Contaminated drinking water alerts cause up to 10% school absence rates in Jackson, Mississippi

A Brown-led research team compared boil water alerts and unexcused absence rates in Jackson’s public schools to show the wide-ranging negative effects of water contamination on children’s health.

Peer-Reviewed Publication

BROWN UNIVERSITY

PROVIDENCE, R.I. [Brown University] — When a team led by researchers from Brown University’s School of Public Health tried to gather data about the health effects of the longstanding water contamination crisis in Jackson, Mississippi, little was available, even on the toxicity of the water supply.

So they turned to two sources that were accessible — school attendance records and public safety alerts that advised residents to boil water before use.

Now, the team’s analysis of this information in a study published in Nature Water shows how boil water alerts significantly disrupted student learning: Each time an alert was issued, unexcused absence rates in Jackson’s public schools increased between 1% and 10%.

Chronic school absenteeism impacts not only a child’s academic record, but also their health and well-being, said lead author Erica Walker, an assistant professor of epidemiology at Brown. Research shows that chronic absenteeism is associated with increased likelihood of poverty and decreases in mental and physical health. 

“We’re talking about much larger repercussions than gastrointestinal illness from drinking unsafe water,” Walker said. “These findings show how chronic exposure to contaminated water over time can negatively affect the trajectory of a child’s life.”

The water crisis in Jackson has made global headlines as a major environmental catastrophe, impacting the health and well-being of residents. The researchers focused on the city’s most vulnerable population: its children.

To conduct the study, the team used data on boil water alerts issued by the City of Jackson’s Water and Sewer Business Administration Office between 2015 and 2021, daily school attendance data from Jackson’s Public School District and demographic data from the U.S. Census Bureau’s American Community Survey.

The data showed that each time a boil water alert was issued, unexcused absence rates increased by 1 to 10%.

They also showed decreases in unexcused absences in schools where much of the student body receives free and reduced lunches — likely, Walker said, because the water contamination disrupts at-home meal preparation, so families may instead count on schools to safely provide lunch for children that day.

As the director of the Community Noise Lab at Brown, Walker originally wanted to study the effects of noise pollution on public health in Jackson. However, when the community made clear that the water contamination was a more pressing concern, Walker shifted focus.

She organized a team, which included graduate students from Brown, to set up mobile laboratories across the city to test tap water quality — work that remains ongoing. Separately, Walker partnered with researchers from the University of Mississippi, Massachusetts Institute of Technology, Boston University and Salem State University to learn more about the effects of contaminated water on community health. They recognized that the ubiquity of boil water alerts would make them an accessible metric that would be understandable to the public.

In the study, the researchers concluded that their analysis highlights the urgency of addressing the root causes of the poor water quality in Jackson. They provide suggestions for how municipalities can more effectively spread the word about contaminated water, including social media posts, voicemails or conducting door-to-door outreach when resources enable it. They also suggested that the Mississippi Department of Health publish a sample press release for local water systems that includes information about the cause of the boil water alert, the population and public schools impacted, and what precautions to take.

The team said the findings could benefit other cities struggling with poor water infrastructure and shed light on the many issues directly and indirectly caused by boil water alerts. Team members from MIT created a data visualization to engage the community both within Jackson and across the world about the research findings.

A personal connection to a community project

This issue is personal for Walker, who grew up in Jackson. She said she does not remember hearing about boil water alerts when she was a child. Yet in 2020 alone, Walker said, the City of Jackson issued approximately 500 boil water advisories because of unsafe drinking water. These interruptions ranged from a few hours to weeks long.

In a commentary for Nature Water that accompanied the study, Walker imagined what it would be like to live with the water crisis in Jackson.

“When a boil water advisory is issued, families with school-aged children living in the impacted communities must boil their water before any consumption, making necessary school preparation chores that we normally take for granted like brushing teeth, taking medications, and preparing meals difficult, if not impossible,” Walker wrote.

Walker’s essay explored her nostalgia for the Jackson of her youth, and her feelings of survivor’s guilt. She wrote, “Would I be who I am now if I lived in the Jackson that exists today?”

Walker said that the team helped train community members as well as students at the Piney Woods School, a historically Black co-educational private boarding school in Mississippi, how to test water for contaminants. As next steps, the team hopes to use the information from the mobile testing labs to examine the biological effects of contaminated water. They created an activity book for children and adults to explain the current water situation in Jackson and how drinking water comes from its source — “so that the next time people get a boil water notice, they’ll have a better understanding of what it means and how it affects them,” Walker said.

