First Report of the Joint Exposure to Glyphosate and Glufosinate of a Male Population in the Province of Córdoba (Argentina).

Despite potential health implications, data on the presence of Glyphosate (GLY) and other non-GLY herbicides in human matrices remain scarce. This study aimed to develop a simple and cost-effective methodology for detecting and quantifying GLY, its primary biodegradation product; aminomethylphosphonic acid (AMPA); and glufosinate (GLU) in plasma and urine of environmentally and occupationally exposed populations from the province of Córdoba (Argentina). Different alternatives of pre-treatment, derivatization with FMOC-Cl, solid phase extraction, and final sample conditioning steps were evaluated to improve the quantification of the herbicides by a high-performance liquid chromatography system coupled to a triple-quadrupole mass spectrometer. Recoveries ranged from 39 to 84% in both matrices, while limits of quantification were 3, 1, and 0.3 ng/mL and 3.6, 5.1, and 0.3 ng/mL for AMPA, GLY, and GLU in plasma and urine, respectively. In plasma samples, GLY was the most frequently detected analyte (32%), followed by GLU (10%). In urine samples, GLU was the most frequently detected herbicide (13%), followed by GLY (6%). No differences between group or matrix correlations were found. This study is the first report of GLU in human biological matrices and should be used to establish baseline values for future surveillance systems.

Vigilancia del cáncer colorrectal en la provincia de Córdoba mediante prevención y detección temprana: resultados de una prueba piloto / Surveillance of colorectal cancer in the province of Córdoba through prevention and early detection: results of a pilot test

INTRODUCCIÓN: El cáncer colorrectal (CCR) es la segunda causa de mortalidad por cáncer en Argentina. Su diagnóstico tardío reduce sustancialmente las posibilidades de sobrevida. El objetivo fue describir el estudio de implementación de prevención del CCR realizado en el departamento cordobés de Pocho y analizar factores de riesgo y vulnerabilidad según condiciones de riesgo promedio (RP) o elevado (RE). MÉTODOS: Se incluyó a 265 adultos de 50-75 años residentes en Pocho. Se diseñó un dispositivo de intervención territorial; se construyeron y analizaron indicadores de cobertura, salud, referencia y contrarreferencia. RESULTADOS: Hubo 19,6% de participantes con RE y 80,4% con RP. La cobertura por invitación fue de 36,6% de la población objetivo, con una tasa de aceptación del 84,2%, una positividad del test de sangre oculta en materia fecal inmunoquímico (TSOMFi) del 19,3% y un índice de cumplimiento de videocolonoscopia del 81,8%. El consumo inadecuado de frutas, verduras y carnes asadas fue mayor en el grupo de RP (p≤0,05); 17,4% había consumido al menos un cigarrillo en los últimos 30 días; 77,6% había realizado al menos 30 minutos diarios de actividad física; 52% reportó al menos una vez presión elevada, 21,7% glucemia elevada y 21,8% colesterol elevado; 29,5% presentó obesidad. DISCUSIÓN: La adherencia al test y al circuito de atención fue alta. Se sentaron las bases para el escalamiento provincial de la estrategia preventiva del CCR mediante tamizaje con TSOMFi.

Atrazine characterization: An update on uses, monitoring, effects, and environmental impact, for the development of regulatory policies in Argentina.

Atrazine (ATZ) is the third most widely used herbicide in Argentina (10 000 t year-1 ) and is approved for sugar cane, flax, corn, sorghum, and tea. An assessment of the ATZ environmental impacts was conducted at the request of the Ministry of Environment and Sustainable Development of Argentina. A review of 541 national and international technical and scientific reports and a survey among agricultural technicians, applicators, and producers was done. The survey revealed that 94% of ATZ applications are terrestrial and use diversion exists, associated mainly with soybean cultivation. Atrazine was reported at high frequencies (50%-100%) in surface and groundwater, sediments, and soils, sometimes exceeding permitted limits. Several sublethal effects induced by ATZ on invertebrate and vertebrate species were found, sometimes at concentrations lower than those in water quality guidelines (<3 µg L-1 ) or the environmental concentrations found in Argentina. Available epidemiological or human health studies of local populations are extremely scarce. This assessment also demonstrated that herbicides are ubiquitous in the environment. The investigation highlights the need for further studies assessing the adverse effects of ATZ on local species, ecosystems, and human health. Therefore, the precautionary principle is recommended to promote better application standards and product traceability to reduce volumes entering the environment and to avoid use deviation. In addition, this work concluded that there is a need for reviewing the toxicological classification, establishing buffer zones for ATZ application, introducing specific management guidelines, and expanding local studies of toxicity, ecotoxicity, and human epidemiology for environmental and health risk assessments. This study could also serve as a preliminary risk evaluation for establishing a final regulatory action and for considering ATZ inclusion in Annex III of the Rotterdam Convention. Finally, the requirements to consider its inclusion in Annex A (Elimination) or B (Restriction) of the Stockholm Convention were evaluated and discussed, and information on the potential of long-range transport was the only criterion with no information to consider. Integr Environ Assess Manag 2023;19:684-697. © 2022 SETAC.

Food insecurity profile according to habits and lifestyles in workers with subsistence jobs, Medellín-Colombia 2016.

