The global distribution of epidemiological studies involving waste pickers: A systematic review.

Waste pickers, who work with the collection of recyclable materials in search of a source of income, are subject to various risks and diseases that are very well researched. The aim of this systematic review was therefore to identify and analyze the results of epidemiological research on waste pickers over the last 20 years as well as to investigate the geographical distribution and quality of these studies. The studies were selected from the literature by creating search keys with representative keywords in different databases. This systematic review exceptionally includes research qualified according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. In total, 61 epidemiological studies with waste pickers were found in 15 different countries, with the largest number of studies carried out in the American continent compared to the African and Asian, respectively. Regarding the quality, 91.80 % were classified as excellent and 8.20 % as good. Although the results show a significant number of epidemiological studies with waste pickers, demonstrating scientific evidence, that there is still a lack of research focusing on waste pickers in different work scenarios, from different health perspectives and in different parts of the world, and it is not possible to highlight the trends in health research for this profession.

A qualitative study understanding immigrant Latinas, violence, and available mental health care.

Women from Latin American countries experience high levels of psychological and physical abuse and violence. Immigrant Latina women are often subjected to a patriarchal system in both family and government, which has resulted in a variety of complex and far-reaching outcomes. This qualitative study sought to understand the experiences of immigrant Latina women who were exposed to violence, as well as their access to mental health care. This study used 20 interviews with immigrant Latina women from El Salvador, Guatemala, and Mexico who had accessed mental health services in California. The primary themes that emerged from analysis of the data included motivating factors for seeking services (e.g., motherhood, community, hope, and mental health needs), barriers to accessing services (e.g., fatalism, marianismo, stigma, finances, language barriers, threats, abuse, and systemic insensitivity), and treatment and solutions (e.g., empathy, advocacy, and community approaches). These results appeared to be indicative of the importance of addressing sociopolitical, historical, and cultural trauma as an imperative component of effective treatment. In this context, the authors explore liberation psychology, a concept and approach that promotes social justice values and emphasizes the empowerment of immigrant Latina women in clinical practice. It is recommended that the historical sociocultural abuse of immigrant Latina women be thoughtfully considered and discussed in the therapeutic process to create lasting psychological change. Future research, policy efforts, and program development, including psychotherapeutic treatment modalities, should focus specifically on marginalized groups facing barriers to mental health care in order to increase access and effectiveness of treatment.

Healthcare waste generation in hospitals per continent: a systematic review.

There are increasing worldwide concerns about the negative impacts of healthcare waste generated in hospitals, especially in low- and middle-income countries. Hazardous type of waste can contribute to adverse effects both in human populations and the environment because of its physical, chemical, and biological characteristics. A comprehensive view on increasing waste in the world has not been conducted to understand the breadth of the issue; thus, this paper sought to provide an analysis of hospitals' healthcare waste generation rate. Comparisons were made with Wilcoxon and Kruskal-Wallis tests for simple and multiple comparisons, to analyze nonparametric data, with post hoc by Nemenyi test. Median values indicated that hospital waste was the highest in North and South America (4.42, 1.64 kg/bed/day, respectively) and was almost nonexistent in Oceania (0.19 kg/bed/day), while the median rates for hazardous waste were the highest in Oceania (0.77 kg/bed/day). Africa was almost the lowest producer of waste in each category (0.19 and 0.39 kg/bed/day for hospital and hazardous waste, respectively). Over time, linear regression indicated that hazardous waste in Asia and Europe has increased, while in Oceania, the total waste also increased. Interestingly, in North America, it was observed a reduction in the generation for both total and hazardous waste. This information highlights the importance of understanding continent-specific characteristics and rates, which can be used to create a more individualized approach to addressing healthcare waste in the world.

Understanding mental health outcomes related to compassion fatigue in parents of children diagnosed with intellectual disability.

