[Proof of life, proof of death: An anthropology of cancer among rural teachers exposed to agrochemicals in southeastern Cordoba (Argentina)]. / Pruebas de vida, pruebas de muerte: Antropología del cáncer entre docentes rurales expuestas a agroquímicos en el sudeste de Córdoba (Argentina).

This article presents the results of anthropological research on cancer among rural teachers occupationally exposed to agrochemicals. The study was carried out in the southeastern region of the province of Cordoba (Argentina), an area characterized by the large-scale production of transgenic crops intensively treated with agricultural pesticides. Regarding the methodology, fieldwork was conducted between 2019 and 2020 and included in-depth interviews with ten teachers, as well as observations of everyday situations in the towns where they live and work. Among the main findings, it was possible to identify a hegemonic narrative that naturalizes the existence of cancer and renders it invisible; despite this, it was possible to document the social suffering it caused among rural teachers. The article concludes that there is a need to bring visibility to these conditions in order to protect the health and wellbeing of this sector of Argentine teaching professionals.

En este artículo se presentan resultados de una investigación antropológica sobre el cáncer entre docentes rurales expuestas ocupacionalmente a agroquímicos. El estudio se desarrolló en la zona sudeste de la provincia de Córdoba (Argentina), caracterizada por la producción a gran escala de cultivos transgénicos tratados de manera intensiva con plaguicidas agrícolas. A nivel metodológico, el trabajo de campo realizado entre 2019 y 2020 incluyó entrevistas en profundidad a diez docentes y observación de situaciones de la vida cotidiana en los poblados donde vivían y trabajaban estas docentes. Se propone como hallazgo principal que existe una narrativa hegemónica que naturaliza e invisibiliza la existencia del cáncer pero que, a pesar de ella, es posible documentar los padecimientos individuales y sociales que esta enfermedad provoca entre las docentes rurales. Se concluye que es necesario visibilizar esos padecimientos para resguardar la salud y la vida de este sector de la docencia argentina.

Intoxicação cutânea grave por Paraquat / Serious skin poisoning by Paraquat

O Paraquat é um herbicida não seletivo altamente tóxico, sendo responsável por altas taxas de letalidade acidentais ou provocadas, devido, principalmente, à insuficiência respiratória. Apesar de a intoxicação por via oral ser a principal e mais grave, o contato prolongado com a substância em uma grande área corporal pode gerar uma toxicidade similar e levar ao óbito ­ fato pouco elucidado na literatura. Este é o relato de caso de um homem de 22 anos, que foi admitido em um hospital devido a queixas de mal-estar, náuseas, febre, cefaleia, dor abdominal, diarreia, queimaduras e dispneia. A suspeita diagnóstica inicial foi de hantavirose, leptospirose, dengue e tromboembolismo pulmonar e, posteriormente, foi comprovado intoxicação exógena com agrotóxico por via inalatória e cutânea. Exames de imagem revelaram fibrose pulmonar difusa e ele também apresentou alterações renais, hepáticas e coagulatórias. Como não há antídoto específico, foi empregado tratamento sintomático e suportivo, com uso de carvão ativado, antibióticos, corticoides, antioxidantes e hemodiálise. No entanto, o paciente teve uma piora progressiva do quadro, vindo a óbito devido à síndrome da angústia respiratória aguda e fibrose pulmonar. O Paraquat, embora proibido no Brasil em 2020, continua sendo utilizado de forma ilegal. Além disso, seu substituto, o Diquat, possui toxicidade semelhante. Assim, é fundamental que os profissionais da saúde reconheçam o diagnóstico da intoxicação por tais substâncias e suas diferentes vias de exposição. Também são necessárias novas medidas de fiscalização das substâncias e maior investimento em educação em saúde para evitar exposições acidentais, assim como relatado (AU).

Paraquat is a highly toxic non-selective herbicide and is responsible for high accidental or provoked lethality rates, mainly due to respiratory failure. Although oral poisoning is the primary and most severe, prolonged contact with the substance in a large body area can lead to similar toxicity and death ­ a fact that is little elucidated in the literature. This is the case report of a 22-year-old man admitted to a hospital due to complaints of malaise, nausea, fever, headache, abdominal pain, diarrhea, burns and dyspnea. The initial diagnostic suspicion was hantaviruses, leptospirosis, dengue and pulmonary thromboembolism, and there was subsequently proven exogenous intoxication with pesticides by inhalation and cutaneous route. Imaging tests revealed diffuse pulmonary fibrosis and he also had renal, hepatic and coagulation alterations. As there is no specific antidote, symptomatic and supportive treatment was performed using activated charcoal, antibiotics, corticosteroids, antioxidants and hemodialysis. However, the patient had a progressive worsening of the condition and died due to acute respiratory distress syndrome and pulmonary fibrosis. Paraquat, although banned in Brazil in 2020, continues to be used illegally. In addition, its substitute, the Diquat, has similar toxicity. Thus, it is essential that health professionals recognize the diagnosis of intoxication by such substances and their different exposure routes. New control measures for these substances and greater investment in health education are also needed to prevent accidental exposure, as reported (AU).