“Hopefully,” she said, “this community research partnership will lead to education, empowerment and advocacy around the issue of contaminated water and how it impacts public health.”

The research was supported in part by the Robert Wood Johnson Foundation and the Carl Kawaja and Wendy Holcombe Endowed Fund.

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JOURNAL

Nature Water

DOI

10.1038/s44221-023-00062-z 

METHOD OF RESEARCH

Meta-analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Boil water alerts and their impact on the unexcused absence rate in public schools in Jackson, Mississippi.

Diphtheria outbreak – updates from Europe, UK, Germany, Austria

Reports and Proceedings

EUROPEAN SOCIETY OF CLINICAL MICROBIOLOGY AND INFECTIOUS DISEASES

**Note: the release below from the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2023, Copenhagen, 15-18 April). Please credit the conference if you use this story**

Various European countries experienced outbreaks of diphtheria mostly linked to incoming migrants.

Europe 

Dr Helena Seth-Smith (University of Zurich), Dr Sylvain Brisse (Institut Pasteur - Paris (France) and collaborators from across Europe including the European Centres for Disease Control and Prevention (ECDC) assessed cases of diphtheria in migrants that had arrived in 10 European countriesSwitzerland (52 cases), Germany (118), UK (59), Austria (69), France (30), Belgium (21), Norway (8), The Netherlands (5), Italy (3), and Spain (1).

For their short report, click here

Dr Helena Seth-Smith, University of Zurich, Swtizerland. E) hsethsmith@imm.uzh.ch

Dr Sylvain Brisse, Institut Pasteur, Paris, France. T) +33 6 77 94 65 34

E) sylvain.brisse@pasteur.fr

This press release is based on abstract 2670 at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) annual meeting. The material has been peer reviewed by the congress selection committee.  The research has been not yet been submitted to a medical journal for publication.

For full poster, click here

UK

Linked to an increase in migrant arrivals via small boat in the Summer of 2022, the UK experienced a sharp increase in diphtheria cases caused by toxigenic Corynebacterium diphtheriae last year, recording 73 when the annual average for previous years (including cases due to toxigenic C. ulcerans) was 12 cases. A further single case has been recorded in 2023.

The UK Health Security Agency (UKHSA) has two abstracts and posters containing all the relevant information about the outbreak (see links below) Steps taken by UK health authorities included recommending mass administration of antibiotic prophylaxis and vaccination in initial reception centres and other accommodation settings for recent arrivals. UKHSA preliminary data as of 18 January 2023 estimates approximately 40% and 88% of eligible arrivals received prophylactic antibiotics and vaccination, respectively, since implementation.

For further information on diphtheria in the UK, please contact the UKHSA Press Office. T) +44 20 7654 8400 E) ukhsa-pressoffice@ukhsa.gov.uk 

Alternative contact Tony Kirby in the ECCMID Media Centre. T) +44 7834 385827 E) tony.kirby@tonykirby.com

This press release is based on abstract 5308 and late breaker abstract LB103 at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) annual meeting. The material has been peer reviewed by the congress selection committee.  The research has been not yet been submitted to a medical journal for publication.

For full 5308 abstract click here, for full poster click here

For full LB103 abstract click here, for full poster click here

Twitter (for when embargo lifts): @escmid #ECCMID2023

Germany

In Germany, experts are continuing to track an outbreak of imported diphtheria that began in Summer 2022, and as of March 2023 affected 169 migrants that had arrived in Germany, mostly from Afghanistan and Syria. This is despite the fact that diphtheria incidence and vaccination coverage in Afghanistan and Syria has remained mostly unchanged over the last few years

Whole genome sequencing and phylogenetic analysis at the National Consiliary Laboratory for Diphtheria (Oberschleissheim, Germany) and migration route analysis at the Robert Koch Institute, Berlin, Germany, suggests that migrants affected had acquired toxigenic Corynebacterium diphtheriae neither in their home country nor in Germany, but in between while migrating – mainly along the Balkan route which includes, among other countries, Albania, Bosnia and Herzegovina, Bulgaria, Croatia, North Macedonia, Romania, Serbia, and Slovenia.

Franziska Badenschier, based at the Department for Infectious Disease Epidemiology at the Robert Koch Institute, and her colleagues were able to detect this outbreak within six weeks of the first cases being reported. It then became clear that this outbreak in Germany was part of an international outbreak in Europe.

