La amenaza del cambio climático a la salud de la población y la necesidad urgente de actuar

Climate change is associated with negative health outcomes, such as cardiovascular and respiratory diseases. This article analyses the threat of climate change on population health and the urgent need to implement measures to avoid this damage. Heat vulnerability, heatwave exposures, and wildfire exposure to forest fires have increased in Chile. In 2018, the annual mean concentration of fine particulate matter (PM2.5) exceeded the safe level proposed by the World Health Organization, increasing the risk of negative health outcomes. Thus, multidisciplinary and intersectoral mitigation and adaptation policies are needed. Among other elements, mental health impacts of climate change, health education provided by health workers to reduce negative health impacts of climate change, greater engagement of academia to generate evidence useful for policy-making processes and a better articulation between central and local governments should be considered. Finally, achieving a healthy population should be the aim of all these policies and efforts.

Estudio de metales urinarios y plomo en sangre: parámetros poblacionales en Antofagasta, 2018 / Urinary heavy metals and blood lead levels among residents of Antofagasta, Chile

Background: The presence of toxic metals in human populations is strongly associated with chronic diseases. Aim: To determine levels of lead, chromium, cadmium, mercury and inorganic arsenic (AsIn) in the general population aged over 5 years in Antofagasta, Chile. Material and Methods: People living in Urban Antofagasta for at least five years were considered eligible. Biological samples were obtained to measure heavy metals. Results: One thousand two hundred three participants with a median age of 43 years (656 women) were studied. Their mean time of residence in the city was 30 years, and 52% smoked. Eight percent of the adult population and 12% of children had AsIn values above 35 µg/L, while 75% of the population had levels below 21.9 µg/L. The other metals were below the risk levels defined by the health authority (10 µg/L for chromium, 10 µg/L for mercury, 2 µg/L for cadmium, 5 and 10 μg/dL for blood lead for children and adults, respectively). The factors associated with high levels of AsIn in adults were male sex, living more than 200 meters from monitoring points, and low schooling. In children, the associated variables were high intake of seafood products and having a caregiver with less than 8 years of schooling. Contrary to expectations, the greatest risk of presenting altered levels of the metals occurred in the population living more than 500 meters from the identified risk sources (90% of the population). Conclusions: The findings of this study suggest that all potential sources of exposure to AsIn should be evaluated, and surveillance actions should be established to reduce involuntary exposure to this metalloid.

Análisis espacial de la anemia gestacional en el Perú, 2015 / Spatial analysis of gestational anemia in Peru, 2015

RESUMEN Objetivos Establecer las prevalencias regionales e identificar conglomerados distritales con altas prevalencias deanemia en gestantes atendidas en los establecimientos de salud públicos del Perú en el 2015. Materiales y métodos Se realizó un estudio ecológico de datos de gestantes con anemia, registrados en el Sistema de Información del Estado Nutricional (SIEN), que fueron atendidas en 7703 establecimientos públicos de salud durante el 2015. Se calcularon prevalencias de anemia gestacional regionales y distritales. Mediante el índice de Moran se identificaron conglomerados distritales con alta prevalencia de anemia gestacional. Resultados Se recolectó información de 311 521 gestantes, distribuidas en 1638 distritos del Perú. La prevalencia nacional de anemia fue de 24,2% (IC 95%: 24,0-24,3) y 30,5% en el área rural vs. 22,0% en el área urbana. Las regiones de Huancavelica (45,5%; IC 95%: 44,2-46,7), Puno (42,8%; IC 95%: 41,9-43,7), Pasco (38,5%; IC 95%: 36,9-40,0), Cusco (36,0%; IC 95%: 35,3-36,8) y Apurímac (32,0%; IC 95%: 30,8-33,1) tuvieron las mayores prevalencias de anemia. El índice local de Moran identificó 202 distritos (12,3%) (44 urbanos y 158 rurales) de alta prioridad (alto-alto o hot spots) situados en Ancash, Apurímac, Arequipa, Ayacucho, Cajamarca, Cusco, Huancavelica, Huánuco, Junín, La Libertad, Lima, Pasco y Puno, que muestran conglomerados distritales con altas prevalencias. Conclusiones La anemia gestacional en Perú concentra sus mayores prevalencias en las áreas rural y sur de la sierra. Los conglomerados distritales con altas prevalencias de anemia gestacional coinciden con las zonas de alta prevalencia regional.

