Status and influencing factors on the leftover school meals among students the Nutrition Improvement Program for Rural Compulsory Education Students in 2019 / 中华流行病学杂志

Objective: To analyze the situation and influencing factors of school meals leftover among primary and secondary school students in the area of the Nutrition Improvement Program for Rural Compulsory Education Students, improve the quality of school meals, develop healthy dietary behavior, and reduce food waste. Methods: In 2019, among the 50 monitoring counties that implemented the Compulsory Education Student Nutrition Improvement Program, two primary schools and two junior schools were randomly selected according to different food supply patterns.This study randomly selected one or two classes from grade 3 to grade 9. Basic information and school meals of 26 778 students were collected by using a student questionnaire. Multivariate logistic regression was used to analyze the influencing factors of leftovers rate. Results: 54.93% (14 709) of students wasted school meals, in which the highest rate was the staple food, with the main reason as "not in favor". 11.87% (1 743) of the students wasted school meals 6-7 days a week, with 54.20% (7 957) of students wasted but in less amount. The leftover rate of staple food was the highest (29.78%), followed by vegetables and meat. The main reason of leftovers was that they didn't like this kind of food (33.52%). The rate of school meal waste was higher for girls (OR=1.19,95%CI:1.13-1.25), junior high school students (OR=1.17, 95%CI: 1.11-1.25), resident students (OR=1.06, 95%CI: 1.00-1.12), lower economic level (OR=1.06, 95%CI: 1.00-1.12), parents working outside their houses (OR=1.22, 95%CI: 1.13-1.30), health education classes (OR=1.70, 95%CI: 1.40-2.06), company-based meals (OR=1.89, 95%CI: 1.71-2.07) and school meals were not as good as home food(OR=1.89, 95%CI: 1.78-2.00)(P<0.05). Conclusions: It is common for poor rural primary and middle school students in central and western China to waste school meals, and the reasons were affected by many factors. Reducing food waste requires the joint efforts of individuals, families, schools and society.

Lipid production by oleaginous microorganisms using food wastes: a review / 生物工程学报

Food wastes are rich in nutrients and can be used for producing useful chemicals through biotransformation. Some oleaginous microorganisms can use food wastes to produce lipids and high value-added metabolites such as polyunsaturated fatty acids, squalene, and carotenoids. This not only reduces the production cost, but also improves the economic value of the products, thus has large potential for commercial production. This review summarized the advances in food waste treatment, with a focus on the lipid production by oleaginous microorganisms using food wastes. Moreover, challenges and future directions were prospected with the aim to provide a useful reference for related researchers.

Las epidemias en La Pampa (Argentina), en perspectiva histórica* / The epidemics in La Pampa (Argentina), from a historical perspective

Resumen Este artículo describe el inicio de las preocupaciones sanitarias vinculadas a las epidemias ocurridas durante el siglo XX en La Pampa, provincia argentina. Las epidemias, como las de la viruela, fueron un estímulo para estas políticas que frecuentemente tuvieron origen en Buenos Aires, la capital del país. El contagio de muchas epidemias dependía de carencias de infraestructura: agua, desagüe y desecho adecuado de basuras, de la ausencia de un número suficiente de trabajadores de salud, de la presencia de vectores transmisores de enfermedades como los mosquitos y, en última instancia, de la pobreza. La experiencia histórica descrita en este texto resalta la importancia de analizar el impacto del SARS-CoV-2 más allá de las grandes ciudades.

Abstract This article describes the emergence of health concerns relating to the epidemics that occurred during the twentieth century in La Pampa, a province in Argentina. Epidemics such as smallpox drove such policies, which frequently originated in Buenos Aires, the country's capital. The spread of many epidemics was due to shortages: water, sewage and adequate refuse disposal, an insufficient number of health care workers, the presence of disease transmission vectors such as mosquitos, and, ultimately, poverty. The historical experience described in this text highlights the importance of analyzing the impact of SARS-CoV-2 beyond the big cities.

Hepatitis B prevalence in Brazilian waste pickers: a systematic review with meta-analysis

ABSTRACT OBJECTIVE: To describe the hepatitis B prevalence in Brazilian waste pickers. METHODS: We performed a literature search in the SciELO, Biblioteca Virtual em Saúde (BVS), PubMed and Web of Science databases using the descriptors: "hepatitis B" AND ("informal recycling" OR "waste picker" OR "recyclable waste collectors" OR "solid waste segregator") AND ("recyclable waste" OR "solid waste") AND Brazil. Epidemiological studies on HBV in Brazilian waste pickers published prior to February 2020 were included and evaluated for quality and bias using a funnel plot. RESULTS: This meta-analysis consisted of five articles. Prevalence of HBV surface antigen seropositivity was 14% (95%CI: 6%-22%) in Brazilian waste pickers. CONCLUSION: HBV prevalence in Brazilian waste pickers remains high. There should be more campaigns showing the importance of vaccination and personal protective equipment use.

