[Prevalence and factors associated with partner violence among pregnant and puerperal women in Santiago, Chile]. / Violencia contra la mujer durante la gestación y postparto infligida por su pareja en Centros de Atención Primaria de la zona norte de Santiago, Chile.

BACKGROUND: Violence against women (VAW) is a violation of women's fundamental rights and special attention must be paid during the gestational and postpartum period. AIM: To determine the prevalence of violence against women attending antenatal and postpartum controls in Primary Health Centers. MATERIAL AND METHOD: The Woman Abuse Screening Tool (WAST) for early detection of VAW was applied to 279 pregnant and 102 puerperal women attending five public primary health centers in metropolitan Santiago. RESULTS: The prevalence ofviolence against pregnant and puerperal women was 5.7 and 5.9%, respectively. In both groups, the factors associated with a greater risk of violence were being immigrants, a history of domestic violence, not having a supportive partner and alcohol consumption by the partner. CONCLUSIONS: Violence against these women is a multifactorial, complex and structural phenomenon, which involves the victim, the abuser and the entire social system. Primary health care level and health professionals can be key elements applying early detection strategies, timely referral mechanisms and bringing emotional support for victims.

Violencia contra la mujer durante la gestación y postparto infligida por su pareja en Centros de Atención Primaria de la zona norte de Santiago, Chile / Prevalence and factors associated with partner violence among pregnant and puerperal women in Santiago, Chile

Background: Violence against women (VAW) is a violation of women's fundamental rights and special attention must be paid during the gestational and postpartum period. Aim: To determine the prevalence of violence against women attending antenatal and postpartum controls in Primary Health Centers. Material and Method: The Woman Abuse Screening Tool (WAST) for early detection of VAW was applied to 279 pregnant and 102 puerperal women attending five public primary health centers in metropolitan Santiago. Results: The prevalence ofviolence against pregnant and puerperal women was 5.7 and 5.9%, respectively. In both groups, the factors associated with a greater risk of violence were being immigrants, a history of domestic violence, not having a supportive partner and alcohol consumption by the partner. Conclusions: Violence against these women is a multifactorial, complex and structural phenomenon, which involves the victim, the abuser and the entire social system. Primary health care level and health professionals can be key elements applying early detection strategies, timely referral mechanisms and bringing emotional support for victims.

Exposure to organophosphate (OP) pesticides and health conditions in agricultural and non-agricultural workers from Maule, Chile.

The objective was to evaluate the characteristics of exposure to OP pesticides and health status in Chilean farm workers from the Maule Region. An occupational health questionnaire was administered in 207 agricultural and non-agricultural workers. For the group of agricultural workers, we asked about specific occupational exposure history and symptoms of OP pesticide poisoning. The main health problem of the exposed group was previous OP pesticide poisoning (p < 0.001). Fifty-six percent of agricultural workers reported symptoms consistent with acute OP pesticide poisoning. The use of respiratory personal protective equipment and younger age were protective against these symptoms, and number of years of OP pesticide exposure was positively associated with reporting symptoms of poisoning. Of the pesticide applicators 47 % reported using chlorpyrifos. The regulations regarding use and application of pesticides should be strengthened, as should training and intervention with workers to improve the use of personal protective equipment.

Plaguicidas organofosforados y efecto neuropsicológico y motor en la Región del Maule, Chile / Organophosphate pesticides and neuropsychological and motor effects in the Maule Region, Chile

Objetivo: Evaluar la exposición a plaguicidas organofosforados y el desempeño neuropsicológico y motor de trabajadores/as agrícolas y no agrícolas de la Región del Maule, Chile. Método: Estudio transversal analítico con 93 trabajadores/as agrícolas expuestos/as a plaguicidas organofosforados y 84 trabajadores/as no agrícolas no expuestos/as. Se administró una batería de cuatro pruebas neuropsicológicas junto con un examen físico neuromotor. Resultados: Los/las trabajadores/as agrícolas expuestos/as tuvieron un menor desempeño en la escala de inteligencia de Wechsler para Adultos (WAIS-IV) en comprensión verbal (Beta=−3,2; p=0,034), en velocidad de procesamiento (Beta=−4,4; p=0,036) y en la escala total (Beta=−4; p=0,016); sensibilidad discriminativa (Beta=1, p=0,009) ajustada por años de educación o edad en comparación con los controles. Conclusiones: Se sugiere el desarrollo de políticas en materia de control, venta y uso de plaguicidas organofosforados, y de intervenciones con la población expuesta respecto a medidas de seguridad (AU)

Objective: To evaluate organophosphate pesticide exposure and neuropsychological and motor performance in agricultural and non-agricultural workers in the Maule Region in Chile. Method: Analytic cross-sectional study in 93 exposed farm workers and 84 unexposed non-agricultural workers. A battery of four neuropsychological tests was administered together with a neuro-motor physical examination. Results: On the Weschler adult intelligence scale (WAIS-IV), exposed agricultural workers exhibited poorer performance than non-agricultural workers in verbal comprehension (Beta=−3.2; p=0.034) and processing speed (Beta=−4.4; p=0.036) and in the full scale (Beta=−4; p=0.016), as well as in discrimination sensitivity (Beta=1, p=0,009), adjusted by years of schooling and/or age. Conclusions: We suggest the development of policies and regulations for the control, sale and use of organophosphate pesticides and intervention strategies on safety measures aimed at the exposed population (AU)

Chronic exposure to organophosphate (OP) pesticides and neuropsychological functioning in farm workers: a review.

