Search Results (363)

(1) Background: Metabolic disorders, including hypertension, hyperlipidemia, and hyperglycemia (HHH), rank at the top of the disease burden in China. However, population-level assessment of pharmacological treatment remains limited by the lack of scalable metrics for monitoring medication use and outcomes. (2) Methods: We pioneered the use of standardized combined “HHH” medication usage—encompassing antihypertensive, antidiabetic, and lipid-lowering agents—as an integrated proxy for evaluating interventions for cardiovascular diseases and diabetes. Leveraging wastewater-based epidemiology (WBE), we quantified HHH medication loads (mg/d/1000 persons) across 30 prefectures covering all regions in China, and mapped the associated geographical disparities using independent t-tests. Associations with environmental, socioeconomic, demographic, social service, and health-related behavioral and lifestyle factors were further examined via correlation analysis. (3) Results: Our findings confirmed a pronounced north–south gradient in HHH medication uses (the mean standardized loads in the north were approximately twice as high as those in the south, p < 0.05). Furthermore, aging, sex ratio, nicotine consumption, obesity rate, the comprehensive Air Quality Index (AQI), precipitation and the Urban Wellness and Healthcare Index were identified as the top seven influencing factors (|r| values ranging from 0.37 to 0.71, all p < 0.05). (4) Conclusions: As a comprehensive national-scale analysis of multi-drug use for HHH via WBE, this study provides valuable insights into national multi-disease pharmacological treatment, offering evidence-based support for refining clinical prescribing guidelines and rationalizing the allocation of healthcare resources. Full article

Antibiotic resistance (ABR) is a significant threat to human and animal health, as well as to the environment. Antibiotic residues, antibiotic-resistant bacteria and antibiotic resistance genes are emerging contaminants of water resources. The present study aimed to assess the prevalence of ABR among waterborne enterococci in an anthropogenic-affected section of the Yantra River (Bulgaria). The susceptibility of 426 strains to 13 antibiotics (ABs) was tested by the disk diffusion method, and the genes encoding resistance by PCR analyses. A total of 39% of isolates were found to be antibiotic-resistant, with 9% mainly being multidrug-resistant to three AB classes. The most common resistance was to erythromycin (19%), tetracycline (18%) and ampicillin (14%), encoded by the ermB, tetM and blaTEM genes. A total of 3% of isolates were ciprofloxacin-resistant and only 1% was resistant to vancomycin or high-level gentamicin. All isolates were susceptible to teicoplanin and linezolid. Spatial variations in ABR levels were found, with the lowest abundance of antibiotic-resistant enterococci occurring in upstream river waters, away from urban areas, and the highest in urban areas. The spread of waterborne antibiotic-resistant enterococci highlights the need for water pollution management, monitoring and control to limit anthropogenic pressures through wastewater discharges and diffuse fecal pollution, and to ensure the ecological well-being of receiving waters. Full article

This study evaluated the occurrence, spatial distribution, and associated human health risks of trace metals in water intended for human consumption from urban and rural areas of Satu Mare County (northwestern Romania) based on monitoring data collected between 2022 and 2024. A total of 271 samples from 122 localities were analyzed for As, Cd, Cr, Mn, Ni, Pb, and Se using high-resolution continuum source graphite furnace atomic absorption spectrometry (HR-CS GFAAS). Spatial analysis, non-parametric statistics, Spearman correlation, and principal component analysis (PCA) were applied to identify distribution patterns and differences between supply systems. Arsenic was identified as the main contaminant of concern, with concentrations reaching 320.5 µg/L, primarily in rural groundwater sources. Most other metals remained below regulatory limits, and elevated concentrations were spatially localized rather than widespread. Non-carcinogenic risk (HRI > 1) was observed in 5.74% of samples, while arsenic-related carcinogenic risk (ILCR > 10⁻⁶) occurred in a limited number of locations in 2024, with no values exceeding 10⁻⁴. Risk estimates were based on total arsenic concentrations and should be interpreted conservatively due to the lack of speciation. No statistically significant differences between urban and rural areas were observed for most metals, except for manganese. Multivariate analysis revealed distinct geochemical behaviors, with a Pb–Ni–Se–Cd cluster in rural samples, while arsenic and manganese showed more independent patterns consistent with redox-controlled processes. Urban samples showed more coherent patterns and higher variance explained by PCA (78.9%) compared to rural datasets (60.1%). Risk estimates were based on total arsenic concentrations and should be interpreted conservatively. The findings highlight the vulnerability of decentralized groundwater systems and support targeted monitoring strategies in line with Directive (EU) 2020/2184. Full article