Estudio transversal de la cultura ambiental y la salud ocupacional de recicladores informales de Lima, Perú / A cross-sectional study on the environmental culture and occupational health of informal waste pickers in Lima, Peru

OBJETIVOS: Determinar el nivel de cultura ambiental de los recicladores del sector informal y el cumplimiento de los estándares de salud ocupacional de los recicladores informales. OBJETIVOS ESPECÍFICOS: conocer la relación entre el nivel de cultura ambiental y cumplimiento de los estándares de salud ocupacional: exposición a los agentes físicos, químicos, biológicos y ergonómicos en los recicladores informales en 2019. METODOLOGÍA: Estudio cuantitativo, correlacional, corte transversal y no experimental. Participó una muestra de 400 recicladores informales. Se aplicaron dos cuestionarios: cultura ambiental y estándares de salud ocupacional. RESULTADOS: Existe relación entre positiva media y positiva débil entre la variable cultura ambiental y los diferentes agentes (físico, químico, biológico y ergonómico). Existe correlación significativa positiva media, entre la cultura ambiental y la salud ocupacional. Igualmente, existe correlación significativa positiva débil entre la cultura ambiental y los agentes (físico, químico, biológico y ergonómico), y correlación significativa positiva entre cultura ambiental y el agente responsabilidad social. CONCLUSIONES: Los recicladores informales no satisfacen sus necesidades básicas y derechos. El reciclaje informal se caracteriza por inseguridad en su salud ocupacional, por lo que es necesario crear entornos laborales formales y seguros, con prácticas de promoción y prevención sanitaria.

PURPOSE: To determine the level of environmental culture of the informal sector waste pickers and compliance with occupational health standards of informal waste pickers. SPECIFIC OBJETIVES: to explore the relationship between the level of environmental culture and compliance with occupational health standards: exposure to physical, chemical, biological, and ergonomic agents in informal waste pickers in 2019. METHODS: Quantitative, correlational, cross-sectional, and non-experimental study. A sample of 400 informal waste pickers participated. Two questionnaires were applied: environmental culture and occupational health standards. RESULTS: There is a medium positive and weak positive relationship between the environmental culture variable and the different agents (physical, chemical, biological, and ergonomic). There is a significant positive correlation between environmental culture and occupational health. Likewise, there is a weak positive significant correlation between environmental culture and agents (physical, chemical, biological, and ergonomic), and a significant positive correlation between environmental culture and the social responsibility agent. CONCLUSIONS: Informal waste pickers do not have their basic needs and rights met. A lack of occupational health safety characterizes informal recycling, so it is necessary to create formal and safe work environments with health promotion and prevention practices.

Caracterização e quantificação dos resíduos perfurocortantes gerados por diabéticos do município de Umuarama, PR, Brasil / Characterization and quantification of perforating waste generated by diabetics in Umuarama, Paraná, Brazil

Resumo A pesquisa teve como objetivo caracterizar e quantificar os resíduos perfurocortantes produzidos no domicílio de pessoas com diabetes mellitus (DM), bem como analisar as práticas de descarte desse material. A coleta de dados foi realizada por meio de um questionário aplicado aos pacientes da Atenção Primária. A amostra foi composta por 149 pessoas, das quais a maioria era idosa e com baixo nível de escolaridade. No que tange à geração dos resíduos, 88,64% dos depoentes atestaram utilizar uma seringa por dia, realizando de 1 a 4 aplicações. O reuso do material foi relatado por 66,67% dos investigados. Depois de utilizados, os resíduos eram armazenados - com maior prevalência - em sacolas plásticas (20,80%), garrafas PET, frascos de amaciante/maionese, etc. (46,98%). O lixo doméstico comum foi o principal local de descarte dos perfurocortantes. Ademais, verificou que aqueles que não receberam informações sobre o manejo dos resíduos os desprezam de maneira incorreta. Diante dos resultados, pode-se concluir que os diabéticos que participaram desse estudo possuem práticas inadequadas de acondicionamento e descarte dos perfurocortantes em decorrência da ausência de orientações e de programas públicos.

Abstract The scope of this research was to characterize and quantify the perforating waste produced domestically by people with diabetes mellitus (DM), as well as to analyze the discard and disposal practices for these materials. The data collection was performed through a questionnaire applied to primary care patients. The sample consisted of 149 people, the majority of whom were elderly and with a low level of schooling. Regarding the generation of waste, 88.64% of the deponents declared the use of one syringe per day, performing 1 to 4 applications. The reuse of the material was reported by 66.67% of the declarants. After being used, the waste was stored - with higher prevalence - in plastic bags (20.8%), plastic bottles, clothes softener and mayonnaise containers, etc. (46.98%). Ordinary household waste was the main disposal site for the perforating waste. Furthermore, it was revealed that those people who did not receive instructions regarding appropriate waste disposal discarded their waste incorrectly. Based on the results, the conclusion drawn is that the diabetics who participated in this study fail to discard and dispose of the perforating waste appropriately due to the lack of adequate guidelines and public programs.

