Corticosteroids for COVID-19 patients requiring oxygen support? Yes, but not for everyone: Effect of corticosteroids on mortality and intensive care unit admission in patients with COVID-19 according to patients' oxygen requirements.

Corticosteroids reduce mortality in hospitalized patients with coronavirus disease 2019 (COVID-19), but the response seems to vary according to the level of respiratory support needed. This retrospective cohort study included COVID-19 patients with oxygen saturation (SatO2 ) in room air <92% admitted between March 3 and April 30, 2020. Following the interim protocol, patients could receive dexamethasone or methylprednisolone, and were classified according to oxygen requirements. The primary endpoint was admission to the intensive care unit (ICU) or mortality. Kaplan-Meier and Cox hazards analyses were used. Of the 115 patients included, 38 received corticosteroids. Among requiring high-flow, noninvasive ventilation (NIV) or fraction of inspired oxygen (FiO2 ) > 0.40, the hazard ratio (HR) for death or ICU admission, between the corticosteroids and non-corticosteroids group, was 0.07 (95% CI 0.01-0.4), p = .002, and for patients requiring low-flow oxygen, the HR was 0.70 (95% CI 0.13-3.8), p = .68. Significant differences were also observed when all patients were analyzed together. A significant reduction in mortality and ICU admission frequency was observed among patients requiring high-flow oxygen or NIV, but not among those requiring low-flow oxygen. Better targeting of COVID-19 patients is needed for the beneficial use of corticosteroids.

Is flooding considered a threat in the degraded tropical peatlands?

Tropical peatland degradation due to oil palm plantation development has reduced peat's ability to naturally regulate floods. In turn, more severe and frequent flooding on peatlands could seriously impair plantation productivity. Understanding the roles of peatland ecosystems in regulating floods has become essential given the continued pressure on land resources, especially in Southeast Asia. However, the limited knowledge on this topic has resulted in the oversimplifications of the relationships between floods, commercial plantations and peatland sustainability, creating major disagreement among policymakers at different levels in governments, companies, NGOs and society. Hence, this study identifies whether flood policies are integrated within peatland management through a qualitative policy analysis of publicly available papers, government reports, and other official documents that discuss flooding, and/or more in general, hydrology in peatlands. Document analysis was then triangulated with data obtained from several semi-structured discussions. The analysis indicates that the industry on peatlands and the peatland's environmental sustainability could be threatened by increased flooding. We show that, in spite of this, flood policies in SE Asian countries like Malaysia and Indonesia have not been well-integrated into peatland management. We also discuss how the countries could move forward to overcome this problem.

A formal model concerning policy strategies to build public acceptance of potable water reuse.

Water stress is an increasing burden in regions with arid climates, aquifer vulnerability, and erratic rainfall. Population growth and competing domestic, industrial, and agricultural uses are also stretching the capacity of water supply systems. Beyond groundwater extraction, surface water overuse, and inter-basin transfers, governments are exploring alternative sources amidst looming supply threats. These alternatives include desalination, greywater recycling, and reclaimed or recycled wastewater. The latter, also known as water reuse with varying levels of treatment, has been applied for irrigation, street cleaning, industrial processes, and groundwater recharge. However, reused water for potable purposes has seen limited uptake, due in part to lack of public acceptance. This article examines the dynamics of public acceptance for potable water reuse. The article's theoretical contribution is a formal mathematical model for understanding public acceptance of water reuse. The model conceptualizes how governments, water utilities and the public interact to facilitate or hinder acceptance of water supply sources, including potable reuse. The article concludes by applying the model to cases of water reuse in Windhoek, Namibia, and Singapore.

The transboundariness approach and prioritization of transboundary aquifers between Mexico and Texas.