Genótipos e Fenótipos de Resistência a Metais Pesados e Agrotóxicos em Patógenos de Alto Risco em Saúde Única / Genotypes and Phenotypes of Resistance to Heavy Metals and Pesticides in High-Risk Pathogens in Single Health

As atividades industriais e de agronegócio, embora necessárias para o desenvolvimento da sociedade, tem causado sérios problemas ambientais devido à eliminação inadequada de seus efluentes, sendo o tratamento destes um dos assuntos mais importantes em relação ao controle de poluição. Os microrganismos podem ser utilizados como biomarcadores de contaminação, portanto, o conhecimento de mecanismos associados à resistência e a capacidade de imobilização e biotransformação de poluentes é um fator importante para a identificação de linhagens adaptadas, que podem ser eficientes no tratamento e na recuperação de áreas contaminadas. O objetivo do presente projeto foi avaliar o perfil de tolerância de patógenos bacterianos de alto risco em saúde única, aos metais pesados (mercúrio, prata, telúrio e arsênio) e ao agrotóxico glifosato; identificando o resistoma associado. A correlação fenótipo-genótipo foi avaliada em isolados de Klebsiella pneumoniae (n= 35), Escherichia coli (n=46), e Salmonella spp. (n=19), determinando a CIM pelo método de microdiluição, e analisando as respectivas sequências genômicas. Entre os isolados de K. pneumoniae, 32 cepas apresentaram CIM elevadas (64- 512µg/mL) para o metal prata, dos quais 20 carregam o operon silPABCRSE responsável por conferir resistência. Uma cepa de K. pneumoniae carregando genes terABCE apresentou uma CIM de 64 µg/mL para telúrio. Seis cepas de E. coli apresentaram uma CIM >32 µg/mL para telúrio, sendo que 3 cepas carregam os genes tehA/B. Outras 6 cepas de E. coli apresentaram CIM para prata de 256-512 µg/mL, mas só duas carregaram genes silPFCE. Duas cepas de Salmonella apresentaram CIM 64-128 µg/mL para telúrio, e carregam genes tehA/B e terABCDEF. Em relação ao arsênio, 24 cepas de E. coli apresentaram uma CIM ≥ 512 µg/mL, e destas, 12 cepas carregam os genes arsRBC. Salmonella spp., que carregam o gene merR apresentaram CIMs de 8-16 µg/mL para mercúrio. Não foi possível correlacionar a presença do operon phnC-P (sugerido como responsável pela tolerância ao glifosato) com CIMs elevadas para este composto. Os resultados obtidos suportam a hipóteses que a exposição de bactérias de origem humana, animal e ambiental, aos metais pesados pode estar contribuindo para a seleção de linhagens tolerantes, sendo que a tolerância à prata mediada pelo operon silPABCRSE em K. pneumoniae foi predominante no grupo clonal CG258, característica com potencial de biomarcador que pode ser utilizado para monitorar o impacto do uso deste metal nas diferentes atividades humanas. Neste trabalho foi possível padronizar a técnica de PCR com os genes do operon sil de interesse

Industrial and agribusiness activities have caused serious environmental problems due to the inadequate disposal of their effluents, the treatment of which being one of the most important issues in relation to pollution control. Microorganisms can be used as biomarkers of contamination, therefore the knowledge of mechanisms associated with resistance and the immobilization and biotransformation capacity of pollutants can be an important factor for the identification of adapted strains, efficient in the treatment and recovery of contaminated areas. The aim of this study was to evaluate the tolerance profile of critical priority bacterial pathogens relevant in One Health, to heavy metals (mercury, silver, tellurium, and arsenic) and to the pesticide glyphosate, identifying the associated resistome. The phenotype-genotype correlation was evaluated in antibiotic-resistant isolates of Klebsiella pneumoniae (n= 35), Escherichia coli (n= 46), and Salmonella spp. (n= 19), by MIC determination using the microdilution method, and by analysis of their respective genomic sequences. Among the isolates of K. pneumoniae, 32 strains showed elevated MIC (64-512 µg/mL) for silver metal, of which 20 carried the silPABCRSE operon responsible for conferring resistance. A strain of K. pneumoniae carrying terrace genes showed a MIC of 64 µg/mL for tellurium. Six strains of E. coli showed an MIC> 32 µg/mL for tellurium, with 3 strains carrying the Thea/B genes. Other 6 strainsof E. coli showed MIC for silver of 256-512 µg/mL, but only two carried silPFCE genes. Two strains of Salmonella showed MIC 64-128 µg/mL for tellurium and carried the/B and terABCDEF genes. In relation to arsenic, 24 strains of E. coli had a MIC 512 µg/mL, and of these, 12 strains carried the arsRBC genes. Salmonella spp., which carriedthe mer gene, had MICs of 8-16 µg/mL for mercury. It was not possible to correlate thepresence of the phonic-P operon (suggested as responsible for glyphosate tolerance) with elevated MICs for this compound. The silver tolerance mediated by the operon sil was a predominant feature in K. pneumoniae strains belonging to the clonal group CG258, suggesting a intrinsic property that has contributed to the persistence and wide dissemination of CG258 within a One Health context, which could be as a biomarkerto monitor the impact of the use of silver compounds and silver-based biomaterial on different human activities. In this work it was possible to standardize the PCR technique with the genes of the sil operon of interest