The quality of water for human consumption depends on the supply method and source type. Water may contain pathogens and excessive constituents that pose health risks, and timely monitoring and planned service provision help ensure its quality. This study assessed the supply system, quality, and health risks associated with the consumption of water from three sources in the high-elevation Andean city of Andahuaylas, Peru, managed by the Municipal Sanitation Service Provider Chanka (EMSAP). The sources were found to provide between 0.8 and 32 L/s, with consumption of about 17 m³ per connection per month, at a cost of 0.20 USD/m³. The system shows a current deficit and a projected deficit for 2027 due to increasing user debts and the absence of mechanisms for payment for ecosystem services (PESs), despite the existence of cross-subsidies. Water quality, assessed using the WQI-Pe, ranged from regular to excellent, although with high levels of heavy metals according to the Environmental Quality Standards for Water (EQS–Peru), which increases the non-carcinogenic health risk. Chronic non-carcinogenic exposure (HQ) from consumption and dermal contact exceeded one, mainly for arsenic (As), while the deterministically and probabilistically evaluated incremental lifetime cancer risk (ILCR) was linked to high levels of As, Cr, and Cd across all age groups (infants, children, adolescents, and adults). Overall, this study provides insight into the state of water in areas without conventional treatment, so the implementation of buffer zones in the basin’s headwaters in localities with similar characteristics is vital. Full article

Large wastewater treatment plants (WWTP) are increasingly supplemented with quaternary treatment. Classical monitoring hereby relies mostly on the measurement of oxygen demand, micropollutants and the nutrients phosphorus and nitrogen. From a microbiological perspective, relevant parameters to assess treatment performance include the removal efficacies of the fecal gene load as a proxy of pathogenic risk, antibiotic resistance genes and the bacterial regrowth potential. For this purpose, a combination of flow cytometry and quantitative PCR, together with a viability assessment, was applied to characterize a full-scale pilot plant. The pilot plant comprised conventional treatment and MBR and ozonation for advanced treatment. The assessment of fecal gene load was based on the quantification of Bacteroidales of human origin, as these obligate anaerobic bacteria cannot replicate within wastewater treatment plants. Whereas conventional treatment resulted in only moderate removal of these parameters, quaternary treatment typically led to a much stronger decrease. MBR treatment contributed most strongly to the removal with an appr. 6 log reduction compared to the primary clarification effluent, corroborating its microbiological merit for wastewater treatment. In addition to removing microorganisms and their genetic content, data also suggested a 95% reduction in extracellular DNA. Ozonation further enhanced microbiological removal. From an analytical perspective, the study shows the added value of using a long amplicon qPCR approach together with sample treatment with a viability dye to minimize false-positive signals and to avoid underestimation of treatment performance. The chosen diagnostic approach shows promise in assessing the microbiological treatment efficacy of WWTPs and as a basis to decide on the microbiological necessity of treatment upgrades. Full article

