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Pesticide residues in leafy vegetables and human health risk assessment in North Central agricultural areas of Chile.
| Idioma(s): Inglés
To investigate pesticide residue concentrations and potential human health risk, a study was conducted in 118 leafy vegetable samples collected in 2014-2015 from the North Central agricultural areas of Chile. The pesticide residues were determined using the multiresidue QuEChERS method by gas chromatography as well as high-performance liquid chromatography. The results indicated that 27% of the total samples contained pesticide residues above the maximum residue limits of each active ingredient. The maximum estimated daily intake obtained for carbon disulphide (CS ), methamidophos, azoxystrobin and cypermethrin were 0.57, 0.07, 0.06 and 0.05 mg kg , respectively, which was higher than their acceptable daily intake. It is concluded that inhabitants of the North Central agricultural area of Chile are not exposed to health risks through the consumption of leafy vegetables with the exception of methamidophos. Nevertheless, the high levels of methamidophos detected in leafy vegetables could be considered a potential chronic health risk.
Impacto económico del tabaquismo en los sistemas de salud de América Latina: un estudio en siete países y su extrapolación a nivel regional./ [Financial impact of smoking on health systems in Latin America: A study of seven countries and extrapolation to the regional level].
| Idioma(s): Español
Objective: Estimate smoking-attributable direct medical costs in Latin American health systems. Methods: A microsimulation model was used to quantify financial impact of cardiovascular and cerebrovascular disease, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and nine other neoplasms. A systematic search for epidemiological data and event costs was carried out. The model was calibrated and validated for Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, countries that account for 78% of Latin America's population; the results were then extrapolated to the regional level. Results: Every year, smoking is responsible for 33 576 billion dollars in direct costs to health systems. This amounts to 0.7% of the region's gross domestic product (GDP) and 8.3% of its health budget. Cardiovascular disease, COPD, and cancer were responsible for 30.3%, 26.9%, and 23.7% of these expenditures, respectively. Smoking-attributable costs ranged from 0.4% (Mexico and Peru) to 0.9% (Chile) of GDP and from 5.2% (Brazil) to 12.7% (Bolivia) of health expenditures. In the region, tax revenues from cigarette sales barely cover 37% of smoking-attributable health expenditures (8.1% in Bolivia and 67.3% in Argentina). Conclusions: Smoking is responsible for a significant proportion of health spending in Latin America, and tax revenues from cigarette sales are far from covering it. The region's countries should seriously consider stronger measures, such as an increase in tobacco taxes.
Impacto económico del tabaquismo en los sistemas de salud de América Latina: un estudio en siete países y su extrapolación a nivel regional/ Financial impact of smoking on health systems in Latin America: A study of seven countries and extrapolation to the regional level
| Idioma(s): Español
RESUMEN Objetivo Estimar los costos médicos directos atribuibles al tabaquismo en los sistemas de salud de América Latina. Métodos Se utilizó un modelo de microsimulación para cuantificar el impacto económico en enfermedad cardiovascular y cerebrovascular, enfermedad pulmonar obstructiva crónica (EPOC), neumonía, cáncer de pulmón y otras nueve neoplasias. Se realizó una búsqueda sistemática de datos epidemiológicos y de costos de los eventos. El modelo se calibró y validó para Argentina, Bolivia, Brasil, Chile, Colombia, México y Perú, países que representan el 78% de la población de América Latina; luego se extrapolaron los resultados a nivel regional. Resultados Cada año el tabaquismo es responsable de 33 576 millones de dólares en costos directos para el sistema de salud. Esto equivale a 0,7% del producto interno bruto (PIB) de la región y a 8,3% del presupuesto sanitario. La enfermedad cardiovascular, la EPOC y el cáncer fueron responsables de 30,3%, 26,9% y 23,7% de este gasto, respectivamente. El costo atribuible al tabaquismo varió entre 0,4% (México y Perú) y 0,9% (Chile) del PIB y entre 5,2% (Brasil) y 12,7% (Bolivia) del gasto en salud. En la región, la recaudación impositiva por la venta de cigarrillos apenas cubre 37% del gasto sanitario atribuible al tabaquismo (8,1% en Bolivia y 67,3% en Argentina). Conclusiones El tabaquismo es responsable de una importante proporción del gasto sanitario en América Latina, y la recaudación impositiva por la venta de cigarrillos está lejos de llegar a cubrirlo. La profundización de medidas como el aumento de impuestos al