Asociación entre comercialización de agrotóxicos con prematuridad y bajo peso al nacer al sur de Brasil / Association of Commercialization of Pesticides with Premature and Low Birth Weight in Southern Brazil

Introducción: Brasil expandió el mercado de agrotóxicos y Río Grande do Sul se destaca como mayor comercializador desde 2014. La población rural, factores socioeconómicos, ambientales y la exposición a agrotóxicos pueden ocasionar la prematuridad y bajo peso al nacer. Objetivo: Verificar la asociación entre la comercialización de agrotóxicos y la ocurrencia de prematuridad, bajo peso al nacer y factores socioeconómicos. Métodos: Estudio ecológico con 496 municipios del estado do Río Grande do Sul, Brasil, en los años 2017 y 2018. La población fueron los nacidos vivos por residencia materna, notificados en el Sistema de Informaciones Sobre Nacidos Vivos. La comercialización de agrotóxicos fue obtenida del Sistema Integrado de Gestión de Agrotóxicos. Se clasificaron los municipios en cuatro grupos de orden creciente, con base en cuartiles de comercialización. Se realizaron análisis de estadísticas en el programa IBM SPPS versión 21.0, considerando nivel de significancia de 5 por ciento (p 0,05). Conclusión: El consumo de agrotóxicos, la disminución de acceso a educación, servicios de salud y ambientes inseguros de trabajo, pueden contribuir para surgimiento de recién-nacidos prematuros y con bajo peso(AU)

Introduction: Brazil expanded the pesticide market and Rio Grande do Sul stands out as the largest marketing state since 2014. The rural population, socioeconomic and environmental factors, as well as exposure to pesticides can cause prematurity and low weight at birth. Objective: To verify the association between the commercialization of pesticides and the occurrence of prematurity, low weight at birth and socioeconomic factors. Methods: Ecological study carried out, in the years 2017 and 2018, with 496 municipalities of Rio Grande do Sul State, Brazil. The population was made up of the live births by maternal residence and reported in the Live Births Information System. Information regarding the commercialization of pesticides was obtained from the Integrated System for Pesticide Management. The municipalities were classified into four groups of increasing order, based on marketing quartiles. Statistical analyses were carried out in the program IBM SPPS (version 21.0); considering a significance level of 5 percent (P 0.05). Conclusion: Consumption of pesticides, decrease in access to education and healthcare services, as well as unsafe work settings, can contribute to the occurrence of premature and underweight newborns(AU)

Percepção de uma população rural sobre o uso de agrotóxicos / Perception of a rural population on the use of agrotoxic / Percepción de una población rural sobre el uso de agrotoxicos

Objective:To identify the knowledge of a rural population about the health implications generated by the abuse of pesticides. Method: qualitative, exploratory-descriptive study. The semi-structured interviews took place from July to August 2017, including 12 rural residents from one of the areas covered by the Basic Health Unit of the municipality of Antônio Carlos. Data were submitted by thematic analysis. Results: it was revealed that the participants know the concept of pesticides, however, have failed to identify the damage generated to health. Another important factor was the disuse of personal protective equipment, as well as the lack of knowledge about possible health-promoting activities. Conclusion: the population has little knowledge of the consequences of using pesticides, using them incorrectly due to need and / or lack of knowledge of alternatives. It is evident the need for health education activities, together with the multidisciplinary team, focused on primary care

Objetivo: Identificar o conhecimento de uma população rural sobre as implicações na saúde geradas pelo uso abusivo de agrotóxicos. Método: estudo qualitativo, exploratório-descritivo. As entrevistas semiestruturadas ocorreram de julho a agosto de 2017, incluindo 12 moradores rurais de uma das áreas de abrangência da Unidade Básica de Saúde do município de Antônio Carlos. Os dados foram submetidos pela análise temática. Resultados: revelou-se que os participantes conhecem o conceito de agrotóxicos, contudo, apresentam falha na identificação dos prejuízos gerados à saúde. Outro fator destacado, consistiu-se no desuso dos equipamentos de proteção individual, da mesma forma, que o desconhecimento das possíveis atividades promotoras da saúde. Conclusão: a população possui pouco conhecimento das consequências da utilização dos agrotóxicos, utilizando-os de maneira incorreta por necessidade e/ou pela falta de conhecimento das alternativas. Evidencia-se, a necessidade de atividades de educação a saúde, em conjunto a equipe multiprofissional, voltadas a atenção primária

