***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective A focus on bacterial contamination has limited many studies of water service delivery in slums , with diarrheal illness being the presumed outcome of interest . We conducted a mixed methods study in a slum of 12,000 people in Mumbai , India to measure deficiencies in a broader array of water service delivery indicators and their adverse life impacts on the slum ’s residents . Methods Six focus group discussion s and 40 individual qualitative interviews were conducted using purpose ful sampling . Quantitative data on water indicators — quantity , access , price , reliability , and equity — were collected via a structured survey of 521 households selected using population -based r and om sampling . Results In addition to negatively affecting health , the qualitative findings reveal that water service delivery failures have a constellation of other adverse life impacts — on household economy , employment , education , quality of life , social cohesion , and people ’s sense of political inclusion . In a multivariate logistic regression analysis , price of water is the factor most strongly associated with use of inadequate water quantity ( ≤20 liters per capita per day ) . Water service delivery failures and their adverse impacts vary based on whether households fetch water or have informal water vendors deliver it to their homes . Conclusions Deficiencies in water service delivery are associated with many non-health-related adverse impacts on slum households . Failure to evaluate non-health outcomes may underestimate the deprivation result ing from inadequate water service delivery . Based on these findings , we outline a multidimensional definition of household “ water poverty ” that encourages policymakers and research ers to look beyond evaluation of water quality and health . Use of multidimensional water metrics by governments , slum communities , and research ers may help to ensure that water supplies are design ed to advance a broad array of health , economic , and social outcomes for the urban poor Background People living with HIV/AIDS have substantially greater need for water , sanitation , and hygiene . Encouraging hygiene education for People Living with HIV/AIDS in home based care services and additional support for the provision of water , sanitation , and hygiene services is recommended . Methods A cross-sectional study was carried during 2009 to assess  water , sanitation status and hygiene practice  s and associated factors among People Living with HIV/AIDS in home based care services in Gondar city of Ethiopia . A systematic r and om sampling was used to select study subjects from 900 Home Based Care clients of People Living HIV/AIDS in Gondar city . Data was collected from 296 People Living with HIV/AIDS from two NGO ’s in the city . For in-depth interview , four different categories were participated . Logistic regression and thematic framework analysis were performed for quantitative and qualitative part respectively . Results Two hundred ninety four subjects ( 72.8 % ( 214 ) females and 27.2 % ( 80 ) males ) were studied . The mean age was 35.8 ± 8.7 years . In the study , 42.9 % ( 126 ) of the households have  unimproved water status , 67 % ( 197 ) of the households have unimproved sanitation status , and 51.7 % ( 152 ) of the households have poor hygienic practice . Diarrhoea with water status ; educational status and latrine availability with sanitation status ; and h and washing device availability and economical reasons for the affordability of soap with hygienic practice were significantly associated . Economical reasons and hygiene education were factors that affect water , sanitation , and hygienic practice . Stigma and discrimination were minimized as a factor in the study area . Conclusions There is high burden of water , sanitation and hygiene in people living HIV/AIDS in home based care services . Encouraging hygiene education for people living HIVAIDS in home based care services and additional support for the provision of water , sanitation , and hygiene services is recommended Background Governments , multinational organisations , and charities have commenced the distribution of sanitary products to address current deficits in girls ’ menstrual management . The few effectiveness studies conducted have focused on health and education outcomes but have failed to provide quantitative assessment of girls ’ preferences , experiences of absorbents , and comfort . Objectives of the study were , first , to quantitatively describe girls ’ experiences with , and ratings of reliability and acceptability of different menstrual absorbents . Second , to compare ratings of freely-provided reusable pads ( AFRIpads ) to other existing methods of menstrual management . Finally , to assess differences in self-reported freedom of activity during menses according to menstrual absorbent . Methods Cross-sectional , secondary analysis of data from the final survey of a controlled trial of reusable sanitary pad and puberty education provision was undertaken . Participants were 205 menstruating schoolgirls from eight schools in rural Ug and a. 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods ( predominately new or old cloth ) . Results Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities , less difficulties changing absorbents , and less disgust with cleaning absorbents . There were no significant differences in reports of outside garment soiling ( OR 1.00 95%CI 0.51–1.99 ) , or odour ( 0.84 95%CI 0.40–1.74 ) during the last menstrual period . When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods . However , when asked about activities avoided during menstruation , those using reusable pads participated less in physical sports , working in the field , fetching water , and cooking . Conclusions Reusable pads were rated favourably . This translated into some benefits for self-reported involvement in daily activities , although reports of actual soiling and missing activities due to menstruation did not differ . More research is needed comparing the impact of menstrual absorbents on girls ’ daily activities , and validating outcome measures for menstrual management research The lifting and carrying of loads in agriculture on small l and holdings are unavoidable . Rural communities often lack access to appropriate technologies which may result in various health hazards . The objective was to study gender participation in agricultural activities involving manual material h and ling tasks , to assess MSDs experienced in various MMH tasks and to evaluate traditional method and design ed technology . The study was conducted on 100 agricultural workers . Data on gender participation in MMH tasks in household , animal husb and ry and agriculture and result ing MSDs was gathered . Pre and post assessment of technology intervention was done for NIOSH Lifting Index , QEC , and RPE . The results revealed greater susceptibility of females to musculoskeletal problems in most of the household and animal husb and ry tasks . The h and trucks design