Plaguicidas organofosforados y cáncer en Latinoamérica: Evidencia para una discusión bioética

There is evidence that the exposure to highly hazardous pesticides is associated with cancer development. Organophosphate pesticides (OP) are within this group and are widely used in Latin America. The aim of this paper was to review the Latin American research on exposure to organophosphate pesticides and its effects on the development of human cancer and discuss their bioethical implications. A systematic search was run in PubMed database, then replicating it in other databases. Eligibility criteria were: Latin American scientific studies, samples of human population or tissue, OP exposure and cancer development. Search terms were organophosphates, cancer and the name of each country. Of a total of 1092 articles, 11 met the criteria. All found relationship between OP pesticide exposure and cancer development. 81 % of the studies were experimental and showed that exposure to chlorpyrifos, parathion and malathion cause the development of human breast carcinoma. We conclude that Latin American research suggests that OP pesticide exposure generates cancer in humans; therefore, the development of policies that regulate the use of pesticides and forbid the most dangerous is required.Existe evidencia de que la exposición a plaguicidas altamente peligrosos se asocia con el desarrollo de cáncer. Los plaguicidas organofosforados (OP) están dentro de este grupo y son muy utilizados en Latinoamérica. El objetivo fue analizar estudios latinoamericanos sobre la exposición a plaguicidas organofosforados y sus efectos en el desarrollo de cáncer humano y discutir sus implicancias bioéticas. Para ello, se realizó una búsqueda sistemática en PubMed, replicándola luego en otras bases de datos. Los criterios de elegibilidad fueron: estudios científicos latinoamericanos, muestras de población o tejido humano, exposición a OP y desarrollo de cáncer. Los términos de búsqueda fueron organofosforados, cáncer y el nombre de cada país. De un total de 1092 artículos, 11 cumplieron con los criterios. Todos encontraron relación entre exposición a plaguicidas OP y desarrollo de cáncer. El 81 % de los estudios eran experimentales y demostraron que la exposición a clorpirifos, paratión o malatión provocan el desarrollo de carcinoma mamario humano. Se concluye que las investigaciones latinoamericanas apuntan a que la exposición a plaguicidas OP genera cáncer en humanos, por lo tanto se requiere el desarrollo de políticas que regulen su uso y prohibición de los más peligrosos

Redistribution of heart failure as the cause of death: the Atherosclerosis Risk in Communities Study

Background Heart failure is sometimes incorrectly listed as the underlying cause of death (UCD) on death certificates, thus compromising the accuracy and comparability of mortality statistics. Statistical redistribution of the UCD has been used to examine the effect of misclassification of the UCD attributed to heart failure, but sex- and race-specific redistribution of deaths on coronary heart disease (CHD) mortality in the United States has not been examined. Methods We used coarsened exact matching to infer the UCD of vital records with heart failure as the UCD from 1999 to 2010 for decedents 55 years old and older from states encompassing regions under surveillance by the Atherosclerosis Risk in Communities (ARIC) Study (Maryland, Minnesota, Mississippi, and North Carolina). Records with heart failure as the UCD were matched on decedent characteristics (five-year age groups, sex, race, education, year of death, and state) to records with heart failure listed among the multiple causes of death. Each heart failure death was then redistributed to plausible UCDs proportional to the frequency among matched records. Results After redistribution the proportion of deaths increased for CHD, chronic obstructive pulmonary disease, diabetes, hypertensive heart disease, and cardiomyopathy, P < 0.001. The percent increase in CHD mortality after redistribution was the highest in Mississippi (12%) and lowest in Maryland (1.6%), with variations by year, race, and sex. Redistribution proportions for CHD were similar to CHD death classification by a panel of expert reviewers in the ARIC study. Conclusions Redistribution of ill-defined UCD would improve the accuracy and comparability of mortality statistics used to allocate public health resources and monitor mortality trends

Concordancia en la codificación de causas de muerte: una comparación internacional

Artículo de publicación ISIThis study evaluates the agreement of nosologic coding of cardiovascular causes of death between a Chilean coder and one in the United States, in a stratified random sample of death certificates of persons aged ≥ 60, issued in 2008 in the Valparaíso and Metropolitan regions, Chile. All causes of death were converted to ICD-10 codes in parallel by both coders. Concordance was analyzed with inter-coder agreement and Cohen’s kappa coefficient by level of specification ICD-10 code for the underlying cause and the total causes of death coding. Inter-coder agreement was 76.4% for all causes of death and 80.6% for the underlying cause (agreement at the four-digit level), with differences by the level of specification of the ICD-10 code, by line of the death certificate, and by number of causes of death per certificate. Cohen's kappa coefficient was 0.76 (95%CI: 0.68-0.84) for the underlying cause and 0.75 (95%CI: 0.74-0.77) for the total causes of death. In conclusion, causes of death coding and inter-coder agreement for cardiovascular diseases in two regions of Chile are comparable to an external benchmark and with reports from other countries