Estoque e descarte de medicamentos no domicílio: uma revisão sistemática / Storage and disposal of pharmaceuticals at home: a systematic review

Resumo Este estudo teve como objetivo analisar a evidência científica nacional e internacional existente sobre o motivo do estoque e a forma de descarte dos medicamentos no domicílio. Realizou-se uma revisão sistemática da literatura de 2001 a 2016 nas bases de dados PubMed, Lilacs e Elsevier's Scopus Database, utilizando os seguintes unitermos: "Disposal of medicines in household", "Disposal of expired drugs", "Residential expired drugs", "Management of expired medications in household". Foram selecionados 33 estudos originais após aplicação dos critérios de inclusão e exclusão. Os estudos analisados demonstraram que os principais motivos de estoque no domicílio foram: automedicação; guarda para uso futuro e sobras de tratamentos anteriores. E quanto ao descarte dos medicamentos, prevalecem práticas inadequadas, como descarte no lixo comum e na rede de esgoto. Alguns países têm adotado programas de orientação sobre o armazenamento e o descarte correto, no entanto, foi apenas encontrado um estudo que descreve um programa nacional gratuito, para orientar essas práticas. A partir das evidências cientificas verificou-se a importância do incentivo para a elaboração e a implementação de políticas públicas voltadas para o uso e descarte adequado de medicamentos no domicílio.

Abstract This study's objective was to analyze Brazilian and international scientific evidence on the reasons people store medication at home and the disposal methods used. This systematic literature review includes studies published from 2001 to 2016 and indexed in PubMed, Lilacs and Elsevier's Scopus Database, using the following key words: Disposal of medicines in household, Disposal of drugs expired, Residential expired drugs, Management of expired medications in household. Thirty-three studies were selected after applying inclusion and exclusion criteria. The studies reveal that the main reasons people keep a stock of medicines at home include the possibility of future use, leftovers from previous treatments, and self-medication. Inappropriate disposal methods prevail, such as throwing medicines in the household trash or flushing them into the sewer. Some countries have adopted programs to educate on proper storage and disposal of medicines, though only one study describes a national program guiding these practices that is free of charge. Evidence shows there is a need to implement public policies intended to provide guidance on the proper storage and disposal of medicines at home.

Crop residues activity against the free-living stages of small ruminant nematodes / Atividade de resíduos de culturas contra os estágios de vida livre de nematoides de pequenos ruminantes

Abstract The nematicidal effect of different organic materials was evaluated in order to develop a non-chemical alternative soil treatment for control of the free-living stages of small ruminant gastrointestinal nematodes. The selected organic materials were residues from the juice industry of acerola, cashew, grape, guava, papaya and pineapple, as well as castor residue from the biodiesel industry. LC90 results showed that pineapple residue was the most efficient inhibitor of larval development, followed by castor, grape, cashew, acerola, guava and papaya. Castor residue was also a good source of nitrogen and was used in a greenhouse experiment to prevent larval development in contaminated goat faeces that was deposited in pots containing the grasses Brachiaria brizantha (var. Paiaguás) or Megathyrsus maximus x M. infestum (var. Massai). Castor residue caused a significant (P < 0.05) reduction (85.04%) in Paiaguás grass contamination (L3.dry mass-1) and a reduction of 17.35% in Massai grass contamination (P > 0.05), with an increase in the biomass production of Massai (251.43%, P < 0.05) and Paiaguás (109.19%, P > 0.05) grasses. This strategy, called Econemat®, with good results in vitro shows to be promising on pasture increasing phytomass production.

Resumo O efeito nematicida de diferentes materiais orgânicos foi avaliado, com o objetivo de desenvolver um tratamento alternativo não químico do solo para o controle dos estágios de vida livre de nematoides gastrintestinais de pequenos ruminantes. Os materiais orgânicos selecionados foram resíduos da indústria de suco de acerola, caju, uva, goiaba, mamão e abacaxi, além do resíduo de mamona da indústria de biodiesel. Os resultados da LC90 mostraram que o resíduo de abacaxi foi o mais eficiente inibidor do desenvolvimento larval, seguido pela mamona, uva, caju, acerola, goiaba e mamão. O resíduo de mamona também se mostrou uma boa fonte de nitrogênio, sendo usado em experimento em casa de vegetação para prevenir o desenvolvimento larval em fezes contaminadas, depositadas em vasos, contendo as gramíneas Brachiaria brizantha (var. Paiaguás) ou Megathyrsus maximus x M. infestum (var. Massai). O resíduo de mamona reduziu (85,04%) significativamente (P < 0,05) a contaminação no capim-Paiaguás (L3.dry massa-1), 17,35% no capim Massai (P> 0,05), e aumentou a produção de biomassa das gramíneas Massai (251,43%, P <0,05) e Paiaguás (109,19%, P> 0,05). Essa estratégia, chamada Econemat®, com bons resultados in vitro, mostra-se promissora nas pastagens aumentando a produção de fitomassa.

