La Reconversión de la Vigilancia Epidemiológica en Vigilancia de Salud Pública

ResumenA pesar de que los procedimientos tradicionales de vigilancia epidemiológica incluyeran en su origen una función estratégica, más allá del control de las epidemias, en nuestro país el sistema de enfermedades de declaración obligatoria ha sido el único caso de vigilancia que ha merecido tal consideración. Este sistema sufre, desde hace unos años, una grave crisis, debido a la poca utilidad de unos resultados; sea como consecuencia de la falta de usuarios que los empleen para tomar decisiones sanitarias; bien porque se ocupa exclusivamente de enfermedades transmisibles o de brotes epidémicos agudos.Al margen de este sistema oficial de vigilancia, en los últimos años se han ido desarrollando fuentes y procedimientos informativos de gran interés sanitario como los registros de cáncer, las estadísticas de accidentes de tráfico o las de contaminación atmosférica. A su vez, la elaboración de políticas en las que se comprometen objetivos de salud, demandan también instrumentos informativos capaces de racionalizar tales objetivos y de permitir la evaluación de las intervenciones llevadas a cabo para corregirlos. Se describen, pues los principales sistemas de información útiles para la vigilancia.Concluimos que el término de vigilancia de la salud pública define mejor sus funciones de a) seguimiento y evaluación de las políticas de salud y b) detección e investigación de epidemias. Por último, identificamos algunos elementos de la reconversión, como son: a) completar las ausencias de información detectadas, especialmente en relación a los efectos adversos de las intervenciones sanitarias y los riesgos laborales y ambientales; b) facilitar el acceso a la información a través de la creación de bases de datos automatizadas; y c) homogeneizar las distintas fuentes de datos de interés sanitario.SummaryAlthough epidemiological surveillance include originaly a strategic function, beyond epidemic control, in Spain the communicable diseases control system has been the only surveillance scheme. This system suffer a severe crisis, probably due to the scarse uses of the information and/or because the system produce exclusively information about communicable diseases or outbreaks.In the lastfewyears, information sources and procedure have been developed out of the official surveillance, such as cancer register, traffic accidents or air contamination statistics and so on. Moreover, national and regional health plans which signify specific health objectives entail information tools with ability to rank and evaluate the interventions. The principal health information system useful to surveillance has been described.We conclude that the expression public health surveillance define much better the functions of a) monitoring and evaluation of the health policy and b) detection and research of epidemics. Finally, we identify some elements for the change, such as: a) to include information related to adverse effects of the sanitary interventions, and environmental and occupational hazards; b) to facilitate the access of information by means of self-operating database and c) to make comparable the different information sources

Immigrant populations, work and health—a systematic literature review

Objectives This paper summarizes the information on immigrant occupational health available from recent studies, incorporating varied study designs. Methods A systematic search was carried out in PubMed employing terms of interest to the study and related terms supplied by the same search engine. Articles were selected through the following process: (i) reading the title and abstract, in English or Spanish, for the period 1990–2005, (ii) reading of the entire text of selected articles; (iii) making a manual search of the relevant citations in the selected articles; (iv) eliminating articles without a focus on the themes of central interest (immigration, work, and health), and (v) reading and analyzing the definitive article set. No quality criteria were used in the article selection. Results The location of studies was not straightforward and required careful thought about the search terms. The included 48 papers were often multifaceted and difficult to categorize. They generally came from countries historically associated with immigration and described occupational risk factors, health consequences, and the social, economic, and cultural influences on worker health. They were also based on data, surveillance, training, and preventive measures that were inadequate. Conclusions Increased migration is a reality in industrialized countries all over the world, and it has social, political, and economic consequences for migrating groups, as well as for their sending and host societies. More reliable data, targeted appropriate interventions, and enforcement of existing regulations are necessary to improve the health of immigrant workers. Furthermore, studies in sending and developing countries should be encouraged to form a more complete understanding of this complex situation

Migration & Self-Rated Health: Comparing Occupational Cohorts in California & Spain (MICASA and ITSAL Projects)

