Addressing the environmental determinants of health in vector surveillance and control strategies: promoting key interventions

[Introduction]. Climate change and other environmental changes are among the main factors that have led to the emergence or reemergence of vector-borne diseases. These factors may increase the geographical distribution of these diseases and extend the transmission season, which influences the morbidity and mortality they cause. Infectious diseases have a significant impact on public health in the Region of the Americas. For example, in 2017 a total of 483,208 cases of dengue causing 253 deaths were reported to the Pan American Health Organization (PAHO). That same year, more than 180,000 cases of chikungunya were also reported, and there were 583,451 suspected and 223,477 confirmed cases of Zika between 1 January 2015 and 4 January 2018, with 20 confirmed deaths and 3,720 confirmed cases of congenital Zika syndrome. Given this impact, a number of integrated multisectoral approaches must be incorporated into vector surveillance and control strategies. These approaches should include initiatives that promote healthy environments, such as better and safer management of solid waste, water, and sewage to ensure the continuity and quality of service, and the proper management of chemical residues from vector control activities. This publication offers key interventions to promote vector surveillance and control activities that emphasize environmental health, using interprogrammatic and intersectoral approaches.

Controle ambiental: prevenção e manejo das doenças atópicas / Environmental control: prevention and management of atopic diseases

A asma é uma das doenças crônicas mais prevalentes no mundo, sendo que 50% a 80% dos pacientes apresentam o fenótipo alérgico. A asma resulta da interação entre predisposição genética e exposição ambiental. Os aeroalérgenos perenes, especialmente os ácaros da poeira doméstica, são considerados um dos responsáveis pelo aumento da prevalência da asma em todo mundo. O controle ambiental é uma das medidas necessárias para o tratamento e controle da asma.

Asthma is one of the most prevalent chronic diseases worldwide, and 50 to 80% of affected patients have the allergic phenotype. Asthma results from the interaction between genetic predisposition and environmental exposure. Perennial aeroallergens, especially household dust mites, are considered one of the reasons for the increase in the prevalence of asthma worldwide. Environmental control is a necessary measure to treat and control asthma.

Penalized regression models to select biomarkers of environmental enteric dysfunction associated with linear growth acquisition in a Peruvian birth cohort.

Environmental enteric dysfunction (EED) is associated with chronic undernutrition. Efforts to identify minimally invasive biomarkers of EED reveal an expanding number of candidate analytes. An analytic strategy is reported to select among candidate biomarkers and systematically express the strength of each marker's association with linear growth in infancy and early childhood. 180 analytes were quantified in fecal, urine and plasma samples taken at 7, 15 and 24 months of age from 258 subjects in a birth cohort in Peru. Treating the subjects' length-for-age Z-score (LAZ-score) over a 2-month lag as the outcome, penalized linear regression models with different shrinkage methods were fitted to determine the best-fitting subset. These were then included with covariates in linear regression models to obtain estimates of each biomarker's adjusted effect on growth. Transferrin had the largest and most statistically significant adjusted effect on short-term linear growth as measured by LAZ-score-a coefficient value of 0.50 (0.24, 0.75) for each log2 increase in plasma transferrin concentration. Other biomarkers with large effect size estimates included adiponectin, arginine, growth hormone, proline and serum amyloid P-component. The selected subset explained up to 23.0% of the variability in LAZ-score. Penalized regression modeling approaches can be used to select subsets from large panels of candidate biomarkers of EED. There is a need to systematically express the strength of association of biomarkers with linear growth or other outcomes to compare results across studies.

