[Systematic review of the impact of chlordecone on human health in the French West Indies]. / Revue systématique de l'impact du chlordécone sur la santé humaine aux Antilles françaises.

INTRODUCTION: Several publications have highlighted the adverse effects of chlordecone on human and animal species. The possible long-term consequences continue to be explored as chlordecone still contaminates Caribbean soils. The objective of this literature review is to determine the long-term effects of chlordecone on human health. MATERIAL AND METHOD: We searched for the keyword "chlordecone" on different scientific databases: Medline®, ISI Web of Knowledge, Google Scholar, EM Premium. We have enriched our research with first degree references, related articles on PubMed and grey literature. RESULTS: Of the 192 articles analyzed, 12 responded to the impact of chlordecone on human health in the French West Indies. In obstetrics, exposure to chlordecone was associated with a lower incidence of gestational hypertension. In pediatrics, these studies have shown an association between prenatal exposure to chlordecone and increased risk of prematurity, decreased birth weight (especially when the mother gained excessive weight during pregnancy), decreased fine cognitive and motor acquisition, and changes in circulating concentrations of certain thyroid hormones. In oncology, exposure was associated with an increased risk of prostate cancer, particularly if there was a family history of prostate cancer. CONCLUSION: While the effects of acute exposure to chlordecone at high doses are well described (Kepone Shake syndrome at the time of the Hopewell accident), the effects at environmental doses are becoming clearer even if they remain complex to identify.

Lung Function in Rural Guatemalan Women Before and After a Chimney Stove Intervention to Reduce Wood Smoke Exposure: Results From the Randomized Exposure Study of Pollution Indoors and Respiratory Effects and Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter Study.

BACKGROUND: COPD is the third most frequent cause of death globally, with much of this burden attributable to household biomass smoke exposure in developing countries. As biomass smoke exposure is also associated with cardiovascular disease, lower respiratory infection, lung cancer, and cataracts, it presents an important target for public health intervention. METHODS: Lung function in Guatemalan women exposed to wood smoke from open fires was measured throughout the Randomized Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE) stove intervention trial and continued during the Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter (CRECER) cohort study. In RESPIRE, early stove households received a chimney woodstove at the beginning of the 18-month trial, and delayed stove households received a stove at trial completion. Personal exposure to wood smoke was assessed with exhaled breath carbon monoxide (CO) and personal CO tubes. Change in lung function between intervention groups and as a function of wood smoke exposure was assessed using random effects models. RESULTS: Of 306 women participating in both studies, acceptable spirometry was collected in 129 early stove and 136 delayed stove households (n = 265), with a mean follow-up of 5.6 years. Despite reduced wood smoke exposures in early stove households, there were no significant differences in any of the measured spirometric variables during the study period (FEV1, FVC, FEV1/FVC ratio, and annual change) after adjustment for confounding. CONCLUSIONS: In these young Guatemalan women, there was no association between lung function and early randomization to a chimney stove or personal wood smoke exposure. Future stove intervention trials should incorporate cleaner stoves, longer follow-up, or potentially susceptible groups to identify meaningful differences in lung function.

Hematological and hepatic alterations in Brazilian population heavily exposed to organochlorine pesticides.