Introduction: Although the informal economy absorbs a considerable portion of the population, there is still little evidence that contributes to identify the lifestyles and eating habits that outline food insecurity in workers with subsistence jobs. Objectives: To determine the profile of food insecurity according to habits and lifestyles in workers with subsistence jobs. Methods: Cross-sectional study with primary sources of information, obtained through an assisted survey, to a census of 686 workers in 2016. The results of the nutritional component of a doctoral thesis approved by the Institutional Ethics Committee of the CES University, Medellín, Colombia, are presented. Results: In this working population, 52.6% were 50 years or old; however, 86.1% reported being the main household provider, and 33.3% did not have a permit to work in public areas. Moreover, 56.8% reported being sedentary/little active, and the highest consumption of alcohol and tobacco was recorded in men, who also ate their food alone. Conversely, women considered that mood affected their appetite, and they consumed their food while serving customers and handling money. In general, less than 50.0% of workers had a set time to consume their food. Food insecurity in workers' households was explained by alcohol consumption (prevalence ratio = 1.62; confidence interval = 1.05;2.38) and having exclusive hours to consume food (prevalence ratio = 1.40; confidence interval = 1.00;1.96). Their food insecurity is defined by not consuming alcoholic beverages, considering that their mood affects their appetite, consuming one or two meals a day, without a defined schedule, not having permission to work, presenting moderate/severe food insecurity, and being a woman. Conclusions: The conditions that explain and outline food insecurity in this working population contribute to their socio-environmental and labor vulnerability, however, these conditions can be reversed.

Introducción: Aunque la economía informal ocupe una gran parte de la población, todavía existen pocas evidencias que ayuden a identificar los estilos de vida y hábitos alimentarios que definen la inseguridad alimentaria entre los trabajadores con empleos de subsistencia. Objetivos: Determinar el perfil de inseguridad alimentaria según hábitos y estilos de vida en trabajadores con empleos de subsistencia. Métodos: Estudio transversal con fuentes primarias de información, realizado a través de encuesta asistida, con un censo de 686 trabajadores en 2016. Los resultados del componente nutricional de una tesis doctoral aprobada por el Comité de Ética Institucional de la Universidad CES, en Medellín, Colombia, son presentados. Resultados: De esta población trabajadora, el 52,6% tenía más de 50 años, sin embargo, el 86,1% reportó ser la persona que más aportaba en el hogar y al 33,3% no se le permitía trabajar en los espacios públicos. El 56,8% refirió ser sedentario/poco activo, registrándose el mayor consumo de bebidas alcohólicas y cigarrillos en los hombres, quienes también comían solos. Por su parte, las mujeres consideraban que el estado de ánimo afectaba al apetito y, cuando comían, simultáneamente atendían a los clientes y manejaban dinero. En general, menos del 50,0% tenía un tiempo definido para consumir sus alimentos. Explicaron inseguridad alimentaria en sus hogares, consumo de bebidas alcohólicas (RP = 1,62. IC = 1,05;2,38) e horarios exclusivos para consumir alimentos (RP = 1,40. IC = 1,00;1,96). Perfilan su inseguridad alimentaria no consumir bebidas alcohólicas, considerar que el estado de ánimo afectaba al apetito, consumir una o dos comidas al día, sin horario definido, no tener permiso para trabajar, presentar inseguridad alimentaria moderada/grave y ser mujer. Conclusiones: Las condiciones que explican y perfilan la inseguridad alimentaria de esta población trabajadora contribuyen a configurar su vulnerabilidad socioambiental y laboral, sin embargo, pueden ser revertidas.

[Environmental sociodemographic conditions associated with health-nutrition profiles among elderly people, Córdoba-Argentina]. / Condiciones sociodemográficas ambientales asociadas a perfiles de salud-alimentación entre personas adultas mayores, Córdoba-Argentina.

INTRODUCTION: Demographic trends indicate that population aging is not exclusive to developed countries. Argentina reaches 15.5% of the elderly population. The Covid-19 pandemic has brought to the forefront the public health situation of this population, challenging health systems, with disproportionate impacts on this group, which has suffered more than 80% of the deaths in the country, mainly in those with comorbidities. OBJECTIVE: To analyze the sociodemographic and environmental conditions involved in the process of development of health and nutrition profiles of the elderly people of Córdoba, Argentina 2020. METHODOLOGY: Epidemiological, cross-sectional, population-based study that included 221 elderly people (≥60 years old), through random sampling. Data on sociodemographic and environmental conditions, health and dietary profiles were collected through structured interviews. RESULTS: The average age of the participants was 68 years. Eighty-five percent recognized neighborhood contamination, 38% of them being garbage dumps close to their homes. Eighty-nine percent reported at least one non-communicable disease (NCD) or associated risk factor and 66% were overweight (BMI≥25kg/m2). The presence of obesity (BMI≥30kg/m2) was associated (OR=2.05; CI 1.007-3.922) with the development of NCDs. Only 4% of the population complied with the daily fruit and vegetable consumption recommendation. CONCLUSION: The predominant characteristics of the health and dietary profiles associated with NCDs identified suggest the need to study in depth the social determinants that condition the aging process.

Health Effects of Pesticide Exposure in Latin American and the Caribbean Populations: A Scoping Review.

BACKGROUND: Multiple epidemiological studies have shown that exposure to pesticides is associated with adverse health outcomes. However, the literature on pesticide-related health effects in the Latin American and the Caribbean (LAC) region, an area of intensive agricultural and residential pesticide use, is sparse. We conducted a scoping review to describe the current state of research on the health effects of pesticide exposure in LAC populations with the goal of identifying knowledge gaps and research capacity building needs. METHODS: We searched PubMed and SciELO for epidemiological studies on pesticide exposure and human health in LAC populations published between January 2007 and December 2021. We identified 233 publications from 16 countries that met our inclusion criteria and grouped them by health outcome (genotoxicity, neurobehavioral outcomes, placental outcomes and teratogenicity, cancer, thyroid function, reproductive outcomes, birth outcomes and child growth, and others). RESULTS: Most published studies were conducted in Brazil (37%, n=88) and Mexico (20%, n=46), were cross-sectional in design (72%, n=167), and focused on farmworkers (45%, n=105) or children (21%, n=48). The most frequently studied health effects included genotoxicity (24%, n=62) and neurobehavioral outcomes (21%, n=54), and organophosphate (OP) pesticides were the most frequently examined (26%, n=81). Forty-seven percent (n=112) of the studies relied only on indirect pesticide exposure assessment methods. Exposure to OP pesticides, carbamates, or to multiple pesticide classes was consistently associated with markers of genotoxicity and adverse neurobehavioral outcomes, particularly among children and farmworkers. DISCUSSION: Our scoping review provides some evidence that exposure to pesticides may adversely impact the health of LAC populations, but methodological limitations and inconsistencies undermine the strength of the conclusions. It is critical to increase capacity building, integrate research initiatives, and conduct more rigorous epidemiological studies in the region to address these limitations, better inform public health surveillance systems, and maximize the impact of research on public policies. https://doi.org/10.1289/EHP9934.

