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Journal of Athletic Training Dec 2023Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this back-to-back...
A systematic review on oral rehydration beverages for treating exerciseassociated dehydrationPart II. The effectiveness of alternatives to carbohydrate-electrolyte drinks.
OBJECTIVE
Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this back-to-back review demonstrated that commercial sports drinks can be suggested for effective restoration of fluid balance in dehydrated persons. This systematic review was undertaken to compare alternative liquids, such as milk, beer, and coconut water, with water for effective oral rehydration after prolonged exercise.
DATA SOURCES
Cochrane Library, PubMed, and Embase were searched for relevant literature in June 2022.
STUDY SELECTION
Controlled experimental and observational studies involving adults and children were included when dehydration was induced by physical exercise and oral rehydration fluids were administered and compared with regular water. No additional food intake accompanied the rehydration drinks or water. Articles in all languages were included if an English abstract was available.
DATA EXTRACTION
The study design, study population, intervention, outcome measures, and study limitations were extracted from each included article.
DATA SYNTHESIS
Out of 3485 records, 11 studies were included comparing skim or low-fat milk, coconut water, and beer (0-5% alcohol) with water. Four studies showed that drinking skim or low-fat milk, without additional food intake, led to a statistically significant improved volume/hydration status when compared with drinking water. In three trials, no significant differences were shown at multiple timepoints for outcomes related to volume and hydration status following rehydration with fresh coconut water compared with water. Lastly, there is insufficient evidence to recommend beer for rehydration (0-5% alcohol).
CONCLUSIONS
Consuming skim or low-fat cow's milk without additional food as compared with water appears to improve volume/hydration status in persons with exercise-induced dehydration. However, evidence is of very low certainty and should be interpreted with caution.
PubMed: 38116818
DOI: 10.4085/1062-6050-0686.22 -
Journal of Athletic Training Dec 2023Exercise-associated dehydration is a common problem, especially at sporting events. Although there are recommendations to drink a certain volume per kg body mass lost...
OBJECTIVE
Exercise-associated dehydration is a common problem, especially at sporting events. Although there are recommendations to drink a certain volume per kg body mass lost after exercise, there is no clear guidance about the type of rehydration beverage. The aim of this systematic review is to assess the effectiveness of carbohydrate-electrolyte solutions as a rehydration solution for exercise-associated dehydration.
DATA SOURCES
Medline (via the PubMed interface), Embase and the Cochrane Library were searched for relevant studies. The search is up to date until June 2022.
STUDY SELECTION
Controlled trials involving adults and children were included if dehydration was the result of physical exercise and if drinking carbohydrate-electrolyte solutions, of any percentage carbohydrate, was compared with drinking water. All languages were included as long as an English abstract was available.
DATA EXTRACTION
Data on study design, study population, interventions, outcome measures and study limitations were extracted from each included article. Certainty was assessed using GRADE.
DATA SYNTHESIS
Out of 3485 screened articles, 19 studies were included that assessed carbohydrate-electrolyte solutions (0% - 9% carbohydrate) compared with water. Although there is variability amongst the identified studies, drinking 0-3.9% and, especially, 4-9% carbohydrate-electrolyte (CE) solution may be effective for rehydration.
CONCLUSIONS
A potential beneficial effect of drinking CE drinks compared with water was seen for many of the reviewed outcomes. Commercial CE drinks (ideally 4-9% CE drinks or alternatively 0-3.9% CE drinks) could be suggested for rehydration in persons with exercise associated dehydration when whole foods are not available.
