Prevalence of musculoskeletal disorders and rheumatic diseases in Cuenca, Ecuador: a WHO-ILAR COPCORD study.

The aim of this study was to determine the prevalence of musculoskeletal pain and rheumatic diseases in subjects over 18 years of age from the canton of Cuenca, Ecuador. Cross-sectional analytical community-based study was conducted in subjects over 18 years of age using the validated Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) questionnaire. Random sampling was used. The questionnaire was administered by standardized health workers. Subjects were visited house by house. Subjects positive for musculoskeletal (MSK) pain in the last 7 days and at some point in life were assessed by rheumatologists to confirm the diagnosis. A total of 4877 subjects participated, with an average age of 42.8 (SD 18.8) years of age; 59.7 % were women; 69.7 % lived in urban areas. 32.5 % reported MSK pain in the last 7 days and 45.7 % at some point in life. The prevalence of knee osteoarthritis was 7.4 %, hand osteoarthritis 5.3 %, low back pain 9.3 %, rheumatoid arthritis 0.8 %, fibromyalgia 2 %, gout 0.4 %, and lupus 0.06 %. Subjects from rural areas reported experiencing more MSK pain in the last 7 days and at some point in life, lower income, poorer health-care coverage, and increased physical activity involving repetitive tasks such as lifting weights or cooking with firewood. MSK pain prevalence was high. Osteoarthritis and low back pain were the most common diseases. Age, sex, physical activity, repetitive tasks, living in a rural area, and lack of health-care coverage were found to be associated with MSK pain.

Association of regional and cultural factors with the prevalence of rheumatoid arthritis in the Mexican population: a multilevel analysis.

BACKGROUND: The overall estimated prevalence of rheumatoid arthritis (RA) in Mexico is 1.6%, but there are major variations in different geographic areas of the country. OBJECTIVE: This study aimed to determine the impact of individual and regional variables on the geographic distribution of RA in Mexico. METHODS: This multilevel analysis used data from a cross-sectional study that investigated the prevalence of RA among 19,213 individuals older than 18 years throughout 5 geographic regions in Mexico. Logistic regression models were used to determine predictors of RA, including individual and regional variables as well as cultural factors. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were determined. RESULTS: The prevalence of RA varied from 0.77% to 2.8% across the 5 regions. Individual factors associated with RA were sex (OR, 2.32; 95% CI, 1.74-3.07), previous medical diagnosis of RA ( OR 3.3, 95%CI: 2919­5.1 [corrected]), disability (OR, 2.07; 95% CI, 1.48-2.93), and the 56- to 65-year age group (OR, 1.95; 95% CI, 1.08-3.74). The regional factor of speaking an indigenous language had an OR of 2.27 (95% CI, 1.13-4.55). CONCLUSIONS: Various individual and regional factors were associated with variations in the prevalence of RA in the Mexican population.

A community-based study on the prevalence of spondyloarthritis and inflammatory back pain in Mexicans.

BACKGROUND: The prevalence of spondyloarthritis (SpA) varies across populations. In Mexicans, the prevalence of SpA is still unknown. OBJECTIVE: The objective of this study was to determine the prevalence of SpA in the community as well as that of inflammatory back pain (IBP) and ankylosing spondylitis (AS). METHODS: We identified individuals older than 18 years with nontraumatic back pain (BP) in a door-to-door nurse survey using the Community Oriented Program for the Control of Rheumatic Diseases. Then, general physicians and rheumatology fellows selected those likely to have IBP (Berlin criteria). Finally, 2 expert rheumatologists assessed IBP individuals according to clinical data and classification criteria and requested HLA-B27 and radiographic studies to determine the clinical condition of the individual and SpA (European SpA Study Group) classification. RESULTS: The prevalence of BP among 4059 individuals was 14.6% (95% confidence interval [CI], 13.6-15.8). The prevalence of IBP and SpA was 1.3% (95% CI, 1.0-1.7) and 0.6% (95% CI, 0.4-0.9), respectively. Ankylosing spondylitis prevalence was 0.1% (95% CI, 0.02-0.2). Inflammatory back pain and SpA percentage of males and females was similar. The percentage of individuals with IBP according to the 2 experts was lower than that determined by general physicians and rheumatology fellows, but all cases with HLA-B27, radiographic sacroiliitis, SpA, and AS had previous IBP confirmation by the expert. CONCLUSIONS: The prevalence and sex distribution of patients classified with SpA in this community study--as well as that of patients diagnosed with AS--are consistent with those found in recent studies. Expert assessment of individuals with positive responses to questionnaires is relevant for the classification of IBP and SpA.