ABSTRACT Objectives To establish regional prevalences of anemia in pregnant women receiving care at public clinics in Peru in 2015 and identify high-prevalence district conglomerates. Materials and Methods An ecological study was carried out on data from pregnant women with anemia registered on the Nutritional Status Information System (SIEN) who received care in 7703 public clinics in 2015. Regional and district prevalences of gestational anemia were calculated. District conglomerates with a high prevalence of gestational anemia were identified using the Moran Index. Results Information was gathered from 311,521 pregnant women distributed in 1638 districts in Peru. The national prevalence of anemia was 24.2% (95% confidence interval [95% CI]: 24.0-24.3%), the rural prevalence was 30.5%, and the urban prevalence was 22.0%. The regions of Huancavelica (45.5%; 95% CI: 44.2-46.7%), Puno (42.8%; 95% CI: 41.9-43.7%), Pasco (38.5%; 95% CI: 36.9-40.0%), Cusco (36.0%; 95% CI: 35.3-36.8%), and Apurímac (32.0%; 95% CI: 30.8-33.1%) had the highest prevalences of anemia. The local Moran Index identified 202 high-priority districts (hot spots) (12.3% of total; 44 urban and 158 rural) located in Ancash, Apurímac, Arequipa, Ayacucho, Cajamarca, Cusco, Huancavelica, Huánuco, Junín, La Libertad, Lima, Pasco, and Puno containing high-prevalence district conglomerates. Conclusions Gestational anemia in Peru has its highest prevalence rates in rural and southern mountainous areas. The district conglomerates with high prevalence rates of gestational anemia coincide with the areas of high regional prevalence.

High exposure to boron in drinking water and sperm parameters in Chilean young people / Exposición elevada a boro en el agua potable y parámetros de esperma en gente joven chilena

Our aim was to describe sperm parameters in residents from Northern Chile. We evaluated in 101 volunteers (18 and 30 years old) urinary and drinking water Boron levels using Inductively Coupled Plasma Mass Spectrometry; semen parameters were measured with standardized methods. Each individual was categorized in 3 levels of exposure: low (B levels in urine 2.94 mgL-1 or tap water 3.0 mgL-1), medium (urinary B between 2.95-7.4 mgL-1 and B in tap water with 3.0-7.0 mgL-1) and high (urinary B > 7.4 mgL-1 or tap water > 7.0 mgL-1). We found no significant differences among groups by pH, sperm concentration (45.1; 48.2 and 38 million/mL), motility 1th hour (38.1; 40.0 and 45.5 %) and vitality 1th hour (88.6; 88.0 and 76.9 %) respectively. Abnormal morphology was significant different (83.3; 90 and 83 %). Young men exposed to B in drinking water present sperm variations associated with the level of exposure. Most of these changes are positive at intermediate levels of B. For the highest exposures were observed negative changes in sperm morphology, concentration, motility and vitality, all relevant parameters of fertility. Beneficial effect is observed at medium exposure, like a "U curve".

El objetivo de este trabajo fue describir los parámetros espermáticos en residentes del norte de Chile. Se evaluaron en 101 voluntarios (18 y 30 años), los niveles urinarios y de agua potable de boro, usando "Inductively Coupled Plasma Mass Spectrometry". Los parámetros del semen se midieron con métodos estandarizados. Cada individuo se clasificó en 3 niveles de exposición: bajo (niveles B en la orina 2,94 mgL-1 o agua potable 3,0 mgL-1), medio (B urinario entre 2,95-7,4 mgL-1 y B en agua de beber con 3,0- 7,0 mgL-1) y alto (B urinario >7,4 mgL-1 o agua potable > 7,0 mgL-1). No se encontraron diferencias significativas entre los grupos por pH, concentración de espermatozoides (45,1; 48,2 y 38 millones/mL), motilidad a 1 hora (38,1; 40,0 y 45,5%) y vitalidad 1 hora (88,6; 88,0 y 76,9%) respectivamente. La morfología anormal fue significativamente diferente (83,3; 90 y 83%). Los hombres jóvenes expuestos a B en el agua potable presentan variaciones espermáticas asociadas con el nivel de exposición. La mayoría de estos cambios son positivos en niveles intermedios de B. Para las exposiciones más altas se observaron cambios negativos en la morfología, concentración, motilidad y vitalidad del esperma, parámetros relevantes de la fertilidad. Un efecto beneficioso se observa en la exposición media, como una "curva U".