BACKGROUND: Parenting a child diagnosed with intellectual disability includes a variety of stressors. The degree to which stress affects these parents has been given little emphasis. Compassion fatigue includes experiencing an emotional response to being unable to relieve the suffering of a loved one, burnout, strain and stress on the caregiver. Compassion fatigue develops in parents of children diagnosed with intellectual disability due to their caregiving roles. METHOD: A phenomenological qualitative study was conducted using 25 semi-structured interviews to understand the mental health outcomes of parents caring for a child diagnosed with intellectual disability. RESULTS: The results showed that initial emotional reactions after receiving their child's diagnosis was a combination of anxiety, depression and compassion satisfaction. This study's findings suggest that parents of children diagnosed with intellectual disability experience moderate levels of compassion fatigue in the caring of their child. CONCLUSIONS: This research provides evidence that the caregiving of a child diagnosed with intellectual disability comes with a myriad of stressors that can lead to compassion fatigue.

A mixed methods study reviewing consumer experiences for oral health treatment in Medicaid-eligible children in Florida.

OBJECTIVES: Oral health is essential to a person's overall health, well-being, and dignity; unfortunately, dental caries, which can cause pain and difficulty eating, affect approximately 50 percent of children between 6 and 8 years old. This is in part because Medicaid-eligible children face numerous obstacles obtaining dental care. To date, there are 74 million Americans who do not have dental coverage or access to dental services, which is strongly associated with race, class, gender, and ethnicity. The objective of this research was to identify barriers to accessing and utilizing children's Medicaid oral health care and services, to evaluate care delivery and quality, and to assist in establishing a more consumer-driven approach. METHODS: A mixed methods study was conducted throughout the state of Florida, using qualitative and quantitative data collection to seek answers to these questions. There were 422 surveys and 39 interviews distributed to Medicaid-eligible families and individuals across the state; data collection focused on experiences with oral health care, gaps in current access to Medicaid dental care, and concerns when utilizing care. RESULTS: Our study shows the majority of barriers parents face when accessing Medicaid oral health care are due to logistical access issues, such as cost, appointment wait-times, and confusion surrounding which dental providers accept specific insurance plans. The findings also highlight how location, race, language, and ethnicity impact families who lack preventive dental health services access and how, in turn, families view their own access to dental services. CONCLUSION: Ultimately, there exists an avenue to implement programs and policies that address existing disparities in oral health to improve health outcomes by increasing access to care and reducing cultural and socioeconomic barriers.

Hepatitis B and C prevalence in waste pickers: a global meta-analysis.

BACKGROUND: The objective of this research was to use a meta-analysis to understand the prevalence of hepatitis B or C in waste pickers worldwide. METHODS: Epidemiological studies on hepatitis B and C in waste pickers were included adopting a systematic review with meta-analysis. Each selected article had its quality scored by all authors, evaluated according to the Loney's criteria, and evaluated for quality and bias verified with a funnel plot. RESULTS: After employing Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, there were 12 studies used for this meta-analysis. The rate of hepatitis B seropositivity was 0.15 (95% CI 0.10-0.20), and hepatitis C was 0.08 (95% CI 0.04-0.12). This information suggests that waste pickers are exposed to many risks associated with poor quality of life working conditions as well as low health literacy rates. CONCLUSION: The results of this meta-analysis confirm the vulnerability of waste pickers to hepatitis B and C infection and reinforce the importance of using personal protective equipment and immunizing workers.

Understanding Patient-Provider Interaction, Treatment Acceptance, and Outcomes in Medically Unexplained Symptoms.

INTRODUCTION: Medically unexplained symptoms (MUS) is an umbrella term used for chronic and often disabling health symptoms and conditions that remain unexplained after standard medical examinations, testing, and/or appropriate workup. Patients with MUS tend to receive little to no treatment but remain distressed, stigmatized, and disabled by symptoms and iatrogenic factors. METHODS: A qualitative phenomenological study was conducted to explore daily challenges and psychosocial and iatrogenic factors affecting the management of MUS. RESULTS: The analysis of the interviews revealed that MUS could cause significant distress to patients, impairing their functioning and leading to permanent disability. Conventional healthcare cannot meet the medical needs of these patients and might be a potential source of harm to them. It should be noted that confirmation of conditions associated with clinically significant psychiatric premorbidity was not provided. CONCLUSION: Inconsistent diagnostic criteria, lack of proper training and research, diagnostic overshadowing, and implicit bias in healthcare professionals can lead to negative patient outcomes and the overuse of alternative or non-evidence-based services. Guidance, practice-based improvement ideas, and suggestions specific to improving patient-provider relationships can be applied to generate positive health effects.

