Temporal and Spatial Trends of Adverse Pregnancy and Birth Outcomes in a Sample of Births from a Public Hospital in Chile.

Understanding temporal and spatial trends in pregnancy and birth outcomes within an urban area is important for the monitoring of health indicators of a population. We conducted a retrospective cohort study of all births in the public hospital of Temuco, a medium-sized city in Southern Chile between 2009 and 2016 (n = 17,237). Information on adverse pregnancy and birth outcomes, as well as spatial and maternal characteristics (insurance type, employment, smoking, age, and overweight/obesity), was collected from medical charts. Home addresses were geocoded and assigned to neighborhood. We tested whether births and prevalence of adverse pregnancy outcomes changed over time, whether birth events were spatially clustered (Moran's I statistic), and whether neighborhood deprivation was correlated to outcomes (Spearman's rho). We observed decreases in eclampsia, hypertensive disorders of pregnancy, and small for gestational age, while gestational diabetes, preterm birth, and low birth weight increased over the study period (all p < 0.01 for trend), with little changes after adjusting for maternal characteristics. We observed neighborhood clusters for birth rate, preterm birth, and low birth weight. Neighborhood deprivation was negatively correlated with low birth weight and preterm birth, but not correlated with eclampsia, preeclampsia, hypertensive disorders of pregnancy, small for gestational age, gestational diabetes, nor stillbirth. Several encouraging downward trends and some increases in adverse pregnancy and birth outcomes, which, overall, were not explained by changes in maternal characteristics were observed. Identified clusters of higher adverse birth outcomes may be used to evaluate preventive health coverage in this setting.

Spatial distribution of hospital admissions for asthma in the central area of Asturias, Northern Spain.

BACKGROUND: Asturias is one of the communities with the highest rates of hospital admission for asthma in Spain. The environmental pollution or people lifestyle are some of the factors that contribute to the appearance or aggravation of this illness. The aim of this study was to show the spatial distribution of asthma admissions risks in the central municipalities of Asturias and to analyze the observed spatial patterns. METHODS: Urgent hospital admissions for asthma and status asthmaticus occurred between 2016 to 2018 on the public hospitals of the central area of Asturias were used. Population data were assigned in 5 age groups. Standardised admission ratio (SAR), smoothed relative risk (SRR) and posterior risk probability (PP) were calculated for each census tract (CT). A spatial trend analysis was run, a spatial autocorrelation index (Morans I) was calculated and a cluster and outlier analysis (Anselin Local Morans I) was finally performed in order to analyze spatial clusters. RESULTS: The total number of hospital urgent asthma admissions during the study period was 2324, 1475 (63.46%) men and 849 (36.56%) women. The municipalities with the highest values of SRR and PP were located on the northwest area: Avilés, Gozón, Carreño, Corvera de Asturias, Castrillón and Illas. A high risk cluster was found for the municipalities of Avilés, Gozón y Corvera de Asturias. CONCLUSIONS: The spatial analysis showed high risk of hospitalization for asthma on the municipalities of the northwest area of the study, which highlight the existence of spatial inequalities on the distribution of urgent hospital admissions.

Spatial distribution of unscheduled hospital admissions for chronic obstructive pulmonary disease in the central area of Asturias, Spain.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality worldwide and also reports high morbidity rates and the global burden COPD has continued to rise over the last several decades. The best-known COPD risk factors are tobacco smoke and air pollution, but genetics, age, sex, and socioeconomic status are additional factors. This study aimed to assess the spatial distribution of unscheduled COPD hospital admissions of men and women in the central area of Asturias during 2016-2018 and identify trends, spatial patterns, or clusters in the area. METHODS: Unscheduled COPD hospital admissions in the central area of Asturias were registered, geocoded, and grouped by census tracts (CTs), age, and sex. Standardized admission ratio, smoothed relative risk, posterior risk probability, and spatial clusters between relative risks throughout the study area were calculated and mapped. RESULTS: The spatial distribution of COPD hospital admissions differed between men and women. For men, high-risk values were located primarily in the northwestern area of the study, whereas for women the cluster pattern was not as clear and high-risk CTs also reached central and southern areas. In both men and women, the north-northwest area included the majority of CTs with high-risk values. CONCLUSIONS: The present study showed the existence of a spatial distribution pattern of unscheduled COPD hospital admissions in the central area of Asturias that was more pronounced for men than for women. This study could provide a starting point for generating knowledge about COPD epidemiology in Asturias.