Casos de dengue e coleta de lixo urbano: um estudo na Cidade do Recife, Brasil / Cases of dengue and urban waste collection: a study in the City of Recife

Resumo O objetivo desse estudo foi identificar quais categorias de lixo urbano apresentam associação com casos de dengue e, em seguida, avaliar o impacto da coleta de lixo sobre os casos da doença na cidade do Recife. Foram utilizados dados da pesagem categorizada de lixo, juntamente com os casos confirmados de dengue no município. Os dados foram analisados através do coeficiente de correlação de Pearson para as treze categorias de lixo, seguido pela Regressão Linear Multivariada, selecionando as variáveis pelo método de "stepwise". Identificou-se a existência de correlação negativa entre o total de casos de dengue em sete categorias: lixo domiciliar (r = -0,835), resíduos diferenciados (r = -0,835), resíduos de operações especiais (r = -0,711), entulhos (r = -0,687), coleta seletiva (r = -0,425) e pneus (r = -0,423). O modelo de regressão foi capaz de explicar 75% da variação, apontando que um incremento de 1.000 toneladas na coleta de lixo doméstico proporciona uma redução de 0,032 casos de dengue enquanto que o mesmo incremento na coleta de pneus é capaz de reduzir 0,465 casos da doença. Os resultados demonstram que a coleta de lixo possui um forte impacto negativo nos casos de dengue e podem ser adotados como estratégia de prevenção pelos governos municipais.

Abstract The scope of this study was to identify which categories of urban waste are associated with cases of dengue and to evaluate the impact of garbage collection on dengue infection in the City of Recife (Brazil). Data from categorized waste weighing and the confirmed cases of dengue in the city were used. The data were analyzed using Pearson's correlation coefficient for the 13 categories of urban garbage, followed by Multivariate Linear Regression, selecting the variables by the stepwise method. A negative correlation between dengue infections in seven categories was identified: household garbage (r = -0.835), differentiated residues (r = -0.835), special operations residues (r = -0.711), building rubble (r = -0.687), selective waste collection (r = -0.425) and tires (r = -0.423). The regression model was able to explain 75% of the variation, indicating that an increase of 1,000 tons in household garbage collection provides a decrease of 0.032 in cases of dengue, while the same increase in tire collection esults in a decrease of 0.465. The results show that garbage collection has a strong negative impact on dengue cases and can be adopted as a prevention strategy by municipal governments.

Conhecimento e comportamento autorreferidos sobre descarte domiciliar de medicamentos / Authorreferated knowledge and behavior on disposal of domiciliary medicines / Conocimiento y comportamiento autorreferidos sobre descarte domiciliar de medicamentos

Objetivo: Analisar o conhecimento e comportamento autorreferidos sobre o descarte domiciliar de medicamentos. Método: Estudo transversal tipo survey, com dados coletados por meio de um questionário em maio de 2017, na cidade de Picos­PI, com amostra de 153 residências. Resultados: Sobre o conhecimento autorreferido, apesar de 139 (90,8%) afirmarem ter ciência sobre o risco ambiental, 144 (94,1%) relataram não ter conhecimento sobre local adequado de realizar o descarte,104 (68,0%) admitiram que o modo como descarta os medicamentos no ambiente traz algum risco individual e 118 (77,1%) perceberam a existência de risco coletivo. Quanto ao comportamento, 107 (69,9%) afirmaram já ter descartado medicamento devido ao fato do prazo de validade vencido, e a maioria afirmou realizar o descarte dentro da embalagem original e no lixo doméstico, 124 (81,0%). Conclusão: O conhecimento e comportamento autorreferidos demonstram fragilidades que comprometem a saúde pública e ambiental

Objective: To analyze the self-reported knowledge and behavior on the disposal of medicines. Method: A cross-sectional study with data collected through a questionnaire in May 2017, in the city of Picos-PI, with a sample of 153 residences. Results: Regarding the selfreported knowledge, 139 (90.8%) stated that they had knowledge about environmental risk, 144 (94.1%) reported having no knowledge of the appropriate disposal site. 104 (68.0%) admit that the way they dispose of medicines in the environment poses some individual risk and 118 (77.1%) perceive the existence of a collective risk. Regarding the behavior, 107 (69.9%) stated that they had discarded medication due to the fact that the expiration date had expired, and the majority stated that they disposed of 124 (81.0%) in the original packaging and household waste. Conclusion: Self-reported knowledge and behavior demonstrate fragilities that compromise public and environmental health

Objetivo: Analizar el conocimiento y el comportamiento autorreferidos sobre el descarte domiciliar de medicamentos. Método: Estudio transversal tipo survey, con datos recogidos por medio de un cuestionario en mayo de 2017, en la ciudad de Picos-PI, con muestra de 153 residencias. Resultados: Sobre el conocimiento autorreferido a pesar de 139 (90,8%) afirmar tener ciencia sobre el riesgo ambiental, 144 (94,1%) relató no tener conocimiento sobre el lugar adecuado de realizar el descarte. (68,0%) admite que el modo en que descarta los medicamentos en el ambiente trae algún riesgo individual y 118 (77,1%) percibe la existencia de riesgo colectivo. En cuanto al comportamiento, 107 (69,9%) afirmaron ya haber descartado medicamento debido al hecho del plazo de validez vencido, y la mayoría afirmó realizar el descarte dentro del embalaje original y en la basura doméstica, 124 (81,0%). Conclusión: El conocimiento y comportamiento autorreferidos demuestran fragilidades que comprometen la salud pública y ambiental

Biosurfactant Production by Bacillus strains isolated from sugar cane mill wastewaters

Abstract Biosurfactants possess diverse chemical properties and provide important characteristics to the producing microorganisms, which can act as surface-actives and emulsifiers of hydrocarbon and others water insoluble substances. Most of them are lipopeptides synthetized by Bacillus. This study evaluated the biosurfactant production by strains of Bacillus previously obtained from liquid residues of sugar-alcohol industry. The bacterial isolates LBPMA: BSC, BSD, J1, J2 and L1 were cultivated in medium that induces production of biosurfactants (Landy medium). During 48 h of incubation, at intervals of 12 h, the total contents of proteins, reducing carbohydrates and surfactant activity of the filtrated growth media free of cells were evaluated. The results showed that these strains use glucose as a source of carbon, energy and for synthesis of surfactant. In this medium (24 h), the best producer of biosurfactant was the strain LBPMA-J2, molecularly identified as Bacillus thuringiensis. Once the supernatant free of cells of this microorganism disperses the oil phase in the water, this strain has potential for being utilized on bioremediation processes.