Condiciones sociodemográficas ambientales asociadas a perfiles de salud-alimentación entre personas adultas mayores, Córdoba-Argentina / Environmental sociodemographic conditions associated with health-nutrition profiles among elderly people, Córdoba-Argentina

Introducción: Las tendencias demográficas indican que el envejecimiento poblacional no es exclusivo de los países desarrollados. Argentina alcanza el 15,5% de la población adulta mayor. La pandemia por COVID-19 puso en escena la situación de salud pública de esta población, desafiando los sistemas de salud, con impactos desproporcionados en este grupo que sufrió más del 80% de los decesos ocurridos en el país, principalmente en quienes presentaban comorbilidades. Objetivo: Analizar las condiciones sociodemográficas y ambientales que intervienen en el proceso de desarrollo de perfiles de salud y alimentación de la población adulta mayor de Córdoba, Argentina 2020. Metodología: Estudio epidemiológico de corte transversal, de base poblacional, que incluyó 221 personas adultas mayores (≥60 años) mediante muestreo aleatorizado. A través de entrevista estructurada se indagaron datos sobre condiciones sociodemográficas, ambientales, perfiles de salud y alimentación. Resultados: La edad promedio de los participantes fue de 68 años. Un 85% reconoció contaminación barrial, siendo el 38% basurales cercanos al domicilio. El 89% manifestaron al menos una enfermedad no transmisible (ENT) o factor de riesgo asociado y el 66% presentó exceso de peso (IMC≥25kg/m2). La presencia de obesidad (IMC≥30kg/m2) se asoció (OR: 2,05; IC: 1,007-3,922) con el desarrollo de ENT. Solo el 4% de la población cumplió con la recomendación de consumo diario de frutas y verduras. Conclusión: Las características predominantes de perfiles de salud y alimentación asociadas a ENT identificadas, plantean la necesidad de profundizar sobre los determinantes sociales que condicionan el proceso de envejecimiento. (AU)

Introduction: Demographic trends indicate that population aging is not exclusive to developed countries. Argentina reaches 15.5% of the elderly population. The Covid-19 pandemic has brought to the forefront the public health situation of this population, challenging health systems, with disproportionate impacts on this group, which has suffered more than 80% of the deaths in the country, mainly in those with comorbidities. Objective: To analyze the sociodemographic and environmental conditions involved in the process of development of health and nutrition profiles of the elderly people of Córdoba, Argentina 2020. Methodology: Epidemiological, cross-sectional, population-based study that included 221 elderly people (≥60 years old), through random sampling. Data on sociodemographic and environmental conditions, health and dietary profiles were collected through structured interviews. Results: The average age of the participants was 68 years. Eighty-five percent recognized neighborhood contamination, 38% of them being garbage dumps close to their homes. Eighty-nine percent reported at least one non-communicable disease (NCD) or associated risk factor and 66% were overweight (BMI≥25kg/m2). The presence of obesity (BMI≥30kg/m2) was associated (OR=2.05; CI 1.007–3.922) with the development of NCDs. Only 4% of the population complied with the daily fruit and vegetable consumption recommendation. Conclusion: The predominant characteristics of the health and dietary profiles associated with NCDs identified suggest the need to study in depth the social determinants that condition the aging process. (AU)

[Health-illness and dental care in rural areas: Social representations of Argentine women]. / Salud-enfermedad y cuidados odontológicos en la ruralidad: representaciones sociales de mujeres argentinas.

The purpose of this study was to identify the social representations of the health/illness/care process from a dental dimension in rural dwellers in the north of the province of Cordoba, Argentina. Qualitative research was conducted based on the interpretivist paradigm. A purposive sampling was designed and selected to set up interviews with women who attend the hospital in Villa Candelaria Norte, and in-depth interviews with a subsample of dwellers from the area. The data were analyzed based on the grounded theory using Atlas Ti Software. The research was approved by the Ethics Committee (Res. 384/13). The people interviewed were separated into three groups: a) dwellers from the town center, b) dwellers from surrounding areas, and c) the health care team. The analysis dimension of the health/illness/care process is identified from a dental dimension in two sub-categories: perception of pain and loss of teeth. The results obtained serve to highlight the fact that "health" is associated with the demand for care when faced with an oral disease, which reproduces a biomedical model ­ repairing illness; pain and loss of teeth have become naturalized. It can be concluded that the results obtained reflect the lack of a positive conception of oral health which would lead to preventive care. Acknowledging these social representations related to health guides the construction of knowledge to plan actions pertaining to oral health care and disease.

