Acute pesticide poisoning: Comparison of epidemiological characteristics between the rural and urban population

Objective: To analyze the behavior of pesticide poisoning associated with lethality in rural and urban populations in Colombia from 2007 to 2017. Methodology: Retrospective observational study that included a descriptive cross-sectional study and an ecological design that analyzed aggregate measures of morbidity, mortality, and risk attributable to the population in rural and urban areas. In the cross-sectional study, the relative risk was estimated to measure the factors associated with lethality among intoxications using Poisson regression with logarithmic function. For the time series, the trends were established with simple linear regression, and the seasonal decomposition was performed using the multiplicative model. Autocorrelations were tested using the Box-Ljung statistic. Results: Between 2007-2017; 89 490 cases were reported. The Morbidity due to poisoning showed a higher proportion in the rural population 36.03 cases per 100 000; this indicator was three times higher than in urban areas (12.33 cases per 100 000). The mortality rates in rural and urban areas were 1.00 and 0.13 cases per 100 000, respectively. The relative risk of fatality in case of intoxication was associated with the intention of suicide in the rural population Relative Risk (RR): 5.9 (95% CI: 5.0-6.9). Conclusion: A higher proportion of lethality associated with these events occurred in populations living in rural areas and reporting cases of suicidal intent. In addition, morbidity and mortality due to pesticide poisoning had the highest proportion in rural areas and a growing trend over time.

Objetivo: Analizar el comportamiento de las intoxicaciones por plaguicidas en poblaciones rurales y urbanas asociadas a la letalidad en Colombia durante 2007-2017. Metodología: Estudio observacional retrospectivo que incluyó: un estudio descriptivo transversal y un diseño ecológico que analizó medidas agregadas de morbilidad, mortalidad y riesgo atribuibles a la población en áreas rurales y urbanas. En el estudio transversal se estimó el riesgo relativo para medir los factores asociados a la letalidad entre las intoxicaciones mediante regresión de Poisson con función logarítmica. Para la serie de tiempo, las tendencias se establecieron con regresión lineal simple y la descomposición estacional se realizó mediante el modelo multiplicativo. Las autocorrelaciones se probaron mediante el estadístico Box-Ljung. Resultados: Entre 2007-2017; Se notificaron 89 490 casos. La Morbilidad por intoxicación presentó mayor proporción en la población rural 36,03 casos por 100 000; este indicador fue tres veces mayor que en las áreas urbanas (12,33 casos por 100 000). Las tasas de mortalidad en el área rural y urbana fueron de 1,00 y 0,13 casos por 100 000, respectivamente. El riesgo relativo de fatalidad en caso de intoxicación se asoció con la intención de suicidio en la población rural RR: 5,9 (IC 95%: 5,0-6,9). Conclusión: Una mayor proporción de letalidad asociada a estos eventos ocurrió en poblaciones que viven en áreas rurales y reportan casos de intención suicida. Además, la morbilidad y mortalidad por intoxicación por plaguicidas tuvo la mayor proporción en las zonas rurales y una tendencia creciente en el tiempo.

Objetivo: Analisar o comportamento das intoxicações por agrotóxicos em populações rurais e urbanas associadas à letalidade na Colômbia durante 2007-2017. Metodologia: Estudo observacional retrospectivo que incluiu: estudo transversal descritivo e delineamento ecológico que analisou medidas agregadas de morbidade, mortalidade e risco atribuíveis à população em áreas rurais e urbanas. No estudo transversal, o risco relativo foi estimado para medir os fatores associados à letalidade entre as intoxicações por meio da regressão de Poisson com função logarítmica. Para as séries temporais, as tendências foram estabelecidas com regressão linear simples e a decomposição sazonal foi realizada usando o modelo multiplicativo. As autocorrelações foram testadas usando a estatística Box-Ljung. Resultados: Entre 2007-2017; 89.490 casos foram notificados. A Morbidade por intoxicação apresentou maior proporção na população rural 36,03 casos por 100.000; este indicador foi três vezes superior ao das zonas urbanas (12,33 casos por 100 000). As taxas de mortalidade nas áreas rural e urbana foram de 1,00 e 0,13 casos por 100.000 habitantes, respectivamente. O risco relativo de fatalidade em caso de intoxicação associou-se à intenção de suicídio na população rural RR: 5,9 (IC 95%: 5,0-6,9). Conclusão: Maior proporção de letalidade associada a esses eventos ocorreu em populações residentes em áreas rurais e com relato de casos de intenção suicida. Além disso, a morbimortalidade por intoxicação por agrotóxicos teve maior proporção na zona rural e tendência crescente ao longo do tempo.

Assessment of Factors Influencing Personal Exposure to Air Pollution on Main Roads in Bogota: A Mixed-Method Study.

