Microbial groundwater quality and its health implications for a border-strip irrigated dairy farm catchment, South Island, New Zealand

Intensification of dairying on irrigated pastures has led to concern over the microbial quality of shallow groundwater used for drinking purposes. The effects of intensive dairying and border-strip irrigation on the leaching of E. coli and Campylobacter to shallow groundwater were assessed over a three-year period in the Waikakahi catchment, Canterbury, New Zealand. Well selection excluded other sources of contamination so that the effect of dairying with border-strip irrigation could be assessed. Groundwater samples (135) were collected, mostly during the irrigation season, with E. coli being detected in 75% of samples. Campylobacter was identified in 16 samples (12%). A risk assessment of drinking water with these levels of Campylobacter was undertaken. A probability distribution was fitted to the observed Campylobacter data and the @RISK modeling software was used, assuming a dose response relationship for Campylobacter and consumption of 1 L/day of water. The probability of infection on any given day in the study area was estimated at 0.50% to 0.76%, giving an estimated probability of infection during the irrigation season of 60% to 75%. An epidemiological assessment of the Canterbury region comparing areas encompassing dairy within major irrigation schemes (approximately 55% border-strip irrigation) to two control groups was undertaken. Control group 1 (CG1) encompasses areas of dairying without major irrigation schemes, and a second larger control group (CG2) comprises the rest of the Canterbury region. Comparisons of the subject group to control groups indicated that there was a statistically significant increase in age-standardised rates of campylobacteriosis (CG1 Relative Risk (RR)=1.51 (95% CI = 1.31-1.75); CG2 RR = 1.51 (1.33-1.72)); cryptosporidiosis (CG1 RR = 2.08 (1.55-2.79); CG2 RR = 5.33 (4.12-6.90)); and salmonellosis (CG2 RR = 2.05 (1.55-2.71)).     

Differential behaviour of Escherichia coli and Campylobacter spp. in a stream draining dairy pasture

The faecal indicator bacterium Escherichia coli and thermotolerant Campylobacter spp., which are potentially pathogenic, were investigated in the Toenepi Stream draining a pastoral catchment dominated by dairying. Bacteria concentrations were monitored routinely at fortnightly intervals over 12 months and intensively during storm events to compare the transport dynamics of bacterial indicator and pathogen under varying hydro-meteorological conditions. Routine monitoring indicated median concentrations of 345 E. coli MPN 100 ml^-1 and relatively low concentrations of 2.3 Campylobacter MPN 100 ml^-1. The bacterial flux was three orders of magnitude greater under elevated stream flow compared with base-flow. E. coli peak concentrations occurred very close to the turbidity peak and consistently ahead of the Campylobacter spp. peak (which was close to the hydrograph peak). We postulate that, under flood conditions, the E. coli peak reflects the entrainment and mobilisation of in-stream stores on the flood wave front. In contrast, Campylobacter spp. are derived from wash-in from land stores upstream and have travelled at the mean water velocity which is slower than the speed of the flood wave. Our findings of different dynamics for E. coli and Campylobacter spp. suggest that mitigation to reduce faecal microbial impacts from farms will need to take account of these differences.     

Risk factors for sporadic Shiga toxin-producing Escherichia coli infections in children, Argentina

We evaluated risk factors for sporadic Shiga toxin-producing Escherichia coli (STEC) infection among children in Argentina. We conducted a prospective case-control study in 2 sites and enrolled 150 case-patients and 299 controls. The median age of case-patients was 1.8 years; 58% were girls. Serotype O157:H7 was the most commonly isolated STEC. Exposures associated with infection included eating undercooked beef, living in or visiting a place with farm animals, and contact with a child <5 years of age with diarrhea. Protective factors included the respondent reporting that he or she always washed hands after handling raw beef and the child eating more than the median number of fruits and vegetables. Many STEC infections in children could be prevented by avoiding consumption of undercooked beef, limiting exposure to farm animals and their environment, not being exposed to children with diarrhea, and washing hands after handling raw beef.     

Domestic water carrying and its implications for health: a review and mixed methods pilot study in Limpopo Province,South Africa

Background  

Lack of access to safe water remains a significant risk factor for poor health in developing countries. There has been little research into the health effects of frequently carrying containers of water. The aims of this study were to better understand how domestic water carrying is performed, identify potential health risk factors and gain insight into the possible health effects of the task.     

Non-attendance in general practice: a systematic review and its implications for access to primary health care

BACKGROUND: Non-attendance in general practice has received increasing attention over the past few years. Its relationship with access to health care has been recognized and is of particular relevance in light of the access targets set out in the NHS Plan. METHODS: The literature was searched for articles relating to non-attendance. Titles and abstracts were examined, and relevant articles obtained. Bibliographies were examined for further references. Articles that described interventions for reducing non-attendance that were comparative studies and that examined general appointments, as opposed to appointments for screening purposes for example, were of particular interest. RESULTS AND CONCLUSIONS: The epidemiology of non-attendance has been well described, but there is little work on the reasons for non-attendance. Evidence for effective interventions to improve attendance in primary care is lacking, and this may prove to be an area of research interest in the future. As well as specific interventions to reduce non-attendance, new approaches to health care access are required in order to tackle this issue.     

