Patient Co-Creation Initiatives in the Ambulatory Care Setting during COVID-19: A Systematic Review.

Background and Objectives: The COVID-19 pandemic has led to significant changes in ambulatory care to meet new healthcare demands. Materials and Methods: A review of 21 articles focusing on patient co-creation initiatives during the pandemic shows that integrating patient feedback was crucial in transforming care delivery. Results: Joint efforts between healthcare professionals and patients led to new patient-focused telemedicine platforms, more efficient appointment systems, and improved safety measures. These adaptations overcame care barriers and maintained continuity of care. Key themes identified include monitoring community health standards, combining technology with patient-provider communication, and enhancing patient participation in health research. Conclusions: These co-creation efforts not only boosted patient satisfaction and outcomes but also demonstrated the potential for long-term healthcare innovations beyond the pandemic. The review further illuminates that co-creation in healthcare, particularly in tracking community health trends, is a practical strategy that involves diverse stakeholders in shaping healthcare delivery. The widespread adoption of co-creation in outpatient care during the pandemic highlights its role in driving patient-centered behavioral changes through innovative methods like crowdsourcing and dialogue conferencing. The review also recognizes that co-creation has been instrumental in responding to demographic changes, enhancing resources, creativity, and problem-solving in municipal-volunteer collaborations. Additionally, the evolution of technology in patient-provider communication, from initial resistance in the 1990s to its current critical role, particularly during the COVID-19 pandemic, underscores its importance in enhancing healthcare service delivery and patient data communication. The review also emphasizes the need for ethically and accessibly designed technology, especially for vulnerable groups, and highlights the significance of patient involvement in healthcare research, advocating for user-centered design and shared decision-making to create truly patient-centric interventions.

Bereavement During and Not During the Pandemic in Terms of Complicated Grief and Social Support.

Mandated measures to reduce the risk of spreading the coronavirus (e.g., social distancing and travel restrictions) led to isolation and reshaped the dying process as well as grief rituals for loved ones of deceased individuals due to COVID-19 and other causes of death. The purpose of this study was to investigate the difference between those who lost a loved one during and not during the global pandemic in terms of complicated grief and perceived social support. A cross-sectional quantitative approach was employed, surveying 580 individuals, all of whom had experienced the loss of a loved one. Our findings suggest that bereavement during the COVID-19 era uniquely intensified the Complicated Grief experience. However, the perceived social support did not vary based on the timing of the bereavement. The strengths, limitations, and future research directions are further explored.

Effective Drug Candidates against Global Pandemic of Novel Corona Virus (nCoV-2019): A Probability Check through Computational Approach for Public Health Emergency.

The infection of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started form Wuhan, Chinais a devastating and the incidence rate has increased worldwide. Due to the lack of effective treatment against SARS-CoV-2, various strategies are being tested in China and throughout the world, including drug repurposing. To identify the potent clinical antiretroviral drug candidate against pandemic nCov-19 through computational tools. In this study, we used molecular modelling tool (molecular modelling and molecular dynamics) to identify commercially available drugs that could act on protease proteins of SARS-CoV-2. The result showed that Saquinavir, an antiretroviral medication can be used as a first line agent to treat SARS-CoV-2 infection. Saquinavir showed promising binding to the protease active site compared to other possible antiviral agents such as Nelfinavir and Lopinavir. Structural flexibility is one of the important physical properties that affect protein conformation and function and taking this account we performed molecular dynamics studies. Molecular dynamics studies and free energy calculations suggest that Saquinavir binds better to the COVID-19 protease compared to other known antiretrovirals. Our studies clearly propose repurposing of known protease inhibitors for the treatment of COVID-19 infection. Previously ritonavir and lopinavir were proved an important analogues for SARS and MERS in supressing these viruses. In this study it was found that saquinavir has exhibited good G-score and E-model score compared to other analogues. So saquinavir would be prescribe to cure for nCov-2019 either single drug or maybe in combination with ritonavir.

The Indigenous Peoples in time of a global pandemic.

The coronavirus disease-2019 (COVID-19) pandemic poses a grave threat to Indigenous Peoples (IPs) around the world. In a recent correspondence, the author explores the vulnerabilities at the local level during COVID-19. IPs experience a high degree of socio-economic marginalization and are at disproportionate risk in public health emergencies, becoming even more vulnerable during the COVID-19 pandemic, owing to factors such as their lack of access to effective monitoring and early-warning systems, and adequate health and social services. This correspondence calls for a 'multisectoral strategy of intervention' and a 'preferential option for the indigenous peoples' during this global pandemic.