El objetivo de este estudio fue identificar las representaciones sociales del proceso salud/enfermedad/atención desde una dimensión odontológica en pobladores rurales en el norte de Córdoba, Argentina. Se realizó una investigación de carácter cualitativo a partir del paradigma interpretativista. Se realizó observación, registrada en un cuaderno de bitácora. Se diseñó y seleccionó un muestreo intencional para la implementación de entrevistas a mujeres que asisten al hospital de Villa Candelaria Norte y efectores de salud, así como entrevistas en profundidad a una submuestra de mujeres. La información fue cargada en el Software Atlas Ti para su análisis a través de la teoría fundamentada. El proyecto fue aprobado por un Comité de Ética (Res. 384/13). Las personas entrevistadas se clasificaron en 3 grupos: a) pobladoras del centro de la localidad, b) pobladoras de parajes y c) equipo de salud. Se identifica la dimensión de análisis "proceso salud/enfermedad/atención desde una dimensión odontológica" en dos sub-categorías: a través de la percepción de dolor y la pérdida de elementos dentarios. Los resultados alcanzados ponen en evidencia que "salud" se asocia a la demanda de atención que surge ante una enfermedad bucal, reproduciendo un modelo biomédico - reparador de la enfermedad; existe una naturalización del dolor y de la pérdida de elementos dentarios. Se concluye que los resultados expuestos reflejan ausencia de una concepción de salud bucal positiva e integral que permita su cuidado desde una perspectiva preventiva. El reconocimiento de las representaciones sociales de la salud orienta la construcción de conocimientos sobre salud y enfermedad bucal.

Prácticas alimentarias vinculadas a la ocurrencia de enfermedades no transmisibles entre personas adultas mayores / Dietary practices linked to the occurrence of non-communicable diseases among older adults

Introducción: El proceso de envejecimiento poblacional argentino cursa una transición demográfica avanzada que transforma los perfiles de salud, prevaleciendo enfermedades no transmisibles. En tanto la alimentación en la vejez constituye un hecho social, cultural y ambiental, que incide en la calidad de vida y la salud. Objetivo: Identificar las condiciones de vida, potencialmente asociadas al desarrollo de enfermedades no transmisibles, que intervienen en el desarrollo de las prácticas alimentarias de personas adultas mayores de la ciudad de Córdoba y Gran Córdoba, en el periodo 2017 - 2019. Métodos: Estudio analítico de corte transversal, con triangulación metodológica cuali-cuantitativa. Se diseñó una muestra no probabilística de personas adultas mayores (≥ 60 años de edad) por cuotas según nivel de instrucción, implementando cuestionarios semiestructurados (n = 384), entrevistas (n = 12) y observaciones participantes. Resultados: En el espacio singular, emerge la presencia de enfermedades asociadas a la vejez que traen cambios alimentarios y de salud. En la dimensión particular-colectiva, se reconocen variaciones de salud a nivel de grupos; la enfermedad que individualmente se vivencia como una preocupación pasa a ser parte de la trama de vinculación social. El análisis multivariado identificó dos modalidades con una mirada multidimensional de la salud y la alimentación contextualizadas. En el espacio general se plantea una tensión entre el nuevo paradigma sobre el envejecimiento y las condiciones materiales de vida para ello. Conclusiones: Analizar la salud y alimentación de personas adultas mayores en su contexto, permite reconocer puntos de encuentro entre modos predominantes de envejecer, visibilizando el principio de un cambio social(AU)

Introduction: The process of aging of the Argentine population is undergoing an advanced demographic transition that transforms health profiles, prevailing non-communicable diseases. While food in old age is a social, cultural and environmental fact, which affects the quality of life and health. Objective: Identify the living conditions, potentially associated with the development of non-communicable diseases, that impact in the development of food practices of older adults in the city of Córdoba and Gran Córdoba, in the period 2017 - 2019. Methods: Cross-sectional analytical study, with qualitative-quantitative methodological triangulation. A non-probabilistic sample of older adults (≥ 60 years of age) was designed by quotes according to level of education, implementing semi-structured questionnaires (n = 384), interviews (n = 12) and participant observations. Results: In the solo space, the presence of diseases associated with old age that bring dietary and health changes emerges. In the particular-collective dimension, health variations are recognized at the group level; the disease that is individually experienced as a concern becomes part of the fabric of social bonding. The multivariate analysis identified two modalities with a contextualized multidimensional view of health and food. In the general space there is a tension between the new paradigm on aging and the material conditions of life for it. Conclusions: Analyzing the health and nutrition of older adults in their context, allows to recognize points of encounter between predominant ways of aging, and making visible the principle of a social change(AU)

Validation of exposure indexes to pesticides through the analysis of exposure and effect biomarkers in ground pesticide applicators from Argentina.

The characterization of the population exposed to pesticides and the use of effective biomarkers to evaluate potential health effects are determinant to identify vulnerable groups, understanding the causality of diverse pathologies and propose prevention policies. This is particularly important in countries where intensive agricultural practices had an explosive expansion in last decades. The aim of this study was assessing the usefulness of two exposure indexes questionnaire-based: Intensity Level of the pesticide Exposure (ILE) and Cumulative Exposure Index (CEI) and their scales, in terrestrial applicators of pesticide from the Province of Córdoba (Argentina). The analysis was performed contrasting ILE and CEI results with perceived symptomatology, in addition to effect and exposure biomarkers. A cross-sectional study was designed to compare pesticides body burdens and effect biomarkers between subjects occupationally (OE) and non-occupationally exposed (NOE) to pesticides. Prevalence of perceived symptomatology and genotoxicity damage was higher in the OE group. The exposure condition was the only variable explaining these differences. Significant associations were found between CEI and neurologic symptomatology (p < 0.05) and between ILE and plasmatic cholinesterase (p < 0.1). However, residues of HCB, ß-HCH, α-endosulfan, pp'DDE, endrin, ß-endosulfan, pp'DDT, endosulfan sulfate and mirex were found in blood samples from both groups. To our knowledge, this is the first report on pesticides body burdens in occupational exposure settings in Argentina. So far, our current results indicate that the occupational condition affects the health of the workers. Significant associations found between symptomatology and biomarkers with scales of CEI and ILE suggest their usefulness to verify different levels of exposure. Further research is necessary to propose these indexes as an affordable tool for occupational health surveillance in areas with difficult access to health care centres.

Pilot study of exposure of the male population to organophosphate and pyrethroid pesticides in a region of high agricultural activity (Córdoba, Argentina).

