Evaluating in-home water purification methods for communities in Texas on the border with Mexico

Rev Panam Salud Publica. 2006;20(6): pp. 403-6.This study evaluated user preferences among three alternative in-home water treatment technologies suitable for households relying on trucked water in El Paso County, Texas, which is on the border with Mexico. The three technologies were: chlorination of household storage tanks, small-scale batch chlorination, and point-of-use ultraviolet disinfection. Fifteen households used each of the three technologies in succession for roughly four weeks each during April through June of 2004. Data were collected on treated water quality, and a face-valid survey was administered orally to assess user satisfaction with the technologies on a variety of attributes. Treatment with a counter-top ultraviolet disinfection system received statistically significantly higher ratings for taste and odor and likelihood of future use than the other two approaches. Ultraviolet disinfection and small-scale batch chlorination both received significantly higher ratings for ease of use than did storage tank chlorination. Over-chlorination was a common problem with both batch chlorination and storage tank chlorination. Water quality in the households using trucked water is now higher than was reported by a previous study, suggesting that water quality has improved over time

Cognitive Decline Associated with Longitudinal Changes in 24-h Ambulatory Blood Pressure Variability

Background: Cognitive decline has been associated with variability in blood pressure (BP). However, whether the increment of the BP variability during follow-up precedes cognitive decline remains undocumented. We aimed this study to investigate cognitive decline in relation to longitudinal changes in 24-h reading-to-reading BP variability. Methods: We conducted an observational longitudinal study that included 717 dementia-free participants from the Maracaibo Aging Study who underwent follow-up assessment in both 24-h ambulatory BP monitoring and cognitive tests between 1998 and 2015. Cognitive domains consisted of selective reminding tests (total, long-term, short-term, and recognition memory) and the Mini-Mental State Examination (MMSE). Cognitive decline was a longitudinal decrease in cognitive scores. Participants underwent 24-h ambulatory BP monitoring between 2-4 times – with at least one-year interval. Systolic and diastolic BP variability was studied during 24-h and divided into daytime (from 06h00 to 23h00), and nighttime (23h00 to 06h00) periods. To account for BP level, we used variability independent of the mean (VIM) to compute systolic and diastolic BP variability. Other measures of BP variability included the nocturnal BP drop in comparison to the daytime BP level, which was estimated as the night-to-day ratio. Statistics included multivariate linear regression mixed models. Results: Overall, the mean age was 65.6±7.36 years old and 66.5% (n=447) of the participants were women. In mixed models, a decline in all memory domains was associated with greater variability in the 24-h, daytime, and nighttime systolic BP during follow-up, with an estimated decline in cognitive scores ranging from -0.2 to -0.04 points per unit increase in VIM systolic BP during follow-up (P values ranged from 0.022 to 0.003). Decline in total, short-term, and MMSE memory domains was associated with greater 24-h and daytime diastolic BP variability (P≤0.015). A lower night-to-day dipping ratio during follow-up increased the risk of cognitive decline, with a -5.8 to -1.6 decline in long-term memory and MMSE scores; respectively (P≤0.037). Conclusions: Cognitive decline associates with greater reading-to-reading 24-h BP variability and lower falls in nocturnal BP over time. These findings might be indicative of deteriorated regulatory mechanisms to maintain steady BP levels as individuals age

Not a Waste: Wastewater Surveillance to Enhance Public Health

Domestic wastewater, when collected and evaluated appropriately, can provide valuable health-related information for a community. As a relatively unbiased and non-invasive approach, wastewater surveillance may complement current practices towards mitigating risks and protecting population health. Spurred by the COVID-19 pandemic, wastewater programs are now widely implemented to monitor viral infection trends in sewersheds and inform public health decision-making. This review summarizes recent developments in wastewater-based epidemiology for detecting and monitoring communicable infectious diseases, dissemination of antimicrobial resistance, and illicit drug consumption. Wastewater surveillance, a quickly advancing Frontier in environmental science, is becoming a new tool to enhance public health, improve disease prevention, and respond to future epidemics and pandemics

Association of Variability and Hypertensive Peaks in 24-h Blood Pressure with Cardiovascular Risk and Mortality