Development of a novel compound microbial agent for degradation of kitchen waste

Abstract Large quantities of kitchen waste are produced in modern society and its disposal poses serious environmental and social problems. The aim of this study was to isolate degradative strains from kitchen waste and to develop a novel and effective microbial agent. One hundred and four strains were isolated from kitchen waste and the 84 dominant strains were used to inoculate protein-, starch-, fat- and cellulose-containing media for detecting their degradability. Twelve dominant strains of various species with high degradability (eight bacteria, one actinomycetes and three fungi) were selected to develop a compound microbial agent "YH" and five strains of these species including H7 (Brevibacterium epidermidis), A3 (Paenibacillus polymyxa), E3 (Aspergillus japonicus), F9 (Aspergillus versicolor) and A5 (Penicillium digitatum), were new for kitchen waste degradation. YH was compared with three commercial microbial agents-"Tiangeng" (TG), "Yilezai" (YLZ) and Effective Microorganisms (EM), by their effects on reduction, maturity and deodorization. The results showed that YH exerted the greatest efficacy on mass loss which decreased about 65.87% after 14 days. The agent inhibited NH3 and H2S emissions significantly during composting process. The concentration of NH3 decreased from 7.1 to 3.2 ppm and that of H2S reduced from 0.7 to 0.2 ppm. Moreover, E4/E6 (Extinction value460nm/Extinction value665nm) of YH decreased from 2.51 to 1.31, which meant YH had an obvious maturity effect. These results highlighted the potential application of YH in composting kitchen waste.

Green conversion of municipal solid wastes into fuels and chemicals

Presently, the society is facing a serious challenge for the effective management of the increasing amount of produced municipal solid wastes. The accumulated waste has caused a series of environmental problems such as uncontrolled release of greenhouse gases. Moreover, the increasing amount of wastes has resulted in a shortage of areas available for waste disposal, resulting in a nonsustainable waste management. These problems led to serious public concerns, which in turn resulted in political actions aiming to reduce the amount of wastes reaching the environment. These actions aim to promote sustainable waste management solutions. The main objective of these policies is to promote the recycling of municipal solid waste and the conversion of waste to energy and valuable chemicals. These conversions can be performed using either biological (e.g., anaerobic digestion) or thermochemical processes (e.g., pyrolysis). Research efforts during the last years have been fruitful, and many publications demonstrated the effective conversation of municipal solid waste to energy and chemicals. These processes are discussed in the current review article together with the change of the waste policy that was implemented in the EU during the last years.

[Audit on the quality of school vaccination in the region of Monastir [Tunisia]]

We conducted a clinical audit by observing 55 vaccinators in schools in the governorate of Monastir in 2014. We used a set of criteria by referring to the national immunization programme. The cold chain was respected in most cases. Accumulators, the collector of syringes and needles, cotton balls soaked in alcohol and emergency box were available in 85.5%, 76.4%, 98.2% and 41.8% of cases respectively. Hand washing before immunization session was performed in 29.1% of cases. Waste disposal according to the hygiene rules was done by 40 agents. Health education of students regarding the interest of vaccination was done in 67.3% of cases. Therefore, improvements in hand hygiene practice and education are recommended

Use of performance indicators to assess the solid waste management of health services

ABSTRACT Modern society faces serious challenges, among them, the complexity of environmental problems. Thus, there are several possible sources of environmental degradation, however, the waste produced by health services have an important peculiarity due to its toxic or pathogenic characteristics, since when managed improperly provide also health risk public. The involvement of solid waste from healthcare services environmental impact integrates matters a little more complex, because in addition to environmental health, they also interfere with the healthiness of environments that generate, with the consequences of nosocomial infections, occupational health and public. Thus, the management has become an urgent need, especially when we see no use of performance indicators management in healthcare environments in the city of São Mateus, ES. For this, we used the Analytic Hierarchy Process Method to prioritize such indicators as the potential improvement in health services waste management process - WHS and thus environmental analysis was performed with the use of a template for SWOT analysis. The results showed that the performance indicator training strategies developed with employees has the greatest potential to assist in improvements in WHS (Health Services Waste) management process followed indicator knowledge of the regulations associated with procedures performed by employees and importance of biosafety regulations.