Abordaje de los determinantes ambientales de la salud en las estrategias de vigilancia y control de vectores: orientaciones para promover intervenciones clave

[Introducción]. El clima y otros cambios ambientales son algunos de los principales factores que han concurrido para que aparecieran o reaparecieran enfermedades transmitidas por vectores (ETV). Estos factores pueden expandir la distribución geográfica de dichas enfermedades y extender la temporada de transmisión, con lo que influyen en la morbilidad y mortalidad de estas enfermedades. Las enfermedades infecciosas tienen una repercusión importante en la salud pública de la Región de las Américas. Por ejemplo, en 2017 se notificó a la Organización Panamericana de la Salud (OPS) que hubo un total de 483.208 casos de dengue y 253 muertes por esta causa. Ese mismo año también se notificaron más de 180.000 casos de chikunguña, y el número acumulado de casos presuntos o confirmados de zika en el período comprendido entre 1 de enero 2015 y el 4 de enero de 2018 fue de 583.451 y 223.477, respectivamente, con 20 muertes confirmadas y 3.720 casos confirmados de síndrome congénito por el virus de Zika. Considerando estos impactos, será necesario incorporar múltiples enfoques integrales y multisectoriales en las estrategias de vigilancia y control de vectores. En dichos enfoques se deberán tomar en cuenta iniciativas que promuevan entornos saludables, por ejemplo, mediante la mejora de la gestión de los residuos sólidos, la gestión segura del agua y el saneamiento a fin de garantizar la continuidad y la calidad de los servicios, y el manejo adecuado de los residuos químicos que se usan en el control de vectores, entre otros. En esta publicación se presentan algunas orientaciones clave para promover acciones de vigilancia y control de vectores que pongan énfasis en las intervenciones en materia de salud ambiental, utilizando enfoques interprogramáticos e intersectoriales.

[Systematic review of the impact of chlordecone on human health in the French West Indies]. / Revue systématique de l'impact du chlordécone sur la santé humaine aux Antilles françaises.

INTRODUCTION: Several publications have highlighted the adverse effects of chlordecone on human and animal species. The possible long-term consequences continue to be explored as chlordecone still contaminates Caribbean soils. The objective of this literature review is to determine the long-term effects of chlordecone on human health. MATERIAL AND METHOD: We searched for the keyword "chlordecone" on different scientific databases: Medline®, ISI Web of Knowledge, Google Scholar, EM Premium. We have enriched our research with first degree references, related articles on PubMed and grey literature. RESULTS: Of the 192 articles analyzed, 12 responded to the impact of chlordecone on human health in the French West Indies. In obstetrics, exposure to chlordecone was associated with a lower incidence of gestational hypertension. In pediatrics, these studies have shown an association between prenatal exposure to chlordecone and increased risk of prematurity, decreased birth weight (especially when the mother gained excessive weight during pregnancy), decreased fine cognitive and motor acquisition, and changes in circulating concentrations of certain thyroid hormones. In oncology, exposure was associated with an increased risk of prostate cancer, particularly if there was a family history of prostate cancer. CONCLUSION: While the effects of acute exposure to chlordecone at high doses are well described (Kepone Shake syndrome at the time of the Hopewell accident), the effects at environmental doses are becoming clearer even if they remain complex to identify.

La atención del cáncer en el Ecuador: pasado, presente y futuro / Cancer care in Ecuador: past, present and future

Contexto: El Ecuador tiene un sistema nacional de salud caracterizado por una amplia fragmentación institucional, por segmentación poblacional y del financiamiento. Esto determina una distribución inequitativa de recursos y servicios para el control del cáncer. SOLCA es una organización privada que desde 1951, ofrece al país atención especializada en cáncer. Por otra parte, la incorporación de los servicios de oncología en los hospitales públicos del MSP es relativamente reciente. Discusión: la nueva Estrategia Nacional para la Atención Integral del Cáncer en Ecuador incluye líneas de acción dirigidas a la prevención, detección temprana, diagnóstico, tratamiento, rehabilitación y cuidados paliativos, promoviendo la acción social e intersectorial e incidiendo en la educación de la población. Además, se espera que esta estrategia disminuya la carga socioeconómica, promueva la calidad de vida y reduzca la inequidad en el acceso a los servicios de salud; sin embargo, su adecuada implementación requerirá de la participación y los esfuerzos de todos los sectores involucrados, incluyendo las organizaciones civiles. Conclusión: el control y atención integral del cáncer en Ecuador debe ser una prioridad nacional por lo cual, las decisiones y acciones futuras, deberán basarse en una responsabilidad compartida entre los diferentes actores, en el marco de una verdadera conciencia social y en la aplicación del derecho constitucional a la salud. (AU)