Objetivo:Identificar el conocimiento de una población rural sobre las implicaciones para la salud generadas por el abuso de pesticidas. Método: estudio cualitativo, exploratorio-descriptivo. Las entrevistas semiestructuradas tuvieron lugar de julio a agosto de 2017, incluidos 12 residentes rurales de una de las áreas cubiertas por la Unidad Básica de Salud del municipio de Antônio Carlos. Los datos fueron presentados por análisis temático. Resultados: se reveló que los participantes conocen el concepto de pesticidas, sin embargo, no han podido identificar el daño generado a la salud. Otro factor importante fue el desuso del equipo de protección personal, así como la falta de conocimiento sobre posibles actividades de promoción de la salud. Conclusión: la población tiene poco conocimiento de las consecuencias del uso de pesticidas, usándolos incorrectamente debido a la necesidad y / o falta de conocimiento de alternativas. Es evidente la necesidad de actividades de educación para la salud, junto con el equipo multidisciplinario, centrado en la atención primaria

A comprehensive view on mechanistic approaches for cancer risk assessment of non-genotoxic agrochemicals.

Currently the only methods for non-genotoxic carcinogenic hazard assessment accepted by most regulatory authorities are lifetime carcinogenicity studies. However, these involve the use of large numbers of animals and the relevance of their predictive power and results has been scientifically challenged. With increased availability of innovative test methods and enhanced understanding of carcinogenic processes, it is believed that tumour formation can now be better predicted using mechanistic information. A workshop organised by the European Partnership on Alternative Approaches to Animal Testing brought together experts to discuss an alternative, mechanism-based approach for cancer risk assessment of agrochemicals. Data from a toolbox of test methods for detecting modes of action (MOAs) underlying non-genotoxic carcinogenicity are combined with information from subchronic toxicity studies in a weight-of-evidence approach to identify carcinogenic potential of a test substance. The workshop included interactive sessions to discuss the approach using case studies. These showed that fine-tuning is needed, to build confidence in the proposed approach, to ensure scientific correctness, and to address different regulatory needs. This novel approach was considered realistic, and its regulatory acceptance and implementation can be facilitated in the coming years through continued dialogue between all stakeholders and building confidence in alternative approaches.

The chronic kidney disease epidemic in El Salvador: the influence of agrochemicals / La epidemia de enfermedad renal crónica en El Salvador: la influencia de los agroquímicos

Introduction: An epidemic of chronic kidney disease (CKD) of devastating consequences has been taking place in El Salvador over the last few decades. In a significant portion of affected subjects, no other common cause of chronic kidney disease is present, such as diabetes and hypertension. This illness is usually called Chronic Kidney Disease from Non-Traditional Causes (CKDnT). Previous studies have shown a high prevalence of exposure to agrochemicals in affected populations, particularly in rural areas. In addition to sustained exposure to agrochemicals, the other leading hypothesis to explain this epidemic is prolonged exposure to high temperatures and dehydration in a context of exhausting agricultural work. Objectives: To assess the possible causal effect of exposure to agrochemicals in the emergence of the CKD epidemic in the adult population of El Salvador. Methods: We conducted a case-control analysis based on the 2015 survey of Chronic Diseases in Adults in El Salvador, a national probabilistic sample that covered 4,817 adults ;20 years old. Those suffering from CKD were considered cases; the rest were managed as controls. Self-reported agrochemical exposures, other risk factors and health conditions were recorded. For binary exposures, the odds ratio (OR) of CKD and CKDnT was estimated. For variables measuring length of exposure, the average valu 8203; 8203;for cases and for controls were compared. In all cases, the corresponding 95 percent confidence intervals were calculated. Multivariate logistic regression was used to examine the association between exposure to agrochemicals and CKD while controlling for potential confounding variables. Results: Regardless of how past exposure to agrochemicals was characterized (e.g., contact with paraquat or aerial fumigation) the OR of both CKD and CKDnT was always greater than 1.0 (range, 1.36 to 3.75). Similarly, the average number of years of exposure was consistently higher for cases than for controls for all continuous variables examined (greater than 2 years in most cases). Conclusions: The results of this study are consistent with previous epidemiologic and toxicological evidence and support the hypothesis that exposure to agrochemicals may be causally implicated in the ongoing CKD epidemics in El Salvador(AU)