Changes in water use and wastewater generation influenced by the COVID-19 pandemic: A case study of China.

This paper examines and projects the water use and wastewater generation during and after the SARS-CoV-2 (COVID-19) in China, and discussed the water use/wastewater generation pattern changes among different sectors. Existing studies on the impact of pandemic spread-prevention measures on water consumption and wastewater treatment during the pandemic are reviewed. The water use and wastewater discharge in China through the COVID-19 period are then projected and analyzed using Multivariate Linear Regression. The projection is carried out for years 2019-2023 and covers an (estimated) full process of pre-pandemic, pandemic outbreak, and recovery phase and provides essential information for determining the complete phase impact of the COVID-19. Two scenarios, i.e. the recovery scenario and the business as usual scenario, are set to investigate the water use and wastewater generation characteristics after the pandemic. The results imply that in both scenarios, the water use in China shows a V-shaped trend from 2019 to 2023 and reached a low point in 2020 of 5,813✕108 m3. The wastewater discharge shows an increasing trend throughout the COVID period in both scenarios. The results are also compared with the water consumption and wastewater generation during the SARS-CoV-1 period. The implication for policymakers is the possible increase of water use and wastewater discharge in the post COVID period and the necessity to ensure the water supply and control of water pollution and wastewater discharge.

Global pandemic crisis and risk contagion in GCC stock markets.

This study investigates how the COVID-19 outbreak has shaped the volatility spillover between oil and Gulf Cooperation Council (GCC) stock markets. Contagion analysis is conducted by implementing a vector error correction (VECM) asymmetric BEKK model, wherein both cointegration and asymmetric features are considered. Financial market uncertainty caused by the recent health crisis is captured using Baker et al.'s (2020) newly developed infectious disease tracker. Our results indicate a significant discrepancy in the GCC group, as shock and volatility linkages between oil and equities are more apparent for some countries but not for others. The estimated VECM-asymmetric BEKK model reveals cross-market asymmetric spillover effects only in Kuwait, Qatar, and Saudi Arabia. We report that the global pandemic has strongly affected crude oil market volatility, while the GCC region seems to be less affected by the emergence of the new infectious disease. Our findings underscore the diversification opportunities offered by Gulf equity markets to international investors.

Will COVID-19 accelerate telecommuting? A cross-country evaluation for Israel and Czechia.

The COVID-19 crisis has forced many people to work from home, rather than at their regular workplace. This paper aims to assess the impact of the pandemic on telecommuting and commuting behavior after the end of the crisis: Will people embrace teleworking and reduce commuting, even to some extent, or will they resume their pre-pandemic work patterns? This study, implementing a cross-country survey from Israel and Czechia, combines data regarding revealed preferences about work habits before and during the pandemic and stated intentions data regarding anticipated work patterns when life returns to "normal" after the pandemic. Two models were used for the data analysis, one addressing factors that affect the increased/decreased teleworking trend and the other addressing factors that affect the frequency of actual commutes. The results reveal that most respondents (62% in Israel and 68% in Czechia) will maintain the same telecommuting/working from home balance. About 19% of respondents in both countries expressed their intention to reduce the number of commuting days, while 6% stated they would increase out-of-home days. However, these estimates rely only on workers' expectations not accounting for employers' point of view and other constraints they may have. Not accounting for potential bias, a moderate reduction of 6.5% and 8.7% (in Israel and in Czechia, respectively) in the number of commuting trips is expected in the post-pandemic era. The anticipated decrease in commuting days is accompanied by an increase in teleworking: from 10% to 14% among those who work more than 20 h a week (in both countries) and a drop in the rate of those who telework five hours or less a week (down from 73% to 63% in Israel and from 76% to 70% in Czechia). Self-employment, travel time to work, working solely on premise during the lockdown, and personal preferences regarding telework versus working away from home were found to significantly contribute to a decrease in the number of commuting days and to an increase in teleworking. An interesting finding is the high probability of increased teleworking among people who teleworked for the first time during the lockdown or who increased their teleworking time during the lockdown. This indicates that the teleworking experience due to the pandemic has enabled some people to view working from home as viable. Although, overall, the change in working habits does not seem dramatic, our results suggest that hybrid schemes for combining on premise and telework are expected to be adopted by some sectors.