The aim of this study was to investigate the frequency of hematological and hepatic alterations and possible association with serum levels of beta-hexachlorocyclohexane (beta-HCH), p,p'-DDE, and hexachlorobenzene (HCB) among residents in an area heavily contaminated with organochlorine (OC) pesticides. A cross-sectional study was conducted in 415 male and 432 female residents aged >14 years. Serum samples were collected and analyzed for OC pesticides concentrations and biochemical parameters. Frequencies of hematological and hepatic alterations were calculated for each gender. Association between beta-HCH, p,p'-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl) ethylene), and HCB levels and presence of alterations was determined by logistic regression stratified by gender and controlling for confounders. Highest frequencies were observed for eosinophilia (23% men and 18% women), low hemoglobin (12% men and 15% women), and low erythrocyte count (12% men). High levels of bilirubin, glutamic-oxaloacetic transaminase (GOT), and glutamic-pyruvic transaminase (GPT) were observed, respectively, in 10, 11, and 12% of men and <10% of women. Gamma-glutamyl transferase (GGT) was elevated in 26 and 25% of males and females, respectively. Multivariate analysis revealed associations between eosinophilia and beta-HCH in men (OR = 1.06, 95%CI = 1.01-1.12) and women (OR = 1.05, 96%CI = 0.99-1.11), p,p'-DDE in men (OR = 1.03, 95%CI = 0.99-1.06) and women (OR = 1.02, 95%CI = 0.99-1.06), and HCB in women (OR = 1.54, 95%IC = 0.85-4.45). Beta-HCH was found to be associated with increased risk of elevated bilirubin in females (OR = 1.18, 95%CI = 1.07-1.29) and males (OR = 4.21, 95%CI = 1.87-9.47 for fourth vs. first quintile). Thus, OC pesticides may exert adverse effects on hematopoietic tissue and liver in populations chronically exposed to high levels of these compounds.

Relationship between daily exposure to biomass fuel smoke and blood pressure in high-altitude Peru.

Household air pollution from biomass fuel use affects 3 billion people worldwide; however, few studies have examined the relationship between biomass fuel use and blood pressure. We sought to determine if daily biomass fuel use was associated with elevated blood pressure in high altitude Peru and if this relationship was affected by lung function. We analyzed baseline information from a population-based cohort study of adults aged ≥ 35 years in Puno, Peru. Daily biomass fuel use was self-reported. We used multivariable regression models to examine the relationship between daily exposure to biomass fuel smoke and blood pressure outcomes. Interactions with sex and quartiles of forced vital capacity were conducted to evaluate for effect modification. Data from 1004 individuals (mean age, 55.3 years; 51.7% women) were included. We found an association between biomass fuel use with both prehypertension (adjusted relative risk ratio, 5.0; 95% confidence interval, 2.6-9.9) and hypertension (adjusted relative risk ratio, 3.5; 95% confidence interval, 1.7-7.0). Biomass fuel users had a higher systolic blood pressure (7.0 mm Hg; 95% confidence interval, 4.4-9.6) and a higher diastolic blood pressure (5.9 mm Hg; 95% confidence interval, 4.2-7.6) when compared with nonusers. We did not find interaction effects between daily biomass fuel use and sex or percent predicted forced vital capacity for either systolic blood pressure or diastolic blood pressure. Biomass fuel use was associated with a higher likelihood of having hypertension and higher blood pressure in Peru. Reducing exposure to household air pollution from biomass fuel use represents an opportunity for cardiovascular prevention.

In utero and early childhood exposure to arsenic decreases lung function in children.

The lung is a target organ for adverse health outcomes following exposure to As. Several studies have reported a high prevalence of respiratory symptoms and diseases in subjects highly exposed to As through drinking water; however, most studies to date has been performed in exposed adults, with little information on respiratory effects in children. The objective of the study was to evaluate the association between urinary levels of As and its metabolites with lung function in children exposed in utero and in early childhood to high As levels through drinking water. A total of 358 healthy children were included in our study. Individual exposure was assessed based on urinary concentration of inorganic As. Lung function was assessed by spirometry. Participants were exposed since pregnancy until early childhood to an average water As concentration of 152.13 µg l⁻¹. The mean urinary As level registered in the studied subjects was 141.2 µg l⁻¹ and only 16.7% had a urinary concentration below the national concern level. Forced vital capacity was significantly decreased in the studied population and it was negatively associated with the percentage of inorganic As. More than 57% of the subjects had a restrictive spirometric pattern. The urinary As level was higher in those children with restrictive lung patterns when compared with the levels registered in subjects with normal spirometric patterns. Exposure to As through drinking water during in utero and early life was associated with a decrease in forced vital capacity and with a restrictive spirometric pattern in the children evaluated.