Context: Ecuador has a national health system characterized by a wide institutional fragmentation, by population segmentation and financing. This determines an inequitable distribution of re-sources and healthcare services for cancer control. The Society for the Fight against Cancer (SOLCA) is a private organization that, since 1951, offers specialized cancer care in the country. On the other hand, the incorporation of oncology services in public hospitals of the MSP is relatively recent. Discussion: dthe new National Strategy for Comprehensive Cancer Care in Ecuador includes lines of action aimed at prevention, early detection, diagnosis, treatment, rehabilitation and palliative care, promoting social and intersectoral action, and influencing the education of the population. In addition, this strategy is expected to reduce the socioeconomic burden, promote quality of life and reduce inequity in access to health services. However, its proper implementation will re-quire the participation and efforts of all the sectors involved, including civil organizations. Conclusion: the control and comprehensive care of cancer in Ecuador should be a national priority There-fore, decisions and future actions should be based on a shared responsibility among the differ-ent actors, within the framework of a true social conscience and in the application of constitu-tional right to health. (AU)

The potential of synthetic biology for improving environmental quality and human health in developing countries / Biología Sintética: un nuevo potencial para mejorar la calidad ambiental y la salud humana en países en desarrollo

ABSTRACT Environmental quality is a major factor in global health that mainly affects the poorest populations. Vector- borne diseases, climate change, pollution and unintentional poisonings are recognized as the primary causes of environmental diseases burden in developing countries. The development and implementation of new technologies to reduce the impact of these risk factors on health in developing countries is a priority in the current research. In this regard, synthetic biology, a nearly new research area, has initiated a big revolution through the de novo design or rewiring of biological components, organisms, and functions with the aim to reduce the adverse effects of environmental risk factors on human health. Despite synthetic biology is well recognized for being a multidisciplinary area where biotechnologist, biologist, physicists, mathematicians and engineers play together, its integration with public health and other social sciences seems to be of relevance to apply these technologies into a practical context. In this review, we discuss the major advances in synthetic biology with potential to improve environmental quality and human health in developing countries.

RESUMEN La calidad ambiental es reconocida como uno de los factores con mayor impacto sobre la salud humana principalmente en los países en vías de desarrollo. Las enfermedades transmitidas por vectores, el cambio climático, la contaminación y las intoxicaciones no intencionales han sido reportados como las principales causas de enfermedades ambientales en estos países. El desarrollo y la implementación de nuevas tecnologías encaminadas a reducir el impacto de estos factores ambientales en la salud es una prioridad de la investigación actual. En ese sentido, la biología sintética ha iniciado una gran revolución al permitir el diseño de novo y el mejoramiento de diversos componentes biológicos, organismos y funciones biológicas que tienen el potencial de reducir los efectos adversos de estos factores en la salud humana de una manera más eficiente y económica. A pesar de que la biología sintética es reconocida como un área multidisciplinaria donde biotecnólogos, biólogos, físicos, matemáticos e ingenieros unen sus esfuerzos, su integración con el área de la salud pública y las ciencias sociales es muy importante para llevar estas tecnologías a la práctica. En esta revisión, nosotros discutimos los más importantes avances en biología sintética y su potencial para mejorar la calidad ambiental y la salud humana en países en vías de desarrollo.

Neurologic complications of acute environmental injuries.