Tanneries impact on groundwater quality: a case study of Kasur city in Pakistan.

Leather industry is the second largest export-earning sector of Pakistan. However, because of poor waste management, this industry has been continuously polluting the environment. In this paper, the impact of tanneries on the groundwater quality of Kasur city (i.e., the second largest leather producing city) is examined. The study is conducted in the following three phases: (I) water samples collection, (II) determination of physio-chemical properties, and (III) application of data mining techniques. In phase I, groundwater samples were collected from various sources such as hand pumps, motor pumps, and tube wells. In phase II, several physio-chemical properties such as (i) total dissolved solids (TDS), (ii) pH, (iii) turbidity, (iv) electrical conductivity (EC), (v) total hardness (TH), (vi) total alkalinity (TA), (vii) nitrates, (viii) chromium, (ix) fluoride, and (x) chloride were estimated. The estimated values of all these foregoing parameters are then compared with the Punjab Environmental Quality Standards for Drinking Water (PEQSDW). In phase III, principle component analysis and cluster analysis of the estimated parameters were performed to elucidate the relation between various parameters and to highlight the highly vulnerable sites, respectively. The results exhibit that most of the sampling collections sites are at the threshold of losing quality water. Moreover, it is also found that Mangal Mandi carries the worst groundwater quality among all sampling locations. Overall, it is concluded that serious attention is due from the water and wastewater authorities to further investigate and monitor the groundwater quality of Kasur before the country strikes with another pandemic after COVID-19.

Multiplicity and dynamics of social representations of the COVID-19 pandemic on Chinese social media from 2019 to 2020.

Documenting the emergent social representations of COVID-19 in public communication is necessary for critically reflecting on pandemic responses and providing guidance for global pandemic recovery policies and practices. This study documents the dynamics of changing social representations of the COVID-19 pandemic on one of the largest Chinese social media, Weibo, from December 2019 to April 2020. We draw on the social representation theory (SRT) and conceptualize topics and topic networks as a form of social representation. We analyzed a dataset of 40 million COVID-19 related posts from 9.7 million users (including the general public, opinion leaders, and organizations) using machine learning methods. We identified 12 topics and found an expansion in social representations of COVID-19 from a clinical and epidemiological perspective to a broader perspective that integrated personal illness experiences with economic and sociopolitical discourses. Discussions about COVID-19 science did not take a prominent position in the representations, suggesting a lack of effective science and risk communication. Further, we found the strongest association of social representations existed between the public and opinion leaders and the organizations' representations did not align much with the other two groups, suggesting a lack of organizations' influence in public representations of COVID-19 on social media in China.

Urban parks as a potential mitigator of suicide rates resulting from global pandemics: Empirical evidence from past experiences in Seoul, Korea.

Globally, the increased suicide rate of the general population has become a concern not only because of the COVID-19 pandemic, but also because of its associated socioeconomic insecurity, loss of jobs, and economic shocks. This study employed robust fixed-effects panel models to empirically identify the mitigating effects of infectious diseases, via urban parks, on the suicide rate, and to examine gender differences in this regard, based on previous experiences in Seoul, Korea. We found that the differentiating mitigating effect did not significantly affect suicide rates during the 2015 MERS epidemic. However, during the 2009 H1N1 pandemic, wherein the number of confirmed cases was very high and diffused nationwide, urban parks significantly reduced the suicide rates for both men and women. The role of parks as a mitigator was more enhanced in cities with a high number of confirmed cases if it was associated with economic shocks. However, this effect was significant only in the suicide rates of men, not women. During a pandemic, urban parks can help maintain social interaction and sustain physical activities (i.e., walking and exercise) while maintaining physical distance. National and local governments should develop urban parks to actively control the suicide rate influenced by movement restriction measures inevitably occurring during the spread of infectious diseases.

Adverse consequences of emotional support seeking through social network sites in coping with stress from a global pandemic.