Management of “SHARPS” Wastes in Manila Hospitals (Part 3) Off -Site Management of Hazardous Healthcare Wastes in Six Tertiary Hospitals in South Manila, Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The aim of this study was to determine if the collection, treatment and final disposal of hospital hazardous wastes conform to the rules and regulations and standards set by the Philippine Government and the World Health Organization (WHO). <br /><strong>METHODS:</strong> Three private and three government tertiary hospitals located in South Manila were randomly chosen and the companies that provides them with hospital waste disposal services were asked to participate in the study to validate their conformity to the national and international hazardous waste disposal standards. Validation was done through the use of observer checklists and photographs.<br /><strong>RESULTS:</strong> Results of the study showed that there were four companies who services 6 selected hospitals included in the study. All of these conformed to the standards of the World Health Organization, and to rules and regulations as set by the Philippine government. All of the companies conformed as to standards for Legal Permits, Off-site Transport, Personal Protective Devices and Off-Site Waste Disposal.<br /><strong>CONCLUSION:</strong> All of the companies servicing the 6 selected hospitals conformed to the standards set by WHO and the Philippine government.</p>

Conhecimentos, atitudes e práticas dos profissionais de saúdes obre o gerenciamento de resíduos farmacêuticos e o risco ambiental: um estudo de caso em uma unidade hospitalar / Knowledge, attitudes and practices of health professionals on the management of pharmaceutical waste and environmental risk: a case study in a hospital

Introdução: Os resíduos farmacêuticos são aqueles contendo produtos farmacêuticos como,por exemplo: medicamentos vencidos ou que não necessitam mais serem utilizados,englobando também os itens contaminados ou contendo medicamentos, como ampolas,seringas, frascos etc., sendo caracterizados como resíduos perigosos dos serviços de saúde. As práticas de descarte dos resíduos farmacêuticos, combinadas com a excreção fisiológica dos fármacos e seus metabólitos, podem favorecer a incorporação de substâncias com atividade farmacológica em especial na cadeia trófica aquática. O desconhecimento ou a falta de informações sobre o correto gerenciamento dos resíduos farmacêuticos em serviços de saúde faz com que em muitos casos estes resíduos sejam ignorados, com consequências ainda incertas na saúde pública e no meio ambiente, ou recebam um tratamento com excesso de zelo, onerando os recursos das instituições de saúde. Objetivos: Analisar os conhecimentos,atitudes e práticas, bem como a percepção de risco ambiental, em profissionais de saúde de uma realidade hospitalar pública na cidade do Rio de Janeiro frente ao gerenciamento dos resíduos farmacêuticos. Metodologia: Trata-se de estudo exploratório, com aplicação de questionário auto preenchido em profissionais das classes médica, enfermagem e farmácia, de níveis superior e técnico, e visita observacional às áreas de atenção da instituição com aplicação de lista de verificação. A amostra foi composta por 313 profissionais de saúde e a visita foi realizada em cinco locais de diferentes áreas de atenção. Foram calculados indicadores compostos relacionados aos aspectos avaliados com o questionário. Resultados: Observou-se baixo nível de conhecimento relacionado ao gerenciamento dos resíduos farmacêuticos, além de atitudes e práticas inadequadas de gerenciamento destes resíduos nos locais geradores, principalmente devido às deficiências na etapa de segregação dos resíduos farmacêuticos e dúvidas quanto à adequação dos métodos de descarte disponíveis nos locais de trabalho. Apesar da percepção de risco ambiental relacionada aos resíduos farmacêuticos mostrar-se alta entre os profissionais participantes, observaram-se diferenças nas opiniões acerca do risco ambiental entre diferentes classes terapêuticas de medicamentos. A falta de procedimentos e instruções para o descarte ou devolução de resíduos farmacêuticos foi evidenciada durante as visitas observacionais. Foram sugeridos pelos profissionais entrevistados material educativo, treinamento e elaboração de rotinas para o descarte dos resíduos farmacêuticos, para minimizar o possível risco ambiental. Conclusões: Há necessidade de capacitação e educação sobre o tema, além de melhorias na infraestrutura nos locais geradores de resíduos farmacêuticos, com definição de procedimentos para o gerenciamento mais adequado destes resíduos, contribuindo assim para o cumprimento efetivo do plano de gerenciamento de resíduos da instituição e diminuição dos riscos ao meio ambiente.

Introduction: Pharmaceutical waste are expired or no longer needed medications, also including items contaminated by or containing pharmaceuticals such as ampoules, syringesand vials. This type of waste is regarded as a hazardous medical waste and may pose a varietyof environmental and health risks. Disposal practices for pharmaceutical products, combinedwith the physiological excretion of drugs and their metabolites, may favour the incorporationof substances with pharmacological activity especially in the aquatic food chain. Lack of information on the correct and safe management of pharmaceutical waste in health care services may cause adverse consequences on public health and the environment, also burdening the resources of health institutions by overzealous treatment. Objectives: The main objective of this investigation is to evaluate the knowledge, attitudes, practices and perception of environmental risk of the disposal of pharmaceutical waste, in health care professionals of apublic tertiary hospital in Rio de Janeiro. Methodology: This is an exploratory study using aself-administered questionnaire to doctors, nurses, pharmacists and their technical staff, and observational visits with checklist. Indicators for the questionnaire aspects (knowledge, attitudes and practices, risk perception) were calculated. Results: Three hundred and thirteen healthcare professionals answered the questionnaire. There were low scores of knowled gerelated to the management of pharmaceutical waste, as well as in attitudes and practicesscores, mainly due to deficiencies in waste separation, and doubts about the suitability of disposal methods available in the workplace. Despite the high scores on perception of environmental risk indicator, there were differences in opinions about the environmental risk between different therapeutic classes of drugs. In the open-ended question, the respondents suggested actions concerning increasing information, training, educating and policies towards disposing pharmaceutical wastes to minimise the risk. Observational visits were conducted atfive different areas of attention and have shown that there is a lack of procedures and instructions for disposal or return of pharmaceutical waste. Conclusions: These findings suggest that there is need for training and education on the topic, as well as improvements in infrastructure of waste generators locations and defining procedures for the appropriate management of pharmaceutical waste, thus contributing to the effective implementation of the institutional hospital waste management plan and reducing risks to the environment.