Background and Objectives: Particulate Matter (PM), particles of variable but small diameter can penetrate the respiratory system via inhalation, causing respiratory and/or cardiovascular diseases. This study aims to evaluate the association of environmental particulate matter (PM2.5) and black carbon (BC) with respiratory health in users of different transport modes in four roads in Bogotá. Materials and Methods: this was a mixed-method study (including a cross sectional study and a qualitative description of the air quality perception), in 300 healthy participants, based on an exploratory sequential design. The respiratory effect was measured comparing the changes between pre- and post-spirometry. The PM2.5 and black carbon (BC) concentrations were measured using portable devices. Inhaled doses were also calculated for each participant according to the mode and route. Perception was approached through semi-structured interviews. The analysis included multivariate models and concurrent triangulation. Results: The concentration of matter and black carbon were greater in bus users (median 50.67 µg m-3; interquartile range (-IR): 306.7). We found greater inhaled dosages of air pollutants among bike users (16.41 µg m-3). We did not find changes in the spirometry parameter associated with air pollutants or transport modes. The participants reported a major sensory influence at the visual and olfactory level as perception of bad air quality. Conclusions: We observed greater inhaled doses among active transport users. Nevertheless, no pathological changes were identified in the spirometry parameters. People's perceptions are a preponderant element in the assessment of air quality.

Intento de suicidio en Colombia: un estudio de los factores asociados a la intoxicación intencionada. 2007-2017

Objetivo: Identificar los factores asociados a la intoxicación intencionada por plaguicidas en Colombia durante 2007-2017. Metodología: Se llevó a cabo un estudio analítico transversal en la población de intoxicados con intención suicida por plaguicidas de Colombia entre 2007 a 2017. Se calcularon prevalencias ajustadas por edad, expresadas por 100 000 personas contadas por sexo. Se realizó un modelo de regresión bivariado, en el cual la condición final se constituyó en la variable de interés (variable y; 0=vivo 1=muerto) y las variables explicativas fueron (variables x): sociodemográficas (sexo, edad, escolaridad y procedencia) y específicas del evento (vía de exposición). Resultados: el comportamiento de los Odds Ratio evidencia que, los hombres tienen un riesgo de fallecer de 1.39 (95 % IC: 1.238-1.567) más veces que las mujeres. Con respecto al régimen de afiliación en salud, las personas no aseguradas tienen un riesgo de fallecer por suicidio de 1.33 más veces con respecto a los que sobreviven (95 % IC: 1.131-1.555). Para la mortalidad por suicidio se identifican los siguientes factores asociados a la supervivencia (intentos de suicidio no consumados): en primer lugar, el área de residencia urbana y, en segundo lugar, los grupos de edad, adolescente y la adultez temprana. Conclusiones: Al analizar la mortalidad por suicidio asociada a la intoxicación por plaguicidas los hombres son identificados y caracterizados como el grupo de mayor riesgo, siguiendo tendencias generales (todos los métodos) similares a estudios realizados a nivel mundial.

Objective: To identify the social factors associated with intentional poisoning by pesticides in Colombia, during the 2007-2017 period. Methodology: A cross-sectional analytical study was carried out in the population of those intoxicated by pesticides with suicidal intent in Colombia between 2007 and 2017. Age-adjusted prevalences were calculated, expressed per 100,000 people, counted by sex. A bi-variate regression model was carried out, in which the final condition was constituted in the variable of interest (variable y; 0 = alive 1 = dead), and the explanatory variables were (variables x): sociodemographic (sex, age, education and origin) and specific to the event (route of exposure). Results: the behavior of the Odds Ratio shows that men have a risk of dying 1,393 (95% CI: 1,238-1,567) more times than women. Regarding the health affiliation scheme, uninsured people have a risk of dying by suicide 1.33 times more than those who survive (95% CI: 1.131-1.555). For mortality due to suicide, the following factors associated with survival (unsuccessful suicide attempts) are identified: firstly, the urban residence area and secondly, age groups: adolescents and early adulthood. Conclusions: When analyzing suicide mortality associated with pesticide poisoning, men are identified and characterized as the highest risk group, following general trends (all methods) similar to studies carried out worldwide.

Assessment of Personal Exposure to Particulate Air Pollution in Different Microenvironments and Traveling by Several Modes of Transportation in Bogotá, Colombia: Protocol for a Mixed Methods Study (ITHACA).