Badenschier also explains that some cases were initially thought to be mpox, until testing dismissed this and confirmed the cases as diphtheria. She and her colleagues conclude that, for better and more timely diagnosis of diphtheria, clinicians, microbiologists, and institutions working with migrants shall raise awareness and intensify sample collection from wounds with subsequent laboratory diagnostics.

Since the outbreak is ongoing and the sources of it have not been identified yet, Badenschier and her co-authors suggest active case finding and outbreak detection in countries along the Balkan route.

Franziska Badenschier, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. T) +49 (0)30 18754-2069 E) badenschierf@rki.de

This press release is based on late breaker abstract LB096 at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) annual meeting. The material has been peer reviewed by the congress selection committee.  The research has been not yet been submitted to a medical journal for publication.

 For full poster, click here

Austria

 

Population study shows one third of people not adequately protected against diphtheria

Tests on blood samples of some 16,000 people in Austria show one third of the population have insufficient immunity against diphtheria. The research is presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2023, Copenhagen, 15-18 April) and is by Prof Ursula Wiedermann-Schmidt and Angelika Wagner, Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Australia, and colleagues. 

Various European countries, including the UK, Germany and Austria, reported an unusual increase in diphtheria cases in 2022, with around 80% of these cases in migrants arriving in those countries from countries such as Syria and Afghanistan.  Austria reported 62 cases of diphtheria in 2022. The authors, concerned about possible onward transmission of this disease among the general population, aimed to estimate the level of immunity (seroprotection) against diphtheria among people living in Austria.

The authors analysed antibody concentrations against diphtheria toxoid from all individuals requesting voluntary antibody testing at the Austrian reference laboratory at the Institute of Specific Prophylaxis and Tropical Medicine (ISPTM) at the Medical University of Vienna between March 1, 2010 and January 31, 2022.  Individuals requesting such testing are usually doing so to check their immunity to see if they need a booster to maintain protection. 

In total, the authors included diphtheria-toxoid (DT) specific antibody concentration results from 15 852 individuals and of those 12 539 individuals also requested determination of tetanus-toxoid (TT) specific antibodies. Individuals requesting antibody testing were mainly located in the eastern Austrian provinces (Table 1), with around half the total participants coming from the Vienna Province. Antibody concentrations of under 0.01 IU/mL were considered as non-protective; between 0.01 and 0.1 IU/mL as inadequately protective and 0.1 IU/mL and above as adequately protective.

When looked at as three distinct age groups, the results showed individuals aged 60 years and over had the lowest antibody concentrations compared to those under 15 years and those between 15 and 60 years (Figure 2). Those aged under 15 years also had lower protection when compared with those aged 15-60 years. Participants aged above 60 years had the highest proportion of non-protected (4.8%) and insufficiently protected individuals (40.7%) (Figure 3).

Overall, 33% of individuals lacked seroprotection against diphtheria (Figure 3, Table 3). When stratified further according to age (0-6 years 6-15 years, 15-25, 25-35, 35-45, 45-55, 55-65, 65-75, and above 75 years) and sex, the data showed those aged 6-15 years and age groups 55 years and over as having the lowest protection.

Regarding tetanus antibody levels, young individuals had lowest median tetanus antibody concentrations (compared to 15-60 years old and 60 years and over). Interestingly, tetanus levels did not differ between the 15-60 years group and those over 60 years old.

The authors conclude: “Our data show insufficient seroprotection against diphtheria in all age groups, while seroprotection rate against tetanus is higher throughout all age groups. Thus, awareness for regular booster vaccination with combination vaccines (including diphtheria, tetanus and whooping cough) needs to be urgently increased as recommended every 10 years (5 years in those aged over 60 years), according to the Austrian National Immunization Plan. The fact that tetanus antibody levels and seroprotection are generally higher and longer lasting, illustrates the necessity to reintroduce of monovalent diphtheria vaccines for diphtheria catch-up vaccination. In addition, the use of higher diphtheria vaccine doses - as used for primary immunisation – for adult booster vaccinations, might be an option to close gaps in diphtheria seroprotection.”

Prof Ursula Wiedermann-Schmidt, Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria.  T) +43 1 40160 38290 E) ursula.wiedermann-schmidt@meduniwien.ac.at

Angelika Wagner, Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria. Please email to arrange interview. E)

This press release is based on abstract 6915 (Late breaker LB119) at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) annual meeting. The material has been peer reviewed by the congress selection committee.  The research has been not yet been submitted to a medical journal for publication.