This study explores how using social networking sites (SNSs) to cope with stressors induced by a global pandemic (in this case, COVID-19) can have negative consequences. The pandemic has imposed particular stressors on individuals, such as the threats of contracting the virus and of unemployment. Owing to the lockdowns and confinements implemented to limit the spread of the pandemic, SNS use has surged worldwide. Drawing on Lazarus and Folkman's theory of stress and coping, we consider COVID-19 obsession to be an adverse emotional response to the stressors brought about by the pandemic and emotional support seeking through SNS as a coping strategy. Furthermore, we identify SNS exhaustion as an adverse outcome of this form of coping. Finally, we analyze the intention to reduce SNS use as a corrective behavioral outcome to mitigate the negative effect of SNS-mediated coping. The findings indicate that: 1) the threat of the COVID-19 disease and the threat of unemployment drive COVID-19 obsession; 2) COVID-19 obsession contributes to emotional support seeking through SNS; 3) emotional support seeking through SNS exerts a positive effect on SNS exhaustion; 4) SNS exhaustion contributes to the intention to reduce SNS use. Our results advance Information Systems (IS) research by focusing on the use of Information Technology (IT) to cope with stressors that are essentially not IT-related; such research is largely absent from previous literature. Furthermore, our paper contributes to the increasing amount of literature on IT-mediated coping with stressors and reduced social media use.

Covid-19 in America: Global supply chain reconsidered.

This research asks: To what extent has America's reliance on the global supply network aggravated the country's public health and economic crisis; and how did the American government respond to supply chain weaknesses during the early years of the Covid-19 pandemic? This study first assesses important conceptual considerations that explain the expansion of global value chains and the growth of trade interdependencies among nations. Next, an analytical case study observes (1) America's supply chain vulnerability through three major waves of infection, (2) the difficulty to mend weaknesses in the supply linkages once the novel coronavirus spread globally and (3) American government's failures to both anticipate and respond to supply shortages, especially in the health sector. Trump administration's policies failed to ensure a reliable supply of simple personal protective equipment (PPE) for healthcare professionals and hospitals throughout the first three waves of infection. Moreover, state and federal governments' substantial reliance on large manufacturers who have established procurement relationship with government led to continuous nationwide supply shortages throughout 2020. The federal government's inability to engage small and medium manufacturers in the production of critical supplies of PPE and diagnostic tests deepened and prolonged the devastating impacts of the pandemic. Our case study demonstrates that the American government needs to rethink the country's substantial reliance on the global supply chain, and the specific requirements to boost domestic manufacturing capacity. The revitalisation of America's manufacturing ability and the local supply networks will boost the productive power of the nation, strengthen resiliency, reduce vulnerability in disruptive times and prepare the nation for future crises.

NATIONAL HEALTH FINANCING SYSTEMS AGAINST THE BACKDROP OF A GLOBAL PANDEMIC: NEW CHALLENGES AND PROSPECTS.

OBJECTIVE: The aim: The purpose of the article is to study the challenges and prospects for the development of national health financing systems against the background of a pandemic. PATIENTS AND METHODS: Materials and methods: Our research consists of two interrelated stages. At the first stage, the central task was to determine the size of the drop in world GDP. In the second part of the study, we focused on the definition of the essence of concession agreements in order to use t in the field of medical care. The key methods used in this study were data analysis, generalization, and comparison. CONCLUSION: Conclusions: National health financing systems in the vast majority of the world's countries have experienced unprecedented pressures and problems both in terms of health insurance due to the huge losses of the insurance industry in 2020. In order to improve health care financing systems, it is necessary to update the forms, methods and tools of the insurance market functioning in terms of the health insurance segment, and to introduce new mechanisms for financing the medical sector in the process of combating the spread of coronavirus infection.

The sophisticated literacy practitioner and the global pandemic.

Negative portrayals in the Australian media situate teachers as a problem and teaching as a deficit practice. Society is positioning teachers, especially teachers of literacy, as the reason for poor student performance. In addition, negative media discourse around deficit initial teacher education, especially with regard to the teaching of reading and writing, is adding to the overall assumption that teachers of literacy are failing. This article highlights instances of teacher practice by literacy teachers during the global pandemic of COVID-19 which oppose the 'problem teacher' discourse. Snowball sampling was used to garner seven early years and primary school teachers for interviews, focussing on teacher perceptions of multimodal texts. A Foucaultian lens of governmentality and power and Fairclough's approach to Critical Discourse Analysis (CDA) were used as lens and method of analysis. The findings of this study indicate that these participant teachers have been sophisticated practitioners in their planning and practice during the pandemic, despite the institutional barriers and extreme disruptions experienced. On reflection, therefore, the constructed societal discourse around 'problem teachers' needs to be reviewed and adjusted.

