Environmental Health Risk Perception: Adaptation of a Population-Based Questionnaire from Latin America.

BACKGROUND: Environmental risk assessments and interventions to mitigate environmental risks are essential to protect public health. While the objective measurement of environmental hazards is important, it is also critical to address the subjective perception of health risks. A population's perception of environmental health hazards is a powerful driving force for action and engagement in safety and health behaviors and can also inform the development of effective and more sustainable environmental health policies. To date, no instruments are available to assess risk perception of environmental health hazards in South America even though there are many concerning issues in the region, including mining. OBJECTIVE: We aimed to adapt and validate an environmental health risk perception questionnaire in a Chilean population affected by mining activity among other risks frequently reported in Latin American countries and included the collection of information on trust on public information sources. METHODS: We adapted an Australian risk perception questionnaire for validation in an adult population from a Chilean mining community. This adaptation included two blinded translations (direct, inverse), a pre-test study (n = 20) and a review by environmental health experts. Principal Component Analyses (PCA) was used to identify factors within major domains of interest. The Bartlett test of sphericity, Kaiser-Meyer-Olkin (KMO) measure and the Cronbach α test were used to assess the instrument's validity and reliability. The instrument was pilot tested in 205 adults from a mining community in Chañaral. RESULTS: The final adapted questionnaire proved to be a good instrument to measure risk perception in a community chronically exposed to mining waste. For community risks, four factors explained 59.4% of the variance. "Global Issues" (30.2%) included air pollution, contamination of mining, ozone layer depletion and vector diseases. For personal risks, the first two components explained 59.5% of the variance, the main factor (36.7%) was "unhealthy behaviors within the household". For trust in information, the first factor (36.2%) included as main sources "Media and authorities". The Cronbach α ranged between 0.68 and 0.75; and the KMO test between 0.7 to 0.79 for community and personal risks and trust. CONCLUSIONS: The final questionnaire is a simple, reliable and useful instrument that can assist in evaluating environmental health risk perceptions in Latin American countries.

A Positive Relationship between Exposure to Heavy Metals and Development of Chronic Diseases: A Case Study from Chile.

Chile is a mining country, where waste mining is frequently found in the vicinity of inhabited areas. To explore the association between metal exposure and alterations in glucose metabolism, inflammatory status, and oxidative stress in individuals with chronic exposure to metals, a cross-sectional study was performed with 25 volunteers, between 45-65 years old. Inductive coupled plasma mass spectrometry (ICP-MS) was used to measure urinary levels of total arsenic (As) and its metabolites, cooper, nickel, chromium, and lead. Lipid profile, glucose, and insulin were measured in blood, as well as inflammation (interleukin-6, IL-6) and oxidative stress (8-hydroxy-2'deoxyguanosine, 8-OHdG) markers. Increased levels of Low-density lipoprotein, high-density lipoproteins, cholesterol and 8-OHdG, and the index for homeostasis model assessment-insulin resistance (HOMA-IR) were observed in 72%, 60%, and 56% of the volunteers, respectively. Blood-glucose levels were correlated with dimethylarsinic acid (DMA) (R2 = 0.47, p = 0.019), inorganic As (Asi) (R2 = 0.40, p = 0.012), and Ni (R2 = 0.56; p = 0.044). The models with these compounds explained 72% of the glycemia variability (ßDMA = -6.47; ßAsi = 6.68; ßNi = 6.87). Ni showed a significantly influence on IL-6 variability (ß = 0.85: R2 = 0.36). Changes in glycemia could be related to exposure to low levels of Asi and Ni, representing risk factors for metabolic diseases. Body mass index would confuse the relation between IL-6 and Ni levels, probably due to known chronic inflammation present in obese people.

An integrated study of health, environmental and socioeconomic indicators in a mining-impacted community exposed to metal enrichment.