"Transboundariness" refers to a new approach that identifies and prioritizes transboundary aquifers using socio-economic and political criteria, improving their characterization by using other variables in addition to their mere physical boundaries. This approach is applied to the hydrogeological units/aquifers shared by Mexico and Texas, with the following results. First, the rankings agree with the current level of attention to transboundary aquifers in the region by both countries, providing a quantifiable system that could be tested in other transboundary aquifers. Second, this approach provides a holistic and integrative perspective for transboundary aquifer assessment and prioritization. Third, this prioritization exercise expands the criteria currently used into a more integrative regime of groundwater links to the community as a whole. Finally, the results reflect not only how the transboundary aquifers are being used (or neglected) but also the socio-political context of the populations that depend on these resources for current and future development.

Factors associated to duration of hepatitis a outbreaks: implications for control.

Even though hepatitis A mass vaccination effectiveness is high, outbreaks continue to occur. The aim of this study was to investigate the association between duration and characteristics of hepatitis A outbreaks. Hepatitis A (HA) outbreaks reported between 1991 and 2007 were studied. An outbreak was defined as ≥2 epidemiologically-linked cases with ≥1 case laboratory-confirmed by detection of HA immunoglobulin M (IgM) antibodies. Relationships between explanatory variables and outbreak duration were assessed by logistic regression. During the study period, 268 outbreaks (rate 2.45 per million persons-year) and 1396 cases (rate 1.28 per 10(5) persons-year) were reported. Factors associated with shorter duration were time to intervention (OR = 0.96; 95% CI: 0.94-0.98) and school setting (OR = 0.39; 95% CI: 0.16-0.92). In person-to-person transmission outbreaks only time to intervention was associated with shorter outbreak duration (OR = 0.96; 95% CI: 0.95-0.98). The only variables associated with shorter outbreak duration were early administration of IG or vaccine and a school setting. Timely reporting HA outbreaks was associated with outbreak duration. Making confirmed HA infections statutory reportable for clinical laboratories could diminish outbreak duration.

[Nosocomial outbreak due to Listeria monocytogenes in a neonatal unit]. / Brote nosocomial por Listeria monocytogenes en una Unidad de Neonatos.

INTRODUCTION: Description of an outbreak of Listeria monocytogenes in a neonatal intensive care unit. METHODS: A questionnaire, environmental investigation and molecular study were performed. RESULTS: We identified a nosocomial outbreak of L. monocytogenes, confirmed by the genetic study, in a neonatal intensive care unit. Three infants were affected. Although the transmission mechanism could not be elucidated, cross-infection was strongly suggested. CONCLUSION: Adherence to universal hygiene standards is necessary to avoid nosocomial outbreaks.

Hepatitis A among men who have sex with men in Barcelona, 1989-2010: insufficient control and need for new approaches.

BACKGROUND: Men who have sex with men (MSM) are a known group at risk for hepatitis A and outbreaks among this group are frequent. In Barcelona, vaccination for MSM has been recommended since 1994. In 1998 a vaccination campaign among preadolescents was implemented and an immunization program in gay bathhouses began in 2004. OBJECTIVE: to asses the incidence of hepatitis A in adults in Barcelona from 1989 to 2010 and to evaluate the outbreaks among MSM including all genotypes involved. METHODS: All cases of acute hepatitis A among young adults notified to the Public Health Agency of Barcelona from 1989 to 2010 were included for analyses. We calculated the annual incidence rate and the incidence ratio male-to-female (M:F) as a marker for MSM. Spearman's coefficient was used to evaluate trends. We also evaluated the outbreaks among MSM and compared their characteristics using Chi-squared and ANOVA test. Fragment amplification of the VP1/P2A region was used for genetic analysis. RESULTS: The median annual incidence for the period of study was 4.7/100000 among females and 11.7/100000 among males. The rate of hepatitis A for adult woman decreased over time (Spearman' coefficient = -0.63, p = 0.002), whereas there was no decrease for adult men (Spearman' coefficient = 0.097, p = 0.67). During the study period the M:F ratio increased (Spearman' coefficient = 0.73, p < 0.001).Three large outbreaks among MSM were detected. When comparing outbreaks, there was a decrease in the percentage of bathhouse users (from 47% to 19%, p = 0.0001) and sex workers (from 6.5% to 0%) while the percentage of HIV infected individuals did not change significantly (range: 21%-28%, p = 0.36). The isolated strains were closely related to those circulating in Europe. CONCLUSIONS: Annual incidences remain high among MSM without tendency to decrease. More strategies which effectively reach the whole MSM community are needed.