Epidemiology of demyelinating diseases in Mexico: A registry-based study.

BACKGROUND: Demyelinating diseases (DD) are a group of chronic neurological diseases associated with loss and injury of brain or spinal cord regions. These conditions could trigger impairment of neurological functions and disability from earlier stages of life. Epidemiological data on DD remains insufficient for decision-making in the Mexican healthcare system. This study aims to describe the epidemiology of DD based on data from Mexico's National Registry of Demyelinating Diseases. METHODS: A cross-sectional, registry-based, observational study was performed. We analyzed 408 reports of multiple sclerosis (331, 81%), neuromyelitis optica spectrum disorder (67, 16%), chronic recurrent inflammatory optic neuropathy (5, 1%), clinically isolated syndrome (4, 0.9%), and autoimmune encephalitis (1, 0.2%) reported across 2021. RESULTS: The time from first symptoms to diagnosis of any DD was about 3 years. A treatment failure history was detected in 40% of patients. It was estimated that NMOSD accounts for 20% of all disorders. There was evidence that the use of brand-name and generic IFN drug products lead to increased therapeutic failures. CONCLUSION: Our research team suggests reinforcing educational programs and activities based on diagnosis and clinical management improvement to first-contact physicians and specialty doctors and promoting awareness in the whole population.

Birth weight in children with birth defects.

BACKGROUND: Birth defects (BDs) are a serious public health problem in Mexico. The objective of this paper was to identify the frequency of newborns (NBs) that are born small for gestational age with a birth defect. MATERIALS AND METHODS: A cross-sectional study of NBs from hospitals part of the Mexican Institute of Social Security in Chihuahua, Mexico, was conducted. NBs were classified according to the presence or absence of a BD and according to their weight percentile using regional standards of birth weight. RESULTS: NBs diagnosed with (n = 263) or without BDs (n = 64,626) were included in this study. A greater proportion of NBs small for gestational age were identified in cases involving BDs (20%), compared with NBs without BDs (9%). Moreover, the average decrease in birth weights of NBs with BDs associated with their digestive system was 210 grams (95% confidence interval [CI], -436/-12), with their genital organs 440 grams (95% CI, -730/-151), involving chromosomal abnormalities 230 grams (95% CI, -435/-26), or with their musculoskeletal system 289 grams (95% CI, -43/-147) according to the gestational age, sex, and condition of the NB (p < 0.05). CONCLUSIONS: A greater proportion of NBs with BDs were associated with a low birth rate for their gestational age. In addition, some BDs were found to be associated with an impaired birth weight more often than others This suggests that clinical decisions regarding NBs with congenital defects and a lower birth weight for their gestational age should be diagnosed and treated for additional nutritional considerations as needed. Birth Defects Research (Part A), 2011. © 2011 Wiley-Liss, Inc.

Prevalence of musculoskeletal pain and rheumatic diseases in the southeastern region of Mexico. A COPCORD-based community survey.