Urinary metabolites of organophosphate (OP) and pyrethroid (PYR) pesticides and biomarkers of effects were studied in a population (n=40) residing in an important agricultural area of the province of Córdoba (Argentina). Detection frequencies (DF) higher than 85% were observed for the metabolites of pirimiphos (2-diethylamino-6-methylpyrimidin-4-ol -DEAMPY-, median 7.5 µg/g creatinine, DF: 100%), parathion (p-nitrophenol, 0.99 µg/g creatinine, 100%), and chlorpyrifos (3,5,6-trichloro-2-pyridinol, 0.25 µg/g creatinine, 85%). The DEAMPY concentrations doubled the levels found in other studies and were negatively associated with Er-AChE activity, suggesting the appearance of health effects already in environmental exposure levels below established acceptable daily intakes (ADIs). 3-Phenoxybenzoic acid, the metabolite of several PYR pesticides, was also found in all samples. This metabolite was also significantly negatively correlated with Er-AChE, indicating effects of pyrethroid pesticides on the acetylcholine system even at concentrations below the ADI.

Health care and exposure to pesticides in periurban horticulture: the case of the Green Belt of the City of Cordoba, Argentina. / Exposición a plaguicidas y cuidados de la salud en la horticultura periurbana: el caso del Cinturón Verde de la Ciudad de Córdoba, Argentina.

This article aims to analyze health care and exposure to pesticides within the context of productive and reproductive practices or the everyday life of horticulturists in the Green Belt of the City of Cordoba (GBCC), Argentina, from the individual, particular and general domains as the comprehensive framework of health determining processes. An explanatory analytical study was implemented which included the use of mixed methodologies between 2013 and 2017. A triangulation analysis was carried out of the results of the quantitative and qualitative aspects. It was observed that the dominant agricultural productive model has determined the deterioration of the productive conditions and exposure to pesticides of the horticultural population of the GBCC. Deficient systems for regulating land use, weak legislation and control from the State in accordance with the context impact on everyday life and block the horticulturists' individual health protection practices.

El propósito de este artículo es analizar la exposición a plaguicidas y cuidados de la salud, en el contexto de las prácticas productivas y reproductivas de la vida cotidiana de horticultores del Cinturón Verde de Córdoba (CVCC), Argentina, desde los dominios individual, particular y general como marco comprensivo de los procesos de determinación de salud. Se implementó un estudio analítico explicativo que incluyó el uso de metodologías mixtas entre 2013 y 2017. Se efectuó un análisis de triangulación de resultados provenientes de las vertientes cuantitativas y cualitativas. Se observó que el Modelo Productivo Agrícola Dominante determina el deterioro de las condiciones productivas y la exposición a plaguicidas de la población hortícola del CVCC. Los deficientes sistemas de regulación del uso de la tierra, débil legislación y control acorde al contexto, por parte del Estado, inciden en la vida cotidiana y obturan las prácticas individuales protectoras de la salud de los horticultores.

Exposición a plaguicidas y cuidados de la salud en la horticultura periurbana: el caso del Cinturón Verde de la Ciudad de Córdoba, Argentina / Health care and exposure to pesticides in periurban horticulture: the case of the Green Belt of the City of Cordoba, Argentina

Resumen El propósito de este artículo es analizar la exposición a plaguicidas y cuidados de la salud, en el contexto de las prácticas productivas y reproductivas de la vida cotidiana de horticultores del Cinturón Verde de Córdoba (CVCC), Argentina, desde los dominios individual, particular y general como marco comprensivo de los procesos de determinación de salud. Se implementó un estudio analítico explicativo que incluyó el uso de metodologías mixtas entre 2013 y 2017. Se efectuó un análisis de triangulación de resultados provenientes de las vertientes cuantitativas y cualitativas. Se observó que el Modelo Productivo Agrícola Dominante determina el deterioro de las condiciones productivas y la exposición a plaguicidas de la población hortícola del CVCC. Los deficientes sistemas de regulación del uso de la tierra, débil legislación y control acorde al contexto, por parte del Estado, inciden en la vida cotidiana y obturan las prácticas individuales protectoras de la salud de los horticultores.

Abstract This article aims to analyze health care and exposure to pesticides within the context of productive and reproductive practices or the everyday life of horticulturists in the Green Belt of the City of Cordoba (GBCC), Argentina, from the individual, particular and general domains as the comprehensive framework of health determining processes. An explanatory analytical study was implemented which included the use of mixed methodologies between 2013 and 2017. A triangulation analysis was carried out of the results of the quantitative and qualitative aspects. It was observed that the dominant agricultural productive model has determined the deterioration of the productive conditions and exposure to pesticides of the horticultural population of the GBCC. Deficient systems for regulating land use, weak legislation and control from the State in accordance with the context impact on everyday life and block the horticulturists' individual health protection practices.

Trayectorias y dinámicas alimentarias de adultos/as mayores: la alimentación como relato de vida / Trajectories and food dynamics of Elderly People: food as life story