Environmental injuries can result in serious neurologic morbidity. This chapter reviews neurologic complications of thermal burns, smoke inhalation, lightning strikes, electric injury, near drowning, decompression illness, as well as heat stroke and accidental hypothermia. Knowing the pathophysiology and clinical presentation of such injuries is essential to proper management of primary and secondary medical complications. This chapter highlights the most frequently encountered neurologic injuries secondary to common environmental hazards, divided into the topics: injuries related to fire, electricity, water, and the extremes of temperature.

Impact of large industrial emission sources on mortality and morbidity in Chile: A small-areas study.

Chile suffers significant pollution from large industrial emitters associated with the mining, metal processing, paper production, and energy industries. The aim of this research was to determine whether the presence of large industrial facilities (i.e. coal- and oil-fired power plants, pulp and paper mills, mining facilities, and smelters) affects mortality and morbidity rates in Chile. For this, we conducted an ecological study that used Chilean communes as small-area observation units to assess mortality and morbidity. Public databases provided information on large pollution sources relevant to Chile. The large sources studied were oil- and coal-fired power plants, copper smelters, pulp and paper mills, and large mining facilities. Large sources were filtered by first year of production, type of process, and size. Mortality and morbidity data were acquired from public national databases, with morbidity being estimated from hospitalization records. Cause-specific rates were calculated for the main outcomes: cardiovascular, respiratory, cancer; and other more specific health outcomes. The impact of the large pollution sources was estimated using Bayesian models that included spatial correlation, overdispersion, and other covariates. Large and significant increases in health risks (around 20%-100%) were found for communes with power plants and smelters for total, cardiovascular, respiratory, all-cancer, and lung cancer mortality. Higher hospitalization rates for cardiovascular disease, respiratory disease, cancer, and pneumonia (20-100%) were also found for communes with power plants and smelters. The impacts were larger for men than women in terms of both mortality and hospitalizations. The impacts were also larger when the sources were analyzed as continuous (production volume) rather than dichotomous (presence/absence) variables. In conclusion, significantly higher rates of total cardiovascular, respiratory, all-cancer and lung cancer mortality and cardiovascular, respiratory, cancer and pneumonia hospitalizations were observed in communes with power plants and smelters.

Experimentally increased temperature and hypoxia affect stability of social hierarchy and metabolism of the Amazonian cichlid Apistogramma agassizii.

The primary goal of this study was to understand how changes in temperature and oxygen could influence social behaviour and aerobic metabolism of the Amazonian dwarf cichlid Apistogramma agassizii. Social hierarchies were established over a period of 96h by observing the social interactions, feeding behaviour and shelter use in groups of four males. In the experimental environment, temperature was increased to 29°C in the high-temperature treatment, and oxygen lowered to 1.0mg·L(-1)O2 in the hypoxia treatment. Fish were maintained at this condition for 96h. The control was maintained at 26°C and 6.6mg·L(-1)O2. After the experimental exposure, metabolism was measured as routine metabolic rate (RMR) and electron transport system (ETS) activity. There was a reduction in hierarchy stability at high-temperature. Aggression changed after environmental changes. Dominant and subdominant fish at high temperatures increased their biting, compared with control-dominant. In contrast, hypoxia-dominant fish decreased their aggressive acts compared with all other fish. Shelter use decreased in control and hypoxic dominant fish. Dominant fish from undisturbed environments eat more than their subordinates. There was a decrease of RMR in fish exposed to the hypoxic environment when compared with control or high-temperature fish, independent of social position. Control-dominant fish had higher RMR than their subordinates. ETS activity increased in fish exposed to high temperatures; however, there was no effect on social rank. Our study reinforces the importance of environmental changes for the maintenance of hierarchies and their characteristics and highlights that most of the changes occur in the dominant position.

