Valoración de la adherencia del paciente diabético al consejo nutricional y evaluación de mejoras tras su reeducación: una investigación-acción en la costa mediterránea / Adherence to nutritional advice and improvement evaluation after reeducation among diabetic patients: an investigation-action on the Mediterranean coast

RESUMEN Objetivo: Valorar la adherencia del paciente diabético tipo 2 a las recomendaciones dietéticas profesionales, posteriormente educar en hábitos nutricionales saludables y evaluar las mejoras implementadas. Método: Investigación-Acción Evaluativa a 32 residentes diabéticos tipo 2 en la costa mediterránea española elegidos aleatoriamente en 2016 durante ingreso hospitalario. El diseño constó de 3 fases: exploratoria, educativa y evaluativa. Las técnicas empleadas fueron: la entrevista semiestructurada y métodos mixtos educativos. Los instrumentos fueron: el cuestionario MUST y el marco evaluativo de mejoras ISTEW. Resultados: Los entrevistados de ambos sexos (19 hombres y 13 mujeres) y media de edad de 74 años, no se sentían responsables de la elección y elaboración de la dieta diaria. Tampoco se sentían bien informados ni creían tener herramientas para abordar su salud nutricional correctamente. Se detectó un consumo excesivo de dulces y de grasas saturadas, no correspondiéndose con el tipo de dieta mediterránea esperable propia de la zona. Tras la intervención educativa se corroboró un alto grado de satisfacción y mejoras en su desempeño. Conclusiones: La no adherencia dietética se puede explicar por la ausencia de un canal de información eficaz paciente-familia-profesional y la ausencia del vínculo terapéutico al disminuir el empoderamiento y el nivel de gravedad percibida por la persona. La adherencia a la dieta mediterránea fue baja. El conocimiento de su patología no se explica por el nivel académico y socioeconómico.

ABSTRACT Objective: To assess adherence to professional dietary recommendations among type 2 diabetic patients and then evaluate improvements after education on healthy nutritional habits. Methods: In 2016, thirty-two type 2 diabetics who resided on the Mediterranean Coast of Spain were randomly selected and invited to participate at hospital admission. The design consisted of 3 phases: exploration, education and evaluation. The techniques used were: semi-structured interviews and mixed educational methods. The instruments were: the MUST questionnaire and the ISTEW improvement evaluation framework. Results: The interviewees of both sexes (19 men and 13 women) with an average age of 74 years did not feel responsible for the choice and elaboration of their daily diet. They also did not feel well informed, nor did they believe they had the tools to address their nutritional needs correctly. Excessive consumption of sweets and saturated fats was detected, not corresponding to the type of Mediterranean diet expected in the area. After the educational intervention, a high degree of satisfaction and improvements in performance were corroborated. Conclusions: Dietary nonadherence can be explained by the absence of an effective patient-family-professional information channel and the absence of a therapeutic link reduced patient empowerment and level of severity perceived by the person. Adherence to the Mediterranean diet was low and the adherence to the Mediterranean diet was low. The knowledge of his pathology is not explained by the academic and socioeconomic level.

Sos1 disruption impairs cellular proliferation and viability through an increase in mitochondrial oxidative stress in primary MEFs.

Using a 4-hydroxytamoxifen (4OHT)-inducible, conditional Sos1-null mutation, we analyzed wild-type (WT), single Sos1-KO, Sos2-KO and double Sos1/2 KO primary mouse embryonic fibroblasts (MEF) with an aim at evaluating the functional specificity or redundancy of the Sos1 and Sos2 alleles at the cellular level. The 4OHT-induced Sos1-KO and Sos1/2-DKO MEFs exhibited distinct flat morphology, enlarged cell perimeter and altered cytoskeletal organization that were not observed in the WT and Sos2-KO counterparts. The Sos1-KO and Sos1/2-DKO MEFs also displayed significant accumulation, in comparison with WT and Sos2-KO MEFs, of cytoplasmic vesicular bodies identified as autophagosomes containing degraded mitochondria by means of electron microscopy and specific markers. Cellular proliferation and migration were impaired in Sos1-KO and Sos1/2-DKO MEFs in comparison with WT and Sos2-KO MEFs, whereas cell adhesion was only impaired upon depletion of both Sos isoforms. RasGTP formation was practically absent in Sos1/2-DKO MEFs as compared with the other genotypes and extracellular signal-regulated kinase phosphorylation showed only significant reduction after combined Sos1/2 depletion. Consistent with a mitophagic phenotype, in vivo labeling with specific fluorophores uncovered increased levels of oxidative stress (elevated intracellular reactive oxygen species and mitochondrial superoxide and loss of mitochondrial membrane potential) in the Sos1-KO and the Sos1/2-DKO cells as compared with Sos2-KO and WT MEFs. Interestingly, treatment of the MEF cultures with antioxidants corrected the altered phenotypes of Sos1-KO and Sos1/2-DKO MEFs by restoring their altered perimeter size and proliferative rate to levels similar to those of WT and Sos2-KO MEFs. Our data uncover a direct mechanistic link between Sos1 and control of intracellular oxidative stress, and demonstrate functional prevalence of Sos1 over Sos2 with regards to cellular proliferation and viability.