For full abstract click here

For full poster click here

 

First-in-Canada clinical RNA sequencing platform may improve rare disease diagnostics in pediatrics

A clinical RNA sequencing platform at SickKids, the first of its kind in Canada, offers insights into complex genetic conditions and the future of precision diagnostics

Peer-Reviewed Publication

THE HOSPITAL FOR SICK CHILDREN

 

IMAGE: DR. KYOKO YUKI AND DR. LIANNA KYRIAKOPOULOU ARE MOVING THE NEEDLE ON PRECISION DIAGNOSTICS FOR RARE DISEASES THROUGH A NEW CLINICAL RNA SEQUENCING PLATFORM AT SICKKIDS. view more 

CREDIT: THE HOSPITAL FOR SICK CHILDREN (SICKKIDS)

A new clinical RNA sequencing platform at The Hospital for Sick Children (SickKids) is helping to facilitate research into rare genetic conditions and carve a path for Precision Child Health, a movement at SickKids to deliver individualized care for every patient.

RNA sequencing provides a different way of looking at the genes, by looking at how the body interprets the genetic code rather than looking directly at the genetic code itself. While DNA-based tests like genome sequencing take a picture of a person’s genetic code, scientists can better understand how the DNA is being read by also looking at RNA, which carries instructions for making proteins in our body.

Across the SickKids Research Institute, scientists have been working closely together over the last six years to build and incorporate RNA sequencing into the research pipeline. Now, championed by Dr. Lianna Kyriakopoulou, a Clinical Laboratory Director in the Division of Genome Diagnostics, and Laboratory Specialist Dr. Kyoko Yuki, this technology is, for the first time in Canada, validated to be used in the clinical space as a new tool for precision diagnostics.

“The clinical RNA sequencing platform at SickKids is helping to move the needle in achieving a diagnosis for patients with rare genetic conditions through patient-centred care, or what SickKids calls Precision Child Health,” says Dr. Lianna Kyriakopoulou. “Used together, genome sequencing and RNA sequencing can potentially further inform which findings are relevant to help guide clinical decision-making.”

Combined DNA and RNA sequencing offers improved diagnostic information for complex genetic conditions

Using this clinical RNA sequencing platform, a team of SickKids researchers, in collaboration with Dr. Panagiota Klentrou at Brock University, performed genome sequencing and RNA sequencing on 97 individuals from 39 different families in the Complex Care Program, a clinical program focused on diagnosis and care of children with unexplained medical complexity.

In a study published in the American Journal of Human Genetics, the RNA analysis provided useful diagnostic information for an additional eight per cent of the patients whose diagnosis was not confirmed using genome sequencing alone, either confirming or ruling out the impact of a DNA variant identified during genome sequencing.

“Our findings demonstrate a clear benefit to pairing RNA sequencing with genome sequencing in a cohort of children who are suspected to have a genetic diagnosis,” explains co-first author Dr. Ashish Deshwar, a resident physician in Medical Genetics & Genomics.  

This study is also one of the first to examine the utility of a trio-approach to RNA sequencing, a process which involves conducting RNA sequencing on the affected individual and both parents. While trio RNA sequencing with this population did not uncover any new genetic variants, it decreased the amount of time researchers needed to spend reviewing results and made the analysis more efficient.

Deshwar, alongside other first-authors Yuki and Dr. Huayun Hou, a Bioinformatician in the Wilson Lab, also noticed inherited RNA patterns between family members and are optimistic about its potential use in further research. 

“We hope that the results of our study will help support the inclusion of clinical based RNA-testing in diagnostic workflows for children with rare conditions,” say co-leads and physician-scientists Drs. Gregory Costain and Jim Dowling, Scientist-Track Investigator and Senior Scientist (respectively) in the Genetics & Genome Biology program.  

RNA sequencing platform sparks new research into genetic conditions

The study is just one of the many research programs harnessing RNA sequencing at SickKids.  

At The Centre for Applied Genomics (TCAG) in the SickKids Research Institute, automated screening platforms are also available to researchers thanks to a collaborative effort including the Wilson Lab, Dowling Lab, Costain Lab, Shlien Lab, Brudno Lab, and others as well as the equipment and expertise at The Centre for Computational Medicine (CCM).

Current research already underway includes the study of allergic responses with Dr. Thomas Eiwegger and blood samples from individuals with lupus with Dr. Linda Hiraki.

Bridging clinical and research for the future of Precision Child Health

As more research is done into the benefits of RNA sequencing, scientists and clinicians are excited to better define the scenarios where clinical RNA sequencing can provide real insights for patients with rare genetic conditions, as well as other patient groups. This will be essential to providing the evidence needed to inform decisions about making RNA sequencing more broadly available for precision diagnostics.