Thermal water-supplied swimming pools are increasingly used worldwide for recreation, wellness, and therapeutic purposes, yet their management poses specific challenges due to the complex physicochemical properties of thermal and mineral waters and the need to balance microbiological safety with preservation of their natural characteristics. This scoping review adopts an integrative and comparative methodological approach, combining a systematic mapping of the scientific literature with a structured analysis of regulatory documents across 39 countries. It maps and comparatively synthesizes current evidence on health benefits, safety issues, and regulatory frameworks governing thermal pools. The analysis focuses on microbiological hazards and chemical risks related to disinfection practices, including the formation of disinfection by-products (DBPs). The review also examines emerging contaminants (CECs), including pharmaceuticals and personal care products (PPCPs), and discusses the potential role of thermal water environments in the development and spread of antimicrobial resistance (AMR). Moving beyond a purely descriptive approach, the analysis introduces a comparative framework that identifies distinct regulatory models and evaluates their implications for risk management and disinfection strategies. Thermal pools are conceptualized as integrated exposure systems generating complex mixtures with uncertain toxicological effects. The analysis reveals global regulatory heterogeneity and critical gaps in managing DBPs, CECs, and AMR-related risks, highlighting the need for integrated, risk-based and harmonized approaches within a One Health framework. Full article

Microbiological contamination of drinking water remains a significant public health concern worldwide, necessitating the development of efficient and environmentally friendly disinfection technologies. This study investigated the effectiveness and physicochemical mechanisms of water treatment using high-frequency electrical discharge plasma. Experimental research was conducted employing a laboratory dielectric barrier discharge reactor operating at 10–30 kHz and 10–25 kV, with treatment durations ranging from 5 to 20 min. Plasma exposure resulted in pronounced physicochemical changes in the aqueous medium, including a decrease in pH from 7.1–7.3 to 5.4–6.0 and an increase in electrical conductivity from 280–340 µS/cm to 480–620 µS/cm. The formation of reactive oxygen species, including hydroxyl radicals, ozone, and hydrogen peroxide, was confirmed, with hydrogen peroxide concentrations varying between 0.35 and 1.20 mg/L. Microbiological analysis demonstrated a reduction in microbial concentration from approximately 10⁵–10⁶ CFU/mL to 10²–10³ CFU/mL, corresponding to 3–4 log inactivation. The results indicated that microbial reduction was strongly associated with the generation of reactive species and treatment duration. Energy density within the range of 0.3–1.2 kWh/m³ was found to support effective disinfection performance. The findings demonstrated that high-frequency plasma treatment established a strong oxidative environment leading to microbial membrane disruption and cellular damage. Overall, the study confirmed the potential of high-frequency electrical discharge plasma technology as a promising approach for drinking water disinfection and provided a basis for further optimization and scale-up investigations. Full article

Circulation of pool water via a treatment plant is critical for maintaining pool water in a condition that is a safe and attractive for bathers. It is also one of the pool operations that is most costly in terms of energy used and associated carbon footprint. In this study, we compare and contrast circulation rate guidelines developed for the UK and for other northern and southern European countries and, where possible, provide an explanation of the underlying rationale. We focus on the management of turbidity-forming material and Cryptosporidium oocysts. We reveal that the parameters used to assess safe operational bathing load are relatively consistent across Europe, based on physical space requirements for bathing and other constraints such as lifeguarding. Circulation rate, on the other hand, is based on either rule-based turnover times, or a more flexible approach based on the volume of water to be treated per bather. The latter offers scope for innovation and energy savings, with the proviso that safe water is maintained for bathers. The guidance in several countries suggests reducing circulation rate when the pool is not being used by bathers. We conclude that a more progressive risk-based approach to pool management, building on these findings, offers significant opportunities for pool operators to run pools better and should be a priority for future research. Full article

