Indicators for local health plan monitoring and evaluation: A modified Delphi consensus.

OBJECTIVE: There is still a lack of health indicators for monitoring and evaluating health planning at the local level. In Portugal, local health plans (LHP) include a prioritized set of health priorities, which should be monitored and evaluated. This study is an example of a low-resource method to identify and reuse indicators for LHP monitoring and evaluation already collected for other purposes. DESIGN AND SAMPLE: A modified Delphi consensus method was applied, with three rounds of email rating questionnaires and a final meeting, between January 2018 and January 2019. The Delphi panel consisted of eight members from the Planning and Administration Group of the Espinho/Gaia Local Public Health Unit. MEASUREMENTS: Panelists were asked to assess the indicators' validity for monitoring diseases/determinants from a pre-selected list of potential binomials between 140 PHC indicators and 15 diseases/determinants. RESULTS: After four rounds, there was consensus in considering 141 binomials (34.0%) as appropriate, diabetes mellitus being the disease with more appropriate indicators. CONCLUSION: This study portrays the applicability of a commonly used, easy and low-resource method in a Portuguese Local Public Health Unit to select and reuse primary health care indicators for LHP monitoring and evaluation.

Effect of humic acid on Cd(II), Cu(II), and Pb(II) uptake by freshwater algae: kinetic and cell wall speciation considerations.

Thepresent study examines the effect of humic acid on the uptake kinetics of Cd(II), Cu(II), and Pb(II) by the freshwater alga Chlorella kesslerii. The results demonstrated that the relative proportion of Pb in the cell wall layer is greater than that of the internalized Pb, while internalized Cd and Cu were comparable or greater than the adsorbed metal concentration. In the presence of 10 mg L(-1) humic acid (HA), Cd and Cu uptake kinetics were consistent with that predicted by measured free metal concentrations. For Pb, the uptake flux and amount of lead bound to internalization and adsorption sites were an order of magnitude higher than those found at the same free lead ion concentrations in the presence of citric acid. Chemodynamic modeling suggested that the enhancement of the Pb uptake flux in the presence of HA originates from an increasing amount of Pb bound to the internalization sites through a ternary complex formation between lead-humic acid complex and internalization sites. Cell wall speciation calculations indicated that the lead-humic acid complex is the predominant species in the cell wall layer, while for Cu(II) and Cd(II) metal bound to the internalization (Cu) and adsorption (Cd) sites significantly dominated over the M-HA complex. The findings of the work show the relevance of the cell wall layer concentration and speciation and its key role in defining the local equilibrium conditions between metal and internalizations sites. The results of the present kinetic study have important consequences for improvement of the mechanistic understanding of the role of dissolved organic matter in metal uptake in phytoplankton and biogeochemical cycling of metals in the surface waters.

Comparison of Cd(II), Cu(II), and Pb(II) biouptake by green algae in the presence of humic acid.

The present study examines the role of humic acid, as a representative of dissolved organic matter, in Cd(II), Cu(II), and Pb(II) speciation and biouptake by green microalgae. Cellular and intracellular metal fractions were compared in the presence of citric and humic acids. The results demonstrated that Cd and Cu uptake in the presence of 10 mg L(-1) humic acid was consistent with that predicted from measured free metal concentrations, while Pb biouptake was higher. By comparing Cd, Cu, and Pb cellular concentrations in the absence and presence of humic acid, it was found that the influence of the increased negative algal surface charge, resulting from humic acid adsorption, on cellular metal was negligible. Moreover, the experimental results for all three metals were in good agreement with the ternary complex hypothesis. Given that metal has much higher affinity with algal sites than humic acid adsorbed to algae, the contribution of the ternary complex to metal bioavailability was negligible in the case of Cd (II) and Cu (II). In contrast, the ternary complex contributed to over 90% of total cellular metal for Pb(II), due to the comparable affinity of Pb to algal sites in comparison with humic acid adsorbed to algae. Therefore, the extension of the biotic ligand model by including the formation of the ternary complex between the metal, humic acid, and algal surface would help to avoid underestimation of Pb biouptake in the presence of humic substances by green algae Chlorella kesslerii.

Characterization of H+ and Cd2+ binding properties of the bacterial exopolysaccharides.

The proton and Cd binding capacities of microbially produced exopolysaccharides, EPS, were quantified by the determination of stability constants and the concentration of complexing sites using H(+) or Cd(2+) selective electrodes in dynamic titrations. The influence of ionic strength, pH and the Cd to EPS ratio was evaluated over large concentration ranges. The applicability of the non-ideal competitive adsorption isotherm combined with a Donnan electrostatics approach was tested with respect to the EPS. Proton and cadmium binding data were compared with literature data examining other ubiquitous environmental ligands including humic substances, alginate, bacteria, etc. Subsequent modelling of Cd speciation in aquatic (fresh and marine waters) and soil systems suggested that the exopolysaccharides would play non-negligible role, under most conditions. The quantitative information provided in this paper thus represents an important advance in our understanding of Cd transport, bioavailability and impact in aquatic and terrestrial systems.

Influence of the composition of natural organic matter on Pb bioavailability to microalgae.

The current work examines the effects of model allochtonous (humic substances) and autochtonous (microbial polysaccharides) natural organic matter (NOM) on Pb speciation and bioaccumulation. The results demonstrated that polysaccharides, in particular alginic acid, had complexing properties and effects on Pb bioaccumulation by the green alga Chlorella kesslerii that were similar to equivalent complexing capacity of humic substances. Pb uptake decreased in the presence of humic, alginic, and polygalacturonic acids with respect to noncomplexed Pb, but accumulated Pb was higher than predicted from measured Pb2+ concentrations or from previous results obtained in the presence of simple synthetic ligands. An improved fit between experimental observations and Pb speciation was obtained by taking into account the formation of a ternary complex at the algal surface. The contribution of the ternary complexes to Pb bioaccumulation was dependent on the relative binding constants of the Pb to the NOM and to the binding sites on the biological surface. In the presence of the humic acid, a decreased surface charge and increased membrane permeability were considered to be of secondary importance to explain the observation of increased Pb uptake with respect to that predicted on the basis of [Pb2+]. The environmental implications of the results are discussed with respect to the development of site-specific water quality criteria.

Quantifying Pb and Cd complexation by alginates and the role of metal binding on macromolecular aggregation.

The Pb and Cd binding capacity of alginates were quantified by the determination of their complex stability constants and the concentration of complexing sites using H+, Pb2+, or Cd2+ selective electrodes in both static and dynamic titrations. Centrifugation filter devices (30 kDa filter cutoff), followed by inductively coupled plasma mass spectrometry (ICP-MS) measurements of lead or cadmium in the filtrates, were used to validate the results. The influence of ionic strength, pH, and the metal-to-alginate ratio was determined for a wide range of metal concentrations. Because of their polyelectrolytic properties, alginates may adopt different conformations depending on the physicochemistry of the medium, including the presence of metals. Therefore, molecular diffusion coefficients of the alginate were determined by fluorescence correlation spectroscopy under the same conditions of pH, ionic strength, and metal-to-alginate ratios that were used for the metal binding studies. The complexation and conformational properties of the alginate were related within the framework of the nonideal competitive adsorption isotherm (NICA) combined with a Donnan approach to account for both intrinsic and electrostatic contributions.