Variabilidad y cambio climáticos: su repercusión en la salud / Variability and climatic changes: their influence on health

A lo largo de la historia la tierra ha experimentado cambios en los parámetros climáticos de temperatura, humedad, presión, vientos, precipitaciones, nubosidad, entre otros. Inicialmente, a esos cambios que dependen fundamentalmente de la naturaleza se les llamaba variabilidad natural del clima, pero desde hace varios años en estos ha incidido la acción del hombre, por lo que se ha usado también la expresión cambio climático antropogénico. Al respecto, los impactos del cambio climático en sistemas humanos y naturales se prevén graves, de largo alcance y capaces de afectar desproporcionadamente a los sectores de la población más vulnerables física y económicamente; por ello muchos países, entre ellos Cuba, han trabajado para minimizar las consecuencias de este. Los autores de este artículo consideraron importante describir los efectos actuales y futuros de la variabilidad y el cambio climáticos en la salud(AU)

Along history the earth has experienced changes in the climatic parameters of temperature, humidity, pressure, winds, rains, nubosity, among others. Initially, those changes which depend fundamentally on nature were called natural variability of climate, but for several years the man's action has impacted on them, so that the expression anthropogenic climatic change has also been used. On this respect, the impacts of the climatic change on human and natural systems are considered severe, of long reach and able to affect disproportionately the physically and economically more vulnerable population's sectors; so that many countries, among them Cuba, have worked to minimize its consequences. The authors of this work considered important to describe the current and futures effects of the variability and the climatic change in health(AU)

Lung Function in Rural Guatemalan Women Before and After a Chimney Stove Intervention to Reduce Wood Smoke Exposure: Results From the Randomized Exposure Study of Pollution Indoors and Respiratory Effects and Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter Study.

BACKGROUND: COPD is the third most frequent cause of death globally, with much of this burden attributable to household biomass smoke exposure in developing countries. As biomass smoke exposure is also associated with cardiovascular disease, lower respiratory infection, lung cancer, and cataracts, it presents an important target for public health intervention. METHODS: Lung function in Guatemalan women exposed to wood smoke from open fires was measured throughout the Randomized Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE) stove intervention trial and continued during the Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter (CRECER) cohort study. In RESPIRE, early stove households received a chimney woodstove at the beginning of the 18-month trial, and delayed stove households received a stove at trial completion. Personal exposure to wood smoke was assessed with exhaled breath carbon monoxide (CO) and personal CO tubes. Change in lung function between intervention groups and as a function of wood smoke exposure was assessed using random effects models. RESULTS: Of 306 women participating in both studies, acceptable spirometry was collected in 129 early stove and 136 delayed stove households (n = 265), with a mean follow-up of 5.6 years. Despite reduced wood smoke exposures in early stove households, there were no significant differences in any of the measured spirometric variables during the study period (FEV1, FVC, FEV1/FVC ratio, and annual change) after adjustment for confounding. CONCLUSIONS: In these young Guatemalan women, there was no association between lung function and early randomization to a chimney stove or personal wood smoke exposure. Future stove intervention trials should incorporate cleaner stoves, longer follow-up, or potentially susceptible groups to identify meaningful differences in lung function.

Hematological and hepatic alterations in Brazilian population heavily exposed to organochlorine pesticides.