Urinary Arsenic Concentration and Its Relationship with Bronchial Asthma in Children from Arica, Chile.

In the city of Arica, northern Chile, the population has been involuntarily exposed to arsenic of natural and anthropogenic origin. This study aims to evaluate the association between urinary arsenic concentration and bronchial asthma diagnosis in the children of Arica. A cross-sectional analysis of a database of 1892 subjects under 18 years of age enrolled in the Environmental Health Centre between 2009 and 2021 was carried out. Arsenic exposure was obtained from a urine sample and bronchial asthma diagnosis from the database of the system for the management of explicit health guarantees. Logistic regression models were used to assess the association between inorganic arsenic and asthma. The median inorganic arsenic was 15 µg/L, and the prevalence of asthma was 7.4%. After adjusting for sex, age, ethnicity, and urinary creatinine, children with the highest tertile of urinary arsenic concentration (≥21.4 µg/L) had a greater chance of developing asthma (odds ratio (OR) 1.90; 95% confidence interval (CI) [1.13-3.18]). When exploring the modifying effect of ethnicity, the association increased among children belonging to any ethnic group (OR 3.51, 95%CI [1.43-8.65]). These findings suggest a relationship between arsenic exposure and bronchial asthma in children. While further studies are needed to assess the impact of arsenic on respiratory health, mitigation efforts to reduce arsenic exposure should be maintained.

Spatial Distribution of Hospitalizations for Ischemic Heart Diseases in the Central Region of Asturias, Spain.

Hospitalizations for ischemic heart disease have an uneven distribution throughout Spain, in which Asturias is the community with the highest rates of acute myocardial infarction (AMI) and angina pectoris (AP). Cardiovascular diseases are related to environmental, socioeconomic and previous medical conditions, which result in geographical differences in the incidence of hospital admissions and mortality. The goal of this study was to describe the spatial distribution of hospital admissions in the central area of Asturias and explore the existence of spatial patterns or clusters. Urgent hospital admissions for AMI and angina AP in the hospitals of the central area of Asturias were registered, geocoded and grouped by census tracts. Standardized admission ratio, smoothed relative risk, posterior risk probability and analysis of spatial clusters between relative risks throughout the study area were calculated and mapped. Geographical differences were found in the distribution of hospital admissions for AMI and AP across the area and between men and women. The cluster analysis indicated contiguous census tracts with high relative risk values in the northwest region of the study area and low relative risk in the east, particularly for men. The geographical analysis shows the existence of patterns and spatial clusters in the incidence of AMI and AP, for both men and women, in the central area of Asturias.

Psychometric Validation of a Questionnaire to Assess Perception and Knowledge About Exposure to Pesticides in Rural Schoolchildren of Maule, Chile.

Exposure to pesticides during infancy is associated with numerous adverse health outcomes. The assessment of knowledge and perception of pesticides exposure and risk among children has not been thoroughly studied. The aim of the study was to evaluate the reliability and validity of a questionnaire that measures the knowledge and perception of exposure to organophosphate pesticides among rural schoolchildren. The questionnaire was administered to 151 schoolchildren between 9 and 13years from four Chilean rural schools. An internal consistency analysis of the ordinal alpha coefficient and a polychoric factor analysis for categorical data were used. The results show that the ordinal alpha was 0.95. Polychoric matrices of rotated components show the 17 questions summarized pesticide knowledge in five factors extracted after promax rotation. This factorial model explains 56.3% of the variance. The questions were grouped as follows: knowledge about pesticides (Factor 1); knowledge of health effects related to pesticides exposure (Factor 2); pesticide exposure through the growing of fruits and vegetables (Factor 3); perception and action against pesticides exposure at school (Factor 4); and perception and action against pesticides exposure at home (Factor 5). The questionnaire provides a useful tool for examining pesticide exposure in agricultural regions, allowing younger community members to participate.

Occupational exposure to pesticides and health symptoms among family farmers in Brazil.

OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Longitudinal exposure to pyrethroids (3-PBA and trans-DCCA) and 2,4-D herbicide in rural schoolchildren of Maule region, Chile.

BACKGROUND: Several studies showed that early exposure to pesticides affects the development and health of children. In Maule, there is previous evidence of the high exposure to organophosphate pesticides (OP) of schoolchildren. However, to date, there are no studies assessing exposure to pyrethroids and the herbicide 2,4-D. Objetive. To evaluate children's exposure to pyrethroids insecticides 3-phenoxybenzoic acid (3-PBA), trans 3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (trans-DCCA) and 2,4 dichlorophenoxyacetic acid (2,4-D) herbicides. METHOD: Longitudinal study with 48 schoolchildren from two rural schools in the Maule region, Chile. Urinary metabolites of pyrethroids 3-PBA, Trans-DCCA and 2,4-D herbicides were evaluated in 2016 and 2017. Mann-Whitney U for repeated measurements and Spearman's rho correlation tests were used for data analysis. Also, we used a system of impulsive differential equations for mathematical modeling. RESULTS: All the schoolchildren assessed had more than two pesticide urinary metabolites in both years, with the 3-PBA metabolite being the most frequent. There was an increase in concentrations of urinary 3-PBA in November 2017, compared to 2016 (from 0.69 µg/L to 1.90 µg/L). In 2016, the specific metabolites of 3-PBA were correlated with Trans-DCCA, 2,4-D, chlorpyrifos, diazinon, and para-nitrophenol. In 2017, 3-PBA was correlated with 2,4-D, and Trans-DCCA. The concentrations of 3-PBA of Chilean children were higher than studies conducted in the USA that found an association of prenatal exposure to these metabolites with cognitive difficulties. CONCLUSIONS: We found high concentrations of pyrethroid metabolites among all the schoolchildren assessed, which may impact on their health and development. These insecticides had received no attention from the scientific community in Chile, and neither from the government agencies, despite the increased use of these chemicals in recent years. This is the first study in South America that confirms the exposure to pyrethroids and herbicides through biomarkers in human population living near farm fields.

Epidemic trends, public health response and health system capacity: the Chilean experience in four months of the COVID-19 pandemic.

OBJECTIVES: To report the surveillance of COVID-19 pandemic in Chile and analyse the response to public health interventions implemented from 3 March to 30 June 2020 and to assess the risks of collapse of the health care system. METHODS: We analysed the effective reproductive number, underreporting of cases, burden of critical beds, case fatality ratio and number of diagnostic RT-PCR for SARS-CoV-2. RESULTS: After an accelerated onset, the COVID-19 pandemic seemed to be relatively controlled in Chile (late April 2020), with reproductive numbers close to 1.00. However, at this time, the load of infected patients was high, with an important number of underreported cases; the diagnostic effort was still limited and heterogeneous across regions. After 1 May up to 30 June a marked exponential increase in the number of cases was observed with a peak on June 14. In this last period the occupation of intensive care unit beds increased to saturation level (89% nationally; 95% in the Metropolitan Region). CONCLUSIONS: Our findings suggest that the implemented public health interventions have been initially effective in decreasing the spread of the pandemic. Premature decisions to relax these interventions may have resulted in a rebound in cases with a rapid saturation of the health care system.

OBJETIVOS: Informar sobre la vigilancia de la pandemia por COVID-19 en Chile, analizar la respuesta a las intervenciones de salud pública implementadas desde el 3 de marzo hasta el 30 de junio de 2020 y evaluar los riesgos de colapso del sistema de salud. MÉTODOS: Se analizó el número reproductivo efectivo, el subregistro de casos, la carga sobre las camas de cuidados intensivos disponibles, la tasa de letalidad y el número de pruebas diagnósticas de RT-PCR efectuadas para el SARS-CoV-2. RESULTADOS: Tras un inicio acelerado, la pandemia por COVID-19 parecía estar relativamente controlada en Chile a finales de abril de 2020, con números reproductivos cercanos a 1,00. Sin embargo, en ese momento, la carga de pacientes infectados activos era elevada, con un número importante de casos no notificados; la capacidad diagnóstica era todavía limitada y heterogénea entre las regiones del país. Desde el 1 de mayo hasta el 30 de junio se observó un marcado incremento exponencial en el número de casos, con un pico el 14 de junio. En este último período la ocupación de camas en las unidades de cuidados intensivos aumentó hasta el nivel de saturación (89% a nivel nacional; 95% en la Región Metropolitana). CONCLUSIONES: Nuestros hallazgos sugieren que las intervenciones de salud pública implementadas parecen haber sido efectivas inicialmente para disminuir la propagación de la pandemia. Las decisiones prematuras de relajar estas intervenciones pueden haber ocasionado un rebote en los casos con una rápida saturación del sistema de atención de salud.