tabaco debería ser seriamente considerada por los países de la región. ABSTRACT Objective Estimate smoking-attributable direct medical costs in Latin American health systems. Methods A microsimulation model was used to quantify financial impact of cardiovascular and cerebrovascular disease, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and nine other neoplasms. A systematic search for epidemiological data and event costs was carried out. The model was calibrated and validated for Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, countries that account for 78% of Latin America’s population; the results were then extrapolated to the regional level. Results Every year, smoking is responsible for 33 576 billion dollars in direct costs to health systems. This amounts to 0.7% of the region’s gross domestic product (GDP) and 8.3% of its health budget. Cardiovascular disease, COPD, and cancer were responsible for 30.3%, 26.9%, and 23.7% of these expenditures, respectively. Smoking-attributable costs ranged from 0.4% (Mexico and Peru) to 0.9% (Chile) of GDP and from 5.2% (Brazil) to 12.7% (Bolivia) of health expenditures. In the region, tax revenues from cigarette sales barely cover 37% of smoking-attributable health expenditures (8.1% in Bolivia and 67.3% in Argentina). Conclusions Smoking is responsible for a significant proportion of health spending in Latin America, and tax revenues from cigarette sales are far from covering it. The region’s countries should seriously consider stronger measures, such as an increase in tobacco taxes.
FREQUENCY OF ANTI- Toxocara spp. ANTIBODIES IN INDIVIDUALS ATTENDED BY THE CENTRO DE SALUD FAMILIAR AND ENVIRONMENTAL CONTAMINATION WITH Toxocara canis EGGS IN DOG FECES, IN THE COASTAL NIEBLA TOWN, CHILE.
| Idioma(s): Inglés
The frequency of anti-Toxocara spp. antibodies in individuals attended by the Centro de Salud Familiar in the coastal Niebla town, Chile, was related to the host and to environmental factors. IgG anti- Toxocara antibodies were detected with a commercial ELISA kit (SCIMEDX Corporation, USA). Samples with undetermined absorbance values were subjected to an additional ELISA standardized by the Instituto de Salud Pública, Chilean Health Ministry, a commercial ELISA (NOVATEC, Germany), and a commercial Western blot kit (LDBio Diagnostics, France). Hematological exams were performed using an automated blood counter and blood smears. Dog feces were collected from the ground along the main road in Niebla, including rural and urban locations. Ninety (25.4%) of the 355 examined individuals were positive by the ELISA test. The frequency of anti-Toxocara antibodies and the infection risk were significantly higher (p < 0.05) among those individuals ≥ 40 years old with respect to the 20-39 years old group, in individuals from rural locations, those who did not have a safe drinking water supply in the house or who presented blood eosinophilia. The proportion of positive samples of dog feces and the mean number of Toxocara canis eggs/g of feces in urban and rural areas were similar (p > 0.05).
Evaluación de una intervención educativa nutricional en trabajadores de la construcción para prevenir enfermedades crónicas no transmisibles en Chile./ [Assessment of a nutrition education intervention among construction workers].
| Idioma(s): Español
BACKGROUND: Unhealthy lifestyles and overweight are common among blue collar workers. AIM: To evaluate a nutrition education intervention in construction workers to prevent chronic diseases. MATERIAL AND METHODS: One hundred forty two participants were randomly assigned to an experimental group (n = 69) and or a control group (n = 73). The experimental group received nutrition education consisting in individual lifestyle counseling, group workshop, group counseling in healthy lifestyles, and environmental intervention. At baseline and after one year of intervention, clinical evaluations consisting in laboratory determinations, anthropometry and nutritional assessment evaluation were carried out. RESULTS: The experimental group experienced a significant decrease in waist circumference, total cholesterol, triglycerides, and an increase in HDL cholesterol. A significant reduction in total calorie intake, especially at the evening snack was observed during week-days. The same reduction in total calories occurred at dinner during the week-end. A significant increase was observed in the consumption of fruits, vegetables and fish. In the control group there was a significant increase in weight, waist circumference, body mass index, glucose and insulin, without changes in total calorie intake or healthy food consumption. High soft drink consumption did not change in both groups. CONCLUSIONS: In construction workers, integral nutrition intervention at the individual, group and environmental level had an impact in nutritional and biochemical indicators.