BACKGROUND: Air pollution in most countries exceeds the levels recommended by the World Health Organization, causing up to one-third of deaths due to noncommunicable diseases. Fine particulate matter (PM2.5) and black carbon (BC) from mobile sources are the main contaminants. OBJECTIVE: The aim of this study is to assess the relationship of exposure to air pollutants (PM2.5 and BC) in microenvironments according to respiratory health and physical activity in users traveling by different types of transportation in Bogotá, Colombia. METHODS: A mixed methods study based on a convergent parallel design will be performed with workers and students. The sample will include 350 healthy transport users traveling by different urban transportation modes in three main routes in Bogotá. The study is broken down into two components: (1) a descriptive qualitative component focused on assessing the individual perception of air pollution using semistructured interviews; and (2) a cross-sectional study measuring the individual exposure to PM2.5 and BC using portable instruments (DustTrak and microAeth, respectively), pulmonary function by spirometry, and physical activity with accelerometry. The analysis will include concurrent triangulation and logistic regression. RESULTS: The findings will be useful for the conception, design, and decision-making process in the sectors of health and mobility from public, academy, and private perspectives. This study includes personal measurements of PM2.5 and BC during typical trips in the city to assess the exposure to these contaminants in the major roadways in real time. The study further compares the performance of two different lung tests to identify possible short-term respiratory effects. As a limitation, the protocol will include participants from different institutions in the city, which are not necessarily representative of all healthy populations in Bogotá. In this sense, it is not possible to draw causation conclusions. Moreover, a convergent parallel design could be especially problematic concerning integration because such a design often lacks a clear plan for making a connection between the two sets of results, which may not be well connected. Nevertheless, this study adopts a procedure for how to integrate qualitative and quantitative data in the interpretation of the results and a multilevel regression. The time that participants must live in the city will be considered; this will be controlled in the stratified analysis. Another limitation is the wide age range and working status of the participants. Regional pollution levels and episodes (PM2.5) will be handled as confounding variables. The study is currently in the enrollment phase of the participants. Measurements have been made on 300 participants. Pandemic conditions affected the study schedule; however, the results are likely to be obtained by late 2022. CONCLUSIONS: This study investigates the exposure to air pollutants in microenvironments in Bogotá, Colombia. To our knowledge, this is the first mixed methods study focusing on PM2.5, BC, and respiratory health effects in a city over 2 meters above sea level. This study will provide an integration of air pollution exposure variables and respiratory health effects in different microenvironments. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/25690.

La "moda del burnout' en el sector salud: una revisión sistemática de la literatura / The «fashion of burnout"in the health sector: a systematic review of the literature

Resumen El propósito de este revisión sistemática fue describir la situación actual del síndrome de burnout en Colombia en estudiantes y trabajadores de las ciencias de la salud. Se realizó una búsqueda en las bases de datos Medline, Scopus, Science Direct, Lilacs y repositorios de revistas como Scielo, Pubmed, Redylacs, BIRE-ME. Se llevó a cabo un filtro inicial mediante títulos y resúmenes de acuerdo con los criterios de inclusión y exclusión. Posteriormente, se evaluó la calidad metodológica y con los estudios incluidos se estimó la prevalencia global. Finalmente se seleccionaron tres estudios. La población total fue de 5874 estudiantes y profesionales de las ciencias de la salud, 96,1 % (n=5647) y 3,86 % (n=227), respectivamente. Esta revisión deja en evidencia que en Colombia, aunque se han realizado varios estudios relacionados con el síndrome de Burnout, aún se requieren más investigaciones con mayor rigurosidad metodológica que profundicen en las intervenciones una vez sea diagnosticado.

Abstract The aim of the present systematic review was to describe the current situation of the Burnout Syndrome in Colombia in students and workers of the health sciences. A search was made in the databases: Medline, Scopus, Science Direct, Lilacs and magazine repositories: Scielo, Pubmed, Redylacs, BIREME. An initial filter was carried out through titles and abstracts according to the inclusion and exclusion criteria. Subsequently, the methodological quality was evaluated and with the included studies, the overall prevalence was estimated. Finally, three studies were selected, the total population was of 5874 students and professionals of the health sciences, 96.1% (n = 5647) and 3.86% (n = 227) respectively. This review shows that in Colombia, although several studies related to Burnout Syndrome have been carried out, there is still more research with greater methodological rigor that delves into complications once the syndrome is diagnosed.

