Does sulfuric acid have a 'protective' effect on battery recyclers exposed to lead?

Culturally significant interventions to prevent lead exposure of battery recyclers are required. Sulfuric acid used in batteries causes skin lesions and could facilitate the recognition of hazards. This study explored whether joint exposure to lead and sulfuric acid can be used in interventions to manage hazardous work conditions. Data were collected from 120 informal workers, and the blood lead level was measured. Predictors of blood lead levels were explored using a tobit model. The median blood lead level was 9.45 µg/dL (Q75-Q25: 48.9 µg/dL); when lead and sulfuric acid exposure occurred, the level increased to 11.44 µg/dL, and when exposure to lead and other substances occurred, the level was 11.50 µg/dL. Workers are unaware of the risks of obvious and acute silent chronic exposure. Future preventive interventions could confront the economic benefits of battery recycling with the recognition of susceptibility and severity related to lead and sulfuric acid exposure.

Multimorbidity patterns among COVID-19 deaths: proposal for the construction of etiological models.

OBJECTIVES: To describe patterns of multimorbidity among fatal cases of COVID-19, and to propose a classification of patients based on age and multimorbidity patterns to begin the construction of etiological models. METHODS: Data of Colombian confirmed deaths of COVID-19 until June 11, 2020, were included in this analysis (n=1488 deaths). Relationships between COVID-19, combinations of health conditions and age were explored using locally weighted polynomial regressions. RESULTS: The most frequent health conditions were high blood pressure, respiratory disease, diabetes, cardiovascular disease, and kidney disease. Dyads more frequents were high blood pressure with diabetes, cardiovascular disease or respiratory disease. Some multimorbidity patterns increase probability of death among older individuals, whereas other patterns are not age-related, or decrease the probability of death among older people. Not all multimorbidity increases with age, as is commonly thought. Obesity, alone or with other diseases, was associated with a higher risk of severity among young people, while the risk of the high blood pressure/diabetes dyad tends to have an inverted U distribution in relation with age. CONCLUSIONS: Classification of individuals according to multimorbidity in the medical management of COVID-19 patients is important to determine the possible etiological models and to define patient triage for hospitalization. Moreover, identification of non-infected individuals with high-risk ages and multimorbidity patterns serves to define possible interventions of selective confinement or special management.

OBJETIVOS: Describir los patrones de multimorbilidad entre los casos fatales de COVID-19, y proponer una clasificación de los pacientes basada en la edad y los patrones de multimorbilidad para iniciar la construcción de modelos etiológicos. MÉTODOS: Se incluyeron los datos de las muertes confirmadas por COVID-19 en Colombia hasta el 11 de junio de 2020 (n=1 488 muertes). Se exploraron las relaciones entre la COVID-19, las combinaciones de enfermedades y la edad utilizando regresiones polinómicas con ponderación local. RESULTADOS: Las enfermedades más frecuentes fueron la hipertensión arterial, las enfermedades respiratorias, la diabetes, las enfermedades cardiovasculares y las enfermedades renales. Las díadas más frecuentes fueron la hipertensión arterial combinada con diabetes, enfermedades cardiovasculares o enfermedades respiratorias. Algunos patrones de multimorbilidad aumentan la probabilidad de morir en las personas mayores, mientras que otros no están relacionados con la edad o disminuyen la probabilidad de morir en las personas mayores. A diferencia de lo que con frecuencia se considera, no toda la multimorbilidad aumenta con la edad. La obesidad, aislada o combinada con otras enfermedades, se asocia con un mayor riesgo de enfermedad grave en los jóvenes, mientras que el riesgo de la díada hipertensión arterial/diabetes tiende a tener una distribución en U invertida en relación con la edad. CONCLUSIONES: La clasificación de los individuos según la multimorbilidad en el manejo médico de los pacientes con COVID-19 es importante para determinar los posibles modelos etiológicos y definir el triaje de los pacientes para su hospitalización. Además, la identificación de los individuos no infectados con edades y patrones de multimorbilidad de alto riesgo sirve para definir posibles intervenciones de confinamiento selectivo o manejo especial.