International migration is a growing global phenomenon.  The magnitude of the global population living outside their countries of origin substantiates the value of considering potential public health issues and their population-wide burden.  As migration has yet to be generally accepted as an exposure in and of itself, and encompasses a wide range of experiences and health effects, a measure of overall health is well suited for this research. This study compares self-rated health between two independently collected occupational cohorts as part of the ITSAL study in Spain and the MICASA study in Mendota, California, USA.  We observed greater gender balance in the MICASA sample than the ITSAL sample, where there was a substantial male majority.  Mexican-born workers in the MICASA sample tended to be older, less educated, and more likely to work in agriculture than their Moroccan-born counterparts in the ITSAL study.  We also observed a higher prevalence of poor self-rated health in the MICASA sample compared to the ITSAL sample.  Differences may be due to sampling and data collection issues, cultural issues and the subjectivity of self-rated health as an outcome, as well as actual health differences.  Further research is needed to determine common and distinct migration-related public health issues.L'immigration internationale est un phénomène mondial en plein essor. Le pourcentage élevé de personnes dans le monde vivant dans un pays autre que son pays d'origine justifie l'intérêt de prendre en compte les problèmes de santé publique potentiels et le fardeau que cela implique à l'échelle de la population. Alors que l'immigration n'est pas encore généralement reconnue comme une exposition en soi, et englobe un large éventail d'expériences et d'effets sur la santé, une évaluation de la santé globale est tout à fait appropriée pour cette étude. Cette étude compare la santé auto-évaluée de deux cohortes professionnelles, les donnés ayant été recueillies indépendamment dans le cadre de l'étude ITSAL en Espagne et de l'étude MICASA à Mendota, en Californie. Nous avons observé un plus grand équilibre entre les sexes dans l'échantillon MICASA que dans l'échantillon ITSAL, dans lequel il y avait une majorité considérable d'hommes. Les ouvriers de l'échantillon MICASA nés au Mexique avaient tendance à être plus âgés, à avoir un niveau d'instruction moindre, et à être plus susceptibles de travailler dans l'agriculture que leurs homologues nés au Maroc de l'étude ITSAL. Nous avons également observé une plus forte prévalence de mauvaise santé auto-évaluée dans l'échantillon MICASA que dans l'échantillon ITSAL. Les différences peuvent être dues aux méthodes d'échantillonnage et de recueil des données, à des aspects culturels et à la subjectivité des résultats de la santé auto-déclarée, ainsi qu'à de réelles différences en matière de santé. D'autres études sont nécessaires pour déterminer les problèmes de santé publique liées à l'immigration communs et distincts.La migración internacional es un fenómeno creciente a nivel mundial. La magnitud de la población mundial que vive fuera de su país de origen justifica el valor del estudio de los problemas potenciales para la salud pública y la carga que supone para la población en general. Debido a que todavía no se ha aceptado de forma generalizada que la migración supone una exposición por sí misma y al hecho de que abarca una amplia gama de experiencias y efectos para la salud, una medición de la salud en general parece apropiada para este estudio. En este trabajo se compara la autoevaluación de la salud entre dos cohortes ocupacionales analizadas independientemente como parte del estudio ITSAL en España y el estudio MICASA en Mendota (California, Estados Unidos.). Hemos observado un mayor equilibrio entre sexos en la muestra de MICASA que en la de ITSAL, donde había una importante mayoría masculina. Los trabajadores de origen mexicano de la muestra de MICASA tendían a ser mayores, con menor nivel educativo y con mayor probabilidad de trabajar en la agricultura que los colegas de origen marroquí del estudio ITSAL. Asimismo, hemos observado una mayor prevalencia de salud deficiente en la muestra de MICASA en comparación con la muestra de ITSAL. Las diferencias pueden deberse a problemas de muestreo y de recopilación de datos, a aspectos culturales y a la subjetividad de los resultados de la autoevaluación de la salud, así como a verdaderas diferencias de salud. Asimismo, es necesario realizar otros estudios para determinar qué aspectos de salud pública relacionados con la migración se comparten y cuáles son diferentes

Enhanced skin carcinogenesis and lack of thymus hyperplasia in transgenic mice expressing human cyclin D1b (CCND1b)