Cadmium, mercury and lead in the blood of urban women in Croatia, the Czech Republic, Poland, Slovakia, Slovenia, Sweden, China, Ecuador and Morocco.

OBJECTIVES: The aim of the study was to make an international comparison of blood levels of cadmium (B-Cd), lead (B-Pb) and mercury (B-Hg) of women in seven European, and three non-European cities, and to identify determinants. MATERIALS AND METHODS: About 50 women (age: 46-62) from each city were recruited (totally 480) in 2006-2009. Interview and questionnaire data were obtained. Blood samples were analysed in one laboratory to avoid interlaboratory variation. RESULTS: Between the European cities, the B-Pb and B-Cd results vary little (range of geometric means: 13.5-27.0 µg/l and 0.25-0.65 µg/l, respectively); the variation of B-Hg was larger (0.40-1.38 µg/l). Between the non-European cities the results for B-Pb, B-Cd and B-Hg were 19.2-68.0, 0.39-0.99 and 1.01-2.73 µg/l, respectively. Smoking was a statistically significant determinant for B-Cd, while fish and shellfish intakes contributed to B-Hg and B-Pb, amalgam fillings also contributed to B-Hg. CONCLUSIONS: The present results confirm the previous results from children; the exposure to lead and cadmium varies only little between different European cities suggesting that other factors than the living area are more important. The study also confirms the previous findings of higher cadmium and lead levels in some non-European cities. The geographical variation for mercury is significant.

Windows of lead exposure sensitivity, attained height, and body mass index at 48 months.

OBJECTIVE: To examine longitudinal associations of prenatal, infancy, and early childhood lead exposure during sensitive periods with height and body mass index (BMI). STUDY DESIGN: A total of 773 participants were recruited between 1994 and 2005 in Mexico City. Lead exposure history categories were constructed for the prenatal period (maternal patellar lead concentration) and for infancy and childhood (mean child blood lead concentration at birth to 24 months and 30-48 months, respectively). Linear regression models were used to study lead exposure history with height and BMI at 48 months. RESULTS: Mean height at age 48 months was significantly lower in children with a blood lead level exceeding the median during infancy (-0.84 cm; 95% CI, -1.42 to -0.25) than in children with a level below the median. Prenatal lead exposure was not associated with height at 48 months. Results for attained BMI generally trended in the same direction as for height. CONCLUSION: Our findings suggest an effect of lead exposure early in life on height attainment at 48 months, with the exposure window of greatest sensitivity in infancy.

Acoustic stapedius muscle reflex in mercury-exposed Andean children and adults.

CONCLUSION: The results suggested mercury (Hg)-induced anomalies in the brainstem-mediated acoustic stapedius muscle reflex in children. OBJECTIVES: Hg exposure has been associated with hearing impairment and brainstem anomalies. Acoustic stapedius reflex (ASR) thresholds, growth functions, decay/adaptation times, and behavioral auditory thresholds were used to screen Andean children and adults for Hg-induced auditory brainstem and facial nerve impairment. METHODS: Fifty-one participants, which included 22 children (aged 6-17 years) and 29 adults (aged 19-83 years) living in gold mining areas of Ecuador where Hg is widely used in amalgamation, were screened using ASR immittance procedures. RESULTS: Mean blood mercury (HgB) level in the children was 15.6 µg/L (SD, 21.3; median, 7 µg/L; range, 2.0-89 µg/L), and in the adults 8.5 µg/L (SD, 7.1; median, 6 µg/L; range, 2.0-32 µg/L). Mean contralateral ASR thresholds (ASRT) for the screening frequency of 2000 Hz in the children (39 ears) was 92.9 dB HL (SD, 6.1; range, 80-105 dB HL), and in the adults (53 ears) 90.0 dB HL (SD, 6.4; range, 65-105 dB HL). The ASRT in the children increased significantly with HgB level (rho = 0.433; p = 0.008).

A community randomised controlled trial evaluating a home-based environmental intervention package of improved stoves, solar water disinfection and kitchen sinks in rural Peru: rationale, trial design and baseline findings.

