A harmful religio-cultural practice (Chhaupadi) during menstruation among adolescent girls in Nepal: Prevalence and policies for eradication.

BACKGROUND: Chhaupadi is a deeply rooted tradition and a centuries-old harmful religio-cultural practice. Chhaupadi is common in some parts of Karnali and Sudurpaschim Provinces of western Nepal, where women and girls are considered impure, unclean, and untouchable in the menstrual period or immediately following childbirth. In Chhaupadi practice, women and girls are isolated from a range of daily household chores, social events and forbidden from touching other people and objects. Chhaupadi tradition banishes women and girls into menstruation huts', or Chhau huts or livestock sheds to live and sleep. These practices are guided by existing harmful beliefs and practices in western Nepal, resulting in poor menstrual hygiene and poor physical and mental health outcomes. This study examined the magnitude of Chhaupadi practice and reviewed the existing policies for Chhaupadi eradication in Nepal. METHODS: We used both quantitative survey and qualitative content analysis of the available policies. First, a quantitative cross-sectional survey assessed the prevalence of Chhaupadi among 221 adolescent girls in Mangalsen Municipality of Achham district. Second, the contents of prevailing policies on Chhaupadi eradication were analysed qualitatively using the policy cube framework. RESULTS: The current survey revealed that most adolescent girls (84%) practised Chhaupadi in their most recent menstruation. The Chhaupadi practice was high if the girls were aged 15-17 years, born to an illiterate mother, and belonged to a nuclear family. Out of the girls practising Chhaupadi, most (86%) reported social and household activities restrictions. The policy content analysis of identified higher-level policy documents (constitution, acts, and regulations) have provisioned financial resources, ensured independent monitoring mechanisms, and had judiciary remedial measures. However, middle (policies and plans) and lower-level (directives) documents lacked adequate budgetary commitment and independent monitoring mechanisms. CONCLUSION: Chhaupadi remains prevalent in western Nepal and has several impacts to the health of adolescent girls. Existing policy mechanisms lack multilevel (individual, family, community, subnational and national) interventions, including financial and monitoring systems for Chhaupadi eradication. Eradicating Chhaupadi practice requires a robust multilevel implementation mechanism at the national and sub-national levels, including adequate financing and accountable systems up to the community level.

A project to identify the best practices and health performance objectives for building construction and renovation.

The 2014-2018 National Prevention Plan (NPP), in order to promote a correct relationship between health and the environment, indicated, among the central objectives, the definition of guidelines to promote the building hygiene codes in an eco-compatible way, but also to develop specific skills on the subject of confined environments and residential construction in the operators of the Regional Health Services. The CCM2015 Project has therefore set itself the goal of taking stock of the best health practices available today in terms of sustainability and eco-compatibility in the buildings' construction and renovation actions. All this in order to define updated health performance targets to be made available to the competent Authorities, to adapt the current legislation at national, regional and local level, and finally to define the contents of a continuing education (training courses) capable to support operators in risk assessment related to the built environment and in the definition of effective preventive measures.

From building regulations and local health rules to the new local building codes: a national survey in Italy on the prescriptive and performance requirements for a new performance approach.

BACKGROUND: World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues. METHODS: The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects. RESULTS: The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc. CONCLUSION: The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.

Hygienic and sanitary standards of housing in Europe: a comparative analysis of nine countries.

In recent years, growing interest was devoted to housing conditions from both scientific community and public health, so they are now considered among the main environmental and social health determinants of health of the population. Aim of the study is to analyze and compare the current regulations regarding housing sanitary requirements in different Countries of the EU (Sweden, United Kingdom, Denmark, the Netherlands, France, Germany, Portugal, Spain) with the contents of the Italian Health Ministerial Decree 5th July 1975. From the websites of the official channels of the various countries the regulations have been downloaded. For the comparison, only the aspects of BCs concerning the scale of the building were examined; the comparison concerned all the requirements of the Health Ministerial Decree of 5.07.1975 and some other parameters (e.g. indoor chemical pollution, ionizing radiation, non-ionizing radiation) not provided for in the Ministerial Decree, treated in the other standards regulations, and relevant for the indoor well-being of the occupants. The authors observe a wide variability in the contents and in the formulation of the hygienic-sanitary requirements among the different Building Codes, above all as regards the dimensional data and some fundamental themes (e.g. heating systems, mechanical ventilation) whose treatment is often not it is updated with respect to the technological-scientific innovation consolidated over the past few years. A diverse approach among European Countries is also observed: from a market-oriented logic (e.g. UK), to a prescriptive one (Italy), to a functionality-oriented (the Netherlands). The comparative analysis we carried out made it possible to identify convergences and divergences in the standards analysed for the different European countries. As far as the Italian legislation on the usability of residential premises, finally, considering the health, social, environmental and economic trends, many standards contained in the MD 5th July 1975 should be reviewed and updated.