Examining Opportunities, Challenges and Quality of Life in International Retirement Migration.

As the world has become more interconnected due to the invention and innovation of communication and transportation technologies, more individuals than ever before have been able to travel long distances. In recent years, a growing number of physically able adults in late adulthood have chosen to move across national borders to less costly countries in order to obtain better quality of life upon reaching retirement age. In light of this under-researched but increasingly popular retirement trajectory, this research aimed to provide more insight into the opportunities and challenges that international retired migrants have encountered while retiring abroad. Through the lens of humanistic theory, this research employed a systematic review of research literature, the majority of which were peer-reviewed studies published within the last five years. The reviewed studies (n = 22) conducted spanned four out of seven continents, with heavy emphasis on Europe, the Americas, and Asia. Research results indicated that many of the international retired migrants took advantage of the opportunities of pleasant weather, lower cost of living, and various amenities offered by their host countries to enhance their quality of life by engaging in an active and meaningful lifestyle. However, language barriers, lack of social support, rising healthcare costs, increases in the cost of living, uncertain political climate, and different healthcare practices in their host countries, presented considerable challenges to many international retirees.

A Scoping Review on Category A Agents as Bioweapons.

Category A agents are biological pathogens that could pose a threat to health and human safety if used as bioweapons. The exploration and possibility of these threats must be comprehensively reviewed to create a preparedness plan to recognize outbreaks, to educate the public, and to offer vaccinations and/or treatment options, if available. A scoping review using PRISMA guidelines was performed to categorize current information on Category A biological agents as well as understand their potential for future threats. The results used 34 articles and found that while botulin neurotoxins were the most lethal, anthrax posed the most likely threat for use as a bioweapon. Most research was conducted on plague, though it is not the most likely threat. Smallpox is the most likely agent to vaccinate against as there is already a working vaccine that has proven effective and the issue at hand is the need for a larger stockpile. Ultimately, preparedness efforts should include vaccinations and continued research and development of them. Category A agents are a serious public health concern; updated and reformed bioterrorism preparedness plans could greatly minimize panic and mortality.

A Qualitative Study on Noncommunicable Diseases in Waste Pickers in Brazil.

BACKGROUND: Noncommunicable chronic diseases are associated with multiple risks factors and negative outcomes that are long-lasting and difficult to treat. Some populations may be at greater risk because of their socioeconomic status, lack of healthcare, environment, and poor work and living conditions. Informal waste pickers may experience higher levels of chronic diseases and often do not have access to care to manage symptoms. OBJECTIVES: The aim of the present study was to understand the prevalence of chronic diseases in waste pickers, along with perceived associated risks and available treatments. METHODS: A qualitative study was conducted, using interviews with 24 waste pickers who worked at Estrutural dumpsite in Brasilia, Brazil which was historically the second largest open-air dumpsite in the world. RESULTS: Participants believed their commonly experienced chronic diseases were a result of working in the open-air dumpsite. Chronic diseases commonly noted in the interviews included hypertension, chronic pain, respiratory disease, diabetes, and kidney problems. Participants discussed self-medication or prescribed medication used to treat their conditions. Most participants had varying beliefs regarding prevention strategies to reduce disease; some ideas for prevention focused on religion, fate, and God when discussing outcomes related to illnesses. When answering questions regarding ideal working conditions to help prevent diseases, participants responded by expressing a desire for protective gear (e.g. PPE) which could help mitigate hazards associated with the dump. CONCLUSIONS: Recyclable collectors were aware of occupational hazards to which they were exposed and associated noncommunicable chronic diseases but lacked education on the importance of preventive measures and access to healthcare services. The findings of the present study confirm the need to strengthen intersectoral actions to protect and uphold the health rights of this vulnerable population. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: This study was approved by the Research and Ethics Committee of the Health School of Brasília University under Opinion n. 1.517.670/2016. COMPETING INTERESTS: The authors declare no competing financial interests.