PubMed: 38116803
DOI: 10.4085/1062-6050-0682.22 -
ACS ES&T Water Dec 2023Astroviruses (AstVs) are a major cause of gastroenteritis, especially in children. They can be transmitted through various pathways, including environmental... (Review)
Review
Astroviruses (AstVs) are a major cause of gastroenteritis, especially in children. They can be transmitted through various pathways, including environmental contamination via water matrices. This study aimed to investigate the prevalence of AstV in different types of water, such as untreated and treated wastewater, surface water (e.g., rivers, lakes, and seawater), groundwater, drinking water, and other water matrices (e.g., irrigation water, gray water, reservoir water, floodwater, and pig slaughterhouse effluents). The meta-analysis included 80 articles, and the overall prevalence of AstV in water matrices was 36.6% [95% confidence interval (CI) of 29.6-44.0]. The highest prevalence was found in untreated wastewater at 56.8% (95% CI of 41.5-71.5), followed by treated wastewater at 48.5% (95% CI of 30.6-66.5), surface water at 28.6% (95% CI of 21.1-36.7), other matrices at 9.8% (95% CI of 0.7-25.3), drinking water at 3.3% (95% CI of 0.2-8.7), and groundwater at 0.5% (95% CI of 0.0-3.4). The most frequent AstVs detected in water environments were human AstVs, but canine and feline AstVs were also detected. Our findings highlight the importance of water as a potential route for AstV transmission, even in high-income countries. Effective water surveillance and treatment measures are necessary to minimize AstV environmental circulation and human infection through water.
PubMed: 38094915
DOI: 10.1021/acsestwater.3c00415 -
Does fluoride exposure affect thyroid function? A systematic review and dose-response meta-analysis.Environmental Research Feb 2024Fluoride exposure may have various adverse health effects, including affecting thyroid function and disease risk, but the pattern of such relation is still uncertain. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Fluoride exposure may have various adverse health effects, including affecting thyroid function and disease risk, but the pattern of such relation is still uncertain.
METHODS
We systematically searched human studies assessing the relation between fluoride exposure and thyroid function and disease. We compared the highest versus the lowest fluoride category across these studies, and we performed a one-stage dose-response meta-analysis for aggregated data to explore the shape of the association.
RESULTS
Most retrieved studies (27 of which with a cross-sectional design) were conducted in Asia and in children, assessing fluoride exposure through its concentrations in drinking water, urine, serum, or dietary intake. Twenty-four studies reported data on thyroid function by measuring thyroid-related hormones in blood (mainly thyroid-stimulating-hormone - TSH), 9 reported data on thyroid disease, and 4 on thyroid volume. By comparing the highest versus the lowest fluoride categories, overall mean TSH difference was 1.05 μIU/mL. Dose-response curve showed no change in TSH concentrations in the lowest water fluoride exposure range, while the hormone levels started to linearly increase around 2.5 mg/L, also dependending on the risk of bias of the included studies. The association between biomarkers of fluoride exposure and TSH was also positive, with little evidence of a threshold. Evidence for an association between fluoride exposure and blood concentrations of thyroid hormones was less evident, though there was an indication of inverse association with triiodothyronine. For thyroid disease, the few available studies suggested a positive association with goiter and with hypothyroidism in both children and adults.
CONCLUSIONS
Overall, exposure to high-fluoride drinking water appears to non-linearly affect thyroid function and increase TSH release in children, starting above a threshold of exposure, and to increase the risk of some thyroid diseases.