Towards an update of the Italian Ministerial Decree July 5th, 1975.

In recent years, the Scientific Community and the Public Health world, in general, have devoted increasing interest to housing conditions, which are considered, to date, one of the main environmental and social determinants of the population's health. In particular, the Scientific Community has identified and studied various indoor well-being factors (e.g. lighting, temperature, ventilation, air quality, etc.). Some of these factors have been regulated by laws and regulations at various levels: the availability of clear and updated health requirements dictated by the regulations is fundamental to effectively protect public health, especially in confined environments. In the present work, we propose a revision of the Italian Ministerial Decree of July 5th, 1975 titled Modificazioni alle istruzioni ministeriali 20 giugno 1896 relativamente all'altezza minima ed ai requisiti igienico sanitari principali dei locali d'abitazione (Modifications to the ministerial instructions of June 20th, 1896 regarding the minimum height and the main hygienic-sanitary requirements of living spaces) in order to update the definition of the essential elements that qualify a space as habitable from the hygienic-sanitary point of view, taking into account the evidence gathered from the technical and scientific literature on the requirements and contents of the Building Codes of the major European countries.

A proposal of hygienic and sanitary standards for the new Building Code in Italy.

The traditional emphasis of Public Health on the type and quality of housing today merges with other wider determinants of health such as: the neighbourhood, the community and the "place" where a home is located, but also the policies that make access to a healthy home within everyone's reach. At the neighbourhood scale, context-related aspects heavily influence the internal quality and real usability of the buildings themselves, with particular reference to factors such as the quality of the site, the relationship between the building and the context, the presence and quality of the greenery and open spaces surrounding the building, as well as all measures that make it possible to reduce the building's impact on the environment, to protect it against environmental pollution, and to manage the building in an integrated manner for maintenance purposes. Creating healthy living environments means referring to the different dimensions mentioned above, and this not only requires the attention of Public Health operators, but also implies an integration of vision and objectives among various professional skills and competences that puts health at the center of all policies. This proposal, which starts from the analysis of existing local hygiene regulations and scientific literature, aims to take stock of a number of areas considered fundamental for the assessment of building hygiene aspects, with particular reference to the eco-sustainability of buildings and adaptation to climate change. The aspects identified can be considered as a starting point for the preparation of integrated building and hygiene regulations based on documented effective practices for the protection of Public Health.

Current legislation on tattooing in France.

Since 2004, tattooing products have been recognized as such by French law. A tattooist must declare his activity to the ARS (French regional health agency). A tattooist is legally compelled to undergo training sessions on occupational safety and hygienic requirements and to deliver his certificate to the ARS. A tattooist commits himself to preliminarily informing his customers of the risks they possibly incur and of the precautions to be taken. He also commits himself to complying with general rules and regulations and with good practices of hygiene and safety; lastly, he signs an agreement pertaining to waste disposal (DASRI). Contrary to pharmaceutical products, tattooing products are not subject to authorization prior to their commercialization. Any adverse effect after tattooing must be the subject of a declaration addressed to the ANSM (French health products safety agency) by the customer, the tattooist or a health professional.

Face masks. Technical, technological and functional characteristics and hygienic-sanitary aspects related to the use of filtering mask in the community.

INTRODUCTION: The health emergency caused by the spread of SARS-COV-2 virus has required the adoption of passive measures against contagion, such as social distancing. The use of filtering masks, of the different types available on the market, such as surgical and facial filtering masks (FFP1, FFP2 and FFP3), is also recommended. OBJECTIVES: The aim of this paper, within the Italian and European regulatory reference framework, is to suggest a rational application of existing methodologies that enable to know and assess the features and/or make a face mask intended to be used by the community. In addition to this, the study aims to provide a correct regulatory framework and useful information for a correct use and disposal of face masks. Another purpose is the assessment of the hygienic, sanitary and regulatory aspects related to the use and disposal of face masks. METHODS: The analysis of filtering masks is based on the review of scientific literature, the state of art of technology and the filtering means/materials available. Reference is made to filtering mechanisms and devices, the testing methods, the technical, manufacturing and performance features, and to the Italian and European regulatory reference framework. Reference is also made to the hygienic, sanitary and regulatory aspects related to the use and disposal of face masks. RESULTS: Surgical masks or, alternatively, filtering masks with a filtration efficiency between 90% and 95% for 3-µm particles, are the most practicable choice with minor contraindications. The reusable type of mask is conceptually superior compared to single-use masks, but cleaning procedures to be followed are quite complex and not always described in a clear way. CONCLUSIONS: The definition of rigorous and repeatable tests on mask filtration capacity, breathability, wearability, duration of use, regeneration, as well as safe disposal methods, are the main way to provide users with correct selection and use criteria. The results must be disclosed and disseminated quickly.