Pax2+ astrocytes in the fish optic nerve head after optic nerve crush.

The transcription factor Pax2 actively participates in the development of the vertebrate visual system. In adults, Pax2 expression persists in a subpopulation of Müller cells and/or astrocytes in the retina and optic nerve head (ONH), although its function remains elusive. In a previous work we showed that the pax2 gene expression is modified and the Pax2(+) astrocyte population in the ONH strongly reacted during the regeneration of the retina after a lesion in goldfish. In the present work we have analyzed Pax2 expression in the goldfish ONH after optic nerve (ON) crush. At one week post-injury, when the regenerating axons arrive at the ONH, the pax2 gene expression level increases as well as the number of Pax2(+) astrocytes in this region. These Pax2(+) astrocytes show a higher number of Cytokeratin (Ck)(+)/GFAP(+) processes compared with control animals. In contrast, a different S100(+) astrocyte population is not modified and persists similar to that of controls. Furthermore, we find a ring that surrounds the posterior ONH that is formed by highly reactive astrocytes, positive to Pax2, GFAP, Ck, S100, GS and ZO1. In this region we also find a source of new astrocytes Pax2(+)/PCNA(+) that is activated after the injury. We conclude that Pax2(+) astrocytes constitute a subpopulation of ONH astrocytes that strongly reacts after ON crush and supports our previous results obtained after retina regeneration. Altogether, this suggests that pax2 gene expression and Pax2(+) astrocytes are probably directly involved in the process of axonal regeneration.

Gurltia paralysans (Wolffhügel, 1933): description of adults and additional case reports of neurological diseases in three domestic cats from southern Chile.

Adults of Gurltia paralysans were obtained from veins of the spinal cord subarachnoid space from three domestic cats presenting with chronic paraparesis/paraplegia from rural areas of southern Chile. Four adult nematodes were collected (2 males and 2 females) were recovered from cat 1, 14 adult nematodes (12 females and 2 males) from cat 2, and 12 nematodes (10 females and 2 males) were collected from cat 3. Parasite induced lesions that compromised subarachnoid vein microvasculature at the thoracic, lumbar, sacral spinal cord segments extending to conus medularis. Female nematodes measured 25 mm long (range=25-30 mm) and 0.1mm wide. Male measured a mean of 16 mm length (range=13-18 mm) with a body diameter of 0.1mm (range=0.08-0.15 mm). The present study described structural features of G. paralysans, a rare parasite first reported in the 1930s, and provides additional reports on associated clinical and pathological findings in naturally infected domestic cats.

Obesidad mórbida asociada a quiste broncogénico y leiomioma subcardial que simula GIST: caso clínico / Morbid obesity, esophageal bronchogenic cyst and subcardial leiomioma: report of one case

Gastric wall diseases are found in approximately of 1 percent of the patients submitted to bariatric surgery. Half of these are leiomiomas. Esophageal bronchogenic cysts are exceptional We report a 57 years old female with morbid obesity, a bronchogenic esophageal cyst and subcardial leiomioma. The preoperative study and intraoperative biopsy, suggested the presence of a gastrointestinal stromal tumor (GIST), but the definitive pathological study did not confirm its presence. A total gastrectomy was performed, with an uneventful postoperative course.