Thermal groundwater resources constitute valuable health-oriented georesources, particularly when integrated into regional strategies for wellness, balneotherapy, and therapeutic tourism. This study presents the first comprehensive and integrated hydrochemical, geospatial, and balneological characterization of thermal groundwater systems in Uruguay, enabling their classification from a medical hydrology perspective and supporting the assessment of their potential use in balneotherapy. Seven thermal groundwater sources located in northwestern Uruguay were investigated, mainly associated with the Guaraní Aquifer System (GAS), together with the singular Almirón spring, which represents a distinct hydrogeological setting. Field measurements and laboratory analyses were conducted to determine physicochemical parameters, major ions, and gases. Hydrogeochemical facies were identified using Piper and Gibbs diagrams, while multivariate statistical techniques, including Principal Component Analysis (PCA) and hierarchical clustering, were applied to discriminate water types and support their balneological classification. The results indicate that most thermal waters associated with the GAS are characterized by sodium–bicarbonate facies, weak to medium mineralization. Dry residue to 180 °C, (311–734 mg/L), and mesothermal to hyperthermal temperatures (36.3–44.5 °C), reflecting deep confined circulation and prolonged water–rock interaction. By comparison, the Almirón spring exhibits a chloride–sodium facies with strong mineralization. Dry residue to 180 °C, (6590 mg/L) and hypothermal (32 °C), consistent with a distinct hydrogeological origin involving crystalline basement and Devonian sedimentary units and reflecting more evolved geochemical conditions. Based on the obtained results, and by analogy with comparable international hydrothermal profiles, the main balneological indications of these waters include musculoskeletal and rheumatic disorders, dermatological disorders, and other emerging indications such as stress, sleep disorders, obesity, and Long COVID. In conclusion, this study reveals the hydrochemical diversity of Uruguay’s thermal groundwater and its possible use in balneology. Future research should focus on controlled clinical and balneological studies to validate specific therapeutic effects. Full article

The spread of antibiotic resistance is contributing to 4.95 million cases of mortality per year, and it is categorised as one of the top three threats to public health in modern society, threatening the ability to treat common infections. Wastewater treatment plants influence the dissemination and acquisition of antibiotic resistance to enteric bacteria due to the abundance of nutrients present in them. This narrative review synthesises published evidence on antibiotic resistance patterns in South African Wastewater treatment plants, with specific emphasis on WHO-listed critical priority enteric pathogens. This review is the first to provide a temporal analysis (2009–2024) of antibiotic resistance trends in South African Wastewater treatment plants before and after the WHO’s 2017 Bacterial Priority Pathogen List (BPPL), revealing a 20–50% increase in resistance to critical antibiotics, such as vancomycin and carbapenems, across Escherichia coli, Klebsiella pneumoniae, Enterococcus spp., Salmonella spp., and Campylobacter spp. Inconsistent monitoring methods, provincial disparities, and limited molecular investigations hinder a comprehensive national assessment. This review fills a critical geographic gap by focusing on South Africa, a low-middle-income country with unique socio-economic and environmental challenges and integrates local data with WHO’s global health priorities. By synthesising 24 studies and employing statistical analysis, it identifies region-specific resistance patterns and proposes a novel framework for enhanced monitoring using metagenomics and predictive modelling, advancing beyond existing African wastewater resistome studies. Full article

Legionella species are ubiquitous bacteria found worldwide in water, moist environments, soils, and compost. Infection occurs through the inhalation of aerosols, leading to either Pontiac fever or Legionnaires’ disease (LD). Current routine diagnostics typically combine culture-based isolation with Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) for species identification and the Latex Agglutination Test (LAT) for serotyping. However, this workflow is fragmented: MALDI-TOF MS lacks serogroup-specific resolution, while LAT relies on subjective visual interpretation. Therefore, this study evaluated Fourier-transform infrared spectroscopy (FT-IR) as a rapid, high-resolution typing method for Legionella isolates to assess its potential as a single-step diagnostic tool. A total of 200 clinical and environmental Legionella isolates were analyzed using FT-IR, including L. pneumophila serogroups (SG) 1–15 and various non-pneumophila species. Spectral data were analyzed using Principal Component Analysis (PCA) and Linear Discriminant Analysis (LDA). While MALDI-TOF MS provided accurate species identification, FT-IR spectroscopy demonstrated superior typing capabilities by successfully distinguishing L. pneumophila SG 1 distinct from the SG 2–15 complex and allowing for clear discrimination of most non-pneumophila species. Additionally, FT-IR resolved isolates that showed ambiguous or non-reactive results in LAT. These findings demonstrate that FT-IR overcomes the serotyping limitations of MALDI-TOF MS and offers a more objective, cost-efficient extension to the current multi-step routine, potentially closing the diagnostic gap between simple species identification and deep strain characterization. Full article