Water-Handling Patterns and Associated Microbial Profiles in relation to Hygiene in Babati Town, Tanzania.

Introduction: In rapidly urbanizing centres in Tanzania, water supply infrastructure lags behind the speed of urbanization, affecting water availability and accessibility. We believe that inhabitants' access water using various ways which are characterizable and understanding them could inform about the risks to hygiene-related diseases. This study aimed at characterizing water-handling chains and their microbial profiles in Babati town to inform hygiene education policy and water supply planning. Methodology: A cross-sectional study design employing a proportional sampling for each of the 8 wards was conducted between November 2016 and March 2017. A total of 564 samples of water were collected using the USA EPA procedures from 37 randomly selected households. Water samples were collected from the common sources of water as well as from the downstream points to multiple storage containers. Using EPA membrane filtration techniques, two microorganisms were tested: fecal coliforms and Salmonella typhi. Results. Three water-handling chains/patterns in Babati town were determined, and they were as follows: (i) untreated-source-to-treated-reservoir-to-households (untrS2trR2HH) chain, (ii) untreated-source-to-untreated-reservoir-to-households (untrS2untrR2HH) chain; (iii) untreated-source-straight-to-households (untrS2HH) chain. In terms of the microbial profile, the most contaminated water-handling chain was the untreated-source-straight-to-households (untrS2HH). The number of users in these three chains was not statistically significantly different (p=0.5226), meaning that all people utilized the various chains almost equally, depending on the water situation. Most households (83%) did not treat their drinking water making those using the untreated-source-to-household chain (untrS2HH) most vulnerable to waterborne diseases. Conclusion: Determination of water-handling chains among the household is a novel approach which allows an understanding of the points at which highest fecal loading occurs. This approach therefore may inform the development of policies in the areas of household hygiene education, drinking water treatment, and water supply planning in urbanized towns in Tanzania and other developing countries.

[The Activities of the Ministry of Public Education Related to Amelioration of School Sanitary Hygienic Standards in Beginning of XX Century].

The article considers the role of the Ministry of National Education in development of the legislation of sanitary hygienic standards in worldly schools. In the beginning of XX century, in educational institutions of the Western Siberia the process of application of the mentioned legislative acts was in progress. The actual legal base promoted organization of more efficient activity of the administration of the Western Siberian educational okrug related to prevention of diseases among school pupils, activization of activities of physicians related to sanitary educational propaganda among schoolchildren, their parents and whole population of the region. During the studied period the Ministry of National Education was headed by V. G. Glazov. During his administration, an increasing of attention to prevention of epidemics in educational institutions was noted. Also, a whole complex of measures concerning development of health preserving technologies among students and pedagogic personnel was implemented for the first time.

Hygienic Requirements of Urban Living Environment in the Russian Federation and in Italy: a comparison.

AIM: Urban planning tries to contain and regulate the uncontrolled growth of cities, encouraging their sustainable development at environmental, social and health levels. In the present work, the authors compare the regulatory frameworks of the Russian Federation and of Italy, with particular attention paid to the urban aspects of living spaces. METHODS: Considering the extant normative production in the two countries, the authors examine national legislation for Italy and federal legislation for Russia, mainly taking into account the following aspects: urban planning tools and environmental and sanitary protection of living spaces. RESULTS: Hygienic-sanitary requirements regarding living environment in Russia are essentially expressed by two regulatory systems (SNiP and SanPiN), while in Italy they are regulated by the D.M. 07/05/1975. The main principles of urban planning in Russia are expressed by federal standards, while in Italy they are incorporated in the Municipal General Plan (PRG) and in the various local regulations, where all the superordinate regulations are summarized. Finally, aspects related to environmental quality in both countries are governed by various specific laws (federal and state); a complex system of rules that take into account potential impacts on health and the environment. CONCLUSIONS: The authors reckon that clear and updated regulatory tools should be developed, especially in Italy that lags behind, regarding the building and urban hygiene, relying on the most recent acquisitions of international scientific literature in order to guarantee the highest standards in Public Health safeguard.

[Legal and management issues of public health requirements for swimming pools in Regione Toscana]. / Inquadramento giuridico e gestione delle attività svolte al fine del mantenimento dei requisiti igienico-sanitari negli impianti natatori nella Regione Toscana.