INTRODUCTION: Pneumonia and diarrhoea are leading causes of death in children. There is a need to develop effective interventions. OBJECTIVE: We present the design and baseline findings of a community-randomised controlled trial in rural Peru to evaluate the health impact of an Integrated Home-based Intervention Package in children aged 6 to 35 months. METHODS: We randomised 51 communities. The intervention was developed through a community-participatory approach prior to the trial. They comprised the construction of improved stoves and kitchen sinks, the promotion of hand washing, and solar drinking water disinfection (SODIS). To reduce the potential impact of non-blinding bias, a psychomotor stimulation intervention was implemented in the control arm. The baseline survey included anthropometric and socio-economic characteristics. In a sub-sample we determined the level of faecal contamination of drinking water, hands and kitchen utensils and the prevalence of diarrhoegenic Escherichia coli in stool specimen. RESULTS: We enrolled 534 children. At baseline all households used open fires and 77% had access to piped water supplies. E. coli was found in drinking water in 68% and 64% of the intervention and control households. Diarrhoegenic E. coli strains were isolated from 45/139 stool samples. The proportion of stunted children was 54%. CONCLUSIONS: Randomization resulted in comparable study arms. Recently, several critical reviews raised major concerns on the reliability of open health intervention trials, because of uncertain sustainability and non-blinding bias. In this regard, the presented trial featuring objective outcome measures, a simultaneous intervention in the control communities and a 12-month follow up period will provide valuable evidence.

Condiciones ambientales como factores de riesgo para la salud y su relación con enfermedades diarreicas e infecciones respiratorias agudas, en niños/as menores de 5 años que acuden al hospital de Quillacollo entre septiembre a noviembre del 2010 / Environmental conditions as risk factors for health and their relationship with diarrheal diseases and acute respiratory infections in children / as under 5 attending the hospital Quillacollo from September to November 2010

Las condiciones de vivienda y saneamiento básico son fundamentales para llevar una vida sana y de calidad; sin embargo, al no contar con los mismos o si éstos son utilizados de manera ineficiente, llega a ser dañino para la salud. El presente estudio relacionó estos factores de vivienda y saneamiento básico con la incidencia de dos enfermedades con más altas tasas de de morbi mortalidad en niños/as menores de 5 años, en el hospital de segundo nivel de Quillacollo, con un total de 98 menores de 5 años que asistieron a consulta externa por una de estas dos enfermedades.Un 73.6% de niños/as que tuvo diarrea y un 74.4% que tuvo tos, cuenta con servicios básicos adecuados como agua por cañería, recojo de basura a través de un carro basurero y alcantarillado, y un 26.4% que tuvo diarrea y un 25.6% que tuvo tos, cuentan con servicios alternativos como agua de pozo, disposición de basura a través de un contenedor y letrina sanitaria. Estos resultados llevaron a la elaboración de propuestas de educación para el mejoramiento de las condiciones de vivienda y saneamiento básico, tanto para el personal de salud y las autoridades del municipio, con el objetivo de sensibilizar a los mismos y lograr una mayor atención a la población, velando de esta manera por la salud, sobre todo la infantil

Púrpura trombocitopénica inmune en la infancia: 20 años de experiencia: 1985-2005 estado Cojedes-Venezuela / Autoimmune thrombocytopenic purpura in infancy: 20 years of experience: 1985-2005 Cojedes state-Venezuela