Attention deficit hyperactivity disorder and its association with heavy metals in children from northern Chile.

INTRODUCTION: Exposure to lead and arsenic has been associated with child behavior problems. In Arica, a northern city of Chile, the natural presence of arsenic in water has been registered. Also, the city has a history of heavy metals contamination of anthropogenic origin. The purpose of this study was to explore the association between the concentration of blood lead and urinary inorganic arsenic with attention deficit hyperactivity disorder (ADHD) as reported by parents. METHODS: Cross-sectional design with data analysis of 2656 children between the ages of 3 and 17 enrolled at the Environmental Health Center of Arica between 2009 and 2015. The diagnosis of ADHD was made based on the parents' response to questions about health history. Multiple logistic regression models were used to adjust for confounding variables. RESULTS: The prevalence of ADHD was 6.4%. The means urinary inorganic arsenic and blood lead were 21 µg/L and 1.5 µg/dl, respectively. In the lead model adjusted for sex, age, housing material quality and exposure to secondhand tobacco smoke report; children with blood lead concentrations ≥5 µg/dl were more likely to develop ADHD [Odds Ratio (OR): 2.33 95% confidence intervals (CI) 1.32-4.12)]. Regarding arsenic, the adjusted model revealed a higher chance of developing ADHD in the fifth quintile of exposure (OR = 2.02 IC 95% 1.12-3.61). CONCLUSION: The findings of this study suggest that exposure of children to lead and inorganic arsenic was associated with ADHD. This study provides additional evidence to existing literature regarding the potential role of toxic metals such as lead and arsenic in children's behavior. However, our findings should be interpreted with caution due to the limitations of the study.

Occupational exposure to pesticides and health symptoms among family farmers in Brazil

ABSTRACT OBJECTIVE: To explore the association of occupational pesticide exposure with acute and mental health symptoms. METHODS: Cross-sectional survey carried out with 78 Brazilian family farmers, who were pesticide applicators and helpers conveniently selected. Symptoms and exposure data were collected by interviews, and mental health outcomes by the Self-Reporting Questionnaire. Blood samples were analyzed to assess cholinesterase levels. Exposure indicators and symptoms were compared between applicators and helpers, and Poisson regression was performed to estimate prevalence ratios. RESULTS: Farmers reported exposure to multiple pesticides from early ages; they worked without safety training, technical support, and full protective equipment, and they had a high prevalence of acute and mental health symptoms (e.g., headache, mucosal irritation, tachycardia, and depressive signs). Applicators had more cholinesterase changes than helpers, but less symptoms. Helpers used less personal protection and had significantly higher prevalence ratio of headache, dyspnea, wheezing, cough, poor digestion, tiredness, and feeling worthless, after adjustment. CONCLUSIONS: Acute and mental health symptoms were observed, both among farmers and helpers. Thus, surveillance actions must be reinforced in Brazil, technical support and safety training improved, focused on applicators and helpers, who are occupationally and environmentally exposed to pesticides. Agricultural practices of these groups with less pesticide use should receive incentive.

Structural Equation Modelling in the exploration and analysis of intrauterine environmental exposures with infant health effects.