La patología intramural gástrica tiene una frecuencia menor al 1 por ciento, en cirugía gástrica. Alrededor del 50 por ciento corresponden a leiomiomas. Los quistes broncogénicos tienen origen embriológico y son excepcionales, y la mayor parte de los reportes corresponden a pacientes pediátricos. Se presenta un caso clínico de paciente portadora de Obesidad mórbida (IMC = 52), asociado a lesión subcardial que simula GIST, cuyo estudio histopatológico resultó ser un quiste esofágico de origen broncogénico de 40 mm, asociado a leiomioma subcardial de 10 mm. Fue sometida a gastrectomía total más anastomosis esófago-yeyunal en Y de Roux, con asa de 180 cm. No presentó morbi-mortalidad postoperatoria. Se discuten los métodos de estudio preoperatorio y las alternativas terapéuticas. No hemos encontrado en la literatura otro caso de asociación de estas raras patologías.

Lentiviral gene replacement therapy of retinas in a mouse model for Usher syndrome type 1B.

One of the most disabling forms of retinal degeneration occurs in Usher syndrome, since it affects patients who already suffer from deafness. Mutations in the myosin VIIa gene (MYO7A) cause a major subtype of Usher syndrome, type 1B. Owing to the loss of function nature of Usher 1B and the relatively large size of MYO7A, we investigated a lentiviral-based gene replacement therapy in the retinas of MYO7A-null mice. Among the different promoters tested, a CMV-MYO7A chimeric promoter produced wild-type levels of MYO7A in cultured RPE cells and retinas in vivo. Efficacy of the lentiviral therapy was tested by using cell-based assays to analyze the correction of previously defined, MYO7A-null phenotypes in the mouse retina. In vitro, defects in phagosome digestion and melanosome motility were rescued in primary cultures of RPE cells. In vivo, the normal apical location of melanosomes in RPE cells was restored, and the abnormal accumulation of opsin in the photoreceptor connecting cilium was corrected. These results demonstrate that a lentiviral vector can accommodate a large cDNA, such as MYO7A, and mediate correction of important cellular functions in the retina, a major site affected in the Usher syndrome. Therefore, a lentiviral-mediated gene replacement strategy for Usher 1B therapy in the retina appears feasible.

Lipofuscin accumulation, abnormal electrophysiology, and photoreceptor degeneration in mutant ELOVL4 transgenic mice: a model for macular degeneration.

Macular degeneration is a heterogeneous group of disorders characterized by photoreceptor degeneration and atrophy of the retinal pigment epithelium (RPE) in the central retina. An autosomal dominant form of Stargardt macular degeneration (STGD) is caused by mutations in ELOVL4, which is predicted to encode an enzyme involved in the elongation of long-chain fatty acids. We generated transgenic mice expressing a mutant form of human ELOVL4 that causes STGD. In these mice, we show that accumulation by the RPE of undigested phagosomes and lipofuscin, including the fluorophore, 2-[2,6-dimethyl-8-(2,6,6-trimethyl-1-cyclohexen-1-yl)-1E,3E,5E,7E-octatetraenyl]-1-(2-hyydroxyethyl)-4-[4-methyl-6-(2,6,6,-trimethyl-1-cyclohexen-1-yl)-1E,3E,5E-hexatrienyl]-pyridinium (A2E) is followed by RPE atrophy. Subsequently, photoreceptor degeneration occurs in the central retina in a pattern closely resembling that of human STGD and age-related macular degeneration. The ELOVL4 transgenic mice thus provide a good model for both STGD and dry age-related macular degeneration, and represent a valuable tool for studies on therapeutic intervention in these forms of blindness.

Detection of macroglial cells in the fish optic nerve by intracellular injection in fixed tissue / Detección de células macrogliales en el nervio óptico de peces mediante inyección intracelular en tejido fijado

In this study we made intracellular injections of Lucifer Yellow fluorochrome into macroglial cells, astrocytes and oligodendrocytes of the fixed optic nerve of tench (Tinca tinca). From their three-dimensional morphology, we identified oligodendrocytes and at least four different types of astrocytes, both in the central zones of the nerve and in that forming part of the glia limitans. Moreover, we have identified and described groups of associated astrocytes (AU)

En este estudio realizamos inyecciones intracelulares del fluorocromo Amarillo Lucifer en las células macrogliales, astrocitos y oligodendrocitos del nervio óptico fijado de la tenca (Tinca tinca). En base a su morfología tridimensional, pudimos identificar oligodendrocitos y al menos cuatro tipos distintos de astrocitos, tanto en las zonas centrales del nervio como en la zona que forma parte de la glia limitans. Adicionalmente, identificamos y describimos grupos de astrositos asociados (AU)

Non-neuronal cells involved in the degeneration and regeneration of the fish retina.