Examen de calidad de la educación superior Saber Pro: factores sociodemográficos en el desempeño académico en Instrumentación Quirúrgica / Test on quality of higher education saber pro: sociodemographic factors associated with results obtained by surgical instrument technicians

Los examenes de calidad de la educación superior Saber Pro en Colombia hacen parte de la estrategia gubernamental para garantizar la alta calidad de la educación. El programa de instrumentación quirúrgica lo ha presentado desde 2010; se desarrolla en 16 instituciones de educación superior (IES) del país. Objetivo: determinar los factores sociodemográficos asociados con el desempeño entre 2010 y 2011. Métodos: análisis multinivel para determinar la correlación de las variables sociodemográficas e institucionales con las académicas mediante la información de la base de datos FTP del ICFES. El análisis se hizo con medida de tendencia central, dispersión y frecuencias absolutas. Se construyó una base de datos en excel y se utilizó el programa stata 12. Resultados: el principal factor asociado con el desempeño en los componentes genéricos del examen Saber Pro 2010 y 2011 es la edad más joven del estudiante, en los demás componentes existen diferentes factores de acuerdo con la competencia evaluada...

The tests on the quality of undergraduate education in Colombia (Saber Pro) are part of the strategy undertaken by the National Government to guarantee the high quality of education. The surgical instrument technician program students have taken this exam since 2010. It is applied in 16 Colombian undergraduate education institutions and although they share the objective of formation the test results may be associated to various factors, some institution-related and others related to the student´s social and demographic characteristics. Objective: to determine the social and demographic characteristics associated to test results between 2010 and 2011. Methods: a multilevel analysis to determine the correlation of social and demographic characteristics and institutional variables with academic variables using the information recorded in the ICFES FTP data bases. Students of Colombian instrument technician schools and programs were included. Cases with incongruent information were excluded. Central tendency measures, dispersion and absolute frequencies were used. An excel data base was constructed and the Stata 12 program was utilized. Results: younger age of the student was the major result-associated factor in the generic components of the 2010 and 2011 Saber Pro exam. Other components are associated with various factors related to the specific competence assessed...

Exposición a agentes de riesgo biológico en trabajadores chilenos: Reporte del Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile (CITUC) / Exposure to occupational biological risks: Experience of a toxicology information center

Background: Exposure to Biological Agents during work is an emergent type of occupational risk. Aim: To characterize occupational biological risk exposure among Chilean workers which have been registered by the Toxicology Information Center, between January 2006 and December 2009. Material and Methods: All incoming calls reporting exposure to biological agents during the studied period were analyzed. The information obtained from the caller was registered using the Communication Record Instrument of the WHO International Programme on Chemical Safety (IPCS INTOX). Results: In the studied period, 77 calls were received. The mean age of exposed patients was 35 ± 15 years and 57% of them were females. The most common involved agents were vaccines for veterinary use (42%) followed by Loxosceles laeta bites in 16%. The main routes of exposure were injections, cuts and needle stick injuries in 39% and stings and bites in 38%. The highest exposure rates were observed in Southern Chile due to self-inoculation of veterinary vaccines used in the salmon industry (22.7/100.000 actual workers). Fifty-eight percent of calls were from health care workers, and 51% of them were from health care facilities. Sixty percent of exposures occurred during summer and spring. There was a fourfold higher risk of calls involving women exposed to bites or stings (odds ratio (OR) 4.5 (CI95 1.5-13.9, p < 0.01). Men had a fourfold higher risk of being exposed to vaccines or medications for veterinary use (OR 4.2, CI95 1.4-12.6 p < 0.01). Conclusions: Most calls involving an exposure to a biological agent were caused by self-inoculation of veterinary medications.