La púrpura trombocitopénica idiopática (PTI) es un síndrome caracterizado por diátesis hemorrágica consecuencia de la excesiva destrucción periférica de plaquetas, globalmente es considerada la trombocitopenia inmune más frecuente en niños. Describir el comportamiento clínico-epidemiológico de la PTI en el estado Cojedes, Venezuela. Se realizó un estudio descriptivo, prospectivo en niños con clínica de PTI que acudieron entre 1985 y 2005 al Hospital "Dr. Egor Nucete" de referencia del estado Cojedes, Venezuela. Las variables estudiadas fueron: época del año, procedencia, edad, género, antecedentes, manifestaciones clínicas, signos hematológicos, variedad clínica y tratamiento. Se realizó análisis estadístico descriptivo con distribuciones de frecuencia, porcentajes y gráficos de segmentos. 112 niños con PTI, incidencia acumulada promedio anual de 4,4/100.000 menores de 12 años; marzo, junio, julio y agosto mostraron el mayor número de casos y también los municipios San Carlos (30,36%), Falcón (18,75%) y Rómulo Gallegos (17,86%). Hubo mayor incidencia de PTI entre los 5 y 8 años (39%), sin diferencia entre géneros, pero con antecedentes de afección respiratoria superior en 82%; en lugar de predominó la forma aguda (91%), trombocitopenia menor de 50.000 plaquetas/mm3, sólo el 9% no recibió tratamiento terapéutico. La PTI es una patología de importante morbilidad en el estado Cojedes, de comportamiento epidemiológico similar al resto de América Latina y el mundo, su aparición está influenciada por factores ambientales, se resalta el predomino de la enfermedad entre los 2-8 años, sin distingo de género, con antecedentes infecciosos como factor de riesgo en la génesis del cuadro clínico y evolución satisfactoria aún sin tratamiento.

The immune thrombocytopenic purpura (ITP) it is a syndrome characterized by hemorrhagic, diathesis consequence of the excessive peripheric destruction of platelets, widely spread in the world and considered the most frequent thrombocytopenia in children. To description the clinic-epidemic behavior of the ITP in Cojedes state, Venezuela. It was done a descriptive prospective study with children with clinic of ITP who request medical assistance at the Hospital "Dr. Egor Nucete" of Cojedes state in a 20 years period. The variables studied were: time of the year, origin, age, gender, antecedents, clinical features, hematological signs, clinical variety and treatment. It was carried out statistical analysis. 112 children with ITP, cumulative annual average incidence of 4.4 for each 100.000 children less 12 years old; March, June, July and August showed most cases and also the municipalities of San Carlos (30.36%), Falcón (18.75%) and Rómulo Gallegos(17.86%). There was higher incidence of ITP among 5-8 years (39%), without difference among gender, but with antecedents of respiratory upper tract infection in 82% of the cases; The acute disease was predominant (91%), thrombocytopenia lower than 50.000 platelets/mm³, only 9% didn't receive treatment. The ITP is a disease of important morbility in the Cojedes state, with similar epidemic behavior than the rest of Latin America and the world, being its occurrence influenced by environmental factors, prevalence of the illness among the 2-8 years, without distinguish of gender, with infection antecedents as factor of risk in the genesis of the clinical features and satisfactory evolution without treatment.

Proliferative activity in clinically healthy oral mucosa exposed to tobacco smoking and alcohol: a longitudinal study using the agNOR staining technique.

OBJECTIVE: To evaluate cell proliferation in clinically healthy oral mucosa exposed to smoking and alcohol carcinogens over a period of 24 months using the AgNOR staining technique. STUDY DESIGN: Sixty patients were initially evaluated: 17 were control individuals, 25 were smokers and 18 were smokers and alcohol drinkers. Fifty-two of these patients were reevaluated. Specimens for cytology were obtained from swabs of lower lip mucosa, border of the tongue and floor of the mouth and underwent AgNOR staining for evaluation of mean number and mean area of AgNOR dots per nucleus and percentage of nuclei with > 3 and > 5 AgNOR dots. Student t and Kruskal-Wallis tests were used to compare values obtained. RESULTS: A statistically significant increase was found in mean number of AgNOR dots per nucleus in 2 groups. One group showed a tendency toward increase of these values. The results of the longitudinal evaluation (Kruskal-Wallis test) revealed a statistically significant difference in number and area of AgNOR dots in the cells of the lower lip. CONCLUSION: The increase of the variables suggests that the longitudinal evaluation of changes in cell proliferation in individuals exposed to smoking and alcohol carcinogens may be a useful monitoring tool.