OBJECTIVE: To assess the prevalence of musculoskeletal (MSK) pain and rheumatic diseases in the southeastern Mexican state of Yucatán. METHODS: Using the Community Oriented Program in the Rheumatic Diseases (COPCORD) methodology, we performed a door-to-door, cross-sectional study generated through a multistage, stratified, randomized method on 3915 adult residents (age 42.7 ± 17.1 yrs; women 61.8%; urban setting 45.7%) of the Mexican state of Yucatán. We used universally accepted criteria for the diagnosis or classification of rheumatoid arthritis (RA), osteoarthritis (OA; knee and hand), fibromyalgia, systemic lupus erythematosus (SLE), gout, ankylosing spondylitis, regional rheumatic pain syndromes, and inflammatory back pain. RESULTS: Nontraumatic MSK pain in the last 7 days was present in 766 (19.6%; 95% CI 18.3-20.8) individuals. MSK pain was more prevalent in women (26.6%) versus men (12.2%; p < 0.01). Self-reported MSK disability occurred in 1.7%. Most MSK pain-related variables were consistently more prevalent in the urban setting. The prevalence of rheumatic disease was: OA 6.8% (95% CI 6.0-7.6); back pain 3.8% (95% CI 3.2-4.4); RA 2.8% (95% CI 2.2-3.3); rheumatic regional pain syndromes 2.3% (95% CI 1.9-2.8); inflammatory back pain 0.7% (95% CI 0.5-1.0); fibromyalgia 0.2% (95% CI 0.1-0.4); gout 0.1% (95% CI 0.07-0.3); and SLE 0.07% (95% CI 0.01-0.2). CONCLUSION: The prevalence of MSK pain was 19.6%. MSK pain was more prevalent in women and in the urban setting. A remarkably high prevalence of RA was found in this population, which suggests a role for geographic factors.

Epidemiology of the rheumatic diseases in Mexico. A study of 5 regions based on the COPCORD methodology.

OBJECTIVE: To estimate the prevalence of musculoskeletal (MSK) disorders and to describe predicting variables associated with rheumatic diseases in 5 regions of México. METHODS: This was a cross-sectional, community-based study performed in 5 regions in México. The methodology followed the guidelines proposed by the Community Oriented Program for the Control of the Rheumatic Diseases (COPCORD). A standardized methodology was used at all sites, with trained personnel following a common protocol of interviewing adult subjects in their household. A "positive case" was defined as an individual with nontraumatic MSK pain of > 1 on a visual analog pain scale (0 to 10) during the last 7 days. All positive cases were referred to internists or rheumatologists for further clinical evaluation, diagnosis, and proper treatment. RESULTS: The study included 19,213 individuals; 11,602 (68.8%) were female, and their mean age was 42.8 (SD 17.9) years. The prevalence of MSK pain was 25.5%, but significant variations (7.1% to 43.5%) across geographical regions occurred. The prevalence of osteoarthritis was 10.5%, back pain 5.8%, rheumatic regional pain syndromes 3.8%, rheumatoid arthritis 1.6%, fibromyalgia 0.7%, and gout 0.3%. The prevalence of MSK manifestations was associated with older age and female gender. CONCLUSION: The prevalence of MSK pain in our study was 25.5%. Geographic variations in the prevalence of MSK pain and specific diagnoses suggested a role for geographic factors in the prevalence of rheumatic diseases.

Epidemiology of rheumatic diseases. A community-based study in urban and rural populations in the state of Nuevo Leon, Mexico.