Argentina atraviesa un proceso de transición demográfica avanzada, ya que los/as adultos mayores (AM) alcanzan el 15,1% de la población. Ello pone en tensión el lugar de las/os AM en la sociedad, sus condiciones de acceso y resolución de necesidades, entre ellas la alimentación. En este trabajo se postula que hablar de la alimentación, de los alimentos, es hablar de los/as AM, de la historia de vida de estas personas que se va escribiendo entre sustancias y circunstancias que hacen a actividades tan cotidianas como el cocinar y el comer. Así, se planteó como objetivo, indagar acerca de la categoría trayectorias y dinámicas alimentarias (TyDA) de los/as AM de la Ciudad de Córdoba-Argentina, para establecer diálogo(s) posible(s) entre alimentación y curso de vida. Se realizó una investigación con posicionamiento epistemológico mixto entre paradigma interpretativista y crítico; con triangulación metodológica cuali-cuantitativa. Etapa cuantitativa: muestra no probabilística por cuotas según nivel de instrucción (n=384); incluyendo a AM de Córdoba y gran Córdoba que integran espacios participativos. Se implementó un cuestionario semiestructurado. Etapa cualitativa: muestra intencional (n=10) a partir del muestro anterior. Se realizaron observaciones participantes, bitácora de campo y entrevistas. Participaron 384 AM, edad promedio de 72 años (DE=7), 79% mujeres y 21% varones. Las "TyDA", siguiendo una idea de proceso que se construye y reconstruye constantemente, fueron abordadas desde: a) Etapa de la vida b) Sistema Alimentario y c) Alimentos identificadores. Reconstruir la historia de la comida de los/as AM propicia el reencuentro con la propia historia (infancia, juventud, adultez, vejez). Esta matriz de sentido es una invitación a repensar los abordajes en materia de políticas públicas destinados a este grupo poblacional; que genera cambios demográficos tanto a nivel macrosocial (cultura, economía, mercado de trabajo, sistemas políticos) pero especialmente en la experiencia de vida de los y las AM.

Biomonitoreo en exposición a plaguicidas y su aporte en vigilancia epidemiológica en agroaplicadores en Córdoba, Argentina / Biomonitoring in exposure to pesticides, its contribution to epidemiological surveillance of pesticide applicators in Cordoba, Argentina

Objetivo: Evaluar el nivel de exposición a plaguicidas y su correlación con indicadores de salud percibida y biomarcadores de daño (alteraciones genotóxicas y de actividad enzimática de la butirilcolinesterasa), en la población de agroaplicadores de cultivos extensivos (ACE) de la Provincia de Córdoba, Argentina. Método: Estudio transversal, en ACE (n = 47) seleccionados aleatoriamente de una muestra de 2000, y sujetos no expuestos controles (n = 52). Se relevaron variables sociodemográficas, condicionantes de exposición y de salud percibida, mediante cuestionario autoadministrado; indicadores biológicos de genotoxicidad: micronúcleos, aberraciones cromosómicas y ensayo cometa, y actividad de butirilcolinesterasa. Resultados: El 40% de los ACE tiene una antigüedad mayor de 10 años y casi el 50% reside a menos de 500 m de campos asperjados; reportan bajas tasas de uso de equipo de protección personal durante la mezcla, aplicación o reparación de equipos. Los síntomas generales, cardiorrespiratorios y dermatológicos fueron mayores entre los ACE (p <0,05), así como los indicadores de daño genotóxico (p <0,001). La actividad butirilcolinesterasa se asoció negativamente a niveles de exposición a plaguicidas. Conclusiones: Los ACE presentan un importante impacto negativo en la salud vinculado a la exposición a plaguicidas. Las escalas de exposición asociadas al uso de biomarcadores resultaron una herramienta útil para la vigilancia de la salud de los agroaplicadores

Objective: To assess the level of exposure to pesticides and its correlation with perceived health indicators and injury biomarkers (genotoxic alterations and those caused by butyrylcholinesterase enzyme activity) in the population of pesticide applicators in extensive crops (PAEC) in Córdoba, Argentina. Methods: Transversal study, in PAEC (n = 47) randomly selected from a sample of 2000, and non-exposed subject controls (n = 52). The sociodemographic variables, exposure conditioning, and perceived health were surveyed by means of a self-administered questionnaire; biological indicators of genotoxicity: micronuclei, chromosomal aberrations and kite assay, and butyrylcholinesterase activity. Results: 40% of PAEC have over 10 years' length of service and almost 50% of them reside less than 500 m from the sprinkled fields; they report low rates of personal protective equipment use while mixing, applying, or repairing the equipment. General, cardio-respiratory, and dermatological symptoms were greater among PAEC (p <0.05) as well as indicators of genotoxic injury (p <0.001). The butyrylcholinesterase activity was negatively associated with levels of exposure to pesticides. Conclusions: The PAEC show an important negative impact on health linked to exposure to pesticides. The exposure scales associated to the use of biomarkers were a useful tool for monitoring pesticide applicators' health

[Biomonitoring in exposure to pesticides, its contribution to epidemiological surveillance of pesticide applicators in Cordoba, Argentina]. / Biomonitoreo en exposición a plaguicidas y su aporte en vigilancia epidemiológica en agroaplicadores en Córdoba, Argentina.

OBJECTIVE: To assess the level of exposure to pesticides and its correlation with perceived health indicators and injury biomarkers (genotoxic alterations and those caused by butyrylcholinesterase enzyme activity) in the population of pesticide applicators in extensive crops (PAEC) in Córdoba, Argentina. METHODS: Transversal study, in PAEC (n = 47) randomly selected from a sample of 2000, and non-exposed subject controls (n = 52). The sociodemographic variables, exposure conditioning, and perceived health were surveyed by means of a self-administered questionnaire; biological indicators of genotoxicity: micronuclei, chromosomal aberrations and kite assay, and butyrylcholinesterase activity. RESULTS: 40% of PAEC have over 10 years' length of service and almost 50% of them reside less than 500 m from the sprinkled fields; they report low rates of personal protective equipment use while mixing, applying, or repairing the equipment. General, cardio-respiratory, and dermatological symptoms were greater among PAEC (p <0.05) as well as indicators of genotoxic injury (p <0.001). The butyrylcholinesterase activity was negatively associated with levels of exposure to pesticides. CONCLUSIONS: The PAEC show an important negative impact on health linked to exposure to pesticides. The exposure scales associated to the use of biomarkers were a useful tool for monitoring pesticide applicators' health.