“We have built a strong bridge between the research and clinical labs at SickKids which will benefit ongoing and future studies contributing to precision medicine becoming standard of care, as well as patients throughout the hospital,” says Dr. Michael Wilson, a Senior Scientist in the Genetics & Genome Biology program, who previously held a Canada Research Chair in Comparative Genomics. “By carefully sequencing and analysing RNA from diverse populations of sick and healthy children we have the potential to improve how we find diagnoses for patients with rare genetic conditions.” 

This research was funded by Genome Canada, SickKids Centre for Genetic Medicine, SickKids Research Institute and the University of Toronto McLaughlin Centre. Additional funding for the development of the RNA sequencing platform was provided by SickKids Innovators Fund.

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JOURNAL

American Journal of Human Genetics

DOI

10.1016/j.ajhg.2023.03.006 

ARTICLE TITLE

Trio RNA sequencing in a cohort of medically complex children

ARTICLE PUBLICATION DATE

Shift to ‘flash droughts’ as climate warms

Peer-Reviewed Publication

UNIVERSITY OF SOUTHAMPTON

Thursday, 13 April 2023

‘Flash droughts’ have become more frequent due to human-caused climate change and this trend is predicted to accelerate in a warmer future, according to research published today [13 April 2023] involving the University of Southampton.

The research published in Science shows that flash droughts, which start and develop rapidly, are becoming ‘the new normal’ for droughts, making forecasting and preparing for their impact more difficult.

Flash droughts can develop into severe droughts within a few weeks. They are caused by low precipitation and high evapotranspiration, which quickly depletes the soil of water. While they start quickly, the droughts can last for months, damaging vegetation and ecosystems, and triggering heat waves and wildfires.

A multinational group of researchers wanted to understand if there had been a transition from conventional ‘slow’ droughts to flash droughts and how this trend will develop under different carbon emission scenarios.

“Climate change has effectively sped up the onset of droughts,” says Professor Justin Sheffield, Professor of Hydrology and Remote Sensing at the University of Southampton and co-author of the paper.

“While it varies between different regions, there has been a global shift towards more frequent flash droughts during the past 64 years.”

The transition to flash droughts is most notable over East and North Asia, Europe, the Sahara, and the west coast of South America. Some areas, such as eastern North America, Southeast Asia and North Australia, saw fewer flash and slow droughts, but the speed of drought onset had increased. In the Amazon and West Africa, there was no evidence of a transition to flash droughts; the Amazon saw an increase in slow droughts and West Africa saw an increase in the frequency and extremity of both fast and slow droughts.

Professor Justin Sheffield added: “As we head towards a warmer future, flash droughts are becoming the new normal. Our models show that higher-emission scenarios would lead to a greater risk of flash droughts with quicker onset which pose a major challenge for climate adaptation.”

The transition to flash droughts may have irreversible impacts on ecosystems as they may not have enough time to adapt to a sudden lack of water and extreme heat. Forecasting flash droughts is also difficult as current approaches to predicting droughts use longer time scales.

The researchers say new approaches are needed to provide early warnings of flash droughts, as well as a better understanding of how natural ecosystems and humans will be impacted.

A global transition to flash droughts under climate change is published in Science.

Funding for the research was provided by the National Natural Science Foundation of China, the National Key R&D Program of China, the Natural Science Foundation of Jiangsu Province for Distinguished Young Scholars, and the UK-China Research & Innovation Partnership Fund through the Met Office Climate Science for Service Partnership (CSSP) China as part of the Newton Fund.

ENDS

Notes for Editors

1. A global transition to flash droughts under climate change will be published by Science in print on Friday, 14 April 2023 and online at 19:00 (7:00 pm) BST on Thursday, 13 April 2023. More information, including a copy of the paper, can be found online at the Science press package at https://www.eurekalert.org/press/scipak/
2. For further information and interviews with Professor Justin Sheffield, Professor of Hydrology and Remote Sensing at the University of Southampton, please contact: Steve Williams, Media Relations, University of Southampton. press@soton.ac.uk 023 8059 3212.
3. The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top 100 institutions globally (QS World University Rankings 2023). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 22,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 200,000 alumni. www.southampton.ac.uk
    

www.southampton.ac.uk/news/contact-press-team.page

Follow us on twitter: http://twitter.com/unisouthampton

Like us on Facebook: www.facebook.com/unisouthampton

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JOURNAL

Science

DOI

10.1126/science.abn6301 

ARTICLE TITLE

A global transition to flash droughts under climate change

ARTICLE PUBLICATION DATE

14-Apr-2023

Free trade deal is a major threat to UK public health, warn experts

New deal will make it harder for the UK to regulate tobacco and alcohol or ban products like those containing harmful pesticides

Peer-Reviewed Publication

BMJ

The UK’s decision to join one of the world’s largest free trade agreements, known as the Comprehensive and Progressive Agreement on Trans-Pacific Partnership (CPTPP), poses a major threat to UK public health, warn experts in The BMJ today.

