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PloS One 2022Community-led total sanitation (CLTS) is a widely used approach to reduce open defecation in rural areas of low-income countries. Following CLTS programs, communities...
Community-led total sanitation (CLTS) is a widely used approach to reduce open defecation in rural areas of low-income countries. Following CLTS programs, communities are designated as open defecation free (ODF) when household-level toilet coverage reaches the threshold specified by national guidelines (e.g., 80% in Ghana). However, because sanitation conditions are rarely monitored after communities are declared ODF, the ability of CLTS to generate lasting reductions in open defecation is poorly understood. In this study, we examined the extent to which levels of toilet ownership and use were sustained in 109 communities in rural Northern Ghana up to two and a half years after they had obtained ODF status. We found that the majority of communities (75%) did not meet Ghana's ODF requirements. Over a third of households had either never owned (16%) or no longer owned (24%) a functional toilet, and 25% reported practicing open defecation regularly. Toilet pit and superstructure collapse were the primary causes of reversion to open defecation. Multivariate regression analysis indicated that communities had higher toilet coverage when they were located further from major roads, were not located on rocky soil, reported having a system of fines to punish open defecation, and when less time had elapsed since ODF status achievement. Households were more likely to own a functional toilet if they were larger, wealthier, had a male household head who had not completed primary education, had no children under the age of five, and benefitted from the national Livelihood Empowerment Against Poverty (LEAP) program. Wealthier households were also more likely to use a toilet for defecation and to rebuild their toilet when it collapsed. Our findings suggest that interventions that address toilet collapse and the difficulty of rebuilding, particularly among the poorest and most vulnerable households, will improve the longevity of CLTS-driven sanitation improvements in rural Ghana.
Topics: Bathroom Equipment; Community Participation; Cross-Sectional Studies; Defecation; Family Characteristics; Ghana; Humans; Ownership; Poverty; Rural Population; Sanitation; Socioeconomic Factors; Toilet Facilities
PubMed: 34995310
DOI: 10.1371/journal.pone.0261674 -
Current Opinion in Environmental... Feb 2022Emerging infectious diseases (EIDs) of zoonotic origin appear, affect a population and can spread rapidly. At the beginning of 2020, the World Health Organization... (Review)
Review
Emerging infectious diseases (EIDs) of zoonotic origin appear, affect a population and can spread rapidly. At the beginning of 2020, the World Health Organization pronounced an emergency public health advisory because of the SARS-CoV-2 coronavirus outbreak, and declared that COVID-19 had reached the level of a pandemic, rapidly spreading around the world. In order to identify one of the origins of EIDs, and propose some control alternatives, an extensive review was conducted of the available literature. The problem can originate in live animal markets, where animal species of all kinds, from different origins, ecosystems, and taxonomic groups are caged and crowded together, sharing the same unsanitary and unnatural space, food, water, and also the ecto- and endoparasitic vectors of disease. They defecate on each other, leading to the exchange of pathogenic and parasitic microorganisms, forcing interactions among species that should never happen. This is the ideal scenario for causing zoonoses and outbreaks of EIDs. We must start by stopping the illegal collection and sale of wild animals in markets. The destruction of ecosystems and forests also promote zoonoses and outbreaks of EIDs. Science and knowledge should be the basis of the decisions and policies for the development of management strategies. Wildlife belongs in its natural habitat, which must be defended, conserved, and restored at all costs.
PubMed: 34931177
DOI: 10.1016/j.coesh.2021.100310 -
Clinics in Orthopedic Surgery Aug 2023This prospective randomized controlled study aimed to determine the effects of abdominal massage on constipation management in elderly patients with hip fractures. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
This prospective randomized controlled study aimed to determine the effects of abdominal massage on constipation management in elderly patients with hip fractures.
METHODS
From August 2017 to December 2018, patients aged above 65 years with hip fractures (n = 88) were randomly assigned to a massage group that received a bowel massage (n = 48) or a control group that did not receive a bowel massage (n = 40). Patients in the bowel massage group received a bowel massage from a trained caregiver after breakfast at approximately 9:00 AM for an hour. On admission, 5 days after surgery, and on the day of discharge, the patient's normal and actual defecation pattern, stool consistency, and any problems with defecation were assessed through a structured interview. The questionnaire comprising the Bristol Stool Scale, patient assessment of constipation, time to defecation, medication for defecations, failure to defecate, cause of admission, admission period, and date of surgery were recorded. Statistical analyses were performed 5 days after surgery and on the day of discharge.