[Estimation of exposure to fluoride in "Los Altos de Jalisco", México]. / Estimación de la exposición a fluoruros en Los Altos de Jalisco, México.

OBJECTIVE: To estimate the level of fluoride exposure and human health risks in Los Altos de Jalisco (Jalisco State Heights) region. MATERIAL AND METHODS: This study was conducted between May and July 2002. The fluoride concentrations of 105 water wells and six tap water samples were electrochemically measured. Exposure doses to fluoride and total intake of fluoride were estimated for babies (10 kg), children (20 kg), and adults (70 kg). RESULTS: The fluoride concentration of the water samples ranged from 0.1 to 17.7 mg/l. More than 45% of the water samples exceeded the national guideline value for fluoride of 1.5 mg/l. The estimated values of the exposure doses to fluoride and total intake of fluoride were in the range of 0.04-1.8 mg/kg/d and 0.5-18.4 mg/d, respectively. CONCLUSIONS: Dental fluorosis, skeletal fluorosis, and bone fractures are some of the potential health risks due to the intake of high doses of fluoride for the population of Los Altos de Jalisco. In order to reduce health risks, fluoridated salt,fluoridated toothpastes, and drinking water containing more than 0.7 mg/l of fluoride should be avoided.

Estimación de la exposición a fluoruros en Los Altos de Jalisco, México / Estimation of exposure to fluoride in \"Los Altos de Jalisco\", México

OBJETIVO: Estimar la exposición a fluoruros y riesgos potenciales a la salud humana en Los Altos de Jalisco, México. MATERIAL Y MÉTODOS: Se midió electroquímicamente la concentración de fluoruros en 105 pozos y seis tomas de agua potable, en los Altos de Jalisco, de mayo a julio de 2002. Se estimó la dosis de exposición y la ingestión total de fluoruros para: bebés de 10 kg, niños de 20 kg y adultos de 70 kg. RESULTADOS: La concentración de fluoruros en las muestras de agua varió entre 0.1 y 17.7 mg/l. El 45 por ciento de las muestras excede el límite permitido por la normatividad (1.5 mg/l). La ingestión total y dosis de exposición a fluoruros estimados están en los rangos de 0.5-18.4 mg/d y 0.04-1.8 mg/kg/d, respectivamente. CONCLUSIONES: Una parte importante de la población está expuesta a fluorosis dental, fluorosis esquelética y fracturas óseas. Para reducir los riesgos se debe evitar el consumo de sal fluorada, pastas dentales con flúor y agua potable cuya concentración de fluoruros sea mayor de 0.7 mg/l.

A homeopatia na prevenção das doenças de origem ambiental por agrotóxicos: um estudo de caso com engenheiros agrônomos e técnicos agrícolas / The homeopathy in the prevention of the diseases of environmental origin for pesticides: a case study with agricultural and technical engineers

Trata-se de um estudo epidemiológico descritivo, que avalia a prevalência de sinais e sintomas de 39 profissionais û Engenheiros Agrônomos e técnicos agrícolas da região serrana do estado do Rio de Janeiro û através da aplicação de um questionário de dados ocupacionais e de condições de vida, bem como das avaliações clínica e neurológica, seguidas de exames laboratoriais, visando estabelecer o possível nexo entre a exposição ocupacional e os sintomas encontrados nos trabalhadores expostos da população em estudo. Os indivíduos integrantes do estudo tem entre 19 e 56 anos, com predominância do sexo masculino (95 porcento), residentes nos municípios de Teresópolis, Nova Friburgo, Bom Jardim, Cordeiro, Sumidouro, São Sebastião do Alto, Santa Maria Madalena, Cantagalo e Duas Barras. Foram observados nessa população os seguintes sintomas e sinais: cefaléia (35,8 por cento), hipertensão arterial (28,2 por cento), diminuição da memória (23 por cento), tosse, irritação nasal e secreção brônquica (18 porcento), câimbras, agitação e irritabilidade (15,3 por cento), labilidade emocional, formigamentos, diminuição da força muscular e agressividade (7,7 por cento) e visão turva (5,2 por cento). Os níveis da enzima acetilcolinesterase plástica mantiveram-se dentro de parâmetros normais com um média de 10.380 U/L. Destacou-se, também, a observação dos profissão em relação à crise da assistência técnica no campo e a percepção de mudança do padrão ambiental e do perfil epidemiológico na população de agricultores no último ano, com dados que, ao mesmo tempo em que apontam para uma redução dos quadros de intoxicação aguda, ressaltam, em contrapartida, um aumento da gravidade em relação às intoxicações crônicas. Concluiu-se que o problema da exposição ocupacional aos agrotóxicos adquire uma dimensão de forte impacto, pois, além da população de agricultores diretamente expostos, atinge também, de forma indireta, populações bem informadas em relação ao problema... (AU)

