Hygiene,health and environment: European directives

Summary The setting up of the 1993 single market aimed at promoting free movement within the European Community, requires the elaboration of documents intended for the State members, so that the latter may adapt their own national standards which, at the present time, often hinder this free circulation. As for the ?Construction products?, a Directive was passed in this respect on December 21, 1988. It defines six essential requirements applicable to both building and civil engineering works, among which the one entitled: ?Hygiene, Health and Environment?. Each of these requirements will give rise to the elaboration of an ?Interpretative Document? which is aimed at explaining the contents of each requirement, specifying the relevant terminology, allowing the requirements, to be transformed into levels (or classes) of performances to comply with, as well as stating precisely the standards and harmonized technical documents indispensable for both the expression and checking of these levels. With respect to the range of subjects pertinent to the ?Hygiene, Health and Environment? requirement, it should be possible to deal easily with certain aspects such as hydrological cycle, in so far as both regulations and means of verification have, for a long time, been determined in most EEC countries. On the other hand, it will be more difficult to treat other aspects such as: air quality, emission of pollutants or radiation, owing to an almost total absence of any regulations at the present time.     

Rural water and sanitation. Community participation in appropriate water supply and sanitation technologies: the mythology for the Decade

The International Drinking Water Supply and Sanitation Decade (1981-90) is almost upon us. During this period, massive international efforts will be made to accelerate the provision of domestic water supply and sanitation facilities for the rural population of developing countries. Certain concepts and approaches are being developed and promoted as guiding themes that will help to steer and coordinate the activities of the Decade. Among them are 'appropriate technology' 'community participation' and a 'village level' or 'user-choice' approach. The validity and importance of these concepts are discussed. It is concluded that these concepts are often applied in an over-simplified manner and that they divert attention away from the fundamental political and administrative realities that primarily determine the success or failure of rural water and sanitation programmes.     

Childhood stunting and cognitive effects of water and sanitation in Indonesia

Close to 100 million Indonesians lack access to improved sanitation, while 33 million live without improved drinking water. Indonesia is home to the second largest number of open defecators in the world, behind India. Repeated exposure to fecal pathogens, especially common in areas where open defecation is practiced, can cause poor absorption and nutrient loss through diarrhea and poor gut function, leading to undernutrition, growth stunting and irreversible impairment of health, development, learning and earnings – the effects of which outlast a lifetime. Using data from a sample of over six thousand children in the Indonesia Family Life Survey (IFLS), a household socioeconomic panel representative of over 80 percent of the Indonesian population, we examine the relationship between poor household and community water and sanitation services and childhood stunting and cognitive development. We find that children living in households that have access to improved sanitation when they are under 2 years of age are approximately 5 percentage points less likely to end up being stunted. Community rates of sanitation are also important. Children living in open defecation free communities during this critical development window are more than 10 percentage points less likely to be stunted, than children in communities where all other households defecate in the open. Further, cognitive test scores are adversely affected by open defecation. These findings suggest that owning a toilet and living in a community where most of one’s neighbors own a toilet are important drivers of child growth and development.     

Evolutionary psychiatry: foundations,progress and challenges

Evolutionary biology provides a crucial foundation for medicine and behavioral science that has been missing from psychiatry. Its absence helps to explain slow progress; its advent promises major advances. Instead of offering a new kind of treatment, evolutionary psychiatry provides a scientific foundation useful for all kinds of treatment. It expands the search for causes from mechanistic explanations for disease in some individuals to evolutionary explanations for traits that make all members of a species vulnerable to disease. For instance, capacities for symptoms such as pain, cough, anxiety and low mood are universal because they are useful in certain situations. Failing to recognize the utility of anxiety and low mood is at the root of many problems in psychiatry. Determining if an emotion is normal and if it is useful requires understanding an individual's life situation. Conducting a review of social systems, parallel to the review of systems in the rest of medicine, can help achieve that understanding. Coping with substance abuse is advanced by acknowledging how substances available in modern environments hijack chemically mediated learning mechanisms. Understanding why eating spirals out of control in modern environments is aided by recognizing the motivations for caloric restriction and how it arouses famine protection mechanisms that induce binge eating. Finally, explaining the persistence of alleles that cause serious mental disorders requires evolutionary explanations of why some systems are intrinsically vulnerable to failure. The thrill of finding functions for apparent diseases is evolutionary psychiatry's greatest strength and weakness. Recognizing bad feelings as evolved adaptations corrects psychiatry's pervasive mistake of viewing all symptoms as if they were disease manifestations. However, viewing diseases such as panic disorder, melancholia and schizophrenia as if they are adaptations is an equally serious mistake in evolutionary psychiatry. Progress will come from framing and testing specific hypotheses about why natural selection left us vulnerable to mental disorders. The efforts of many people over many years will be needed before we will know if evolutionary biology can provide a new paradigm for understanding and treating mental disorders.     