Propuesta de políticas públicas que relacionen el ambiente como determinante del estado de salud poblacional e individual: resumen ejecutivo de propuestas para los candidatos a la presidencia de la república y al parlamento / Public politics proposal considering environment as population and individual health determinant executive summary of proposals to the candidates to the republic presidency and parliament

El Departamento de Medio Ambiente del Colegio Médico de Chile ha concordado una serie de medidas que a su juicio deben ser implementadas por las nuevas autoridades políticas de Chile elegidas, con el fi n de corregir aquellos problemas ambientales que son determinantes de salud poblacional e individual. La implementación de estas medidas deberá impactar positivamente en la salud y calidad de vida de los habitantes de Chile, disminuir la mortalidad aguda y o diferida causada por exposición a diversos contaminantes ambientales. En especial, deberá afectar positivamente a las futuras generaciones al disminuir la exposición prenatal o infantil temprana a agentes que determinan el desarrollo de enfermedades o cambios conductuales más tarde en la vida. Estas proposiciones fueron entregadas a todos los candidatos presidenciales y explicadas en reuniones con cada uno de los 4 candidatos presidenciales que tienen las mejores opciones de de ser electos, de acuerdo a encuestas realizadas en el país.

The Environment Department of the Colegio Médico de Chile (Chilean College of Physicians) agreed a series of measures that should be implemented by the new elected Chilean political authorities, with the purpose of correction the environmental problems which are population and individual health determinants. The implementation of these measures should positively impact Chilean population health and quality of life and decrease acute or delayed mortality caused by exposure to various pollutants. Especially, it should positively affect future generations preventing prenatal or infant exposure to agents determining the development of diseases or behavioural changes later in life. These proposals were delivered to all presidential candidates, and explained in meetings with each of the four presidential candidates with the best perspectives to be elected, according to opinion polls carried out in the country.

Citric acid production from orange peel wastes by solid-state fermentation

Valencia orange (Citrus sinensis) peel was employed in this work as raw material for the production of citric acid (CA) by solid-state fermentation (SSF) of Aspergillus niger CECT-2090 (ATCC 9142, NRRL 599) in Erlenmeyer flasks. To investigate the effects of the main operating variables, the inoculum concentration was varied in the range 0.5À10³ to 0.7À10(8) spores/g dry orange peel, the bed loading from 1.0 to 4.8 g of dry orange peel (corresponding to 35-80 percent of the total volume), and the moisture content between 50 and 100 percent of the maximum water retention capacity (MWRC) of the material. Moreover, additional experiments were done adding methanol or water in different proportions and ways. The optimal conditions for CA production revealed to be an inoculum of 0.5À10(6) spores/g dry orange peel, a bed loading of 1.0 g of dry orange peel, and a humidification pattern of 70 percent MWRC at the beginning of the incubation with posterior addition of 0.12 mL H2O/g dry orange peel (corresponding to 3.3 percent of the MWRC) every 12 h starting from 62 h. The addition of methanol was detrimental for the CA production. Under these conditions, the SSF ensured an effective specific production of CA (193 mg CA/g dry orange peel), corresponding to yields of product on total initial and consumed sugars (glucose, fructose and sucrose) of 376 and 383 mg CA/g, respectively. These results, which demonstrate the viability of the CA production by SSF from orange peel without addition of other nutrients, could be of interest to possible, future industrial applications.

Biotechnological production of citric acid

This work provides a review about the biotechnological production of citric acid starting from the physicochemical properties and industrial applications, mainly in the food and pharmaceutical sectors. Several factors affecting citric acid fermentation are discussed, including carbon source, nitrogen and phosphate limitations, pH of culture medium, aeration, trace elements and morphology of the fungus. Special attention is paid to the fundamentals of biochemistry and accumulation of citric acid. Technologies employed at industrial scale such as surface or submerged cultures, mainly employing Aspergillus niger, and processes carried out with Yarrowia lipolytica, as well as the technology for recovering the product are also described. Finally, this review summarizes the use of orange peels and other by-products as feedstocks for the bioproduction of citric acid.