SARS-CoV-2 and work-related transmission: results of a prospective cohort of airport workers, 2020.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has spread rapidly around the globe. Even though multiple strategies are available for controlling infectious respiratory diseases, the current approach for managing this pandemic is the prevention of person-to-person transmission. Despite the quarantine strategy, some work positions must remain active, such as airport personnel. OBJECTIVES: To identify risk factors for COVID-19 transmission among workers at the El Dorado, Luis Carlos Galán Airport from March to July 2020. METHODS: This is a prospective cohort study with workers of the El Dorado International Airport, in Bogotá, Colombia. A sociodemographic questionnaire was for searching for symptoms associated with COVID-19 and other risk factors. Nasopharyngeal swabs were collected for determining the presence of COVID-19. In order to identify seroconversion, we used an automated chemiluminescent immunoassay for anti-SARS-CoV-2 IgM and IgG antibodies. Patients with positive results were followed-up for 21 days. RESULTS: We observed an incidence of infection of 7.9%; most cases were asymptomatic. The main risk factor associated with infection was the duration of daily commute (relative risk 1.02 [95% confidence interval, 1.002-1.041]). CONCLUSIONS: We observed asymptomatic infection by COVID-19 among airport workers. Future research should contribute with knowledge for developing strategies that guarantee the protection of airport workers.

From environment to clinic: the role of pesticides in antimicrobial resistance.

Antimicrobial resistance (AMR) in pathogens has been associated mainly with excessive use of antibiotics. Most studies of resistance have focused on clinical pathogens; however, microorganisms are exposed to numerous anthropogenic substances. Few studies have sought to determine the effects of chemical substances on microorganisms. Exposure to these substances may contribute to increased rates of AMR. Understanding microorganism communities in natural environments and AMR mechanisms under the effects of anthropogenic substances, such as pesticides, is important to addressing the current crisis of antimicrobial resistance. This report draws attention to molecules, rather than antibiotics, that are commonly used in agrochemicals and may be involved in developing AMR in non-clinical environments, such as soil. This report examines pesticides as mediators for the appearance of AMR, and as a route for antibiotic resistance genes and antimicrobial resistant bacteria to the anthropic environment. Available evidence suggests that the natural environment may be a key dissemination route for antibiotic-resistant genes. Understanding the interrelationship of soil, water, and pesticides is fundamental to raising awareness of the need for environmental monitoring programs and overcoming the current crisis of AMR.

La resistencia a los antimicrobianos (RAM) en los agentes patógenos ha sido relacionada principalmente con el uso excesivo de los antibióticos. La mayoría de los estudios sobre la resistencia se han centrado en los agentes patógenos de importancia clínica; sin embargo, los microorganismos están expuestos a numerosas sustancias antropogénicas. Son muy pocos los estudios dedicados a determinar los efectos que producen las sustancias químicas en los microorganismos. La exposición a estas sustancias puede contribuir a los niveles mayores de la RAM. Comprender las comunidades de microorganismos en el medioambiente natural y los mecanismos de la RAM por los efectos de las sustancias antropogénicas, como los plaguicidas, resulta importante para abordar la actual crisis de la resistencia a los antimicrobianos. En este informe se hace énfasis en las moléculas, en lugar de los antibióticos, que se usan generalmente en los productos agroquímicos y que podrían contribuir a que se desarrolle la RAM en entornos no clínicos, como el suelo. Asimismo, se analiza el papel de los plaguicidas como mediadores en la aparición de la RAM, así como la manera en la que los genes y los microorganismos resistentes a los antibióticos se trasladan hacia el entorno antrópico. La evidencia indica que el entorno natural podría ser una vía clave de propagación para los genes resistentes a los antibióticos. Comprender la interrelación entre el suelo, el agua y los plaguicidas es fundamental para crear consciencia en cuanto a la necesidad de establecer programas de seguimiento ambiental y así poder superar la crisis actual de la RAM.

A resistência antimicrobiana dos patógenos está principalmente associada ao uso excessivo de antibióticos. Os estudos sobre resistência se concentram, na sua maioria, nos patógenos de importância clínica. Porém, os microrganismos são expostos a inúmeras substâncias antropogênicas e existem poucos estudos sobre os efeitos que os compostos químicos causam nos microrganismos. A exposição a estes compostos pode contribuir para o aumento da resistência antimicrobiana. Entender as comunidades de microrganismos em ambiente natural e os mecanismos de resistência antimicrobiana por ação das substâncias antropogênicas, como os pesticidas, é essencial no combate à atual crise de resistência antimicrobiana. Este informe destaca os compostos ativos (exceto antibióticos) normalmente usados nos produtos agroquímicos que podem contribuir para o surgimento de resistência antimicrobiana em ambientes não clínicos, como o solo. Examina-se o papel dos pesticidas como mediadores da resistência antimicrobiana e as vias pelas quais os genes que conferem resistência e as bactérias resistentes aos antimicrobianos alcançam o ambiente antrópico. As evidências indicam que o ambiente natural pode ser uma das principais vias de disseminação dos genes que conferem resistência aos antibióticos. Entender a inter-relação entre solo, água e pesticidas é fundamental para conscientizar sobre a necessidade de programas de monitoramento ambiental e combater a atual crise de resistência antimicrobiana.