Cyclin D1b is an alternative transcript of the cyclin D1 gene (CCND1) expressed in human tumors. Its abundance is regulated by a single base pair polymorphism at the exon 4/intron 4 boundary (nucleotide 870). Epidemiological studies have shown a correlation between the presence of the G870A allele (that favors the splicing for cyclin D1b) with increased risk and less favorable outcome in several forms of cancer. More recently, it has been shown that, unlike cyclin D1a, the alternative transcript D1b by itself has the capacity to transform fibroblasts in vitro. In order to study the oncogenic potential of cyclin D1b, we developed transgenic mice expressing human cyclin D1b under the control of the bovine K5 promoter (K5D1b mice). Seven founders were obtained and none of them presented any significant phenotype or developed spontaneous tumors. Interestingly, K5D1b mice do not develop the fatal thymic hyperplasia, which is characteristic of the cyclin D1a transgenic mice (K5D1a). Susceptibility to skin carcinogenesis was tested in K5D1b mice using two-stage carcinogenesis protocols. In two independent experiments, K5D1b mice developed higher papilloma multiplicity as compared with wild-type littermates. However, when K5D1b mice were crossed with cyclin D1KO mice, the expression of cyclin D1b was unable to rescue the carcinogenesis-resistant phenotype of the cyclin D1 KO mice. To further explore the role of cyclin D1b in mouse models of carcinogenesis we carried out in silico analysis and in vitro experiments to evaluate the existence of a mouse homologous of the human cyclin D1b transcript. We were unable to find any evidence of an alternatively spliced transcript in mouse Ccnd1. These results show that human cyclin D1b has different biological functions than cyclin D1a and confirm its oncogenic properties.Fil: Rojas, Paola Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentina. University of Texas; Estados UnidosFil: Benavides, Fernando. University of Texas; Estados UnidosFil: Blando, Jorge. University of Texas; Estados UnidosFil: Pérez, Carlos. University of Texas; Estados UnidosFil: Cardenas, Kim. University of Texas; Estados UnidosFil: Richie, Ellen. University of Texas; Estados UnidosFil: Knudsen, Erik S.. Thomas Jefferson University; Estados UnidosFil: Johnson, David G.. University of Texas; Estados UnidosFil: Senderowicz, Adrian M.. Department of Health and Human Services. Food and Drug Administration. Center for Drug Evaluation and Research; Estados UnidosFil: Rodriguez Puebla, Marcelo L.. University of North Carolina; Estados UnidosFil: Conti, Claudio. University of Texas; Estados Unido

Health inequity in workers of Latin America and the Caribbean

Latin America and the Caribbean (LAC) is the world’s most inequitable region in terms of wealth distribution. The full scale of social inequalities in health has been hidden by the lack of reliable data. This study aimed to measure and compare health inequalities in the working population within and between 15 countries of LAC

Fiber Burden and asbestos-Related Diseases: an Umbrella Review

OBJECTIVE: What are the levels of asbestos exposure that cause each type of health effect? The objective of this study was to review the available scientific evidence on exposure levels for asbestos and their relationship to health effects. METHOD: An umbrella review of English-language reviews and meta-analyses, from 1980 to March 2021 was conducted. We included reviews involving quantified asbestos exposures and health outcomes. The review has been adapted to the indications of the PRISMA declaration. Methodological quality of the selected studies was assessed using the AMSTAR instrument. RESULTS: We retrieved 196 references. After applying the search strategy and quality analysis, 10 reviews were selected for in-depth analysis. For lung cancer, the highest risk was observed with exposure to amphiboles. Longer, thinner fibers had the greatest capacity to cause lung cancer, especially those \u3e 10 μm in length. For mesothelioma, longer and thinner fibers were also more pathogenic; amphiboles ≥ 5 μm are especially associated with increased mesothelioma risk. No studies observed an increased risk for lung cancer or mesothelioma at asbestos exposure levels CONCLUSIONS: Banning all asbestos exposure remains the best measure to preventing its negative health effects. The highest quality reviews and meta-analyses support that there is little risk of lung cancer or mesothelioma at daily exposure levels below 0.1 f/ml