Lay-Based Morbidity Profiles of Sugar Cane Workers: Testing a New Method Using Free Lists.

Epidemiological profiles are key elements in preventive medicine and public health planning activities. There are no standard methods to identify these profiles. We explored the epidemiological profile of sugar cane workers in the municipality of Ginebra (Valle del Cauca, Colombia) using free lists of municipal morbidity data. We administered an instrument to 30 sugar cane workers, 15 health care workers and 15 people from the general community in order to compare the health problems experienced by the community. Sugar cane workers reported their own health problems and health professionals and community members served as informants for health problems in the general community. Respiratory problems were part of the morbidity profile of all groups evaluated, flu was part of the profile of the general community, and other respiratory problems were part of the profile of sugar cane workers and health personnel. Musculoskeletal problems were predominant only for sugar cane workers, and we found differences between the health problems expressed by the community and those reported by health personnel. The free lists method constitutes a quick, efficient, and useful tool to develop an approximation of an epidemiological profile and is easily interpreted, especially when typical and previously described occupational diseases are considered together with diseases associated with occupational groups. Epidemiological profiles based on free lists are useful to identify new opportunities for prevention strategies.

Zika Virus Infection during Pregnancy and Sensorineural Hearing Loss among Children at 3 and 24 Months Post-Partum.

OBJECTIVE: The objectives of this study were to describe the findings of the auditory screening in children of mothers with ZIKV during pregnancy or suspicious of congenital ZIKV, and to determine whether hearing loss was in the first 2 years in life, regardless of whether microcephaly was also present. METHODS: This is a cases report. The information was collected and recorded in a database between January 2016 and April 2018. We perform two auditory tests to 3 and 24 months of life. The study was developed in Aguachica (Cesar, Colombia). It is considered a high-risk area for ZIKV infection. Participants included children of mothers with confirmed ZIKV during pregnancy or suspicious of congenital ZIKV exposure of ZIKV infection during an epidemic period in a tropical area. We defined a positive case according to the epidemiological definition and clinical criteria based on maternal symptoms. However, other children of mothers without clinical signs of Zika were evaluated at the same time. The main outcome was the presence of sensorineural hearing loss. RESULTS: The median age in the study group (n = 43) was 3.5 months (rank: 0-6) and the comparison group (n: 23, children of mothers without clinical signs of ZIKV) was 3 months (rank: 0-12). Screening hearing test was done using distortion product otoacustic emissions. At 3 months follow-up, children were evaluated using distortion product otoacustic emissions and automatized auditory brainstem response. None of the patients evaluated in this study were found to have sensorineural hearing loss. CONCLUSIONS: We did not find hearing loss during the first 2 years in the children whose mother showed Zika during pregnancy. We recommend these children must be assessed to closed because there is a high risk the hearing loss as it usually may occur with CMV.

Mining leachate contamination and subfecundity among women living near the USA-Mexico border.

The contamination of the Sonora River with 40,000 m3 of toxic leachate released from a copper mine on August 6, 2014, was considered the worst environmental disaster of the mining industry in Mexico, exceeding safety levels in the concentrations of heavy metals and arsenic. To explore the potential association of the toxic release with subfecundity, by comparing time to pregnancy (TTP) of women with different levels of exposure at municipalities located along the Sonora River watershed, just 35 km south of the Arizona-Mexico border. Data from 235 pregnancies were included in a retrospective cohort study. Exposure was measured whether pregnancy occurred before or after the disaster and included a non-exposed community outside the watershed. Pregnancies were also compared between communities according to the concentration-level gradient of water pollutants found in the river. Fecundability odds ratios (fORs) were calculated using discrete time analogue of Cox's proportional hazard models. Multiple analysis included all pregnancies with TTP of no more than 12 months, only first-time pregnancy, or excluding women with TTP = 1. The probability for pregnancy decreased after the disaster (fOR 0.55, 95% CI 0.31, 0.97), when the residency was located mid-or-downstream the watershed (fOR 0.37, 95% CI 0.15, 0.91), when reported chicken consumption, when mining was the father's occupation, and when surface water was reported to be used for crop irrigation and for animal consumption. There was a decrease in fecundity on women exposed to the contaminated river. There is a need for more studies to prove these findings and to broaden the knowledge of other possible adverse health effects associated with this environmental disaster.