INTRODUCTION: In epidemiology, generalized linear models are the main statistical methods used to explore associations. However, the use of other methods such as Structural Equation Modelling (SEM) is gradually increasing. OBJECTIVE: The aim of the study was to illustrate the use of SEM in the assessment of salivary cortisol concentration in infants as a biomarker of perinatal exposure to inorganic arsenic. MATERIAL AND METHODS: This was a cohort study of pregnant women recruited from public health care centres in Arica, Chile, in 2013. Socio-demographic information and urine samples to assess inorganic arsenic were collected during the second trimester of pregnancy. Saliva samples were collected to assess cortisol in infants between 18-24 months of age. Four linear regression models (LRMs) and two SEMs were run to estimate the effect of prenatal exposure to inorganic arsenic on cortisol concentration in infants. RESULTS: According to LRMs and SEMs, prenatal exposure to inorganic arsenic and salivary cortisol were not associated. However, the association between maternal cortisol and cortisol in infants was statistically significant in all models; for each increase in standard deviation of the covariate Ln(maternal cortisol), the outcome Ln(cortisol in infant) increased by 0.49 units of variance in both SEMs. CONCLUSIONS: LRMs and SEMs were useful to assess the effect of prenatal exposure to inorganic arsenic on cortisol in infants. However, SEM allowed the adjustment of estimations by an estimated latent that obtained the information about income, occupation, education and ethnicity in a more comprehensive way than achieved by LRM.

An educational intervention on the risk perception of pesticides exposure and organophosphate metabolites urinary concentrations in rural school children in Maule Region, Chile.

BACKGROUND: Organophosphate (OP) pesticides can be hazardous to human health if not applied with appropriate precautions. There is evidence in the Maule region of Chile that rural schoolchildren are exposed to OP pesticides. OBJECTIVE: To evaluate the effectiveness of an educational intervention on OP exposure and understanding of pesticides and their hazards (risk perception) in two school communities in the Maule Region of Chile during 2016. METHOD: We conducted a quasi-experimental study about the effects on OP pesticide exposure of a community outreach and education program (COEP) administered in four 2-h sessions that's included hands-on activities among 48 schoolchildren from two rural schools. The intervention was directed to groups of parents and school-children separately, and aimed to educate them about the risks of exposure to pesticides and their effects on health. We measured 3,5,6-trichloro-2-pyridinol (TCPy), 2-isopropyl-4-methyl-6-hydroxypyrimidine (IMPY), malathion dicarboxylic acid (MDA), p-nitrophenol (PNP), specific urinary metabolites of the OP pesticides chlorpyrifos, diazinon, malathion and parathion, respectively, as well as the non-specific diethylakylphosphates (DEAPs) and dimethylalkylphosphates (DMAPs) in 192 urine samples of schoolchildren collected before and after the intervention. The risk perception of school children and their parents was also assessed through a questionnaire before and after the intervention. Generalized Estimated Equations were used to account for each child's repeated measures during four sessions, two in September 2016 (pre-intervention) and two in November 2016 (post-intervention). RESULTS: The intervention level had significant effect on the risk perception of adults and children, which increased after the intervention. However, the intervention was not associated with reduced of urinary metabolites levels, with no significant differences between the pre and post measures. The detection frequencies were 1.1% (MDA), 71.4% (TCPy), 43.3% (IMPY), 98.96% (PNP), and 100% (DEAPs and DMAPs). Higher DEAPs urine concentrations were associated with eating more fruit at school (p = 0.03), a younger age (p = 0.03), and being male (p = 0.01). DMAPs showed no associations with potential predictor variables (e.g. OPs applied at home, fruit consumption at school, among others). Higher TCPy was associated with attending a school closer to farms (p = 0.04) and living in a home closer to farm fields (p = 0.01); higher PNP was marginally associated with children younger age (p = 0.035). CONCLUSION: Environmental exposure to OP pesticides was unchanged even after behavior changes. It is possible that a longer time period is needed to observe changes in both behavior and urinary metabolites. The levels of DEP and DMP metabolites found here are above the reference population of the US, and our findings indicate exposure to a wide variety of OP pesticides. Given that individual-level interventions were not associated with lower exposures, efforts to reduce exposure must occur upstream and require stricter regulation and control of pesticide use by government agencies.

Is prenatal arsenic exposure associated with salivary cortisol in infants in Arica, Chile? An exploratory cohort study.