ed were pushing type with power grasp h and le . The respondents were advised to carry 5 kg of weight per lift instead of lifting more weight in one lift/minute while filling the h and truck . By decreasing the weight and increasing the number of lifts per minute the respondents were seen falling in green zone indicating significant reduction in NIOSH lifting index . QEC scores concluded that for filling the h and truck 5 kg of weight should be carried to keep the exposure level low This paper examines the impact of water fetching  by women and the quality of water during periods of water scarcity on the health of women in the Kumasi metropolitan area . A sample of 210 women drawn using systematic r and om procedure is used for the study . Formal interview is the main instrument used . The survey has established that income , quality of water , hours spent fetching water during scarcity and age are the main factors influencing women 's health in the metropolis during water scarcity . In both the core and periphery , the water-related problem influencing health is hours spent fetching water during scarcity . An empirical model on water needs and women 's health has emerged from the survey . Recommendations have been made on strategies to ensure regular volume of surface water , effective management of scarce water re sources with the participation of women , and ensuring gender equity in domestic services The use of self-assessed health status  ( SAHS ) as a measure of health is common in empirical research . We analyse a unique Australian survey in which a r and om sub- sample of respondents answer a  st and ard self-assessed health question twice-before and after an additional set of health related questions . A total of 28 % of respondents change their reported health status . Response reliability is related to age , income and occupation . We also compare the responses of these individuals to other respondents who are queried only once , to isolate effects of question order and mode of administration We used a community engagement approach to develop a One Health profile of an agro-pastoralist population at the interface of wildlife areas in eastern South Africa . Representatives from 262 r and omly-selected households participated in an in-person , cross-sectional survey . Questions were design ed to ascertain the participants ' knowledge , attitudes , and practice s with regard to human health , domestic animal health , and natural re sources including wildlife and water . Surveys were conducted within four selected villages by a team of trained surveyors and translators over four weeks in July-August 2013 . Questions were a combination of multiple choice ( single answer ) , multiple selection , open-ended , and Likert scale . The study found that nearly three-quarters of all households surveyed reported owning at least one animal ( 55 % owned chickens , 31 % dogs , 25 % cattle , 16 % goats , 9 % cats , and 5 % pigs ) . Among the animal-owning respondents , health concerns identified included dissatisfaction with government-run cattle dip facilities ( 97 % ) and frequent morbidity and mortality of chickens that had clinical signs consistent with Newcastle disease ( 49 % ) . Sixty-one percent of participants believed that diseases of animals could be transmitted to humans . Ninety-six percent of respondents desired greater knowledge about animal diseases . With regard to human health issues , the primary barrier to health care access was related to transportation to/from the community health clinics . Environmental health issues revealed by the survey included disparities by village in drinking water reliability and frequent domiciliary rodent sightings positively associated with increased household size and chicken ownership . Attitudes towards conservation were generally favorable ; however , the community demonstrated a strong preference for a dichotomous approach to wildlife management , one that separated wildlife from humans . Due to the location of the community , which neighbors the Great Limpopo Transfrontier Conservation Area , and the livestock-dependent lifestyle of the re source -poor inhabitants , a One Health approach that takes into consideration the interconnectedness of human , animal , and environmental health is necessary . The community profile described in this study provides a foundation for health research and planning initiatives that are driven by community engagement and consider the multitude of factors affecting health at the human-domestic animal-wildlife interface . Furthermore , it allows for the determination and quantification of the linkages between human , animal , and environmental health OBJECT The  Hoffmann sign  is commonly used in clinical practice to assess cervical spine disease . It is unknown whether the sign correlates with the severity of myelopathy , and no consensus exists regarding the significance of a positive sign in asymptomatic individuals . METHODS In a retrospective review of cervical spine surgeries for myelopathy due to cervical spondylosis , ossification of the posterior longitudinal ligament , or disc herniation performed at a tertiary center , the authors compiled data on the presence of hyperreflexia , the Hoffmann and Babinski signs , and modified Japanese Orthopaedic Association ( mJOA ) scale scores . Then , in a prospect i ve evaluation , new patients with lumbar spine complaints were examined for the presence of a Hoffmann sign , and , if present , a cervical MR imaging study was assessed for cord compression . RESULTS Of the 225 surgically treated patients , a  Hoffmann sign occurred in 68 % , hyperreflexia in 60 % , and a Babinski sign in 33 % . In patients with milder disability ( mJOA Scores 14 - 16 ) , the Hoffmann sign was present in 46 % , whereas a Babinski sign occurred in 10 % ; in those with severe myelopathy and mJOA scores of < or = 10 , the Hoffmann sign was present in 81 % and the Babinski sign in 83 % . Of 290 patients presenting exclusively with lumbar spine-related complaints , 36 ( 12 % ) had a positive Hoffmann sign . Magnetic resonance imaging demonstrated spinal cord compression in 91 % when the sign was present bilaterally and 50 % when positive unilaterally . CONCLUSIONS In patients surgically treated for cervical myelopathy , the  Hoffmann sign is more prevalent and more likely to be seen in individuals with less severe neurological deficits than the Babinski sign . In patients with lumbar symptoms , a bilateral Hoffmann sign was a highly sensitive marker for occult cervical cord compression , whereas a unilateral Hoffmann sign correlated with similar disease in about one-half of patients 
    Output:
    
Overall , the studies suggest that water carriage is associated with negative aspects of the water carriers ' health .
There is moderate quantitative and strong qualitative evidence that water carriage is associated with pain , fatigue , perinatal health problems and violence against vulnerable people , and inconclusive evidence of an association with stress or self-reported mental health and general health status .