Likely Exacerbation of Psychological Disorders from Covid-19 Response.

Anxiety and fear felt by people around the world regarding the coronavirus pandemic is real and can be overwhelming, resulting in strong emotional reactions in adults and children. With depressive and anxiety disorders already highly prevalent in the general population (300 million worldwide), depression and/or anxiety specifically because of the pandemic response is likely. Moreover, the current state of panic in the face of uncertainty is apt to produce significant amounts of stress. While this situation has the potential to cause psychological disorders in previously unaffected populations, perhaps more impactful is the exacerbation of symptoms of many existing disorders including anxiety, depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and hoarding disorder.

A systematic review on informal waste picking: Occupational hazards and health outcomes.

Informal waste picking is a common way for people to earn an income, especially in low-income countries; unfortunately, there are various occupational hazards and health outcomes associated with waste picking. This study focused on comprehensively identifying and exploring occupational hazards and health outcomes associated with informal waste picking. A systematic review of available relevant and peer-reviewed literature was completed to exhaustively analyze the full scope of these hazards and outcomes associated with informal waste picking; 58 papers were included. The results from this study provided insight and information related to the most common occupational hazards and negative health outcomes associated with informal waste pickers outlined in available literature. The most common reported occupational hazards were physical (77.6%), social (70.7%), biological (65.5%), chemical and safety (53.4%), ergonomic (34.5%) and mechanic (25.9%). Health outcomes appeared to include epidermal (50.0%), communicable disease (46.6%), musculoskeletal (44.8%), respiratory disease (41.4%), non-communicable diseases (39.7%), physiological (34.5%), gastrointestinal (31.0%) and waterborne diseases (17.2%). Physical hazards were often associated with slips, trips, and falls, which makes sense because of the unstable environment where waste pickers work. Health outcomes related to these hazards included bruises, cuts, and lacerations. This information also aligns with health outcomes, as epidermal outcomes were most reported in waste pickers (50.0% of data). It is clear that moving forward, additional research related to these occupational hazards and health outcomes associated with informal waste picking is needed to help create change in this affected population, as well as finding effective solutions to mitigate these hazards and outcomes. These hazards can be mitigated by simple, common control measures, like providing safety equipment, reducing hazards from the outside environment (e.g., less time in sun, breaks, etc.), and placing barriers between waste pickers and the hazards (e.g., covered stations, flat ground, etc.) or more complex engineering, administrative or work controls. Because of the breadth of health problems faced by workers, more research is needed to correctly assess health outcomes (e.g. use of health practitioners) in waste pickers across time to ensure accurate data and a focused answer to the far-reaching problem.

Social vulnerabilities of female waste pickers in Brasília, Brazil.

Worldwide, waste pickers are exposed to adverse health effects resulting from hazards at work. This study aimed to identify possible gender disparities among waste pickers. A quantitative cross-sectional epidemiological study, using semi-structured data was conducted in Estrutural's dumpsite, Brasília, Brazil. It included 1,025 waste pickers, with 67% being female. Most of them lived without partners (73.7%), have 3 to 4 children (47.8%), and have a lower monthly income (62.6%

A Bottom-Up Approach Addressing Patient Care and Differential Diagnosis Amidst the Covid-19 Response.

Patient care often refers to the broad spectrum of care, prevention, and treatment that a provider delivers, while the point of a differential diagnosis is to make a distinction between 2 or more conditions that share similar signs or symptoms. A broad differential should be considered for every single patient who is currently ill (eg, all patients with respiratory illnesses); without it, there will likely be an increase of misdiagnosis, unnecessary patient suffering, and an influx of patients to the emergency department. The COVID-19 response has forced many of these basic medical values aside, like providing differential diagnosis or practicing bedside manner through social interaction, while physicians struggle to continue care for patients. As a result, newly formed hospital and clinical policies may have dangerously traded everyday diagnosis and treatment of patients for the pandemic and quarantine recommendations. This type of assumptive medicine is based on a singular differential that can be detrimental to patients, who are more likely affected with more common illnesses, like bronchitis or pneumonia-or perhaps, even more threatening illnesses, like a pulmonary embolism, COPD exacerbation, congestive heart failure and even lung cancer. Although these new policies and reactions to COVID-19 are proactive, these actions could be at the cost of providing quality patient care for people who have not contracted COVID-19.

