BACKGROUND: Spina bifida, a developmental malformation of the spinal cord, is associated with high rates of mortality and disability. Although folic acid-based preventive strategies have been successful in reducing rates of spina bifida, some areas continue to be at higher risk because of chemical exposures. Bangladesh has high arsenic exposures through contaminated drinking water and high rates of spina bifida. This study examines the relationships between mother\'s arsenic exposure, folic acid, and spina bifida risk in Bangladesh.
METHODS: We conducted a hospital-based case-control study at the National Institute of Neurosciences & Hospital (NINS&H) in Dhaka, Bangladesh, between December 2016 and December 2022. Cases were infants under age one year with spina bifida and further classified by a neurosurgeon and imaging. Controls were drawn from children seen at NINS&H and nearby Dhaka Shishu Hospital. Mothers reported folic acid use during pregnancy, and we assessed folate status with serum assays. Arsenic exposure was estimated in drinking water using graphite furnace atomic absorption spectrophotometry (GF-AAS) and in toenails using inductively coupled plasma mass spectrometry (ICP-MS). We used logistic regression to examine the associations between arsenic and spina bifida. We used stratified models to examine the associations between folic acid and spina bifida at different levels of arsenic exposure.
RESULTS: We evaluated data from 294 cases of spina bifida and 163 controls. We did not find a main effect of mother\'s arsenic exposure on spina bifida risk. However, in stratified analyses, folic acid use was associated with lower odds of spina bifida (adjusted odds ratio [OR]: 0.50, 95% confidence interval [CI]: 0.25-1.00, p = 0.05) among women with toenail arsenic concentrations below the median value of 0.46 µg/g, and no association was seen among mothers with toenail arsenic concentrations higher than 0.46 µg/g (adjusted OR: 1.09, 95% CI: 0.52-2.29, p = 0.82).
CONCLUSIONS: Mother\'s arsenic exposure modified the protective association of folic acid with spina bifida. Increased surveillance and additional preventive strategies, such as folic acid fortification and reduction of arsenic, are needed in areas of high arsenic exposure.

Municipal water supply through truck-to-cistern systems is common in northern Canada. Household satisfaction and concerns about water services likely impact user preferences and practices. This case study explores household perspectives and challenges with regard to domestic access to water in a decentralized truck-to-cistern system. A case study was conducted in the Northern Village of Kangiqsualujjuaq, Nunavik (Quebec, Canada). A paper-based questionnaire was completed by 65 households (one quarter of the population). Many households (37%) reported not drinking tap water from the truck-to-cistern system. Chlorine taste was a frequently reported concern, with those households being significantly less likely to drink water directly from the tap (p = 0.002). Similarly, households that reported a water shortage in the previous week (i.e., no water from the tap at least once) (33%) were more likely to express dissatisfaction with delivered water quantity (rs = 0.395, p = 0.004). Interestingly, 77% of households preferred using alternative drinking water sources for drinking purposes, such as public tap at the water treatment plant, natural sources or bottled water. The study underscores the importance of considering household perspectives to mitigate the risks associated with service disruptions and the use of alternative sources for drinking purposes.

UNASSIGNED: Stunting is associated with disorders of the small intestines caused by environmental factors and poor hygiene practices. Prevention of stunting should be conducted in the first 1,000 days of life; namely, from conception until the child is two years old. This research aimed to analyze the relationship between environmental risk factors and maternal personal hygiene with the incidence of stunting in children aged 6-23 months.
UNASSIGNED: This study was conducted using a case-control design, with a total sample of 212 (106 cases and 106 controls) enrolled purposively. Data were collected through interviews using a questionnaire. The analysis used chisquare tests and multiple logistic regression.
UNASSIGNED: The results of multivariate analysis showed the independent variables that have a significant association on the incidence of stunting are access to safe drinking water and maternal hygiene practices. The external variables that have a significant relationship is birth length and feeding practice.
UNASSIGNED: Having no access to safe drinking water, not proper sanitation, and poor maternal hygiene practices have a higher risk of stunting in children aged 6-23 months. The implications of this research include the need for increased access to a safe environment and improvement of mother\'s behavior as essential efforts to prevent stunting.