Use of assessment scales, turnover and job strain in nursing staff: A study in a Colombian hospital.

AIM: To evaluate the association between job strain and socio-demographic characteristics, social support, job insecurity, use of patient assessment scales, and turnover of nursing staff in a Colombian hospital. BACKGROUND: Nursing is an occupation with high probability of job strain. Use of patient assessment scales and turnover of nursing staff could increase exposure to psychosocial risk. METHOD: A cross-sectional study of 222 nurses was conducted. A survey and the Job Content Questionnaire were used to obtain data at the individual level and free lists and institutional records were used at the hospital unit level. The associations of interest were evaluated with a logistic regression model with robust variance estimator. RESULTS: Many nurses (50.9%) nurses reported job strain, which was positively associated with high use of patient assessment scales (OR = 2.73; 95% CI = 1.35-5.51) but negatively associated with social support (OR = 0.89; 95% CI = 0.80-0.98). Turnover was not statistically associated with job strain. CONCLUSION: Job strain among nurses was associated with a high use of patient assessment scales, but not with turnover of nursing staff. IMPLICATIONS FOR NURSING MANAGEMENT: The findings of this study suggest possible opportunities for managers to improve nursing processes, the work conditions of nursing staff, and the quality of institutions.

[Clinics adjacent to private pharmacies in Mexico: infrastructure and characteristics of the physicians and their remuneration]. / Consultorios adyacentes a farmacias privadas en México: infraestructura y características del personal médico y su remuneración.

OBJECTIVE: To analyze and compare the physicians' characteristics, their remuneration, the compliance with regulation and the services offered between clinics adjacent to pharmacies (CAF) and independent medical clinics (CMI). MATERIALS AND METHODS: Questionnaire applied to 239 physicians in 18 states including the Federal District, in Mexico in 2012. RESULTS: Physicians in CAF had less professional experience (5 versus 12 years), less postgraduate studies (61.2 versus 81.8%) and lower average monthly salaries (USD 418 versus USD 672) than their peers in CMI. In CAF there was less compliance in relation to medical record keeping and prescribing. CONCLUSIONS: The employment situation of physicians in CAF is more precarious than in CMI. It is necessary to strengthen the enforcement of existing regulations and develop policies according to the monitoring of its performance, particularly, but not exclusively, in CAF.

Individual and community effectiveness of a cervical cancer screening program for semi-urban Mexican women.

The effectiveness at the individual and community level of an educational intervention to increase cervical cancer screening self-efficacy among semi-urban Mexican women was evaluated and changes in reported community barriers were measured after the intervention was implemented. The educational intervention was evaluated with a quasi-experimental pre-test/post-test design and a control group, based on the Integrative Model of Behavior Prediction and AMIGAS project materials. For the intervention group, increased self-efficacy increased requests to obtain a Pap (p < 0.05). Barriers to obtaining a Pap were embarrassment and lack of time at the individual level, and lack of time, test conditions and fear of social rejection in the community's cultural domain. At both the individual and community levels, having more information about the test and knowing it would be performed by a woman were primary facilitators. Few women used medically precise information when referring to the Pap and cervical uterine cancer. Although the level of self-efficacy of the participants increased, barriers in the health system affect the women's perceived ability to get a Pap. Better care for users is needed to increase consistent use of the test. The study shows the importance of using culturally adapted, multilevel, comprehensive interventions to achieve successful results in target populations.