In acceding to the CPTPP, the government hopes to boost trade, improve economic growth, and strengthen the UK’s strategic position as a global rule setter. 

But Courtney McNamara and colleagues argue that free trade deals have serious and wide ranging implications for public health and policy making, as they commit countries to certain regulatory and legal obligations. 

As such, they call on the government to commission a health impact assessment before signing takes place later in 2023 to evaluate the potential benefits and harms of this deal.

The CPTPP poses several threats to public health in the UK, they explain. For example, it is likely to make it more difficult to enact policies to cut consumption of tobacco, alcohol, and unhealthy food and drinks through clauses that allow foreign corporations to contest any such regulations.

It also contains provisions that effectively rule out a precautionary approach to food safety, meaning that bans on products like those containing harmful pesticides can be challenged.

And while some workers might benefit from a boost in exports and demand, which might increase wages, they argue that those working in industries that are undercut by cheaper imports and unable to compete are likely to experience economic insecurity and potentially job losses, which carry huge consequences for health.

The UK government has said the agreement will not mean lower health or food standards in the UK, and the authors acknowledge that the gross domestic product (GDP) boosting consequences of a free trade agreement could conceivably have positive health effects.

Based on the UK government’s own calculations, however, they point out that the economic case for joining the CPTPP “amounts to no more than a 0.08% increase in the country’s GDP over a 15 year period.”

More problematically, the government’s calculations fail to account for the implementation costs of joining the agreement, they add. “To our knowledge, no national evaluation has been done to account for implementation costs with respect to changes in regulatory and dispute settlement rules.”

“If a priority of the government is to do no harm, a commitment made explicit during Brexit negotiations, then it should take account of the health implications of its trade policies,” they write.

“Even if it is unlikely that, given the government’s poor track record on public health, the findings would influence its decision to sign, evidence produced by the assessment will still be extremely valuable by pointing to populations at risk and communities whose health might be safeguarded during the agreement’s implementation,” they add.

If the government fails to undertake a health impact assessment, it will fall to public health scholars, professionals, and advocates to mobilise and act to undertake this important work, they conclude.

[Ends] 

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JOURNAL

The BMJ

DOI

10.1136/bmj-2022-073302 

METHOD OF RESEARCH

Content analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The CPTPP trade deal is a major threat to public health and warrants a health impact assessment

ARTICLE PUBLICATION DATE

12-Apr-2023

The hidden culprit behind nitrogen dioxide emissions

Peer-Reviewed Publication

POHANG UNIVERSITY OF SCIENCE & TECHNOLOGY (POSTECH)

 

IMAGE: RESEARCH IMAGE view more 

CREDIT: POSTECH

Nitrogen dioxide is one of the criteria air pollutants that plays an important role as a precursor gas of fine particulate matter and ozone. NO2 emissions are known to be primarily generated by industrial facilities or vehicle exhausts. Recently, a research team from POSTECH analyzed satellite remote sensing data from the European Space Agency (ESA) and released results showing that food processing facilities and high-rise apartments that are 10 stories or higher are significant sources of NO2 emissions. Their findings have drawn attention from NASA.

 

A POSTECH research team led by Professor Hyung Joo Lee used the TROPOspheric Monitoring Instrument (TROPOMI), an instrument on an Earth observation satellite that can monitor atmospheric composition, to analyze NO2 emissions from various types of properties in California. Their analysis suggests that NO2 emissions were highest at food processing facilities and residential complexes with high population density.   

 

The team estimated average NO2 concentrations at the spatial resolution of 500 m in California between 2018 and 2019 and assessed whether NO2 concentrations measured at ground monitors were representative of population exposures to NO2 in each county. They also evaluated which property types showed the highest NO2 emissions and therefore exposures. Their assessment revealed that the highest NO2 exposures were attributed to food processing facilities and high-rise apartments that are 10 stories or higher. The same results were obtained when traffic was taken into consideration.

