Tiempo para quedar en embarazo: consideraciones generales y metodológicas / Evaluation of time-to-pregnancy as a measure in environmental epidemiology

Desde la segunda mitad de la década de los 80, el tiempo para quedar en embarazo se está utilizando en epidemiología ambiental para explorar efectos adversos sobre la fecundidad. En este artículo se revisa la racionalidad de los estudios de tiempo para quedar en embarazo y los principales elementos que se deben considerar en el diseño de un estudio de este tipo: tipo de estudio, poblaciones, tamaño de muestra, medición del evento, análisis estadístico y sesgos. Se sugieren algunas pautas por tener en cuenta para la realización de este tipo de estudios

Economic burden of illness from pesticide poisonings in highland Ecuador

Active surveillance of acute pesticide poisonings in a potato-growing region of highland Ecuador during 1991-1992 uncovered a rate of 171/100.000, due predominantly to occupational exposures to organophosphate and carbamate pesticides. Occupational exposure among agricultural workers was the most common reason for poisoning (32 male workers and 1 female worker, out of a total of 50 cases). Of these 33 cases, 28 of them reported pesticide application as the work task just prior to poisoning, with over 80 por cent citing the use of World Health Organization Hazard Category I pesticides. The suicide rate of 17.1/100.000 and the overall mortality rate of 20.5/100.000 that we found are among the highest reported anywhere in the world. At the exchange rates prevailing at that time, median costs associated with these poisonings were estimated as follows: public and social security health care direct costs of US$ 9.85/case; private health costs of US$ 8.33/case; and lost-time indirect costs of US$ 8.33/agricultural worker. Each one of those costs was over five times the daily agricultural wage, which was then about US$ 1.50. Further costing of pesticide poisonings should be carried out in other settings to provide appropriate information for decisions about pesticide use. In addition, integrated pest management should be further evaluated as an appropriate technology to reduce the economic burden of illness from pesticide poisonings in developing countries

Vigilancia de las enfermedades provocadas por plaguicidas: La experiencia nicaraguense

In 1984, work designed to expanded cholinesterase screening activities and improve the reporting of pesticide poisonings was initiated in Nicaragua's León-Chinandega region as a pilot project. Using a field tintometric method, 1,960 workers were screened for whole blood cholinesterase. The percentage with low cholinesterase activity levels (50 per cent or less) increased sharply during the peak spraying season. Airfield workers were most affected, though a noteworthy share of certain agricultural workers were also found to have low levels. Workers who used certain kinds of personal protective equipment were significantly less affected (p .05). In addition to these survey findings, six deaths and 396 pesticide-related poisonings were reported in the León-Chinandega region in 1984. This indicated a relatively high rate of 74.6 poisoning cases per 100,000 inhabitants, 84 per cent of them occurring in October-December. Ninety-four percent of the cases reported via questionnaires were occupationally related, small farms being the most affected. Menthyl parathion was implicated in roughly half of these cases , two-thirds of which were due to dermal exposure. Policy recommendations derived from the initial results reported here include reduction of methyl parathion use, installation of closed systems for safer aircraft loading, provisión and use of clothing that protects the skin against exposure