Introducción: Durante las últimas décadas, una epidemia de enfermedad renal crónica (ERC) de consecuencias devastadoras ha tenido lugar en El Salvador. Una parte importante de los sujetos afectados, no padece de una causa frecuente para padecer enfermedad renal crónica, tal como como diabetes e hipertensión. En tal caso, suele distinguirse la dolencia mediante el nombre de Enfermedad Renal Crónica de Causas no Tradicionales (ERCnT). Estudios previos muestran una alta prevalencia de exposición a agroquímicos en las poblaciones afectadas, particularmente en las zonas rurales. Además de la exposición sostenida a agroquímicos, la otra hipótesis principal para explicar esta epidemia es la exposición prolongada a altas temperaturas y deshidratación, en un contexto de trabajo agrícola agotador. Objetivos: Evaluar el posible efecto causal de la exposición a agroquímicos en la irrupción de la epidemia de ERC en la población adulta de El Salvador. Métodos: Se realizó un estudio de casos y controles, a partir de la Encuesta de Enfermedades Crónicas no Transmisibles en Adultos en El Salvador, basada en una muestra probabilística nacional que abarcó 4,817 adultos de 20 o más años de edad, concluida en 2015. Fueron considerados casos todos aquellos que padecían ERC; el resto dos restantes participantes se manejaron como controles. Se registraron las exposiciones a agroquímicos, así como a otros factores de riesgo y condiciones de salud según testimonio de los participantes. Para las exposiciones binarias, se estimó la razón de odds (OR) con respecto a padecer ERC y ERCnT. Para las variables que medían la duración de la exposición, se compararon los valores medios para casos y controles. En todos los casos, se calcularon los respectivos intervalos de confianza al 95 por ciento. Se utilizó la regresión logística multivariada para examinar la asociación entre la exposición a agroquímicos y la ERC, controlando las posibles variables confusoras. Resultados: Independientemente de cómo fuera caracterizada la exposición pasada a agroquímicos (por ejemplo, contacto con paraquat o fumigación aérea), el OR de ERC y ERCnT siempre fue mayor que 1.0 (rango, 1.36 a 3.75). Del mismo modo, la media de años de exposición fue consistentemente más alta para los casos que para los controles, para todas las variables continuas examinadas (más de 2 años en la mayoría de los casos). Conclusiones: Los resultados de este estudio son consistentes con la evidencia epidemiológica y toxicológica previa y respaldan la hipótesis de que la exposición a agroquímicos puede estar causalmente implicada en la epidemia de ERC que se registra en El Salvador(AU)

Environmental and Occupational Risk Factors Associated with Chronic Kidney Disease of Unknown Etiology in West Javanese Rice Farmers, Indonesia.

Chronic kidney disease of unknown etiology (CKDu) in agricultural population is an increasing issue. This study aims to obtain a prevalence estimate of CKDu in male rice farmers in West Java, Indonesia; and analyze the relationship between CKDu and environmental and occupational factors. The study design was cross-sectional. This study included 354 healthy male farmers in two rice agriculture areas in West Java with different altitudes (low altitude and high-altitude location). This research included blood and urine sampling from the farmers for serum creatinine (SCr) level and proteinuria; questionnaire on demographic information, occupational factors and other risk factors for CKDu. We measured ambient temperature and humidity in both study locations for environmental factors. From SCr level and proteinuria, we categorized the farmers into five stages of CKD; then we distinguished CKDu from CKD if the farmers had stage 1-4 of CKD but without diabetes, hypertension and other traditional causes. Data were analyzed with multivariate logistic regression to get prevalence odd ratios of CKDu and its relationship with environmental and occupational factors, adjusted with other risk factors of CKDu. The overall prevalence of CKD was 24.9% and CKDu was 18.6%. For the environmental factors, farm location (high altitude versus low altitude location) was associated with CKDu (Prevalence Odds Ratio (POR): 2.0; 95% CI: 1.2-3.5). For the occupational factors, although not significant, the risk of CKDu increased with the longer use of insecticide and with the more frequent of insecticide use. We suggested that there was a need to conduct future research to investigate more on the association of those environmental and occupational factors with CKDu.

Efeitos dos agrotóxicos na saúde auditiva de trabalhadores rurais / Effects of pesticides on the hearing health of rural workers / Efectos de los pesticidas en la salud auditiva de los trabajadores rurales

Introdução: O agrotóxico é um assunto complexo e está pulverizado em diversas instituições e ações, tanto no âmbito do SUS como em outros órgãos de governo, necessitando urgente de constituição de um grupo para viabilizar a articulação das diferentes instâncias. Objetivo: verificar os efeitos da contaminação por agrotóxicos na saúde auditiva de trabalhadores rurais. Material e Métodos: Participaram 8 trabalhadores rurais com no mínimo dois anos de experiência. Os trabalhadores selecionados foram submetidos a dois questionários e avaliação audiológica, por meio dos seguintes procedimentos: entrevista específica, questionário de qualidade de vida no trabalho, audiometria tonal liminar e de alta frequência, logoaudiometria, imitanciometria. A coleta de dados foi realizada na Clinica de Fonoaudiologia da Faculdade de Odontologia de Bauru-Universidade de São Paulo. Resultados: Na avaliação audiológica os resultados encontrados mostraram normalidade, de acordo com padrões pré-estabelecidos, entretanto os participantes foram orientados a realizar acompanhamento devido à faixa limite de normalidade na audiometria convencional e altas frequências, assim como a presença de recrutamento em alguns indivíduos. Conclusão: Os resultados sugerem que as exposições constantes aos agrotóxicos podem causar alterações do sistema auditivo periférico, mesmo que não haja presença de ruído no local de trabalho. Este estudo, e muitos outros, propõem dados que demonstram a importância de programas de prevenção quanto à exposição ao agrotóxico na saúde do trabalhador, implementar o controle dos agentes, assim como a vigilância. Outros trabalhos com uma população mais robusta devem ser desenvolvidos de forma a expor as evidências de comprometimento periférico.