RESULTS
The mean age of the study cohort was 81.4 years (range, 65-99 years). The number of constipation remedies was significantly lower in the massage group than in the control group on postoperative day (POD) 5 and at discharge (9 vs. 15, = 0.049 and 6 vs. 11, = 0.039, respectively). The number of defecation failures was significantly lower in the massage group than in the control group (10 vs. 17, = 0.028) on POD 5. However, the number of defecation failures at discharge was not significantly different between the two groups ( = 0.131). The development of postoperative ileus ( = 0.271) and length of hospital stay ( = 0.576) were not different between the groups.
CONCLUSIONS
The number of constipation remedies was significantly lower in the massage group than in the control group on POD 5 and discharge, and the number of defecation failures was significantly lower in the massage group than in the control group on POD 5. Therefore, abdominal massage may be considered as an independent nursing initiative for constipation management.
Topics: Aged; Humans; Aged, 80 and over; Defecation; Prospective Studies; Constipation; Massage; Hip Fractures
PubMed: 37529190
DOI: 10.4055/cios22091 -
Clinical and Translational... May 2022Biofeedback therapy (BFT) is a well-known treatment for functional anorectal disorders. The effect of BFT was monitored in fecal incontinence (FI) patients with the...
INTRODUCTION
Biofeedback therapy (BFT) is a well-known treatment for functional anorectal disorders. The effect of BFT was monitored in fecal incontinence (FI) patients with the Fecobionics test and with the conventional technologies, anorectal manometry (ARM) and balloon expulsion test (BET).
METHODS
Studies were performed in 12 patients before and after 8 weeks of biofeedback training. The Fecal Incontinence Severity Index (FISI) score was obtained. Anal resting and squeeze pressures were measured before the bag was distended in the rectum until urge to defecate. Pressure recordings were made during Fecobionics evacuation.
RESULTS
BFT resulted in 24% reduction in FISI scores (P < 0.01). Seven patients were characterized as responders. Anal pressures, the urge-to-defecate volume, and defecatory parameters did not change significantly during BFT. For ARM-BET, the maximum anal squeeze pressure, the urge-to-defecate volume, and the expulsion time were lower after BFT compared with those before BFT (P < 0.05). For Fecobionics, the change in urge volume (r = 0.74, P < 0.05) and the change in defecation index (r = 0.79, P < 0.01) were associated with the change in FISI score. None of the ARM-BET parameters were associated with the change in FISI score. It was studied whether any pre-BFT data could predict treatment success. The Fecobionics expulsion duration and the defecation index predicted the outcome (P < 0.05). The defecation index had a sensitivity of 100% and a specificity of 72%. None of the ARM-BET parameters predicted the outcome (all P > 0.2).
DISCUSSION
Fecobionics was used as a tool to monitor the effect of BFT and proved better than conventional technologies for monitoring and predicting the outcome in the FISI score.
Topics: Biofeedback, Psychology; Defecation; Fecal Incontinence; Humans; Manometry; Severity of Illness Index
PubMed: 35363631
DOI: 10.14309/ctg.0000000000000491 -
BMC Public Health Jun 2024There has been extensive research conducted on open defecation in Ethiopia, but a notable gap persists in comprehensively understanding the spatial variation and...
INTRODUCTION
There has been extensive research conducted on open defecation in Ethiopia, but a notable gap persists in comprehensively understanding the spatial variation and predictors at the household level. This study utilizes data from the 2021 Performance Monitoring for Action Ethiopia (PMA-ET) to address this gap by identifying hotspots and predictors of open defecation. Employing geographically weighted regression analysis, it goes beyond traditional models to account for spatial heterogeneity, offering a nuanced understanding of geographical variations in open defecation prevalence and its determinants. This research pinpoints hotspot areas and significant predictors, aiding policymakers and practitioners in tailoring interventions effectively. It not only fills the knowledge gap in Ethiopia but also informs global sanitation initiatives.