This study examines the historical relationship between water management and epidemic diseases in the Region of Murcia (Southeast Spain) between the 16th and 19th centuries. It focuses on two major pathologies—yellow fever and cholera—which, despite differing transmission mechanisms (vector-borne and waterborne, respectively), both depended critically on aquatic and semi-endorheic ecosystems. By analysing archival records, parish death registers, and historical reports of floods and droughts, the paper demonstrates how inadequate hydraulic infrastructure and poor sanitation practices intensified epidemic outbreaks. At least five large-scale epidemic episodes (1804, 1834, 1854, 1865, and 1885) coincided with extreme hydrological events, indicating a clear correlation between water governance failures and mortality peaks. Conversely, periods of effective state intervention through regulation and infrastructure maintenance reveal a marked reduction in disease incidence. The results highlight that water governance was not only a technical challenge but also a socio-political determinant of public health. These historical insights remain relevant today, particularly as climate change exacerbates water-related risks worldwide. Understanding the long-term interactions between ecology, infrastructure, and disease contributes to current debates on environmental resilience and sustainable management of water resources as key components of collective health and social stability. Full article

Peloid maturation is governed by geological settings, duration of water–sediment interaction (microbial reworking), and thermomineral water properties, with molecular distributions providing insights into transformation mechanisms. To assess site-specific biomarker maturity, geochemical parameters were applied to five Serbian therapeutic muds, including spa peloids (Bujanovac, Jošanica, Kanjiža) and natural systems (Vrujci, Rusanda). Mineralogy was determined via X-ray diffraction, and organic matter (OM) was characterized by gas chromatography–mass spectrometry of n-alkanes, steranes and hopanes. Samples are mostly clay-rich, providing favorable catalytic conditions for biomarker transformations. Bujanovac shows a higher plant OM signature (n-C₂₉ maximum) and elevated biomarker maturity (high Ts/Tm, near-equilibrium C₂₉ S/(S + R)), likely inherited from volcanically influenced source material. Jošanica exhibits high CPI but low Ts/Tm and C₂₉ S/(S + R), indicating largely immature OM despite four years of spa aging. Kanjiža shows unexpectedly high apparent maturity after one-day aging, with a pronounced UCM and C₃₁ S/(S + R) (0.58), consistent with incorporation of migrated petrogenic hydrocarbons. Vrujci displays coherent maturity due to prolonged water–sediment interaction, clay-rich mineralogy, extended aging, and regional geothermal gradients. Rusanda exhibits decoupled parameters (CPI 3.91, C₂₉ S/(S + R) 0.69), indicative of hydrocarbon overprinting. Overall, integrating biomarker geochemistry with mineralogy, depositional context, and local thermal/geological conditions provides a robust framework to evaluate peloid maturation. Full article

Riparian soils co-contaminated with heavy metals and organic pollutants present a formidable environmental challenge; conventional single-target remediation strategies are frequently insufficient due to the synergistic interactions between contaminant classes. This review offers a systematic synthesis of phytoremediation as an integrative and ecologically sustainable paradigm for addressing these complex multi-pollutant scenarios. Through a critical examination of underlying mechanisms—namely phytoextraction, rhizodegradation, phytostabilization, and phytovolatilization—we evaluate the efficacy of selected hyperaccumulator and pollution-tolerant species in simultaneously mitigating inorganic (e.g., Pb, Cd, As) and organic (e.g., PAHs, pesticides) contaminants. Furthermore, the discussion highlights emerging strategic integrations, including genetic engineering for enhanced metal accumulation, the application of engineered nanomaterials to modulate pollutant bioavailability and plant stress tolerance, rhizosphere amendment with low-molecular-weight organic acids, and biochar-mediated immobilization coupled with microbial stimulation. The analysis posits that phytoremediation, particularly when augmented by these advanced synergies, constitutes a viable, multifunctional, and environmentally benign strategy for the holistic restoration of riparian ecosystems. Future inquiries should prioritize the mechanistic elucidation of combined technologies, the development of predictive performance models, and rigorous long-term field validation to guarantee operational efficacy and environmental safety. Full article