Paternal exposure to pesticides and congenital malformations

OBJECTIVES: A case-referent study with 261 matched pairs was carried out in 8 hospitals of Comunidad Valenciana, Spain, to assess the relation between occupational exposure to pesticides and selected congenital malformations. In this paper, the results concerning paternal exposure are presented. METHODS: The parents of the case patients and the referents were interviewed to collect information about exposure to pesticides and potential confounding variables. Detailed information on direct involvement in the handling of pesticides was collected for the interviewees involved in agricultural activities during a previously defined period in relation to conception and pregnancy. Exposure data were reviewed by 2 experts who assigned ordinal scores for the probability and intensity of exposure to pesticide classes and active ingredients. RESULTS: The dichotomous analysis of exposure (absent, present) yielded some increased risks, although not statistically significant, for aliphatic hydrocarbons [adjusted odds ratio (adjusted OR) 2.05, 95% confidence interval (95% CI) 0.62-6.80], inorganic compounds (adjusted OR 2.02, 95% CI 0.53-7.72), and glufosinate (adjusted OR 2.45, 95% CI 0.78-7.70), and a significant association for pyridil derivatives (adjusted OR 2.77, 95% CI 1.19-6.44). The analysis based on the experts' scores (2 levels of exposure) showed some consistent associations for these compounds. CONCLUSIONS: This research indicates a possible risk of congenital malformations for paternal exposure to some pesticides, notably, pyridils, aliphatic hydrocarbons, inorganic compounds, and glufosinate. It did not find an increased risk for paternal exposure to pesticides in the classes of organophosphates, carbamates, organochlorines, chloroalkylthio fungicides and organosulfurs. These findings warrant further investigation

Direct and indirect effects of climate on demography and early growth of Pinus sylvestris at the rear edge: changing roles of biotic and abiotic factors

Global change triggers shifts in forest composition, with warming and aridification being particularly threatening for the populations located at the rear edge of the species distributions. This is the case of Scots pine (Pinus sylvestris) in the Mediterranean Basin where uncertainties in relation to its dynamics under these changing scenarios are still high. We analysed the relative effect of climate on the recruitment patterns of Scots pine and its interactions with local biotic and abiotic variables at different spatial scales. Number of seedlings and saplings was surveyed, and their annual shoot growth measured in 96 plots located across altitudinal gradients in three different regions in the Iberian Peninsula. We found a significant influence of climate on demography and performance of recruits, with a non-linear effect of temperature on the presence of juveniles, and a positive effect of precipitation on their survival. Abundance of juveniles of P. sylvestris that underwent their first summer drought was skewed towards higher altitudes than the altitudinal mean range of the conspecific adults and the optimum elevation for seedlings¿ emergence. At local level, light availability did not influence juveniles¿ density, but it enhanced their growth. Biotic interactions were found between juveniles and the herb cover (competition) and between the number of newly emerged seedlings and shrubs (facilitation). Results also highlighted the indirect effect that climate exerts over the local factors, modulating the interactions with the pre-existing vegetation that were more evident at more stressful sites. This multiscale approach improves our understanding of the dynamics of these marginal populations and some management criteria can be inferred to boost their conservation under the current global warming.Funding was provided by the Spanish Ministry for Innovation and Science with the grant Consolider-Montes (CSD2008_00040), and the European Union with the projects BACCARA (CE: FP7-226299, 7FP) and FunDivEUROPE (CE: FP7-ENV-2010. 265171).Peer Reviewe

Monitoring Self-Perceived Occupational Health inequities in Central america, 2011 and 2018

Objectives. to analyze changes in occupational health inequity between 2011 and 2018 among workers in Central America. Methods. Data were collected by face-to-face interviews at the workers\u27 homes for the 2 Central America Working Conditions Surveys (n = 12 024 in 2011 and n = 9030 in 2018). We estimated health inequity gaps by means of absolute and relative population attributable risks and the weighted Keppel index. We stratified all analyses by gender. Results. Between 2011 and 2018, the proportion of workers reporting poor self-perceived health decreased both in women (from 32% to 29%) and men (from 33% to 30%). However, the health inequity gaps remained wide in the 4 stratifiers. Measured by the Keppel index, health inequity gaps between countries increased from 22% to 39% in women and from 20% to 29% in men. Conclusions. While health improved between 2011 and 2018, health inequity gaps remained wide. Wider health inequity gaps were observed between countries than by gender, age, occupation, or education. Public Health Implications. This first benchmark of occupational health inequities in Central America could be useful when developing and evaluating the impact of public policies on work