Disinfection by-products (DBPs) are prevalent contaminants in drinking water and are primarily linked to issues regarding water quality. These contaminants have been associated with various adverse health effects. Among different treatment processes, nanofiltration (NF) has demonstrated superior performance in effectively reducing the levels of DBPs compared to conventional processes and ozone-biological activated carbon (O3-BAC) processes. In this experiment, we systematically investigated the performance of three advanced membrane filtration treatment schemes, namely \"sand filter + nanofiltration\" (SF + NF), \"sand filter + ozone-biological activated carbon + nanofiltration\" (SF + O3-BAC + NF), and \"ultrafiltration + nanofiltration\" (UF + NF), in terms of their ability to control disinfection by-product (DBP) formation in treated water, analyzed the source and fate of DBP precursors during chlorination, and elucidated the role of precursor molecular weight distribution during membrane filtration in relation to DBP formation potential (DBPFP). The results indicated that each treatment process reduced DBPFP, as measured by trihalomethane formation potential (THMFP) and haloacetic acid formation potential (HAAFP), with the SF + O3-BAC + NF process being the most effective (14.27 μg/L and 14.88 μg/L), followed by the SF + NF process (21.04 μg/L and 16.29 μg/L) and the UF + NF process (26.26 μg/L and 21.75 μg/L). Tyrosine, tryptophan, and soluble microbial products were identified as the major DBP precursors during chlorination, with their fluorescence intensity decreasing gradually as water treatment progressed. Additionally, while large molecular weight organics (60-100,000 KDa) played a minor role in DBPFP, small molecular weight organics (0.2-5 KDa) were highlighted as key contributors to DBPFP, and medium molecular weight organics (5-60 KDa) could adhere to the membrane surface and reduce DBPFP. Based on these findings, the combined NF process can be reasonably selected for controlling DBP formation, with potential long-term benefits for human health.

BACKGROUND: Chronic Kidney Disease of unknown cause (CKDu) a disease of exclusion, and remains unexplained in various parts of the world, including India. Previous studies have reported mixed findings about the role of heavy metals or agrochemicals in CKDu. These studies compared CKDu with healthy controls but lacked subjects with CKD as controls. The purpose of this study was to test the hypothesis whether heavy metals, i.e. Arsenic (As), Cadmium (Cd), Lead (Pb), and Chromium (Cr) are associated with CKDu, in central India.
METHODS: The study was conducted in a case-control manner at a tertiary care hospital. CKDu cases (n = 60) were compared with CKD (n = 62) and healthy subjects (n = 54). Blood and urine levels of As, Cd, Pb, and Cr were measured by Inductively Coupled Plasma- Optical Emission Spectrometry. Pesticide use, painkillers, smoking, and alcohol addiction were also evaluated. The median blood and urine metal levels were compared among the groups by the Kruskal-Wallis rank sum test.
RESULTS: CKDu had significantly higher pesticide and surface water usage as a source of drinking water. Blood As levels (median, IQR) were significantly higher in CKDu 91.97 (1.3-132.7) µg/L compared to CKD 4.5 (0.0-58.8) µg/L and healthy subjects 39.01 (4.8-67.4) µg/L (p < 0.001) On multinominal regression age and sex adjusted blood As was independently associated with CKDu[ OR 1.013 (95%CI 1.003-1.024) P < .05].Blood and urinary Cd, Pb, and Cr were higher in CKD compared to CKDu (p > .05). Urinary Cd, Pb and Cr were undetectable in healthy subjects and were significantly higher in CKDu and CKD compared to healthy subjects (P = < 0.001). There was a significant correlation of Cd, Pb and Cr in blood and urine with each other in CKDu and CKD subjects as compared to healthy subjects. Surface water use also associated with CKDu [OR 3.178 (95%CI 1.029-9.818) p < .05).
CONCLUSIONS: The study showed an independent association of age and sex adjusted blood As with CKDu in this Indian cohort. Subjects with renal dysfunction (CKDu and CKD) were found to have significantly higher metal burden of Pb, Cd, As, and Cr as compared to healthy controls. CKDu subjects had significantly higher pesticide and surface water usage, which may be the source of differential As exposure in these subjects.