A homeopatia na prevenção das doenças de origem ambiental por agrotóxicos: um estudo de caso com engenheiros agrônomos e técnicos agrícolas / The homeopathy in the prevention of the diseases of environmental origin for pesticides: a case study with agricultural and technical engineers

Trata-se de um estudo epidemiológico descritivo, que avalia a prevalência de sinais e sintomas de 39 profissionais - Engenheiros Agrônomos e técnicos agrícolas da região serrana do estado do Rio de Janeiro - através da aplicação de um questionário de dados ocupacionais e de condições de vida, bem como das avaliações clínica e neurológica, seguidas de exames laboratoriais, visando estabelecer o possível nexo entre a exposição ocupacional e os sintomas encontrados nos trabalhadores expostos da população em estudo. Os indivíduos integrantes do estudo tem entre 19 e 56 anos, com predominância do sexo masculino (95 porcento), residentes nos municípios de Teresópolis, Nova Friburgo, Bom Jardim, Cordeiro, Sumidouro, São Sebastião do Alto, Santa Maria Madalena, Cantagalo e Duas Barras. Foram observados nessa população os seguintes sintomas e sinais: cefaléia (35,8 por cento), hipertensão arterial (28,2 por cento), diminuição da memória (23 por cento), tosse, irritação nasal e secreção brônquica (18 porcento), câimbras, agitação e irritabilidade (15,3 por cento), labilidade emocional, formigamentos, diminuição da força muscular e agressividade (7,7 por cento) e visão turva (5,2 por cento). Os níveis da enzima acetilcolinesterase plástica mantiveram-se dentro de parâmetros normais com um média de 10.380 U/L. Destacou-se, também, a observação dos profissão em relação à crise da assistência técnica no campo e a percepção de mudança do padrão ambiental e do perfil epidemiológico na população de agricultores no último ano, com dados que, ao mesmo tempo em que apontam para uma redução dos quadros de intoxicação aguda, ressaltam, em contrapartida, um aumento da gravidade em relação às intoxicações crônicas. Concluiu-se que o problema da exposição ocupacional aos agrotóxicos adquire uma dimensão de forte impacto, pois, além da população de agricultores diretamente expostos, atinge também, de forma indireta, populações bem informadas em relação ao problema. Nesse contexto, este estudo articula-se a outros, visando inserir a utilização da homeopatia na prevenção das doenças de origem ambiental, com o objetivo de contribuir com estas questões na área de produção, ambiente e saúde

Environmental determinants of infectious and parasitic diseases

A review of the role of the environment as a determinant of infectious and parasitic diseases is presented. Historical considerations and the several environmental classifications of diseases are introduced. In a broader perspective the subject is analyzed in view of the emergence of the environmental health area, with its new paradigms. A review of epidemiological studies about environmental sanitation conditions and measures is presented, analyzing the conclusions derived from 256 studies. Finally, an epidemiological study carried out in Betim, Minas Gerais is briefly described, in order to illustrate the potentiality of this kind of study. Setting priorities of interventions regarding diarrhea control was the aim of this investigation. Conclusion about the role of this approach to optimize preventive measures for the control of infectious and parasitic diseases, of sound importance to the reality of the developing world, is stated.