Legionellen sind stäbchenförmige Bakterien, die in nennenswerten Konzentrationen und als Krankheitserreger vorrangig in technischen Systemen in Erscheinung treten. Ziel dieser Arbeit ist es, die bisher erschienene Literatur sowohl aus dem mikrobiologisch-hygienischen Bereich als auch aus dem technischen Bereich zu sichten, zu vergleichen und auf dieser Basis, unter Berücksichtigung der ökonomischen Konsequenzen an dem konkreten Beispiel des Carl-Thiem-Klinikum Cottbus, ein sinnvolles Konzept zur Legionellenprävention vorzuschlagen. Das Konzept ist so aufgebaut, daß es durch Betrachtung verschiedener Risikobereiche leicht auf andere Pflegeeinrichtungen oder auch Wohnanlagen bzw. Industriebetriebe übertragbar ist. Regelmäßige Messungen werden von verschiedenen Arbeitsgruppen alternativ oder zusätzlich zu Präventionsmaßnahmen gefordert. In dieser Arbeit werden jährliche Messungen in jedem Kollektor zur Beurteilung des Gesamtsystems, 1/2-jährliche Kontrollen in den Gebäuden, in denen sich Pflegestationen befinden, und 1/4-jährliche Kontrollen in Bereichen mit hohem Risiko, wie zum Beispiel den Isolierzimmern der Hämatologie, empfohlen. Die tolerierten Grenzwerte variieren entsprechend des Riskobereiches, in dem sie auftreten. Das in dieser Arbeit am Beispiel des Carl-Thiem-Klinikum Cottbus dargestellte Präventionskonzept beruht im wesentlichen auf regelmäßigen Kontrollen und sieht die Durchführung einer differenziert angewandten Präventionsmaßnahme nur bei nachgewiesener erhöhter Belastung des Systems durch Legionellen vor. Hier hat sich die Dezentralisierung des Warmwassersystems mit Hilfe dezentral installierter Plattenwärmetauscher in das zentrale Heiznetz als die wirtschaftlichste der hygienisch sinnvollen Maßnahmen herausgestellt. Aber auch diese Art der Prävention entbindet nicht von den weiterhin durchzuführenden Kontrollmessungen - mindestens zur Qualitätssicherung. Insgesamt bleibt jedoch jede Festlegung von Grenzwerten, jede Anwendung einer Präventionsmaßnahme immer ein Kompromiß zwischen dem technisch Machbaren und dem ökonomisch Realisierbaren. Große Studien, die hierzu detailliertere Auskunft geben könnten fehlen bis heute, so daß auch weiterhin jeder Betreiber einer Warmwasseranlage seine eigenen Festlegungen treffen muß. / Legionella is a rod-shaped bacteria, that occur with priority in considerable numerus aswell as pathogens concentration in technical systems. Target of this work is to sight the literature appeared so far both from the micro-biological-hygenic area and from the technical area to compare and on this base to suggest with consideration of the economic consequences by the concrete example Carl Thiem clinical center (Cottbus), a meaningful concept to the Legionella - prevention. The concept is structured by view of different risk areas and therefor easily portable to other nursing facilities or also housing estates and industrial companies. Regular measurements are required by different working groups alternatively or additionally to prevention measures. Recommended in this work are annual measurements in each central warmwater line for the evaluation of the total system, 1/2-annual checks in the buildingswith maintenance stations, and 1/4-annual checks within areas with high risk, like for example, the isolating rooms of the Haematology. The tolerated limit values vary according to the risk-area, in which they occur. The prevention concept put up for Carl Thiem clinical center (Cottbus) has been based essentially on regular checks and more detailed means of prevention for areas with proven increased numbers of Legionella. Here the decentralization of the warm-water system by means of peripherally installed plate-type heat exchanger fed by the central heating network has prooven to be the most economical and aswell hygenically meaningful measure. Never the less, this concept of prevention does not relieve of the regularly check on Legionella - at least for quality assurance. Altogether however each definition of Legionella limit values as well as each prevention concept always is a compromise between the technically feasible means and the economically realizable ones. Large studies, to gain more information on this problem are missing until today, so that further on each operator of a warm water system must find his own definitions out of the broad possibilities of regulations.