The prevalence of dental caries in peatlands and non-peatlands in West Kalimantan require preventive acts based on its natural conditions and the behavior of local communities. The objective was to analyse risk factors for dental caries in communities living in peatlands and non-peatlands in West Kalimantan. The research is a causal comparative study with cross-sectional approach. The samples were chosen by purposive sampling technique among adolescents aged 17-27 years, who were domiciled in Pontianak City (peatland) and Bengkayang (non-peatland) all their lives. The results showed that dental caries is significantly correlated with debris in peatlands (rs = 0.289). On non-peatlands, dental caries is correlated with drinking water phosphate (rs = 0.313) and calculus (rs = 0.034). In West Kalimantan, dental caries is significantly correlated with drinking water minerals (fluoride rs = -0.243; phosphate rs = 0.260), drinking water pH (rs = 0.235), behavior (rs = -0.327), and debris (rs = 0.240). The risk factors for dental caries in peatlands and non-peatlands in West Kalimantan are pH and drinking water minerals (fluoride and calcium), debris, calculus, and behavior.

Water quality, increasingly recognized for its significant impact on health, is garnering heightened attention. Previous studies were limited by the number of water quality indicators and the duration of analysis. This study assessed the drinking water quality and its associated health risk in suburban areas of Wuhan, a city in central China, from 2016 to 2021. We collected 368 finished water samples and 1090 tap water samples and tested these for 37 different indicators. The water quality was evaluated using the water quality index, with trends over time analyzed via the Mann-Kendall test. Furthermore, an artificial neural network model was employed for future water quality prediction. Our findings indicated that the water quality in rural Wuhan was generally good and had an improvement from 2016 to 2021. The qualification and excellent rates were 98.91% and 86.81% for finished water, and 97.89% and 78.07% for tap water, respectively. The drinking water quality was predicted to maintain satisfactory in 2022 and 2023. Additionally, principal component analysis revealed that the primary sanitary issues in the water were poor sensory properties, elevated metal contents, high levels of dissolved solids, and microbial contamination. These issues were likely attributable to domestic and industrial waste discharge and aging water pipelines. The health risks associated with the long-term consumption of this water have been steadily decreasing over the years, underscoring the effectiveness of Wuhan\'s ongoing water management efforts.

These days, the presence of pesticide residues in drinking water sources is a serious concern. In drinking water treatment plants (DWTPs), various methods have been proposed to remove pesticide residues. This study was designed with the objectives of monitoring the occurrence and seasonal variations of pesticides in the output of drinking water treatment plants in two Northern provinces of Iran, Gilan and Golestan, and identifying their human health risks. Seventeen pesticide residues from different chemical structures were determined by using a gas chromatograph-mass spectrometer (GC-MS). The results showed that only Alachlor, Diazinon, Fenitrothion, Malathion, and Chlorpyrifos were detected. The pesticide concentrations ranged from ND to 405.3 ng/L and were higher in the first half-year period. The total non-carcinogenic human health risks was in safe range for infants, children, and adults (HI < 1). The carcinogenic human health risks of Alachlor for infants, children, and adults were in the range of 4.3 × 10-7 to 1.3 × 10-6, 2.0 × 10-7 to 9.6 × 10-7, and 1.1 × 10-7 to 5.5 × 10-7, respectively. These values do not pose health risks for adults and children, but may present a possible cancer risk for infants in two DWTPs of Golestan. In conclusion, considering the possibility of exposure to these pesticides through other routes, simultaneously, it is suggested to carry out a study that examines the level of risk by considering all exposure routes. We also propose stricter regulations for the sale and use of pesticides in Iran.

Acque Bresciane is a public company that manages the integrated water cycle for more than 580,000 inhabitants in the Province of Brescia, in the north of Italy, providing drinking water, waste water treatment, and sewer systems. Drinking water systems are supplied with different types of groundwater, springs, and surface water sources (from lakes and rivers) whose availability and quality can be affected by climate change events. A multidisciplinary team, in collaboration with the University of Milano Bicocca, developed a specific Water Safety Plan (WSP) risk matrix focusing on the evaluation of climate-related hazardous events and calculation of their likelihood of occurrence, also using thematic maps. Moreover, to reduce the residual risks, in the risk matrix, possible control measures are suggested, such as the activation of an emergency plan, the use of other water sources, storage tanks, and interconnection with other water distribution networks. This work shows a simple and effective tool that can be applied by drinking water utilities to evaluate climate-related catchment risks, using a WSP risk matrix, thematic maps, and possible control measures to reduce risks in terms of water quality and availability and to respond with resilience to changes.