Diagnostic concordance of pathological methods and reports of hematopathologists compared to local nonspecialized pathologists in the diagnosis of lymphoma in Mexico.

OBJECTIVES: To assess the concordance between lymphoma diagnoses made via tissue biopsy by local pathologists and also to assess the after review of these specimens by more specialized hematopathologists. METHODS: A prospective, non-interventional and multicenter study was conducted at seven sites in Mexico from January 2017 to October 2017. Eligible biopsies were sampled from patients with a previous diagnosis of lymphoma on lymph node biopsy or a diagnosis of extranodal lymphoma, with adequate amount and tissue preservation for the review analysis. The biopsy tissues reviewed by local pathologists were also reviewed by hematopathologists participating in the study. The concordance in diagnosis results was classified into three categories: diagnostic agreement, minor discrepancy and major discrepancy. RESULTS: Out of 111 samples received, 105 samples met the eligibility criteria and were included for full analysis. The median patient age (range) was 54 (16-94) years. A diagnostic agreement was observed in 23 (21.9%) biopsies, minor discrepancies were observed in 32 (30.5%) biopsies and major discrepancies were observed in 50 (47.6%) biopsies. Diagnostic concordance varied across the seven study sites; the rate of major discrepancies ranged from 0% to 100% and the rate of diagnostic agreement ranged from 0% to 81.8%. Out of the 105 reviewed biopsies, a total of 89 cases were diagnosed as lymphoma by hematopathologists. CONCLUSIONS: This study showed that major discrepancies were observed following the review by hematopathologists compared with that of the local pathologist's initial diagnosis in nearly one-half cases. In addition, there was a wide variation in the percentage of diagnostic agreements and discrepancies among different study sites.

Reduction in personal exposures to particulate matter and carbon monoxide as a result of the installation of a Patsari improved cook stove in Michoacan Mexico.

UNLABELLED: The impact of an improved wood burning stove (Patsari) in reducing personal exposures and indoor concentrations of particulate matter (PM(2.5)) and carbon monoxide (CO) was evaluated in 60 homes in a rural community of Michoacan, Mexico. Average PM(2.5) 24-h personal exposure was 0.29 mg/m(3) and mean 48-h kitchen concentration was 1.269 mg/m(3) for participating women using the traditional open fire (fogon). If these concentrations are typical of rural conditions in Mexico, a large fraction of the population is chronically exposed to levels of pollution far higher than ambient concentrations found by the Mexican government to be harmful to human health. Installation of an improved Patsari stove in these homes resulted in 74% reduction in median 48-h PM(2.5) concentrations in kitchens and 35% reduction in median 24-h PM(2.5) personal exposures. Corresponding reductions in CO were 77% and 78% for median 48-h kitchen concentrations and median 24-h personal exposures, respectively. The relationship between reductions in median kitchen concentrations and reductions in median personal exposures not only changed for different pollutants, but also differed between traditional and improved stove type, and by stove adoption category. If these reductions are typical, significant bias in the relationship between reductions in particle concentrations and reductions in health impacts may result, if reductions in kitchen concentrations are used as a proxy for personal exposure reductions when evaluating stove interventions. In addition, personal exposure reductions for CO may not reflect similar reductions for PM(2.5). This implies that PM(2.5) personal exposure measurements should be collected or indoor measurements should be combined with better time-activity estimates, which would more accurately reflect the contributions of indoor concentrations to personal exposures. PRACTICAL IMPLICATIONS: Installation of improved cookstoves may result in significant reductions in indoor concentrations of carbon monoxide and fine particulate matter (PM(2.5)), with concurrent but lower reductions in personal exposures. Significant errors may result if reductions in kitchen concentrations are used as a proxy for personal exposure reductions when evaluating stove interventions in epidemiological investigations. Similarly, time microenvironment activity models in these rural homes do not provide robust estimates of individual exposures due to the large spatial heterogeneity in pollutant concentrations and the lack of resolution of time activity diaries to capture movement through these microenvironments.

The impact of improved wood-burning stoves on fine particulate matter concentrations in rural Mexican homes.

To evaluate the impact of improved wood burning stoves on indoor air pollution, 53 homes in a rural town in Michoacán, Mexico, were selected from a health intervention study and monitored before and after receiving improved wood-burning stoves. Fine particulate matter--particles with aerodynamic diameter less than 2.5 microm (PM(2.5))--concentrations were measured in the central plaza of the community and in three microenvironments in the home (next to the stove, in the kitchen away from the stove, and outdoor patio). Forty-eight hour mean PM(2.5) concentrations in homes that burned wood in open fires were 693 microg/m(3) (95% CI: 246-1338) near the stove, 658 microg/m(3) (95% CI: 67-1448) in the kitchen away from the stove, and 94 microg/m(3) (95% CI: 36-236) on the patio. Mean ambient 24-h concentrations in the main plaza of the community were 59 microg/m(3) (95% CI: 29-92). Paired measurements before and after the installation of the Patsari improved wood-burning stove indicate a median 71% reduction in PM(2.5) concentrations near the stove and 58% reductions in kitchen concentrations, whereas patio and main plaza concentrations remain unaffected. Only 44% of participants reported to use their Patsari stoves exclusively during the transition period. Even with the predominant mixed use of the Patsari stove with open fires, estimated daily average personal exposures to PM(2.5) were reduced by 50%.

La salud ambiental en México / The environment health in Mexico

Se presenta amplia información sobre las condiciones de la salud ambiental en México, así como el marco de referencia de la salud ambiental, la contaminación atmosférica, cantidad y calidad del agua en México, condiciones industriales de trabajo y la regulación y los servicios de salud ambiental. El documento se divide en nueve capítulos: 1. Introducción 2. Campo de la salud ambiental 3. Diagnóstico internacional de la salud ambiental 4. Diagnóstico nacional de la salud ambiental 5. Programas de educación superior en salud ambiental 6. Investigación 7. Investigación 8. Programas organizativos en el desarrollo de la salud ambiental 9. Conclusiones