From environment to clinic: the role of pesticides in antimicrobial resistance

[ABSTRACT]. Antimicrobial resistance (AMR) in pathogens has been associated mainly with excessive use of antibiotics. Most studies of resistance have focused on clinical pathogens; however, microorganisms are exposed to numerous anthropogenic substances. Few studies have sought to determine the effects of chemical substances on microorganisms. Exposure to these substances may contribute to increased rates of AMR. Understanding microorganism communities in natural environments and AMR mechanisms under the effects of anthropogenic substances, such as pesticides, is important to addressing the current crisis of antimicrobial resistance. This report draws attention to molecules, rather than antibiotics, that are commonly used in agrochemicals and may be involved in developing AMR in non-clinical environments, such as soil. This report examines pesticides as mediators for the appearance of AMR, and as a route for antibiotic resistance genes and antimicrobial resistant bacteria to the anthropic environment. Available evidence suggests that the natural environment may be a key dissemination route for antibiotic-resistant genes. Understanding the interrelationship of soil, water, and pesticides is fundamental to raising awareness of the need for environmental monitoring programs and overcoming the current crisis of AMR.

[RESUMEN]. La resistencia a los antimicrobianos (RAM) en los agentes patógenos ha sido relacionada principalmente con el uso excesivo de los antibióticos. La mayoría de los estudios sobre la resistencia se han centrado en los agentes patógenos de importancia clínica; sin embargo, los microorganismos están expuestos a numerosas sustancias antropogénicas. Son muy pocos los estudios dedicados a determinar los efectos que producen las sustancias químicas en los microorganismos. La exposición a estas sustancias puede contribuir a los niveles mayores de la RAM. Comprender las comunidades de microorganismos en el medioambiente natural y los mecanismos de la RAM por los efectos de las sustancias antropogénicas, como los plaguicidas, resulta importante para abordar la actual crisis de la resistencia a los antimicrobianos. En este informe se hace énfasis en las moléculas, en lugar de los antibióticos, que se usan generalmente en los productos agroquímicos y que podrían contribuir a que se desarrolle la RAM en entornos no clínicos, como el suelo. Asimismo, se analiza el papel de los plaguicidas como mediadores en la aparición de la RAM, así como la manera en la que los genes y los microorganismos resistentes a los antibióticos se trasladan hacia el entorno antrópico. La evidencia indica que el entorno natural podría ser una vía clave de propagación para los genes resistentes a los antibióticos. Comprender la interrelación entre el suelo, el agua y los plaguicidas es fundamental para crear consciencia en cuanto a la necesidad de establecer programas de seguimiento ambiental y así poder superar la crisis actual de la RAM.

[RESUMO]. A resistência antimicrobiana dos patógenos está principalmente associada ao uso excessivo de antibióticos. Os estudos sobre resistência se concentram, na sua maioria, nos patógenos de importância clínica. Porém, os microrganismos são expostos a inúmeras substâncias antropogênicas e existem poucos estudos sobre os efeitos que os compostos químicos causam nos microrganismos. A exposição a estes compostos pode contribuir para o aumento da resistência antimicrobiana. Entender as comunidades de microrganismos em ambiente natural e os mecanismos de resistência antimicrobiana por ação das substâncias antropogênicas, como os pesticidas, é essencial no combate à atual crise de resistência antimicrobiana. Este informe destaca os compostos ativos (exceto antibióticos) normalmente usados nos produtos agroquímicos que podem contribuir para o surgimento de resistência antimicrobiana em ambientes não clínicos, como o solo. Examina-se o papel dos pesticidas como mediadores da resistência antimicrobiana e as vias pelas quais os genes que conferem resistência e as bactérias resistentes aos antimicrobianos alcançam o ambiente antrópico. As evidências indicam que o ambiente natural pode ser uma das principais vias de disseminação dos genes que conferem resistência aos antibióticos. Entender a inter-relação entre solo, água e pesticidas é fundamental para conscientizar sobre a necessidade de programas de monitoramento ambiental e combater a atual crise de resistência antimicrobiana.

La consulta en los tiempos de WhatsApp: una revisión rápida de la literatura / The Consultation in the Times of WhatsApp: A Quick Review of the Literature

Resumen Las tecnologías digitales en salud han permitido que los pacientes estén mejor informados, reducir tiempos y distancias para intervenciones en salud, lo que ha generado un cambio en la relación médico-paciente. El objetivo de este artículo fue explorar la evidencia relacionada con la influencia de WhatsApp en la relación médico-paciente. Por ello, se realizó una rápida revisión de la literatura en cinco bases de datos científicas. Obtuvimos un total de cuatro estudios que completaron los criterios de inclusión para la revisión: un reporte de caso, un estudio de casos y controles y dos estudios observacionales. El 65 % de los estudios incluidos informaron el uso de WhatsApp para la relación médico-paciente. La aplicación WhatsApp puede ser una herramienta útil como canal de comunicación en la relación. Se requiere tener especial cuidado con los aspectos éticos y legales de la comunicación entre profesionales y pacientes.