Background: Blood pressure (BP) variability relates to cardiovascular (CV) diseases and one unexplored mechanism may involve hypertensive peaks caused by high BP variability. OBJECTIVES: To test this hypothesis, we studied the association of cumulative hypertensive peaks (CHP) in 24-h systolic BP with CV risk. Methods: A total of 1212 participants from the Maracaibo Aging Study (mean age, 66; women, 67.2%) underwent 24-h ambulatory BP monitoring and were followed between 1998 and 2010. BP variability was the 24-h average real variability (ARV). CHP in systolic BP (expressed as %) was the number of systolic BP measures ≥125 mmHg (based on the ACC/AHA threshold) each participant experienced over 24-h divided by the number of recordings. The primary endpoint was a composite of fatal and nonfatal coronary, heart failure, and stroke events, while secondary endpoints were total and CV mortality, and fatal and nonfatal coronary and stroke endpoints. Statistics included adjusted Cox proportional models adjusted. Results: During a median follow-up of 8 years, 242 participants developed a composite of any CV endpoint, and 353 died (210 cardiovascular deaths), 129 had coronary and 57 stroke endpoints. An increment of +2 mmHg in 24-h ARV (HR [hazard ratio], 1.18; 95% confidence interval [CI], 1.05-1.33) or +5% in CHP (HR, 1.05; 95% CI, 1.02-1.07) increased CV risk. The inclusion of both indexes in the same Cox proportional models resulted in CHP, but not ARV (P=0.075), associated with the primary endpoints (P=0.004). For secondary endpoints, the association of ARV attenuated while CHP was similar. Conclusions: In this population-based cohort study, CHP in 24-h systolic BP explains the association of high 24-h BP variability and CV risk. Clinical management of high 24-h BP variability is challenging but recognizing that an increased variability results in CHP seems a feasible alternative to address in CV prevention

Contribution of 24-h Blood Pressure Variability to Dementia-Related Disorders in Hispanics

Introduction: As the number of people living with dementia is increasing at alarming rates worldwide, there is an urgent need to understand the physiopathology of dementia syndromes. Among the most important preventable risk factors, treatment of vascular risk factors such as high blood pressure (BP) decreases the risk of Alzheimer’s disease and related dementias (ADRD). Recent evidence suggests that examining BP variability provides additional physiopathological and predictive information above the mean BP level. However, studies examining the relationship between 24-h BP variability and ADRD are limited, and evidence of the association with dementia has not been documented yet. Therefore, we aimed in this study to assess the association of 24-h ambulatory BP variability with brain imaging and cognitive markers of ADRD. Methods: A cross-sectional observational study was conducted using a subset of 420 individuals from the Maracaibo Aging Study aged ≥40 years. Study participants underwent brain MRI scanning and 24-h ambulatory BP monitoring assessments. Markers of ADRD included 1) cerebral small vessel disease (CSVD, defined as white matter hyperintensities, presence of lacunes, cerebral microbleeds, and enlarged perivascular spaces, and hippocampal volume), 2) cognitive functioning addressed with the mini-mental state exam (EMEMS), and 3) diagnose of dementia at baseline. 24-h ambulatory BP variability was studied as the average real variability index. Adjusted linear and logistic regression models were used to analyze the association between 24-h BP and ADRD and accounted for age, sex, education level, body mass index (BMI), current smoking, alcohol intake, hypertension treatment, diabetes mellitus, serum total cholesterol, previous cardiovascular diseases, and cephalic circumference and 24-h mean BP level. Results: The mean age was 57.1±11.8 years old and 73.2% were women (n=303). In adjusted analysis, each unit increase in the 24-h systolic BP variability was significantly associated with lower hippocampus volume (β, -0.036; 95% confidence interval [CI], -0.064, -0.008, P=0.011), greater white matter hyper intensities volume (β, 0.026; 95% CI, 0.008, 0.044; P=0.006), lower cognitive scores (β, -0.370; 95% CI, -0.729, -0.011; P=0.044), greater presence of lacunes (Odds ratios [OR], 1.38; 95% CI, 1.10, 1.71; P=0.004), enlarged perivascular spaces (OR,1.34; 95% CI, 1.08, 1.67; P=0.007), and dementia prevalence (OR, 1.41; 95% CI, 1.07, 1.85; P=0.014). 24-hour diastolic blood pressure variability was only significantly associated with lacunes (OR, 1.42; 95% CI, 1.06, 1.90; P=0.017). In exploratory analysis, we found that neither daytime nor nighttime variability in BP significantly relate with ADRD. Conclusions: Excessive 24-h BP variability associates with ADRD independently of the mean BP level. Understanding the physiological mechanisms explaining the relationship between excessive 24-h BP variability and ADRD may be clinically relevant in the prevention of ADRDs