OBJECTIVE: To estimate the prevalence of rheumatic diseases in rural and urban populations using the WHO-ILAR COPCORD questionnaire. METHODS: We conducted a cross-sectional home survey in subjects > 18 years of age in the Mexican state of Nuevo Leon. Results were validated locally against physical examination in positive cases according to an operational definition by 2 rheumatologists. We used a random, balanced, and stratified sample by region of representative subjects. RESULTS: We surveyed 4713 individuals with a mean age of 43.6 years (SD 17.3); 55.9% were women and 87.1% were from urban areas. Excluding trauma, 1278 individuals (27.1%, 95% CI 25.8%-28.4%) reported musculoskeletal pain in the last 7 days; the prevalence of this variable was almost twice as frequent in women (33% vs 17% in men); 529 (11.2%) had pain associated with trauma. The global prevalence of pain was 38.3%. Mean pain score was 2.4 (SD 3.4) on a pain scale of 0-10. Most subjects classified as positive according to case definition (99%) were evaluated by a rheumatologist. Main diagnoses were osteoarthritis in 17.3% (95% CI 16.2-18.4), back pain in 9.8% (95% CI 9.0-10.7), undifferentiated arthritis in 2.4% (95% CI 2.0-2.9), rheumatoid arthritis in 0.4% (95% CI 0.2-0.6), fibromyalgia in 0.8% (95% CI 0.6-1.1), and gout in 0.3% (95% CI 0.1-0.5). CONCLUSION: This is the first regional COPCORD study in Mexico performed with a systematic sampling, showing a high prevalence of pain. COPCORD is a useful tool for the early detection of rheumatic diseases as well as for accurately referring patients to different medical care centers and to reduce underreporting of rheumatic diseases.

Prevalence of rheumatic regional pain syndromes in adults from Mexico: a community survey using COPCORD for screening and syndrome-specific diagnostic criteria.

OBJECTIVE: To assess the prevalence of rheumatic regional pain syndromes (RRPS) in 3 geographical areas of México using the Community Oriented Program in the Rheumatic Diseases (COPCORD) screening methodology and validate by expert consensus on case-based definitions. METHODS: By means of an address-based sample generated through a multistage, stratified, randomized method, a cross-sectional survey was performed on adult residents (n = 12,686; age 43.6 ± 17.3 yrs; women 61.9%) of the states of Nuevo León, Yucatán, and México City. Diagnostic criteria for specific upper (Southampton group criteria) and lower limb (ad hoc expert consensus) RRPS were applied to all subjects with limb pain as detected by COPCORD questionnaire. RESULTS: The overall prevalence of RRPS was 5.0% (95% CI 4.7-5.4). The most frequent syndrome was rotator cuff tendinopathy (2.36%); followed by inferior heel pain (0.64%); lateral epicondylalgia (0.63%); medial epicondylalgia (0.52%); trigger finger (0.42%); carpal tunnel syndrome (0.36%); anserine bursitis (0.34%); de Quervain's tendinopathy (0.30%); shoulder bicipital tendinopathy (0.27%); trochanteric syndrome (0.11%); and Achilles tendinopathy (0.10%). There were anatomic regional variations in the prevalence of limb pain: Yucatán 3.1% (95% CI 2.5-3.6); Nuevo León 7.0% (95% CI 6.3-7.7); and México City 10.8% (95% CI 9.8-11.8). Similarly, the prevalence of RRPS showed marked geographical variation: Yucatán 2.3% (95% CI 1.8-2.8); Nuevo León 5.6% (95% CI 5.0-6.3); and México City 6.9% (95% CI 6.2-7.7). CONCLUSION: The overall prevalence of RRPS in México was 5.0%. Geographical variations raise the possibility that the prevalence of RRPS is influenced by socioeconomic, ethnic, or demographic factors.

Prevalence of back pain in the community. A COPCORD-based study in the Mexican population.