Manejo de resíduos em uma unidade de alimentação e nutrição

A Unidade de Alimentação e Nutrição (UAN) é responsável pela geração de uma grande quantidade de resíduos. A coleta seletiva e a reciclagem têm um papel muito importante para o meio ambiente; já o risco de contaminação exige atenção redobrada dos manipuladores. Este estudo teve como objetivo avaliar a coleta seletiva, as condições estruturais, de manejo e de armazenamento dos resíduos. Foi aplicado um checklist elaborado a partir do Manual de Boas Práticas da empresa, baseado na legislação vigente (RDC 216 de setembro de 2004), por meio do qual foram verificadas as conformidades e não conformidades. Dos 14 itens avaliados, obteve-se um índice de 21,4% de não conformidades. Conclui-se que a UAN avaliada apresentou algumas não conformidades, porém pequenas intervenções resolveriam as inadequações.

The Food Service is responsible for generating a large amount of waste. The separate collection and recycling have a very important role for the environment; although the risk of contamination requires special attention of the handlers. This study aimed to evaluate the selective collection, the structural conditions, management and waste storage. A checklist made from the company' s Best Practice Manual was applied, based on the current legislation (RDC 216, September 2004), wherewith the conformities and non-conformities were found. Of the 14 items evaluated was obtained an index of 21.4% of non-compliance. Concludes that the Unit assessed presented some non-conformities, however small interventions solve the inadequacies.

Orientações sobre o descarte de resíduos gerados em domicílios de usuários de insulina / Directrices para la eliminción de residues generados en los hogares de los usuarios de insulina / Orientations about disposal of waste generated in residences by insulin users

O objetivo deste estudo foi identificar os tipos de orientação recebidas por usuários de insulina quanto ao descarte de resíduos gerados pelo uso desse medicamento e monitoramento glicêmico em seus domicílios. Esta pesquisa, de caráter descritivo exploratório, foi realizada em um Núcleo de Saúde da Família de Ribeirão Preto(SP), Brasil. Participaram do estudo 26 usuários de insulina, os dados foram coletados durante o mês de julho de 2010 e, posteriormente, foram analisados por meio da estatística descritiva. Verificou-se que 61,5% (16) dos entrevistados recebeu orientação sobre o descarte dos resíduos gerados. Desses sujeitos, 62,6% (10) foram orientados a descartar as seringas e agulhas em recipientes plásticos e encaminhá-los para o serviço de saúde que frequentam. Quanto ao descarte das fitas reagentes e frascos de insulina, respectivamente, 56,2% (9) e 75,2% (12) participantes afirmaram não ter recebido nenhum tipo de orientação. No que se refere à origem das orientações, 12,6% (6) dos participantes foram orientados por funcionários da farmácia pública. Considera-se, com este estudo, a importância da implantação de um protocolo sobre o manejo de resíduos do serviço de saúde em domicílio para direcionar as ações e orientações aos usuários de insulina.

The aim of this study was to identify the type of guidance received by insulin users regarding the disposal of waste generated by the use of that substance and glucose monitoring at their homes. This research employed the descriptive and exploratory methodologies. The research was conducted in a Family Health Center of Ribeirão Preto, in the state of São Paulo. It included 26 insulin users. Data was collected during the month of July, in 2010, and were subsequently analyzed through a descriptive statistics method. We found out that 61.5% (16) of the respondents received some type of guidance on how to dispose the waste generated. Out of this population, 62.6% (10) were instructed to dispose syringes and needles in plastic containers and send them to the health center that they are used to attend. For the disposal of reagent strips and insulin vials, respectively 56.2% (9) and 75.2% (12) of the participants said that they had not received any guidance. Regarding the source of the guidelines, 12.6% (6) of the participants were instructed by officials of the public drugstore. We took into account, in this study, the importance of the implementation of a protocol on how to properly handle medical waste at home, in order to direct the actions and guidelines for insulin users.