Case management of severe malaria--a forgotten practice: experiences from health facilities in Uganda

Introduction

Severe malaria is a life-threatening medical emergency and requires prompt and effective treatment to prevent death. There is paucity of published information on current practices of severe malaria case management in sub-Saharan Africa; we evaluated the management practices for severe malaria in Ugandan health facilities

Methods and Findings

We did a cross sectional survey, using multi-stage sampling methods, of health facilities in 11 districts in the eastern and mid-western parts of Uganda. The study instruments were adapted from the WHO hospital care assessment tools. Between June and August 2009, 105 health facilities were surveyed and 181 health workers and 868 patients/caretakers interviewed. None of the inpatient facilities had all seven components of a basic care package for the management of severe malaria consistently available during the 3 months prior to the survey. Referral practices were appropriate for <10% (18/196) of the patients. Prompt care at any health facility was reported by 29% (247/868) of patients. Severe malaria was correctly diagnosed in 27% of patients (233).Though the quinine dose and regimen was correct in the majority (611/868, 70.4%) of patients, it was administered in the correct volumes of 5% dextrose in only 18% (147/815). Most patients (80.1%) had several doses of quinine administered in one single 500 ml bottle of 5% dextrose. Medications were purchased by 385 (44%) patients and medical supplies by 478 patients (70.6%).

Conclusions

Management of severe malaria in Ugandan health facilities was sub-optimal. These findings highlight the challenges of correctly managing severe malaria in resource limited settings. Priority areas for improvement include triage and emergency care, referral practises, quality of diagnosis and treatment, availability of medicines and supplies, training and support supervision.     

中国生态卫生建设的潜力、挑战与对策

立足于社会一经济.自然复合生态系统结构与功能框架,以中国农村卫生系统为重点,在分析卫生系统现状水平的基础上,结合地理布局和社会经济发展状况,划分了中国发展生态卫生的6个分区,并研究了各分区现状及其4类卫生系统的人口分布.缺乏基本卫生设施的地区是未来中国发展生态卫生的最大潜力地区,这些地区包括了严重缺乏投入资金的4 682万农村人口,主要集中在中西部和西南部地区,占67.8%.若在该区域推广生态卫生,可能产生社会、经济及环境效益如下:带动新兴产业,增加5～10万的直接就业机会;降低疾病感染率;回收沼气56万m3;卫生厕所投入控制在可接受的600～750元·户-1;促进生态农业循环;降低污染物排放、保障生态安全.文章还探讨了中国生态卫生的分区发展对策和系统瓶颈.     

The effects of water supply and sanitation on childhood mortality in urban Eritrea

Child mortality differentials according to water supply and sanitation in many urban areas of developing countries suggest that access to piped water and toilet facilities can improve the survival chances of children. The central question in this study is whether access to piped water and a flush toilet affects the survival chance of children under five in urban areas of Eritrea. The study uses data collected by the Demographic and Health Survey (DHS) project in Eritrea in 1995. The results show that while the unadjusted effect of household environment (water supply and toilet facility) is large and statistically significant during the post-neonatal and child periods, it is relatively small and statistically insignificant during the neonatal period. The effect of household environment remains substantial during the post-neonatal and child periods, even when other socioeconomic variables are held constant. However, the household environment effect totally disappears during the neonatal period when the socioeconomic factors are controlled for.     

Breast-feeding, diarrhoea and sanitation as components of infant and child health: a study of large scale survey data from Ghana and Nigeria

Using Demographic and Health Survey datasets from Ghana and Nigeria, this study examined whether the protective effects of breast-feeding are greatest where the poorest sanitation conditions prevail. It was found that mixed-fed infants aged between 0 and 11 months tend to have a higher risk of diarrhoea than fully breast-fed children, while the risk of diarrhoea among weaned infants is twice that of mixed-fed infants. The probit regression models employed in the analysis were used to predict the probability of diarrhoea associated with each breast-feeding pattern for both 'poor' and 'good' sanitation areas. It was found that the risk of diarrhoea among mixed-fed infants in the poor sanitation areas tends to be high while the same risk among fully breast-fed infants tends to be minimal. In essence, the health risks of mixed feeding are real, particularly for infants aged less than 7 months, and are even worse for those weaned before 6 months of age.     

Crisis in our schools: survey of sanitation facilities in schools in Bloomsbury health district.

OBJECTIVE--To survey sanitation facilities in schools in Bloomsbury health district. DESIGN--Postal questionnaire. SETTING--Inner London health district. PARTICIPANTS--School nurses. RESULTS--16 of 17 school nurses responded (37 of 41 schools). Fifteen schools did not have the minimum number of toilets and hand basins established in the Education (School Premises) Regulations 1981. In two schools toilets were kept locked for most of the day. In 10 schools toilet paper was not always available, and three of five secondary schools did not have disposal units for sanitary towels in the girls'' toilet areas. In 18 of the schools the toilets were not kept adequately clean. CONCLUSIONS--These conditions raise serious questions about environmental health, with the potential for the spread of infectious diseases, and undermine attempts to teach children basic hygiene. Health professionals have an important role in assessing health and safety standards in schools and ensuring that necessary improvements are made.