OBJECTIVE: Back pain (BP) is frequent in the community; its prevalence in México is 6%. Our objective was to determine the prevalence of BP in Mexican communities and determine its most important characteristics. METHODS: A cross-sectional study of individuals aged > 18 years was conducted in Mexico City and in urban communities in the state of Nuevo León. Sampling in Mexico City was based on community census and in Nuevo León, on stratified, balanced, and random sampling. Procedures included a door-to-door survey, using the Community Oriented Program for the Control of Rheumatic Diseases, to identify individuals with BP > 1 on a visual analog scale in the last 7 days. General practitioners/rheumatology fellows confirmed and characterized BP symptoms. RESULTS: In all, 8159 individuals (mean age 43.7 yrs, two-thirds female) were surveyed and 1219 had BP. The prevalence of nontraumatic BP in the last 7 days was 8.0% (95% CI 7.5-8.7). The mean age of these individuals was 42.7 years, and 61.9% were female. Thirty-seven percent had inflammatory BP [prevalence of 3.0% (95% CI 2.7-3.4)]. Compared with the state of Nuevo Léon, the characteristics and consequences of BP in Mexico City were more severe. In logistic regression analysis, living in Mexico City, having a paid job, any kind of musculoskeletal pain, high pain intensity, and obesity among other variables were associated with BP. CONCLUSION: The prevalence of nontraumatic BP in the last 7 days in urban communities in México is 8.0%. However, clinical features and consequences differed among the communities studied, suggesting a role for local factors in BP.

Validity of the COPCORD core questionnaire as a classification tool for rheumatic diseases.

OBJECTIVE: Rheumatic diseases are vastly underdiagnosed and undertreated, particularly among minorities and those of low socioeconomic status. The WHO-ILAR Community Oriented Program in the Rheumatic Diseases (COPCORD) advocates screening of musculoskeletal complaints in the community. The objective of this study was to evaluate the performance of the COPCORD Core Questionnaire (CCQ) as a diagnostic tool for rheumatic diseases. METHODS: We conducted a cross-sectional study designed in parallel with a large COPCORD survey in Mexico. A subsample of 17,566 questionnaires, selected from 4 of the 5 states included in a national COPCORD survey were included in the analysis as a diagnostic test to evaluate sensitivity, specificity, receiver operating characteristics curve (ROC), and positive likelihood ratio (LR+) of the CCQ as a case-detection tool for rheumatic diagnosis and for the most frequent diagnoses identified in the survey, osteoarthritis, regional rheumatic pain syndromes, and rheumatoid arthritis (RA). Logistic regression with the questions with LR+ ≥ 1 was performed to identify the strength of association (OR) for each question. RESULTS: Pain in the last 7 days, high pain score (> 4), and previous diagnosis were the questions with highest LR+ for diagnosis, and for diagnosis of RA treatment with NSAID. The variables that contributed most to the model were pain in the last 7 days (OR 2.0, 95% CI 1.8-2.3), NSAID treatment (OR 3.3, 95% CI 3.0-3.7), a high pain score (OR 1.15, 95% CI 1.13-1.17), and having a previous diagnosis (OR 1.4, 95% CI 1.3-1.6). These 4 questions had R(2) = 0.24, p < 0.01, for detection of any rheumatic diagnosis. The single variable that explains 16% (OR 1.33, 95% CI 1.31-134) of variance was a high pain score in the last 7 days. CONCLUSION: Some variables were identified in the CCQ that could be combined in a brief version for case detection of rheumatic diseases in community surveys. The validity of this proposal has to be tested against the original version.

Syndemic and syndemogenesis of low back pain in Latin-American population: a network and cluster analysis.

INTRODUCTION: Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. OBJECTIVE: To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. METHODS: Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. RESULTS: Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals' variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). CONCLUSIONS: LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations. Key points • Syndemic and syndemogenesis evidence health disparities in Latin-American populations, documenting the complexity of suffering from a disease such as low back pain that is associated with comorbidities, unhealthy habits, and the social and regional context where they live. • The use of network and cluster analyses are useful tools for documenting the complexity and the multifaceted impact in health in large populations as well as the differences between countries. • The variability and impact of socioeconomic indicators (e.g., Gini index) related to low back pain and comorbidities could be felt through the use of cluster analysis, which generates evidence of regional inequality in Latin America. • Populations can be studied from different models (network and cluster analysis) and grouping, presenting new interpretations beyond geographical groupings, such as syndemic and inequity in health.

Regional differences in time to pregnancy among fertile women from five Colombian regions with different use of glyphosate.