METHODS
The study comprised a total weighted sample of 24,747 household participants. ArcGIS version 10.7 and SaT Scan version 9.6 were used to handle mapping, hotspots, ordinary least squares, Bernoulli model analysis, and Spatial regression. Bernoulli-based model was used to analyze the purely spatial cluster detection of open defecation at the household level in Ethiopia. Ordinary Least Square (OLS) analysis and geographically weighted regression analysis were employed to assess the association between an open defecation and explanatory variables.
RESULTS
The spatial distribution of open defecation at the household level exhibited clustering (global Moran's I index value of 4.540385, coupled with a p-value of less than 0.001), with significant hotspots identified in Amhara, Afar, Harari, and parts of Dire Dawa. Spatial analysis using Kuldorff's Scan identified six clusters, with four showing statistical significance (P-value < 0.05) in Amhara, Afar, Harari, Tigray, and southwest Ethiopia. In the geographically weighted regression model, being male [coefficient = 0.87, P-value < 0.05] and having no media exposure (not watching TV or listening to the radio) [coefficient = 0.47, P-value < 0.05] emerged as statistically significant predictors of household-level open defecation in Ethiopia.
CONCLUSION
The study revealed that open defecation at the household level in Ethiopia varies across the regions, with significant hotspots identified in Amhara, Afar, Harari, and parts of Dire Dawa. Geographically weighted regression analysis highlights male participants lacking media exposure as substantial predictors of open defecation. Targeted interventions in Ethiopia should improve media exposure among males in hotspot regions, tailored sanitation programs, and region-specific awareness campaigns. Collaboration with local communities is crucial.
Topics: Ethiopia; Humans; Male; Female; Adult; Defecation; Sanitation; Middle Aged; Young Adult; Spatial Regression; Spatial Analysis; Family Characteristics; Toilet Facilities; Adolescent
PubMed: 38910246
DOI: 10.1186/s12889-024-19222-1 -
JMIR Research Protocols May 2024The population is constantly aging, and most older adults will experience many potential physiological changes as they age, leading to functional decline. Urinary and...
Finite Element Analysis of Pelvic Floor Biomechanical Models to Elucidate the Mechanism for Improving Urination and Defecation Dysfunction in Older Adults: Protocol for a Model Development and Validation Study.
BACKGROUND
The population is constantly aging, and most older adults will experience many potential physiological changes as they age, leading to functional decline. Urinary and bowel dysfunction is the most common obstacle in older people. At present, the analysis of pelvic floor histological changes related to aging has not been fully elucidated, and the mechanism of improving intestinal control ability in older people is still unclear.
OBJECTIVE
The purpose of this study is to describe how the finite element method will be used to understand the mechanical characteristics of and physiological changes in the pelvic cavity during the rehabilitation process, providing theoretical support for the mechanism for improving urination and defecation dysfunction in older individuals.
METHODS
We will collect magnetic resonance imaging (MRI) and computed tomography (CT) data of the pelvic cavity of one male and one female volunteer older than 60 years and use the finite element method to construct a 3D computer simulation model of the pelvic cavity. By simulating different physiological states, such as the Valsalva maneuver and bowel movement, we will verify the accuracy of the constructed model, investigate the effects of different neuromuscular functional changes, and quantify the impact proportions of the pelvic floor muscle group, core muscle group, and sacral nerve.
RESULTS
At present, we have registered the study in the Chinese Clinical Trial Registry and collected MRI and CT data for an older male and an older female patient. Next, the construction and analysis of the finite element model will be accomplished according to the study plan. We expect to complete the construction and analysis of the finite element model by July 2024 and publish the research results by October 2025.
CONCLUSIONS
Our study will build finite element models of the pelvic floor of older men and older women, and we shall elucidate the relationship between the muscles of the pelvic floor, back, abdomen, and hips and the ability of older adults to control bowel movements. The results of this study will provide theoretical support for elucidating the mechanism for improving urination and defecation dysfunction through rehabilitation.
TRIAL REGISTRATION
Chinese Clinical Trial Registry ChiCTR2400080749; https://www.chictr.org.cn/showproj.html?proj=193428.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/56333.
Topics: Humans; Male; Female; Finite Element Analysis; Pelvic Floor; Aged; Biomechanical Phenomena; Defecation; Middle Aged; Urination; Magnetic Resonance Imaging; Computer Simulation
PubMed: 38820582
DOI: 10.2196/56333 -
International Journal of Physiology,... 2022Functional constipation is defined as a delay or difficulty in defecation that lasts two weeks or more which history and physical examination have ruled out its organic...
