely to have a larger family than non-adopting neighbours. Cleanliness (48%, 56/116) and health benefits (42%, 49/116) were the most frequently reported advantages of latrines. CONCLUSION: The latrine promotion programme dramatically increased latrine access and use at very low cost. The method of community mobilization used could be an effective way of reaching millennium development sanitation targets. (+info)
Microbiological hazards of household toilets: droplet production and the fate of residual organisms.
(31/110)
Large numbers of bacteria and viruses when seeded into household toilets were shown to remain in the bowl after flushing, and even continual flushing could not remove a persistent fraction. This was found to be due to the adsorption of the organsims to the porcelain surfaces of the bowl, with gradual elution occuring after each flush. Droplets produced by flushing toilets were found to harbor both bacteria and viruses which had been seeded. The detection of bacteria and firuses falling out onto surfaces in bathrooms after flushing indicated that they remain airborne long enough to settle on surfaces throughout the bathroom. Thus, there is a possibility that a person may acquire an infection from an aerosol produced by a toilet. (+info)
Association between intestinal parasitic infections and type of sanitation system in rural El Salvador.
(32/110)
OBJECTIVE: To identify demographic, behavioural and environmental determinants of intestinal parasitic infection, evaluate the impact of a variety of dry sanitation systems on intestinal parasitic infection, and evaluate the safety of using stored biosolids in agriculture in order to guide future sanitation interventions in rural areas of El Salvador. METHODS: Interviews were conducted with 109 households in eight communities where double-vaulted and solar urine-diverting desiccating latrines, pit latrines or no latrines were used. Faecal samples from 499 individuals were tested for enteric helminths and protozoa. RESULTS: Users of solar desiccating latrines had the lowest prevalence of enteric parasite infection. Double-vault, urine-diverting desiccating latrines effectively reduced the transmission of some pathogens, but may not achieve the conditions sufficient for the complete destruction of the more environmentally persistent pathogens, Ascaris lumbricoides and Trichuris trichiura. Contact with inadequately treated latrine biosolids was associated with an increased risk of Ascaris infection. CONCLUSIONS: Solar latrines were associated with the overall lowest prevalence of enteric parasitic infections. Members of households where latrine biosolids were used in agriculture had a higher prevalence of infection than those where biosolids were buried. We therefore recommend the promotion of solar latrines in rural areas of El Salvador over other dry sanitation systems, and recommend that stored biosolids not be used in agriculture. (+info)