In the present work we show that during the degenerative process occurring after the cryo-elimination of the tench peripheral growing zone many non-neuronal cell types in addition to the resident microglial cells, appear within the affected areas. Some of them are normally found in the retina, such as the retinal pigmented epithelium cells and others originate from extra-retinal tissues. We identified these as granular leukocytes and macrophages. The microglial cells and macrophages, those resident in the sub-retinal space, and the invasive ones, act as phagocytes. The analysis of the injured retina following lesion shows that the invasive macrophages, arising from the scleral extra-retinal tissues, penetrate the neural retina, and migrate from the scleral to the vitreal portion. In contrast those coming from the vitreal extra-retinal tissues migrate in the opposite direction. Moreover, the retinal pigmented epithelium cells present remarkable modifications in their morphology and distribution and enter the neural retina, where they disrupt the surrounding tissue. We have also observed that this cryo-lesion causes an inflammation mediated by a type of granular leukocyte, denominated heterophils which penetrate the neural retina and probably come from the blood supply. Our results suggest that, during the first days after the lesion, the participation of diverse non-neuronal cells removing cell debris from the damaged zone should create a favourable environment allowing the regeneration of the neural retina.

Growing and regenerating axons in the visual system of teleosts are recognized with the antibody RT97.

We have analyzed the immunolabeling with the antibody RT97, a good marker for ganglion cell axons in several species, in the normal and regenerating visual pathways of teleosts. We have demonstrated that RT97 antibody recognizes several proteins in the tench visual system tissues (105, 115, 160, 200, 325 and 335 kDa approximately). By using immunoprecipitation and Western blot we have found that after crushing the optic nerve the immunoreactivity to anti RT97 increased markedly in the optic nerve. In immunohistochemical analysis we also found a different pattern of labeling in normal and regenerating visual pathways. In normal tench RT97 is a good marker for the horizontal cells in the retina, for growing ganglion cell axons which run along the optic nerve from the retina to the optic tectum and of the axon terminals in the stratum opticum and stratum fibrosum and griseum superficiale in the optic tectum. After optic nerve crush, no immunohistochemistry modifications were observed in the retina. However, in accordance with Western blot experiments, in the optic nerve intensely stained groups of regenerating axons appeared progressively throughout the optic nerve as far as the optic tectum. We conclude that the antibody RT97 is an excellent marker of growing and regenerating axons of the optic nerve of fish.

Phytochrome and post-translational regulation of nitrate reductase in higher plants.

The possible influence of phytochrome on the activity state of nitrate reductase (NR) was investigated in etiolated plants where the expression of the NR gene is known to be under the control of phytochrome. Activity state is defined as NR activity assayed in the presence of Mg(2+) as percentage of NR activity measured in the absence of Mg(2+). This measurement is assumed to reflect non-phosphorylated NR as percentage of total NR. Beside etiolated barley and maize leaves, a photosynthetic mutant of Lemna aequinoctialis was investigated and compared with the wild type. The increase of NR activity following a red light pulse, mediated via phytochrome, was confirmed in all etiolated plant species investigated as well as in both strains of L. aequinoctialis cultivated in glucose-containing medium. The effect of continuous red light surpassed the effect of a single red light pulse in each case. However, the results did not show any stimulating effect of phytochrome on the activity state caused by post-translational modulation. The activity state was strongly increased by continuous red light in the wild type of L. aequinoctialis but not in the photosynthetic mutant. These results show that the phytochrome system is not important for the post-translational regulation of NR.

Deletion of the nitrate reductase N-terminal domain still allows binding of 14-3-3 proteins but affects their inhibitory properties.