Características epidemiológicas y factores asociados a la evolución de coqueluche en menores de un año, en la ciudad de Córdoba, Argentina / Características epidemiológicas e fatores associados à evolução da coqueluche em crianças menores de um ano, na cidade de Córdoba, Argentina / Epidemiological characteristics of whooping cough and associated factors to its evolution in under one-year-old children, in the city of Córdoba, Argentina

Coqueluche es una enfermedad respiratoria de alto impacto sanitario en población infantil. Objetivo: Describir patrón epidemiológico, factores de riesgo asociados a ocurrencia y evolución en niños <1 año, atendidos en el Hospital Infantil Municipal de la Ciudad de Córdoba (2007-2010). Metodología: estudio observacional, descriptivo correlacional, pacientes <1 año con diagnóstico de coqueluche confirmado por laboratorio (n=60). Resultados: mediana de edad: 2 meses, 95% fueron <6 meses, 66,6% requirió internación (probabilidad de internación fue 8 veces mayor para los <2 meses). Un 72,5% adquirió la enfermedad en entorno familiar, 53% de los niños presentó carné de vacunación completo. El 15% bajo peso al nacer, 27,5% prematuros María Elisa Corres1 Mariana Butinof2 1 Dra. en Medicina y Cirugía. Prof. Adjunta a cargo de la titularidad de la Cátedra de Epidemiología General y Nutricional. Escuela de Nutrición. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. 2 Bioquímica. Magister en Salud Pública. Especialista en Salud Pública. Jefa de la División Laboratorio del Hospital Infantil Municipal. Secretaría de Salud. Municipalidad de Córdoba. Miembro Titular de la Subcomisión de Salud Pública del Colegio de Bioquímicos de la Provincia de Córdoba. Autor de correspondencia: María Elisa Corres Esteban Echeverría 2230 ­ B° Mariano Balcarce ­ 5010 ­ Córdoba, Argentina. (+351-156342048) elisa_corres@yahoo.com.ar El presente trabajo no ha sido financiado. Trabajo recibido: 19 setiembre 2018. Aprobado: 14 de mayo 2019. 41 Revista de Salud Pública, (XXIII) 2:40-52 Junio 2019 Córdoba, Argentina. / Características epidemiológicas y factores asociados a la evolución de coqueluche en menores de un año, en la ciudad de María Elisa Corres, Mariana Butinof. y 40% de madres adolescentes. Todos presentaron tos, 80% síntomas catarrales, 75% tos paroxística, 78,3% cianosis y 23,3% apnea. Leucocitosis elevada en 20%. La gravedad se asoció a estacionalidad, leucocitosis y síntomas catarrales. Conclusiones: La cobertura vacunal universal es la base de la prevención

Whooping cough is a respiratory disease of high impact in children's health. Objective: To describe epidemiological pattern, risk factors associated with occurrence and evolution in children <1 year, seen at Municipal Children>s Hospital of the City of Cordoba (2007- 2010). Methodology: observational, correlational, descriptive study; patients <1 year old with diagnosis of pertussis confirmed by lab study (n = 60). Results: median age: 2 months old, 95% were <6 months old, 66.6% required hospitalization (probability of hospitalization was 8 times higher for those <2 months old). Seventy-two point five per cent acquired the disease in a family environment, 53% of the children presented a complete vaccination card. Fifteen percent had low birth weight, 27.5% were premature and 40% had teenage mothers. All patients presented cough, 80% cold symptoms, 75% paroxysmal cough, 78.3% cyanosis and 23.3% apnea. High leukocytosis in 20%. Severity was associated with seasonality, leukocytosis and cold symptoms. Conclusions: Universal vaccination coverage is the basis for prevention

A coqueluche é uma doença respiratória de alto impacto sanitário na população infantil. Objetivo: Descrever o padrão epidemiológico, os fatores de risco associados à ocorrência e a evolução em crianças <1 ano, atendidos no Hospital Infantil Municipal da Cidade de Córdoba (2007-2010). Metodologia: estudo observacional, descritivo correlacional, pacientes <1 ano com diagnóstico laboratorial confirmado de coqueluche (n = 60). Resultados: mediana da idade: 2 meses, 95% foram <6 meses, 66,6% necessitaram de hospitalização (a probabilidade de hospitalização foi 8 vezes maior para aqueles <2 meses). 72,5% adquiriu a doença em ambiente familiar, 53% das crianças apresentaram carteira de vacinação completa. 15% abaixo do peso normal ao nascer, 27,5% prematuros e 40% de mães adolescentes. Todos tiveram tosse, 80% sintomas catarrais, 75% tosse paroxística, 78,3% cianose e 23,3% apneia. Leucocitose alta em 20%. A gravidade esteve associada à sazonalidade, leucocitose e sintomas catarrais. Conclusões: A cobertura universal de vacinação é a base da prevenção

Valoración de la exposición a plaguicidas en cultivos extensivos de Argentina y su potencial impacto sobre la salud / Pesticide Exposure Assessment in Argentinian Extensive Crops and its Potential Health Impact

INTRODUCCIÓN: Los plaguicidas configuran un aspecto central de las prácticas agrícolas. OBJETIVOS: Describir la distribución espacial de la exposición a plaguicidas en Argentina y su asociación con indicadores de carga de cáncer, construir índices de exposición global y validar índices de exposición individual con biomarcadores de efecto en sujetos laboralmente expuestos. MÉTODOS: Se construyeron dos índices globales (de exposición a plaguicidas [IEP] y de impacto ambiental total [IIAT]), se estudiaron sus distribuciones espaciales y mediante un estudio ecológico a nivel nacional se estimó la asociación con las tasas de mortalidad de cáncer total, mama y próstata, usando los departamentos como nivel de desagregación (n=564). Dos índices de exposición, construidos con información (individual) de agroaplicadores de Córdoba, se validaron mediante biomarcadores (actividad de butirilcolinesterasa y genotoxicidad). RESULTADOS: El área pampeana agrupa un IEP mayor al promedio nacional y los IIAT superiores, correspondientes al 2,4-D y clorpirifos. El aumento en ambos índices de exposición se asoció a incrementos en las tasas de mortalidad por cáncer a nivel departamental. El daño genotóxico en aplicadores no se asoció a los niveles de exposición; sí la disminución de la actividad de butirilcolinesterasa. CONCLUSIONES: Los instrumentos ­índices­ y resultados alcanzados brindan valiosos elementos para vigilar la exposición a plaguicidas en Argentina.