BACKGROUND
Functional constipation is defined as a delay or difficulty in defecation that lasts two weeks or more which history and physical examination have ruled out its organic causes. In this study, we aimed to evaluate the efficacy of non-pharmacological treatments (dietary changes and increased physical activity) for adult patients with chronic constipation.
METHODS
This prospective randomized clinical trial was performed in 2020-2021 on 64 patients with functional constipation with the Iranian Registry of Clinical Trials (IRCT) code IRCT20200601047621N2 (https://en.irct.ir/trial/48798). The demographic data and constipation severity were collected by checklist. The diet was designed by a nutritionist containing 25 to 30 grams of fiber and eight glasses of water or liquids other than tea daily for 12 weeks. The amount of sufficient physical activity was defined as doing half an hour of brisk walking daily to increase the heart rate by 50%. All cases were visited during the study and the constipation severity questionnaire was completed at baseline and after 2, 4, 8 and 12 weeks after the beginning of the study.
RESULTS
Patients had significantly improved defecation frequencies after 12 weeks (P = 0.03 compared to baseline). We also observed that patients had improvements in having a hard stool (P = 0.001 compared to baseline), painful defecation (P = 0.03 compared to baseline), use of a finger to defecate (P = 0.04 compared to baseline), and straining while defecation (P < 0.001 compared to baseline). Patients with age groups 30-40 and 40-50 significantly improved defecation frequencies, painful defecation, and straining while defecating compared to other age groups.
CONCLUSION
Non-pharmacological treatments could significantly improve functional constipation in patients. Significant improvements were observed in patients between 30-50 years of age.
PubMed: 36161258
DOI: No ID Found -
Clinical and Translational... Dec 2019Defecation is a complex process that can be easily disturbed. Defecatory disorders may be diagnosed using specialized investigation, including anorectal manometry (ARM)... (Clinical Trial)
Clinical Trial
INTRODUCTION
Defecation is a complex process that can be easily disturbed. Defecatory disorders may be diagnosed using specialized investigation, including anorectal manometry (ARM) and the balloon expulsion test (BET). Recently, we developed a simulated stool named Fecobionics that integrates several tests and assesses pressures, orientation, and bending during evacuation. The aim was to evaluate the feasibility and performance of Fecobionics for assessing defecatory physiology in normal subjects.
METHODS
Physiological expulsion parameters were assessed in an interventional study design. The 10-cm-long Fecobionics probe contained pressure sensors at the front and rear and inside a bag and 2 motion processor units. The bag was distended in the rectum of 20 presumed normal subjects (15 female/5 male) until urge to defecate. ARM-BET was also performed. Three subjects used +2 minutes to evacuate BET, and 1 subject had a high fecal incontinence score. Therefore, the normal group consisted of 16 subjects (13 female/3 male aged 25-78 years).
RESULTS
All subjects reported that Fecobionics evacuation was similar to normal defecation. Fecobionics expulsion pressure signatures demonstrated 5 phases, reflecting rectal pressure, anal relaxation, and anal passage. Preload-afterload loop diagrams demonstrated clockwise contraction cycles. The expulsion duration for BET and Fecobionics was 16 ± 2 and 23 ± 5 seconds (P > 0.2), respectively. The duration of the Fecobionics and BET expulsions was associated (P < 0.001). The change in bending of Fecobionics during defecation was 40 ± 3°.
DISCUSSION
Fecobionics obtained reliable data under physiological conditions. Agreement was found for comparable variables between ARM-BET and Fecobionics but not for other variables. The study suggests that Fecobionics is safe and effective in evaluation of key defecatory parameters.
Topics: Adult; Aged; Constipation; Defecation; Feasibility Studies; Fecal Incontinence; Female; Healthy Volunteers; Humans; Male; Manometry; Middle Aged; Rectum; Reproducibility of Results
PubMed: 31800543
DOI: 10.14309/ctg.0000000000000108 -
BMC Gastroenterology Jan 2023Chronic constipation is prevalent and involves both colon sensitivity and various changes in intestinal bacteria, particularly mucosa-associated microflora. Here we...