Intra-hospital mortality among neonates transported by ambulance in Colombia.

BACKGROUND: The aims of this study were to identify the main variables associated with intra-hospital mortality among patients transferred to a specialized neonatal care center, and to evaluate agreement and accuracy of referring and admission diagnoses. METHODS: A 6 month observational study was conducted to obtain clinical variables for intra-hospital mortality among patients requiring interfacility transport. Association among variables was estimated using Poisson regression with robust variance. Agreement was evaluated between diagnosis before and after transfer using Cohen's kappa, sensitivity, specificity and Youden's I. RESULTS: The study included 191 neonates, 12.57% of whom died. Increased mortality was associated with the Transport Risk Index of Physiologic Stability (TRIPS). The associated variables were as follows: TRIPS (adjusted prevalence ratio [aPR], 1.05; 95% confidence interval [CI]: 1.02-1.08), weight 1500-2499 g (aPR, 0.08; 95%CI: 0.01-0.40), weight >2500 g (aPR, 0.56; 95%CI: 0.02-0.19), cardiopathy (aPR, 0.20 95%CI: 0.05-0.75), congenital defects (aPR, 4.59; 95%CI: 0.97-21.82) and renal failure (aPR, 3.69; 95%CI: 1.26-10.78). Diagnosis remained unchanged for 71.15% of the neonates. The greatest differences were hyaline membrane disease (49.4%) followed by transient tachypnea (59.9%). Youden's I for referral diagnosis was 0.22 for transient tachypnea, 0.66-0.69 for cardiopathy, esophageal atresia and pneumonia, 0.72-0.74 for hyaline membrane disease and pulmonary hypertension, and >0.90 for the remaining diagnoses. CONCLUSIONS: Weight <1500 g, renal failure, congenital defects (except congenital cardiopathies) and high TRIPS were associated with a higher risk of intra-hospital mortality. The findings suggest that improving transfer time and quality of care in ambulances would decrease mortality.

[Health expenditures, income inequality, and the marginalization index in Mexico's health system]. / Gasto en salud, la desigualdad en el ingreso y el índice de marginación en el sistema de salud de México.

OBJECTIVE: Evaluate the effect of the relationship among public health expenditures, income inequality, and the marginalization index on maternal and child mortality in Mexico, to determine the effect of these factors on health system performance from a technical efficiency perspective. METHODS: An ecological study of 32 Mexican states. Correlations were estimated between maternal and infant mortality and public health expenditures in total per capita, federal per capita, and state per capita for the years 2000, 2005, and 2010 (Gini coefficient and marginalization index). Linear regressions were used to explore the association of these variables with health indicators in the state systems. RESULTS: Negative correlations were observed for the marginalization index and Gini coefficient with regard to life expectancy at birth (-0.62 and -0.28 respectively). Furthermore, there was a positive correlation of 0.59 between the marginalization index and infant mortality (P <0.05). Multiple linear regression models revealed a negative effect of the marginalization index and Gini coefficient on health out-comes. Federal funding had a positive effect on system performance in terms of health indicators. CONCLUSIONS: Health system reform in Mexico has had a positive impact on the country's health indicators; federal financial investment seems to be effective in this regard. Social determinants have an important effect on health system performance, and analysis using multisectoral and multidisciplinary approaches are needed in addressing them.

Effect of households' social networks on lice infestation among vulnerable Mexican children: a qualitative comparative analysis.