INTRODUCTION: In animal models, gestational exposure to inorganic arsenic has been associated with higher corticosterone concentration and consequent impairment of stress control in offspring. An equivalent association relating cortisol, a glucocorticoid hormone, in humans has not been previously studied. OBJECTIVE: The aim of the study was to explore the association between prenatal inorganic arsenic exposure and salivary cortisol in infants from Arica, Chile. MATERIAL AND METHODS: A cohort study of 168 mother-child dyads was recruited. In the 2nd trimester of pregnancy, urinary inorganic arsenic was assessed; 18-24 months after delivery, salivary cortisol was measured in the children. Maternal cortisol, maternal depression, stress, and socio-economic status were also evaluated. RESULTS: The adjusted association was estimated with multiple linear regression after evaluating confounding through a directed acyclic graph. Median urinary inorganic arsenic in pregnant women was 14.1 µg/L (IQR: 10.4-21.7) while salivary cortisol in the children was 0.17 µg/L (IQR: 0.11-0.38). Among children from the highest income families (> 614 USD/month), arsenic exposure was associated with salivary cortisol. Children in the third quartile of arsenic exposure had -0.769 units of the logarithm of salivary cortiso, compared with those in the first quartile (p = 0.045). CONCLUSIONS: In this sample, prenatal exposure to arsenic was associated with salivary cortisol (third quartile of inorganic arsenic), only in infants belonging the highest income strata (> 614 USD). More studies are needed to confirm these preliminary results.

Reliability and factorial validity of a questionnaire to assess organophosphate pesticide exposure to agricultural workers in Maule, Chile.

The aim was to evaluate the reliability and validity of a questionnaire to assess organophosphate pesticide (OP) exposure in agricultural workers. We then enrolled a random sample of 114 agricultural workers from the region of Maule, Chile (mean age = 50 years [SD = 12]). An internal consistency analysis (Cronbach's alpha> 0.70) and a Varimax rotational factorial analysis were applied. The instrument had a high reliability to predict likely occupational pesticide exposures: Cronbach's alpha = 0.95, the Kaiser-Meyer-Olkin (KMO) measure was 0.90 and the Bartell sphericity test = p < 0.001. Four factors explaining 68% of the variance were extracted. The factors identified were as follows: (1) labor conditions during application of OPs; (2) use of personal protective equipment; (3) workplace conditions related to OP exposure and (4) home conditions related to OP exposure. The questionnaire has adequate metric properties to characterize likely OP exposure of agricultural workers and to explore associated working and home conditions.

Principales aeroalérgenos en rinoconjuntivitis alérgica en la ciudad de Temuco, Chile / Aeroallergens causing rhinoconjunctivitis

Background: Allergic rhinoconjunctivitis (ARC) has a prevalence of 30% in industrialized countries. For an accurate diagnosis and treatment, it is crucial to identify the causative aeroallergen. Aim: To evaluate aeroallergen sensitization in adults with ARC in the city of Temuco, Chile. Patients and Methods: A skin test against the main aeroallergens present in Temuco was carried out in patients aged 15 to 64 years with ARC diagnosed by medical examination and the Score For Allergic Rhinitis. Results: At least one aeroallergen sensitization was present in 234 (62.4%) out of 375 patients. Pollen-sensitized patients were positive mainly for Grasses (44.4%), Plantago (27.8%), Cynodon (26.1%), Sorrel (23.5%), Birch (14.9%), Nothofagus obliqua (13.3%) and Alder (11.1%). Dust mites were the most common non-pollinic sensitizing aeroallergens, including Dermatophagoides pteronyssinus (70.1%) and Dermatophagoides farinae (62.8%). Conclusions: According to our results, skin tests in the city of Temuco should include at least dust mites, pollens of Grasses, Plantago, Cynodon, Sorrel, Birch, Nothofagus obliqua and Alder, because these allergens account for 93% of ARC cases in this city.

Integrating multivariate and geostatistical analyses for assessing the socio-environmental vulnerability of children in the vicinity of a contaminated site.

Vulnerability assessments are commonly based on complex indices that may be inappropriate for characterizing risks in small groups of people exposed to environmental hazards. The aim was to present a multivariate and geostatistical approach to explore human health risks at the individual, household and community level. First, biological and socioeconomic characteristics from 179 children were used in a cluster analysis to find groups and identify vulnerability profiles. Then, both the exposure of children to arsenic and lead in soils and their accessibility to community resources were assessed using a geospatial analysis. The results identified three vulnerability profiles among children that were not in agreement with the environmental exposure and deficit of community resources. The proposed approach helps optimize strategies to manage both environmental and social risks based on the vulnerability of the exposed population.