The aim of this study was to investigate the frequency of hematological and hepatic alterations and possible association with serum levels of beta-hexachlorocyclohexane (beta-HCH), p,p'-DDE, and hexachlorobenzene (HCB) among residents in an area heavily contaminated with organochlorine (OC) pesticides. A cross-sectional study was conducted in 415 male and 432 female residents aged >14 years. Serum samples were collected and analyzed for OC pesticides concentrations and biochemical parameters. Frequencies of hematological and hepatic alterations were calculated for each gender. Association between beta-HCH, p,p'-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl) ethylene), and HCB levels and presence of alterations was determined by logistic regression stratified by gender and controlling for confounders. Highest frequencies were observed for eosinophilia (23% men and 18% women), low hemoglobin (12% men and 15% women), and low erythrocyte count (12% men). High levels of bilirubin, glutamic-oxaloacetic transaminase (GOT), and glutamic-pyruvic transaminase (GPT) were observed, respectively, in 10, 11, and 12% of men and <10% of women. Gamma-glutamyl transferase (GGT) was elevated in 26 and 25% of males and females, respectively. Multivariate analysis revealed associations between eosinophilia and beta-HCH in men (OR = 1.06, 95%CI = 1.01-1.12) and women (OR = 1.05, 96%CI = 0.99-1.11), p,p'-DDE in men (OR = 1.03, 95%CI = 0.99-1.06) and women (OR = 1.02, 95%CI = 0.99-1.06), and HCB in women (OR = 1.54, 95%IC = 0.85-4.45). Beta-HCH was found to be associated with increased risk of elevated bilirubin in females (OR = 1.18, 95%CI = 1.07-1.29) and males (OR = 4.21, 95%CI = 1.87-9.47 for fourth vs. first quintile). Thus, OC pesticides may exert adverse effects on hematopoietic tissue and liver in populations chronically exposed to high levels of these compounds.

Relationship between daily exposure to biomass fuel smoke and blood pressure in high-altitude Peru.

Household air pollution from biomass fuel use affects 3 billion people worldwide; however, few studies have examined the relationship between biomass fuel use and blood pressure. We sought to determine if daily biomass fuel use was associated with elevated blood pressure in high altitude Peru and if this relationship was affected by lung function. We analyzed baseline information from a population-based cohort study of adults aged ≥ 35 years in Puno, Peru. Daily biomass fuel use was self-reported. We used multivariable regression models to examine the relationship between daily exposure to biomass fuel smoke and blood pressure outcomes. Interactions with sex and quartiles of forced vital capacity were conducted to evaluate for effect modification. Data from 1004 individuals (mean age, 55.3 years; 51.7% women) were included. We found an association between biomass fuel use with both prehypertension (adjusted relative risk ratio, 5.0; 95% confidence interval, 2.6-9.9) and hypertension (adjusted relative risk ratio, 3.5; 95% confidence interval, 1.7-7.0). Biomass fuel users had a higher systolic blood pressure (7.0 mm Hg; 95% confidence interval, 4.4-9.6) and a higher diastolic blood pressure (5.9 mm Hg; 95% confidence interval, 4.2-7.6) when compared with nonusers. We did not find interaction effects between daily biomass fuel use and sex or percent predicted forced vital capacity for either systolic blood pressure or diastolic blood pressure. Biomass fuel use was associated with a higher likelihood of having hypertension and higher blood pressure in Peru. Reducing exposure to household air pollution from biomass fuel use represents an opportunity for cardiovascular prevention.

In utero and early childhood exposure to arsenic decreases lung function in children.

The lung is a target organ for adverse health outcomes following exposure to As. Several studies have reported a high prevalence of respiratory symptoms and diseases in subjects highly exposed to As through drinking water; however, most studies to date has been performed in exposed adults, with little information on respiratory effects in children. The objective of the study was to evaluate the association between urinary levels of As and its metabolites with lung function in children exposed in utero and in early childhood to high As levels through drinking water. A total of 358 healthy children were included in our study. Individual exposure was assessed based on urinary concentration of inorganic As. Lung function was assessed by spirometry. Participants were exposed since pregnancy until early childhood to an average water As concentration of 152.13 µg l⁻¹. The mean urinary As level registered in the studied subjects was 141.2 µg l⁻¹ and only 16.7% had a urinary concentration below the national concern level. Forced vital capacity was significantly decreased in the studied population and it was negatively associated with the percentage of inorganic As. More than 57% of the subjects had a restrictive spirometric pattern. The urinary As level was higher in those children with restrictive lung patterns when compared with the levels registered in subjects with normal spirometric patterns. Exposure to As through drinking water during in utero and early life was associated with a decrease in forced vital capacity and with a restrictive spirometric pattern in the children evaluated.