Verificación de la aplicabilidad de la fórmula de regresión logística para determinar el sexo por medio de odontometría del canino inferior, en una muestra bogotana / Verifying applicability of the logistic regression formula for gender estimation through odontometry of the lower canine in a Bogotan sample

Objetivo: Evaluar la validez predictiva de la fórmula de regresión logística propuesta por Mesa y colaboradores para determinar el sexo en una población colombiana. Métodos: Se utilizó una muestra de 98 caninos inferiores, extraídos de cuerpos de cadáveres encontra¬dos en Bogotá que ingresaron al Instituto Nacional de Medicina Legal y Ciencias Forenses (INMLCF). Utilizando un odontómetro, cada diente se midió cuidadosamente y se reimplantó dentro del alvéolo. Se construyó una base de datos en Excel y se analizaron los datos con el programa SPSS 12.0. Se hicieron pruebas de normalidad (Shapiro-Wilk y Kolmogorov-Smirnov) y de correlación (Pearson) para evaluar la asociación entre medidas dentales y sexo. Para la segunda parte del estudio se tomó la adecuación propuesta por Mesa y colaboradores para determinar el sexo de los especímenes, realizando análisis de pruebas de concordancia diagnóstica; se calcularon características operativas como sensibilidad, especificidad, valores predictivos y exactitud de diagnóstico con sus correspondientes intervalos de confianza (Win-Episcope 2.0, α=0,05). Resultados: De los 62 especímenes de hombres, el modelo de regresión logística categorizó adecuadamente 54 (87,8%), mientras que de las 36 muestras de mujeres se categorizaron adecuadamente 17 (52,8%). El por¬centaje total de categorización acertada fue 74,5%. Conclusiones: La ecuación logística mostró una mayor capacidad predictiva para establecer el sexo de los hombres que para el sexo de las mujeres, con un error cercano a 25%.

Objective: Evaluate the predictive validity of the logistic regression formula proposed by Mesa et al. for gender estimation in Colombian population. Methods: A sample of 98 mandi¬bular canines extracted from human corpses was gathered at the National Institute of Legal Medicine and Forensic Sciences (INMLCF) in Bogota. Each tooth was carefully measured using an odontometer and repositioned to the alveolar bone. A database was created to collect the data that were analyzed with SPSS 12.0. Normal distribution of data was analyzed through the Shapiro-Wilk and Kolmogorov-Smirnov tests and the association between tooth measures and gender were determined through Pearson correlation. For the second part of the study, the modification proposed by Mesa et al. was used to estimate gender in the samples through diagnostic concordance; operative characterisitics such as predictive sen¬sitivity, specificity, predictive values and diagnostic accuracy including confidence intervals were determined (Win-Episcope 2.0, α=0.05). Results: 62 samples belonged to deceased males of which 54 (87.8%) were adequately classified through the logistic regression model. On the other hand, 36 samples belonged to deceased females of which 17 were properly classified with the model. Of the total samples, 74.5% were properly classified. Conclusions: The logistic equation showed a greater predictive capacity in the estimation of gender in males than in females, failing to estimate 25% of the cases.

Colección de estudios de epidemiología ambiental / Collection of environmental epidemiology studies

En el año 2004, el Departamento de Salud Pública de la Pontificia Universidad Católica desarrolló junto con el SESMA un programa de capacitación en Epidemiología Ambiental en este servicio. El curso se basó en el análisis epidemiológico de los problemas que cada profesional tiene a su cargo: agua, residuos, alimentos, emisiones atmosféricas, zoonosis y salud ocupacional. Se entregaron elementos básicos de bioestadística, epidemiología, relación entre la exposición a contaminantes y efectos en salud.

Evaluación ultraestructural de la remineralización del esmalte por medio de la saliva después del grabado acido / Teeth polish ultraestructural evaluation

Se realizó un estudio descriptivo con una muestra piloto de 21 dientes que iban a ser extraídos por razones ortodónticas,dichas muestras se dividieron en dos grupos;los que se desmineralizaron y se dejaron en boca por diferentes intervalos de tiempo,1 hora, 24 horas, 48 horas, 72 horas y 96 horas y el segundo grupo control con los mismos intervalos de tiempo que se desmineralizaron post-exodoncia para evitar el contacto con saliva. Estas muestras se observaron al microscopio electrónico de barrido en diferentes magnificaciones, se tomaron microfotografías y se compararon entre sí y con el diente sin desmineralizar. Se encontró que la saliva es un medio eficaz para el proceso de remineralización

Terapêutica de enfermagem nos casos de prolapso uterino / The nursing actions in treatment of women with uterine prolapse

Trabalho realizado no Hospital Universitário "Pedro Ernesto" - UERJ. Comenta as açoes de enfermagem na assistência a pacientes portadoras de prolapso uterino. Apresenta consideraçoes sobre o problema e ilustra a proposta terapêutica de enfermagem com a descriçao de três casos.