Nitrate reductase (NR) is post-translationally regulated by phosphorylation and binding of 14-3-3 proteins. Deletion of 56 amino acids in the amino-terminal domain of NR was previously shown to impair this type of regulation in tobacco (Nicotiana plumbaginifolia) (L. Nussaume, M. Vincentez, C. Meyer, J.-P. Boutin, M. Caboche [1995] Plant Cell 7: 611-621), although both full-length NR and deleted NR (DeltaNR) appeared to be phosphorylated in darkness (C. Lillo, S. Kazazaic, P. Ruoff, C. Meyer [1997] Plant Physiol 114: 1377-1383). We show here that in the presence of Mg(2+) and phosphatase inhibitors, NR and endogenous 14-3-3 proteins copurify through affinity chromatography. Assay of NR activity and western blots showed that endogenous 14-3-3 proteins copurified with both NR and DeltaNR. Electron transport in the heme-binding domain of DeltaNR was inhibited by Mg(2+)/14-3-3, whereas this was not the case for NR. This may indicate a different way of binding for 14-3-3 in the DeltaNR compared with NR. The DeltaNR was more labile than NR, in vitro. Lability was ascribed to the molybdopterin binding domain, and apparently an important function of the 56 amino acids is stabilization of this domain.

A comparative study of protein kinase C-like immunoreactive cells in the retina.

The present study is a morphological and quantitative analysis of protein kinase C-like immunoreactive (PKC-L ir) bipolar cells in the retinas of five different vertebrate species (chicken, tench, zebrafish, goldfish and rat). The morphology of PKC-L-ir bipolar cell axon terminals in fish differs significantly from those of chicken and rat retinas. Fish have bulky terminals whereas chicken and rat have their terminals in the form of small knob-shaped branches. In tench and goldfish, PKC-L-ir bipolar cells gradually decrease in size from the medial (i.e., in tench: mean +/- SD soma area of 30.09 +/- 5.98 microm2) to the peripheral (i.e., in tench: 19.93 +/- 1.73 microm2) retinal regions. This is not observed in chicken, rat or zebrafish where there is more homogeneity in s oma and axon terminal sizes between different retinal regions. Except in chicken, cell density increases from the central (i.e., in tench: mean +/- SD 1795.88 +/- 242.35 cells/mm2) to the peripheral (i.e., in tench: 4295.41 +/- 279.23 cells/mm2) retina. This study provides data that show relevant differences in the PKC-L-ir bipolar morphology and density among birds, fish and mammals. Moreover, these structural variations could mean not only differences in the cellular physiology, but also in the patterns of development and maintenance of the retina in each species.

Enzyme histochemical identification of microglial cells in the retina of a fish (Tinca tinca).

Histochemistry for nucleoside diphosphatase was used to study the microglial cells in the adult tench retina. An abundant population of microglial cells was located in the vascular membrane, nerve fibre layer, inner and outer plexiform layers and scattered cells were observed in the inner nuclear layer. Rounded and amoeboid cells could be seen close to the vessel in the vascular membrane, bipolar cells in the nerve fibre layer and ramified cells in the rest of the layers. Several microglial forms could correspond to developing cells. The pattern of distribution was similar to that described in other vertebrates, but with several differences, such as the presence of microglial cells in the vascular membrane and inner nuclear layer and the overlap of processes in the plexiform layers.

Response of microglial cells after a cryolesion in the peripheral proliferative retina of tench.

We studied the glial response after inducing a lesion in the zone of the peripheral retina of tench, where there is proliferative neuroepithelium. In the retina and optic nerve, the microglial response was analysed with tomato lectin and the macroglial response with antibodies against GFAP and S-100. In lesioned retinas, there was a temporal-spatial distribution pattern of microglia. One day after lesion, primitive ramified cells appeared in the nerve fibre layer. These cells appeared progressively from the vitreal to the scleral layers until day 7 when cells appeared in all layers, with the exception of the outer plexiform layer. From this point, labelling decreased. In the optic nerve, 3 days after lesion, an increase in the number of microglial cells was observed, first in the nerve folds and from day 15 in specific areas of the optic nerve. In the central retina, in the optic nerve head and within the optic nerve itself, the appearance of microglial cells, after the lesion, near the blood vessels, could indicate a vascular origin of microglia, as has been proposed by many authors. However, we cannot discount the idea that some of the reactive microglial cells arise by proliferation of the microglia existing in the normal state. Using GFAP and S-100 antibodies, no important changes in the retina were observed, however in the optic nerve there was response to the lesion. Thus, the macroglial cells appeared to be involved in reorganisation of the optic nerve axons after lesion.

Ultrastructural organization of the optic nerve of the tench (Cyprinidae, Teleostei).