Water quality index and sanitary and socioeconomic indicators in Minas Gerais, Brazil.

Minas Gerais is one of the 27 federative units of Brazil; it is the fourth state with the largest territorial area and the second in number of inhabitants. Since 1997, the monitoring of the surface water quality of the State of Minas Gerais has been carried out. In this study, generalized regression models were constructed to determine the correlation between the Water Quality Index (WQI) and the sanitary and socioeconomic variables: Municipal Population, Human Development Index (HDI), Gini Index, Percentage of Vulnerables to Poverty (Poverty), Monthly Per Capita Income, Percentage of Inadequate or Poor Sanitation. In addition to the sanitary and socioeconomic variables listed, it also used year of water quality monitoring, altitude of the monitoring point, and distance from the monitoring point to the urban center of the municipality. The results from the generalized models showed that the variables year, altitude, Gini Index, monthly per capita income, and poor sanitation variables were positively associated with WQI. In other words, high values of each variable increased WQI, while population variables HDI and poverty were negatively related to WQI, that is, a high population value, HDI, or poverty implies a low WQI value. Socioeconomic variables such as HDI, Gini Index, poorness, or poor sanitation percentage present the coefficients with the largest modulus. Thus, among the socioeconomic variables studied, these are the ones that most contribute to the variability of WQI. The year and altitude variables have positive regression coefficients, indicating that when these variables increase, WQI also increases. The positive correlation with the year shows that the surface water quality of Minas Gerais improved during the monitoring years.

Virulence, antimicrobial resistance and phylogenetic analysis of zoonotic walking pneumonia Mycoplasma arginini in the one-humped camel (Camelus dromedarius).

In the scientific literature, a small amount of information is found concerning mycoplasmosis in camel species. A variety of pathogens could be causative agents for pneumonia, but walking pneumonia is mostly caused by Mycoplasma with slow development and mild symptoms. The aim of this study was to identify mycoplasmas from camels (Camelus dromedarius) and extending the arsenal of factors implicated in pathogenicity of M. arginini to shed light on the current knowledge gap. 460 lung samples (pneumonic; n=210 and apparently healthy; n=250) were randomly collected from the one-humped camels (C. domedarius) that have been imported from Sudan and slaughtered at Cairo Slaughterhouse. 48 out of 210 isolates (22.9%) recovered from the pneumonic lungs were recorded as M. arginini. Positive PCR results were obtained for all 48 isolates. On the other hand, infection with the organism was not detected in the apparently healthy lungs. Hemolysis and hydrogen sulphide (H2S) production, a compound that has previously not been identified as a virulence factor in M. arginini, was evident in 100% of the isolates. The 48 M. arginini isolates were weak in their ability to form biofilm on polystyrene surfaces. All isolates were 100% susceptible to florfenicol and streptomycin and 100% resistant to ciprofloxacin. Resistance to lincomycin, spiromycin, tylosin, doxacyclin and erythromycin was observed at different frequencies. 13 different combinations of antibiotics representing one to four classes were evident with the Macrolide erythromycin being the most represented. It also should be noted that the ciprofloxacin, doxacyclin, lincomycin, erythromycin combination was the most noted in 21/48 isolates. Surprisingly, none of the virulence genes (vsp, uvrC and gapA) and quinolone resistance genes (parC and gyrA) were detected by PCR.

Vector-borne diseases in waste pickers in Brasilia, Brazil.