The objective of this study was to test whether there was an association between the use of glyphosate when applied by aerial spray for the eradication of illicit crops (cocaine and poppy) and time to pregnancy (TTP) among fertile women. A retrospective cohort study (with an ecological exposure index) of first pregnancies was undertaken in 2592 fertile Colombian women from 5 regions with different uses of glyphosate. Women were interviewed regarding potential reproductive, lifestyle, and work history predictors of TTP, which was measured in months. Fecundability odds ratios (fOR) were estimated using a discrete time analogue of Cox's proportional hazard model. There were differences in TTP between regions. In the final multivariate model, the main predictor was the region adjusted by irregular relationship with partner, maternal age at first pregnancy, and, marginally, coffee consumption and self-perception of water pollution. Boyaca, a region with traditional crops and. recently, illicit crops without glyphosate eradication spraying (manual eradication), displayed minimal risk and was the reference region. Other regions, including Sierra Nevada (control area, organic agriculture), Putumayo and Narino (illicit crops and intensive eradication spray program), and Valle del Cauca, demonstrated greater risk of longer TTP, with the highest risk for Valle del Cauca (fOR 0.15, 95% CI 0.12, 0.18), a sugar-cane region with a history of use of glyphosate and others chemicals for more than 30 yr. The reduced fecundability in some regions was not associated with the use of glyphosate for eradication spraying. The observed ecological differences remain unexplained and may be produced by varying exposures to environmental factors, history of contraceptive programs in the region, or psychological distress. Future studies examining these or other possible causes are needed.

Birthweight percentiles by gestational age and gender for children in the North of Mexico.

The objective of this study was to determine the 10th, 50th and 90th percentiles of birthweight, by gestational age and sex, for newborns covered by the Mexican Institute of Social Security (IMSS) in the State of Chihuahua. To generate the database, we used IMSS hospitals' records in the State of Chihuahua, covering the period between 1 January 2000 and 31 December 2004. We included singleton live births only, and excluded babies with congenital malformations. The birthweights of 88,368 children born at 21-44 weeks of gestation comprised our data. From these data, we calculated the 10th, 50th and 90th percentiles for each sex, at 32-44 weeks of gestation. The observed cutoffs for the 10th percentile in our population were 40-250 g higher than those reported in other references with Mexican populations. These results constitute an updated birthweight reference that will allow the identification of newborns in the North region of the country with low birthweight-for-gestational age. Such information can be a useful instrument for preventing or diminishing associated risks.

Coca and poppy eradication in Colombia: environmental and human health assessment of aerially applied glyphosate.