BACKGROUND
Chronic constipation is prevalent and involves both colon sensitivity and various changes in intestinal bacteria, particularly mucosa-associated microflora. Here we examined regulatory mechanisms of TRPV4 expression by co-culturing colon epithelial cell lines with intestinal bacteria and their derivatives. We also investigated TRPV4 expression in colon epithelium from patients with constipation.
METHODS
Colon epithelial cell lines were co-cultured with various enterobacteria (bacterial components and supernatant), folate, LPS, or short chain fatty acids. TRPV4 expression levels and promoter DNA methylation were assessed using pyrosequencing, and microarray network analysis. For human samples, correlation coefficients were calculated and multiple regression analyses were used to examine the association between clinical background, rectal TRPV4 expression level and mucosa-associated microbiota.
RESULTS
Co-culture of CCD841 cells with P. acnes, C. perfringens, or S. aureus transiently decreased TRPV4 expression but did not induce methylation. Co-culture with clinical isolates and standard strains of K. oxytoca, E. faecalis, or E. coli increased TRPV4 expression in CCD841 cells, and TRPV4 and TNF-alpha expression were increased by E. coli culture supernatants but not bacterial components. Although folate, LPS, IL-6, TNF-alpha, or SCFAs alone did not alter TRPV4 expression, TRPV4 expression following exposure to E. coli culture supernatants was inhibited by butyrate or TNF-alphaR1 inhibitor and increased by p38 inhibitor. Microarray network analysis showed activation of TNF-alpha, cytokines, and NOD signaling. TRPV4 expression was higher in constipated patients from the terminal ileum to the colorectum, and multiple regression analyses showed that low stool frequency, frequency of defecation aids, and duration were associated with TRPV4 expression. Meanwhile, incomplete defecation, time required to defecate, and number of defecation failures per 24 h were associated with increased E. faecalis frequency.
CONCLUSIONS
Colon epithelium cells had increased TRPV4 expression upon co-culture with K. oxytoca, E. faecalis, or E. coli supernatants, as well as TNFα-stimulated TNFαR1 expression via a pathway other than p38. Butyrate treatment suppressed this increase. Epithelial TRPV4 expression was increased in constipated patients, suggesting that TRPV4 together with increased frequency of E. faecalis may be involved in the pathogenesis of various constipation symptoms.
Topics: Humans; Butyrates; Colon; Constipation; Escherichia coli; Lipopolysaccharides; Staphylococcus aureus; TRPV Cation Channels; Tumor Necrosis Factor-alpha; Cell Line
PubMed: 36639736
DOI: 10.1186/s12876-023-02647-0 -
Medicine Oct 2022Two formulations were developed in the form of an oral sachet containing probiotics, and their efficacy and safety were evaluated in adults with functional constipation. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Two formulations were developed in the form of an oral sachet containing probiotics, and their efficacy and safety were evaluated in adults with functional constipation.
METHODS
One formulation with Lactobacillus acidophilus, Bifidobacterium bifidum and Lactobacillus rhamnosus (3 billion Colony Forming Units - CFU); and another with Lactobacillus acidophilus, Bifidobacterium bifidum, Lactobacillus rhamnosus, Lactobacillus paracasei, Bifidobacterium longum, Bifidobacterium lactis, Lactobacillus casei, Bifidobacterium animallis (8 billion CFU). The participants were randomized in a 3-arm parallel study and one oral sachet was auto-administered once a day for 30 days.
RESULTS
Primary outcomes were improvement in increasing the frequency of weekly bowel movements and improvement in stool quality. Secondary outcomes were number of adverse events. In the first week one observed an increase in stool frequency and in the quality of stools, showing an improvement in constipation. No statistically significant differences were observed between the three treatment groups in relation to these outcomes (P ≥ .05). Only one adverse event was observed in a patient of group 2, related to abdominal pain.
CONCLUSION
The two probiotic cocktails were effective in improving the symptoms of functional constipation, by increasing both the weekly frequency of evacuation and stool quality, and were deemed safe. Clinicaltrials.gov number: NCT04437147.
Topics: Adult; Humans; Constipation; Probiotics; Bifidobacterium; Defecation; Bifidobacterium bifidum; Double-Blind Method
PubMed: 36316826
DOI: 10.1097/MD.0000000000031185