Solid waste management is a challenge in developing countries. The Structural dump in Brasilia, Brazil, was the largest Latin American open-air dump until its closure in 2018. Thus, this study sought to investigate the prevalence of self-reported dengue, Zika and Chikungunya arbovirus infections in waste pickers who worked at the dumpsite and assess its association with the sanitary conditions in their residences and workplaces. This research used a mixed methods study using a questionnaire for the quantitative method and semi-structured interviews for the qualitative portion. A cross-sectional, observational, epidemiological study along with a phenomenological study were carried out to characterize socio environmental, occupational and health-related aspects to vector-borne diseases in Structural dumpsite in Brazil. Of the 1,025 respondents, 301 (29.2%) reported to have gotten sick from dengue, Zika or chikungunya fevers. We found significant associations between place of residence of waste pickers (p = 0,003) and the work conditions, use of personal protective equipment (p < 0.001) and weekly workload (p = 0.04) and occurrence of vector-borne disease. Results were confirmed by qualitative data and geo-referencing, in relation to location of their homes and proximity to the dumpsite, as well as through the vulnerability due to their working conditions. This research confirms that waste pickers are highly susceptible to vector-borne diseases; this situation that needs to be immediately addressed by interdisciplinary and intersectoral approaches in waste management and public health. This information confirms vulnerability of waste pickers to diseases transmitted by Ae. aegypti mosquito as a result of sanitary conditions at their residence and workplace.

Vancomycin and florfenicol resistant Enterococcus faecalis and Enterococcus faecium isolated from human urine in an Egyptian urban-rural community.

Multidrug resistance is one of the top three threats to global public health. Understanding resistance of bacteria is important to help decrease resistance and improve the development of novel antimicrobial agents or other alternative tools to combat public health challenges. Thus, the goal of this study was to investigate the vancomycin and florfenicol resistance genes of five E. faecalis and 15 E. faecium isolated from patients with urinary tract infections. There were 20 Enterococcus obtained from the library collection of randomly selected private hospitals located in the city of El Qanater El Khayreya; these samples were isolated during 2017. Samples were evaluated for their phenotypic characterization of virulence factors, antimicrobial resistance and PCR was conducted to detect the prescence of the vancomycin vanABC and florfenicol resistance genes encoding the catAB, fexAB and cfu. There were six different antibiotic resistance profiles observed. The 20 isolates showed resistance to clindamycin, oxytetracycline and gentamycin. Resistance was evident to ciprofloxacin, norfloxacin and florfenicol in the absence of the cfr gene in all of the 20 Enterococcus isolates. In addition, all isolates produced biofilms and were classified as extensive drug resistant. MARindices of the isolates were >0.6. The MARindex of human isolates of enterococci suggest these pathogens originate from a high-risk source of contamination where antibiotics are often used. This information highlights a possible public health concern to the Egyptian community. The results also suggest the emergence of a linezolid sensitive-vancomycin resistant E. faecium and E. faecalis in the absence of the cfr gene.

Continued Medical Waste Exposure of Recyclable Collectors Despite Dumpsite Closures in Brazil.

BACKGROUND: Brasilia, the capital of Brazil, currently has the largest dumpsite of the Americas at Estrutural, with over 30 million tons of waste accumulated. Recyclable waste collectors are a group of workers who, in addition to having a low socioeconomic status and residing in vulnerable areas, work sorting garbage in inadequate and unsanitary areas. This profession puts individuals at risk, resulting in death, mutilation, and disease for workers. OBJECTIVES: The aim of this study was to understand the effects of waste on recyclable collectors, along with their perceptions of associated risks. METHODS: A qualitative study was conducted, using interviews with 34 participants at Estrutural. RESULTS: Collectors were exposed to several hazards, including biological, physical, and more extreme hazards (e.g. being run over by waste trucks). Personal protective equipment was not adequately used, exposing recyclable collectors to injury. Accidents included cuts, burns, skin lesions, eyes lesions, and arm, leg, head, feet, and hand injuries and amputations. Often, homecare remedies and collected medical waste (e.g. pain killers) were used on these injuries instead of seeking out proper medical care. CONCLUSIONS: Recyclable collectors were aware of occupational hazards, but lacked education on the risks and consequences associated with exposure to medical hazards. Moreover, Brazil recently formally closed all dumpsites, complicating this issue. The findings of the present study confirm the need to address these hazards to provide a safe working environment for waste pickers. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: This study was approved by the Research and Ethics Committee of the Health School of Brasília University under Opinion n. 1.517.670/2016. COMPETING INTERESTS: The authors declare no competing financial interests.