Introduction: The pesticide is a complex issue and is powdered in various institutions and actions, both within the SUS and in other government agencies, requiring the urgence to set up a group to facilitate the articulation of different instances. Objective: To assess the effects of pesticide contamination on hearing health of rural workers. Methods: Participants were eight rural workers with at least two years of experience. Selected employees underwent two questionnaires, and audiological evaluation, using the following procedures: interview specifies, quality of life questionnaire at work, pure tone audiometry and high frequency, speech audiometry, tympanometry. Data collection was performed at the at the Speech Patology and Audiology of the Bauru School of Dentistry-University of São Paulo Results: In the audiological evaluation the results showed normal, according to established standards, however the participants were asked to perform periodic monitoring due to normal range in conventional audiometry and high frequencies as well as the presence of recruitment in some individuals. Conclusion: The results suggest that constant exposure to pesticides are likely to cause changes of the peripheral auditory system even if there is not noise present in the workplace. This study and many others propose data demonstrating the importance of prevention programs of the exposition to these agrochemicals to the worker health, highlighting vigilance . Other studies with larger populations should be developed in order to expose more evidence.

Introduccion: El agrotóxico es un asunto complejo y está pulverizado en diversas instituciones y acciones, tanto en el ámbito del SUS como en otros órganos de gobierno, necesitando urgente de constitución de un grupo para viabilizar la articulación de las diferentes instancias. Objetivo: verificar los efectos de la contaminación por agrotóxicos en la salud auditiva de trabajadores rurales. Material y Métodos: Participaron 8 trabajadores rurales con al menos dos años de experiencia. Los trabajadores seleccionados fueron sometidos a dos cuestionarios y evaluación audiológica, por medio de los siguientes procedimientos: entrevista específica, cuestionario de calidad de vida en el trabajo, audiometría tonal liminar y de alta frecuencia, logoaudiometría, imitanciometría. La recolección de datos fue realizada en la Clínica de Fonoaudiología de la en la Clínica de Logopedia de la Facultad de Odontología de Bauru-Universidad de São Paulo Resultados: En la evaluación audiológica los resultados encontrados mostraron normalidad, de acuerdo con estándares preestablecidos, sin embargo los participantes fueron orientados a realizar seguimiento debido al rango límite de normalidad en la audiometría convencional y altas frecuencias, así como la presencia de reclutamiento en algunos individuos. Conclusión: Los resultados sugieren que las exposiciones constantes a los agrotóxicos pueden causar alteraciones del sistema auditivo periférico aunque no haya presencia de ruido en el lugar de trabajo. Este estudio y muchos otros proponen datos que demuestran la importancia de programas de prevención en cuanto a esos químicos. Otros trabajos con mayor población deben ser desarrollados para exponer mayores evidencias.

Mechanisms of action of agrochemicals acting as endocrine disrupting chemicals.

Agrochemicals represent a significant class of endocrine disrupting chemicals that humans and animals around the world are exposed to constantly. Agrochemicals can act as endocrine disrupting chemicals through a variety of mechanisms. Recent studies have shown that several mechanisms of action involve the ability of agrochemicals to mimic the interaction of endogenous hormones with nuclear receptors such as estrogen receptors, androgen receptors, peroxisome proliferator activated receptors, the aryl hydrocarbon receptor, and thyroid hormone receptors. Further, studies indicate that agrochemicals can exert toxicity through non-nuclear receptor-mediated mechanisms of action. Such non-genomic mechanisms of action include interference with peptide, steroid, or amino acid hormone response, synthesis and degradation as well as epigenetic changes (DNA methylation and histone modifications). This review summarizes the major mechanisms of action by which agrochemicals target the endocrine system.

La determinación social de la enfermedad renal crónica de causas no tradicionales (ERCnT) en Guatemala / The social determination of chronic kidney disease of non-traditional causes (CKDnT) in Guatemala

La Enfermedad Renal Crónica de Causas no Tradicionales (ERCnT) ha aumentado en los últimos 20 años, convirtiéndose en un problema de salud pública importante que se observa principalmente en países de Centroamérica y Asia, afectando especialmente a trabajadores agrícolas jóvenes. La presencia de factores de riesgo relacionados con toxinas, medio ambiente y condiciones laborales sugiere una causa multifactorial, la cual puede que involucre la exposición a agroquímicos, contaminantes ambientales, y episodios repetidos de deshidratación. La comprensión de las condiciones sociales que unen estos factores en grupos específicos de población es fundamental para el desarrollo de programas de salud pública tendientes a la prevención de esta epidemia devastadora. Luego de presentar brevemente los antecedentes, este ensayo discute el paradigma de causalidad de la enfermedad implícito en la literatura disponible sobre ERCnT, concretamente la "multicausalidad", sitúa el enfoque en su contexto histórico, y presenta sus fortalezas y limitaciones. Luego, el ensayo presenta dos paradigmas de causalidad que podrían ayudar a avanzar en la investigación sobre las causas de la enfermedad, específicamente los enfoques socioecológico y de determinación social de la salud. El ensayo concluye con recomendaciones para una agenda de investigación e intervención que enfoque en explicar las causas de la ERCnT.