Wastewater Analysis of Mpox Virus in a City With Low Prevalence of Mpox Disease: an Environmental Surveillance Study

BACKGROUND: Tracking infectious diseases at the community level is challenging due to asymptomatic infections and the logistical complexities of mass surveillance. Wastewater surveillance has emerged as a valuable tool for monitoring infectious disease agents including SARS-CoV-2 and Mpox virus. However, detecting the Mpox virus in wastewater is particularly challenging due to its relatively low prevalence in the community. In this study, we aim to characterize three molecular assays for detecting and tracking the Mpox virus in wastewater from El Paso, Texas, during February and March 2023. METHODS: In this study, a combined approach utilizing three real-time PCR assays targeting the C22L, F3L, and F8L genes and sequencing was employed to detect and track the Mpox virus in wastewater samples. The samples were collected from four sewersheds in the City of El Paso, Texas, during February and March 2023. Wastewater data was compared with reported clinical case data in the city. FINDINGS: Mpox virus DNA was detected in wastewater from all the four sewersheds, whereas only one Mpox case was reported during the sampling period. Positive signals were still observed in multiple sewersheds after the Mpox case was identified. Higher viral concentrations were found in the pellet than in the supernatant of wastewater. Notably, an increasing trend in viral concentration was observed approximately 1-2 weeks before the reporting of the Mpox case. Further sequencing and epidemiological analysis provided supporting evidence for unreported Mpox infections in the city. INTERPRETATION: Our analysis suggests that the Mpox cases in the community is underestimated. The findings emphasize the value of wastewater surveillance as a public health tool for monitoring infectious diseases even in low-prevalence areas, and the need for heightened vigilance to mitigate the spread of Mpox disease for safeguarding global health. FUNDING: Center of Infectious Diseases at UTHealth, the University of Texas System, and the Texas Epidemic Public Health Institute. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of these funding organizations

Wastewater Sequencing Reveals Community and Variant Dynamics of the Collective Human Virome

Wastewater is a discarded human by-product, but its analysis may help us understand the health of populations. Epidemiologists first analyzed wastewater to track outbreaks of poliovirus decades ago, but so-called wastewater-based epidemiology was reinvigorated to monitor SARS-CoV-2 levels while bypassing the difficulties and pit falls of individual testing. Current approaches overlook the activity of most human viruses and preclude a deeper understanding of human virome community dynamics. Here, we conduct a comprehensive sequencing-based analysis of 363 longitudinal wastewater samples from ten distinct sites in two major cities. Critical to detection is the use of a viral probe capture set targeting thousands of viral species or variants. Over 450 distinct pathogenic viruses from 28 viral families are observed, most of which have never been detected in such samples. Sequencing reads of established pathogens and emerging viruses correlate to clinical data sets of SARS-CoV-2, influenza virus, and monkeypox viruses, outlining the public health utility of this approach. Viral communities are tightly organized by space and time. Finally, the most abundant human viruses yield sequence variant information consistent with regional spread and evolution. We reveal the viral landscape of human wastewater and its potential to improve our understanding of outbreaks, transmission, and its effects on overall population health

Wastewater pandemic preparedness: Toward an end-to-end pathogen monitoring program

Molecular analysis of public wastewater has great potential as a harbinger for community health and health threats. Long-used to monitor the presence of enteric viruses, in particular polio, recent successes of wastewater as a reliable lead indicator for trends in SARS-CoV-2 levels and hospital admissions has generated optimism and emerging evidence that similar science can be applied to other pathogens of pandemic potential (PPPs), especially respiratory viruses and their variants of concern (VOC). However, there are substantial challenges associated with implementation of this ideal, namely that multiple and distinct fields of inquiry must be bridged and coordinated. These include engineering, molecular sciences, temporal-geospatial analytics, epidemiology and medical, and governmental and public health messaging, all of which present their own caveats. Here, we outline a framework for an integrated, state-wide, end-to-end human pathogen monitoring program using wastewater to track viral PPPs

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701