Abstract Digital technologies in health have allowed patients to be better informed, reduce times and distances for interventions in health, which has generated a change in the doctor-patient relationship. The objective of this article was to explore the evidence related to the influence of WhatsApp among the doctor-patient relationship. Therefore, a rapid review of the literature was carried out in five scientific databases. We obtained a total of four studies who completed the inclusion criteria for the review: a report case study, a case-control study, and two descriptive studies. 65% of the included studies reported the usage of WhatsApp for medical - patient relationship. WhatsApp application can be a useful tool as a communication channel in the relationship. Is required to take special care with ethical and legal aspects of communication between professionals and patients.

Postbiotics for Preventing and Treating Common Infectious Diseases in Children: A Systematic Review.

Postbiotics have recently been tentatively defined as bioactive compounds produced during a fermentation process (including microbial cells, cell constituents and metabolites) that supports health and/or wellbeing. Postbiotics are currently available in some infant formulas and fermented foods. We systematically reviewed evidence on postbiotics for preventing and treating common infectious diseases among children younger than 5 years. The PubMed, Embase, SpringerLink, and ScienceDirect databases were searched up to March 2019 for randomized controlled trials (RCTs) comparing postbiotics with placebo or no intervention. Seven RCTs involving 1740 children met the inclusion criteria. For therapeutic trials, supplementation with heat-killed Lactobacillus acidophilus LB reduced the duration of diarrhea (4 RCTs, n = 224, mean difference, MD, -20.31 h, 95% CI -27.06 to -13.57). For preventive trials, the pooled results from two RCTs (n = 537) showed that heat-inactivated L. paracasei CBA L74 versus placebo reduced the risk of diarrhea (relative risk, RR, 0.51, 95% CI 0.37-0.71), pharyngitis (RR 0.31, 95% CI 0.12-0.83) and laryngitis (RR 0.44, 95% CI 0.29-0.67). There is limited evidence to recommend the use of specific postbiotics for treating pediatric diarrhea and preventing common infectious diseases among children. Further studies are necessary to determine the effects of different postbiotics.

Epigenómica social y conflicto armado: ¿por qué apostarle a la paz? / Social epigenomics and armed conflict: ¿why rooting for peace? / Epigenómica social e conflito armado: o porquê apostar à paz?

This paper presents a summary of the scientific evidence that accounts for the epigenetic effects and their phenotypic ex-pression of exposure to chronic stress environments, typical of populations exposed to armed conflict, considering also the potential implications for the achievement of wellbeing.Materials and methods. A narrative review of the literature of the last 10 years was conducted in Medline, Science Direct and Lilacs databases and repositories of journals such as: Scie-lo and BIREME. An initial filter was carried out through titles and abstracts according to the inclusion and exclusion criteria. Afterwards, full text reading was performed in the selected ar-ticlesResults. 33 articles were obtained for full text reading. Among the main documented effects, the alteration of gene expression to stress was reported through neuronal activation (hypothala-mic-pituitary-adrenal axis) with greater sensitivity to glucocor-ticoids, leading to chronic stress and increased prevalence of non-transmittable chronic diseases.

O presente trabalho apresenta um resumo da evidencia cien-tífica que dá conta dos efeitos epigenéticos e a sua expressão fenotípica da exposição a ambientes de estrese crónico, pró-prios de populações expostas ao conflito armado, consideran-do além das implicações potenciais para atingir um bom viver.Materiais e Métodos. Realizou-se uma revisão narrativa de li-teratura dos últimos 10 anos nas bases de dados Medline e Science Direct e repositórios como SciELO e BIREME. Foram filtrados artigos a traves de critérios de inclusão e exclusão, posteriormente foi realizada uma leitura completa dos tex-to selecionados.Resultados. Foram lidos 33 artigos para leitura de texto com-pleto. Entre os principais efeitos documentados foram repor-tados a alteração da expressão genética ao estresse a través da activação neuronal (eixo hipotálamo -pituitaria- suprarenal) com maior sensibilidade aos glucocorticoides, conducente ao estrese crónico e aumento da prevalência de doenças crónicas não transmissíveis.