In this paper we describe the laws and rules applying to swimming pools. Authorization activity title for recreational swimming pools is regulated according to articles 80 and 86 of the TULPS R.D.n°773/1931. In Regione Toscana periodic management of the hygienic requirements for swimming pools is regulated by Regional Decree 54R/2015. It requires the evaluation of physical-chemical and microbiological indicators. The law applies to structural and organizational requirements of swimming pools as well as defines responsabilities of managers.

Need for improved public health protection of young people wanting body piercing: evidence from a look-back exercise at a piercing and tattooing premises with poor hygiene practices, Wales (UK) 2015.

Following a cluster of serious pseudomonas skin infections linked to a body piercing and tattooing premises, a look-back exercise was carried out to offer clients a screen for blood-borne viruses. Of those attending for screening 72% (581/809) had a piercing procedure in the premises of interest: 94 (16%) were under 16 years of age at the time of screening. The most common site of piercing was ear (34%), followed by nose (27%), nipple (21%) and navel (21%). A small number (<5) tested positive for hepatitis B and C, with no evidence this was linked to the premises. However, 36% (211/581) of clients reported a skin infection associated with their piercing. Using data from client forms, 36% provided a false age. Those aged under 16 years (OR 4.5, 95% CI 2.7-7.7) and those receiving a piercing at an intimate site (OR 2.1, 95% CI 1.3-3.6) were more likely to provide a false age. The findings from this exercise were used to support the drafting of the Public Health (Wales) Bill which proposed better regulation of piercing premises and the need to provide proof of being 18 years of age or over before having a piercing of an intimate site.

[Hygiene and legal aspects of occupational exposure assessment to cytostatics]. / Aspekty higieniczne i prawne oceny narazenia zawodowego na cytostatyki.

The employers responsibilities for the assessment of occupational exposure to cytostatics in the workplace were analyzed in the light of existing legal regulations. Cytostatics may pose a threat to health and life of workers taking care of patients treated oncologically, i.e., pharmacists, physicians, nurses and other personnel. The significant scale of occupational exposure to cytostatics in Poland is confirmed by the data collected in the Central Register of Data on Exposure to Carcinogenic or Mutagenic Substances, Mixtures, Agents or Technological Processes, maintained by the Nofer Institute of Occupational Medicine, Lódz, Poland. The issue of occupational risk assessment of exposure to cytostatics gives raise to numerous concerns. Polish regulations concerning health protection of employees occupationally exposed to cytostatics are not unequivocal, as they are derived from different areas of the law, especially those applying to hazard classification, labeling and preparation of safety data sheets for cytostatics. There are neither binding occupational exposure limits legally set for active compounds of antineoplastic drugs nor methods for monitoring of these substances concentrations in a worker's breathing zone and biological material. This prevents the employer to carry out the correct assessment of occupational exposure, the results of which are the basis for preparing the proper preventive strategy. In this article the consequences of amendments to the European chemical legislation for employers responsible for adequate protection of health and life of employees exposed to cytostatics, were discussed, as well as some legal changes aimed at a better health and life protection of workers exposed to cytostatics in a workplace were proposed. Med Pr 2018;69(1):77-92.

Local health rules and building regulations: a survey on local hygiene and building regulations in Italian municipalities.

INTRODUCTION: WHO has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Local Health Rules (LHRs) and Building Regulations (BRs) are tools which provide safety and building hygiene in construction practices. Currently the Italian Government is considering to establish a National Building Regulation and, related to the following purpose, this paper presents a survey on the status of adoption and updating of LHRs and BRs in Italian municipalities. METHODOLOGY: The current Italian state of LHRs, BRs and Municipal Development Plans (MDPs) have been examined by a survey considering a sample of about 550 cities, with different demo graphic and geographic features, starting from the previous research work by Signorelli et al. (1999). RESULTS: The analysis underlines a serious shortage of updated LHRs, especially in small and medium-sized municipalities whereas BRs and MDPs are widespread. Only 30% of them are previously approved and validated by Local Health Authorities. CONCLUSION: Starting from a survey, the present scenario of Building Regulations requires the introduction of further performance guidelines instead of normative ones and, therefore, the current actions to give rise to a National Building Regulation could be integrated by building hygiene contents of LHRs.

Health inequalities and inadequate housing: the case of exceptions to hygienic requirements for dwellings in Italy.