Combining Family Systems Approaches to Address BIPOC Families' Racial Trauma Amidst the Global Pandemic.

The ACE study (Felitti et al., 1998) led to the recognition of the prevalence and impact of trauma. However, since the ACE study sample was mostly white and middle class, the Philadelphia task force implemented their own study to account for trauma of a more diverse sample. A result of the study was a list of evidence-based treatments to be utilized with BIPOC populations. Of the evidence-based treatments was, ecosystemic structural family therapy (ESFT). A similar effective approach is the family resilience framework. When combined, the approaches can be effective with BIPOC families during the global pandemic and racial trauma, something not typically at the forefront of family counseling goals. In this article, I explain the four steps family counselors should follow when combining the approaches to better approach and treat racial trauma while also partaking in effective advocacy to enhance family resilience of BIPOC families. A case study is provided for family counselors to understand how to effectively utilize this combined approach.

Genetic Correlates of Psychological Responses to the COVID-19 Crisis in Young Adult Twins in Great Britain.

We investigated how the COVID-19 crisis and the extraordinary experience of lockdown affected young adults in England and Wales psychologically. One month after lockdown commenced (T2), we assessed 30 psychological and behavioural traits in more than 4000 twins in their mid-twenties and compared their responses to the same traits assessed in 2018 (T1). Mean changes from T1 to T2 were modest and inconsistent. Contrary to the hypothesis that major environmental changes related to COVID-19 would result in increased variance in psychological and behavioural traits, we found that the magnitude of individual differences did not change from T1 to T2. Twin analyses revealed that while genetic factors accounted for about half of the reliable variance at T1 and T2, they only accounted for ~ 15% of individual differences in change from T1 to T2, and that nonshared environmental factors played a major role in psychological and behavioural changes. Shared environmental influences had negligible impact on T1, T2 or T2 change. Genetic factors correlated on average .86 between T1 and T2 and accounted for over half of the phenotypic stability, as would be expected for a 2-year interval even without the major disruption of lockdown. We conclude that the first month of lockdown has not resulted in major psychological or attitudinal shifts in young adults, nor in major changes in the genetic and environmental origins of these traits. Genetic influences on the modest psychological and behavioural changes are likely to be the result of gene-environment correlation not interaction.

Impact of COVID-related lockdowns on environmental and climate change scenarios.

The outbreak of COVID-19 pandemic has emerged as a major challenge from human health perspective. The alarming exponential increase in the transmission and fatality rates related to this disease has brought the world to a halt so as to cope up with its stern consequences. This has led to the imposition of lockdown across the globe to prevent the further spread of this disease. This lock down brought about drastic impacts at social and economic fronts. However, it also posed some positive impacts on environment as well particularly in the context of air quality due to reduction in concentrations of particulate matter (PM), NO2 and CO across the major cities of the globe as indicated by several research organizations. In China, Italy, France and Spain, there were about 20-30% reduction in NO2 emission while in USA 30% reduction in NO2 emission were observed. Compared to previous year, there was 11.4% improvement in the air quality in China. Drastic reductions in NO (-77.3%), NO2 (-54.3%) and CO (-64.8%) (negative sign indicating a decline) concentrations were observed in Brazil during partial lockdown compared to the five year monthly mean. In India there were about -51.84, -53.11, -17.97, -52.68, -30.35, 0.78 and -12.33% reduction in the concentration of PM10, PM2.5, SO2, NO2, CO, O3 and NH3 respectively. This article highlights the impact of lockdown on the environment and also discusses the pre and post lockdown air pollution scenario across major cities of the world. Several aspect of environment such as air, water, noise pollution and waste management during, pre and post lockdown scenario were studied and evaluated comprehensively. This research would therefore serve as a guide to environmentalist, administrators and frontline warriors for fighting our the way to beat this deadly disease and minimize its long term implications on health and environment.

Air quality changes in cities during the COVID-19 lockdown: A critical review.