Chronic Kidney Disease of non-Traditional Causes (CKDnT) has increased over the past 20 years, becoming a significant public health issue observed mainly in countries in Central America and Asia, primarily affecting young male agricultural workers. The presence of toxin-, environmental-, and work-related risk factors in the affected communities suggests a multifactorial cause, which may involve exposure to agrochemicals, environmental contaminants, and repeated episodes of dehydration. An understanding of the social conditions that bring these factors together in specific groups is essential for the development of public health programs to prevent this devastating epidemic. After a brief background, this essay discusses the paradigm of disease causality implied in the available literature on CKDnT, namely "multicausality", puts it in its historical context, and presents its strengths and limitations. The essay then presents two causality paradigms that could help move forward research about the causes of this disease, specifically the socioecological and the social determination of health approaches. The essay concludes with recommendations for a research and intervention agenda that focuses on explaining the causes of CKDnT.

The Importance of Otoneurological Evaluation in Brazilian Workers Exposed to Pesticides: A Preliminary Study

Introduction: Agrochemicals, also known as pesticides, are widely used in agriculture and in public health. They are organic and inorganic chemical substances with a high level of toxicity not only for the environment, but also for human health. Objective: To verify findings on labyrinthine assessment in endemic disease control agents, and to recommend the inclusion of the vestibular exam in the set of tests for pesticide-exposed populations. Methods: Descriptive, prospective, cross-sectional study with a sample comprising 15 endemic disease control agents, males, mean age of 51.6 years old (standard deviation [SD] = 5.9). All of the participants were submitted to anamnesis, otorhinolaryngological screening, and vestibular assessment. Results: Regarding the most reported complaints, dizziness (73.4%), headache (60%), and tingling in the extremities (53.4%) were observed. The findings of the vestibular exams were normal in 53.3%, while 46.7% showed peripheral vestibular disorder, of which 26.7% were of deficitary type, and 20% of the irritative type. Conclusions: Alteration in the vestibular system was verified in 50% of the workers, with a greater prevalence in the caloric testing. Several disorders related to pesticides intoxication are scientifically known. Actions promoting knowledge and qualification of this population for the proper handling of chemicals are suggested, in addition to the elaboration and inclusion of protocols of vestibular assessment in hearing health programs for the prevention, diagnosis and treatment of vestibular disorders (AU)

Effect of Short-Term Inhalation of The Herbicide 2, 4D on Cardiac Remodeling: Morphological Aspects

Brazil is the worldwide leader in the long-term use of pesticides and herbicides. This compromises the health of handlers by causing harmful neurological, respiratory, and cardiovascular changes. The herbicide 2.4D has been shown to cause cardiac overload with subsequent pathological remodeling. Objective: To analyze the cardiac morphological repercussions on the left ventricle (LV) of mice submitted to nebulization by the herbicide 2.4D. Methods: Fifteen mice were divided into three groups: control group (CG; n = 5) exposed to nebulization with sodium chloride solution; low concentration group (LCG; n = 5) exposed to nebulization of the herbicide 2.4D with 3.71 x 10-3 grams; and high concentration group (HCG; n = 5) exposed to nebulization of the herbicide 2.4D with 9.28 x 10-3 grams for 15 minutes. The fractal dimension analysis was performed through the box-counting method. Later, the ImageJ program was used to calculate the fractal dimension of each group. To evaluate cardiac remodeling, histological slides were prepared and stained with Hematoxylin-Eosin (HE). Fifty areas of cardiomyocytes were analyzed per animal. The comparisons between groups were performed by ANOVA One-Way with Tukey's posttest (p < 0.05). Results: There was no change in fractal dimension values between the CG = 1.37 ± 0.02, LCG = 1.33 ± 0.04 and the HCG = 1.33 ± 0.07 groups. However, cardiac hypertrophy occurred in the HCG = 303.9 ± 38.80 µm(2) when compared to the CG group = 236.9 ± 61.71 µm(2) (p = 0.034). Conclusion: The herbicide 2.4D used for 72 hours did not promote cardiotoxicity when evaluated by fractal dimension. However, cardiomyocyte hypertrophy was observed in the LV

Mesoamerican Nephropathy.

Mesoamerican endemic nephropathy is a type of chronic kidney disease of unknown origin, present in pockets of high prevalence along the Pacific Ocean coast of the Mesoamerican region, from southwest Mexico to Costa Rica. The disease is common in young adult men, most often yet not exclusively from agricultural communities, and with a high mortality rate. Kidney biopsy specimens show primarily tubular atrophy and interstitial fibrosis with some glomerular changes attributed to ischemia. Exposure to agrochemicals, heavy metals or metalloids, intense physical activity under heat stress with dehydration, infections, among other possible causes have been hypothesized as the culprit of the disease. Hypokalemia and hyperuricemia are frequent clinical features. Early diagnosis is key to initiate timely treatment and slow down the progression to end-stage kidney disease. At present, our knowledge about the magnitude of the disease burden imposed by Mesoamerican endemic nephropathy is clearly incomplete and its cause has not been determined. There is a need to implement epidemiologic and mechanistic research projects as well as formal chronic kidney disease and end-stage kidney disease registries in the Mesoamerican region to better understand the real extent of the epidemic, delimit risk populations, and to construct sound public health policy decisions.