 

Such high residential emissions are presumed to be attributed to combustion sources within the apartments, such as water boilers, space heaters, and other indoor-generated emissions vented outdoors. Residential combustion sources have not been considered significant sources of air pollution in previous research.

 

POSTECH Professor Hyung Joo Lee explained, “Highly populated residential areas, specifically high-rise apartments, have not been extensively studied. However, the research indicates that these areas should be regarded as crucial contributors to NO2 emissions in the formulation of environmental policies.”

 

He emphasized the significance of the research by stating, “The research demonstrates that satellite remote sensing can be effectively used to inform air quality management.”

 

The research was published in Science of the Total Environment, one of the most prestigious environmental journals, and was introduced in NASA Earth Observatory.

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JOURNAL

Science of The Total Environment

DOI

10.1016/j.scitotenv.2022.159342 

ARTICLE TITLE

Neighborhood-scale ambient NO2 concentrations using TROPOMI NO2 data: Applications for spatially comprehensive exposure assessment

Female healthworkers need better radiation protection to minimise breast cancer risk

Standard PPE does not fully protect breast tissue; Employers should invest in equipment that ensures the safety of all their staff

Peer-Reviewed Publication

BMJ

Women working in healthcare who are regularly exposed to radiation from x-rays and other imaging procedures need better ionising radiation protection to help minimise their risk of developing breast cancer, argue doctors in The BMJ today.

Ionising radiation is a known human carcinogen and breast tissue is highly radiation sensitive. As such, there are concerns that regular exposure to ionising radiation during image guided procedures may be linked to a higher risk of breast cancer in female healthcare workers.

Personal protective equipment (PPE) such as lead gowns are used to shield the body from harmful radiation during these procedures. But studies have shown that current radiation PPE provides inadequate protection to breast tissue as it leaves the area close to the armpit (known as the upper outer quadrant and axilla - the most common site of breast cancer) exposed.

“Providing adequate breast covering PPE could therefore reduce radiation exposure and potentially help prevent breast cancer in female healthcare workers,” write Isobel Pilkington and colleagues. 

They acknowledge that measuring the risk of occupational radiation induced breast cancer in women working in healthcare is challenging, but as the number of female trainees entering these specialties increases, they say “it is essential that the available evidence is considered and equipment provision improved to minimise this risk.”

They point to observational evidence suggesting an increase in breast cancer risk among female US orthopaedic surgeons compared with an age matched female population, and to a small Finnish study showing breast cancer at 1.7 times the expected rate in radiologists, surgeons, and cardiologists compared with female physicians not working with radiation.

In a study using artificial female torsos to measure radiation exposure, researchers found inadequate upper outer quadrant protection and no statistically significant reduction in dose when standard PPE was compared with a torso without PPE.

Occupational radiation exposure has not been identified as a risk factor for male breast cancer. However, the Ionising Radiation Regulations 2017 state that the radiation dose delivered to all workers should be As Low As Reasonably Achievable (ALARA). The most effective way to achieve this, say the authors, is by reducing the duration of exposure, increasing the distance from the source, and shielding all workers with effective PPE.

They point to additional protection, such as capped sleeves and axillary wings, that can be worn under standard gowns to protect the upper outer quadrant of the breast, and say the European Society for Vascular Surgery 2023 Clinical Practice Guidelines on Radiation Safety have already recommended female operators consider adopting this extra protection. 

“Providing appropriate protection is a legal requirement of an employer, who has a duty of care to all workers exposed to radiation,” they write. “The female breast appears to be particularly vulnerable and it is therefore important employers invest in protective equipment that enhances the safety of all their staff.”

[Ends]

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JOURNAL

The BMJ

DOI

10.1136/bmj-2023-075406 

METHOD OF RESEARCH

Commentary/editorial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Protecting female healthworkers from ionising radiation at work

ARTICLE PUBLICATION DATE

12-Apr-2023

New study demonstrates hospital safety climate and organizational characteristics predict healthcare-associated infections and occupational health outcomes

Findings provide first published evidence of relationship between standard precaution adherence and safety of both healthcare workers and patients

Peer-Reviewed Publication

ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL

Arlington, Va., April 13, 2023 – New data published today in the American Journal of Infection Control (AJIC) provide the first published evidence that a positive safety climate and adherence to standard precautions predict key healthcare-associated infection (HAI) and occupational health outcomes among patients and health care workers, respectively. The findings highlight features within hospitals’ organizations and safety climates that could be modified to improve these outcomes.