INTRODUCTION: Pesticides are a key factor of agricultural practices. OBJECTIVES: To describe the spatial distribution of pesticide exposure in Argentina and its association with cancer burden indicators, build global exposure indices, and validate individual exposure indices with biomarkers of effect in occupationally exposed subjects. METHODS: Two global indices were developed (pesticide exposure [PEI] and total environmental impact [TEII]), their spatial distribution was studied and, by means of a nationwide ecological study, the association with total, breast and prostate cancer mortality rates was estimated, using departments as level of spatial disaggregation (n=564). Two exposure indices, built with (individual) information of pesticide applicators in Córdoba, were validated using biomarkers (butyrylcholinesterase and genotoxicity). RESULTS: The Pampas have a PEI which is higher than national average as well as the highest TEII, corresponding to 2.4-D and chlorpyrifos. The increase in both exposure indices was associated to increases in the mortality rates due to cancer at the departmental level. Genotoxic damage in applicators was not associated to levels of exposure; what was associated was the reduction of butyrylcholinesterase activity. CONCLUSIONS: The instruments ­indices­ and results obtained provide valuable elements for the surveillance of pesticide exposure in Argentina.

Vulnerabilidad y Riesgo por Plaguicidas en Horticultura del Cinturón Verde en Córdoba, Argentina / Vulnerability and risk resulting from pesticides in horticulture in the greenbelt of Cordoba, Argentina / Vulnerabilidade e risco por pesticidas em horticultura do cinturão verde em Córdoba, Argentina

Resumen El Cinturón Verde de la Ciudad de Córdoba (CVCC) en Argentina está marcado por la reproducción de relaciones desiguales, la informalidad y débil institucionalidad para la regulación de la exposición laboral a plaguicidas. Objetivo: visibilizar situaciones de vulnerabilidad y riesgo como construcción social-material, que afecta a quienes trabajan en unidades productivas hortícolas del CVCC, asociadas a condiciones de vida y trabajo. Métodología: Estudio epidemiológico descriptivo correlacional. Se conformó una muestra de 101 trabajadores / productores, con un nivel de confianza del 95%. Se obtuvo información mediante encuesta, indagando aspectos sociodemográficos, condiciones de vida, prácticas laborales, cultivos, estilos de vida y condiciones de salud del productor / trabajador y su familia. Se calcularon estadísticas descriptivas, se usóxi 2como test de hipótesis y análisis factorial de correspondencias múltiples. Resultados: Encontramos diferencias en la situación de vulnerabilidad y riesgo en grupos de propietarios, arrendatario-medieros. En el primero se objetiva el riesgo vinculado a la falta de cuidados al usar plaguicidas; en el segundo se configuran situaciones de vulnerabilidad asociadas a la reproducción de relaciones desiguales. La comprensión de la vulnerabilidad y el riesgo desde la condición laboral, permite precisar aspectos de la exposición a plaguicidas a ser contemplados en programas de salud.

Abstract The Greenbelt of the City of Cordoba (CVCC) (in Spanish, Cinturón Verde de la Ciudad de Córdoba) in Argentina is characterized by the reproduction of unequal relations, informality and weak government institutions to regulate on-the-job exposure to pesticides. Objective: This study intends to visualize vulnerability and risk situations as a social- material construction which affects people working in productive horticulture units in the CVCC associated with living and working conditions. Methodology: This is a correlational descriptive epidemiological study, and 101 workers/producers were part of the sample with a 95% level of confidence. Information was collected using surveys asking about sociodemographic aspects, life, work practices, crops, lifestyles and healthcare conditions of workers/producers and their families. Descriptive statistics were calculated using Pearson's Xi2 test as a hypothesis test and a multiple correspondence factor analysis. Results: we found differences regarding vulnerability and risks in an owners' group, and a tenants-sharecroppers' group. In the first group, the objective is a risk related to a lack of caution when using pesticides, and in the second group, situations of vulnerability related to a reproduction of unequal relations. Understanding vulnerability and risk from a working condition allows a specification of aspects regarding exposure to pesticides which must be contemplated in healthcare programs.

Resumo O Cinturão Verde da Cidade de Córdoba (CVCC) na Argentina está marcado pela reprodução de relações desiguais, pela informalidade e pela fraca institucionalidade para regulamentar a exposição laboral a pesticidas. Objetivo: visibilizar situações de vulnerabilidade e risco como construção social-material que afeta às pessoas que trabalham em unidades produtivas hortícolas do CVCC, associadas a condições de vida e de trabalho. Metodologia: estudo epidemiológico descritivo correlacional. Conformou-se uma amostra de 101 trabalhadores / produtores, com nível de confiança de 95%. Obteve-se informação através de enquete, pesquisando aspetos sócio-demográficos, condições de vida, práticas laborais, culturas, estilos de vida e condições de saúde do produtor / trabalhador e da sua família. Calcularam-se estatísticas descritivas, usou-se xi2 como teste de hipóteses e análises fatorial de correspondências múltiplas. Resultados: encontramos diferencias na situação de vulnerabilidade e risco em grupos de proprietários, arrendador-agricultor. No primeiro grupo, objetiva-se o risco relacionado com a falência de cuidados no uso de pesticidas; no segundo grupo, configuram-se situações de vulnerabilidade associadas à reprodução de relações desiguais. A compreensão da vulnerabilidade e do risco da condição de trabalho permite determinar aspetos de exposição a pesticidas que devem ser levados em conta nos programas de saúde.