The production of coca and poppy as well as the processing and production of cocaine and heroin involve significant environmental impacts. Both coca and poppy are grown intensively in a process that involves the clearing of land in remote areas, the planting of the crop, and protection against pests such as weeds, insects, and pathogens. The aerial spray program to control coca and poppy production in Colombia with the herbicide glyphosate is conducted with modern state-of-the-art aircraft and spray equipment. As a result of the use of best available spray and navigation technology, the likelihood of accidental off-target spraying is small and is estimated to be less than 1% of the total area sprayed. Estimated exposures in humans resulting from direct overspray, contact with treated foliage after reentry to fields, inhalation, diet, and drinking water were small and infrequent. Analyses of surface waters in five watersheds showed that, on most occasions, glyphosate was not present at measurable concentrations; only two samples had residues just above the method detection limit of 25 microg/L. Concentrations of glyphosate in air were predicted to be very small because of negligible volatility. Glyphosate in soils that are directly sprayed will be tightly bound and biologically unavailable and have no residual activity. Concentrations of glyphosate plus Cosmo-Flux will be relatively large in shallow surface waters that are directly oversprayed (maximum instantaneous concentration of 1,229microgAE/L in water 30cm deep); however, no information was available on the number of fields in close proximity to surface waters, and thus it was not possible to estimate the likelihood of such contamination. The formulation used in Colombia, a mixture of glyphosate and Cosmo-Flux, has low toxicity to mammals by all routes of exposure, although some temporary eye irritation may occur. Published epidemiological studies have not suggested a strong or consistent linkage between glyphosate use and specific human health outcomes. An epidemiology study conducted in Colombia did not show any association between time to pregnancy in humans and the use of glyphosate in eradication spraying. The mixture of glyphosate and Cosmo-Flux was not toxic to honeybees. The mixture was, however, more toxic to the alga Selenastrum, the cladoceran Daphnia magna, fathead minnow, and rainbow trout than formulated glyphosate (Roundup) alone. Studies on the use of glyphosate in agriculture and forestry have shown that direct effects on nontarget organisms other than plants are unlikely. Indirect effects on terrestrial arthropods and other wildlife may be the result of habitat alteration and environmental change brought about by the removal of plants by glyphosate. Because of the lack of residual activity, recovery of glyphosate-treated areas in Colombia is expected to be rapid because of good plant growth conditions. However, return to the conditions of tropical old-growth forest that existed before clear-cutting and burning may take hundreds of years, not from the use of glyphosate but because of the clear-cutting and burning, which are the primary cause of effects in the environment. The risk assessment concluded that glyphosate and Cosmo-Flux did not present a significant risk to human health. In the entire cycle of coca and poppy production and eradication, human health risks associated with physical injury during clear-cutting and burning and the use of pesticides for protection of the illicit crops were judged to be considerably more important than those from exposure to glyphosate. For the environment, direct risks from the use of glyphosate and Cosmo-Flux to terrestrial mammals and birds were judged to be negligible. Moderate risks could occur in aquatic organisms in shallow surface waters that are oversprayed during the eradication program. However, the frequency of occurrence and extent to which this happens are unknown as data on the proximity of surface waters to coca fields were not available. Considering the effects of the entire cycle of coca and poppy production and eradication, clear-cutting and burning and displacement of the natural flora and fauna were identified as the greatest environmental risks and are considerably more important than those from the use of glyphosate for the control of coca and poppy.

Reducing pesticide exposure and associated neurotoxic burden in an Ecuadorian small farm population.

The contribution of community-based interventions, including farmer field schools (FFSs) in integrated pest management (IPM), to reducing pesticide exposures and associated neurotoxic burden among small-farm families in Ecuador was assessed in three Andean farming communities in a co-design of targeted action-research. Baseline questionnaire surveys elicited pesticide-related knowledge, practices, and exposure and neurobehavioral assessments were done using an adapted WHO battery. Pesticide applications on plots farmed by FFS versus non-FFS participants were compared. A year later, repeated surveys of participating households (n = 29) and neurobehavioral testing of individuals (n = 63) permitted comparisons of pre- and post-intervention values. The FFS graduates applied pesticides on their plots less frequently (p = 0.171). FFS households had increased pesticide-related knowledge of labels and exposure risk factors (both p < 0.004), better pesticide-handling practices (p < 0.01), and less skin exposure (p < 0.01). Neurobehavioural status had improved, particularly digit span and visuo-spatial function, resulting in overall z-score increases. Thus, community interventions reduced pesticide use, reported skin exposure, and neurotoxic burden among smallholder farm families.

[Adverse reproductive outcomes among women working in Colombian floriculture: a summary of the evidence through metaanalysis]. / Resultados adversos en la procreación en mujeres trabajadoras en la floricultura colombiana: un resumen de la evidencia mediante metanálisis.