El presente trabajo presenta un resumen de la evidencia científica que da cuenta de los efectos epigenéticos y la expresión fenotípica, de la expo-sición a ambientes de estrés crónico, propios de poblaciones expuestas al conflicto armado; considerando, además, las implicaciones potenciales para el logro de un buen vivir.Materiales y métodos. Se hizo una revisión narrativa de la literatura cien-tífica de los últimos 10 años, en bases de datos Medline y Science Direct y repositorios de revistas como SciELO y BIREME. Se llevó a cabo un filtro inicial mediante títulos y resúmenes, de acuerdo con los criterios de inclu-sión y exclusión. Posteriormente, se hizo la lectura del texto completo en los artículos seleccionados.Resultados. Se obtuvieron 33 artículos para lectura de texto completo. Entre los principales efectos documentados, se reportó la alteración de la expresión génica al estrés mediante activación neuronal (eje hipotála-mo-hipófiso-suprarrenal) con mayor sensibilidad a los glucocorticoides, conducente a estrés crónico y aumento de prevalencia de enfermedades crónicas no transmisibles.

Cambio climático y salud humana: una revisión desde la perspectiva colombiana / Climate change and human health: a review from the Colombian perspective

Resumen Este trabajo tiene como objetivo recoger la evidencia científica sobre los efectos del cambio climático sobre la salud humana con énfasis en Colombia. Se llevó a cabo una revisión en bases de datos y repositorios de revistas por medio de un algoritmo de términos MeSH. Fueron incluidos artículos originales, revisiones sistemáticas o metaanálisis que estuvieran disponibles en texto completo o disponible en las bases de datos y repositorios consultados. Se usaron restrictores de idioma, tiempo e idioma. Fueron elegidos 268 títulos en las bases de datos, repositorios de revistas y trabajos de literatura gris: 29 % correspondió a trabajos sobre seguridad alimentaria, 25 % a publicaciones sobre enfermedades transmisibles, 35 % a efectos sobre la calidad del aire y enfermedades respiratorias y 11 % a publicaciones que abordaban varios temas. Solo fueron encontradas 17 publicaciones sobre trabajos colombianos. La evidencia científica revisada permite afirmar que el cambio climático tiene una afectación transversal a la población mundial a distintos niveles y escenarios. El cambio climático afecta la salud humana de forma directa e indirecta. Por otro lado, es importante resaltar que las publicaciones que dan cuenta de los efectos del cambio climático en Colombia se centran en las enfermedades transmitidas por vectores.

Abstract This paper aims to collect the scientific evidence on the effects of climate change on human health with emphasis in Colombia. A review was performed on databases and journal repositories using a MeSH algorithm. Included were original articles, systematic reviews or meta-analyses, which were available in full text or available in databases and repositories consulted. Language, time and language constraints were used. 268 titles were selected from the databases, journal repository and websites. 29 % corresponded to work on food safety, 25 % to publications on communicable diseases, 35 % effects on air quality and respiratory diseases and 11 % about multiple issues. Only 17 papers came from Colombian researches. The revised scientific evidence to suggest that climate change has a cross to the world population affected at different levels and stages. Climate change affects human health directly and indirectly. Furthermore, it is important to highlight the discrete number of publications found to document the effects of climate change in Colombia.

Una deuda del pasado: efectos de los organoclorados en trabajadores del programa de control de vectores - Colombia / A debt from the past: effects of organochlorines in workers of vector control program - Colombia

Introducción: En Colombia se supone no se usan organoclorados debido a la ratificación de la Convención de Estocolmo y el Convenio de Rotterdam, que prohíben el uso de este tipo de sustancias. Objetivo: Evaluar la exposición a plaguicidas organoclorados empleados en salud publica en la población trabajadora del programa de control de vectores en Colombia en 2013. Métodos: Se realizó un estudio descriptivo de corte transversal en el grupo de trabajadores del programa de control de enfermedades transmitidas por vectores. A todos los participantes se aplicó un cuestionario estandarizado para recolectar variables sociodemográficas, ocupacionales, clínicas y toxicológicas. Se determinaron los niveles de 13 organoclorados en suero mediante cromatografía de gases en el Instituto Nacional de Salud de Colombia. Resultados: El reporte de manipulación de insecticidas organoclorados fue del 39,1%. El 100% de los trabajadores que usaron organoclorados refirieron el uso DDT. El 7,5% refirieron el uso de Aldrin. El 100% de los trabajadores refirió ausencia de elementos de protección individual durante la manipulación de clorados. Los organoclorados con niveles más altos fueron 4,4- DDT y α -HCH. Los síntomas de mayor presentación fueron: cefalea 28,7%, mareo 29,9%, disminución de fuerza en miembros superiores 17,2% y síntomas neuropsiquiátricos 24%. Se encontró una asociación entre la exposición laboral a DDT y síntomas neuropsiquiátricos. Conclusiones: El promedio de DDT en sangre de los trabajadores en Colombia son superiores a los reportados en la literatura. Los hallazgos de síntomas neuropsiquiátricos y la exposición laboral a organoclorados concuerdan con los reportes de la literatura.