ABSTRACT Background Water is an essential requirement for the survival and development of people. It is estimated that 435 million people get their drinking water from unprotected wells worldwide. Water scarcity and chemical or biological aspects in water have been revealed, which can negatively affect health. This study aims to explore individuals’ experiences in drinking water with non-public water, hence individual wells. A further aim of the study is to explore authorities’ perspectives for implementing safe drinking water (SDGs 6) in Swedish coastal and rural areas.     Method In this qualitative study, semi-structured interviews were implemented to explore the experiences of 17 individual well owners and 4 authorities in non-public water use in Sweden. A thematic analysis was conducted to analyse the collected data.     Findings There were three main findings in the study: Firstly, concerns about water scarcity and water quality, mostly from families with children. Secondly, there was a feeling of exclusion among individuals due to lack of support from authorities and thirdly, a gap between existing assessment guidelines and the practices of individuals in terms of follow-up and benchmarking of the National health guidelines.   Conclusion The experiences of the individual well owners in Stockholm had some concerns due to water quality, the understanding, and implementation of the guidelines to safe drinking water. The authorities also highlighted the need for sustainable strategies. It concluded that multi-disciplinary approaches, communication, and community participation are necessary for a sustainable water strategy. These must be addressed globally as climate change impacts water supply and has a massive effect on rural and coastal areas. / <p>_{<em>We never know the worth of water till the well is dry (Thomas Fuller)</em>}</p> / The project “Evaluation of individual wells and systems”

Bakgrund: Mineraliseringsstörning på tänder kan antingen vara genetiska eller orsakas av interna och/eller externa faktorer. De olika faktorerna orsakar antingen en lokal eller en generell mineraliseringsstörning på emalj. En av faktorerna är en kemikalisk i form av fluor. Fluoridhalter i vatten som är mellan 1,5 – 3,0 mg/l kan orsaka dental fluoros, vilket gör tänderna ömtåliga och mycket sköra. Det har upptäckts höga fluorhalter, i dricksvatten, även långt över det av WHO rekommenderade, 1,0 mg/l, i flera olika länder, däribland Sydafrika. Syfte: Att studera samband mellan fluoridkoncentration i dricksvatten och dental fluoros i Sydafrika hos barn. Frågeställning: Hur påverkar höga respektive låga fluoridkoncentrationer förekomsten av dental fluoros i Sydafrika? Metod: Databaserna DOSS, MEDLINE samt CINHAL användes för att utföra litteraturstudien. Totalt inkluderades 10 artiklar som sedan kvalitetsgranskades inspirerade Forsberg &amp; Wengström kvalitetsgranskningsmall. Resultat: Barn som bodde i ett lågt fluoridområde med 0,19 mg/l, där var det 49% som hade dental fluoros och 38% hade ingen dental fluoros. På områden med hög fluoridhalt upp till 3,00 mg/l var det 96% av barnen som hade dental fluoros, varav 30% hade grad 5 vilket är svår dental fluoros. Slutsats: Ju högre fluoridkoncentrationer i dricksvatten desto större antal fall av dental fluoros / Background: Teeth mineralization disorder can either be genetic or caused by internal and/or external factors. The various factors cause either a local or a general enamel mineralization disorder. One of the factors is a chemical in the form of fluoride. Fluoride levels in water between 1.5 - 3.0 mg/l can cause dental fluorosis, making teeth delicate and very brittle. High fluorine levels have been detected in drinking water, even well above the WHO recommended 1.0 mg/l, in several different countries, including South Africa. Aim: To study the relationship between fluoride concentration in drinking water and dental fluorosis in South Africa in children. Question: How do high respective low fluoride concentrations affect the incidence of dental fluorosis in South Africa? Method: The DOSS, MEDLINE and CINHAL databases were used to carry out the literature study. A total of 10 articles were included, which were then quality checked inspired by Forsberg &amp; Wengström's quality review template. Results: Children living in a low fluoride range of 0.19 mg/l, where 49% had dental fluorosis and 38% had no dental fluorosis. In areas with high fluoride concentrations up to, 3.00 mg/l, 96% of children had dental fluorosis, of which 30% had grade 5 which is severe dental fluorosis. Conclusion: The higher the fluoride concentrations, the greater the number of dental fluorosis cases.