BACKGROUND: Previous studies have demonstrated that acute poisoning from exposure to organophosphate (OP) pesticides in agricultural workers causes adverse health effects. However, neuropsychological and cognitive effects of chronic occupational exposure to OP pesticides remain controversial. OBJECTIVE: To identify, evaluate, and systematize existing evidence regarding chronic exposure to OP pesticides and neuropsychological effects in farmworkers. METHODS: Using the PubMed search engine, a systematic review process was implemented and replicated according to the PRISMA statement. Eligibility criteria included workers over 18 years of age exposed to OP pesticides as well as assessment of neuropsychological and cognitive functioning. Search terms were in English and Spanish languages and included organophosphate and workers. RESULTS: Of the search results, 33 of 1,256 articles meet eligibility criteria. Twenty-four studies found an association between chronic occupational exposure to OP pesticides and low neuropsychological performance in workers. We classified nine of the studies to have study design limitations. Studies indicated occupational exposure to OP pesticides is linked to difficulties in executive functions, psychomotor speed, verbal, memory, attention, processing speed, visual-spatial functioning, and coordination. Nine studies find no relationship between OP pesticides exposure and neuropsychological performance. CONCLUSIONS: Overall, evidence suggests an association between chronic occupational exposure to OP pesticides and neuropsychological effects. However, there is no consensus about the specific cognitive skills affected.

[Organophosphate pesticides and neuropsychological and motor effects in the Maule Region, Chile]. / Plaguicidas organofosforados y efecto neuropsicológico y motor en la Región del Maule, Chile.

OBJECTIVE: To evaluate organophosphate pesticide exposure and neuropsychological and motor performance in agricultural and non-agricultural workers in the Maule Region in Chile. METHOD: Analytic cross-sectional study in 93 exposed farm workers and 84 unexposed non-agricultural workers. A battery of four neuropsychological tests was administered together with a neuro-motor physical examination. RESULTS: On the Weschler adult intelligence scale (WAIS-IV), exposed agricultural workers exhibited poorer performance than non-agricultural workers in verbal comprehension (ß=-3.2; p=0.034) and processing speed (ß=-4.4; p=0.036) and in the full scale (ß=-4; p=0.016), as well as in discrimination sensitivity (ß=1, p=0,009), adjusted by years of schooling and/or age. CONCLUSIONS: We suggest the development of policies and regulations for the control, sale and use of organophosphate pesticides and intervention strategies on safety measures aimed at the exposed population.

Urticaria due to etanercept in a patient with psoriatic arthritis.

A 50-year-old woman was referred to our emergency room because of urticaria. Eleven days after etanercept therapy was started, the patient developed an urticarial rash of the trunk and face. A diagnosis of generalized urticaria was made. Etanercept treatment was suspended. Treatment was started with methylprednisolone and dexchlorpheniramine. The patient's condition improved and she was discharged. In this case, the most probable cause of urticaria was considered to be etanercept because of the temporal relationship between exposure to the drug and the onset of symptoms. The adverse reaction could be considered probable. Although the overall risk of skin adverse events associated with etanercept appears low, clinicians should be aware of this reaction.

Parapharyngeal abscess in a patient receiving etanercept.

OBJECTIVE: To report a case of parapharyngeal abscess associated with Streptococcus viridans in a patient with rheumatoid arthritis receiving treatment with etanercept. CASE SUMMARY: A 40-year-old man diagnosed with rheumatoid arthritis had received treatment with nonsteroidal antiinflammatory drugs, methotrexate, and deflazacort. Six months prior to admission, the patient had a Disease Activity Score of 3.4; clinicians decided to start treatment with etanercept. Chest X-rays were normal and the tuberculin skin test was negative. Treatment with etanercept plus methotrexate was started. Three months later, methotrexate was discontinued. Six months after etanercept therapy was started, the patient presented to our emergency department with a swelling of his neck, odynophagia, otalgia, and trismus. The clinical course was consistent with parapharyngeal abscess. Etanercept treatment was suspended. The parapharyngeal abscess was drained and intravenous methylprednisolone, amoxicillin/clavulanic acid, and clindamycin were administered. The parapharyngeal abscess secretion culture was positive for S. viridans and Bacteroides spp. The patient's condition improved with antibiotic therapy; he was discharged 5 days after admission. DISCUSSION: Tumor necrosis factor-alpha plays an essential role in the immune-mediated response to infection. In our patient, the most possible cause of parapharyngeal abscess was considered to be etanercept because of the temporal relationship between exposure to the drug and onset of symptoms. Etanercept was the only drug administered before the abscess developed. Based on the Naranjo probability scale, an association between etanercept and the adverse reaction could be considered possible. CONCLUSIONS: Patients initiated on etanercept therapy should be closely monitored for the development of tuberculosis and other infections. During treatment, all febrile or novel illnesses should be evaluated promptly. If clinical evaluation leads to the suspicion of tuberculosis and other infections associated with etanercept, it should be discontinued immediately.