Introduction: It is assumed that in Colombia organochlorides are not used due to the ratification of the Stockholm Convention and the Rotterdam Convention, forbidding the use of those substances. Objective: To evaluate exposure to organochloride pesticides used in the working population of the vector control program in Colombia, 2013. Methods: A descriptive cross-sectional study was performed in the group of workers from the vector-borne disease management program. To all participants were applied a standardized questionnaire to collect sociodemographic, occupational, clinical and toxicological variables. Thirteen organochloride levels in serum were measured by gas chromatography at the National Institute of Health of Colombia. Results: The report show using of organochloride insecticides in the 39.1%. One hundred percent of the workers who used organochlorides reported use of DDT. 7,5% reported use of aldrin. One hundred percent or the workers referred the absence of elements of personal protection when implementing chlorinated compounds. Organochlorides with higher levels were 4,4- DDT y α -HCH. The most common symptoms were: headache 28.7%, dizziness 29.9%, decreased strength in upper limbs 17.2% and neuropsychiatric symptoms 24%. An association between occupational exposure to DDT and neuropsychiatric symptoms were found. Conclusions: The average of DDT in blood of workers in Colombia is higher than those reported in the literature. Findings of neuropsychiatric symptoms and occupational exposure to organochloride are consistent with literature reports.

Caracterización de las condiciones de salud respiratoria de los trabajadores expuestos a polvo de carbón en minería subterránea en Boyacá, 2013 / Characterization of respiratory health conditions of workers exposed to coal dust in underground mining in Boyacá, 2013.

Introducción: la neumoconiosis de los mineros de carbón es una enfermedad pulmonar ocupacional asociada a factores individuales y condiciones laborales específicas. Se manifiesta progresiva e irreversiblemente, afectando la salud de los trabajadores y la productividad laboral. Objetivo: caracterizar las condiciones de salud respiratoria e identificar los factores de riesgo asociados al desarrollo de neumoconiosis en trabajadores que han laborado expuestos a polvo de carbón en minas de socavón en Boyacá, 2013. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en trabajadores de minería de socavón expuestos a polvo de carbón en el departamento de Boyacá. Se llevó a cabo un registro completo de historia clínica ocupacional, examen físico completo, toma de radiografía de tórax, prueba de tuberculina y espirometría. Resultados: participaron 170 trabajadores masculinos. 75% de la población tenía antigüedad en el sector minero mayor a 12,5 años. Roncus, sibilancias y estertores predominaron en trabajadores con más de 20 años de antigüedad. Expectoración y tos se encontraron más frecuentemente en quienes realizaban la extracción mecanizada. El 15,9% de las radiografías de tórax fueron compatibles con neumoconiosis, 17,1% de las pruebas de tuberculina se encontraron positivas. 5,3% de las espirometrías mostraron alteraciones de vía aérea periférica y 2,4% mostraron patrón obstructivo. Discusión y conclusión: Los cambios radiológicos sugestivos de neumoconiosis fueron más frecuentes en trabajadores con antigüedad menor de 20 años. Los hallazgos espirométricos anormales predominaron en el grupo con antigüedad mayor a 20 años. Es necesario revisar protocolos de vigilancia epidemiológica y realizar seguimiento por medicina laboral.

Introduction: coal miners' pneumoconiosis is an occupational lung disease associated with individual factors and specific working conditions. It is manifested progressively and irreversibly, affecting the health of workers and labor productivity. Objective: To characterize the respiratory health conditions and identify risk factors associated with the development of pneumoconiosis in workers that have been exposed to coal dust in the underground mines at Boyacá, 2013. Materials and Methods: A descriptive cross-sectional study was conducted among mining workers exposed to coal dust in the department of Boyacá. It was conducted a complete record of occupational medical history, physical exam, taking chest radiography, tuberculin test and spirometry. Results: 170 male workers participated. 75% of the population had worked in the mining sector for more than12.5 years old. Rhonchi, wheezing and rattling predominated in workers over 20 years old. Expectoration and cough were most frequently found in those who made mechanized extraction. 15.9% of chest X rays were compatible with pneumoconiosis, 17.1% of tuberculin tests were found positive. 5.3% of spirometries showed peripheral airway abnormalities and 2.4% showed obstructive pattern. Discussion and conclusion: Radiological changes suggestive of pneumoconiosis were more frequent in workers under 20 years old. Abnormal spirometric findings predominated in the group with more than 20 years old. It is important to review surveillance protocols and perform monitoring through occupational medicine.