Topics: Adult; Child; Humans; Cross-Sectional Studies; Drinking Water; Fluorides; Thyroid Diseases; Thyroid Hormones; Thyrotropin; Thyroxine; Triiodothyronine
PubMed: 38029816
DOI: 10.1016/j.envres.2023.117759 -
International Journal of Hygiene and... Jan 2024This paper aims to provide a deeper understanding of the water-, sanitation- and hygiene (WASH)-related insecurities that people experiencing homelessness in urban areas... (Review)
Review
This paper aims to provide a deeper understanding of the water-, sanitation- and hygiene (WASH)-related insecurities that people experiencing homelessness in urban areas of high-income countries (HIC) are facing, and how these insecurities are further complicated during extreme weather events. While limited recent research has looked into WASH among people experiencing homelessness in HICs, and while some work has considering the implications of climate change on WASH and health, the nexus of WASH, extreme weather events and homelessness in HICs have not been studied thus far. We conducted the first systematic scoping review of peer-reviewed literature on this nexus, which is understudied and marked by complexity, involving a range of systems and forms of impact. A total of 50 publications were included in our analysis. We found that public facilities like drinking water fountains, toilets, handwashing facilities, and showers are scarce, frequently unavailable, often pose safety and cleanliness issues, and access to non-public facilities may be cost-prohibitive for homeless populations. Consequently, people experiencing homelessness, including those sleeping rough, in encampments, or shelters, are often forced to limit drinking water consumption, forego healthy hygiene behaviours, and resort to open urination and defecation, all of which carry health risks. Extreme weather events, like heatwaves, extreme cold, heavy rain and flooding exacerbate challenges for people experiencing homelessness, further complicating their access to WASH, and reducing the ability of service providers to deliver extra relief, creating a dual WASH and health burden. Our review highlights that the Human Right to Water and Sanitation is not met for people experiencing homelessness in urban areas of high-income countries, with women emerging as one of the most vulnerable subgroups. It reveals that the impact of certain WASH issues (e.g. drinking water) on homeless populations are better understood than others (e.g. waste), and, similarly, the effects of certain extreme weather events (e.g. heatwaves) on the health and WASH conditions of people experiencing homelessness are better understood than others (e.g. flooding). Data gaps and the lack of information on limited WASH access and health circumstances of people experiencing homelessness, further minimize their representation and consequently impose obstacles to improve their situation. Based on our analysis, we established a framework which operationalizes the nexus of WASH, extreme weather events and homelessness. This framework improves our understanding of the underlying complexities at the intersection of these three issues and provides a foundation for enhanced preparedness and health-oriented planning.
Topics: Humans; Female; Sanitation; Extreme Weather; Drinking Water; Developed Countries; Hygiene; Ill-Housed Persons
PubMed: 37925888
DOI: 10.1016/j.ijheh.2023.114285 -
Environmental Health Perspectives Sep 2023
Topics: Drinking Water; Halogenation
PubMed: 37751327
DOI: 10.1289/EHP13164 -
Environmental Health Perspectives Sep 2023
Topics: Drinking Water; Halogenation
PubMed: 37751323
DOI: 10.1289/EHP13870 -
Frontiers in Public Health 2023Several studies have reported on hepatitis E virus (HEV) prevalence in various regions of China, but the results vary widely. Herein, we conducted a systematic review...
INTRODUCTION
Several studies have reported on hepatitis E virus (HEV) prevalence in various regions of China, but the results vary widely. Herein, we conducted a systematic review and meta-analysis to assess the seroprevalence, RNA-positive rate, genotype distribution of HEV in China, and its risk factors.
METHODS
We included 208 related studies involving 1,785,569 participants published between 1997 and 2022. Random-effects models were used to pool prevalence, and subgroup analyses were conducted by population, gender, age, study period, regions, and rural-urban distribution. The meta regression models and pooled odds ratios (OR) were performed to identify risk factors for HEV infections.
RESULTS
The pooled anti-HEV IgG, IgM, and Ag seroprevalence, and RNA detection rates in China from 1997 to 2022 were 23.17% [95% confidence interval (CI): 20.23-26.25], 0.73% (95% CI: 0.55-0.93), 0.12% (95% CI: 0.01-0.32), and 6.55% (95% CI: 3.46-12.05), respectively. The anti-HEV IgG seropositivity was higher in the occupational population (48.41%; 95% CI: 40.02-56.85) and older adult aged 50-59 years (40.87%; 95% CI: 31.95-50.11). The dominant genotype (GT) of hepatitis E in China was GT4. Notably, drinking non-tap water (OR = 1.82; 95% CI: 1.50-2.20), consumption of raw or undercooked meat (OR = 1.47; 95% CI: 1.17-1.84), and ethnic minorities (OR = 1.50; 95% CI: 1.29-1.73) were risk factors of anti-HEV IgG seroprevalence.
DISCUSSIONS
Overall, the prevalence of hepatitis E was relatively high in China, especially among older adults, ethnic minorities, and humans with occupational exposure to pigs. Thus, there is a need for preventive measures, including HEV infection screening and surveillance, health education, and hepatitis E vaccine intervention in high-risk areas and populations.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42023397036.