Agrotóxicos: a ciência e o ataque aos mensageiros / Agrochemicals: science and the attack on the messengers

A pressão ou a tentativa de constranger os pesquisadores é conduta que afronta à ordem jurídica brasileira. A mensagem dos pesquisadores é clara: os dados científicos apontam que estamos expondo a sociedade a níveis críticos de veneno. É contrária à Constituição e ao nosso modelo de organização social a postura de quem ataca o mensageiro, por mais incômodo que seja o conteúdo da mensagem.

Producción subjetiva sobre la exposición a agroquímicos. Revisión de la bibliografía científica / Subjective production of exposure to agrochemicals. A scoping review

Resumen La intensificación de la producción agrícola en los países del cono sur de Latinoamérica ha implicado un incremento en la utilización de agroquímicos. La producción científica disponible en salud se ha concentrado en los aspectos epidemiológicos, y son escasos los estudios que contemplan las dimensiones sociales de la exposición a estas sustancias. Esta revisión bibliográfica tuvo el objetivo de relevar las publicaciones científicas que estudian la producción subjetiva de colectivos expuestos a agroquímicos. Para eso se revisaron artículos en las bases SCOPUS, PubMed, BVS, Scielo y DOAJ, que fueron publicados entre 1991 y 2016. A su vez, como estrategia adicional se revisaron las referencias bibliográficas de los artículos seleccionados. Entre los resultados obtenidos se destaca que lo subjetivo adquiere distintas denominaciones, donde los estudios de percepción de riesgo y de creencias en salud son los dominantes. En cuanto a la explicación- comprensión de los procesos subjetivos, una serie de artículos únicamente contemplan los estilos de vida individuales, y otra porción incorpora los modos de vida colectivos. Lo diverso de los resultados indica que se trata de un campo de estudios en disputa, donde convergen enfoques positivistas y funcionalistas, con estudios situados históricamente y de perspectiva crítica.

Abstract The intensification of agriculture in countries of the Southern Cone of Latin America has led to a significant rise in the use of agrochemicals. Scientific output in the field of health has concentrated on the epidemiological aspects of this issue and studies addressing the social dimensions of exposure to these substances remain scarce. The aim of this scoping review was to assess the scientific literature on the subjective production of groups exposed to agrochemicals. To this end, searches were conducted of the Scopus, PubMed, BVS, SciELO, and DOAJ databases for articles published between 1991 and 2016. A complementary search strategy drawing on references to other studies in the selected articles was also adopted. The findings show that the studies give subjective production different names and that the predominant themes covered by the literature were risk perception and health beliefs. With regard to understanding-explaining the subjective production process, a series of articles focused on individual lifestyles, while another group considered collective ways of life. The wide-ranging findings suggest that this area is a field of study in dispute, where positivist and functionalist approaches converge with historically situated studies that adopt a critical perspective.

Cohort study of workers at a New Zealand agrochemical plant to assess the effect of dioxin exposure on mortality.

OBJECTIVES: To describe how the exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) influenced mortality in a cohort of workers who were exposed more recently, and at lower levels, than other cohorts of trichlorophenol process workers. DESIGN: A cohort study. SETTING: An agrochemical plant in New Zealand PARTICIPANTS: 1,599 men and women working between 1 January 1969 and 1 November 1988 at a plant producing the herbicide 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) with TCDD as a contaminant. Cumulative TCDD exposure was estimated for each individual in the study by a toxicokinetic model. PRIMARY OUTCOME MEASURES: Calculation of cause-specific standardised mortality ratios (SMRs) and 95% confidence intervals (95% CI's) compared those never and ever exposed to TCDD. Dose-response trends were assessed firstly through SMRs stratified in quartiles of cumulative TCCD exposure, and secondly with a proportional hazards model. RESULTS: The model intercept of 5.1 ppt of TCDD was consistent with background TCDD concentrations in New Zealand among older members of the population. Exposed workers had non-significant increases in all-cancer deaths (SMR=1.08, 95% CI 0.86 to 1.34), non-Hodgkin lymphoma (SMR=1.57, 95% CI: 0.32 to 4.59), soft tissue sarcoma (one death) (SMR=2.38, 95% CI: 0.06 to 13.26), diabetes (SMR=1.27, 95% CI: 0.55 to 2.50) and ischaemic heart disease (SMR=1.21, 95% CI: 0.96 to 1.50). Lung cancer deaths (SMR=0.95, 95% CI: 0.56 to 1.53) were fewer than expected. Neither the stratified SMR nor the proportional hazard analysis showed a dose-response relationship. CONCLUSION: There was no evidence of an increase in risk for 'all cancers', any specific cancer and no systematic trend in cancer risk with TCDD exposure. This argues against the carcinogenicity of TCDD at lower levels of exposure.