Impact of multi-morbidity on quality of healthcare and its implications for health policy,research and clinical practice. A scoping review

Abstract

The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing healthcare systems globally. It potentially threatens the coordination, continuity and safety of care. In this paper, we report the results of a scoping review examining the impact of multi-morbidity on the quality of healthcare. We used its results as a basis for a discussion of the challenges that research in this area is currently facing. In addition, we discuss its implications for health policy and clinical practice. The review identified 37 studies focussing on multi-morbidity but using conceptually different approaches. Studies focusing on ‘comorbidity’ (i.e. the ‘index disease’ approach) suggested that quality may be enhanced in the presence of synergistic conditions, and impaired by antagonistic or neutral conditions. Studies on ‘multi-morbidity’ (i.e. multiplicity of problems) and ‘morbidity burden’ (i.e. the total severity of conditions) suggested that increasing number of conditions and severity may be associated with better quality of healthcare when measured by process or intermediate outcome indicators, but with worse quality when patient-centred measures are used. However, issues related to the conceptualization and measurement of multi-morbidity (inconsistent across studies) and of healthcare quality (restricted to evaluations for each separate condition without incorporating considerations about multi-morbidity itself and its implications for management) compromised the generalizability of these observations. Until these issues are addressed and robust evidence becomes available, clinicians should apply minimally invasive and patient-centred medicine when delivering care for clinically complex patients. Health systems should focus on enhancing primary care centred coordination and continuity of care.     

Relative Validity and Reproducibility of a Food Frequency Questionnaire for Assessing Dietary Patterns and Food Group Intake in Older New Zealand Adults: The Researching Eating,Activity, and Cognitive Health Study

BackgroundDietary pattern analysis considers the overall dietary intake and combinations of foods eaten. Valid and reproducible tools for determining dietary patterns are necessary to assess diet–disease relationships.ObjectiveThis study evaluated the relative validity and reproducibility of the Researching Eating, Activity, and Cognitive Health (REACH) Study food frequency questionnaire (FFQ) specifically designed to identify dietary patterns in older adults.DesignA subset of participants from the REACH study completed two identical 109-item FFQs 1 month apart (FFQ1 and FFQ2) to assess reproducibility and a 4-day food record between FFQ administrations to assess relative validity. Foods from each dietary assessment tool were assigned to 57 food groups. Principal component analysis was applied to the food group consumption reported in each dietary assessment tool to derive dietary patterns.Participants and settingDietary data were collected (2018 and 2019) from a subset of the REACH study (n = 294, 37% men) aged 65 to 74 years, living in Auckland, New Zealand.Main outcome measuresDaily intakes of 57 food groups and dietary patterns of older adults participating in REACH living in New Zealand.Statistical analysisAgreement of dietary pattern loadings were assessed using Tucker’s congruence coefficient. Agreement of dietary pattern scores and food group intakes were assessed using Spearman correlation coefficients (acceptable correlation rho = 0.20 to 0.49), weighted kappa statistic (acceptable statistic κ_w = 0.20 to 0.60), and Bland-Altman analysis, including mean difference, limits of agreement, plots, and slope of bias.ResultsThree similar dietary patterns were identified from each dietary assessment tool: Mediterranean style, Western, and prudent. Congruence coefficients between factor loadings ranged from 0.54 to 0.80. Correlations of dietary pattern scores ranged from 0.47 to 0.59 (reproducibility) and 0.33 to 0.43 (validity) (all P values < 0.001); weighted kappa scores from 0.40 to 0.48 (reproducibility) and 0.27 to 0.37 (validity); limits of agreement from ± 1.79 to ± 2.09 (reproducibility) and ± 2.09 to ± 2.27 (validity); a negative slope of bias was seen in the prudent pattern for reproducibility and validity (P < 0.001).ConclusionsThe REACH FFQ generated dietary patterns with acceptable reproducibility and relative validity and therefore can be used to examine associations between dietary patterns and health outcomes in older New Zealand adults.     

Burden of disease from inadequate water,sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries

BackgroundTo develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and middle-income countries.MethodsFor each of the analysed diseases, exposure levels with both sufficient global exposure data for 2016 and a matching exposure-response relationship were combined into population-attributable fractions. Attributable deaths and disability-adjusted life years (DALYs) were estimated for each disease and, for most of the diseases, by country, age and sex group separately for inadequate water, sanitation and hygiene behaviours and for the cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks.FindingsAn estimated 829,000 WASH-attributable deaths and 49.8 million DALYs occurred from diarrhoeal diseases in 2016, equivalent to 60% of all diarrhoeal deaths. In children under 5 years, 297,000 WASH-attributable diarrhoea deaths occurred, representing 5.3% of all deaths in this age group. If the global disease burden from different diseases and several counterfactual exposure distributions was combined it would amount to 1.6 million deaths, representing 2.8% of all deaths, and 104.6 million DALYs in 2016.ConclusionsDespite recent declines in attributable mortality, inadequate WASH remains an important determinant of global disease burden, especially among young children. These estimates contribute to global monitoring such as for the Sustainable Development Goal indicator on mortality from inadequate WASH.