“Despite the infection prevention and safety benefits associated with standard precautions, generating consistent adherence in the healthcare setting has been notoriously challenging, for reasons that are not completely clear,” said Amanda J. Hessels, PhD, MPH, RN, Assistant Professor, Columbia University School of Nursing and Nurse Scientist at Hackensack Meridian Health and the lead author on the published study. “To our knowledge, our study findings are the first to demonstrate an association between adherence, hospitals’ patient-safety climates, and outcomes, and should help to advance the state of the science in patient and occupational health and safety.”

Annually approximately 385,000 sharps injuries occur among America’s 5.6 million healthcare workers, and approximately 2 million hospitalized patients acquire one or more HAIs after receiving healthcare.  Standard precautions such as hand hygiene, use of appropriate personal protective equipment (PPE), and safe use and disposal of sharps, are federally regulated sets of actions designed to limit the risk of blood-borne and other infections among healthcare workers and prevent patient HAIs. Research shows that adherence to standard precautions happens less than 50% of the time.

Dr. Hessels and colleagues created a novel study to determine the relationships among patient safety climate, self-reported or observed standard precaution adherence, and HAIs or healthcare worker sharps and splash exposures.

The researchers surveyed 452 U.S.-based registered nurses about their hospital units’ patient safety climates, collected observational adherence data on 5,285 standard precautions using a standardized tool, and obtained corresponding unit-level data on patient HAIs and healthcare worker sharp and splash exposure data.

Results show:

• Overall adherence to all categories of standard precautions was 64.4%, with significant differences by provider role.
• Overall adherence was highest among nurses (69.1%), followed by other providers (62.1%) and physicians (58%).
• There is a positive correlation (p < 0.1) between patient safety climate in aggregate and reported standard precaution adherence.
• There is an additional, positive correlation between positive perceptions of a work environment that is conducive to standard precautions and reported adherence (p < 0.1).

Additionally, researchers found that a group of variables comprising observed standard precaution adherence, overall patient safety climate, and multiple potential confounders – including hospital Magnet status, level of nurse staffing, hospital ownership, and teaching status -- reliably predicted:

• The rates of catheter-associated urinary tract infections (CAUTI; p = 0.2) and methicillin-resistant Staphylococcus aureus (MRSA; p = 0.3) among patients.

• Nurse mucotaneous exposures (p = 0.004), all staff mucotaneous exposures (p = 0.007), and all staff sharps and needle injuries (p = .001).

Finally, researchers concluded that these variables also explained the sizeable variance in MRSA (41%), CAUTI (23%), mucotaneous exposures (43%), and needlestick and sharps injuries (38%) among those units that reported positive patient safety climates and reliable adherence to standard precautions vs. those that did not.

“Keeping our healthcare workforce and patients safe is our number one priority as healthcare professionals,” said Patricia Jackson, RN, MA, CIC, FAPIC, 2023 APIC president. “The findings from this study provide important insights into the factors that impact HAIs and occupational injuries and will help infection preventionists design focused strategies for improvement.”

About APIC

Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.

 

About AJIC

As the official peer-reviewed journal of APIC, The American Journal of Infection Control (AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at ajicjournal.org.

NOTE FOR EDITORS

“Impact of patient safety climate on infection prevention practices and healthcare worker and patient outcomes,” by Amanda J. Hessels, Jingwen Guo, Cara T. Johnson, and Elaine Larson, was published online in AJIC on April 13, 2023. The article may be found at: https://doi.org/10.1016/j.ajic.2023.01.021

AUTHORS

Amanda J. Hessels, PhD, MPH, RN, CIC, CPHQ, FAPIC, FAAN (corresponding author: ah3269@cumc.columbia.edu; amanda.hessels@hmhn.org), Columbia University School of Nursing, New York, New York, USA; Hackensack Meridian Health, Ann May Center, Neptune, NJ

Jingwen Guo, MS

Columbia University Data Science Institute, New York, New York, USA

Cara T. Johnson, RN, MPH

Columbia University School of Nursing, New York, New York, USA

Elaine Larson, RN, PhD, FAAN, CIC

Columbia University School of Nursing, New York, New York, USA

 

Acknowledgments: This project was supported by the Research Scientist Development Award Agreement Number, 1K01OH011186, funded by the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Its contents are solely the responsibility

of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.               

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JOURNAL

American Journal of Infection Control

DOI

10.1016/j.ajic.2023.01.021 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Impact of patient safety climate on infection prevention practices and healthcare worker and patient outcomes

ARTICLE PUBLICATION DATE

13-Apr-2023