A comprehensive assessment of arsenic in commonly consumed foodstuffs to evaluate the potential health risk in Bangladesh.
| Idioma(s): Inglés
Arsenic (As), particularly of its inorganic form (iAs) is highly toxic, and its presence in food composites is a matter of concern for the public health safety, specifically in Bangladesh which is regarded as the most arsenic affected country throughout the world. This study was carried out to investigate the levels of As in the composite samples of commonly consumed foodstuffs collected from 30 different agro-ecological zones for the first time in Bangladesh. Most of the individual food composites contain a considerable amount of As which was, as a whole, in the range of 0.077-1.5mg/kg fw which was lower than those reported from Spain, EU, France, Korea, whereas higher than those of Mexico, Chile, Japan, Cambodia, Hong Kong, Serbia, respectively. Cereals, vegetables, milk, and fish contribute about 90% to the daily intake of inorganic arsenic. Human health risk of dietary iAs was assessed separately for both the rural and urban adults. The estimated daily dietary intakes (EDI) of iAs for the exposed rural (3.5) and urban residents (3.2 µg/kg-BW/day) clearly exceeded the previous provisional tolerable daily intake (PTDI) value of 2.1 µg/kg-BW/day, recommended by the World Health Organization (WHO). From the health point of view, this study concluded that both the rural and urban residents of Bangladesh are exposed to carcinogenic and non-carcinogenic risks who consume As-contaminated water and foodstuffs.
| Idioma(s): Inglés
BACKGROUND: Maule Cohort (MAUCO), a Chilean cohort study, seeks to analyze the natural history of chronic diseases in the agricultural county of Molina (40,000 inhabitants) in the Maule Region, Chile. Molina´s population is of particular interest because in the last few decades it changed from being undernourished to suffering excess caloric intake, and it currently has the highest national rates of cardiovascular diseases, stomach cancer and gallbladder cancer. Between 2009 and 2011 Molina´s poverty rate dropped from 24.1 % to 13.5 % (national average 20.4 %); in this period the county went from insufficient to almost complete basic sanitation. Despite these advances, chemical pollutants in the food and air are increasing. Thus, in Molina risk factors typical of both under-developed and developed countries coexist, generating a unique profile associated with inflammation, oxidative stress and chronic diseases. METHODS/DESIGN: MAUCO is the core project of the recently established Advanced Center for Chronic Diseases (ACCDiS), Universidad de Chile & Pontificia Universidad Católica de Chile. In this study, we are enrolling and following 10,000 adults aged 38 to 74 years over 10 years. All eligible Molina residents will be enrolled. Participants were identified through a household census. Consenting individuals answer an epidemiological survey exploring risk factors (psycho-social, pesticides, diet, alcohol, and physical activity), medical history and physical and cognitive conditions; provide fasting blood, urine, and saliva samples; receive an electrocardiogram, abdominal ultrasound and bio-impedance test; and take a hand-grip strength test. These subjects will be re-interviewed after 2, 5 and 7 years. Active surveillance of health events is in place throughout the regional healthcare system. The MAUCO Bio-Bank will store 30 to 50 aliquots per subject using an NIH/NCI biorepository system for secure and anonymous linkage of samples with data. DISCUSSION: MAUCO´s results will help design public health interventions tailored to agricultural populations in Latin America.