Urinary Inorganic Arsenic Concentration and Gestational Diabetes Mellitus in Pregnant Women from Arica, Chile.

Introduction: The association of total arsenic exposure with impaired glucose tolerance and gestational diabetes has been shown; however, evidence regarding urinary inorganic arsenic in pregnant women is still limited. Our aim was to evaluate the association between urinary inorganic arsenic concentration and gestational diabetes among pregnant women living in Arica, Chile. Methods: Cross-sectional study of pregnant women receiving care at primary health centers in urban Arica. The exposure was urinary inorganic arsenic concentration, while gestational diabetes was the outcome. The association was evaluated using multiple logistic regression models adjusted by age, education level, ethnicity, and pre-pregnancy body mass index. Results: 244 pregnant women were surveyed. The median urinary inorganic arsenic was 14.95 μg/L, and the prevalence of gestational diabetes was 8.6%. After adjusting, we did not find a significant association between gestational diabetes and inorganic arsenic exposure tertiles (Odds ratio (OR) 2.98, 95% CI = 0.87⁻10.18), (OR 1.07, 95% CI = 0.26⁻4.33). Conclusion: This study did not provide evidence on the relationship between urinary inorganic arsenic concentration and gestational diabetes. Further research is needed to elucidate the factors underlying this association.

[Aeroallergens causing rhinoconjunctivitis]. / Principales aeroalérgenos en rinoconjuntivitis alérgica en la ciudad de Temuco, Chile.

BACKGROUND: Allergic rhinoconjunctivitis (ARC) has a prevalence of 30% in industrialized countries. For an accurate diagnosis and treatment, it is crucial to identify the causative aeroallergen. AIM: To evaluate aeroallergen sensitization in adults with ARC in the city of Temuco, Chile. PATIENTS AND METHODS: A skin test against the main aeroallergens present in Temuco was carried out in patients aged 15 to 64 years with ARC diagnosed by medical examination and the Score For Allergic Rhinitis. RESULTS: At least one aeroallergen sensitization was present in 234 (62.4%) out of 375 patients. Pollen-sensitized patients were positive mainly for Grasses (44.4%), Plantago (27.8%), Cynodon (26.1%), Sorrel (23.5%), Birch (14.9%), Nothofagus obliqua (13.3%) and Alder (11.1%). Dust mites were the most common non-pollinic sensitizing aeroallergens, including Dermatophagoides pteronyssinus (70.1%) and Dermatophagoides farinae (62.8%). CONCLUSIONS: According to our results, skin tests in the city of Temuco should include at least dust mites, pollens of Grasses, Plantago, Cynodon, Sorrel, Birch, Nothofagus obliqua and Alder, because these allergens account for 93% of ARC cases in this city.

Pulmonary transcriptomic responses indicate a dual role of inflammation in pneumonia development and viral clearance during 2009 pandemic influenza infection.

BACKGROUND: The interaction between influenza virus and the host response to infection clearly plays an important role in determining the outcome of infection. While much is known on the participation of inflammation on the pathogenesis of severe A (H1N1) pandemic 09-influenza virus, its role in the course of non-fatal pneumonia has not been fully addressed. METHODS: A systems biology approach was used to define gene expression profiles, histology and viral dynamics in the lungs of healthy immune-competent mice with pneumonia caused by a human influenza A (H1N1) pdm09 virus, which successfully resolved the infection. RESULTS: Viral infection activated a marked pro-inflammatory response at the lung level paralleling the emergence of histological changes. Cellular immune response and cytokine signaling were the two signaling pathway categories more representative of our analysis. This transcriptome response was associated to viral clearance, and its resolution was accompanied by resolution of histopathology. DISCUSSION: These findings suggest a dual role of pulmonary inflammation in viral clearance and development of pneumonia during non-fatal infection caused by the 2009 pandemic influenza virus. Understanding the dynamics of the host's transcriptomic and virological changes over the course of the infection caused by A (H1N1) pdm09 virus may help identifying the immune response profiles associated with an effective response against influenza virus.