PubMed: 37744517
DOI: 10.3389/fpubh.2023.1243408 -
Advances in Nutrition (Bethesda, Md.) Jan 2024The National School Lunch Program (NSLP) provides healthy food to millions of children annually. To promote increased lunch consumption, policy, systems, and... (Review)
Review
The National School Lunch Program (NSLP) provides healthy food to millions of children annually. To promote increased lunch consumption, policy, systems, and environmental (PSE) change strategies are being implemented in child nutrition programs. An evaluation of the current evidence supporting PSE interventions in school nutrition programs is needed to facilitate evidence-based practices across the nation for programs. This systematic review aims to determine the quality and breadth of available evidence of the effectiveness of PSE strategies on the consumption and waste of fruits, vegetables, milk, and water in the NSLP. The inclusion criteria required studies to occur in a United States K-12 school setting, data collection after 2012, report consumption and waste findings for fruit, vegetable, milk, or water, and be an original research article. Articles included in the review are restricted to positive or neutral quality. Thirty studies are included, policy level (n = 4), systems level (n = 8), environmental level (n = 10), and multi-category (n = 8). Results from positively rated policy-level studies suggest that recess before lunch may increase milk consumption, whereas removing flavored milk may decrease consumption. System-level studies of offering vegetables first in isolation of other meal components and offering spiced vegetables compared with traditional preparations may increase vegetable consumption, and locally procuring produce may increase fruit and vegetable consumption. Environmental-level studies such as water promotion strategies such as placing cups near drinking fountains may increase water consumption. Improving the convenience, attractiveness, and palatability of fruits and vegetables may increase consumption. Future PSE research in child nutrition programs should incorporate implementation aides and metrics into their study designs to allow a better understanding of how to sustain interventions from the perspective of school nutrition professionals.
Topics: Child; Humans; United States; Child Nutritional Physiological Phenomena; Fruit; Vegetables; Lunch; Water; Food Services; Nutrition Policy; Food Preferences
PubMed: 37716534
DOI: 10.1016/j.advnut.2023.09.004 -
The Science of the Total Environment Dec 2023Reliance on groundwater is increasing in Sub-Saharan Africa as development programmes work towards improving water access and strengthening resilience to climate change.... (Review)
Review
Reliance on groundwater is increasing in Sub-Saharan Africa as development programmes work towards improving water access and strengthening resilience to climate change. In lower-income areas, groundwater supplies are typically installed without water quality treatment infrastructure or services. This practice is underpinned by an assumption that untreated groundwater is typically suitable for drinking due to the relative microbiological safety of groundwater compared to surface water; however, chemistry risks are largely disregarded. This article systematically reviews groundwater chemistry results from 160 studies to evaluate potential health risk in two case countries: Ethiopia and Kenya. Most studies evaluated drinking water suitability, focusing on priority parameters (fluoride, arsenic, nitrate, or salinity; 18 %), pollution impacts (10 %), or overall suitability (45 %). The remainder characterised general hydrogeochemistry (13 %), flow dynamics (10 %), or water quality suitability for irrigation (3 %). Only six studies (4 %) reported no exceedance of drinking water quality thresholds. Thus, chemical contaminants occur widely in groundwaters that are used for drinking but are not regularly monitored: 78 % of studies reported exceedance of contaminants that have direct health consequences ranging from hypertension to disrupted cognitive development and degenerative disease, and 81 % reported exceedance of aesthetic parameters that have indirect health impacts by influencing perception and use of groundwater versus surface water. Nevertheless, the spatiotemporal coverage of sampling has substantial gaps and data availability bias is driven by a) the tendency for research to concentrate in areas with known water quality problems, and b) analytical capacity limitations. Improved in-country analytical capacity could bolster more efficient assessment and prioritisation of water chemistry risks. Overall, this review demonstrates that universal and equitable access to safe drinking water (Sustainable Development Goal target 6.1) will not be achieved without wider implementation of groundwater treatment, thus a shift is required in how water systems are designed and managed.
Topics: Water Supply; Environmental Monitoring; Drinking Water; Ethiopia; Kenya; Groundwater; Water Quality; Water Pollutants, Chemical
PubMed: 37689199
DOI: 10.1016/j.scitotenv.2023.166929