El objetivo de este estudio fue identificar los tipos de orientación recibida por los usuarios de insulina sobre la eliminación de residuos generados por el uso de eses fármacos y de la vigilancia a la insulina y la glucosa en sus hogares. Esta investigación, estudio descriptivo y exploratorio, se llevó a cabo en un Centro de Salud Familiar de Ribeirão Preto (SP), Brasil. En el estudio participaron 26 usuarios de insulina, se recogieron datos durante el mes de julio de 2010, y se analizaron posteriormente por estadística descriptiva. Se verificó que el 61,5% (16) de los encuestados han recibido algún tipo de orientación sobre la eliminación de residuos generados. De ellos, el 62,6% (10) fueron instruidos para desechar las jeringas y agujas en envases de plástico y remitirlos a los servicios de salud que les asisten. Para la eliminación de las tiras reactivas y los frascos de insulina, respectivamente, el 56,2% (9) y el 75,2% (12) de los participantes dijeron que no habían recibido ningún tipo de orientación. En cuanto al origen de las directrices, el 12,6% (6) de participantes dijeron funcionarios de droguería abierta al público. Se considera, con este estudio, la importancia de la aplicación de un protocolo sobre el manejo de residuos de los servicios de salud en domicilio para dirigir las acciones y directrices para los usuarios de insulina.

Diagnóstico da situação do saneamento no perímetro urbano da cidade de Timon, MA / Diagnosis of the sanitation situation in the urban area of the city of Timon, MA

A gestão do saneamento no Brasil enfrenta desafios, sobretudo pelo fato do crescimento populacional e urbano não serem levados em conta, influenciando direta ou indiretamente na manifestação dos problemas ambientais. A avaliação da combinação entre a universalização do acesso ao saneamento e a realidade encontrada através de um diagnóstico in situ, pode contribuir para levantamento de indicadores precisos sobre as vulnerabilidades regionais. O diagnóstico da situação do saneamento no perímetro urbano da cidade de Timon no estado do Maranhão, foi realizado para contribuir com informações que ofereçam base para tomadas de decisões da gestão pública. O levantamento das informações deu-se em uma amostra com 313 domicílios localizados no perímetro urbano da cidade. Para a determinação da quantidade e localização dos domicílios, inicialmente realizou-se uma avaliação do espaço geográfico da cidade, mapeamento e reconhecimento dos bairros, ressaltando características como área e vias de acesso, dividindo-o em quatro macrorregiões. Utilizou-se inquérito auto relatado, para levantamento de informações socioeconômicas, sobre o provimento e utilização da água, esgotos e descarte de resíduos domiciliares. As análises consistiram de dados da cidade como um todo, sendo construído um banco de dados no Programa Tabwin, que permitiu o cruzamento destes e a realização de análises estatísticas. Observou-se que mais de 61 por cento da população armazena água nos domicílios, sobretudo na MRS e MRO. 5 por cento da população não possui banheiro dentro do domicílio, refletindo riscos por destinação incorreta dos excretas. Ainda, 11 por cento dos domicílios, afirmaram despejar dejetos do vaso em rede pública, sem tratamento algum, não passando por fossas sépticas, sendo despejados em sumidouros, podendo contaminar calçadas e locais de passagem de pedestres. O volume de lixo informado pelos domicílios abordados, demonstra: uma grande quantidade de resíduos sendo descartado; resíduos sendo descartados sem coleta; resíduos coletados em períodos errados. A gestão pública municipal deve permanecer vigilante, principalmente na MRN e na MRO. O levantamento de dados a respeito da coleta de resíduos sólidos domiciliares demostrou que 17 por cento dos domicílios não possuem coleta de resíduos pela companhia de coleta de lixo. Os dados levantados apontam para a necessidade da população por maiores informações sobre condutas corretas de higiene e que a gestão pública necessita ampliar o sistema de saneamento; bem como proporcionar uma coleta de resíduos sólidos adequada para a demanda de descarte atual da população.

Sanitation management in Brazil faces challenges, mainly because the population and urban growth are not taken into account, which influences directly or indirectly in the demonstration of environmental problems. The evaluation of the combination of universal access to sanitation and the reality found through diagnosis in situ, can contribute to raising precise indicators on regional vulnerabilities. The diagnosis of the sanitation situation in the urban area of the city of Timon in the state of Maranhão, was undertaken to contribute information that provides the basis for decision-making in public administration. The gathering of information took place in a sample of 313 households located in the urban area of the city. To determine the number and location of households, there was initially held an assessment of the geographic area of the city, mapping and recognition of neighborhoods, highlighting features such as area and access roads, dividing it into four geographical regions. We used self-reported survey to survey of socio-economic information on the provision and use of water, sewage and disposal of household waste. The analysis consisted of city data as a whole, and a database was built in the program, TabWin, which allowed the crossing of these and performing statistical analyses. It was observed that over 61 percent of the population stores water in theirn households, particularly in MRS and MRO. Five percent of the population does not have a bathroom inside the home, reflecting the risks of improper disposal of excreta. Still, 11 percent of households said there was untreated vessel dump waste in public, not going through septic tanks being dumped into sinks and contaminate sidewalks and pedestrian crossing locations. (...) The volume of waste reported by households covered shows the following: a large amount of waste being disposed of; waste being discarded without collection; waste collected in the wrong periods. The municipal public administration must remain vigilant, particularly in MRN and MRO. The survey data regarding the collection of household solid waste has shown that 17 percent of households have no waste collection by the garbage collection company. The data obtained point to the population’s need for more information concerning correct hygiene conduct. Public management needs to expand sanitation systems; as well as providing a collection of adequate solid waste disposal for the current demand of the population.