The prevalence of pediculosis is high among elementary and secondary school children, which favors the belief that infestation occurs more often in schools than in homes. This study explored the role of households' social networks in the transmission of head lice. Seventeen school children and their social networks (n = 22) from Acatlipa (Morelos, Mexico) participated in a prospective observational study during school vacation. The hair of all the school children was washed with shampoo containing permethrin at the beginning of the study and the incidence of pediculosis (O) was evaluated at the beginning of the school term (follow-up at 1.5 months). The sets included in the qualitative comparative analysis were sex (S), length of hair (H), baseline diagnostic of pediculosis (I) and degree (D) and infestation index (N) obtained through the analysis of social networks. The prevalence of pediculosis was the same at the beginning and the end of follow-up (17.6%). The degree of the school children's networks ranged between 2 and 14. There were 8 configurations, the most frequent being F*i*d*n*h. The most parsimonious configuration associated with the incidence of pediculosis was F*I*d*H (female, previous infestation, low degree and long hair), with a coverage of 0.344 and a consistency of 0.941. Indicators of social networks made it possible to identify the role of households' social networks in the transmission of lice. Individual actions such as the use of shampoo containing insecticides are temporary and, therefore, structural actions should be favored.

Selenium-rich food potentially useful to control mercury levels among Afro-Colombians: Towards an intercultural intervention. / Alimentos ricos en selenio potencialmente útiles para controlar los niveles de mercurio entre afrocolombianos: hacia una intervención intercultural

INTRODUCTION: Diet-based interventions may be a culturally acceptable option to decrease mercury levels and thus prevent the adverse effects of this metal on population health. Selenium is an element present in Colombian geology that can act as a chelator, decreasing mercury concentrations in the human body. OBJECTIVE: To identify potentially useful selenium-rich foods to control the effects of mercury exposure among Afro-Colombians. MATERIALS AND METHODS: A cross-sectional study was carried out with 320 individuals from five municipalities of Chocó. They were asked about the frequency of consumption of selenium-rich foods, and their association with mercury concentrations in hair was estimated with multiple robust regression. RESULTS: Guava, whole wheat flour, strawberries, cow liver, spinach and yeast extract were the foods with higher consumption. Walnuts, whole wheat flour, and yeast extract were identified in multiple robust regression as foods to consider in future interventions. CONCLUSION: It is proposed that the banana juice, the pineapple colada, the borojó (Borojoa patinoi) sorbet, the cucas, and the enyucado are basic elements for a culturally acceptable intervention.

Introducción: Las intervenciones basadas en la dieta pueden ser una opción culturalmente aceptable para disminuir los niveles de mercurio y prevenir los efectos adversos de este metal en la salud de la población. El selenio es un elemento presente en la geología colombiana que puede actuar como quelante, disminuyendo las concentraciones de mercurio en el cuerpo humano. Objetivo: Identificar los alimentos ricos en selenio potencialmente útiles para controlar los efectos de la exposición a mercurio entre afrocolombianos. Materiales y métodos: Se realizó un estudio transversal con 320 individuos de cinco municipios del departamento del Chocó. Se les preguntó sobre la frecuencia de consumo de alimentos ricos en selenio y su asociación con las concentraciones de mercurio en cabello fue estimada con regresión múltiple robusta. Resultados: La guayaba, la harina de trigo integral, las fresas, el hígado de vaca, la espinaca y el extracto de levadura fueron los alimentos de mayor consumo. Las nueces, la harina de trigo integral y el extracto de levadura fueron identificados en regresión múltiple robusta como alimentos por considerar en futuras intervenciones. Conclusiones: Se propone que el jugo de plátano, la piña colada, el sorbete de borojó (Borojoa patinoi), las cucas, el enyucado y la sábida de plátano primitivo maduro son elementos básicos para una intervención culturalmente aceptable.

Contrary Perceptions of Environmental Health and the Governance of the Bucaramanga Metropolitan Area, Colombia.