INTRODUCTION: Workers in floriculture are exposed to pesticides and other risk factors. Work in these occupational environments is suspected to be associated with adverse reproductive outcomes. However, epidemiological studies in Colombia, a country that has a long tradition with this occupation, have not been consistent or conclusive. OBJECTIVE: To quantify the effect of womens work in Colombian floriculture in the occurrence of spontaneous abortion, prematurity, and birth defects, using the results of two previous studies. MATERIAL AND METHODS: The results of two previous studies among Colombian floriculture worker populations were summarized with metaanalysis techniques. A critical evaluation of each of the studies identified potential biases and methodological limitations. RESULTS: The pooled estimator of spontaneous abortion was 2.24 (95CI: 1.87-2.68); that of premature infant birth was 1.49 (95%CI: 0.91-2.43), and of birth defects 1.31 (95%CI: 1.95-1.64). CONCLUSIONS: The analyses suggested that work in floriculture is associated with a higher occurrence of spontaneous abortion and birth defects. However, these effects are not necessarily associated with pesticide exposure. Other risk factors requiring further study are levels of physical activity and high temperature in greenhouses. Data from countries which have initiated occupations in floriculture more recently will add valuable evidence for this controversial association.

Environmental contaminant levels and fecundability among non-smoking couples.

OBJECTIVE: To investigate the effects of low level maternal and paternal persistent contaminant exposures on fecundability among couples from the general population. METHODS: About 41 couples having their first pregnancy completed questionnaires and provided blood samples for analysis of metals, organochlorine pesticides, and polychorinated biphenyls. Associations of personal consumption and contaminant measures for mothers, fathers, and couples overall were analyzed through fecundability odds ratios (fOR, probability of pregnancy per month in more versus less exposed) in multivariable analyses. FINDINGS: Couples with higher reported caffeine consumption (couple consumption > or =111 drinks/month, fOR 0.25, 95% CI, 0.10, 0.63) and higher mercury concentrations in maternal blood (>1.2 microg/L or 0.24 ppm in hair, fOR 0.22, 95% CI, 0.07, 0.72) had lower fecundability, after adjustment for intercourse frequency. CONCLUSION: Reduced fecundability at levels below the mercury reference dose warrants further research and prudent reduction in persistent toxic substances exposure among women and men of reproductive age.

The Social Gap Index and the prevalence of osteoarthritis in the community: a cross-sectional multilevel study in Mexico.

Multilevel studies have gained importance for highlighting social inequalities in health. These associations have been reported previously in diseases such as arthritis and chronic pain. We conducted a cross-sectional study using multilevel analysis to identify individual and contextual factors associated with the variation of prevalence of osteoarthritis (OA) in the Mexican population. The sample included 17,566 individuals of which 10,666 (60.7%) were women. The relationship between individual and contextual factors and OA were analyzed with a multilevel strategy. From the total population, 1,681 individuals had OA. Multilevel analysis showed that individual variables such as female gender (odds ratio (OR) = 1.3, 95% confidence interval (CI) 1.1, 1.4), age range 55-65 years (OR = 1.6, 95% CI 1.3, 2.0), musculoskeletal pain in the last 7 days (OR = 2.6, 95% CI 2.3, 3.0), and use of pain treatments (OR = 1.4, 95% CI 1.2, 1.7) were associated with OA. At the regional level, the Social Gap Index (SGIx) was associated with the diagnosis of OA (coefficient 0.5, 95% CI 0.2-1.1). The SGIx contextual variable was positively associated with the regional prevalence of OA and the variation in prevalence of OA in different regions. The larger the social gap, the greater the variation in OA prevalence. These factors were independently associated with the prevalence of OA: female gender, pain intensity, physical limitation, and the use of pain treatments were individual variables associated with OA. The association between OA prevalence and regional variations with SGIx reflects inequities in health provisions that should be considered in health programs.

[Evaluation of time-to-pregnancy as a measure in environmental epidemiology]. / Tiempo para quedar en embarazo: consideraciones generales y metodológicas.

Since the late 80's, time to pregnancy has been used in environmental epidemiology to explore adverse effects of different exposures. The advantages of this measure and additional elements to be considered in the performance of this type of studies are reviewed. Study design includes the following steps: population selection, sample size, outcome measurement, statistical analyses and sources of bias. Guidelines were suggested for the properly development of this type of study.