Where Are Socioeconomically Deprived Immigrants Located in Chile? A Spatial Analysis of Census Data Using an Index of Multiple Deprivation from the Last Three Decades (1992-2012).
| Idioma(s): Inglés
INTRODUCTION AND PURPOSE OF THE STUDY: Immigrants in Chile have diverse characteristics and include socioeconomically deprived populations. The location of socioeconomically deprived immigrants is important for the development of public policy intelligence at the local and national levels but their areas of residence have not been mapped in Chile. This study explored the spatial distribution of socioeconomic deprivation among immigrants in Chile, 1992-2012, and compared it to the total population. MATERIAL AND METHODS: Areas with socioeconomically deprived populations were identified with a deprivation index which we developed modelled upon the Index of Multiple Deprivation (IMD) for England. Our IMD was based upon the indicators of unemployment, low educational level (primary) and disability from Census data at county level for the three decades 1992, 2002 and 2012, for 332, 339 and 343 counties respectively. We developed two versions of the IMD one based on disadvantage among the total population and another focused upon the circumstances of immigrants only. We generated a spatial representation of the IMD using GIS, for the overall IMD score and for each dimension of the index, separately. We also compared the immigrants´ IMD to the total population´s IMD using Pearson´s correlation test. RESULTS: Results showed that socioeconomically deprived immigrants tended to be concentrated in counties in the northern and central area of Chile, in particular within the Metropolitan Region of Santiago. These were the same counties where there was the greatest concentration of socioeconomic deprivation for the total population during the same time periods. Since 1992 there have been significant change in the location of the socioeconomically deprived populations within the Metropolitan Region of Santiago with the highest IMD scores for both the total population and immigrants becoming increasingly concentrated in the central and eastern counties of the Region. CONCLUSION: This is the first study analysing the spatial distribution of socioeconomic deprivation among international immigrants and the total population in a Latin American country. Findings could inform policy makers about location of areas of higher need of social protection in Chile, for both immigrants and the total resident population in the country.
Developing a Strategic Program for Chilean Health Information Technology: Environmental Scan and Key Informant Interviews.
| Idioma(s): Inglés
As part of an effort to assist Chile in developing a strategic program to foster the development of the health information technology (health IT) sector over the next five to ten years, this study assesses the current state of health IT adoption and implementation in Chile, as well as the challenges and opportunities facing the sector over the coming years. The authors conducted an environmental scan and ten key informant interviews and found that there are a number of successful health IT projects and strategies for further development currently underway in Chile, but that the successful projects are generally localized within specific health care providers and lack integration. These and other challenges suggest significant potential for the Ministry of Economy and other stakeholders to take specific actions designed to encourage further development of the health IT sector in Chile over the coming years. The next phase of this effort will use the results from this study to develop a roadmap for the Ministry of Economy to encourage health IT development in Chile over the short, medium, and long terms.
| Idioma(s): Inglés
BACKGROUND: Chile has recently been reclassified by the World Bank from an upper-middle-income country to a high-income country. There has been great progress in the last 20 to 30 years in relation to air and water pollution in Chile. Yet after 25 years of unrestrained growth, there remain clear challenges posed by air and water pollution, as well as climate change. OBJECTIVE: The aim of this study was to review environmental health in Chile. METHODS: In late 2013, a 3-day workshop on environmental health was held in Santiago, Chile, bringing together researchers and government policymakers. As a follow-up to that workshop, here we review the progress made in environmental health in the past 20 to 30 years and discuss the challenges of the future. We focus on air and water pollution and climate change, which we believe are among the most important areas of environmental health in Chile. RESULTS: Air pollution in some cities remains among the highest in the continent. Potable water is generally available, but weak state supervision has led to serious outbreaks of infectious disease and ongoing issues with arsenic exposure in some regions. Climate change modeling in Chile is quite sophisticated, and a number of the impacts of climate change can be reasonably predicted in terms of which areas of the country are most likely to be affected by increased temperature and decreased availability of water, as well as expansion of vector territory. Some health effects, including changes in vector-borne diseases and excess heat mortality, can be predicted. However, there has yet to be an integration of such research with government planning. CONCLUSIONS: Although great progress has been made, currently there are a number of problems. We suspect that the Chilean experience in environmental health may be of some use for other Latin American countries with rapid economic development.