The participation of civil society is essential for environmental health policies to be accepted. The objective of this study was to know the perceptions of government officials, members of civil society, and academics about environmental health problems and its governance in the Bucaramanga Metropolitan Area, Colombia. In the region, there is a strong citizens movement that defends the moorland ecosystem (páramo) as a source of drinking water for large-scale mining projects. A multi-method study was conducted, including the review of newspaper and scientific articles, a citizens survey, and interviews and focus groups with identified key stakeholders. The findings indicate that government officials prioritize their actions on issues related to air and water pollution and environmental education. In contrast, citizens prioritize water availability from the moorland ecosystem. There are some advances in the management of environmental health, mainly related to greater citizen awareness. Contrary perceptions among government officials, academics, and civil society prevent adequate prioritization of environmental health problems. Participation of civil society is absent in activities related to environmental governance. An ongoing citizens science experience engaging high school students and the academy can be the first meeting point with government officials in the pathway to improve the environmental governance in the territory. The participation of civil society in the environmental health governance must be enforced to broaden the issues of interest and prioritize the activities in short- and long-term policy planning.

Micronuclei, Pesticides, and Element Mixtures in Mining Contexts: The Hormetic Effect of Selenium.

The contexts where there are mining and agriculture activities are potential sources of risk to human health due to contamination by chemical mixtures. These contexts are frequent in several Colombian regions. This study explored the potential association between the frequency of micronuclei and pesticides and elements in regions with ferronickel (Montelibano, Córdoba) and gold (Nechí, Antioquia) mining, and a closed native mercury mine (Aranzazu, Caldas), with an emphasis in the potential effect of selenium as a potential chelator. A cross-sectional study was carried out with 247 individuals. Sociodemographic, occupational, and toxicological variables were ascertained. Blood and urine samples were taken for pesticide analysis (5 organophosphates, 4 organochlorines, and 3 carbamates), 68 elements were quantified in hair, and micronuclei were quantified in lymphocytes. The mixtures of elements were grouped through principal component analysis. Prevalence ratios were estimated with robust variance Poisson regressions to explore associations. Interactions of selenium with toxic elements were explored. The highest concentrations of elements were in the active mines. The potentially most toxic chemical mixture was observed in the ferronickel mine. Pesticides were detected in a low proportion of participants (<2.5%), except paraoxon-methyl in blood (27.55%) in Montelibano and paraoxon-ethyl in blood (18.81%) in Aranzazu. The frequency of micronuclei was similar in the three mining contexts, with means between 4 to 7 (p = 0.1298). There was great heterogeneity in the exposure to pesticides and elements. The "hormetic effect" of selenium was described, in which, at low doses, it acts as a chelator in Montelibano and Aranzazu, and at high doses, it can enhance the toxic effects of other elements, maybe as in Nechí. Selenium can serve as a protective agent, but it requires adaptation to the available concentrations in each region to avoid its toxic effects.

Geological context and human exposures to element mixtures in mining and agricultural settings in Colombia.

Anthropogenic and natural sources contribute to chemical mixtures in air, water, and soil, posing potential risks to the environment and human health. To understand the interplay between element profiles in the human body, geographical location, and associated economic activities, we carried out an observational analytic cross-sectional study. The study recruited 199 participants from three municipalities, two of which had gold-mining as their primary economic activity, while the other was dedicated to agricultural and other local activities not related to mining. The concentrations of a total of 30 elements in human hair samples and 21 elements in environmental soil samples were measured using various spectrometry techniques. Unsupervised clustering analysis using Self-Organizing Maps was applied to human hair samples to analyze element concentrations. Distinct clusters of individuals were identified based on their hair element profiles, which were mapped to geographical location and economic activities. While higher levels of heavy metals (Ag, As, Hg, and Pb) were observed in individuals engaged in mining activities in certain clusters, individuals in agricultural areas show higher concentrations of elements found in pesticides (Ba and Sr). However, the elemental composition of hair is influenced not only by the anthropogenic activities but also by the inherent geological context where people live. Our findings highlight the significance of accounting for environmental factors when evaluating human health risks, as the intricate mixture of elements can yield valuable insights for targeted health interventions.