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Environmental health assessment of deltamethrin in a malarious area of Mexico: environmental persistence, toxicokinetics, and genotoxicity in exposed children.

We reported previously that children are exposed to deltamethrin in malarious areas. In the present work we explored the levels of this insecticide in soil samples and also obtained relevant toxicokinetic data of deltamethrin in exposed children. Results show that, after spraying, indoor levels of deltamethrin in soil samples were higher than outdoor levels. The mean half-life estimated with these data was 15.5 days for outdoor samples and 15.4 days for indoor samples. Children's exposure to deltamethrin was assessed using as biomarkers the urinary concentrations of the metabolites 3-phenoxybenzoic acid (3-PBA) and cis-3-(2,2-dibromovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (Br2CA). The mean level of both biomarkers reached a peak within the first 24 hr postexposure; 6 months after the initial exposure, urinary levels of 3-PBA and Br2CA were found at levels observed before exposure. Approximately 91% of the total 3-PBA or Br2CA was excreted during the first 3 days after exposure. Therefore, we estimated a half-life for this period, the values for 3-PBA and Br2CA being almost identical (13.5 vs. 14.5 hr). Finally, considering reports about the genotoxicity of deltamethrin, we assessed DNA damage in children before and 24 hr after indoor spraying of deltamethrin; we found no differences in the comet assay end points. In conclusion, we observed exposure to deltamethrin in children, but we did not find any relationship between soil concentrations of deltamethrin and urinary levels of the metabolites. At least for genotoxicity, the exposed children appeared not to be at risk.

EAP la salut. Estrategia de apertura orientada al cliente

Se presenta un modelo de apertura, flexible, dinámico1 y cómodo organizado en diferentes fases para movilizar con eficacia los recursos. Se trata de un centro totalmente informatizado, con el programa Organización y Management Informático en Atención Primaria (OMI-AP), cuya organización del equipo de atención primaria (EAP) es por familias. Las principales características de esta estrategia fueron: * La formación del personal sanitario y no sanitario. * La independencia de los dos procesos de registro de datos de afiliación y asistencia sanitaria, durante un tiempo muy corto, con un único mensaje para el usuario: "no es necesario tener médico asignado para recibir atención sanitaria". * El registro de los datos de afiliación en las propias consultas por parte del personal administrativo. * La atención sanitaria sin confusiones ni demoras: durante los primeros 21 días el paciente se encontró una organización del servicio sanitario lo más parecida posible a la del antiguo ambulatorio y, posteriormente, una implantación inmediata del estilo de funcionamiento de la nueva área básica. El registro de las actividades asistenciales en la HCAP informatizada era utilizada 21 días después en el 100 por ciento del EAP (AU)

Endemic fluorosis in San Luis Potosi, Mexico. I. Identification of risk factors associated with human exposure to fluoride.

In order to identify risk factors associated with human exposure to fluoride in San Luis Potosi (SLP), Mexico, a biochemical and epidemiological study was carried out in 1992. Results from the analysis of fluoride sources showed that 61% of tap water samples had fluoride levels above the optimal level of 0.7-1.2 ppm. The levels were higher after boiling. In bottled water, fluoride levels ranged from 0.33 to 6.97 ppm. These sources are important since in SLP 82% of the children drink tap water, 31% also drink bottled water, 92% prepare their food with tap water, 44% boiled all the drinking water, and 91% used infant formula reconstituted with boiled water. The prevalence and severity of dental fluorosis in children (11-13 years old) increased as the concentration of water fluoride increased. At levels of fluoride in water lower than 0.7 ppm a prevalence of 69% was found for total dental fluorosis, whereas at levels of fluoride in water higher than 2.0 ppm a prevalence of 98% was found. In the same children, fluoride levels in urine were quantified. The levels increased as the concentration of water fluoride increased. Regressional analysis showed an increment of 0.54 ppm (P < 0.0001) of fluoride in urine for each ppm of fluoride in water. Fluoride urinary levels were higher in samples collected during the afternoon (1800) when compared with sample collected during the morning (1100). Taking together all these results, three risk factors for human exposure to fluoride in SLP can be identified: ambient temperature, boiled water, and food preparation with boiled water. These factors explain the prevalence of dental fluorosis in SLP.

[Cardiovascular risk factors. An audit of their detection in primary care]. / Factores de riesgo cardiovascular. Audit de su detección en atención primaria.

After having found that the prevalences of hypertension, hypercholesterolemia, obesity and smoking were low in our adult population on care, we developed a study to investigate the causes of the problem and to introduce measures for its solution following the methodology of the medical audit. The indexes showed that the performance of preventive cardiovascular activities (PCVA) was low: blood pressure measurement 45%, blood cholesterol determination 23%, height and weight measurement 8% and questioning on smoking habits 40%. After the implementation of corrective measures, indexes of 79%, 76%, 71% and 56%, respectively, have been achieved. In addition, a defective recording of the detected risk factors was found: 87% in the clinical history record, 72% in the age and sex card; after the corrective measures, the rates were 98% and 91% respectively. The present study demonstrates the effectiveness of quality control measures carried out by the professionals responsible for care to improve its quality.