[Surveillance of the pandemic influenza (H1N1) 2009 in Catalonia: results and implications]. / Vigilancia de la de gripe pandémica (H1N1) 2009 en Cataluña: Resultados e implicaciones.

BACKGROUND: Pandemics require an assessment of its severity. The objective was to determine the characteristics of pandemic influenza in Catalonia. METHODS: We conducted a surveillance study on the incidence of ILI and severe cases between June 2009 and May 2010. A network of 55 doctors reported influenza-like illness and collected nasopharyngeal swabs. The severity of the pandemic was assessed through severe cases confirmed.We calculated the lethality and incidence rates and mortality. The differences are studied with the relative risk (RR) with confidence intervals (CI) of 95%. RESULTS: The incidence of ILI was much higher in the 5 to 14 and from 0 to 4 years old (1227.8 and 1048.4, respectively, in the week of maximum incidence). Of positive samples, 52.4% (477/916) were positive for influenza virus and the majority, 456 (95.6%) were the pandemic influenza virus (H1N1) 2009.The incidence of severe cases was 10.3 per 10(5) and was higher in children (14,5) and adults under 65 years (10,2) (p < 0.0001). Overall mortality was 0.7 per 10(5) and was also higher in children and adults under 65 but the differences were not statistically significant. The fatality rate was estimated at 0.03% and was much higher in the 15 to 44 years (0,03%) (RR = 3.1, 95% CI 1.2 to 8.3), 45 to 64 years (0,11%) (RR = 11.9 95% CI 4.3 to 32.7) and over 64 years (0,73%) (RR = 79.6, 95% CI 25.3 to 250.9) compared to group 5 to 14 years (0,01%). CONCLUSIONS: The incidence of severe hospitalized cases was similar to or lower than that observed in the southern hemisphere. The lower risk of hospitalization in people over 64 years suggests the relative protection of this age group against the pandemic virus.

Hepatitis a virus vaccine escape variants and potential new serotype emergence.

Six hepatitis A virus antigenic variants that likely escaped the protective effect of available vaccines were isolated, mostly from men who have sex with men. The need to complete the proper vaccination schedules is critical, particularly in the immunocompromised population, to prevent the emergence of vaccine-escaping variants.

Social perceptions of the impacts of Colombo water supply projects.

The complexity of development activities, in which the interactions between various forces often mean that outcomes are unpredictable and unanticipated, highlights the importance of objective and comprehensive evaluations. In the specific case of the evaluation of towns east and south of Colombo water supply projects, the findings have major implications for the implementation of the Millennium Development Goals, if the water-related objectives are to be fulfilled. The study found that 30% of the households of these towns that are receiving clean, piped water are not using it for drinking. Instead, they are continuing to drink contaminated well water. Whereas it is considered that the main beneficiaries of water supply projects have been women and people who are sick, elderly, or disabled, the general perception is that the health conditions of the families have not improved with the provision of clean water (in fact, many claim that their health conditions have deteriorated). In spite of the higher cost of the supplied water, people are willing to pay for it as long as the supply is reliable.

Water management for a megacity: Mexico City Metropolitan Area.

The paper presents an overview of the present situation of the Mexico City Metropolitan Area (MCMA). The analysis indicates an urgent need to radically improve the current water supply and wastewater management practices, to become sustainable. The MCMA is one of the most rapidly growing urban centers of the world, with a population of about 21 million people, a very high rate of immigration and numerous illegal settlements. In order to meet the increasing water demand, successive governments have focused almost exclusively on supply management and engineering solutions, which have resulted in investments of hundreds of millions of USD and the construction of major infrastructure projects for interbasin water transfer. Environmental, economic and social policies associated with water management are mostly inadequate and insufficient, which is resulting in increasing deterioration in the environment, health and socioeconomic conditions of a population living in one of the largest urban agglomerations of the world. Surprisingly, however, no long-term strategies on demand-management, reuse, conservation, and improved water-management practices have been developed so far.