The occurrence of toxic metals and metalloids associated with mine tailings is a serious public health concern for communities living in mining areas. This work explores the relationship between metal occurrence (e.g., spatial distribution in street dusts), human health indicators (e.g., metals in urine samples, lifestyle and self-reported diseases) and socioeconomic status (SES) using Chañaral city (in northern Chile) as study site, where a copper mine tailing was disposed in the periurban area. This study model may shed light on the development of environmental and health surveillance plans on arid cities where legacy mining is a sustainability challenge. High concentrations of metals were found in street dust, with arsenic and copper concentrations of 24 ± 13 and 607 ± 911 mg/kg, respectively. The arsenic concentration in street dust correlated with distance to the mine tailing (r = - 0.32, p-value = 0.009), suggesting that arsenic is dispersed from this source toward the city. Despite these high environmental concentrations, urinary levels of metals were low, while 90% of the population had concentrations of inorganic arsenic and its metabolites in urine below 33.2 µg/L, copper was detected in few urine samples (< 6%). Our results detected statistically significant differences in environmental exposures across SES, but, surprisingly, there was no significant correlation between urinary levels of metals and SES. Despite this, future assessment and control strategies in follow-up research or surveillance programs should consider environmental and urinary concentrations and SES as indicators of environmental exposure to metals in mining communities.

Urinary Metal Levels in a Chilean Community 31 Years After the Dumping of Mine Tailings.

BACKGROUND: Between 1938 and 1975, the city of Chañaral, located in the north of Chile, received 200 megatons of unregulated mining waste, which created an artificial beach 10 kilometers long and covering an area larger than 4 km2. In 1983, this deposit was classified as a serious case of marine pollution in the Pacific Ocean, according to the Organization for Economic Cooperation and Development. In 1989, dumping ceased due to a judicial order. Until now, the effects of this pollution on the population living around these mine tailings has been unknown. OBJECTIVE: To determine the prevalence of exposure to metals by dust from mine tailings in Chañaral, a city located in the northern mining area of Chile. METHODS: The level of urinary metals in a representative sample of adults from Chanaral was determined. RESULTS: Urinary levels of total arsenic (44.6 µg/L), inorganic arsenic (17.0 µg/L) and nickel (2.8 µg/L) were higher than in other areas of Chile. Levels of copper (17.9 µg/L), mercury (1.6 µg/L) and lead (0.9 µg/L) exceeded international values. Of the total subjects, 67.5%, 30.4%, 29.4%, 16.9%, 13.2 and 9.3% presented with high levels of copper, nickel, total arsenic, inorganic arsenic, mercury and lead, respectively. CONCLUSION: Thirty-one years after suspension of the discharge of mining waste, the local population in this area remains exposed to metals from the mine tailings. Surveillance and remedial actions addressing the Chañaral mine tailings are needed.

Hiperhidrosis: actualización / Update in hyperhidrosis

La hiperhidrosis se presenta en el 1 por ciento de la población general, en sus formas primaria o secundaria y sus distintas variantes clínicas. Se revisan los conceptos actuales en la fisiología y la bioquímica del olor sudoral, las formas clínicas de hiperhidrosis, las enfermedades asociadas y el tratamiento médico, tópico, iontoforesis, y en especial la terapia con toxina botulínica-A. Todas terapias paliativas y de efecto transitorio. En el tratamiento quirúrgico se resaltan los resultados definitivos y permanentes de las simpatectomías; y en axila, la extirpación local de olas glándulas sudorales que logra una espectacular mejoría con técnicas simples y seguras.

Teratoma sacrococcígeo / Sacrococcygeal teratoma

Se presenta un caso de Teratoma Sacrococcigeo en una recién nacida que fue operada de urgencia al tercer día de vida por necrosis de la piel y hemorragia. Se practicó una resección completa del tumor, con extirpación del coccis y de los últimos segmentos del sacro. El estudio histológico reveló tejido glial maduro, plexos coroídeos hiperplásicos, tejido adiposo, músculo estriado y estructuras epiteliales. No se encontró elementos sospechosos de malignidad. Se hace hincapié en la importancia del examen histológico para descartar cualquier sospecha de malignidad, y en una extirpación quirúrgica lo más precoz y completa posible para disminuir las posibilidades de malignización del tumor y mejorar las alternativas de sobrevida de los pacientes