In response to the rapid spread of coronavirus disease-2019 (COVID-19) within and across countries and the need to protect public health, governments worldwide introduced unprecedented measures such as restricted road and air travel and reduced human mobility in 2020. The curtailment of personal travel and economic activity provided a unique opportunity for researchers to assess the interplay between anthropogenic emissions of primary air pollutants, their physical transport, chemical transformation, ultimate fate and potential health impacts. In general, reductions in the atmospheric levels of outdoor air pollutants such as particulate matter (PM), nitrogen dioxide (NO2), carbon monoxide (CO), sulfur dioxide (SO2), and volatile organic compounds (VOCs) were observed in many countries during the lockdowns. However, the levels of ozone (O3), a secondary air pollutant linked to asthma and respiratory ailments, and secondary PM were frequently reported to remain unchanged or even increase. An increase in O3 can enhance the formation of secondary PM2.5, especially secondary organic aerosols, through the atmospheric oxidation of VOCs. Given that the gaseous precursors of O3 (VOCs and NOx) are also involved in the formation of secondary PM2.5, an integrated control strategy should focus on reducing the emission of the common precursors for the co-mitigation of PM2.5 and O3 with an emphasis on their complex photochemical interactions. Compared to outdoor air quality, comprehensive investigations of indoor air quality (IAQ) are relatively sparse. People spend more than 80% of their time indoors with exposure to air pollutants of both outdoor and indoor origins. Consequently, an integrated assessment of exposure to air pollutants in both outdoor and indoor microenvironments is needed for effective urban air quality management and for mitigation of health risk. To provide further insights into air quality, we do a critical review of scientific articles, published from January 2020 to December 2020 across the globe. Finally, we discuss policy implications of our review in the context of global air quality improvement.

Interdisciplinary Considerations for Nasolabial Repair During a Global Pandemic.

BACKGROUND: At the declaration of the global pandemic on March 11, 2020, many hospitals and institutions developed a tiered framework for the stratification and prioritization of elective surgery. Cleft lip and palate repair was classified as low acuity, and nasoalveolar molding (NAM) clinics were closed. Anticipating the consequences of delayed cleft care and the additional burden this would cause families, we reassessed our risk-stratification and perioperative algorithms. We hypothesized we could safely optimize nasolabial repair without burdening our care systems and without increasing COVID-19-related morbidity/mortality. METHODS: Our multidisciplinary cleft team reevaluated patient selection to maximize surgical impact. Perioperative protocols were adjusted, and COVID-19 preoperative testing was utilized before nasolabial repair and prior to suture removal under anesthesia. RESULTS: Early in the pandemic, unilateral cleft repair was prioritized and successfully completed on 9 patients. There were no complications related to COVID-19. Nasoalveolar molding clinic was reopened after total patient volume was significantly decreased. CONCLUSIONS: We offer an approach for surgical management of nasolabial clefts during a global pandemic. Although guidelines have suggested postponing all cleft care, we found that at our dedicated pediatric hospital with low burden of COVID-19 and adequate resources, we could follow a strategy to safely resume cleft care while decreasing burden on our patients' families and care delivery systems.

Environmental impact of coronavirus (COVID-19) from Turkish perceptive.

ABSTRACT: COVID-19 was not taken seriously by many of us until the wave hit our countries and impacted daily life routines and travel plans, similar to our responses to climate change. COVID-19 led to a decrease of anthropogenic activities in Turkey, largely due to lockdown. Changes in the air quality index (AQI) were assessed before and during coronavirus. In this study, the authors investigated the changes of AQI for 2.5 µm particulate matter (PM2.5), a primary air pollutant, as well as ozone, a secondary air pollutant, in Turkey during December 2019, April 2020, and May 2020. Overall, the PM2.5 index improved by 34.5% by the end of April 2020. However, the ozone index increased from 16.8 to 28.8 by the end of April. The increase in ozone is attributed to the reduction of PM levels, which increased sunlight penetration. Before COVID-19, the AQI for Turkey was categorized as unhealthy for sensitive groups (PM2.5 = 103); however, during the pandemic, AQI fell to lower boundaries of the moderate category by May 2020 (PM2.5 = 56.9). Changes in municipal wastewater were also assessed. Municipal wastewater quality and hospital waste generation did not change during the pandemic in Turkey. Therefore, we should not expect COVID-19 risks in treatment plant effluents. This study gives confidence to regulators that when strict measures are implemented, air quality can improve.