In the past decades, Italian hygienic requirements for dwellings have been modified by multiple derogations. Aim of the present work is to analyse the derogations introduced at a national, regional, and local level. The most important derogations were related to the habitable use of semi-basements and garrets, and building restoration. The paper also describes the regulations regarding indemnity for infringement of building abuses. The authors underline the need for more uniformity and clarity in the determination of health standards of dwellings, as well as for a simplification of the existing legislation.

Rates of and reasons for condemnation of poultry carcases: harmonised methodology at the slaughterhouse.

European hygiene regulations require the condemnation of any unsafe food. However, there is little information identifying and quantifying condemnation of poultry carcases at slaughterhouses. We present an in-depth view of rates of and reasons for the condemnation of broiler, turkey, meat and force-feeding duck, guinea fowl carcases in France. The experiment was conducted in 10 slaughterhouses. For one year, all condemnations were recorded on a standard form following a national reference system. The rates of and reasons for condemnation, as well as factors influencing variation were investigated. The global condemnation rates were 1.04 per cent for broilers, 1.85 per cent for turkeys, 1.23 per cent for meat ducks, 1.42 per cent for force-feeding ducks and 1.20 per cent for guinea fowl. Condemnation rates depended on several factors including slaughterhouse, animal gender and season. Reasons for condemnation varied with species, for example, the three main reasons for broilers were cachexia (41.8 per cent of condemned batches), generalised congestion (29.3 per cent) and non-purulent cutaneous lesions (14.2 per cent) versus conformation abnormalities (58.6 per cent), cachexia (14.61 per cent) and ascites (14.56 per cent) for meat ducks. While the condemnation rates can be considered low for all species, the difference between the rates of and reasons for condemnation highlights the need to lead species-specific epidemiological studies to improve the sanitary situation of poultry production.

[The Importance of Hospital Hygiene: Findings of a German Nationwide Survey]. / Der Stellenwert der Krankenhaushygiene ­ Erkenntnisse einer deutschlandweiten Befragung.

Aim of the study: The German legislature reacted to the increasing number of nosocomial infections with a set of laws to strengthen hospital hygiene. The aim of the study is to measure the current and future importance of hospital hygiene in Germany. Methods: CEOs and hygiene staff from German hospitals took part in a survey on 13 items regarding the current and future importance of hospital hygiene. Statistical analyses were conducted to identify significances regarding the professional groups. Results: The results of the study show that hospital hygiene is currently of high importance and will be rising in the future. Hospital hygiene has a high economic impact, especially as a competitive factor. The patients' fear to suffer from a nosocomial infection, especially caused by multi-resistant bacteria, is countered with intensive educational work. Conclusion: The results demonstrate that the legislators' efforts are taken note of in German hospitals and the future strategic impact of hospital hygiene in a pay-for-performance reimbursement system has become clear.

[Control of potential risk in blood establishments in Brazil: a strategy for regulating authorities]. / Controle de riscos potenciais em serviços de hemoterapia no Brasil: uma abordagem para autoridades reguladoras.

Objective To describe the sanitary status of Brazilian blood establishments (BE) assessed by the national health surveillance system in 2013. Method In the present descriptive study, the sanitary profile of BE was assessed using the Blood Establishment Potential Risk Assessment Method (Método de Avaliação de Risco Potencial de Serviços de Hemoterapia, MARPSH), developed by the National Sanitary Surveillance Agency (Anvisa). The MARPSH involves the evaluation of 471 structure and process items to produce an assessment of potential risk associated with critical control points in the blood cycle (vein-to-vein). Based on this assessment, BE are classified into five risk categories: low, medium-low, medium, medium-high, and high. The results were analyzed regarding the type of service (considering all levels, from coordinating centers to collection units), type of financing (public/private) and geographic region. Results Of the existing BE, 1 212 (60%) were assessed in 2013. Of these, 81% met ≥ 70% of the sanitary requirements (satisfactory status, corresponding to medium, medium-low, and low risk categories). Transfusion agencies (hospital units with the role of storing, running compatibility tests between donors and recipients, and transfusing blood components) and public establishments had the highest number of non-conformity structure and process items. Conclusion The use of the MARPSH facilitated the assessment of BE in Brazil and revealed objective opportunities for improvement. These gaps should be addressed by regulating authorities, especially in public services.

Lighting requirements of dwellings: a comparison between Russian federation and Italy.

Good lighting is a key factor for indoor health and wellness. Hygienic regulations regarding illumination requirements have been elaborated much time ago and in different countries. The authors describe these requirements in Italy and in the Russian Federation, analysing their contents and issues and comparing them. The results show that the Russian ones are updated, more precise and complete. In conclusion, the authors stress the strong need for a revision and update of the specific Italian hygienic and sanitary regulations.