Different parts of the tench optic nerve--the intraocular and intraorbital segments, the chiasm, and the post-chiasmatic segment--were studied using light and electron microscopy. From the head of the optic nerve, a zone of continuous growth constituted by the younger non-myelinated ganglion axons can be differentiated from a mature zone where almost all the axons are myelinated. The transition from one zone to the other is progressive. The area containing only non-myelinated axons is very restricted, and the presence of myelinated and non-myelinated axons in the same fascicle is frequent. In the head of the optic nerve, the growing zone surrounds the central artery. In the intraorbital segment, where the optic nerve is organized as a folded ribbon, the growing edge is surrounded by other mature folds. In the chiasm and in the post-chiasmatic segment of the optic nerve, the organization as a folded ribbon disappears and the youngest axons are situated on the periphery. In the growing zones, the immature astrocytes predominate; in the transition zones, oligodendrocytes, in different stages of maturity, begin to appear. In the mature zone, almost all the glial cells are differentiated, although immature cells can be found. The microglial cells are not abundant and are of the ramified type. Moreover, in contrast to the descriptions of other teleosts, the tench optic nerve is profusely supplied with blood vessels throughout its length.

Characterization of Nitrate Reductase from Light- and Dark-Exposed Leaves (Comparison of Different Species and Effects of 14-3-3 Inhibitor Proteins).

Nitrate reductase (NR) was extracted and partially purified from leaves of squash (Curcurbita maxima), spinach (Spinacia oleracea), and three transgenic Nicotiana plumbaginifolia leaves in the presence of phosphatase inhibitors to preserve its phosphorylation state. Purified squash NR showed activation by substrates (hysteresis) when prepared from leaves in the light as well as in darkness. A 14-3-3 protein known to inhibit phosphorylated spinach NR in the presence of Mg2+ decreased by 70 to 85% the activity of purified NR from dark-exposed leaves, whereas NR from light-exposed leaves decreased by 10 to 25%. Apparent lack of posttranslational NR regulation in a transgenic N. plumbaginifolia expressing an NR construct with an N-terminal deletion ([delta]NR) may be explained by more easy dissociation of 14-3-3 proteins from [delta]NR. Partially purified [delta]NR was, however, inhibited by 14-3-3 protein, and the binding constant of 14-3-3 protein (4 x 108 M-1) and the NR-inhibiting protein concentration that results in a 50% reduction of free NR (2.5 nM) were the same for NR and [delta]NR. Regulation of NR activity by phosphorylation and binding of 14-3-3 protein was a general feature for all plants tested, whereas activation by substrates as a possible regulation mechanism was verified only for squash.

Evidence for increased proton dissociation in low-activity forms of dephosphorylated squash-leaf nitrate reductase.

The pH dependence of squash-leaf nitrate reductase has been studied. It has been found that high- and low-activity forms of purified nitrate reductase (both forms dephosphorylated) have different optimum pH values. A high-activity form has always a higher pH optimum compared with a low-activity form. Model computations show that the decrease in activity and the corresponding change of the pH optimum is apparently due to a conformation-dependent increase of proton dissociation of the enzyme. As previously shown, this behavior is also observed in leaf extracts during the conversion (and probably phosphorylation of nitrate reductase) from a high-active form to a low-active form when plants are transferred from light to darkness.

A comparative study of mortality in agricultural and industrial areas in Spain.

The three main causes of contamination in the industrialized world are energy production, and industrial and agricultural activities. The aim of the present study was to examine changes in cause of death in order to contrast causes of death between agricultural and industrial areas. To this effect we have selected four zones--two predominantly industrial and two mainly agricultural--within the Valencian Community. Mortality figures were gathered corresponding to the same period 1976-1989, published by the Conselleria de Sanitat i Consum of the Generalitat Valenciana (Valencian Community health authorities). Thirty large groups of causes of death were established for posterior analysis. Mortality rate was defined as the number of deaths per 100,000 inhabitants, standardizing the data by the direct method. A simple regression analysis was performed for each cause of death and in each health coverage area studied, to determine the tendencies characterizing each area in time. A statistical significance test was also carried out. A statistically significant increase (95% confidence interval) was observed for digestive cancer, respiratory cancer, benign tumors and non-specific neoplastic diseases in the industrial areas. In the agricultural areas, a significant decrease (95% confidence interval) was observed in tuberculosis and respiratory diseases and infections. Relative risk (RR) was calculated and thus, tuberculosis, mental and central nervous system disorders, respiratory infections and diseases, and male genital disorders were more frequent in agricultural areas.